Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2006 and Certain Provisions Related to the Competitive Acquisition Program of Outpatient Drugs and Biologicals Under Part B, 70116-70476 [05-22160]

Download as PDF 70116 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 405, 410, 411, 413, 414, 424, and 426 [CMS–1502–FC and CMS–1325–F] RINs 0938–AN84 and 0938–AN58 Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2006 and Certain Provisions Related to the Competitive Acquisition Program of Outpatient Drugs and Biologicals Under Part B Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Final rule with comment. AGENCY: SUMMARY: This rule addresses Medicare Part B payment policy, including the physician fee schedule that are applicable for calendar year (CY) 2006; and finalizes certain provisions of the interim final rule to implement the Competitive Acquisition Program (CAP) for Part B Drugs. It also revises Medicare Part B payment and related policies regarding: Physician work; practice expense (PE) and malpractice relative value units (RVUs); Medicare telehealth services; multiple diagnostic imaging procedures; covered outpatient drugs and biologicals; supplemental payments to Federally Qualified Health Centers (FQHCs); renal dialysis services; coverage for glaucoma screening services; National Coverage Decision (NCD) timeframes; and physician referrals for nuclear medicine services and supplies to health care entities with which they have financial relationships. In addition, the rule finalizes the interim RVUs for CY 2005 and issues interim RVUs for new and revised procedure codes for CY 2006. This rule also updates the codes subject to the physician self-referral prohibition and discusses payment policies relating to teaching anesthesia services, therapy caps, private contracts and opt-out, and chiropractic and oncology demonstrations. As required by the statute, it also announces that the physician fee schedule update for CY 2006 is ¥4.4 percent, the initial estimate for the sustainable growth rate for CY 2006 is 1.7 percent and the conversion factor for CY 2006 is $36.1770. DATES: Effective Date: These regulations are effective on January 1, 2006. Comment Date: To be assured consideration, comments must be VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 received at one of the addresses provided below, no later than 5 p.m. on January 3, 2006. ADDRESSES: In commenting, please refer to file code CMS–1502–FC. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. You may submit comments in one of four ways (no duplicates, please): 1. Electronically. You may submit electronic comments on specific issues in this regulation to https:// www.cms.hhs.gov/regulations/ ecomments. (Attachments should be in Microsoft Word, WordPerfect, or Excel; however, we prefer Microsoft Word.) 2. By regular mail. You may mail written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1502– FC, P.O. Box 8017, Baltimore, MD 21244–8017. Please allow sufficient time for mailed comments to be received before the close of the comment period. 3. By express or overnight mail. You may send written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1502– FC, Mail Stop C4–26–05, 7500 Security Boulevard, Baltimore, MD 21244–1850. 4. By hand or courier. If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) before the close of the comment period to one of the following addresses. If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786– 7197 in advance to schedule your arrival with one of our staff members. Room 445–G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security Boulevard, Baltimore, MD 21244–1850. (Because access to the interior of the HHH Building is not readily available to persons without Federal Government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.) Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period. Submission of comments on paperwork requirements. You may PO 00000 Frm 00002 Fmt 4701 Sfmt 4700 submit comments on this document’s paperwork requirements by mailing your comments to the addresses provided at the end of the ‘‘Collection of Information Requirements’’ section in this document. For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section. FOR FURTHER INFORMATION CONTACT: Pam West (410) 786–2302 (for issues related to practice expense). Rick Ensor (410) 786–5617 (for issues related to the nonphysician workpool and supplemental survey data). Stephanie Monroe (410) 786–6864 (for issues related to the geographic practice cost index and malpractice RVUs). Craig Dobyski (410) 786–4584 (for issues related to list of telehealth services). Ken Marsalek (410) 786–4502 (for issues related to multiple procedure reduction for diagnostic imaging services and payment for teaching anesthesiologists). Henry Richter (410) 786–4562 (for issues related to payments for end stage renal disease facilities). Angela Mason (410) 786–7452 or Catherine Jansto (410) 786–7762 (for issues related to payment for covered outpatient drugs and biologicals). Fred Grabau (410) 786–0206 (for issues related to private contracts and opt out provision). David Worgo (410) 786–5919 (for issues related to Federally Qualified Health Centers). Dorothy Shannon (410) 786–3396 (for issues related to the outpatient therapy cap). Vadim Lubarsky (410) 786–0840 (for issues related to National Coverage Decision timeframes). Bill Larson (410) 786–7176 (for issues related to coverage of screening for glaucoma). Lia Prela (410) 786–0548 (for issues related to the competitive acquisition program (CAP) for part B drugs). Diane Milstead (410) 786–3355 or Gaysha Brooks (410) 786–9649 (for all other issues). SUPPLEMENTARY INFORMATION: Submitting Comments: We welcome comments from the public on the following issues: interim RVUs for selected procedure codes identified in Addendum C; and the physician self referral designated health services listed in tables 32 and 33. You can assist us by referencing the file code CMS–1502FC and the specific ‘‘issue identifier’’ that precedes the section on which you choose to comment. Inspection of Public Comments: All comments received before the close of E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. CMS posts all comments received before the close of the comment period on its public web site as soon as possible after they are received. Hard copy comments received timely will be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone 1–800– 743–3951. This Federal Register document is also available from the Federal Register online database through GPO Access a service of the U.S. Government Printing Office. The web site address is: https:// www.access.gpo.gov/nara/. Information on the physician fee schedule can be found on the CMS homepage. You can access this data by using the following directions: 1. Go to the CMS homepage (https:// www.cms.hhs.gov). 2. Place your cursor over the word ‘‘Professionals’’ in the blue areas near the top of the page. Select ‘‘physicians’’ from the drop-down menu. 3. Under ‘‘Billing/Payment’’ select ‘‘Physician Fee Schedule’’. To assist readers in referencing sections contained in this preamble, we are providing the following table of contents. Some of the issues discussed in this preamble affect the payment policies, but do not require changes to the regulations in the Code of Federal Regulations. Information on the regulation’s impact appears throughout the preamble and is not exclusively in section VI. Table of Contents I. Background A. Introduction B. Development of the Relative Value System C. Components of the Fee Schedule Payment Amounts D. Most Recent Changes the Fee Schedule II. Provisions of the Final Rule A. Resource-Based Practice Expense Relative Value Units (PE RVUs) 1. Current Methodology 2. PE Proposals for CY 2006 3. PE Recommendations on CPEP Inputs for CY 2006 4. Payment for Splint and Cast Supplies 5. Miscellaneous PE Issues B. Geographic Practice Cost Indices (GPCIs) C. Malpractice RVUs 1. Five Percent Specialty Threshold VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 2. Specialty Crosswalk Issues 3. Cardiac Catheterization and Angioplasty Exception 4. Dominant Specialty for Low-Volume Codes 5. Collection of Premium Data D. Medicare Telehealth Services 1. Requests for Adding Services to the List of Medicare Telehealth Services 2. Definition of an Originating Site 3. Other Issues E. Contractor Pricing of Unlisted Therapy Modalities and Procedures F. Payment for Teaching Anesthesiologists G. End Stage Renal Disease (ESRD) Related Provisions 1. Revised Pricing Methodology for Separately Billable Drugs and Biologicals Furnished by ESRD Facilities. 2. Adjustment to Account for Changes in the Pricing of Separately Billable Drugs and Biologicals, and the Estimated Increase in Expenditures for Drugs and Biologicals 3. Revisions to Geographic Designations and Wage Indexes Applied to the ESRD Composite Payment Rate 4. Miscellaneous Comments on ESRD Issues 5. Revisions to the Composite Payment Rate Exceptions Process H. Payment for Covered Outpatient Drugs and Biologicals 1. ASP issues 2. Payment for Drugs Furnished During CY 2006 in Connection With the Furnishing of Renal Dialysis Services if Separately Billed by Renal Dialysis Facilities 3. Clotting Factor Furnishing Fee 4. Payment for Inhalation Drugs and Dispensing Fee 5. Supplying Fee 6. Competitive Acquisition of Outpatient Drugs And Biologicals Under Part B I. Private Contracts and Opt-out Provision J. Multiple Procedure Payment Reduction for Diagnostic Imaging K. Therapy Cap L. Chiropractic Demonstration Discussion M. Supplemental Payments to FQHCs Subcontracting with Medicare Advantage Plans N. National Coverage Decisions Timeframes O. Coverage of Screening for Glaucoma P. Additional Issues 1. Corrections to Conditions for Medicare Payment (§ 424.22) 2. Chemotherapy Demonstration Project III. Refinement of RVUs for CY 2006 and Response to Public Comments on Interim RVUs for 2005 A. Summary of Issues Discussed Related to the Adjustment of RVUs B. Process for Establishing Work RVUs for the 2005 PFS C. Work RVU Refinements of Interim RVUs 1. Methodology (Includes Table titled ‘‘Work Relative Value Unit Refinements of the 2004 Interim and Related Relative Value Units’’) 2. Interim 2005 Codes D. Establishment of Interim Work RVUs for New and Revised Physician’s Current Procedural Terminology (CPT) Codes and New Healthcare Common Procedure PO 00000 Frm 00003 Fmt 4701 Sfmt 4700 70117 Coding System Codes (HCPCS) for 2006 (Includes Table titled ‘‘American Medical Association Specialty Relative Value Update Committee and Health Care Professionals Advisory Committee Recommendations and CMS’s Decisions for New and Revised 2006 CPT Codes’’) E. Discussion of Codes for Which There Were No RUC Recommendations or for Which the RUC Recommendations Were Not Accepted F. Establishment of Interim PE RVUs for New and Revised Physician’s Current Procedural Terminology (CPT) Codes and New Healthcare Common Procedure Coding System (HCPCS) Codes for 2006 IV. Five-Year Refinement of RVUs -Status update V. Physician Self-Referral Prohibition: Nuclear Medicine and Annual Update to the List of CPT/HCPCS Codes A. General B. Nuclear Medicine 1. Response to Comments 2. Revisions to the List of Codes Identifying Nuclear Medicine Services C. Annual Update to the Code List 1. Response to Comments 2. Revisions Effective for 2006 VI. Physician Fee Schedule Update for CY 2006 A. Physician Fee Schedule Update B. The Percentage Change in the Medicare Economic Index (MEI) C. The Update Adjustment Factor VII. Allowed Expenditures for Physicians’ Services and the Sustainable Growth Rate A. Medicare Sustainable Growth Rate B. Physicians’ Services C. Preliminary Estimate of the SGR for 2006 D. Revised Sustainable Growth Rate for 2005 E. Final Sustainable Growth Rate for 2004 F. Calculation of 2006, 2005, and 2004 Sustainable Growth Rates VIII. Anesthesia and Physician Fee Schedule Conversion Factors for CY 2006 A. Physician Fee Schedule Conversion Factor B. Anesthesia Fee Schedule Conversion Factor IX. Telehealth Originating Site Facility Fee Payment Amount Update X. Provisions of the Final Rule XI. Waiver of Proposed Rulemaking XII. Collection of Information Requirements XIII. Response to Comments XIV. Regulatory Impact Analysis Addendum A—Explanation and Use of Addendum B. Addendum B—Relative Value Units and Related Information Addendum C—Codes with Interim RVUs Addendum D—2006 Geographic Practice Cost Indices by Medicare Carrier and Locality Addendum E–2006 GAFs Addendum F—CAP: Revised Single Drug Category List Addendum G—CAP: Revised New Drugs for CAP Bidding for 2006 Addendum H—List of CPT/HCPCS Codes Used to Describe Certain Designated Health Services Under Section 1877 of the Social Security Act E:\FR\FM\21NOR2.SGM 21NOR2 70118 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations In addition, because of the many organizations and terms to which we refer by acronym in this proposed final rule with comment, we are listing these acronyms and their corresponding terms in alphabetical order below: AADA American Academy of Dermatology Association AAH American Association for Homecare ABN Advanced Beneficiary Notice ACC American College of Cardiology ACG American College of Gastroenterology ACR American College of Radiology AFROC Association of Freestanding Radiation Oncology Centers AGA American Gastroenterological Association AMA American Medical Association AMP Average manufacturer price AOAO American Osteopathic Academy of Orthopedics ASA American Society of Anesthesiologists ASGE American Society of Gastrointestinal Endoscopy ASP Average sales price ASTRO American Society for Therapeutic Radiation Oncology AUA American Urological Association AWP Average wholesale price BBA Balanced Budget Act of 1997 BBRA Balanced Budget Refinement Act of 1999 BIPA Benefits Improvement and Protection Act of 2000 BLS Bureau of Labor Statistics BMI Body mass index BNF Budget neutrality factor BSA Body surface area CAP Competitive Acquisition Program CBSA Core-Based Statistical Area CF Conversion factor CFR Code of Federal Regulations CMA California Medical Association CMS Centers for Medicare & Medicaid Services CNS Clinical nurse specialist COBC Coordination of Benefits Contractor CPEP Clinical Practice Expert Panel CPI Consumer Price Index CPO Care Plan Oversight CPT (Physicians’) Current Procedural Terminology (4th Edition, 2002, copyrighted by the American Medical Association) CRNA Certified Registered Nurse Anesthetist CT Computed tomography CTA Computed tomographic angiography CY Calendar year DAW Dispense as written DHS Designated health services DME Durable medical equipment DMERC Durable Medical Equipment Regional Carrier VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 DSMT Diabetes outpatient selfmanagement training services EAC Estimated acquisition cost ECP External counterpulsation E/M Evaluation and management EPO Erythopoeitin ESRD End stage renal disease FAX Facsimile FDA Food and Drug Administration FI Fiscal intermediary FQHC Federally qualified health center FR Federal Register GAF Geographic adjustment factor GAO Government Accountability Office GPCI Geographic practice cost index GPOs Group Purchasing Organizations HCPAC Health Care Professional Advisory Committee HCPCS Healthcare Common Procedure Coding System HHA Home health agency HHS (Department of) Health and Human Services HIC Health Insurance Number HIPAA Health Insurance Portability and Accountability Act of 1996, Public Law 104–191 HOCM High Osmolar Contrast Media HPSA Health professional shortage area HRSA Health Resources and Services Administration (HHS) IDTFs Independent diagnostic testing facilities IPF Inpatient psychiatric facility IPPS Inpatient prospective payment system IRF Inpatient rehabilitation facility ISO Insurance Services Office IVIG Intravenous immune globulin JCAAI Joint Council of Allergy, Asthma, and Immunology JUA Joint underwriting association LCD Local coverage determination LTCH Long-term care hospital LOCM Low Osmolar Contrast Media MA Medicare Advantage MCAC Medicare Coverage Advisory Committee MCG Medical College of Georgia MedPAC Medicare Payment Advisory Commission MEI Medicare Economic Index MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003 MNT Medical nutrition therapy MRA Magnetic resonance angiography MRI Magnetic resonance imaging MSA Metropolitan statistical area MSN Medicare summary notice NCD National coverage determination NCQDIS National Coalition of Quality Diagnostic Imaging Services NDC National drug code NECMA New England County Metropolitan Area PO 00000 Frm 00004 Fmt 4701 Sfmt 4700 NECTA New England City and Town Area NP Nurse practitioner NPP Nonphysician practitioners NPWP Nonphysician work pool OBRA Omnibus Budget Reconciliation Act OIG Office of Inspector General OMB Office of Management and Budget OPPS Outpatient prospective payment system OT Occupational therapy PA Physician assistant PC Professional component PE Practice Expense PEAC Practice Expense Advisory Committee PERC Practice Expense Review Committee PET Positron emission tomography PFS Physician Fee Schedule PLI Professional liability insurance PPAC Practicing Physicians Advisory Council PIN Provider identification number PPI Producer price index PPO Preferred provider organization PPS Prospective payment system PRA Paperwork Reduction Act PT Physical therapy RFA Regulatory Flexibility Act RIA Regulatory impact analysis RN Registered nurse RUC (AMA’s Specialty Society) Relative (Value) Update Committee RVU Relative value unit SGR Sustainable growth rate SMS (AMA’s) Socioeconomic Monitoring System SNF Skilled nursing facility SNM Society for Nuclear Medicine TA Technology assessment TC Technical component TEB Thoracic electrical bioimpedance tPA Tissue-type plasminogen activator UAF Update adjustment factor UPIN Unique provider identification number WAC Wholesale acquisition cost WAMP Widely available market price I. Background A. Introduction Since January 1, 1992, Medicare has paid for physicians’ services under section 1848 of the Social Security Act (the Act), ‘‘Payment for Physicians‘ Services.’’ The Act requires that payments under the physician fee schedule (PFS) be based on national uniform relative value units (RVUs) based on the resources used in furnishing a service. Section 1848(c) of the Act requires that national RVUs be established for physician work, practice expense (PE), and malpractice expense. Prior to the establishment of the E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations resource-based relative value system, Medicare payment for physicians’ services was based on reasonable charges. Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments in RVUs may not cause total physician fee schedule payments to differ by more than $20 million from what they would have been had the adjustments not been made. If adjustments to RVUs cause expenditures to change by more than $20 million, we must make adjustments to ensure that they do not increase or decrease by more than $20 million. B. Development of the Relative Value System 1. Work RVUs The concepts and methodology underlying the PFS were enacted as part of the Omnibus Budget Reconciliation Act (OBRA) of 1989, Public Law 101– 239, and OBRA 1990, (Public Law 101– 508). The final rule published November 25, 1991 (56 FR 59502) set forth the fee schedule for payment for physicians’ services beginning January 1, 1992. Initially, only the physician work RVUs were resource-based, and the PE and malpractice RVUs were based on average allowable charges. The physician work RVUs established for the implementation of the fee schedule in January 1992 were developed with extensive input from the physician community. A research team at the Harvard School of Public Health developed the original physician work RVUs for most codes in a cooperative agreement with the Department of Health and Human Services (HHS). In constructing the code-specific vignettes for the original physician work RVUs, Harvard worked with panels of experts, both inside and outside the government, and obtained input from numerous physician specialty groups. Section 1848(b)(2)(A) of the Act specifies that the RVUs for radiology services are based on a relative value scale we adopted under section 1834(b)(1)(A) of the Act, (the American College of Radiology (ACR) relative value scale), which we integrated into the overall PFS. Section 1848(b)(2)(B) of the Act specifies that the RVUs for anesthesia services are based on RVUs from a uniform relative value guide. We established a separate conversion factor (CF) for anesthesia services, and we continue to utilize time units as a basis for determining payment for these services. As a result, there is a separate payment methodology for anesthesia services. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 We establish physician work RVUs for new and revised codes based on recommendations received from the American Medical Association’s (AMA) Specialty Society Relative Value Update Committee (RUC). 2. Practice Expense Relative Value Units (PE RVUs) Section 121 of the Social Security Act Amendments of 1994 (Pub. L. 103–432), enacted on October 31, 1994, amended section 1848(c)(2)(C)(ii) of the Act and required us to develop resource-based PE RVUs for each physician’s service beginning in 1998. We were to consider the staff, equipment, and supplies used in the provision of various medical and surgical services. The legislation specifically required that, in implementing the new system of PE RVUs, we apply the same budgetneutrality provisions that are applicable to other adjustments under the physician fee schedule. Section 4505(a) of the Balanced Budget Act of 1997 (BBA) (Pub. L. 105– 33), amended section 1848(c)(2)(C)(ii) of the Act to delay implementation of the resource-based PE RVU system until January 1, 1999. In addition, section 4505(b) of the BBA provided for a 4-year transition period from charge-based PE RVUs to resource-based RVUs. We established the resource-based PE RVUs for each physician’s service in a final rule, published November 2, 1998 (63 FR 58814), effective for services furnished in 1999. Based on the requirement to transition to a resourcebased system for PE over a 4-year period, resource-based PE RVUs did not become fully effective until 2002. This resource-based system was based on two significant sources of actual PE data: The Clinical Practice Expert Panel (CPEP) data and the AMA’s Socioeconomic Monitoring System (SMS) data. The CPEP data were collected from panels of physicians, practice administrators, and nonphysicians (for example, registered nurses) nominated by physician specialty societies and other groups. The CPEP panels identified the direct inputs required for each physician’s service in both the office setting and out-of-office setting. The AMA’s SMS data provided aggregate specialtyspecific information on hours worked and PEs. Separate PE RVUs are established for procedures that can be performed in both a nonfacility setting, such as a physician’s office, and a facility setting, such as a hospital outpatient department. The difference between the facility and nonfacility RVUs reflects the fact that a facility receives separate PO 00000 Frm 00005 Fmt 4701 Sfmt 4700 70119 payment from Medicare for its costs of providing the service, apart from payment under the PFS. The nonfacility RVUs reflect all of the direct and indirect PEs of providing a particular service outside a facility setting. Section 212 of the Medicare, Medicaid and State Child Health Insurance Program Balanced Budget Refinement Act of 1999 (BBRA) (Pub. L. 106–113) directed the Secretary to establish a process under which we accept and use, to the maximum extent practicable and consistent with sound data practices, data collected or developed by entities and organizations to supplement the data we normally collect in determining the PE component. On May 3, 2000, we published the interim final rule (65 FR 25664) that set forth the criteria for the submission of these supplemental PE survey data. The criteria were modified in response to comments received, and published in the Federal Register (65 FR 65376) as part of the November 1, 2000 final rule. The PFS final rules published in 2001 and 2003, respectively, (66 FR 55246 and 68 FR 63196) extended the period during which we would accept these supplemental data. As discussed in the January 7, 2004 physician fee schedule final rule (69 FR 1092), section 303(a)(1)(B) of MMA amended section 1848(c)(2) of the Act by adding new subparagraph (H), ‘‘Adjustments in Practice Expense Relative Value Units for Certain Drug Administration Services beginning in 2004’’. Subparagraph (H)(i) requires the Secretary to determine the practice expense RVUs for 2004 using practice expense surveys submitted to the Secretary as of January 1, 2003 by a physician specialty organization in accordance with section 212 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act (BBRA) of 1999 if the survey: (1) Covers practice expenses for oncology drug administration services; and (2) meets criteria established by the Secretary for acceptance of such surveys. Consistent with section 1848(c)(2)(H)(i) of the Act, in January 7, 2005 final rule, we announced we would use the ASCO survey to determine the practice expense RVUs for physician fee schedule services furnished on or after January 1, 2004 because it: (1) Was submitted prior to January 1, 2003; (2) includes expenses for drug administration services; and (3) meets criteria we have established for use of surveys. E:\FR\FM\21NOR2.SGM 21NOR2 70120 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 3. Resource-Based Malpractice RVUs Section 4505(f) of the BBA amended section 1848(c) of the Act to require us to implement resource-based malpractice RVUs for services furnished on or after 2000. The resource-based malpractice RVUs were implemented in the PFS final rule published November 2, 1999 (64 FR 59380). The malpractice RVUs are based on malpractice insurance premium data collected from commercial and physician-owned insurers from all the States, the District of Columbia, and Puerto Rico. 4. Refinements to the RVUs Section 1848(c)(2)(B)(i) of the Act requires that we review all RVUs no less often than every five years. The first 5year review of the physician work RVUs went into effect in 1997, published on November 22, 1996 (61 FR 59489). The second 5-year review went into effect in 2002, published on November 1, 2001 (66 FR 55246). The next 5-year review is scheduled to go into effect in 2007. In 1999, the AMA’s RUC established the Practice Expense Advisory Committee (PEAC) for the purpose of refining the direct PE inputs. Through March of 2004, the PEAC provided recommendations to CMS for over 7,600 codes (all but a few hundred of the codes currently listed in the AMA’s Current Procedural Terminology (CPT) codes). In the November 15, 2004, PFS final rule (69 FR 66236), hereinafter referred to as the CY 2005 final rule, we implemented the first 5-year review of the malpractice RVUs (69 FR 66263). 5. Adjustments to RVUS Are Budget Neutral Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments in RVUs for a year may not cause total PFS payments to differ by more than $20 million from what they would have been if the adjustments were not made. In accordance with section 1848(c)(2)(B)(ii)(II) of the Act, if adjustments to RVUs cause expenditures to change by more than $20 million, we make adjustments to ensure that expenditures do not increase or decrease by more than $20 million. C. Components of the Fee Schedule Payment Amounts Under the formula set forth in section 1848(b)(1) of the Act, the payment amount for each service paid under the physician fee schedule is the product of three factors: (1) A nationally uniform relative value unit (RVU) for the service; (2) a geographic adjustment factor (GAF) for each physician fee schedule area; and (3) a nationally uniform conversion VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 factor (CF) for the service. The CF converts the relative values into payment amounts. For each physician fee schedule service, there are 3 relative values: (1) An RVU for physician work; (2) an RVU for practice expense; and (3) an RVU for malpractice expense. For each of these components of the fee schedule, there is a geographic practice cost index (GPCI) for each fee schedule area. To calculate the payment for every physician service, the components of the fee schedule (physician work, PE, and malpractice RVUs) are adjusted by a geographic practice cost index (GPCI). The GPCIs reflect the relative costs of physician work, PEs, and malpractice insurance in an area compared to the national average costs for each component. Payments are converted to dollar amounts through the application of a CF, which is calculated by the Office of the Actuary and is updated annually for inflation. The general formula for calculating the Medicare fee schedule amount for a given service and fee schedule area can be expressed as: Payment = [(RVU work × GPCI work) + (RVU PE × GPCI PE) + (RVU malpractice × GPCI malpractice)] × CF. The CF for calendar year (CY) 2005 appears in section VI, Physician Fee Schedule Update for CY 2006. The RVUs for CY 2006 are in Addendum B. The GPCIs for CY 2006 can be found in Addendum D. Section 1848(e) of the Act requires us to develop GAFs for all physician fee schedule areas. The total GAF for a fee schedule area is equal to a weighted average of the individual GPCIs for each of the three components of the service. However, in accordance with the statute, the GAF for the physician’s work reflects one-quarter of the relative cost of physician’s work compared to the national average. D. Most Recent Changes to the Fee Schedule In the CY 2005 final rule (69 FR 66236), we refined the resource-based PE RVUs and made other changes and clarifications to Medicare Part B payment policy. These included: • Supplemental survey data for PE; • Updated GPCIs for physician work and PE; • Updated malpractice RVUs; • Revised requirements for supervision of therapy assistants; • Revised payment rules for low osmolar contrast media (LOCM); • Payment policies for physicians and practitioners managing dialysis patients; PO 00000 Frm 00006 Fmt 4701 Sfmt 4700 • Clarification of care plan oversight (CPO) requirements; • Requirements for supervision of diagnostic psychological testing services; • Clarifications to the policies affecting therapy services provided incident to a physician’s service; • Requirements for assignment of Medicare claims; • Additions to the list of telehealth services; • Changes to payments for drug administration services; and • Several coding issues. The CY 2005 final rule (69 FR 66236) also addressed the following provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108–173): • Coverage of an initial preventive physical examination. • Coverage of cardiovascular screening blood tests. • Coverage of diabetes screening tests. • Incentive payment improvements for physicians in physician shortage areas. • Changes to payment for covered outpatient drugs and biologicals and drug administration services. • Changes to payment for renal dialysis services. • Coverage of routine costs associated with certain clinical trials of category A devices as defined by the Food and Drug Administration. • Coverage of hospice consultation service. • Indexing the Part B deductible to inflation. • Extension of coverage of intravenous immune globulin (IVIG) for the treatment in the home of primary immune deficiency diseases. • Revisions to reassignment provisions. • Payment for diagnostic mammograms. • Coverage of religious nonmedical health care institution items and services to the beneficiary’s home. In addition, the CY 2005 PFS final rule finalized the calendar year (CY) 2004 interim RVUs for new and revised codes in effect during CY 2004 and issued interim RVUs for new and revised procedure codes for CY 2005; updated the codes subject to the physician self-referral prohibition; discussed payment for set up of portable x-ray equipment; discussed the third 5year refinement of work RVUs; and solicited comments on potentially misvalued work RVUs. In accordance with section 1848(d)(1)(E) of the Act, we also announced that the PFS update for CY 2005 would be 1.5 percent; the initial E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations estimate for the sustainable growth rate for CY 2005 was 4.3; and the CF for CY 2005 would be $37.8975. II. Provisions of the Final Rule In response to the August 8, 2005 proposed rule (70 FR 45764), we received approximately 15,000 comments. We received comments from individual physicians, health care workers, professional associations and societies, and beneficiaries. The majority of the comments addressed the proposals related to PE and the negative update to the PFS, GPCIs, and Teaching Anesthesiology. The proposed rule discussed policies that affected the RVUs on which payment for certain services would be based and other changes to Medicare Part B payment policy. We also discussed changes related to payment for covered outpatient drugs and biologicals; supplemental payments to federally qualified health centers (FQHCs); payment for renal dialysis services; the national coverage decision (NCD) process; coverage of screening for glaucoma; private contracts; and physician referrals for nuclear medicine services and supplies to health care entities with which they have financial relationships. RVU changes implemented through this final rule with comment are subject to the $20 million limitation on annual adjustments contained in section 1848(c)(2)(B)(ii)(II) of the Act. After reviewing the comments and determining the policies we would implement, we have estimated the costs and savings of these policies and discuss in detail the effects of these changes in the Regulatory Impact Analysis in section XIV. For the convenience of the reader, the headings for the policy issues correspond to the headings used in the August 8, 2005 proposed rule. More detailed background information for each issue can be found in the August 8, 2005 proposed rule. A. Resource Based Practice Expense (PE) RVUs Based on section 1848(c)(1)(B) of the Act, PEs are the portion of the resources used in furnishing the service that reflects the general categories of physician and practitioner expenses (such as office rent and wages of personnel, but excluding malpractice expenses). Section 121 of the Social Security Amendments of 1994 (Pub. L. 103–432), enacted on October 31, 1994, required us to develop a methodology for a resource-based system for determining PE RVUs for each physician’s service. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Up until that point, physicians’ PEs were based on historical allowed charges. This legislation stated that the revised PE methodology must consider the staff, equipment, and supplies used in the provision of various medical and surgical services in various settings beginning in 1998. The Secretary has interpreted this to mean that Medicare payments for each service would be based on the relative PE resources typically involved with performing the service. The initial implementation of resource-based PE RVUs was delayed until January 1, 1999, by section 4505(a) of the BBA. In addition, section 4505(b) of the BBA required the new payment methodology be phased-in over 4 years, effective for services furnished in CY 1999, and fully effective in CY 2002. The first step toward implementation called for by the statute was to adjust the PE values for certain services for CY 1998. Section 4505(d) of BBA required that, in developing the resource-based PE RVUs, the Secretary must: • Use, to the maximum extent possible, generally accepted cost accounting principles that recognize all staff, equipment, supplies, and expenses, not solely those that can be linked to specific procedures. • Develop a refinement method to be used during the transition. • Consider, in the course of notice and comment rulemaking, impact projections that compare new proposed payment amounts to data on actual physician PEs. Beginning in CY 1999, Medicare began the 4 year transition to resourcebased PE RVUs. In CY 2002, the resource-based PE RVUs were fully transitioned. 1. Current Methodology The following sections discuss the current PE methodology. a. Data Sources There are two primary data sources used to calculate PEs. The AMA’s SMS survey data are used to develop the PEs per hour for each specialty. The second source of data used to calculate PEs was originally developed by the CPEP. The CPEP data include the supplies, equipment, and staff times specific to each procedure. The AMA developed the SMS survey in 1981 and discontinued it in 1999. Beginning in 2002, we incorporated the 1999 SMS survey data into our calculation of the PE RVUs, using a 5year average of SMS survey data. (See Revisions to Payment Policies and FiveYear Review of and Adjustments to the Relative Value Units Under the PO 00000 Frm 00007 Fmt 4701 Sfmt 4700 70121 Physician Fee Schedule for CY 2002 final rule, published November 1, 2001 (66 FR 55246).) The SMS PE survey data are adjusted to a common year, 1995. The SMS data provide the following six categories of PE costs: • Clinical payroll expenses, which are payroll expenses (including fringe benefits) for clinical nonphysician personnel. • Administrative payroll expenses, which are payroll expenses (including fringe benefits) for nonphysician personnel involved in administrative, secretarial or clerical activities. • Office expenses, which include expenses for rent, mortgage interest, depreciation on medical buildings, utilities and telephones. • Medical material and supply expenses, which include expenses for drugs, x-ray films, and disposable medical products. • Medical equipment expenses, which include depreciation expenses, leases, and rent of medical equipment used in the diagnosis or treatment of patients. • All other expenses, including expenses for legal services, accounting, office management, professional association memberships, and any professional expenses not mentioned above. In accordance with section 212 of the BBRA, we established a process to supplement the SMS data for a specialty with data collected by entities and organizations other than the AMA (that is, the specialty itself). (See the Criteria for Submitting Supplemental Practice Expense Survey Data interim final rule with comment period, published on May 3, 2000 (65 FR 25664).) Originally, the deadline to submit supplementary survey data was through August 1, 2001. This deadline was extended in the November 1, 2001 final rule through August 1, 2003. (See the Revisions to Payment Policies and Five-Year Review of and Adjustments to the Relative Value Units Under the Physician Fee Schedule for CY 2002 final rule, published on November 1, 2001 (66 FR 55246).) Then, to ensure maximum opportunity for specialties to submit supplementary survey data, we extended the deadline to submit surveys until March 1, 2005. (See the Revisions to Payment Policies Under the Physician Fee Schedule for CY 2002 final rule, published on November 7, 2003 (68 FR 63196).) The CPEPs consisted of panels of physicians, practice administrators, and nonphysicians (registered nurses, for example) who were nominated by physician specialty societies and other groups. There were 15 CPEPs consisting E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations of 180 members from more than 61 specialties and subspecialties. Approximately 50 percent of the panelists were physicians. The CPEPs identified specific inputs involved in each physician service provided in an office or facility setting. The inputs identified were the quantity and type of nonphysician labor, medical supplies, and medical equipment. In 1999, the AMA’s Multi-specialty Relative Value Update Committee (RUC) established the PEAC. Since 1999, and until March 2004, the PEAC, a multispecialty committee, reviewed the original CPEP inputs and provided us with recommendations for refining these direct PE inputs for existing CPT codes. Through its last meeting in March 2004, the PEAC provided recommendations which we have reviewed and accepted for over 7,600 codes. As a result of this scrutiny by the PEAC, the current CPEP/RUC inputs differ markedly from those originally recommended by the CPEPs. The PEAC has now been replaced by the Practice Expense Review Committee (PERC), which acts to assist the RUC in recommending PE inputs. b. Allocation of Practice Expenses to Services In order to establish PE RVUs for specific services, it is necessary to establish the direct and indirect PE associated with each service. Our current approach is to allocate aggregate specialty practice costs to specific procedures and, thus, it is often referred to as a ‘‘top-down’’ approach. The Step 2—Calculation of CPEP Cost Pool CPEP data provide expenditure amounts for the direct expense categories (clinical labor, supplies, and equipment cost) at the procedure level. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 specialty PEs are derived from the AMA’s SMS survey and supplementary survey data. The PEs for a given specialty are allocated to the services performed by that specialty on the basis of the CPEP/RUC data and work RVUs assigned to each CPT code. The specific process is detailed as follows: Step 1—Calculation of the SMS Cost Pool for Each Specialty The six SMS cost categories can be described as either direct or indirect expenses. The three direct expense categories include clinical labor, medical supplies and medical equipment. Indirect expenses include administrative labor, office expense, and all other expenses. We combine these indirect expenses into a single category. The SMS cost pool for each specialty is calculated as follows: • The specialty PE per hour (PE/HR) for each of the three direct and one indirect cost categories from the SMS is calculated by dividing the aggregate PE per specialty by the specialty’s total hours spent in patient care activities (also determined by the SMS survey). The PE/HR is divided by 60 to obtain the PE per minute (PE/MIN). • Each specialty’s PE pools (for each of the three direct and one indirect cost categories) are created by multiplying the PE/MIN for the specialty by the total time the specialty spent treating Medicare patients for all procedures (determined using Medicare utilization data). Physician time on a procedurespecific level is available through RUC surveys of new or revised codes and Multiplying the CPEP procedure-level PEs for each of these three categories by the number of times the specialty provided the procedure, produces a total category cost, per procedure, for PO 00000 Frm 00008 Fmt 4701 Sfmt 4700 through surveys conducted as part of the 5-year review process. For codes that the RUC has not yet reviewed, the original data from the Harvard resourcebased RVU system survey is used. Physician time includes time spent on the case before, during, and after the procedure. The physician procedure time is multiplied by the frequency that each procedure is performed on Medicare patients by the specialty. • The total specialty-specific SMS PE for each cost category is the sum, for each direct and indirect cost category, of all of the procedure-specific total PEs. Table 1 illustrates an example of the calculation of the total SMS cost pools for the three direct and one indirect cost categories discussed in step 1. For this specialty, PE/HR for clinical payroll expenses is $9.30 per hour. The hourly rate is divided by 60 minutes to obtain the clinical payroll per minute for the specialty. The total clinical payroll for providing hypothetical procedure 00001 for this specialty of $3,633,465 is the result of taking the clinical payroll per minute of $0.16; multiplying this by the physician time for procedure 00001 (56 minutes); and multiplying the result by the number of times this procedure was provided to Medicare patients by this specialty (418,602). The total amount spent on clinical payroll in this specialty is $667,457,018. This amount is calculated by summing the clinical payroll expenses of procedure 00001 and all of the other services provided by this specialty. that specialty. The sum of the total expenses from each procedure results in the total CPEP category cost for the specialty. E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.002</GPH> 70122 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70123 For example, in Table 2, using CPEP data, the clinical labor cost of procedure 00001 is $65.23. Under the methodology described above in this step, this is multiplied by the number of services for the specialty (418,602), to yield the total CPEP data clinical labor cost of the procedure: $27,305,408. In this example, the clinical labor cost for all other services performed by this specialty is $831,618,600. Therefore, the entire clinical labor CPEP expense pool for the specialty is $858,924,008. Step 2 is repeated to calculate the CPEP supply and equipment costs. Step 3—Calculation and Application of Scaling Factors specialty’s SMS pool by the specialty’s CPEP pool.) The unscaled CPEP cost per procedure value, at the direct cost level, is then multiplied by the respective specialty scalar to yield the scaled CPEP procedure value. The sum of the scaled CPEP direct cost pool expenditures equals the total scaled direct expense for the specific procedure at the specialty level. In the Step 3 example shown in Table 3, the SMS total clinical labor costs for the specialty is $667,457,018. This amount divided by the CPEP total clinical labor amount of $858,924,008 yields a scaling factor of 0.78. The CPEP clinical labor cost for hypothetical procedure 00001 is $65.23. Multiplying the 0.78 scaling factor for clinical labor costs by $65.23 yields the scaled clinical labor cost amount of $50.69. Individual scaling factors must also be calculated for supply and equipment expenses. The sum of the scaled direct cost values, $50.69, $43.90, and $139.45, respectively, equals the total scaled direct expense of $234.04. This step ensures that the total of the CPEP costs across all procedures performed by the specialty equates with the total direct costs for the specialty as reflected by the SMS data. To accomplish this, the CPEP data are scaled to SMS data by means of a scaling factor so that the total CPEP costs for each specialty equals the total SMS cost for the specialty. (The scaling factor is calculated by dividing the TABLE 3.—CALCULATION AND APPLICATION OF SCALING FACTORS Clinical/Labor Step 4—Calculation of Indirect Expenses Indirect PEs cannot be directly attributed to a specific service because they are incurred by the practice as a whole. Indirect costs include rent, utilities, office equipment and supplies, and accounting and legal fees. There is not a single, universally accepted approach for allocating indirect practice costs to individual procedure codes. Rather allocation involves judgment in VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Equipment Total Scaled direct expense (Sum of A, B, and C) (B) (C) (D) $667,457,018 858,924,008 0.78 $344,493,945 411,894,617 52.49 $531,094,831 5,929,275,023 1,556.86 50.69 43.90 139.45 identifying the base or bases that are the best measures of a practice’s indirect costs. To allocate the indirect PEs to a specific service, we use the following methodology: • The total scaled direct expenses and the converted work RVU (the work RVU for the service is multiplied by $34.5030, the 1995 CF) are added together, and then multiplied by the PO 00000 Frm 00009 Fmt 4701 Sfmt 4700 $234.04 number of services provided by the specialty to Medicare patients. • The total indirect PEs per specialty are calculated by summing the indirect expenses for all other procedures provided by that specialty. For example, in Table 4, the physician work RVU for procedure 00001 is 2.36. Multiplying the work RVU by the 1995 CF of $34.5030 equals $81.43. The physician work value is added to the scaled total direct expense from Step 3 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.003</GPH> (a) Total—SMS Pool .......................................................... (b) Total—CPEP Pool ........................................................ (c) Scaling Factor .............................................................. Unscaled Value (e) CPT 00001—Scaled Value .......................................... (c) = (a)/(b) (e) = (c)*(d) Supplies (A) Standard methodology 70124 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ($234.04). The total of $314.47 is a proxy for the indirect PE for the specialty attributed to this procedure. The total indirect expenses are then multiplied by the number of times procedure 00001 is provided by the specialty (418,602), to calculate total indirect expenses for this procedure of $132,055,728. The process is repeated across all procedures performed by the specialty, and the indirect expenses for each service are summed to arrive at the total specialty indirect PE pool of $6,745,545,434. TABLE 4.—CALCULATION OF INDIRECT EXPENSE Physician Work* Total direct expense Total (A) (B) (C) (a) CPT 00001 ......................................................................................................... (b) Allowed Services ................................................................................................ $81.43 .............................. $234.04 .............................. (c) Subtotal .............................................................................................................. (d) All Other Services .............................................................................................. .............................. .............................. .............................. .............................. 132,055,728 6,613,489,706 (e) Total Indirect Expense ....................................................................................... .............................. .............................. 6,745,545,434 Standard Methodology $315.47 418,602 * Calculated by multiplying work RVU of 2.36 by 1995 CF of $34.5030. Step 5—Calculation and Application of Indirect Scaling Factors Similar to the direct costs, the indirect costs are scaled to ensure that the total across all procedures performed by the specialty equates with the total indirect costs for the specialty as reflected by the SMS data. To accomplish this, the indirect costs calculated in Step 4 (Table 4) are scaled to SMS data. The calculation of the indirect scaling factors is as follows: • The specialty’s total SMS indirect expense pool is divided by the specialty’s total indirect expense pool calculated in Step 4 (Table 4), to yield the indirect expense scaling factor. • The unscaled indirect expense amount, at the procedure level, is multiplied by the specialty’s scaling factor to calculate the procedure’s scaled indirect expenses. • The sum of the scaled indirect expense amount and the procedure’s direct expenses yields the total PEs for the specialty for this procedure. In table 5, to calculate the indirect scaling factor for hypothetical procedure 00001, divide the total SMS indirect pool, $3,337,285,089 (calculated in Step 1-Table 1)), by the total indirect expense for the specialty across all procedures of $6,745,545,434. This results in a scaling factor of 0.49. Next, the unscaled indirect cost of $315.47 is multiplied by the 0.49 scaling factor, resulting in scaled indirect cost of $156.07. To calculate the total PEs for the specialty for procedure 00001, the scaled direct and indirect expenses are added, totaling $390.12. TABLE 5.—CALCULATION OF INDIRECT SCALING FACTORS AND TOTAL PRACTICE EXPENSES Indirect costs (a) Total—SMS Indirect Expense ............................................................................ (b) Total Indirect Expense for all Procedures (from Step 4) ................................... (c) Scaling Factor .................................................................................................... (d) CPT 00001—Unscaled Value ............................................................................ (e) CPT 00001—Scaled Value ................................................................................ Direct cost Specialty specific practice expenses (Sum of A, B) (A) Standard methodology (B) (C) $3,337,285,089 6,745,545,434 0.49 315.47 156.07 For codes that are performed by more than one specialty, a weighted-average $390.12 Practice expense value Percent of total allowed services (A) Step 6—Weighted Average of RVUs for Procedures Performed by More Than One Specialty $234.04 (B) PE is calculated based on Medicare frequency data of all specialties performing the procedure as shown in Table 6. TABLE 6.—WEIGHT AVERAGING FOR ALL SPECIALTIES Standard methodology (a) Specialty Total Practice Expense .......................................................................................................... (b) Weighted Avg.—All Other Specialties ................................................................................................... (c) Weighted Avg.—All Specialties .............................................................................................................. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00010 Fmt 4701 Sfmt 4700 E:\FR\FM\21NOR2.SGM $390.12 929.87 481.70 21NOR2 83 17 100 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations Step 7—Budget Neutrality and Final RVU Calculation The total scaled direct and indirect inputs are then adjusted by a budget neutrality factor (BNF) to calculate RVUs. Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments in RVUs may not cause total PFS payments to differ by more than $20 million from what they would have been if the 70125 indirect inputs across all codes for the upcoming year. The BNF is applied to (multiplied by) the scaled direct and indirect expenses for each code to set the PE RVU for the upcoming year. In Table 7, the sum of the scaled direct and indirect expenses for hypothetical code 00001 ($481.70) is multiplied by the BNF (0.02 in this example) to yield a PE RVU of 10.60. adjustments were not made. Budget neutrality for the upcoming year is determined relative to the sum of PE RVUs for the current year. Although the PE RVUs for any particular code may vary from year-to-year, the sum of PE RVUs across all codes is set equal to the current year. The BNF is equal to the sum of the current year’s PE RVUs, divided by the sum of the direct and TABLE 7.—CALCULATE PE RVU Total scaled direct and indirect inputs Budget neutrality factor Final PE RVU (A) (B) (C) (a) Code 00001 .......................................................................................................... As an interim measure, until we could further analyze the effect of the topdown methodology on the Medicare payment for services with no physician work (including the technical components (TCs) of radiation oncology, radiology and other diagnostic tests), we created a separate PE pool for these services. However, any specialty society could request that its services be removed from the nonphysician work NPWP Step 2—Calculation of ChargeBased PE RVU Cost Pool The NPWP calculation uses the 1998 (charge-based) PE RVU value for the VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 pool (NPWP). We have removed some services from the NPWP if we find that the requesting specialty provides the service the majority of the time. 0.02 10.60 This step parallels the calculations described above for the standard ‘‘topdown’’ PE allocation methodology. For codes in the NPWP, the direct and indirect SMS costs are set equal to the weighted average of the PE/HR for the specialties that provide the services in the pool. Clinical staff time is substituted for physician time in the calculation. The clinical staff time for the code is from CPEP data. Otherwise, the calculation is similar to the method described previously for codes with physician time. The following example in Table 8 illustrates this calculation for hypothetical code 00002. In this example, the average clinical payroll PE/HR for all specialties in the NPWP is $12.30 and the clinical staff time for code 00002 is 116 minutes. code, multiplied by the 1995 CF (25.74 × $34.503 = $888.11). The percentage of clinical labor, supplies and equipment are the percentage that each PE category represents for all physicians relative to the total PE for all physicians (calculated from the SMS data) as shown in Table 9. NPWP Step 1—Calculation of the SMS Cost Pool for Each Code PO 00000 Frm 00011 Fmt 4701 Sfmt 4700 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.004</GPH> c. Other Methodological Issues: Nonphysician Work Pool (NPWP) $481.70 70126 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations NPWP Step 3—Calculation and Application of Scaling Factors After the total cost pools for each code in the NPWP are calculated, the steps to ensure the total charge-based PEs for the procedure do not exceed the total SMS PEs for the procedure (scaling) are the same as those described previously for codes with physician work. In Table 10, the SMS total clinical labor costs are $2,499,159. This amount divided by the charge-based total clinical labor amount of $16,613,742 yields a scaling factor of 0.15. The charge-based clinical labor cost for hypothetical procedure 00002 is $158.08 (from NPWP Step 2—Table 9). Multiplying the 0.15 scaling factor for clinical labor costs by $158.08 yields the scaled clinical labor cost amount of $23.78. Individual scaling factors must be calculated for both supply and equipment expenses. The sum of the scaled direct cost values, $23.78, $32.57 and $2.72, respectively, equals the total scaled direct expense of $59.07. TABLE 10.—CALCULATION AND APPLICATION OF DIRECT COST SCALING FACTORS Clinical (a) Total—NPWP Specialty Pool ............................................... (b) Total NPWP Charge-based Pool ......................................... (c) Scaling Factor ...................................................................... (d) CPT 00002—Unscaled Value .............................................. (e) CPT 00002—Scaled Value .................................................. NPWP Step 4—Calculation of Indirect Expenses Because codes in the NPWP do not have work RVUs, indirect expenses are set equal to direct expenses (for codes with physician work, indirect expenses Supplies Equipment Total scaled direct expense (Sum of A, B, and C) (A) NPWP methodology (B) (C) (D) $2,499,159 16,613,742 0.15 158.08 23.78 $1,503,559 4,386,775 0.34 95.03 32.57 equal the sum of the scaled direct expenses and the converted work RVU). This amount is then multiplied by the number of times the procedure is performed. In Table 11, the scaled total direct expense from NPWP Step 3 (Table 10) $650,188 9,986,912 0.06 41.74 2.72 $59.07 ($59.07) is also the proxy for the total indirect expense attributed to the procedure. The total indirect expense is multiplied by the number of services (105,095), to calculate total indirect cost for this procedure of $6,207,961. TABLE 11.—CALCULATION OF INDIRECT EXPENSES Physician work * NPWP Step 5—Calculation and Application of Indirect Scaling Factors Similar to the direct costs, the indirect costs are scaled to ensure that the total of the charge-based PE costs across all procedures equates with the total VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Total (B) (C) ............................ ............................ ............................ $59.07 ............................ ............................ indirect costs as reflected by the SMS data for the code. To accomplish this, the charge-based indirect PEs are scaled to the SMS indirect PEs. In Table 12, to calculate the indirect scaling factor for hypothetical procedure PO 00000 Frm 00012 Fmt 4701 Sfmt 4700 $59.07 105,095 $6,207,961 00002, the total SMS indirect PE, $9,407,404 (from NPWP Step 1—Table 8), is divided by the total charge-based indirect expense of $6,207,961 (from NPWP Step 4—Table 11). This results in a scaling factor of 1.51. Next, the E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.005</GPH> (a) CPT 00002 ............................................................................................................... (b) Allowed Services—NPWP ....................................................................................... (c) Total NPWP Indirect Expense ................................................................................. Total direct expense (A) NPWP methodology Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations unscaled indirect charge-based cost for procedure 00002 of $59.07 (from NPWP Step 4—Table 11) is multiplied by the 1.51 scaling factor, resulting in scaled 70127 indirect costs for this procedure of $89.19. TABLE 12.—CALCULATION AND APPLICATION OF INDIRECT COST SCALING FACTORS Indirect costs (a) Total—NPWP ‘‘SMS’’ Pool ................................................................................ (b) Total NPWP Indirect Expense ........................................................................... (c) Scaling Factor .................................................................................................... (d) CPT 00002—Unscaled Value ............................................................................ (e) CPT 00002—Scaled Value ................................................................................ NPWP Step 6—Budget Neutrality and Final RVU Calculation Similar to the calculation for codes with physician work, the BNF is applied Direct cost Specialty specific PE RVU (Sum of A and B) (A) Standard methodology (B) (C) $9,407,404 6,207,961 1.51 59.07 89.19 to (multiplied by) the scaled direct and indirect expenses for each code to set the PE RVU for the upcoming year. In Table 13, the sum of the scaled direct and indirect expenses for $59.07 $148.26 hypothetical code 00002 ($148.26) is multiplied by the BNF (0.022 in this example) to yield a PE RVU of 3.26. TABLE 13.—BUDGET NEUTRALITY AND FINAL RVU CALCULATION Total scaled direct and indirect inputs Code 00002 ............................................................................................................... d. Facility/Nonfacility Costs Procedures that can be performed in a physician’s office as well as in a hospital have two PE RVUs; facility and nonfacility. The nonfacility setting includes physicians’ offices, patients’ homes, freestanding imaging centers, and independent pathology labs. Facility settings include hospitals, ambulatory surgery centers, and skilled nursing facilities (SNFs). The methodology for calculating the PE RVU is the same for both facility and nonfacility RVUs, but each is calculated independently to yield two separate PE RVUs. Because the PEs for services provided in a facility setting are generally included in the payment to the facility (rather than the payment to the physician under the fee schedule), the PE RVUs are generally lower for services provided in the facility setting. 2. PE Proposals for CY 2006 The following discussions outline the specific PE related proposals for CY 2006. a. Supplemental PE Surveys The following discussions outline the criteria for supplemental survey submission as well as information we have received for approval. (1) Survey Criteria and Submission Dates In accordance with section 212 of the BBRA, we established criteria to VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 $148.26 evaluate survey data collected by organizations to supplement the SMS survey data normally used in the calculation of the PE component of the PFS. In the final rule published November 7, 2003 (68 FR 63196), we provided that, beginning in 2004, supplemental survey data had to be submitted by March 1 to be considered for use in computing PE RVUs for the following year. This allows us to publish our decisions regarding survey data in the proposed rule and provides the opportunity for public comment on these results before implementation. To continue to ensure the maximum opportunity for specialties to submit supplemental PE data, we extended until 2005 the period that we would accept survey data that meet the criteria set forth in the November 2000 PFS final rule. The deadline for submission of supplemental data to be considered in CY 2006 was March 1, 2005. (2) Submission of Supplemental Survey Data The following discussion outlines the survey data submitted for CY 2004 and CY 2005. (a) Surveys Submitted in 2004 As discussed in the August 8, 2005 PFS proposed rule (70 FR 45774), we had received surveys by March 1, 2004 from the American College of Cardiology (ACC), the ACR, and the American Society for Therapeutic Radiation Oncology (ASTRO). The data PO 00000 Frm 00013 Fmt 4701 Sfmt 4700 Budget neutrality factor Final PE RVU 0.022 2.96 submitted by the ACC and the ACR met our criteria. However, as requested by the ACC and the ACR, we deferred using their data until issues related to the NPWP could be addressed. In the August 8, 2005 proposed rule, we proposed to use the ACC and ACR survey data in the calculation of PE RVUs for CY 2006, but only as specified in the proposals relating to a revised methodology for establishing direct PE RVUs. The survey data from ASTRO did not meet the precision criteria established for supplemental surveys, therefore, we indicated we would not use it in the calculation of PE RVUs for CY 2005. However, we proposed to use these data to blend with data submitted by the Association of Freestanding Radiation Oncology Centers (AFROC) for CY 2006, as described below. (b) Surveys Submitted in 2005 In 2005 we received surveys from the AFROC, the American Urological Association (AUA), the American Academy of Dermatology Association (AADA), the Joint Council of Allergy, Asthma, and Immunology (JCAAI), the National Coalition of Quality Diagnostic Imaging Services (NCQDIS) and a joint survey from the American Gastroenterological Association (AGA), the American Society of Gastrointestinal Endoscopy (ASGE), and the American College of Gastroenterology (ACG). E:\FR\FM\21NOR2.SGM 21NOR2 70128 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations As explained in the August 8, 2005 proposed rule, we contract with the Lewin Group to evaluate whether the supplemental survey data that are submitted meet our criteria and to make recommendations to us regarding their suitability for use in calculating PE RVUs. (The Lewin Group report on the 2005 submissions is available on the CMS Web site at https:// www.cms.hhs.gov/physicians/pfs/.) The report indicated that, except for the survey from NCQDIS, all met our criteria and we are proposing to accept these surveys. The survey data submitted by the NCQDIS on independent diagnostic testing facilities (IDTFs) did not meet the precision criterion of a 90 percent confidence interval with a range of plus or minus 15 percent of the mean (that is, 1.645 times the standard error of the mean, divided by the mean, is equal to or less than 15 percent of the mean). For the NCQDIS survey, the precision level was calculated at 16.3 percent of the mean PE/HR (weighted by the number of physicians in the practice). However, the Lewin Group has recommended that we accept the data from NCQDIS. The Lewin Group points out that PE data for IDTFs do not currently exist, and suggests that the need for data for the specialty should be weighed against the precision requirement. We proposed not to accept the NCQDIS data to calculate the PE RVUs for services provided by IDTFs. As just noted, the NCQDIS data did not meet our precision requirements. We established the minimum precision standards because we believe it is necessary to ensure that the data used are valid and reliable, and the consistent application of the precision criteria is the best way to accomplish that objective. Section 303(a)(1) of the MMA added section 1848(c)(2)(I) of the Act to require us to use survey data that include expenses for the administration of drugs and biologicals submitted by a specialty group for which at least 40 percent of the Part B payments are attributable to the administration of drugs in 2002 to adjust PE RVUs for drug administration services. The provision applies to surveys received by March 1, 2005 for determining the CY 2006 PE RVUs. Section 303(a)(1) of the MMA also amended section 1848(c)(2)(B)(iv)(II) of the Act to provide an exemption from budget neutrality for any additional expenditures resulting from the use of this survey data to adjust PE RVUs for drug administration services. In the Changes to Medicare Payment for Drugs and Physician Fee Schedule Payments for CY 2004 interim final rule published VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 January 7, 2004 (69 FR 1084), we stated that the specialty of urology meets the above criteria, along with gynecology and rheumatology (69 FR 1094). Because we proposed to accept the new survey data from the AUA, we are required to exempt from the budget neutrality adjustment any impacts of accepting these data for purposes of calculating PE RVUs for drug administration services. In addition, Lewin recommended blending the radiation oncology data from this year’s AFROC survey data with last year’s ASTRO survey data to calculate the PE/HR. According to the Lewin Group, the goal of the AFROC survey was to represent the population of freestanding radiation oncology centers only. In order to develop an overall average for the radiation oncology PE pool, the Lewin Group recommended we use the AFROC survey for freestanding radiation oncology centers, and the hospital-based subset of last year’s ASTRO survey. Consistent with that recommendation, we proposed to use the new PE/HR calculated in this manner for radiation oncology. As discussed in the August 8, 2005 PFS proposed rule and also in the preamble of this final rule with comment, we proposed to revise our methodology to calculate direct PE RVUs from the current top-down cost allocation methodology to a bottom-up methodology. Although we would continue to use the SMS data and the incorporated supplemental survey data for indirect PEs, we did not extend the deadline for submitting supplemental survey data but rather requested comments on the most appropriate way to proceed to ensure the indirect PEs per hour are accurate and consistent across specialties. b. Revisions to the PE Methodology As discussed in the August 8, 2005 proposed rule, since 1997, when we first proposed a resource-based PE methodology, we have had several major goals for this payment system and have encouraged the maximum input from the medical community regarding our PE data and methodology. We also have had the following three specific goals for the resource-based PE methodology itself, which have also been supported in numerous comments we have received from the medical community: • To ensure that the PE payments reflect, to the greatest extent possible, the actual relative resources required for each of the services on the PFS. This could only be accomplished by using PO 00000 Frm 00014 Fmt 4701 Sfmt 4700 the best available data to calculate the PE RVUs. • To develop a payment system for PE that is understandable and at least somewhat intuitive, so that specialties could generally predict the impacts of changes in the PE data. • To stabilize the PE payments so that there are not large fluctuations in the payment for given procedures from year-to-year. As we explained in the August 8, 2005 proposed rule, we believe that we have consistently made a good faith effort to ensure fairness in our PE payment system by using the best data available at any one time. The change from the originally proposed ‘‘bottomup’’ to the ‘‘top-down’’ methodology came about because of a concern that the resource input data developed in 1995 by the CPEP were less reliable than the aggregate specialty cost data derived from the SMS process. The adoption of the top-down approach necessitated the creation of the NPWP. The NPWP is a separate pool created to allocate PEs for codes that have only a technical (rather than professional) component, or codes that are not performed by physicians. However, the situation has now changed. As we explained in the August 8, 2005 proposed rule, refinement of the original CPEP data is complete and the refined PE inputs now, in general, accurately capture the relative direct costs of performing PFS services. Also, the major specialties comprising the NPWP (radiology, radiation oncology, and cardiology) submitted supplemental survey data that we proposed to accept, which would eliminate the need to treat these technical services outside the PE methodology applied to other services. Due to the ongoing refinement by the RUC of the direct PE inputs, we had expected that the PE RVUs would necessarily fluctuate from year-to-year. However, it became apparent that certain aspects of our methodology exacerbated the yearly fluctuations. The services priced by the NPWP methodology have proven to be especially vulnerable to any change in the pool’s composition. With the CPEP/RUC refinement of existing services virtually complete, we indicated this was an opportunity for us to propose a way to provide stability to the PE RVUs. Therefore, consistent with our goals of using the most appropriate data, simplifying our methodology, and increasing the stability of the payment system, we proposed the following changes to our PE methodology and also requested suggestions that would assist us in further refinement of the indirect PE methodology. E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations (1) Use a Bottom-up Methodology To Calculate Direct PE Costs Instead of using the top-down approach to calculate the direct PE RVUs, where the aggregate CPEP/RUC costs for each specialty are scaled to match the aggregate SMS costs, we proposed to adopt a bottom-up method of determining the relative direct costs for each service. Under this method, the direct costs would be determined by summing the costs of the resources—the clinical staff, equipment and supplies— typically required to provide the service. The costs of the resources, in turn, would be calculated from the refined CPEP/RUC inputs in our PE database. (2) Eliminate the Nonphysician Work Pool (NPWP) Since we proposed to incorporate new survey data for the major specialties that comprise the NPWP, we proposed to eliminate the pool and calculate the PE RVUs for the services currently in the pool by the same methodology used for all other services. This would allow the use of the refined CPEP/RUC data to price the direct costs of individual services, rather than utilizing the pre1998 charge-based PE RVUs. (3) Utilize the Current Indirect PE RVUs, Except for Those Services Affected by the Accepted Supplemental Survey Data As described previously, the SMS and supplemental survey data are the source for the specialty-specific aggregate indirect costs used in our PE calculations. We then allocate to particular codes on the basis of the direct costs allocated to a code and the work RVUs. Although we now believe the CPEP/RUC data are preferable to the SMS data for determining direct costs, we have no information that would indicate that the current indirect PE methodology is inaccurate. We also are not aware of any alternative approaches or data sources that we could use to calculate more appropriately the indirect PE, other than the new supplemental survey data, which we proposed to incorporate into our PE calculations. Therefore, we proposed to use the current indirect PEs in our calculation incorporating the new survey data into the codes performed by the specialities submitting the surveys. We specifically requested suggestions that would assist us in further refinement of the indirect PE methodology. For example, we noted in the proposed rule that we are considering whether we should continue to accept supplementary survey data or whether it would be VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 preferable and feasible to have an SMStype survey of only indirect costs for all specialties; or whether a more formulabased methodology independent of the SMS data should be adopted, perhaps using the specialty-specific indirect-tototal cost percentage as a basis of the calculation. (4) Transition the Resulting Revised PE RVUs Over a 4-Year Period We are concerned that, when combined with an expected negative update factor for CY 2006, the shifts in some of the PE RVUs resulting from our proposals could cause some measure of financial stress on medical practices. Therefore, we proposed to transition the proposed PE changes over a 4-year period. This would also give ample opportunity for us, as well as the medical specialties and the RUC, to identify any anomalies in the PE data, to make any further appropriate revisions, and to collect additional data, as needed prior to the full implementation of the proposed PE changes. During this transition period, the PE RVUs would be calculated on the basis of a blend of RVUs calculated using our proposed methodology described above (weighted by 25 percent during CY 2006, 50 percent during CY 2007, 75 percent during CY 2008, and 100 percent thereafter), and the current CY 2005 PE RVUs for each existing code. Now that the direct PE inputs have been refined, we believe that the CPEP/RUC direct input data are generally superior to the specialtyspecific SMS PE/HR data for the purposes of determining the typical direct PE resources required to perform each service on the PFS. First, we have received recommendations on the procedure-specific inputs from the multi-specialty PEAC that were based on presentations from the relevant specialties after being closely scrutinized by the PEAC using standards and packages agreed to by all involved specialties. Second, the refined CPEP/RUC data are more current than the SMS data for the majority of specialties. Third, for direct costs, it appears more accurate to assume that the costs of the clinical staff, supplies and equipment are the same for a given service, regardless of the specialty that is performing it. This assumption does not hold true under the top-down direct cost methodology, where the specialtyspecific scaling factors create widely differing costs for the same service. We also would argue that the proposed methodology is less confusing and more intuitive than the current approach. For instance, the NPWP PO 00000 Frm 00015 Fmt 4701 Sfmt 4700 70129 would be eliminated and all services would be priced using one methodology, eliminating the complicated calculations needed to price NPWP services. Also, any revisions made to the direct inputs would now have predictable results. Changes in the direct practice inputs for a service would proportionately change the PE RVUs for that service without significantly affecting the PE RVUs for unrelated services. In addition, the proposed methodology would create a system that would be significantly more stable from year-to-year than the current approach. We recognized that there are still some outstanding issues that need further consideration, as well as input from the medical community. For example, although we believe that the elimination of the NPWP would be, on the whole, a positive step, some practitioner services, such as audiology and medical nutrition therapy (MNT), would be significantly impacted by the proposed change. In addition, there are still services, such as the end stage renal disease (ESRD) visit codes, for which we have no direct input information. Also, as mentioned above, we do not have current SMS or supplementary survey data to calculate the indirect costs for most specialties. Further, we do not yet have accurate utilization for the new drug administration codes that were created in response to the MMA provision on drug administration. Therefore, we did not propose to change the RVUs for these services at this time, but to include them under our proposed methodology in next year’s rule when we have appropriate data. The proposed transition period would give us the opportunity to work with the affected specialties to collect the needed survey or other data or to determine whether further revisions to our PE methodology are needed. We requested comments on these proposed changes, particularly those concerning additional modifications to the indirect PE methodology that might help us further our intended goals. Comment: There were 3 main concerns raised in comments we received on our overall proposed PE methodology which included: (1) Many of the proposed decreases appeared anomalous and were not explained; (2) there was insufficient information given to allow specialties to review and analyze the proposal and its impact; and (3) the use of the new PE data from the seven accepted supplementary surveys caused an inequitable redistribution of PE RVUs. As a result of these concerns, many commenters also requested a E:\FR\FM\21NOR2.SGM 21NOR2 70130 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations delay in the implementation of our proposed methodology. The following are examples of the comments detailing the above concerns. The AMA and the RUC agreed with the goals that we have set for an accurate, intuitive and stable methodology to use for the calculation of PE RVUs. The RUC added that it looks forward to helping us meet these goals. However, the AMA urged us to provide more information, such as examples of how the new values were calculated, the PE/HR and source of the data for each specialty and the budget neutrality adjuster applied at the end of the process, so that the medical community would have the opportunity to review the values and impact of the proposal. Medicare Payment Advisory Commission (MedPAC) stated its agreement with the concerns regarding the current PE methodology that motivated us to propose a change, but did request that we assess the impact of proposed changes by groups of services—evaluation and management services, major procedures, other procedures, laboratory tests and imaging services, as well as by physician specialty group. A specialty society representing obstetrics and gynecology commended the goal of the new methodology, but suggested we offer two or more examples of how PE is calculated, starting with the inputs that are used and moving through the process of developing the final PE RVUs for those codes. An optometric association expressed regret that the proposed rule does not provide service-specific examples of how PE RVUs would be calculated using the current and proposed methodologies because this made it difficult to provide detailed comments on the proposal. Therefore, the commenter concluded that we should issue a final with a comment period. Two emergency medicine societies also requested the same service-specific examples. An ophthalmology society was troubled by our failure to make the indirect cost data used in determining the rates of change in PE values available to all specialties for review and by the lack of analysis explaining the significant impacts caused by the acceptance of the supplemental survey data. A specialty society representing cardiology urged us to provide more data and a more detailed explanation of the methodology, along with examples of how RVUs for specific codes were determined, so that stakeholders can VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 gain a thorough understanding of our proposal. A dermatology association commented that it is pleased that we want to transition to a bottom-up approach. The association believes that this will result in a more easily understood and stable payment system, but it would be helpful to have more information in the final rule on the calculation of PE values under the new methodology. For example, the association asks for clarification of why the PE RVUs for several dermatology procedures decreased. A specialty society representing physical medicine expressed concern regarding a number of the results with respect to several physical medicine and rehabilitation codes and requested that we provide a more detailed description of the new methodology and address anomalies in the final rule. The commenter suggested that we establish a percentage decrease threshold that would trigger an opportunity for expedited review to determine whether the direct cost inputs are accurate. Four organizations representing radiation oncology submitted comments stating their concern that several radiation therapy codes, including those for intensity modulated radiation therapy, continuing medical physics consultation and brachytherapy, have inappropriate proposed reductions. Two of the commenters recommended that we examine the impact of the methodology on a code-specific basis and, if necessary, implement an adjustment factor that limits the reduction to no more than 15 percent of the 2005 global RVUs at the end of the 4-year transition period. Comments from societies representing nuclear cardiology and echocardiography also supported a cap on the maximum reduction applied to any procedure that resulted from the decision to adopt the new methodology. A geriatrics society expressed concern that geriatrics will experience a 1 percent reduction under the new methodology and stated that the transition period is critical, as it will lessen the impact of the proposed reduction. The society suggested that, during the transition period, we should work with stakeholders to explain the new methodology, to identify nonintuitive decreases in payment and to identify better ways to pay for indirect expenses. An association representing nursing facility medical directors expressed concern that the new methodology will reduce the PE RVUs for nearly all codes for nursing facility services. If we proceed with the changes, the PO 00000 Frm 00016 Fmt 4701 Sfmt 4700 association suggested that we provide a more detailed explanation of the new methodology in the final rule, with examples of the PE RVU calculations for specific services under the old and new methods. A consulting company expressed concern that we failed to make needed data available, such as the time file, utilization file and scaling factors and pools file. The commenter also requested that, in the future, we consider making available the same files we use to produce the PE RVUs, the assumptions used, such as crosswalks or projected utilization for new services and the data needed to evaluate the methodology used to go from the survey data to a PE/HR. The American Cancer Society expressed concern regarding the specific reductions in payment for screening mammography, pap smears, pelvic/ breast exams and flexible sigmoidoscopies which could potentially reduce access to cancer screenings. An oncology nursing society strongly urged us to include drug administration services in the phase-in of the new methodology and exempt them from budget neutrality requirements. A cancer and blood disorders center expressed the same concern and stated that this omission would skirt the MMA mandate to exempt from budget neutrality limits any 2006 fee schedule changes to drug administration codes. An association representing medical colleges noted that, together with the negative update, the decrease in revenue across faculty practice groups will exceed ¥6 percent. The association recommended that this warrants further review by the medical community and CMS should make public examples of how the new values were calculated, the actual new PE values for each code, the PE per hour and source of the data for each specialty and the budget neutrality adjuster applied as a final step. A medical technology company requested that we explain how we intend to scale PE when CPT codes, such as endogenous radiofrequency ablation procedures, include a vascular as well as a radiology imaging procedure. The commenter recommended we should calculate the costs according to the primary group furnishing the procedure. In addition, the commenter contended that a deflation factor should not be applied to new procedures that have been valued by the RUC and CMS in late 2004 for establishment of 2005 payment. Following are examples of the comments explicitly requesting delay. E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations A comment from specialty societies representing general surgeons, anesthesiology, ophthalmology, hematology, emergency medicine, neurosurgery, cataract surgery, thoracic surgery, orthopaedic surgery, otolaryngology and hand surgery, supported by a letter from a member of the Congress, stated agreement with our goals for a PE methodology. However, the commenters requested that the implementation of the new methodology and data be delayed for 1 year, citing several concerns: First, commenters claimed that CMS did not provide sufficient data and information or time to allow adequate review of the validity of the new methodology, the supplementary survey data or the proposed impact. As a result, the comment argued that physicians have not had a reasonable opportunity to participate in the rule making process, in compliance with the Administrative Procedure Act. In addition, the comment cited the Practicing Physician Advisory Committee recommendation that we delay implementation of the new data and methodology for 1 year. An oncology society commented that a final decision on the proposed revision to the PE methodology should be deferred 1 year until information is available on how the proposal will affect drug administration services. A large provider of oncology services was also troubled by the decision to exclude drug administration services from revisions to the PE methodology. A psychological association stated that its primary concern is ‘‘the proposed rule’s lack of clarity regarding the impacts that the change in methodology will have on each health care specialty.’’ Because of the lack of this data, the Association requested a 1 year delay for our proposal. A specialty society representing surgeons stated that the proposed methodology apparently created many aberrant PE RVUs and gave examples: Closely related procedures with proposed RVUs that are inconsistent with their actual costs; services that contribute significantly to the increases in volume and intensity noted by MedPAC all receive significant increases; within specialties that should benefit from the higher PE/HR in their surveys, there are increases and decreases that cannot be explained; E/M services will be increased in the office setting, but decreased in the hospital setting. The college recommends that we withdraw the current proposal and republish it in a future PFS rule that includes a detailed description of the methodology. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Two specialty societies representing thoracic and chest physicians expressed concern with the significant shifts in the PE that would necessitate a 4-year transition and suggested that there should be no change in PE until all specialties can complete supplemental PE surveys. A specialty society representing spine surgeons requested that we suspend the proposed PE changes until 2007, not because the methodology is flawed, but in order to allow all physicians an equal opportunity to submit data relevant to their specialties. A specialty society representing anesthesiologists contended that lack of information on data and methodology behind the PE changes requires a delay in implementation. The Society requested that we provide information that clearly breaks out the impact of the proposed changes by specialty on the indirect and direct PE payments. A medical group practice association fully supported the 4-year transition of the new PE values achieved under the new bottom-up calculation. However, because it believed that insufficient information has been made available, the association recommended that we delay implementation until the provider community has time to evaluate the methodology used to recalculate the PE RVUs. The following commenters requested a delay in calculating the PE RVUs for their own specific services under the new methodology. Several comments from a specialty society representing heart rhythm services, two manufacturers and a manufacturers association, as well as a provider of remote cardiac monitoring services expressed concern about the proposed cuts for remote cardiac monitoring services and requested that we not implement these proposed reductions, pending further study. Two societies representing audiology and speech language pathology, supported by a comment from two senators, expressed concern about the large reductions in payment for audiology services and urged us to impose a 1 year moratorium on the proposed reductions for these services so that an equitable methodology for their services can be developed. One commenter suggested that if we do not implement a moratorium on payment decreases for audiology services, we should consider an alternative, such as assigning proxy work RVUs for indirect PE using the otolaryngology PE/HR. The following commenters opposed any delay in implementing our proposed methodology. PO 00000 Frm 00017 Fmt 4701 Sfmt 4700 70131 A gastroenterology association commented that, since all medical specialties had equal opportunity to conduct supplemental PE studies, there should not be a delay in the implementation of our proposed changes. A specialty society representing radiation oncology agreed that more information on the new methodology should be provided, but is opposed to any delay in the implementation of the proposed methodology as the transition provides sufficient opportunity for CMS to provide this information and resolve identified problems. A sonography society commented that we should not delay the implementation of the revised TC component services with a 4-year transition. An alternative to the zero-work pool has been many years in the making and we should fully implement the new values this year. An association representing urology disagrees with a 4-year phase in of the revised PE RVUs and strongly urged us to consider other options that will allow specialties with supplemental survey data to realize the full advantages of applying that data in 2006. The commenter claimed that a transition will allow specialties that did not conduct surveys to unfairly take a portion of the 4-year increases from specialties that did. A specialty society representing allergists expressed concern that the RVUs based on the new accepted data will be phased in over 4 years. The commenter contended that we have not provided any rationale for why we are breaking with past policy or why we have decided to phase-in the specialty survey data. The commenter is concerned in particular about the continued applicability of the old and incorrect scaling factors which result in the discounting of the specialty’s costs. A pharmaceuticals company requested that we consider an immediate 100 percent transition to the 2009 proposed PE values for procedures like photodynamic therapy where access has been constrained due to the use of scaling factors. A society representing family physicians commented that the original legislation mandating resource-based PE was enacted in 1994 and that we delayed the initial implementation by a year before entering a 4-year transition under our current methodology. The commenter therefore encouraged us to shorten or eliminate the transition and finally complete the process of implementing resource-based PE. However a society representing internists supported our proposal to transition PE RVU changes resulting E:\FR\FM\21NOR2.SGM 21NOR2 70132 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations from methodological changes in this proposed rule over a 4-year period. Response: We very much appreciate all the thoughtful and helpful comments we received on our proposal to revise our PE methodology. In addition, we are pleased that so many commenters stated their agreement with the goals that we outlined for our PE methodology in order to implement a payment system for physician and practitioner practice costs that is accurate, understandable, and stable. We also still believe, despite all the concerns pointed out by commenters, that the implementation of a methodology that bases the PE calculations on the latest available data, that uses the PEAC-refined CPEP data to create a bottom-up approach for direct costs and that values all services using the same method will help us achieve those goals. However, based on the comments we received, it appears that our PE proposal was not as clear and intuitive as we had intended. We continue to believe that the proposal for direct costs was straightforward; this proposal would do away with costs pools and scaling factors and merely add up the costs of the PEAC-refined input data assigned to each code to arrive at the direct PE RVUs (pre-PE budget neutrality). We had not anticipated that our indirect PE calculation would create difficulties since we intended that, except for those services for which the acceptance of the new supplementary survey data produced direct increases, to utilize the current indirect PE RVUs to develop the pre-PE budget neutrality indirect PE RVUs for 2006. However, due to an error in our indirect PE program, the indirect costs were not calculated as intended. As a result, almost all of the PE RVUs published in the August 8, 2005 proposed rule were incorrect. Therefore, we are concerned that interested parties were not provided notice of the actual effect of the proposed changes in the PE RVU methodology and were not given the sufficient opportunity to submit meaningful comments on the proposal. As a result, we are withdrawing our entire PE methodology proposal and instead, with only three exceptions, we will use the current 2005 PE RVUs to value all services for CY 2006. First, as we usually do each year, we will value the work and PE on an interim basis for all codes that are new in 2006. Second, as required by section 1848(c)(2)(I) of the Act, we will apply the PE/HR data from the urology supplementary survey to the calculation of the PE RVUs for all the drug administration codes performed by urology. Third, we will apply the savings from the VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 implementation of the multiple procedure payment reduction for certain imaging services across all the PE RVUs that are discussed later in the preamble of this rule. We understand that the withdrawal of this proposal will be welcomed by some and will be a disappointment to others, especially those specialties that undertook PE surveys that are not being used for 2006. We want to work with the medical community beginning now through the next proposed rule to exchange thoughts on all of the issues raised, to answer any questions and to provide additional data and corrected information. We hope to hold meetings on these topics early next year so that we can obtain maximum input from all interested parties to ensure that our next proposal does meet the goals we have set for our PE methodology. Acceptance of Supplementary Surveys for 2006 Comment: Many commenters indicated their strong support for our proposal to accept the PE data from 7 supplementary surveys. Several specialty societies representing radiation therapy expressed approval for the proposal to blend the survey data submitted by ASTRO and AFROC to calculate a revised PE/HR for radiation oncology services. A specialty society representing interventional radiology stated support for the proposed use of the ACR’s supplemental PE data for purposes of PE RVU determination. The ACC is pleased that we proposed to incorporate their supplemental PE survey data submitted for cardiology and other specialties that submitted data consistent with the acceptance criteria. The ACC commented that, given the rigorous and detailed analysis conducted by our contractor, these data are very likely superior to the SMS data that were used to calculate PE RVUs and that our acceptance of the supplemental PE data has been an important component of efforts to refine the resource-based PE RVUs. An echocardiography society and a commenter representing cardiovascular angiography also stated its support for use of the cardiology data. Two societies representing gastroenterology commented that they are pleased with our acceptance of the supplemental PE survey data for gastroenterology. The AUA strongly urged us to finalize our proposal to accept the AUA’s supplemental survey data, as they believe language in the section 303(a)(1)(I) of the MMA requires us to accept supplemental data submitted by urology. In addition, the AUA stated that we are required by the MMA to PO 00000 Frm 00018 Fmt 4701 Sfmt 4700 update the 2006 PE RVUs for urology drug administration, applying the exemption from budget neutrality. A commenter representing prosthetic urology also agreed that we should use the urology supplemental data to allocate the indirect PE costs to each urology procedure. However, other commenters had concerns with the proposal. An otolaryngology specialty society questioned the validity of the dramatic increases in the PE/HR for the specialties that have submitted surveys because this could create a two-tiered system between those specialties that have submitted surveys and those which have not. Therefore, the society recommended that use of this new PE data be delayed until such time as a multispecialty PE survey can be conducted. A comment from an occupational therapy association recognized the need to use SMS aggregate data in the indirect calculations, but questioned the impact on specialties who did not participate in the survey and suggested that the transition period be used to examine the atypical impact of this change. Two thoracic surgery groups commented that the PE fluctuations and disparities caused by the acceptance of these surveys are counter-intuitive and advantage those for whom we have accepted data at the expense of those from whom we have not. The specialty society representing surgeons stated that the dramatic increase in the proposed PE/HR figures could cause significant distortions in the relativity of PE payments across specialties and urged that we delay implementation of the new data until a multi-specialty PE survey, similar to the AMA’s SMS survey can be conducted. However, the society also recommended that we use the urology PE/HR data because it would be required by the MMA. A provider group representing remote cardiac services recommended that we should refrain from incorporating any additional survey data until all supplemental data is submitted. Conversely, a society representing echocardiographers stated that it is crucial for us to use the submitted survey meeting our criteria in order to retain the type of trust necessary for physician specialty groups to conduct this type of survey in the future. The commenters from the gastroenterology groups stated that use of these data should not be transitioned, but should be treated consistently with the manner in which all other supplemental data have been treated. Further, the commenter contended that, even if we agree to a delay in the implementation E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations of our proposed methodology, the accepted supplemental PE/HR data should be implemented immediately for both direct and indirect expenses. Response: We understand the considerable effort, time and money expended by the specialty societies that submitted surveys that met our criteria and are aware that there will be considerable disappointment that the new data will not be used for 2006. We also understand the concern of those specialties that have not undertaken a supplementary survey that now fear that they could be relatively disadvantaged if the accepted surveys are used. We would point out that for the last five years there has been an equal opportunity for all specialties to submit supplementary data and it could be presumed that those specialties that did not avail themselves of the opportunity believed the effort was not worth the probable result. In addition, all specialties had the opportunity to comment on our proposed criteria for acceptance of survey data and the medical community at large did not comment that the criteria needed to be more stringent. However, we will not be using the accepted supplementary data in our indirect PE calculations for 2006, with the exception of the urology PE/HR data that we are applying to the drug administration codes performed by urology as required by section 1848(c)(2)(I) of the Act. We are not using the other accepted supplementary PE data because, as explained above, we are not adopting the proposed changes to our PE methodology, we did not propose to use the survey data for calculating the direct PE RVUs and the use of the survey data would have caused significant changes in the PE RVUs for which there would have been no opportunity for comment. Comment: We also received several comments with specific concerns regarding our handling of the submitted PE survey data. A specialty society representing radiation oncology asserted that the approach to blending survey data has inadvertently lowered the values for certain radiation oncology services by under-weighting the PE expenses for freestanding facilities from the AFROC survey and by overestimating the hours in the denominator of the PE/HR calculation. In addition, three commenters questioned an apparent discrepancy with the PE/HR for radiology, radiation oncology and cardiology recommended by the Lewin Group and the PE/HR in the proposed rule and the subsequent correction notice. The commenters requested a clarification on how we applied the deflators in order to ensure VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 that all specialties submitting surveys were evaluated in the same way. A comment from specialty societies representing most major surgical groups, as well as emergency medicine and anesthesia, contended that over the years we have treated supplemental survey data with different standards and have blended some while not blending others. A medical technology company requested that we explain how the data were evaluated, especially because we did not accept some recommendations presented by the Lewin Group. Response: Because we are not utilizing the new supplementary data for indirect PE calculations for 2006, we plan to discuss all of these issues with the relevant specialties in order to determine if adjustments are needed to our calculations of the PE/HR data. However, we do not believe that we have treated supplemental data with different standards, but would request specific information from the commenters. Currently, we are not using any blended data for any supplementary survey that we have accepted and used. Although we rely heavily on the analysis and evaluation of the survey data done by the Lewin Group, we are responsible for the final decision on whether or not to accept the data from a given survey. The Lewin Group did recommend that we accept the data from the NCQDIS survey, which did not meet our precision criteria, because we currently have no survey data for them. However, we believe that it is more equitable to apply the same standards to all who submit surveys and we proposed not to accept the survey data at this time. Comment: The NCQDIS expressed concern that we did not accept their PE survey data for diagnostic imaging services in IDTFs because the precision criteria was not met. NCQDIS pointed out that the Lewin Group recommended that we accept the data in spite of the precision level because PE data for IDTFs do not currently exist. The commenter stated that, after further analysis of the data, NCQDIS determined that inclusion of one inaccurate record skewed the findings outside the acceptable precision range. Therefore, NCQDIS recommended that we accept the revised analysis from the Lewin Group that includes updated PE information for the record in question and that we allow the updated data to be used in development of PE RVUs for 2006. The NCQDIS recommendation was supported by a comment from a society representing diagnostic medical sonography that contended that no alternative data is available for these PO 00000 Frm 00019 Fmt 4701 Sfmt 4700 70133 entities and the current PE data used understates their PE. Response: There have been further discussions between NCQDIS and our contractor. We will be discussing this with the specialty in order to resolve the issue for a future proposal. Comment: A nuclear medicine society stated that it cannot respond to our use of the radiology and cardiology surveys because it has not seen the data as it relates to nuclear medicine. The commenter requested that we make the nuclear medicine supplementary survey information and impact available. A specialty society representing radiation oncology expressed the belief that the new survey data do not reflect the costs of brachytherapy because providers of this service were not adequately represented in the sample. Response: We would be willing to discuss the societies’ concerns to determine an appropriate resolution. Comment: A long term care association urged us to use the data from the ACR supplementary survey as the PE/HR proxy for the portable x-ray set-up code (Q0092) to prevent inconsistencies in the application of the new payment methodology. Response: We do not believe it would be appropriate to use the same indirect costs associated with a free-standing radiology center, which incurs costs for such requirements as lead shielding and structural reinforcements for heavy equipment, as the costs for setting up a portable x-ray machine. Therefore, we will not apply the data from the radiology supplementary survey to the calculations of the PE RVUs for Q0092. Comment: Because we had proposed to accept the supplementary survey data for radiology, radiation oncology and cardiology, the specialties that make up the bulk of the NPWP, we also proposed eliminating the pool and pricing all of the services in the NPWP under the new proposed PE methodology. We received comments from several organizations including those representing diagnostic sonography, urology, medical physicists, allergy geriatrics and a blood disorder center supporting this proposal. However, the specialty society representing audiology urged that, before we dismantle the protection provided by the NPWP, a reasonable formula should be developed to fairly and adequately reimburse audiologists for their services. The societies representing audiology, speech language pathology and medical nutrition all commented that we should assign work RVUs to their services, rather than treating their professional work as PE. Response: We are pleased that most commenters approved of our proposal to E:\FR\FM\21NOR2.SGM 21NOR2 70134 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations eliminate the NPWP. However, because we will not be using the accepted new supplementary survey data in the calculation of PE RVUs for 2006, we believe it would be more equitable to defer the elimination of the pool as well. Therefore, we will not be implementing this proposal for 2006. This will also give us the additional time to work with audiology and other specialties to ensure that our future proposal will be equitable to all. Because we are maintaining the NPWP for 2006, we are deferring our decision regarding work RVUs for audiology, speech language pathology and medical nutrition pending further discussions with the specialties. Bottom-up for Direct PE Comment: We received many comments on our proposal to value the direct PE for all services by the bottomup method, using the PEAC refined staff, supply and equipment costs associated with each procedure as the basis for calculating the direct PE RVUs. Almost all of these comments favored our proposal to modify our PE methodology. This support was expressed whether the commenter also requested a delay in the implementation of our proposed methodology or recommended immediate implementation with no transitioning of the new PE RVUs. Commenters who were pleased with the resulting PE RVUs and those concerned with specific reductions also showed support. Below are some specific examples of the supporting comments. Two comments from specialty societies representing family physicians and internists agreed that the bottom-up approach will produce a more accurate, intuitive and stable PE methodology. One of the commenters contended that the proposed methodology would be more accurate because the bottom-up methodology assumes that the costs of the clinical labor, supplies and equipment are the same for a given service, regardless of the specialty performing it. A urological association supported switching to a bottom-up methodology for calculating PE RVUs and believed it meets our stated goals of using the most appropriate data, simplifying the PE methodology and increasing the stability of the PE payments. A major oncology center applauded our decision to implement a bottom-up approach because of the inequities that result when PE RVUs are set using a top-down approach which allows the frequent ‘‘leakage’’ of a specialty’s costs to other specialties. This rationale was also stated by a society representing VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 anesthesiologists and by a patient advocate foundation. An oncology nursing society commented it has long advocated a bottom-up modification to help ensure that PE payments reflect the actual relative resources required for each service provided by oncology nurses. An organization representing allergy supported our proposal to change to a bottom-up methodology for determining PE values because this is a more rational approach. This view was shared in a comment from a physical medicine and rehabilitation society, which added that a bottom-up approach would result in a more direct relationship between PE RVUs and direct costs. A spine society commented that it welcomed the change to a ‘‘bottom-up methodology because any movement in the direction of stability and uniformity will have positive effects across providers.’’ A specialty society representing neurology supported the proposed change to a bottom-up methodology for calculating direct costs. The society asserted that the top-down method is flawed as it unfairly raises the expenses for high-end procedures. The commenter also stated that the excellent work of the PEAC, and now the PERC, has produced reliable data for all the codes, making CPEP complete for all the codes and must be given primacy in any method we would chose to implement. Two radiation therapy societies stated their strong support of the proposed bottom-up methodology and the proposed implementation for January 1, 2006. One society commented that eliminating the scaling factors, at least for direct costs, is a step in the right direction toward a simpler and more transparent PE methodology. A respiratory care association stated support for our proposed bottom-up approach because this methodology would minimize aberrations that might inadvertently appear in the calculations, providing a more accurate representation of direct PE incurred by pulmonary physicians. A psychological association commented that the refinements approved by the PEAC may allow CMS to utilize a more simplified PE methodology which will make PE more understandable. An organization representing radiology contended that using the bottom-up methodology seems to be a simpler and easier way to make the transition with minimal impact. A medical sonography society stated that our efforts to help ensure a more accurate payment for healthcare services PO 00000 Frm 00020 Fmt 4701 Sfmt 4700 and create more year-to-year stability are to be commended. An occupational therapy association and a physical therapy association both agreed that the bottom-up method would be a preferable methodology. First, because it would rely on actual inputs from the specialties providing each service and second because it would create a more stable and predictable system and would reflect the actual relative resources required for each service. A specialty society representing hematology agreed that the top-down method for calculating the direct PE is extremely complex and not at all intuitive and stated that the bottom-up method will simplify the system and reduce the complexity of the calculations. Other organizations that supported the adoption of the bottom-up approach to valuing direct costs included specialty societies representing podiatry, prosthetic urology, geriatrics, infectious diseases, chest physicians, a pharmaceutical company, and medical group practices. Response: We are very pleased that so many in the medical community approve of the concept of using a bottom-up methodology to value the direct PE RVUs. We believe, along with these commenters, that the use of the bottom-up approach in the future would allow us to calculate more accurately the relative direct costs for each service in the PFS. The bottom-up approach would be simple to understand—we merely sum the costs of the PEACrefined clinical staff, supply and equipment inputs that are assigned to each service. The bottom-up approach would be intuitive—any change in direct inputs would lead to a commensurate change in the direct PE RVUs. The bottom-up methodology should also be more stable—with no cost pools or scaling factors to complicate the computation, direct PE RVUs for a service would only change if there was a revision to the inputs assigned. It was the hard work put forth by the AMA, the PEAC, the RUC and specialty societies in refining the CPEP inputs that made it possible to propose using a bottom-up methodology. However, for reasons discussed in this section, we are not implementing the bottom-up methodology for direct costs for 2006. However, we will be working with the RUC and the medical community to ensure that the inputs assigned to each service are correct and that the overall methodology works as intended so that we can propose this improvement in the future. E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations Comment: Several commenters expressed concern regarding the future refinement of the direct PE inputs that would ensure that a bottom-up methodology continues to lead to appropriate PE RVUs. A radiation oncology specialty society recommended that the bottom-up methodology be reviewed to ensure that the full input amounts are recognized accurately. A specialty society representing podiatry commented that the codes refined in the early stages of the PEAC may have inputs not consistent with codes refined later and that they should be looked at again by PEAC or PERC. The specialty society representing allergy suggested that there needs to be a continuing mechanism, such as the PEAC and PERC, for addressing changes in PE. A physical medicine society asserted that it is essential that we establish a system for updating or revising direct cost inputs based on new data or changes in technology. A thoracic medicine society supported the bottom-up methodology for creating direct PE inputs with continued refinement by the PEAC or the PERC. A pharmaceutical company supported the bottom-up method of determining the relative direct costs of each service, but requested that we establish a system to accept and review external data during the notice and comment period to update the direct cost inputs as needed. A specialty society representing prosthetic urology recommended that we adopt the bottomup method and establish a method to review external data to ensure that the inputs are updated appropriately. Response: We agree with the commenters that there needs to be a continuing review process for the direct PE inputs to reflect changes in practice or new technology. In addition, it will be necessary to ensure that the clinical staff time standards and supply and equipment packages that have been developed through the refinement process are applied appropriately to all services. We are hopeful that the RUC will continue to play a role in this further review and will be discussing this with RUC staff. In addition, we will continue to encourage input from the medical community in general regarding the accuracy of the direct inputs and their pricing. Comment: There were a few specific concerns raised by commenters regarding the bottom-up methodology. A specialty society representing radiation oncology stated that the bottom-up methodology may be unintentionally compressing higher-cost technology. A health care provider supported the bottom-up approach VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 conceptually, but expressed concerns that aggregate budget neutrality would be more difficult to control using a bottom-up approach than using the topdown. A medical group practice association, as well as a large multispecialty clinic, had concerns that the RUC recommendations we have accepted for new technical procedures have, because of budget neutrality, eroded the value attributed to cognitive services. MedPAC had concerns about dealing with overvalued services and with the assumptions we use to allocate the cost of equipment to a specific service. For example, MedPAC questioned whether our assumption of 50 percent utilization for all equipment is valid. Response: We are not sure how the bottom-up methodology would compress higher cost technology, but would be willing to discuss this with the commenter as we develop our next proposal. For budget neutrality, we are not certain that it is harder to control under a bottom-up approach; it would depend on which data source—the aggregate SMS-type data or the PEACrefined input data—produces the most accurate estimate of direct costs. We understand, in a budget neutral system, the concern about the effect that adding inputs for expensive technology has on cognitive services, but under a bottomup methodology there would not be the issue of scaling factors exaggerating this effect. We would like very much to discuss the issue raised by MedPAC as we endeavor to improve our PE methodology. Future Indirect PE Refinement Comment: Although we did not propose any major change to the indirect PE methodology, other than incorporating the new PE survey data, we did indicate our interest in receiving suggestions on ways to continue to refine the indirect PE calculations. Most commenters focused on the need for us to acquire up-to-date survey information for all specialties so that the PE data for all specialties is as current as possible. Specialty societies representing infectious disease physicians, orthopaedists, remote cardiac services, chest physicians and physical medicine commented that we should extend the deadline to allow specialty societies to conduct supplemental PE surveys. A commenter representing otolaryngologists stated this would not be a preferred option since the high cost involved with conducting surveys would disadvantage smaller specialties. Other specialty societies representing cataract surgeons, anesthesiologists, emergency medicine and otolaryngology PO 00000 Frm 00021 Fmt 4701 Sfmt 4700 70135 recommended that an unbiased SMStype survey that cuts across all specialties would be most appropriate for use in the future, instead of having data from different time periods. In arguing for this multi-specialty approach, an emergency medicine association commented that, as MedPAC reports have indicated, only specialty societies who are likely to gain ground have incentive to produce new surveys. The specialty society representing otolaryngology cited the discussion in the Lewin Group report, ‘‘Recommendations Regarding Supplemental Practice Expense Data Submitted for 2006,’’ that suggests that the increase in the surveyed PE/HR could indicate a ‘‘secular trend in rising physician PEs,’’ and the need for a multi-specialty PE survey. The commenter also suggested that a universal survey could be paid for by using funds reallocated from the oncology demonstration. A specialty society representing spine surgeons commented that all physicians should have the opportunity to submit data relevant to their specialties because it would be unfair to reduce PE reimbursement for providers such as neurosurgeons and orthopedic surgeons without allowing those providers that opportunity to submit accurate data. The society suggested that, as we have established a model for survey data, we could allow societies to survey their membership and submit the results, either directly to CMS or through the RUC. An association representing medical group practices recommended that a comprehensive study be initiated to accurately balance the relativity of overhead costs of practice for each service on a nationwide basis and that this include the costs of information technology (IT) implementation. An emergency medicine commenter recommended including survey questions on uncompensated care. Response: We agree with all the commenters that, for the PE RVUs to reflect accurately the relative indirect costs for all services, it would be most preferable to have current data for all specialties. However, section 212 of the BBRA required that we establish a process to use data developed by entities and organizations to supplement the data we normally collect in determining the PE component. We established this process and set criteria and a timeline for submission of this data. Although we twice extended the period during which we would accept these supplemental data, we are not proposing to extend this period beyond this year. We believe E:\FR\FM\21NOR2.SGM 21NOR2 70136 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations that there has been sufficient time for individual specialties that had sufficient member support to do a survey, and that had reason to believe that the results of a survey would be helpful, to submit supplementary PE data to us. Therefore, we agree with the commenters who suggest that a multi-specialty survey done for a uniform time period would be most helpful. We are now planning to work with the AMA and the medical community to develop a strategy for funding and fielding a multi-specialty indirect PE survey that will help ensure that our PE methodology treats all specialties equitably. Comment: Several commenters offered the following suggestions for revisions to the indirect methodology. Comments from two associations representing speech language pathologists and audiologists argued that the current method of assigning indirect costs to their services results in a gross underestimation of these costs for both audiology and speech-language pathology services. One association suggested an alternative method of basing indirect costs on the ratio of the refined direct costs to the total costs for all physicians or for otolaryngologists. A specialty society representing allergy expressed concern that the indirect costs of an allergy practice are not properly accounted for in the current methodology because most either are not assigned work RVUs or have very low work RVUs, but may have high actual indirect costs. The society recommended that we should either establish a mechanism for adjusting the indirect PE when the existing formula yields an inequitable result, or revise the direct costs to include administrative staff time. A comment from a manufacturer stated that we should not use the ‘‘All Physician’’ indirect cost data for IDTFs and recommended using the radiology PE/HR figure for IDTF radiological services and the cardiology PE/HR for IDTF cardiology services, with the exception of the cardiac remote monitoring services which should be paid at current levels, pending the collection of additional data. A comment from a clinical oncology society recommended that any revision in the methodology for direct costs should be accompanied by a revision in the methodology for allocating indirect costs. The society stated that both the Lewin Group and the Government Accountability Office have found that the current methodology for indirect costs is biased against services that lack a physician work component. A family physician association questioned why we use physician work, VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 rather than physician time, in our formula for allocating indirect expenses. The commenter stated that there is no evidence that PE would vary with physician intensity and recommended that we use physician time rather than work in the allocation of indirect expenses. A group representing cardiac services providers recommended that if and when the new methodology is applied to remote cardiac monitoring, indirect costs for these services should be based on a survey of their group and not on the ‘‘All Physician’’ average PE/HR, which fails to reflect the actual practice costs incurred. The group also recommended that we allocated indirect costs solely on the basis of direct costs, without regard to physician work. Response: We thank all the above commenters for their suggestions on improvements to our indirect PE methodology. We will certainly consider all of the above recommendations, as we work with the medical community to develop our next proposal for indirect PE. Comment: The American College of Surgeons recommends that we convene a multi-stakeholder process to address indirect PE methodological issues so that we can make further changes before final implementation of our new methodology. Response: As we have mentioned previously, we agree wholeheartedly with the above recommendation. We plan to initiate an open process with the medical community to exchange ideas, answer questions and provide information regarding changes to all aspects of our PE methodology before publication of the next PFS proposed rule. We recognize that in any payment system based on costs, indirect costs are always the most difficult to allocate fairly and accurately. Therefore, we will welcome all suggestions, including those recommended, to improve our indirect PE methodology. Other Issues Comment: A group representing community cancer centers requested that we review the PE RVUs for drug administration services as soon as the needed data are available to ensure that they accurately reflect all the costs associated with these services. The National Patient Advocate Foundation agreed because of concern that use of the current indirect PE RVUs will not be sufficient to reimburse oncologists for drug administration costs. Response: We should have the utilization data needed for the 2006 proposed rule and plan to include the PO 00000 Frm 00022 Fmt 4701 Sfmt 4700 drug administration services in whatever PE methodology is proposed. Comment: Several commenters recommended that we maintain budget neutrality for PE RVU changes by adjusting the CF proportionately, rather than decreasing only PE RVUs. Response: Though there could be operational difficulties with adjusting the CF to account for PE budget neutrality, we would like to solicit comments on how best to reflect the budget neutrality for PE. 3. PE Recommendations on CPEP Inputs for CY 2006 Since 1999, the PEAC, an advisory committee of the AMA’s RUC, provided us with recommendations for refining the direct PE inputs (clinical staff, supplies, and equipment) for existing CPT codes. The PEAC held its last meeting in March 2004 and the AMA established a new committee, the PERC, to assist the RUC in recommending PE inputs. With the PERC’s assistance, the RUC completed refinement of approximately 200 remaining codes at its meetings held in September 2004 and February 2005. A list of these codes appeared in Addendum C of proposed rule. We reviewed the RUC-submitted PE recommendations and proposed to adopt nearly all of them. We worked with the AMA staff to correct any typographical errors and to make certain that the recommendations are in line with previously accepted standards. As stated in the proposed rule, we revised the PE database to reflect these RUC recommendations which can be found on our web site. (See the ‘‘Supplementary Information’’ section of this rule for directions on accessing our web site.) We disagreed with the RUC’s recommendation for clinical labor time for CPT code 36522, Extracorporeal Photopheresis. In the CY 2005 final rule (69 FR 66236), we assigned, on an interim basis, 223 minutes of total clinical labor for the service period based on the typical treatment time of approximately 4 hours. The RUC, however, recommended 122 minutes total clinical labor time for the service period, which allowed for 90 minutes of nurse ‘‘intra service’’ time for the performance of the procedure (the society originally proposed 180 minutes). We believe that 135 minutes is a more appropriate estimation of the clinical staff time actually needed for the intra time, as it more closely approximates the time assigned to the other procedures in this family of codes, including CPT codes 36514, 36515, and 36516. Therefore, we proposed a total E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations clinical labor time of 167 minutes for the service period. We did not receive specific comments for this revision and are finalizing this change to the clinical labor time. While we have made the change in the PE database, the PE RVUs for 2006 will not reflect the adjustment due to the decision concerning the PE methodology to maintain all PE RVUs at the 2005 level as discussed previously. The RUC also recommended that no inputs be assigned to several codes because the services were not performed in the office setting. However, our utilization data shows that 4 of these codes (CPT codes 15852, 76975, 78350, and 86585) are currently priced in the office and are performed with sufficient frequency in the office to warrant this. Therefore, we proposed not to accept the RUC recommendations for these services at this time, but requested comments from the relevant specialties as to whether the recommendations should be accepted. Comment: We received comments from one specialty society disagreeing with the RUC’s recommendation for CPT 78350, single photon bone densitometry, as they believe this procedure is being performed in the office. They expressed their intentions to work with CMS as they develop appropriate PE inputs for this procedure in the nonfacility setting. The specialty society also expressed their agreement with the RUC’s recommendation to eliminate the nonfacility PE RVUs for 76975 because virtually all of these exams are performed in the facility setting. In addition, a national organization representing medical directors of respiratory care, supported the retention of nonfacility PE RVUs for CPT 86585, TB tine test, because they believe it to be a legitimate office-based procedure. We did not receive comments on the appropriateness of nonfacility RVUs for CPT 15852. Response: We will maintain the nonfacility setting PE RVUs for 78350 and look forward to working with the specialty society in their initiative to develop inputs for this procedure. We will remove the PE inputs for the nonfacility setting for CPT codes 76976 and 15852, although for the 2006 PFS these codes will reflect the 2005 PE RVU amounts. CPT 86585 has been deleted from CPT 2006 and will not appear on Addendum B. 4. Payment for Splint and Cast Supplies In the Physician Fee Schedule (CY 2000); Payment Policies and Relative Value Unit Adjustment final rule, published November 2, 1999 (64 FR 59379) and the Physician Fee Schedule (CY 2002); Payment Policies and VerDate Aug<31>2005 15:52 Nov 18, 2005 Jkt 208001 Relative Value Units Five-Year Review and Adjustments final rule, published November 1, 2000 (66 FR 55245), we removed cast and splint supplies from the PE database for the CPT codes for fracture management and cast/strapping application procedures. Because casting supplies could be separately billed using Healthcare Common Procedure Coding System (HCPCS) codes that were established for payment of these supplies under section 1861(s)(5) of the Act, we did not want to make duplicate payment under the PFS for these items. However, in limiting payment of these supplies to the HCPCS codes Q4001 through Q4051, we unintentionally prohibited remuneration for these supplies when they are not used for reduction of a fracture or dislocation, but rather, are provided (and covered) as incident to a physician’s service under section 1861(s)(2)(A) of the Act. Because these casting supplies are covered in sections 1861(s)(5) or 1861(s)(2)(A) of the Act, we proposed to eliminate the separate HCPCS codes for these casting supplies and to again include these supplies in the PE database. This would allow for payment for these supplies whether based on section 1861(s)(5) or 1861(s)(2)(A) of the Act, while ensuring that no duplicate payments are made. In addition, by bundling the cost of the cast and splint supplies into the PE component of the applicable procedure codes under the PFS, physicians would no longer need to bill Q-codes in addition to the procedure codes to be paid for these materials. Because these supplies were removed from the PE database prior to the refinement of these services by the PEAC, we proposed to add back the original CPEP supply data for casts and splints to each applicable CPT code and we requested that the relevant medical societies review the ‘‘Direct Practice Expense Inputs’’ on our web site and provide us with feedback regarding the appropriateness of the type and amount of casting and splinting supplies. We also requested specific information about the amount of casting supplies needed for the 10-day and 90-day global procedures, because these supplies may not be required at each follow-up visit; therefore, the number of follow-up visits may not reflect the typical number of cast changes required for each service. We reincorporated the following cast and splint supplies as direct inputs: fiberglass roll, 3 inch and 4 inch; cast padding, 4 inch; webril (now designated as cast padding, 3 inch); cast shoe; stockingnet/stockinette, 4 inch and 6 inch; dome paste bandage; cast sole; elastoplast roll; fiberglass splint; ace PO 00000 Frm 00023 Fmt 4701 Sfmt 4700 70137 wrap, 6 inch; and kerlix (now designated as bandage, kerlix, sterile, 4.5 inch) and malleable arch bars. The cast and splint supplies were added, where applicable, to the following CPT codes: 23500 through 23680, 24500 through 24685, 25500 through 25695, 26600 through 26785, 27500 through 27566, 27750 through 27848, 28400 through 28675, and 29000 through 29750. Because we proposed to pay for splint and cast through the PE component of the PFS, we would no longer make separate payment for these items using the HCPCS Q-codes. Comment: We received a comment on behalf of the American Osteopathic Academy of Orthopedics (AOAO) that provided specific information for the type and number of casts needed for the 10 or 90-day global period for each code in the relevant fracture management series. The AOAO also noted the type and amount of casting supplies, including stockinette, cast padding, fiberglass and post-op cast shoe, as appropriate. We also received a comment from the RUC expressing their appreciation for the proposal to make coding and billing for fracture management and casting/ strapping supplies easier by reducing the number of codes for physicians to submit. In addition, the RUC expressed interest in reviewing the data submitted in response to our proposal so that the resulting casts and strapping PE inputs can ‘‘enjoy the same level of scrutiny and cross-specialty refinement that all of the other PE inputs have’’. Other specialty societies supported our proposal to include casting material in the fracture care codes and the elimination of the Q codes. However, some of these societies expressed concerns about bundling all of the necessary casting/strapping supplies for the global period into the fracture management codes. These commenters related that only the initial cast/ strapping supplies should be bundled into the relevant fracture care code series and that physicians should be able to continue to submit separate claims for the CPT codes for the application of casts and strapping procedures during the global period. Many commenters, primarily from orthopedic practices, expressed concern about the proposal, but misunderstood that this proposal was separate from the anticipated negative update for 2006 based on the SGR methodology. Response: We thank AOAO for submitting the information we requested in the proposed rule. The society submitted a clear, E:\FR\FM\21NOR2.SGM 21NOR2 70138 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations comprehensive and beautifully prepared spreadsheet detailing each CPT code in the various fracture management series. We commend them on their efforts to submit such a thorough and meticulous document in response to our proposed rule request. For the 2006 fee schedule, based on the decision concerning PE methodology to maintain all PE RVUs at the 2005 level previously discussed, we have removed the CPEP inputs for casts and splints from the PE database and CMS will retain use of the Q-code fee schedule as done in the past. In addition, we will use the interim time period before the notice of proposed rulemaking for the 2007 fee schedule to work with the affected specialties and the RUC to clarify issues related to Medicare payment policy and establish more appropriate amounts of casting/ strapping materials for the relevant series of fracture management codes and the casts and strapping application codes. Due to the temporary status and intended limited use of the Q-code fee schedule, it is our intention to resolve these important payment issues in the near future. A detailed discussion of the SGR and the update for 2006 is found later in this final rule with comment. 5. Miscellaneous PE Issues In this section, we discuss our specific proposals related to PE inputs. a. Supply Items for CPT Code 95015 We proposed to change the supply inputs for CPT code 95015, intracutaneous (intradermal) tests, sequential and incremental, with drugs, biologicals or venoms, immediate type reaction, specify number of tests, based on comments received from the JCAAI. JCAAI reported that ‘‘venom’’ is the most typical test substance used when performing this service and that ‘‘antigen’’, currently listed in the PE database, is never used. They also suggested that the appropriate venom quantity should be 0.3 ml (instead of the 0.1 ml listed for CY 2005) because of the necessity to use all 5 venoms (honey bee, yellow jacket, yellow hornet, white face hornet and wasp) to perform this sensitivity testing; that is, 1 ml of each venom type for a total of 5 ml of venom. The diluted venoms are sequentially administered until sensitivity is shown, beginning with the lowest concentration of venom and subsequently administering increasing concentrations of each venom. We accepted the specialty’s argument and proposed to change the test substance in CPT code 95015 to venom, at $10.70 (from single antigen, at $5.18) and the quantity to 0.3 ml (from 0.1 ml). VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Comment: JCAAI expressed their appreciation for our proposal to change the supply item input for CPT 95015 from 0.1 ml antigen to .3 ml of venom. Response: The appropriate changes have been made to our PE database. However, as discussed above, because we are making only limited, necessary changes to PE RVUs for the 2006 PFS, the PE RVUs for this code will continue to reflect the 2005 PE RVU amounts. b. Flow Cytometry Services In the CY 2005 final rule (69 FR 66236), we solicited comments on the interim RVUs and PE inputs for new and revised codes, including flow cytometry services. Based on comments received and additional discussions with representatives from the society representing independent laboratories, we proposed to revise the PE inputs for the flow cytometry CPT codes 88184 and 88185. Based on information from the specialty society, we proposed to change the direct inputs used for PE as follows: • Clinical Labor: Change the staff type in the service (intra) period in both CPT codes 88184 and 88185 to cytotechnologist, at $0.45 per minute (currently lab technician, at $0.33 per minute). • Supplies: Change the antibody cost for both CPT codes 88184 and 88185 to $8.50 (from $3.544). • Equipment: Add a computer, printer, slide strainer, biohazard hood, and FACS wash assistant to CPT code 88184. Add a computer and printer to the equipment for CPT code 88185. Comment: We received comments from several organizations including those representing professional services in clinical laboratories, manufacturers, clinical laboratories, and clinical pathologists. These commenters all supported our proposal to revise the PE inputs outlined above for the flow cytometry CPT codes 88184 and 88185. Response: We appreciate the support extended to us by these national organizations in regards to the revision of direct inputs for the CPT codes for flow cytometry. The PE changes have been made, as indicated above, to the database. However, because we are making only limited, necessary changes to PE RVUs for the 2006 PFS, the PE RVUs for these codes will continue to reflect the 2005 PE RVU amounts. c. Low Osmolar Contrast Media (LOCM) and High Osmolar Contrast Media (HOCM) HOCM and LOCM are used to enhance images produced by various types of diagnostic radiological PO 00000 Frm 00024 Fmt 4701 Sfmt 4700 procedures. In the CY 2005 final rule (69 FR 66356), we eliminated the criteria for the payment of LOCM that had been included at § 414.38. Effective April 1, 2005, providers can receive separate payment for LOCM when used with procedures requiring contrast media through the use of separate Qcodes. Payment for HOCM is currently included as part of the PE component under the PFS. We proposed, effective January 1, 2006, to no longer include payment for HOCM under the PFS and to establish Q-codes for the separate payment of HOCM. As noted in the proposed rule we reviewed the PE database and proposed to remove the following two supply items which we have identified as HOCM from the PE database: • Conray inj. iothalamate 43 percent(supply item #SH026, deleted from 64 procedures). • Diatrizoate sodium 50 percent (supply item #SH0238, deleted from 74 procedures). We also identified 5 CPT codes (specifically CPT codes 42550, 70370, 93508, 93510 and 93526) that included omnipaque as a supply item, and proposed to remove this supply item from these 5 CPT codes since omnipaque is actually a type of LOCM. Comment: We received several comments from organizations representing radiology physicians and manufacturers on our proposal to delete HOCM from the PE database. The commenters supported our proposal for separate payment for both HOCM and LOCM to ensure beneficiaries access to all the various types of medical imagining contrast media. The commenter representing the manufacturers requested that we notify carriers that separate payment for LOCM and HOCM is available. Response: We thank the organizations for their comments in support of our proposal which would permit separate payment for HOCM in 2006. We have removed HOCM from the direct inputs in the PE database and also deleted LOCM from the 5 procedures as noted above. However, because we are not implementing the bottom-up methodology which utilizes the direct inputs to determine the PE RVUs, these imaging codes will again be valued in the NPWP where the PE RVUs are established using an appropriate crosswalked charge-based RVU containing HOCM as an inherent supply cost. We will delay separate payment for HOCM until such time the direct inputs are used to determine PE RVUs. For 2006, the PE RVUs will be retained at the 2005 level. We remind the commenters that the average sales price E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations (ASP) quarterly values are published on our Web site at the following address: https://www.cms.hhs.gov/providers/ drugs/asp.asp. d. Imaging Rooms We include standardized ‘‘rooms’’ for certain services in our PE equipment database, rather than listing each item separately. We received pricing information from the ACR for the following rooms that are included in the database. We accepted most of the proposed items that met the $500 threshold for equipment and proposed to include the items in each specific room, as follows: • Basic Radiology Room: $127,750 (xray machine @ $125,550 and camera @ $2,200). The recommended viewbox was not included because most codes assigned this room have also been assigned an alternator (automated film viewer) or a 4-panel viewbox. • Radiographic-Flouroscopic Room: $367,664 (Radiographic machine @ $365,464 and camera @ $2,200). The recommended viewbox was not included because most codes assigned this room have also been assigned an alternator (automated film viewer) or a 4-panel viewbox. • Mammography Room: $168,214 (mammography unit @ $124,900; reporting system @ $16,690; mammography phantom @ $674; densitometer @ $3,660; sensitometer @ $2,750; desktop PC for monitoring @ $1,840; and processor @ $17,700. Separately listed equipment items (densitometer, mammography reporting system, sensitometer, mammography phantom, desktop computer, and the film processor) that duplicated items included in the mammography room were removed from the codes assigned the room, eliminating the reporting system, sensitometer and phantom from the PE database. • Computed tomography (CT) Room: $1,284,000 (16-slice CT scanner with power injector and monitoring system) • Magnetic Resonance Imaging (MRI) Room: $1,605,000 (1.5T MR scanner with power injector and monitoring system) Comment: We received comments from one specialty society requesting that we add 4 cassettes to the composition and cost of the mammography room although each cassette does not meet the $500 equipment threshold. Another commenter representing a large radiology group practice agreed that our cost allowance for the mammography room was appropriate for the standard analog mammography room. However, VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 this commenter asked us to develop a separately identified cost for a digital mammography room, costing approximately 3 to 4 times as much as the analog room, citing this digital system provides better diagnostic services. Response: We appreciate the comments regarding the cost and composition of the mammography room. We are sympathetic to the commenter’s request for the creation of a separate digital mammography room. However, the direct PE inputs for labor, supplies and equipment that are included in physicians’ services reflect the costs involved in the typical procedure or service provided in the nonfacility setting. We believe that the mammography room we proposed represents the equipment used to provide the typical mammography service and was based on information provided by the specialty society. We disagree with the specialty society in regards to adding the cost of the 4 cassettes to the room’s price. The threshold for the inclusion of equipment for PE purposes remains at $500. For this reason, we will finalize the value of the mammography room as proposed, at $168,214. In addition we will finalize the proposed values for all of the above imaging rooms in this final rule with comment. However, because we are adopting only limited, necessary changes to PE RVUs for CY 2006, and will continue to utilize the NPWP to value these services, the RVUs will remain the same as those for 2005. e. Equipment Pricing for Select Services and Procedures From the CY 2005 Final Rule (69 FR 66236) In the August 8, 2005 proposed rule, we presented information on pricing of equipment for select services and procedures based on specialty information and stated we would be accepting the prices. The specific equipment was as follows: • Equipment pricing for certain radiology services received from the ACR were presented in table 15 of the proposed rule. • Equipment pricing on the Ultrasound color Doppler transducers and vaginal probe received from the American College of Obstetrics and Gynecology was presented. • For CPT 36522, extracorporeal photopheresis, we discussed equipment pricing information specific to this procedure. • Pricing of EMG botox machine used in CPT code 92265 as presented by the American Academy of Ophthalmology. PO 00000 Frm 00025 Fmt 4701 Sfmt 4700 70139 No comments were received on these items, therefore, the prices discussed in the proposed rule will be used in the PE database. However, we will continue to use the 2005 PE RVUs for each of these codes for CY 2006. f. Supply Item for In Situ Hybridization Codes (CPT 88365, 88367, and 88368) As discussed in the August 8, 2005 proposed rule, we received comments in response to the CY 2005 final rule from the College of American Pathologists regarding the number of DNA probes assigned to the in situ hybridization codes, CPT codes 88365, 88367, and 88368. Currently, CPT codes 88365 and 88368 have 1.5 probes assigned, while CPT code 88367 has only 0.75 of a probe assigned. The College of American Pathologists requested that we assign 1.5 probes to CPT code 88367, and provided justification for this request. We accepted the College of American Pathologists’ rationale and proposed to change the probe quantity for CPT code 88367 to 1.5. Comment: A society representing clinical pathologists supports the proposed change to the probe quantity for CPT 88367. Response: We have entered the number of probes, at 1.5, to our PE database. This change will not be expressed in the 2006 PE RVUs because as discussed above, we will retain the 2005 PE RVUs. g. Supply Item for Percutaneous Vertebroplasty Procedures (CPT Codes 22520 and 22525) The Society for Interventional Radiology (SIR) provided us with documentation for the price of the vertebroplasty kit used in CPT codes 22520 and 22525. We proposed to accept a new price of $696 for this supply, currently listed as $660.50, a placeholder price from the CY 2005 final rule. Comment: Commenters supported the proposed $696 cost estimate for the vertebroplasty kit. Response: We are finalizing our proposal to value the vertebroplasty kit price at $696 in the supply database, although, as discussed previously, this will not be reflected in the 2006 PE RVUs because we will retain the 2005 PE RVUs. h. Clinical Labor for G-codes Related to Home Health and Hospice Physician Supervision, Certification and Recertification As discussed in the August 8, 2005 PFS proposed rule, 4 G-codes related to home health and hospice physician supervision, certification and E:\FR\FM\21NOR2.SGM 21NOR2 70140 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations recertification, G0179, 180, 181, and 182, are incorrectly valued for clinical labor. These codes are cross-walked from CPT codes 99375 and 99378, which underwent PEAC refinement in January 2003 for the 2004 fee schedule. However, we did not apply the new refinements to these specific G-codes. This was an oversight on our part and we proposed to revise the PE database to reflect the new values in the 2006 physician fee schedule. Comment: Commenters, including those representing the specialty societies for home care physicians and internists, expressed concern about the decrease in PE RVUs for the G-codes for hospice and home health supervision and care plan oversight services. One commenter requested that we elaborate on the sequence of events that lead to this decrease. Response: We appreciate the concern expressed by the commenters and are providing additional information outlining the reason for this change. For the 2001 PFS, these G-codes were created in order to provide payment for these specific services. Changes made to the CPT codes (CPT codes 99375 and 99378) for 2001 did not enable us to recognize the CPT codes for Medicare payment purposes. Therefore, the PE inputs that had been applied to these CPT codes were cross-walked and used to establish the PE RVUS for the G codes that we established for these services. Subsequent to this, the CPT codes underwent refinement by the PEAC at its January 2003 meeting where a majority of the other E/M services were refined. CMS accepted these PE recommendations from the PEAC that included only a total of 36 minutes for clinical labor. The PEAC recommendations did not include supplies and equipment because they did not believe these were utilized in the typical services represented by these codes. These PE inputs were intended to be crosswalked to the G-codes for 2004, however, due to an oversight, this did not occur. We apologize to the specialties that this refinement was not done in a timely manner. Thus, we are finalizing the direct inputs for these Gcodes in this rule and have changed the PE database accordingly. However in 2006, the PE RVUs for these 4 G-codes will remain at the 2005 level, as explained above. i. Programmers for Implantable Neurostimulators and Intrathecal Drug Infusion Pumps Subsequent to the CY 2005 final rule, we received comments from a manufacturer of programmers for implantable neurostimulators and VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 intrathecal drug infusion pumps. The commenter indicated that the equipment costs for these programmers are not a direct expense for the physicians performing the programming of these devices and that the manufacturer furnishes these devices without cost because the programming device is considered a ‘‘necessary, ancillary item to the neurostimulator and drug pump and can only be used to program these devices.’’ Therefore, we proposed to remove the 2 programmers from the PE database: EQ208 for medication pump from 2 codes (CPT 62367 and 62368) and EQ209 for the neurostimulator from 8 codes (CPT 95970–97979). We also requested comments from the specialty societies performing these services as to whether this reflects typical practice. Comment: Several commenters disagreed with this proposal indicating that not all programmers are provided without cost. Specifically, for the one manufacturer, the practice of providing physicians with these programmers free of charge is just a recent occurrence. In addition, one commenter informed us that there are other PE items that are not accounted for, including a printer, for 62367 and 62368. The RUC commented that several specialty societies conducted an email-based survey finding that the majority of the respondents reported paying for these programmers. The RUC asked us to reconsider our decision to delete the programmers from the PE direct inputs because it was based solely on the recommendation of one manufacturer. Response: We are sympathetic to the commenters’ concerns about the programmers used by pain medicine physicians. We have carefully reviewed our decision to delete the programmers from the PE database in light of the comments we received. Therefore, based on the uncertainty as to which brand product is typical, the survey results presented to us by the RUC, and the life, 7 years, of each programmer, we have determined that we will retain these programmers in the database. In addition, we have added ‘‘with printer’’ to the description of EQ208 to match that of EQ209 in order to assuage the commenter’s concern that the price listed in the database, $1975, correctly reflects the cost of both the programmer and the printer. Because the PE RVUs for 2005 contained the price for these programmers, the PE RVUs for 2006 will continue to reflect their costs. j. Pricing of New Supply and Equipment Items As part of the CY 2005 final rule process, we reviewed and updated the PO 00000 Frm 00026 Fmt 4701 Sfmt 4700 prices for equipment items in our PE database and assigned a unique identifier to each equipment item with the first 2 elements corresponding to one of 7 categories. It was brought to our attention that we assigned the same category identifier (ELXXX) for both ‘‘lanes/rooms’’ as well as ‘‘laboratory equipment’’. To correct this, we proposed assigning laboratory equipment items the new category identifier ‘‘EPXXX’’, but the specific numbers associated with each item would remain the same. In addition, supply items were reviewed and updated in the rulemaking process for the 2004 PFS. During subsequent meetings of both the PEAC (now referred to as the PERC) and the RUC, supply and equipment items were added that were not included in the pricing updates. In the proposed rule we included 2 tables (Table 16: Proposed Practice Expense Supply Items and Table 17: Proposed Practice Expense Equipment Items) that listed the additional supply and equipment items for 2006 and the proposed associated prices that we would use in the PE calculation. The listing of new supplies and equipment in the proposed rule does not guarantee that the price listed for each item has been accepted. Rather, the new supply and equipment tables are to make specialties aware of the descriptors and assigned supply or equipment codes that can be used in future proposals to the RUC and HCPAC. As discussed below, the addition of an item to the tables for new supplies or equipment does not preclude the inclusion of the same item on the tables that require more detailed information and documentation from the specialty organization. k. Supply and Equipment Items Needing Specialty Input We also identified certain supply and equipment items for which we were unable to verify the pricing information, reflected in Table 18: Supply Items Needing Specialty Input for Pricing and Table 19: Equipment Items Needing Specialty Input for Pricing of the proposed rule. We stated that the items listed in these tables represent the outstanding items from last year and new items added from the RUC recommendations. Therefore, we requested that commenters, particularly specialty organizations, provide pricing information on items in these tables along with documentation to support the recommended price. Tables 14 and 15 reflect the comments and documentation we received for each item. Specialty societies are asked to review these supplies and equipment, as E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations appropriate, to assure that the item status is accurate and forward any necessary documentation. We would also like to reinforce the types of documents that meet the acceptable category. The following list includes examples of acceptable documentation: • Photocopy or actual vendor catalog listing, indicating price, accessories or components (if applicable), available quantity, company name, brand name, and catalog date. Scanned versions, if readable, can also be emailed. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 • Photocopy of web page with specific supply or equipment including the necessary information listed in above bullet. • Photocopy of invoice indicating the price paid for specific supply or equipment, as well as the specific contents of kit, pack or tray for supplies and component or accessory parts for the equipment item. • Letter, FAX or e-mail from manufacturer, vendor or distributor noting the ASP of the supply or PO 00000 Frm 00027 Fmt 4701 Sfmt 4700 70141 equipment. The description of the item must list all contents, accessories or component parts that are included in the price. The following information is not considered acceptable documentation, including: • Web site addresses. • Vendor, manufacturer, or distributor phone number and address. • Approximated values. BILLING CODE 4121–01–U E:\FR\FM\21NOR2.SGM 21NOR2 VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00028 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.006</GPH> 70142 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00029 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70143 ER21NO05.007</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00030 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.008</GPH> 70144 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00031 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70145 ER21NO05.009</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00032 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.010</GPH> 70146 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70147 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00033 Fmt 4701 Sfmt 4700 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.011</GPH> BILLING CODE 4120–01–C 70148 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations l. Additional PE Issues Raised by Commenters Comment: We received a comment from an equipment distributor and multiple comments from physicians asking us to add more clinical labor, supplies and equipment to CPT codes 78481 and 78483 for cardiac blood pool imaging using the first pass technique. The commenters emphasized that the labor costs are understated, and that additional supplies and equipment are necessary to perform these services. In particular, the commenters requested we add a nuclear medicine gamma camera to the equipment inputs or cross-walk the equipment listed for CPT 78465. The distributor presented supply and equipment tables for both codes, using direct PE inputs currently listed in the PE database, most of these are found in the PE for CPT 78465. Response: The direct inputs for these ‘‘First Pass’’ services were presented by the specialty society to the PEAC at its January 2004 meeting. The RUC forwarded the PEAC’s recommendations to CMS for consideration during the rulemaking process for the 2004 fee schedule at which time these recommendations were accepted. We do not believe that we are in a position to make the type of changes to the PE inputs for these 2 codes that the commenters have requested. We recommend that the commenters and the specialty society whose members perform these procedures, work together so that necessary changes can be considered through the usual RUC process. Comment: We received comments from a specialty society and a manufacturer asking us to replace a supply item, a Tesio type dual catheter, with the Lifesite system in CPT 36566— a procedure described as the insertion of tunneled catheter with subcutaneous port(s). The specialty society explained that when the RUC valued this service in 2003, the incorrect catheter was included with their PE recommendations. The manufacturer asks for our assistance in correcting a ‘‘clerical error’’ in our database. The commenters explain that CPT codes 36565 and CPT 36566 are nearly identical in procedure, although CPT 36566 requires the insertion of ‘‘subcutaneous port(s)’’ and that the Tesio-type catheter, priced at $355, is currently listed for both of these procedures. The Lifesite system, containing a subcutaneous port, is priced at $1750. Both commenters noted that 2 Lifesite systems are necessary to perform this procedure instead of one for a total supply cost of $3500. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Response: We appreciate the commenters concerns about the specific supplies they believe are needed to perform this service. The work and PE values for CPT 36566 were forwarded by the RUC and accepted in our final rule, for the 2004 fee schedule. We believe that the RUC is the appropriate avenue to address correction of inputs to the PE database, particularly due to the expensive nature of this replacement, and are not revising the PE database to reflect this price change. Comment: A specialty society commented that it believes the nonfacility PE RVUs were mistakenly deleted from CPT codes 59812, 59840, and 59841. The specialty also requested that nonfacility PE RVUs be added for CPT 58558. Response: We have reviewed the specialty’s request regarding nonfacility PE RVUs for the 4 codes noted above. The ‘‘NA’’ indicator for PE RVUs in the nonfacility setting is listed incorrectly for CPT codes 59840 and 59841 in Addendum B of our proposed rule. Both of these CPT codes should have PE RVUs listed in the nonfacility setting. The specialty society is mistaken, however, regarding the appropriateness of nonfacility PE RVUs for CPT 59812 and 58558. These codes have both undergone refinement by the PEAC at least once and the recommendations forwarded by the RUC clearly indicated that these procedures were not valued in the nonfacilty setting. We have changed our database, as appropriate, to reflect the changes for CPT 59840 and 59812. Comment: We received comments from a specialty organization citing that the total RVUs for CPT 19298 are too low in comparison to those for CPT 19296—both new CPT codes for CY 2005. The specialty believes this difference is likely due to the supply PE inputs necessary to perform each procedure. The specialty states that the catheter supply expenses should be similar between the 2 services, yet the nonfacility PE RVUs for CPT 19298 (39.56) are significantly lower than those listed for CPT 19296 (117.96). The specialty stated that while the average number of catheters used for CPT 19298 is 25, ranging from 15–30, this cost should be comparable to the catheter required for CPT 19296. Finally, the specialty requests that we crosswalk the total RVUs for the nonfacility setting from CPT 19296 to CPT 19298 for 2006 while they gather detailed information to present to us. Response: We have researched the specialty’s concern about the supply cost differences between the 2 new CPT codes for 2005. Whereas the specialty PO 00000 Frm 00034 Fmt 4701 Sfmt 4700 contends that the catheter expenses are similar, or only somewhat greater for CPT 19296, we found that the differences between these 2 supply costs is significant. The mammosite tray, containing the catheter used for CPT 19296, is priced at $2,550 while the button-end implant catheters used for CPT 19298 are priced at $18.50 each. The PE database indicates that the RUCrecommended typical procedure would require 30 such catheters, opposed to 25 noted by the specialty, for a total cost of $555. Consequently, we will not change the PE RVUs for either procedure, although we remain puzzled as to the commenters’ specific concerns. We look forward to the specialty’s clarification regarding this issue and would urge them to address their concerns through the usual RUC process. We would also like to remind commenters that interim RVUs are published, for new and revised CPT codes, in our final rule each year and are subject to a 60-day comment period at that time. We encourage commenters to observe and utilize the respective comment periods during our annual rulemaking process in order that we may respond timely to issues and concerns. Comment: We received many comments regarding the use of ‘‘NA’’ in Addendum B when used for the ‘‘Nonfacility PE RVUs’’ column, the ‘‘Facility PE RVUs’’ column, and the occasional code with NA noted in both PE RVU columns. These commenters asked us to provide a clear definition of how the service is paid when the NA is affixed to either PE RVU column in Addendum B which our rule for 2005 fee schedule had PE RVUs listed for the nonfacility. One commenter stated that private payors believe that payment is not made when the NA indicator is listed in Addendum B. Response: We appreciate the commenters remarks regarding the uncertainty involved with interpreting Addendum B, particular regarding the use of the ‘‘NA’’ indicator for the PE RVUs nonfacility and facility columns. Due to the confusion expressed by the commenters surrounding the NA designations, we have added explanations to Addendum A in order to assist the readers of Addendum B. We are also including these definitions here because of this issue’s importance. The following 2 explanations also appear in Addendum A of this rule: • An ‘‘NA’’ in the ‘‘Non-facility PE RVUs’’ column of Addendum B means that CMS has not developed a PE RVU in the nonfacility setting for the service because it is typically performed in the hospital (that is, for example, an open heart surgery is generally performed in E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations the hospital setting and not a physician’s office). • Services that have an ‘‘NA’’ in the ‘‘Facility PE RVUs’’ column of Addendum B are typically not paid using the PFS when provided in a facility setting. These services (which include ‘‘incident to’’ services and the technical portion of a diagnostic tests) are generally paid under either the outpatient hospital prospective payment system or bundled into the hospital inpatient prospective payment system payment. Comment: Other commenters, including specialty organizations, device manufacturers and physicians, noted that CMS had either mistakenly removed PE RVUs in the nonfacility setting or that we had made a decision to stop paying for services where, in Addendum B, an ‘‘NA’’ appeared in the proposed rule in the PE RVUs nonfacility column. Another commenter believes that a series of codes for E/M services were incorrectly marked as ‘‘NA’’ in the facility setting. These commenters requested that the PE RVUs be restored to these codes. Response: We apologize to those commenters who found that where, due to the use of a new PE methodology, some of the codes listed in Addendum B of the proposed rule were mistakenly marked with an ‘‘NA’’ in either the nonfacility or facility PE RVU column when the service is actually valued in this setting and PE RVUs were listed previously. These mistakes were corrected for Addendum B in this final rule with comment. Most of the commenters requesting the restoration of ‘‘missing’’ PE RVUs in the nonfacility setting, though, were mistaken because, in fact, we have not developed nonfacility PE RVUs for these services and Addendum B continues to properly reflect the ‘‘NA’’ for the nonfacility PE RVU column. Comment: Several commenters asked us to create PE RVUs for their services by cross-walking the direct inputs from other services. Response: All of the requests we received to establish PE RVUs in the nonfacility setting were for services that the PEAC/RUC had either refined or developed without recommendations for PE nonfacility inputs. We would like to remind the specialty organizations that the RUC has a long standing process for the establishment and refinement of PE inputs and encourage all organizations to follow this process. Comment: A manufacturer requested that we add 15 minutes of clinical labor and a tilt table to the PE database for CPT codes 36475 and 36476—both new codes for CPT 2005. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Response: We agree that the tilt table, for Trendelenberg, is needed for these procedures and are adding this equipment, for the respective service period minutes for each code. However, the commenter’s request for additional clinical labor is not timely because the RVUs for these new codes were published as interim in the CY 2005 PFS final rule with comment at that time. As stated in the response above, we remind commenters to observe and utilize the comment period for new and revised codes at the time they are issued in our final rule or utilize the established RUC process, as appropriate. Comment: We received a comment from an organization representing radiation oncology informing us that equipment for CPT codes 77333 and 77470 was missing. Response: For CPT 77470, we disagree with the commenter that this service should be assigned equipment. At the January 2004 PEAC meeting, this code was valued specifically to compensate for the clinical labor costs involved with certain high-intensity radiation procedures, such as combined chemotherapy and radiation treatment. CPT 77470 was valued to be billed once throughout the course of treatment, that is typically comprised of 25 fractions. On the other hand, we agree with the commenter that the lack of equipment for CPT codes 77333 and CPT 77332 appears to be an oversight. We believe that the PEAC, at their September 2002 meeting, when considering equipment inputs for CPT code 77334, intended to cross-walk this equipment to the other 2 codes in the family, CPT code 77332 and 77333. Therefore, we are adding this equipment to 77332 and 77333, on an interim basis, and have changed the PE database to reflect this addition for the correlating service period time for each service. However, as explained above, because these codes will be valued in the NPWP and the 2005 PE RVUs will be retained in 2006, this addition will be transparent until such time as the direct inputs are used to establish the PE RVUs for the NPWP services. Comment: We received comments from several organizations, a specialty society, device manufacturers, IDTFs and physicians regarding concerns about the remote cardiac event monitoring services, including CPT codes 93012, 93226, 93232, 93271, 93733 and 93736, based on the significant reduction in PE RVUs for these services published in our proposed rule using the bottom-up methodology and the elimination of the NPWP. Two of these services, CPT codes 93012 and 90271, were reviewed PO 00000 Frm 00035 Fmt 4701 Sfmt 4700 70149 by the RUC in April 2005 and forwarded as part of the PERC/RUC recommendations in the proposed rule. The commenters noted that these services are typically provided by IDTFs that are equipped for continuous monitoring capabilities 24 hours a day, 7 days a week and require highly trained staff to perform the monitoring of transmissions. The commenters all agreed that the uniqueness of these services makes a poor fit with the usual accounting for direct practice expenses in the physician office. A specialty society requested CMS to work with the involved provider community, that is, the specialty IDTFs, to ensure that the direct and indirect costs of providing these services are adequately reflected in the nonfacility PE RVUs. Response: We are pleased that the commenters are in agreement that these cardiac event monitoring services may not fit the usual PE model. We are also happy that the specialty society has requested our assistance to work with the specialized provider community in order to ensure more appropriate PE inputs for these services. We look forward to working with the provider organizations before the issuance of our next proposed rule. Comment: A manufacturer requested that we increase the work and PE values for G0166, external counterpulsation (ECP), because of the significant decrease in PE RVUs for the nonfacility setting in the proposed rule. Specifically, the commenter asked that the labor time be increased to include pre and post service time in addition to the 60 minutes allotted for actual ECP treatment time. Response: We agree with the commenter that the 60 minutes is inadequate to account for the other activities that the RN performs in relationship to each ECP service. We have assigned some of the standardized times for the activities previously identified by the PEAC as appropriate to this service, as follows: 3 minutes for meet and greet; 2 minutes to prepare the room; 2 minutes to position the patient; 3 minutes for vitals; and 3 minutes for cleaning the room. This extra 13 minutes has been added to the service period in the PE database yielding a total of 73 minutes for the ECP service— although, as discussed previously, this increase will not take effect in 2006 because, with limited exceptions, we will retain the 2005 PE RVU values for existing codes. Comment: Many commenters, including physicians and a device manufacturer, requested that we increase labor, supplies, and equipment PE values for CPT code 93701, thoracic E:\FR\FM\21NOR2.SGM 21NOR2 70150 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations electrical bioimpedance (TEB). Their concerns arose from the proposed reduction in PE RVUs in the proposed rule for this service. Some of the commenters told us that the average cost of the equipment from one manufacturer is $38,000, the electrodes are 10.95 ($8.95 with discount) and that the labor time for the TEB procedure ranges from 15–20 minutes. The commenters requested that we adjust the PE values accordingly. Response: We are sympathetic to the commenters concerns regarding the decrease in PE RVUs reflected in the proposed rule that reflected both the elimination of the NPWP and the bottom-up methodology. For the labor time request, the PE database does contain 20 minutes, although this time was incorrectly cross-walked to the equipment time. We apologize to the commenters regarding this error, and have changed the equipment time to 20 minutes, from 10, in the database. We disagree with the commenters about the inaccuracy of the equipment cost. During the rulemaking process for the CY 2005 fee schedule, at which time we revalued all equipment in the PE database, we identified 2 different brands of equipment used for the TEB service. When the 2 prices are averaged (using $38,000 as noted above by the commenters), the cost of the TEB equipment is $28,625 which is the price listed in the database. We also repriced our supply database during rulemaking for the 2004 fee schedule. The TEB electrodes or sensors are listed at $9.95 in the database and that amount is based solely on a phone quote from the commenting manufacturer. TEB sensors from the other equipment manufacturer range from $4.43 to $6.00 for each patient application. Based on current valuation of the supplies and equipment in the PE database, we are not changing the price of equipment or supplies for the TEB service. m. Additional PE Issues Raised by Commenters Comment: We received 2 comments from specialty organizations requesting CMS to re-evaluate the lack of physician work value for the 3 G-codes (G0237, G0238, and G0239) CMS created to describe services to improve respiratory function to reflect the physician’s work in overseeing these incident to services. The commenters contend that the addition of CPT 99755, assistive technology assessment, in 2004 created a rank-order anomaly for the respiratory function G-codes. The commenters requested that CMS ask the RUC to evaluate the work for these G-codes. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Response: We disagree with the commenter’s contention that a rank order anomaly exists between the respiratory function G-codes and CPT 97755. We were clear when we created these codes during rulemaking for the 2002 fee schedule that the G-codes would make billing of CPT codes 97000–97799 inappropriate for professionals involved in treating respiratory conditions, unless these services are delivered by physical therapists (PTs) and occupational therapists (OTs) and meet other requirements for physical and occupational therapy services. We also disagree that these services are always provided incident to a physician’s service because in the CORF setting, where respiratory therapy services are statutorily delineated as a CORF service, the physician’s direct supervision is not a requirement and the incident to provisions do not apply. The G-codes enable us to distinguish CORF respiratory therapy and incident to services from the services provided by PTs and OTs under the therapy benefit. Consequently, these G-codes cannot be used to bill for services provided under the physical and occupational benefit category at section 1861(P) of the Act and, as such, cannot create a rank order anomaly with the 97000 series of CPT codes. Although we have not assigned any work values for this final rule with comment, we are still considering the merits of this request and are happy to meet with the commenters prior to the issuance of our next proposed rule to discuss this issue in greater detail. We remind the specialty societies that they can make requests to the RUC to review the G-codes with respect to work values. However, we believe the appropriate review entity would be the HCPAC. Comment: Several commenters expressed their concern regarding the high-priced supply items in our practice expense database. In their comments, the RUC requested that we consider a different approach for payment of highpriced disposable medical supplies, particularly with respect to new technology supply items—where prices commonly decrease within 6–12 months after being distributed into a wider market—as these services move into the physician’s office. As an alternative, the RUC strongly encourages CMS to review and re-price medical supplies, priced at or above $200, on an annual basis. Another commenter noted that our listed price of $677 for the endovenous laser kit used for CPT 36478 is apparently in error because it is readily available at $250–$350 and listed four PO 00000 Frm 00036 Fmt 4701 Sfmt 4700 suppliers who distribute this supply in the noted price range. Response: We appreciate comments and remarks. The RUC’s comments regarding high cost medical supplies and the need to review these prices on a more frequent basis than every 5 years. Because we are committed to ensuring that the prices for supplies and equipment in the PE database are accurate, we also want to account in some way for the volatile nature of prices for new technology. We will consider options for revaluing these high cost ‘‘new tech’’ supply items and include a discussion of this issue in the next proposed rule Comment: We received a comment from an organization representing services of audiologists noting that the salary for audiologists and the equipment for their services are too low or out of date. Response: During the rulemaking process for the 2005 fee schedule, we revalued all equipment in the PE database, and requested specialty input at that time. To the extent that there have been changes since last year, we recommend that the organization utilize the establish RUC process. We would also encourage the commenter to supply us with updated salary information so that we may better address their other concern. Revisions to CPT Code Series 21076 Through 21087 We also want to note that, at the request of the RUC, we have been working directly with representatives of maxillofacial prosthetics to refine the PE inputs for the CPT code series 21076 through 21087. They have submitted spreadsheets to us for labor, supplies and equipment, and much of this information has been entered in the PE database although, as discussed above, the 2005 PE RVUs will be retained for 2006. We will continue to work with the specialty to refine these inputs, verifying prices and quantities, prior to the issuance of our next proposed rule. B. Geographic Practice Cost Indices (GPCIs) Section 1848(e)(1)(A) of the Act requires us to develop separate GPCIs to measure resource cost differences among localities compared to the national average for each of the three fee schedule components. While requiring that the PE and malpractice GPCIs reflect the full relative cost differences, section 1848(e)(1)(A)(iii) of the Act requires that the physician work GPCIs reflect only one-quarter of the relative cost differences compared to the national average. E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations As discussed in the August 8, 2005 proposed rule (70 FR 45783), section 1848(e)(1)(E) of the Act, as amended by section 412 of the MMA, established a floor of 1.0 for the work GPCI for any locality where the GPCI would otherwise fall below 1.0. This 1.0 work GPCI floor was used for purposes of payment for services furnished on or after January 1, 2004 and before January 1, 2007. This 1.0 floor will remain in effect in 2006. Section 602 of the MMA added section 1848(e)(1)(G) of the Act, which sets a floor of 1.67 for the work, PE, and malpractice GPCIs for services furnished in Alaska between January 1, 2004 and December 31, 2005 for any locality where the GPCI would otherwise fall below 1.67. Effective January 1, 2006, this provision will end. In the proposed rule, we indicated the 2006 GPCIs for Alaska will be 1.017 for physician work, 1.103 for PE, and 1.029 for malpractice. Payment Localities In the August 8, 2005 proposed rule (70 FR 45783), we stated that we look for the support of a State medical society as the impetus for changes to existing payment localities. Because the GPCIs for each locality are calculated using the average of the county-specific data from all of the counties in the locality, removing high-cost counties from a locality will result in lower GPCIs for the remaining counties. Because of this redistributive impact, we have refrained, in the past, from making changes to payment localities unless the State medical association provides evidence that any proposed change has Statewide support. After the publication of the CY 2005 final rule, the California Medical Association (CMA) submitted a proposal for a demonstration project that was the same as its proposal submitted in response to the August 5, 2004 PFS proposed rule. The CMS proposed removing ten counties from the existing ‘‘Rest of California’’ payment locality and creating ten new payment localities. Additionally, reductions to the payments to the Rest of California locality, would be balanced by payment contributions from the other payment localities in the State. There were several aspects of the proposal that made implementation problematic for us under our demonstration authority. For example, physicians whose payments would decrease under the demonstration could challenge the validity of a new locality configuration established without providing them the opportunity to comment through the regulatory process (as is our normal process for making VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 locality changes). In particular, physicians who are not members of county medical societies or the CMA, or did not agree to participate in the proposed demonstration may have challenged its implementation. Also, the Medicare PFS currently uses identical GPCIs to pay for services provided in an area by both physicians and nonphysician providers (such as podiatrists, optometrists, physical therapists, and nurse practitioner). Changing the locality configuration for medical doctors and doctors of osteopathic medicine, but not for other professionals, would have some peculiar results that were not addressed in the CMA proposal. For example, in areas where the GPCIs would be reduced under the demonstration, some practitioners not participating under the demonstration (such as physical therapists) could be paid more than physicians in the same locality. Conversely, where the GPCIs would be increased under the demonstration, there would likely be complaints from the nonphysician practitioners not included in the demonstration. Nonetheless, we do recognize the potential impact of wide variations in the practice costs within a single payment locality. In the CY 2005 final rule, we noted that we received many comments from physicians and individuals in Santa Cruz County expressing the opinion that Santa Cruz County should be removed from the Rest of California payment locality and placed in its own payment locality. The county-specific GAF of Santa Cruz County is 10 percent higher than the Rest of California locality GAF. Santa Cruz County is adjacent to Santa Clara County and San Mateo County. Santa Clara and San Mateo Counties have two of the highest GAFs in the nation. The published 2006 GAF for the Rest of California payment locality is 24 percent less than the GAFs of Santa Clara and San Mateo. Sonoma County is also part of the Rest of California payment locality. The county-specific GAF of Sonoma County is 8 percent higher than the Rest of California locality GAF. Sonoma County is bordered by Marin County and Napa County. Using published 2006 values, the payment locality that includes Marin and Napa counties has the fourth highest GAF in the nation, and is 13 percent higher than the GAF of the Rest of California payment locality. We recognize that changing demographics over time may lead to significant payment disparities in particular circumstances. We rely upon State medical societies to identify and propose consensus approaches to PO 00000 Frm 00037 Fmt 4701 Sfmt 4700 70151 resolving these disparities, because there are redistributive impacts in the ‘‘budget neutral’’ process within a State when new localities are created (or existing ones reconfigured). Yet we also recognize our responsibility for establishing fee schedule areas. In the proposed rule, to assure the maximum opportunity for public discussion and comment to identify a consensus approach, we listed alternative locality configurations that we had examined, including: • The CMA demonstration approach comparing county-specific GAFs to the payment locality GAF, and designating any county with a county-specific GAF at least 5 percent higher than its locality GAF as a new locality; • An approach that sorts counties by descending GAFs and compares the highest county to the second highest county. If the difference between these two counties is 5 percent or less, they are included in the same locality. The third highest county GAF is then compared to the highest county GAF and so on, until the next county GAF is not within 5 percent of the highest county GAF. At that point, the county GAF that is more than 5 percent lower than the highest county GAF becomes the comparison for the next lowest county GAF, to create a second locality. This process is repeated down throughout all of the counties; • An approach that compares the county with the highest GAF to the Statewide average, removing counties that are 5 percent or more than the Statewide average; and • An approach that bases GPCI payment localities on Metropolitan Statistical Areas as defined by the Office of Management and Budget. However, because these reconfigurations would result in significant redistributions across most California counties, we simply proposed the approach that would have the least impact on other counties. We proposed that Santa Cruz and Sonoma Counties (the two counties with the most significant disparity between the assigned Rest of California GAF and the county-specific GAF) be removed from the Rest of California payment locality and that each would be its own payment locality. We invited and received comments regarding this proposal and possible alternative approaches to address this issue. We were particularly interested in whether the CMA supported this approach. Those comments and our responses are discussed below. The issue of payment locality designation in light of changing economic and population trends will be E:\FR\FM\21NOR2.SGM 21NOR2 70152 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations of importance to us for the foreseeable future. We also indicated in the proposed rule that we are interested in other solutions to the problem, and with any ideas or suggestions that will help resolve the problems associated with the designation and revision of payment localities. We would use those ideas and suggestions in developing any future proposal that would be subject to comment through the rulemaking process. Comment: Numerous comments from the beneficiaries and health care providers in Santa Cruz and Sonoma Counties, and from several members of the Congress, including a U.S. Senator from California, supported our proposed change. These comments focused on the high costs of practicing in Santa Cruz and Sonoma Counties and were appreciative of the proposal. Most supporters referred to studies that have shown the high costs of working in Santa Cruz and Sonoma Counties have resulted in physicians restricting their practices or withdrawing from practice altogether. According to the commenters, this has made it more difficult for Medicare beneficiaries to find doctors in those counties. These commenters feel that our proposed change will encourage physicians to continue to treat Medicare patients in their Santa Cruz and Sonoma County practices. Response: These two counties currently have the most significant disparities between their present GAFs and their county-specific GAFs. They are also bordered by counties with significantly higher GAFs. As we stated earlier in this section and in the proposed rule, we have received many comments in the past expressing concern that these disparities have led some practitioners to relocate their practices out of these counties, creating potential access problems. The proposal was an attempt to balance the interests of physicians and nonphysician practitioners and their patients in Santa Cruz and Sonoma Counties with the interests of providers and patients in the other counties in the Rest of California. We noted in the proposed rule that the 2006 Rest of California GAF would be 1.011, compared to the 2005 GAF of 1.012. Absent this proposal, the 2006 Rest of California GAF would be 1.017 (2006 is the second year of the transition to the new GPCIs and GAFs incorporating updated data). Comment: We also received comments opposing the proposal from numerous providers and medical associations in the current Rest of California payment locality. In addition, VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 several members of the Congress wrote letters opposing the proposed change. The CMA pointed to the fact, which is the result of the budget neutrality requirement for administrative actions to modify GPCIs, that the Rest of California locality would be negatively impacted. The CMA also notes that the proposal does not address the other localities it identified in its demonstration proposal. These views were echoed by the other commenters objecting to the proposal. Response: It is indicative of the difficult nature of this issue that many of the same commenters who expressed disappointment that our proposal did not address all of the other counties that CMA identified in its demonstration proposal were also concerned that the proposal would simultaneously result in a reduction of the GPCIs for the Rest of California payment locality. Under our current statutory authority, it is well known that changes to the payment localities must be implemented in a budget neutral manner. Therefore, it is not possible to fully meet both objectives without legislation to provide additional funding for physician payments in California. While we appreciate the situation of practitioners in Santa Cruz and Sonoma Counties as described above, we also acknowledge the concerns of those in the Rest of California payment locality about the negative payment impact of removing the GPCI data for Santa Cruz and Sonoma Counties, and the lack of support from the CMA for an administrative solution to these payment concerns. As we mentioned earlier in this section, our proposal was designed to balance these two interests. As we have stated repeatedly in the past, we believe payment locality reconfigurations should be supported broadly across the State. It was our belief that the proposal we presented, which actually would have had the smallest possible negative impact on the Rest of California’s GAF, might meet that criterion. However, based on the comments we received opposing the proposal, particularly those from the CMA, it is apparent that this proposed change is not acceptable to the majority of commenters at this time. Comment: The CMA indicated that it supports a nationwide legislative solution that would provide additional funding for physicians in counties adversely affected by locality reconfigurations. The CMA states ‘‘this is the only GPCI solution that we are supporting at this time.’’ The Medicare Payment Advisory Commission (MedPAC) comments that the locality boundaries have not had a PO 00000 Frm 00038 Fmt 4701 Sfmt 4700 complete review since 1997 and that economic and population trends are likely to have changed since that time. MedPAC is studying these issues, and encourages CMS to do so as well, with the goal of revisiting the boundaries of all payment localities nationwide. We also received a comment from a member of the Congress urging us to conduct a national examination of the definitions of payment localities. The commenter recommended that we propose a method to reconfigure payment localities to be effective January 1, 2008. The commenter also recommended that we develop a process for periodically reviewing payment localities. Response: As we stated earlier in this section and in the proposed rule, we are interested in all ideas that will help resolve the problems associated with the designation and revision of payment localities. Clearly, as illustrated by the situation discussed earlier in this section, one of the most significant issues to be addressed is the redistributive nature of changes to the payment localities in a budget neutral context. There are currently 89 separate payment localities. Of these, 34 are Statewide localities. Our last comprehensive evaluation of the definition and composition of the payment localities was discussed in the July 2, 1996 proposed rule (61 FR 34615) and the November 22, 1996 final rule (61 FR 59494). The localities existing at that time, which were developed by the local Medicare contractors, served as building blocks for the current localities (at the time, there were 210 separate localities, 22 of them were Statewide localities). We stated at the time that our major goals were to simplify payment areas and payment differences among adjacent geographic areas while maintaining accuracy in tracking input price differences among areas. There is an inherent trade-off between these two goals. Thus, at one extreme is a set of Statewide localities with no intra-state geographic adjustments; very simple, but less descriptive of input price differences. At the other extreme is a separate locality for each county; maximum input price adjustment for geographic variation, but operationally very cumbersome, expensive to develop and maintain, and potentially very confusing for providers. We do not disagree with the view that a comprehensive evaluation of the current payment localities is due, and we look forward to working cooperatively with MedPAC in that regard. We are examining all viable E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations options that will meet the general objectives discussed above. We would note, however, that our goals for this analysis are very similar to those we expressed in 1996. Comment: A private insurer is opposed to our proposal because it increases the number of payment localities which increases commercial payer administrative costs. The insurer suggests we reduce the number of California payment localities from 10 to 3. Response: While we appreciate and, as a matter of general policy, agree that it would be preferable to minimize the number of separate payment localities wherever possible, we do not believe that reducing the number of payment localities would resolve the issues discussed above. Comment: We received comments from a medical clinic in Wisconsin and a research and management organization in Colorado. These commenters stated that CMS is using improper data to create the GPCIs. The commenters suggest we change the wage proxy categories to include physicians and remove physician work from the GPCI calculation. They further state that ‘‘Medicare payments are a primary stimulus in attracting greater numbers of physicians to high payment localities’’. The commenters also suggest we look for alternative data sources for rent data. Response: The CY 2005 final rule contained responses to commenters raising the same issues related to the data used to calculate the GPCIs as those noted above (69 FR 66260). Because the data used to calculate the GPCIs was not part of the proposed rule, we refer the commenter to that document rather than repeat that discussion here. We also note that we continue to evaluate other potential sources of data to use to calculate the GPCIs. We are disappointed that there was limited support for the proposal to create new, separate payment localities for Santa Cruz and Sonoma Counties. As we noted above, the proposal was designed to balance concerns of practitioners in higher-cost Santa Cruz and Sonoma Counties with the concerns of those in the Rest of California payment locality about the negative payment impact resulting from removal of the GPCI data for Santa Cruz and Sonoma counties from the Rest of California GPCI calculation. Because of the nearly complete lack of support for this proposal outside the two positively impacted counties, we have decided to withdraw this proposal at this time. As noted above, we intend to work with MedPAC and other interested parties toward a more comprehensive VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 evaluation of potential refinements of the payment localities. Under section 1848(e)(1)(E) of the Act, the floor of 1.67 for the work, PE, and malpractice GPCIs for services furnished in Alaska ends as of January 1, 2006. Therefore, as of that date, the GPCIs for Alaska will be 1.017 for physician work, 1.103 for PE, and 1.029 for malpractice costs. C. Malpractice Relative Value Units (RVUs) We discussed several proposed technical changes and other issues related to the calculation of the malpractice RVUs in the proposed rule. These are summarized below, along with discussions of the comments we received and our responses. 1. Five Percent Specialty Threshold We are concerned that the malpractice RVUs could be inappropriately inflated or deflated due to irregular data based upon incorrectly reported specialty classifications and have examined the impact of establishing a minimum percentage threshold for any procedure performed by any specialty before the risk factor of that specialty is included in the malpractice RVU calculation of a particular code. We proposed excluding data for any specialty that performs less than 5 percent of a particular service or procedure from the malpractice RVU calculation for that service or procedure and discussed the code-specific impact of implementing this proposed threshold. Our assumption was that the infrequent instances of these specialties in our data represent aberrant occurrences and removing the associated risk factor from the malpractice RVU calculation would improve the accuracy and stability of the RVUs. This was based on our belief that removing data attributable to specialties that occur in our data less than 5 percent of the time would most appropriately balance the objective to identify irregular data (claims with a specialty identified that is highly unlikely to have performed a particular procedure) while including specialties that perform a procedure a small percentage (but at least 5 percent)of the time. We excluded evaluation and management (E&M) services from the analysis. Medicare claims data show that E&M services are performed by virtually all physician specialties. Therefore, in the case of E&M codes, it is likely that even the low relative percentages of performance by some specialties would accurately represent the provision of the service by those specialties. PO 00000 Frm 00039 Fmt 4701 Sfmt 4700 70153 For all services other than E&M services, we stated our belief that removing data attributable to specialties that occur in our data less than 5 percent of the time would most appropriately balance the objective to identify irregular data (claims with a specialty identified that is highly unlikely to have performed a particular procedure) while including specialties that perform a procedure a small percentage of the time. The higher the threshold, the more likely it would result in the removal of data for specialties actually performing the procedure, while a lower threshold would be more likely to fail to remove some irregular data, particularly for lowvolume codes (fewer than 100 occurrences, where each claim represents 1 or more percentage points). The overall impact of removing the risk factor for specialties that occur less than 5 percent of the time in our data for a procedure is minimal. There is no impact on the malpractice RVUs for over 5,280 codes, and there is an impact of less than 1 percent on the malpractice RVUs for over 1,300 additional codes. Only 16 codes decrease by at least 0.1 RVUs, with the biggest decrease being a negative 0.28 impact on the malpractice RVU for CPT code 17108, Destruction of skin lesions, from a current RVU of 0.82 to a proposed RVU of 0.54. Conversely, there are 219 codes for which RVUs increase by at least 0.1, the largest increase being a positive 0.81 RVU increase for CPT code 61583, Craniofacial approach, skull, from a current RVU of 8.32 to a proposed RVU of 9.13. Among codes whose malpractice RVUs would increase under our proposal, 646 have increases of less than 1 percent. The impact analysis section of this proposed rule examines the effects of this proposed change by specialty. Comment: Numerous commenters supported the 5 percent specialty threshold. Several commenters suggested that we apply the threshold to the E&M codes. Response: We appreciate the commenters’ support of this change to our methodology. Regarding the exclusion of E&M codes from our analysis, we note our rationale as stated above in this section. The comments we received did not address our concern that all specialties use these codes. Therefore, we still believe it is appropriate not to apply the 5 percent specialty threshold to the E&M codes. Comment: We received a comment recommending the threshold be lowered to 1 percent. The commenter is concerned that a 5 percent threshold inappropriately removes some E:\FR\FM\21NOR2.SGM 21NOR2 70154 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations specialties actually performing interventional radiology services. The example of CPT code 35476 (percutaneous venous angioplasty) was provided. The commenter noted that CMS’s proposed 5 percent threshold removed the risk factors for general surgeons and vascular surgeons, resulting in a decrease in the malpractice RVUs for this code. The commenter states this was contrary to our objective to remove irregular data because both of these specialties actually perform this procedure, and that a 1 percent threshold would better retain those specialties actually providing the service while still removing irregular data. Response: In the case of CPT code 35476, the risk factors for the two specialties that were removed resulted in a decrease in the RVUs for this code; however, we review these data on a regular basis and if, in the future, the data support it, we will change the RVUs accordingly. We note that the majority of commenters supported a 5 percent threshold as reasonable. We do not believe a 1 percent threshold, as suggested by the commenter, is reasonable as this threshold would not be an effective screen for claims with a specialty identified that is highly unlikely to have performed a particular procedure. However, we will continue to assess whether a different threshold may ensure irregular data are removed without also removing data for specialties that actually perform the service. 2. Specialty Crosswalk Issues Malpractice insurers generally use five-digit codes developed by the Insurance Services Office (ISO), an advisory body serving property and casualty insurers, to classify physician specialties into different risk classes for premium rating purposes. ISO codes classify physicians not only by specialty, but in many cases also by whether or not the specialty performs surgical procedures. A given specialty could thus have two ISO codes, one for use in rating a member of that specialty who performs surgical procedures and another for rating a member who does not perform surgery. Medicare uses its own system of specialty classification for payment and data purposes. Therefore, to calculate the malpractice RVUs, it was necessary to map Medicare specialties to ISO codes and insurer risk classes, and in some instances to crosswalk unassigned specialties to the most approximate existing ISO codes and risk classes. We stated in the CY 2005 final rule that we would continue to work with VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 the AMA RUC’s Professional Liability Insurance (PLI) Workgroup to address any potential inconsistencies that may still exist in our methodology. Based upon this commitment, the RUC PLI Workgroup forwarded various recommendations for our consideration. The RUC developed its recommendations based upon comments submitted to them by physician specialty organizations. As discussed in the August 8, 2005 proposed rule, the Workgroup believes the risk factors assigned to certain professions overestimate the insurance premiums for these professions and, based on its recommendations, we proposed revising the risk factor for the following specialties to a risk factor of 1.00: clinical psychology; licensed clinical social work; psychology; occupational therapy; opticians and optometrists; chiropractic and physical therapy. We invited comment from representatives of the affected specialties and others regarding the appropriateness of this proposal, as well as other specialty crosswalks and suggestions for reliable sources of actual malpractice premium data for nonphysician groups. The RUC PLI Workgroup also believed that a number of professions that were assigned to the average for all physicians risk factor should be removed from the calculation of malpractice RVUs altogether and recommended excluding data from the following professions: Certified clinical nurse specialist; clinical laboratory; multispecialty clinic or group practice; nurse practitioner; physician assistant; and physiological laboratory (independent). We agreed with this recommendation and proposed to establish malpractice RVUs based upon the mix of specialties exclusive of the above specialties and professions. The PLI Workgroup also made recommendations for changing the crosswalks for risk factors for the following specialties which we did not accept: Certified registered nurse anesthetists; colorectal surgeons; gynecologists; and oncologists. We did not propose changes to the current crosswalks for these specialties and professions because we believe the current crosswalks we are using for these specialties appropriately reflect the types of services they provide. Comment: One commenter objected to our proposed change in the crosswalk to the lowest current risk factor of 1.00 for opticians and optometrists. The commenter stated that the recommendation from the RUC was not based on examination of the premium data or any other objective evidence. PO 00000 Frm 00040 Fmt 4701 Sfmt 4700 However, another commenter supported the proposal to crosswalk optometrists and opticians to the lowest current risk factor of 1.00, arguing this more appropriately reflects the actual level of risk assumed during the performance of procedures. A commenter objected to the proposed crosswalk change to 1.00 for clinical psychologists, licensed clinical social workers, and psychologists because the commenter believes that the malpractice insurance costs for these nonphysician practitioners are well below those paid by psychiatrists. Response: The proposed changes to the risk adjustment factor crosswalks were based on our agreement with the RUC PLI Workgroup’s assertion that these nonphysician professionals incur costs most similar to the lowest cost physician specialty. Because we do not have actual premium data for these professional groups, it is necessary to select an appropriate crosswalk category. We proposed to change the crosswalks for these specialties because, absent actual premium data, we agree with the RUC that these groups very likely do not incur malpractice costs on par with the average physician specialty. In its comments, the RUC points out that each of the professions for which we proposed to change the malpractice crosswalk is represented on the RUC’s Health Care Professional Advisory Committee (HCPAC). The HCPAC agreed that these professions should review their premium data and report back to the HCPAC at its September 29, 2005 meeting. Subsequently, on October 6, 2005 (after the close of the public comment period), the RUC submitted the results of these reviews. The RUC submitted to us after the close of the public comment period malpractice insurance premium data from many of these nonphysician professional groups. Because these data were received after the close of the comment period, and we believe it is important to allow the affected specialties the opportunity to comment on changes to the crosswalks, we are not incorporating these data in this final rule with comment. However, we would note that the data suggest that the annual premiums paid by these groups are below the average amounts paid by allergists and immunologists, the lowest premium cost physician specialties. We plan to continue to examine this issue in conjunction with the RUC’s PLI Workgroup before the 2007 proposed rule. Based on the fact that commenters did not provide any alternative data to suggest the crosswalks we proposed E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations were inappropriate, we will adopt our proposals for 2006 without change. Comment: One commenter supported our proposal to change the crosswalk for services of occupational therapists to 1.00, but suggests that the crosswalk should not be to allergy and immunology. Instead, the commenter recommended a crosswalk to physical medicine and rehabilitation. Response: We appreciate the commenter’s support of our proposal. With regard to the commenter’s recommendation to crosswalk to the specialty of physical medicine and rehabilitation, we would note that the risk factor for this specialty is 1.26 rather than 1.00. As noted above, because the comments we received did not contain any alternative data to suggest the crosswalks we proposed were inappropriate, we are adopting our proposals for 2006. Comment: Several commenters urged us to reconsider our proposal to not accept the RUC PLI’s recommendations to crosswalk: the specialty of gynecologist/oncologist to surgical oncology; certified registered nurse anesthetists (CRNAs) to anesthesiology; and, colorectal surgery to general surgery. Commenters also suggested separate surgical and nonsurgical risk factors for urology, and that hand surgery be crosswalked to orthopedic surgery (without spine). Response: With respect to the commenters’ recommendation to crosswalk gynecologist/oncologist to surgical oncology, the commenters did not substantially justify the argument that the professional liability premiums of the specialty are similar to those of surgical oncologists; however, we will analyze the data for this suggestion for possible future consideration. Commenters noted that CRNAs are currently crosswalked to general surgery, which means that CRNAs have a higher risk factor than anesthesiologists. These commenters recommended that CRNAs be crosswalked to anesthesiology and we accept this recommendation. For the request to crosswalk colorectal surgery to general surgery, the specialty of colorectal surgery was not crosswalked. Instead, we used actual premium liability insurance data collected for this specialty. Consequently, we disagree that this specialty should be crosswalked to another specialty. As stated previously and in the proposed rule, we only crosswalked specialties for which no premium data were collected. With regard to the comments regarding separate surgical and VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 nonsurgical risk factors for urology, we would be interested in further information regarding the appropriateness of this change. For the request to crosswalk hand surgery to orthopedic surgery, we note that, similar to colorectal surgery above, we used actual premium liability insurance data collected for this specialty. Consequently, we disagree that this specialty should be crosswalked to another specialty. Comment: The RUC supported our proposal to remove the risk adjustment data for the following professions and providers: certified clinical nurse specialist; clinical laboratory; multispecialty clinic or group practice; nurse practitioners, physician assistants; and physiological laboratory (independent). Response: We appreciate these supportive comments for this proposed change. 3. Cardiac Catheterization and Angioplasty Exception In the November 2, 1999 final PFS rule (64 FR 59384), we applied surgical risk factors to the following cardiology catheterization and angioplasty codes: 92980 to 92998 and 93501 to 93536. This exception was established because these procedures are quite invasive and more akin to surgical than nonsurgical procedures. In the CY 2005 (69 FR 66275), we discussed changes to the list of codes that would fall under the exception. In response to a request from the RUC’s PLI Workgroup, we proposed to add the following CPT codes to the existing list of codes under the exception: 92975; 92980 to 92998; and 93617 to 93641. Comment: Several commenters supported the changes made for the cardiac catheterization and angioplasty exception. Response: We appreciate the supportive comments for this proposed change. 4. Dominant Specialty for Low-Volume Codes The final recommendation from the PLI Workgroup was to use the dominant specialty approach for services or procedures with fewer than 100 occurrences, and to apply this approach to the list of 1,844 services supplied by the workgroup. The PLI Workgroup worked in conjunction with various specialty organizations to identify the dominant specialty that performs each service. We did not propose to adopt this methodology and noted that low volume procedures or services are not necessarily performed by only one PO 00000 Frm 00041 Fmt 4701 Sfmt 4700 70155 specialty. As noted previously, we would distinguish between excluding data presumed to be erroneous from data reflecting utilization by specialties that perform a service but are not the dominant specialty. However, we acknowledge that there may be instances where irregular data exist that would not be identified and removed by our proposed 5 percent threshold discussed previously. We will continue to work with the RUC PLI Workgroup examine this issue in the future. Comment: Numerous commenters opposed our policy to use actual specialty data rather than dominant specialties and suggested that we adopt the RUC recommendations. Response: As we stated in the PFS proposed rule (70 FR 45786), we believe that basing payment on all specialties that perform a particular service ensures that the actual professional liability insurance costs of all specialties are included in the calculation of the malpractice RVUs. Therefore, we do not believe it would be appropriate, even for these low-volume services, to include only the dominant specialty if other specialties regularly provide the service. 5. Collection of Premium Data Although this issue was not part of the proposed rule, many commenters suggested that we use alternative sources for our premium data. Comment: Some commenters suggested we used data supplied by the Physicians Insurers Association of America (PIAA) or directly from physician providers. Response: We are currently investigating the usefulness of the PIAA data and once our evaluation of the data is complete we will make a decision. We are not considering using physician provider self-reported premium costs. Final Decision We are implementing the proposed 5 percent threshold and specialty crosswalk changes discussed in the proposed rule. After considering all of the other comments received, we are not making other changes to the calculation of the malpractice RVUs. D. Medicare Telehealth Services 1. Requests for Adding Services to the List of Medicare Telehealth Services As discussed in the August 8, 2005 PFS proposed rule (70 FR 45786), section 1834(m) of the Act defines telehealth services as professional consultations, office and other outpatient visits, and office psychiatry services identified as of July 1, 2000 by CPT codes 99241 through 99275, 99201 E:\FR\FM\21NOR2.SGM 21NOR2 70156 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations through 99215, 90804 through 90809, and 90862. In addition, the statute requires us to establish a process for adding services to or deleting services from the list of telehealth services on an annual basis. In the December 31, 2002 Federal Register (67 FR 79988), we established a process for adding or deleting services to the list of Medicare telehealth services. This process provides the public an ongoing opportunity to submit requests for adding services. We assign any request to make additions to the list of Medicare telehealth services to one of the following categories: • Category #1: Services that are similar to office and other outpatient visits, consultations, and office psychiatry services. In reviewing these requests, we look for similarities between the proposed and existing telehealth services for the roles of, and interactions among, the beneficiary, the physician (or other practitioner) at the distant site and, if necessary, the telepresenter. We also look for similarities in the telecommunications system used to deliver the proposed service (for example, the use of interactive audio and video equipment.) • Category #2: Services that are not similar to the current list of telehealth services. Our review of these requests includes an assessment of whether the use of a telecommunications system to deliver the service produces similar diagnostic findings or therapeutic interventions as compared with the face-to-face ‘‘hands on’’ delivery of the same service. Requestors should submit evidence showing that the use of a telecommunications system does not affect the diagnosis or treatment plan as compared to a face-to-face delivery of the requested service. Since establishing the process, we have added the psychiatric diagnostic interview examination and ESRD services with 2 to 3 visits per month and 4 or more visits per month to the list of Medicare telehealth services (although we require at least one in-person visit a month by a physician, clinical nurse specialist, nurse practitioner, or physician assistant to examine the vascular access site). Requests for adding services to the list of Medicare telehealth services must be submitted and received no later than December 31st of each year to be considered for the next proposed rule. For example, requests submitted before the end of CY 2004 are considered for the CY 2006 proposed rule. For more information on submitting a request for an addition to the list of Medicare telehealth services, visit our web site at VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 www.cms.hhs.gov/physicians/ telehealth. We received the following public requests for additional approved services in CY 2004: (1) Individual medical nutritional therapy (MNT) as described by HCPCS codes G0270, 97802 and 97803; (2) group MNT (HCPCS codes G0271 and 97804); (3) individual diabetes outpatient selfmanagement training (DSMT) services (HCPCS code G0108); (4) Group DSMT (HCPCS code G0109); and (5) modification of the definition of an interactive telecommunications system for purposes of furnishing a telehealth service. After reviewing the public requests, we proposed to add individual MNT as represented by HCPCS codes G0270, 97802 and 97803 to the list of Medicare telehealth services. We also proposed to add individual MNT to the list of Medicare telehealth services at § 410.78 and § 414.65. Moreover, because a certified registered dietitian or other nutrition professional are the only practitioners permitted by law to furnish MNT, we proposed to revise § 410.78 to add a registered dietitian and nutrition professional as defined in § 410.134 to the list of practitioners who may furnish and receive payment for a telehealth service. We did not propose to add any additional services to the list of Medicare telehealth services or to make any changes to the definition of an interactive telecommunications system for CY 2006. For further information on our proposals, see the Federal Register dated August 8, 2005 (70 FR 45786). Individual MNT Comment: Many commenters supported our proposal to approve individual MNT for telehealth and to add a registered dietitian and nutrition professional to the list of practitioners authorized to furnish and receive payment for Medicare telehealth services. Commenters stated that adding MNT to the list of Medicare telehealth services would improve access and services for patients in remote areas where traditional MNT services may not be readily available. For example, a State dietetic association mentioned that in many cases, patients need to drive for more than an hour to receive MNT services and that the ability to furnish individual MNT as a telehealth service will provide great benefit to rural Medicare beneficiaries. Furthermore, a renal association stated that limited access to nutritional therapists is problematic for patients with stage 3 and 4 kidney disease who are located in PO 00000 Frm 00042 Fmt 4701 Sfmt 4700 rural or isolated areas. The commenter explained that nutritional counseling is an important tool for helping beneficiaries improve their nutritional status and in controlling levels of key electrolytes such as potassium and phosphorous. Several MNT practices also urged us to adopt our proposal to approve individual MNT for telehealth. Another commenter supported the addition of individual MNT, however stated that more conclusive data regarding efficacy is needed before further expansion. Response: We agree with the commenters that approving individual MNT for telehealth would help provide greater access to registered dietitians and other nutritional professionals for beneficiaries in rural and or isolated areas. Comment: A few commenters believe that MNT should not be approved as a Medicare telehealth service. For instance, a certified diabetes educator (CDE) stated that it would be very difficult to accurately assess cognitive and literacy levels, emotional state and motivation without seeing the patient. The commenter also believes that faceto-face interaction for assessment, establishment of goals, and reviewing written materials is essential. The commenter expressed support for using telehealth to furnish MNT in very limited circumstances, for example if there was no access to an educator within 50 miles or if the patient was homebound. One commenter contends that it would be difficult to assess a patient’s understanding of the dietary prescription, nutrient content of each food group, portion control and information provided by food labels, especially for beneficiaries who cannot read and or have a vision impairment that prevents them from reading fine print. Moreover, another commenter believes that individual MNT includes skill-based training beyond an individual assessment, not unlike teaching insulin administration or blood glucose monitoring. The commenter stated that the skills taught in MNT cannot be verbally assessed through distance education. Response: As discussed in the proposed rule, we believe that individual MNT is similar in nature to an office or other outpatient visit (which is defined in the law as a Medicare telehealth service). We believe that the components of an E/M office visit involve a similar level of patient counseling for following a treatment plan as compared to individual MNT. We also believe that a registered dietitian at the distant site, along with an appropriate medical professional E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations with the beneficiary at the originating site, could adequately assess and adjust to the beneficiary’s ability to understand and follow his or her nutritional plan. We do not agree with the commenter that the same level of physical, skillbased training that is required in an individual DSMT session, (for example, teaching a Medicare beneficiary the skills necessary for the self-injection of insulin), is a requirement for individual MNT. Comment: One commenter requested that we clarify whether we would pay a physician practice for individual MNT furnished as a telehealth service when a registered dietitian or other nutrition professional reassigns his or her right to bill for payment to the physician practice as an employer. Response: As discussed in the CMS claims processing manual (Pub. 100–04, chapter 1, section 30.2.6), if the employer/employee reassignment exception is met, and the person furnishing the service and the entity wishing to bill are both enrolled in Medicare and each have their own billing number, then we could make payment to the physician practice for the MNT service. Group Medical Nutritional Therapy (MNT) and Diabetes Self-Management Training Services (DSMT) Comment: Some commenters agreed with our proposal not to add DSMT to the list of Medicare telehealth services. For instance, one commenter wrote that DSMT can not be done as a telehealth service because in-person interaction with the client is crucial for assessing the skill development necessary for managing diabetes. Additionally, two certified diabetic educators (CDE) stated that DSMT can not be adequately furnished as a telehealth service and agreed with our proposal not to add DSMT to the list of Medicare telehealth services. Furthermore, another commenter stated that face-to-face interaction for assessment, establishment of goals, and reviewing written materials is essential for DSMT. Response: As discussed in the proposed rule, we believe that DSMT is not similar to the current list of Medicare telehealth services and requires conclusive evidence showing that the use of a telecommunications system is an adequate substitute for the in-person delivery of DSMT. Comment: A few commenters believe group MNT and group DSMT are similar in nature to the current list of Medicare telehealth services and therefore should be approved for telehealth under category 1 criteria. The commenters contend that the same presentation VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 material, text books, manuals, DVD’s and on site support staff are used whether group DSMT or group MNT is furnished in-person or through an interactive audio and video telecommunications system. The commenters stated that the practitioner would conduct the same training session for a telehealth service as they would in-person, and they believe that the interactive differences between group MNT and group DSMT and the current Medicare telehealth services should not be used as a basis for denying these services. The commenters believe that the criteria for approving group MNT and group DSMT should be based on whether the use of a telecommunications system is equivalent to the in-person delivery of the requested service. Moreover, commenters argue that no group services would ever be approved if we base approval upon whether the interactive dynamic of the requested service is similar to existing telehealth services and requested us to add group MNT and group DSMT as a precedent by which other future group service requests could be measured. Response: Category 1 requests are reviewed to ensure that the roles of, and interaction among, the beneficiary and physician (or other practitioner) of the requested service are similar to the current telehealth services, for example office and other outpatient visits and consultation services. In other words, the roles of, and interaction among, the beneficiary and physician (or practitioner) is the criterion used to determine whether the requested service is similar to the current telehealth services. Since the interactive dynamic of group MNT and group DSMT is not similar to the current list of telehealth services, the request to add these services was assigned to category 2. For category 2 services, we assess whether the use of an interactive audio and video telecommunications system to deliver the requested service is equivalent to the in-person delivery of the service. To that end, we review any comparative analyses submitted by the requestor illustrating that the use of a telecommunications system is an adequate substitute for the in-person delivery of the requested service. If the requestor were to submit studies indicating that beneficiaries receiving group MNT and group DSMT comprehend and apply the training material as well by telehealth as in person, we would reconsider approving group MNT and group DSMT for telehealth. PO 00000 Frm 00043 Fmt 4701 Sfmt 4700 70157 Comment: The same group of commenters also believe that individual DSMT is similar to the existing list of telehealth services and should be approved as a category 1 request. The commenters contend that a telepresenter would be able to facilitate the ‘‘hands on’’ aspects of training a patient how to inject insulin. For example, a telepresenter with a patient at the originating site (who is not a certified CDE) could assist with filling syringes, mixing doses, and showing the injection site location through illustration or pointing to areas on the body. Commenters also argue that the use of a large video monitor to show gradient markings on a syringe could be beneficial for patients with poor vision. Response: As discussed in the proposed rule, we considered individual DSMT as a category 2 request because the components included in training a Medicare beneficiary to administer insulin injections are typically not part of the services currently on the list of telehealth services. We did not propose to add individual DSMT because the requestors did not submit any comparative analyses illustrating that the use of an interactive audio and video telecommunications system is an adequate substitute for individual DSMT furnished in-person. Comment: Several commenters submitted summaries of studies and or articles regarding group psychiatry, individual psychotherapy, and medication management furnished as telehealth services. Additionally, an individual practitioner mentioned a study that compared diabetes education furnished through telemedicine with diabetes education furnished in-person. Response: For category 2 services, we require evidence showing that the requested telehealth service is equivalent to the in-person delivery of the same service. The articles regarding mental health services and pharmacologic management do not address whether the use of a telecommunications system is an adequate substitute for the in-person delivery of MNT or DSMT. Additionally, individual psychotherapy and pharmacologic management are already on the list of Medicare telehealth services. The comparison study regarding diabetes education focused on certain aspects of individual DSMT (but, as noted below, not on training patients to inject insulin), and therefore is irrelevant to the request to add group DSMT. The study conclusions mentioned that the ‘‘diabetes nurse educator was even successful in E:\FR\FM\21NOR2.SGM 21NOR2 70158 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations teaching insulin administration via telemedicine to a patient who had very high blood glucose levels’’. However, training patients on the selfadministration of injectable drugs (which typically occurs during an individual training session) was not the focus of this study and no conclusive evidence was provided showing that insulin administration can routinely be taught as a telehealth service. Comment: Some commenters suggested that we approve the majority of DSMT for telehealth and require selected aspects of the training such as the instruction of insulin injections to be furnished in person by a CDE. For instance, one CDE stated that the use of telehealth would not be appropriate for teaching selected skills (such as the administration of self-injectable drugs, glucometer testing, or insulin pump therapy), and should not replace the initial assessment or all follow-up visits. Some CDE’s and DSMT programs stated that a combination of in-person and telehealth training works well for their patients. However, commenters stated that the majority of the curriculum for an American Diabetes Association (ADA) recognized DSMT program can be successfully provided as a telehealth service. For instance, a CDE stated that curriculum components such as nutritional management, foot care, ketone testing, sick day management, use of a supplemental insulin scale, and treatment of hypoglycemia or hyperglycemia could be furnished as a telehealth service. Response: DSMT is furnished either as an individual or group service as described by HCPCS codes G0108 and G0109 respectively. As many commenters mentioned, teaching a patient how to inject insulin is typically furnished as part of an individual DSMT session rather than in a group setting. Additionally, as discussed at § 410.141(c)(1), Medicare payment for initial DSMT may not exceed 10 hours of beneficiary training in which 9 hours of the training are usually furnished as a group service. Since teaching a patient how to inject insulin is typically an integral component of an individual training session, and comprises only 1 hour of a maximum of 10 hours of initial training, we do not believe that it would be appropriate to carve out selected skill-based training from an individual DSMT service. We agree that skill-based training such as teaching patients how to inject insulin would be difficult to accomplish without the physical in-person presence of the teaching practitioner and believe this is not a common aspect of the current list of telehealth services. Given VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 that teaching patients the skills required for insulin injection and blood glucose monitoring are typically furnished during an individual DSMT session we assigned the request to add individual DSMT to category 2. Moreover, as discussed previously, since the interactive dynamic of group DSMT is not similar to the current list of telehealth services, it does not meet the criteria for category 1. Therefore, we require evidence showing that the use of an interactive audio and video telecommunications system in furnishing DSMT is an adequate substitute for DSMT furnished inperson. Comment: Some commenters believed that we compared group MNT to group psychiatric therapy or mental health counseling. The commenters suggest this is not a fair comparison because patients participating in a group MNT session typically do not discuss specific personal health information with the nutrition professional because the group ‘‘therapy’’ is a discussion of nutrition and is centered on a specific medical disease topic (for example, diabetes). Commenters contend that in the case of group MNT, the dietitian presents educational material to many beneficiaries at once and that the level of intense personal interaction found in group mental health services is not necessary in group MNT. Response: As discussed previously, we compared the roles of, and interaction among, the beneficiary and physician (or other practitioner) in furnishing MNT and DSMT to the existing telehealth services. We did not compare group MNT to group psychiatric therapy or to group mental health counseling. Comment: A few commenters stated that furnishing MNT for a diabetic patient is intended to be an adjunct to DSMT. For example, one group of commenters stated that without receiving DSMT, patients would not have an overall understanding of diabetes, how the disease develops and changes, and would not be taught additional methods for controlling glucose beyond those presented in MNT. Response: Approving individual MNT for telehealth is one step along the way to helping more beneficiaries gain access to a collaborative skill-based DSMT program. As discussed earlier, we believe there should be conclusive evidence showing that DSMT can be as effective when furnished as a telehealth service as in a face-to-face encounter before we approve this service for telehealth. PO 00000 Frm 00044 Fmt 4701 Sfmt 4700 Additionally, we conduct and sponsor a number of innovative demonstration projects to test and measure the effect of potential program changes. Our demonstrations study the likely impact of new methods of service delivery, coverage of new types of service, and new payment approaches on beneficiaries, providers, health plans, states, and the Medicare Trust Funds. We would encourage the commenters to take advantage of other programs that the agency has set up to increase medical quality and reduce cost. For more information on demonstration projects visit our web site at www.cms.hhs.gov/researchers/demos. Comment: A few commenters requested that we pay for DSMT education provided to patients over the phone. One commenter submitted several studies and articles regarding telephone-based interventions for diabetes care, (for example, telephone counseling). Response: Patient education provided over the phone is beyond the scope of this provision. Telephone calls do not meet the definition of an interactive telecommunications system and are not on the list of Medicare telehealth services. Additionally, as discussed in the Medicare benefits policy manual, publication 100–2, chapter 15, section 30, no separate payment is made for phone calls under the Medicare program. Comment: One commenter requested us to recognize CDE’s as a Medicare practitioner and allow them to bill the Medicare program directly. Response: The statute does not permit a CDE to bill and receive direct payment for Medicare services. The statute defines a certified DSMT provider as a physician, other individual, or entity who, in addition to providing DSMT services, provides other items or services for which direct payment may be made. We do not have the statutory authority to establish a separate CDE benefit category. Definition of an Interactive Telecommunications System We received many comments regarding the use of an interactive audio and one-way video telecommunications system for delivering a Medicare telehealth consultation. Several commenters expressed qualified support for the use of an interactive audio and one-way video telecommunication for purposes of furnishing a telehealth consultation. For instance, some commenters believe that allowing oneway video would be appropriate in situations when it enables the consulting physician to add value to the E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations diagnosis and decision making capabilities of the patient care team at the originating site which includes, at a minimum, a treating physician; and where observation of the consulting physician by the patient is either unnecessary or not possible (for example, when the patient is unconscious). Some commenters also suggested that we allow one-way video specifically for assessing suitability for stroke thrombolytic tissue-type plasminogen activator (tPA) therapy and compared the remote evaluation of a stroke patient for purposes of determining tPA treatment to a confirmatory consultation. For instance, the treating physician at the originating site would make a determination regarding the use of tPA and request a consultation to confirm his or her decision to use tPA therapy. Another commenter, who currently provides stroke consultation as a Medicare telehealth service, believes this service is an outpatient or inpatient consultation (where the neurologist at the distant site determines the treatment plan rather than offering a second or third opinion). The commenter also explained that they use an interactive audio and video telecommunications system that allows two-way real time video interaction between the consulting physician at the distant site and the originating site medical team. One organization stated that payment should be made for physicians’ services that are safe, effective, medically appropriate, and provided under accepted standards of medical practice. The commenter believes that the critical factor in determining whether to pay for a service should be medical necessity rather than the technology used to furnish the service. The commenter also compared the use of one-way video and two-way audio to a physician furnishing a visit to a blind patient. The commenter contends that we would not deny payment for a face-to-face consultation on the basis that the patient could not see the physician, and therefore we should not deny a telehealth consultation on the same basis. Another commenter requested that we allow the use of one-way video equipment for delivering infectious disease telehealth consultations for ICU patients. The commenter explained that the hospital ICU is currently equipped with a one-way video, two-way audio telecommunications system and contends that moving interactive audio and video teleconferencing equipment to the ICU patient is very cumbersome VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 and is only possible if appropriate technical staff are available. We received a few comments regarding the added clinical value of two-way video versus one-way video and whether one-way video is appropriate for a broad range of specialty consultations. One commenter made the point that two-way video would allow the patient to see the physician or practitioner at the distant site when a greater degree of interaction is necessary. One organization believes that two-way video may add value to a telehealth consultation by allowing the patient and presenting practitioner (if necessary) to see the body language and other non-verbal communication of the physician or practitioner at the distant site. However, the commenter stated that payment should not be denied for using a one-way video telecommunications system. Another commenter supported using one-way video in limited emergent circumstances, but also stated that additional research should be conducted to determine whether the use of one-way video is appropriate for a broad range of specialty consultations. Some commenters did not support the use of one-way video for furnishing a telehealth consultation. For instance, one commenter stated that face-to-face (interactive video) is a better method for obtaining patient compliance and results in a higher level of patient confidence with the health care team. Response: We appreciate the comments on the use of an interactive audio and one-way video telecommunications system for purposes of furnishing a telehealth consultation. We intend to consider the suggestions raised by the commenters as we continue to evaluate conditions of payment for Medicare telehealth services. We continue to believe that the interaction between the consulting physician and the clinical staff at the originating site is important and it is not clear to us that one-way video is as effective in that regard as two-way video. With regard to the commenter who stated that the critical factor in determining whether to pay for a telehealth service should be based on medical necessity, we believe that the method used to furnish the service, for example the use of an appropriate telecommunications system, is just as critical as whether the service itself is medically necessary. 2. Definition of an Originating Site As discussed in the August 8, 2005 proposed rule, section 418 of the MMA required the Health Resources Services Administration (HRSA) within HHS, in PO 00000 Frm 00045 Fmt 4701 Sfmt 4700 70159 consultation with CMS, to conduct an evaluation of demonstration projects under which SNFs, as defined in section 1819(a) of the Act, are treated as originating sites for Medicare telehealth services. The MMA also required HRSA to submit a report to the Congress that would include recommendations on ‘‘mechanisms to ensure that permitting a SNF to serve as an originating site for the use of telehealth services or any other service delivered via a telecommunications system does not serve as a substitute for in-person visits furnished by a physician, or for inperson visits furnished by a PA, NP or CNS, as is otherwise required by the Secretary.’’ We indicated that this report was currently under development and that if the Secretary concludes in the report that it is advisable to include a SNF as a Medicare telehealth originating site under section 1834(m) of the Act, we would consider the recommendations of the report to determine whether to add SNFs to the list of approved originating sites. We also solicited comments on this topic. Comment: We received many comments supporting the use of telehealth in a SNF. The commenters noted that adding a SNF to the definition of an originating site would provide increased access to specialty physicians and practitioners, most notably mental health services, and decrease unnecessary travel for both the beneficiary and nursing facility staff. For example, one mental health practitioner stated that research studies indicate a critical shortage of psychiatrists in non-MSA areas and a lack of appropriate mental health care in rural SNF’s as compared to their urban counterparts. As such, the commenter believes that many rural SNFs do not provide professional psychiatric or mental health care and that telehealth is one method that could be used to meet the mental health needs of the rural SNF population. Furthermore, the commenter stated that the lack of appropriate mental health care results in higher rates of psychiatric hospitalizations and the inability to effectively manage medications. Another commenter believes that allowing telehealth services to be furnished in a SNF would increase access to follow-up care and would result in cost savings. For example, the commenter contends that addressing acute medical conditions earlier before they develop into a crisis could save money by reducing transportation costs and decrease the number of hospital admissions. The commenter also mentioned that traveling and waiting in an unfamiliar waiting room is often E:\FR\FM\21NOR2.SGM 21NOR2 70160 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations confusing and uncomfortable for the patient. The use of telehealth for SNF residents could result in less travel hardships for both the patient and SNF staff. Response: We appreciate the comments regarding the addition of SNFs to the definition of an originating site. At this time the telehealth report to the Congress, as required by section 418 of the MMA, is under development within HHS. As discussed previously, we have the authority to approve telehealth furnished in a SNF if the Secretary concludes in the report that it is advisable to include a SNF as a Medicare telehealth originating site under section 1834(m) of the Act. Comment: A few commenters requested us to add other facilities in addition to a SNF to the definition of an originating site. For example, one organization requested that we expand the definition of an originating site to include domiciliary care facilities and other congregate-living arrangements if SNFs are approved as an originating site. Another commenter requested that we expand the definition of an originating site to allow all community hospitals regardless of their location (for purposes of furnishing a telehealth consultation for stroke patients). The commenter noted that a timely evaluation of a stroke patient is crucial for effective stroke treatment and argued that beyond three hours after onset, resuscitation of injured brain cells becomes increasingly unlikely. The commenter contends that timely access to a critical care neurologist remains a concern for the majority of community hospitals. Moreover, a national society of nephrology requested that we add a dialysis facility to the list of originating sites. Response: The statute defines an originating site facility as a physician’s or practitioner’s office, hospital, critical access hospital, rural health clinic, or FQHC. Additionally, the statute only permits telehealth services to be furnished at an originating site located in a rural health professional shortage area as defined in section 332(a)(1)(A) of the Public Health Service Act or within a county that is not included in a metropolitan statistical area. We do not have the legislative authority (except for SNFs as indicated previously) to expand the definition of an originating site facility or to allow telehealth services to be furnished in a hospital regardless of geographic location. 3. Other Issues Comment: One association urged us to pay for asynchronous ‘‘store and forward’’ dermatology consultations. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 The commenter explained that a store and forward consultation involves the transmission of dermatological photographs and other medical information to the consulting practitioner without interaction between the patient and practitioner at the distant site; the patient is not present for the consultation. The commenter contends that store and forward consultation is more convenient for the patient, originating site and consulting physician. Response: Medicare telehealth services include office and other outpatient visits (99201 through 99215), professional consultations (99241 through 99275), individual psychotherapy (90804 through 90809), pharmacologic management (90862), psychiatric diagnostic interview examination (90801), and ESRD-related services included in the MCP (except for one visit per month to examine the access site). As a condition of payment under Medicare, these services require an in-person patient encounter. We believe that the patient’s presence, and the use of an interactive audio and video telecommunications system permitting the distant site practitioner to interact with the patient, provides a reasonable substitute for an in-person encounter. The statute provides for the use of asynchronous, store and forward technologies for delivering telehealth services only for Federal telemedicine demonstration programs conducted in Alaska or Hawaii. We do not have the authority to expand the use of store and forward technology in delivering telehealth services. Comment: Two commenters urged us to consider adding speech-language pathologist and audiologists as practitioners allowed to furnish and receive payment for telehealth services and noted that we have not submitted the telehealth report to the Congress on additional sites, geographic areas and practitioners that may be appropriate for Medicare telehealth payment. The commenters also mentioned that the American Speech-Hearing Association (ASHA) previously submitted a request for consideration in the CY 2005 physician rule to add various speech and audiology services to the list of Medicare telehealth services. The commenters believe that we have not responded specifically to ASHA’s request to approve speech and audiology services for telehealth. Response: The report to the Congress (as required by section 223(d) of the Medicare, Medicaid and State Child Health Insurance Program Benefits Improvement and Protection Act of 2000 (BIPA) (Pub. L. 106–554)) on PO 00000 Frm 00046 Fmt 4701 Sfmt 4700 additional sites and settings, practitioners, and geographic areas that may be appropriate for Medicare telehealth payment is under development. We are considering the suggestions raised by the commenter as we formulate our recommendations to the Congress. Moreover, since speech language pathologists and audiologists are not permitted under current law to provide and receive payment for Medicare telehealth services at the distant site, we can not fully consider ASHA’s request to add speech and audiology services to the list of Medicare telehealth services. Comment: One commenter requested that we replace the term face-to-face with ‘‘in-person’’. The commenter believes that the term ‘‘in-person’’ is a better description of an encounter where the patient and practitioner are in the physical presence of each other. Response: The commenter’s suggestion to use the term ‘‘in-person’’ to describe an encounter where the physician or practitioner and the beneficiary are physically in the same room has been noted. We will consider the commenter’s suggestion as we discuss Medicare telehealth payment policy. Result of Evaluation of Comments We will add individual MNT as represented by HCPCS codes G0270, 97802 and 97803 to the list of Medicare telehealth services. We also will add individual MNT to the list of Medicare telehealth services at § 410.78 and § 414.65. Moreover, since a certified registered dietitian or other nutrition professional are the only practitioners permitted by statute to furnish MNT, we will revise § 410.78 to add a registered dietitian and nutrition professional as defined in § 410.134 to the list of practitioners that may furnish and receive payment for a telehealth service. E. Contractor Pricing of Unlisted Therapy Modalities and Procedures We recognize that there may be services or procedures performed that have no specific CPT codes assigned. In these situations, it is appropriate to use one of the CPT codes designated for reporting unlisted procedures. These unlisted codes do not typically have RVUs assigned to them. For services coded using these unlisted codes, the provider includes a description of the specific procedure(s) that was furnished. The contractor uses this information to determine an appropriate valuation. As explained in the August 8, 2005 PFS proposed rule (70 FR 45788), currently, there are two unlisted CPT E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations codes with assigned RVUs, CPT 97039, Unlisted modality (specify and time if constant attendance), and 97139 Unlisted therapeutic procedure. To make the pricing methodology consistent with our policy for other unlisted services, and to more appropriately match payments with the actual resources expended to deliver the services provided, we proposed to have our contractors value CPT codes 97039 and 97139. We received several comments on this proposal and provide the following summary of the comments and our response below. Comment: Two commenters were opposed to the proposal. These commenters stated they were concerned that contractor pricing would create inconsistencies in the payment for these services or would lower payment resulting in the services no longer being provided, potentially increasing the administrative burden and resulting in delayed payments. One of these commenters suggested that we work with interested specialties to better understand the services billed under these codes. Another commenter expressed concern that obtaining new CPT codes requires a good deal of research and investigation to ensure accurate payment. Other commenters supported this proposed change, indicating that because these codes are used for widely different services they should be evaluated separately and there is no basis for assigning the code a set fee schedule rate. Response: While it is true that having these codes priced by the contractors may result in some increase in administrative burden and impact the timeliness of payments, it will not necessarily result in lower payments. Our goal is to ensure appropriate payment for the actual services provided and we believe that our contractors will work with the provider community to make certain that this occurs. To the extent that providers believe that new codes are needed they might want to work with the specialty organizations to achieve this objective. Final Decision: We are finalizing our proposal and our contractors will value CPT codes 97039 and 97139. We are assigning a status indicator of ‘‘C’’ to these two CPT codes. F. Payment for Teaching Anesthesiologists In the August 8, 2005 PFS proposed rule (70 FR 45789), we summarized the current policy for the payment for services provided by teaching anesthesiologists, including the VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 revisions to the policy published November 7, 2003 (68 FR 63196 through 63395), where we revised § 414.46 of our regulations to allow teaching anesthesiologists to bill in a similar manner to teaching certified registered nurse anesthetists (CRNAs) for the teaching anesthesiologist’s involvement in two concurrent cases involving residents. This policy took effect for services furnished on or after January 1, 2004 and was intended as an alternative to the ‘‘medical direction’’ payment policy applicable to concurrent cases involving teaching anesthesiologists and residents. As noted in the August 8, 2005 proposed rule, despite the higher level of payment available under this policy, the American Society of Anesthesiologists (ASA) has informed us that it is not aware of any teaching anesthesia programs that have arranged their practices to meet the conditions necessary to bill under the revised policy. The ASA suggests that the teaching physician regulations for teaching anesthesiologists should be similar to those for teaching surgeons for overlapping complex surgery procedures. The ASA thinks that anesthesia is similar to complex surgery in terms of critical periods, overlap, and availability of teaching physicians. However, as we noted in the August 8, 2005 proposed rule, the critical portions of the teaching anesthesia service and the critical portions of the teaching surgeon service are not the same. The ASA believes that inadequate payment levels have contributed to the loss of teaching anesthesiologists and an inability to recruit new faculty. In the August 8, 2005 proposed rule, we requested comments on a teaching physician policy for anesthesiologists that could build on the policy announced in the November 7, 2003 PFS final rule, but could provide the appropriate revisions that would allow it to be more flexible for teaching anesthesia programs. We also indicated we would be interested in receiving data and studies relevant to this issue as well as any offsetting savings that could be made to account for any potential costs that could be incurred if there was a policy change. Discussion of Comments Received As discussed previously in this section, we did not present a formal proposal, but asked for comments from interested stakeholders on these issues. While we have not fully analyzed all the relevant information and data, we have been provided anecdotal evidence that some anesthesiologists may be leaving academic practice for better PO 00000 Frm 00047 Fmt 4701 Sfmt 4700 70161 compensated positions in private practice. While we recognize that Medicare payment policies are an important consideration in these decisions, they are not the only factor. In contrast, as pointed out by a commenter, there has been an increase in the number of nurse anesthesia programs from 83 programs in 2000 to 105 programs projected for 2006. The number of nurse anesthesia graduates has surged from 1075 nurse anesthetists in 2000 to 2035 projected for 2006. Despite these increases, nurse anesthesia programs had reported similar financial problems, such as levels of teachers’ salaries, in recruiting faculty to teaching nurse anesthetists. In terms of anesthesia manpower, we did not receive any information from surgical groups indicating difficulty in getting anesthesiologists or CRNAs to provide anesthesia services. Additionally, we did not receive any comments identifying areas of offsetting savings that might be used to fund any change in the teaching anesthesia payment policy. We will continue to review the information and relevant data presented by the commenters and consult with the stakeholders before we move forward with any proposal. G. End Stage Renal Disease (ESRD) Related Provisions On August 8, 2005, we published the Revisions to Payment Policies Under the Physician Fee Schedule for CY 2006 proposed rule in the Federal Register (70 FR 45789), revising payments to ESRD facilities under the provisions of the MMA. The proposed rule implements section 1881(b) of the Act, as amended by section 623 of the MMA, which directs the Secretary to make a number of revisions to the composite rate payment system, as well as payment for separately billable drugs furnished by ESRD facilities. Under section 1881(b)(12) of the Act, the add-on adjustment must reflect both the effect of the new payment methodology and estimate growth in ESRD drug expenditures. We proposed an add-on adjustment of 8.1 percent to the composite payment rate to account for the difference between previous payments for separately billed drugs and biologicals and the revised pricing that will take effect January 1, 2006. We updated that add-on adjustment to reflect estimated growth in ESRD drug expenditures of 0.7 percent. We combined the add-on adjustment of 8.1 percent that reflects the payment methodology we will be using for ESRD drugs with the 0.7 percent increase for expenditures in 2006 to produce one E:\FR\FM\21NOR2.SGM 21NOR2 70162 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations proposed drug add-on adjustment for CY 2006 of 8.9 percent. Following publication of the proposed rule, it came to our attention that 3 codes had been omitted in our analysis of drug payments and utilization for the top ten ESRD drugs that affected our calculation of the proposed add-on adjustment. On September 1, 2005, we issued a correction notice on the CMS Web site, to correct our omission of the 3 J Codes in the estimation of the market shares for the top ten ESRD drugs used in our calculation of the proposed drug add-on adjustment for 2006. The ‘‘Correction to the Proposed ESRD Drug Add-on Adjustment: Revised Table 22’’ is available at https://www.cms.hhs.gov/ providers/esrd/ 090105_ESRD_Correction.pdf. The corrected table shows the revised weights compared to the weights included in the proposed rule and resulted in a revised proposed total drug add-on adjustment to the composite payment rate of 11.3 percent for 2006. We also proposed to revise the drug pricing for ESRD drugs to ASP+6 percent for the top ten drugs furnished by independent facilities and EPO furnished by hospital-based facilities. In addition, section 1881(b)(12) of the Act as amended by section 623 of the MMA provided authority to the Secretary to revise the geographic index applied to the composite payment rate and phase in any changes to the index over a multi-year period. Accordingly, we proposed to revise the geographic classifications and wage indexes currently in effect for adjusting composite rate payments and to implement these changes over a 2-year transition period. We also proposed to revise the regulations applicable to the composite rate exceptions process to reflect section 623 of the MMA provisions that restricts exceptions to pediatric facilities. No changes to the current case-mix adjustments were proposed. We received a total of 37 comments from the ESRD community that represented major organizations, pharmaceutical companies, beneficiaries, and concerned individuals. The comments and responses are summarized in the following sections. 1. Revised Pricing Methodology for Separately Billable Drugs and Biologicals Furnished by ESRD Facilities In the August 8, 2005 proposed rule, we proposed that payment for drugs furnished in connection with renal dialysis services and separately billed by independent renal dialysis facilities VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 would be based on payment amounts determined under section 1847A of the Act which are 106 percent of the ASP. We proposed to update the payment allowances quarterly, based on the ASP reported to us by drug manufacturers. We also proposed to pay for EPO in hospital-based facilities at the ASP+6 percent. We stated that we are interested in moving to the ASP+6 percent methodology for all separately billed drugs and solicited comments on a drug add-on estimation methodology that would allow us pay hospital-based facilities ASP+6 percent for all separately billable drugs. In this final rule with comment, we are implementing payment of ASP+6 percent for all ESRD drugs furnished by both independent and hospital-based ESRD facilities. A discussion of the final drug payment methodology and related comments and responses can be found in section II.H.2. 2. Adjustment to Account for Changes in the Pricing of Separately Billable Drugs and Biologicals, and the Estimated Increase in Expenditures for Drugs and Biologicals Section 1881(b)(12) of the Act, as added by section 623(d) of the MMA, contains two provisions that describe how the drug add-on adjustment will be implemented in the ESRD payment system. First, the add-on adjustment must reflect the difference between the payment methodology for separately billed drugs under the drug price in effect in CY 2004 and current drug pricing and, second, the aggregate payments for CY 2005 must equal aggregate payments absent this MMA provision. Prior to 2005, separately billable ESRD drugs and biologicals other than EPO furnished in independent facilities were paid under the average wholesale price (AWP) methodology. In 2005, section 1881(b)(13)(A)(ii) of the Act required that we pay the acquisition cost for separately billable ESRD drugs (including EPO) as determined by the Office of the Inspector General (OIG). If the OIG did not determine an acquisition cost for a separately billable drug or biological, then the Secretary was given discretion to determine the payment rate. In the CY 2005 final rule (69 FR 66322–66323), we described the methodology that we used for developing the drug add-on adjustment to the composite rate to account for the difference between estimated drug payments under the AWP payment system and the acquisition costs as determined by the OIG. This adjustment was developed so that aggregate spending for composite rates plus PO 00000 Frm 00048 Fmt 4701 Sfmt 4700 separately billed drugs would remain budget neutral for CY 2005. Section 1881(b)(12) of the Act, as added by section 623 (d) of the MMA, also contains two provisions related to adjustments to payments for drugs and biologicals for CY 2006. Section 1881(b)(12)(C)(ii) of the Act requires that we recalculate the 2005 add-on adjustment to reflect the difference between estimated payments using the AWP payment methodology and the payment methodology for 2006 which we proposed to be ASP+6 percent. In addition, section 1881(b)(12)(F) of the Act requires that, beginning in 2006, we establish an annual update adjustment to reflect estimated growth in expenditures for separately billable drugs and biologicals furnished by ESRD facilities. This update would be applied only to the drug add-on portion of the composite payment rate. In order to meet both requirements, we proposed to develop the CY 2006 drug add-on adjustment in two steps. First, we proposed to recalculate the CY 2005 add-on adjustment to reflect the difference in drug payments using 95 percent AWP pricing and payments using ASP+6 pricing. The result of this calculation would replace the current 8.7 percent adjustment and would be budget neutral to CY 2005 payments. Next, we proposed to develop a proposed annual update methodology that we would first use in CY 2006 to reflect the estimated growth in drug expenditures each year. As stated previously, this update would be applied only to the drug add-on portion of the composite payment rate. For specific details regarding the proposed adjustments, see the August 8, 2005 Federal Register (70 FR 45793 through 45800). As noted previously, we issued a correction to the proposed ESRD drug add-on adjustment contained in the proposed rule. In this notice we acknowledged that our estimation of the market shares for the top ten ESRD drugs that we used in the calculation of the proposed drug add-on for 2006 was incorrect. After further analysis of the 2003 expenditure data used to assign weights to the top ten ESRD drugs, we determined that our data did not account for 3 new ‘‘J’’ codes that were implemented in 2003. As a result, the weights for Iron Sucrose, Sodium Ferric Gluconate and Paricalcitol were understated. In addition, we noted that the weight for EPO incorrectly included expenditures for hospital-based facilities. Since the purpose of the weighting was to allocate the drug spread to all other drugs paid using the E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations proposed ASP+6 percent pricing, hospital-based data should not have been included because we paid for other hospital-based drugs based on cost. Table 16 shows the revised weights 70163 compared to the weights included in the proposed rule. TABLE 16.—REVISED TO REFLECT CORRECTION Published proposed weights Drugs Epogen ......................................................................................................................................................... Calcitriol ....................................................................................................................................................... Doxercalciferol ............................................................................................................................................. Iron dextran .................................................................................................................................................. Iron sucrose ................................................................................................................................................. Levocarnitine ................................................................................................................................................ Paricalcitol .................................................................................................................................................... Sodium ferric glut ......................................................................................................................................... Alteplase, Recombinant ............................................................................................................................... Vancomycin ................................................................................................................................................. We note that as a result of these data corrections, the top ten drugs account for 98 percent of total ESRD drug expenditures, rather than 92 percent as stated in the proposed rule. Using these revised weights, the proposed recalculated 2005 drug add-on adjustment was corrected to 10.4 percent, and the proposed 2006 update was corrected to 0.8 percent. The corrected total drug add-on adjustment proposed for 2006 was 11.3 percent. The proposed rule also discussed a method to estimate the drug spread applicable to hospital-based facilities for non-EPO drugs if we decided to implement ASP+6 percent pricing for all hospital-based drugs. This methodology would use the weighted average drug spread percent for independent facilities to estimate the drug spread for non-EPO drugs furnished by hospital-based ESRD facilities. The following sections discuss the comments we received on these issues and provide a detailed description of the final drug add-on adjustment to the ESRD composite payment rate that will be implemented January 1, 2006. Comment: We received a number of comments advocating that drug payments to hospital based facilities should be the same as to independent facilities. However, most of these comments raised no concerns regarding our proposed methodology for computing the drug spread applicable to hospital-based facilities. Two comments specifically supported our proposal to use the drug pricing drug spread from independent facilities to estimate the spread for hospital-based facilities. Two comments stated we should follow MedPAC’s suggestion that we collect data to estimate hospital-based facilities’ cost and Medicare payment per unit for ESRD drugs, but did not raise concerns with our proposed alternative method VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 for estimating the drug spread applicable to hospital-based facilities if we implemented ASP+6 percent pricing. MedPAC recommended that we use the same methodology to pay for all drugs (regardless of setting) and suggested that we could use dosing data from independent facilities to estimate ASP+6 payments for hospital-based facilities to compute the drug spread related to hospital-based facility drug payments. Response: Given both the MedPAC recommendation that ASP should be the basis of payment for all separately billable ESRD drugs and the overall support for providing consistent drug payments for both hospital-based and independent facilities, we have decided, in light of section 1881(b)(13)(A)(iii) of the Act, to implement ASP+6 percent pricing for hospital-based facilities beginning January 1, 2006. See section II.H.2 for a more detailed discussion of this issue. We are adopting the methodology outlined in the proposed rule to determine the drug spread applicable to hospital-based facilities and to calculate a drug add-on adjustment. We are also adopting the proposed methodology which would permit us to implement a change in payment to ASP+6 percent for all nonEPO drugs provided by hospital-based ESRD facilities. While we agree that the ideal approach would be to collect data from hospital-based facilities, this data collection would significantly delay implementation of a consistent ESRD drug payment policy. Absent the collection of data, we believe that using the estimation methodology described in the proposed rule brings us closer to the actual price of hospital drugs (ASP+6 percent) than does the policy of continuing to rely on reasonable costs. In response to MedPAC’s suggestion, we did an analysis of drug dosing units PO 00000 Frm 00049 Fmt 4701 Sfmt 4700 78.83 0.13 1.74 0.38 0.71 0.89 17.37 0.53 0.18 0.24 Revised proposed weights 69.33 0.84 1.48 0.23 7.03 0.77 14.61 4.96 0.56 0.19 from the billing data of independent facilities and were unable to determine accurate monthly average units from those bills, because facilities do not bill individual line items by date of service. As a result, the average monthly dose we computed for some drugs was significantly below the FDA expected monthly dose. In other words, the average monthly dose for the top ten ESRD drugs from independent facility data that we could use as a proxy for pricing the hospital-based bills was problematic. We believe the statute contemplates a single payment approach for separately billable ESRD drugs. Therefore, using our estimation proposal is a start towards MedPAC’s principle that the same prices should be paid for the same services across all settings which we believe is consistent with the statute. Furthermore, moving to ASP+6 percent pricing for hospitalbased facilities evens out the effect of the drug add-on adjustment between independent and hospital-based facilities. Therefore, we have computed the drug spread for non-EPO hospital based drugs using the weighted average drug spread percentage from independent facilities. We applied that percentage to the total hospital-based drug payments in order to estimate the amount of the drug spread as a result of revising the drug pricing methodology to ASP+6 percent for hospital-based facilities. We believe this method provides a reasonable estimation of the drug spread because, as explained previously, all drugs in both settings are based on ASP+6 pricing. Moreover, we believe that the benefits of implementing a consistent drug payment methodology outweighs any potential drawbacks that may result from estimating the drug spread without more precise data. We intend to pursue options for obtaining additional data to more accurately E:\FR\FM\21NOR2.SGM 21NOR2 70164 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations compute and update the drug add-on adjustment. Once more complete hospital-based ESRD drug data become available, we will re-examine the computation of the drug add-on adjustment and make any necessary revisions to our estimations. Comment: We received comments from two associations representing ESRD facilities that expressed concern about our interpretation of the statutory provision related to the drug add-on adjustment. These comments presented legal arguments challenging our decision to apply a single drug add-on adjustment that is applicable to both hospital-based and independent ESRD facilities. Both comments indicated that as long as separate drug payment methodologies are in place for hospitalbased facilities and independent facilities, the statutory text, structure, and legislative history requires that we establish distinct drug add-on adjustments. Another commenter recommended that the add-on adjustment should be directly linked to hospital-based and independent facilities based on the actual loss of revenue due to changes in reimbursement for separately billed drugs. Response: We continue to believe that our interpretation of this statutory provision represents the best reading of the statute as we explained, for reasons, discussed, in the CY 2005 final rule (see 69 FR 66319 through 66320). Accordingly, rather than adopting separate add-on adjustments for independent and hospital-based ESRD facilities, we are addressing the payment inequities expressed in the comments and pointed out in the MedPAC report that result from differential drug payment methodologies for hospital-based and independent facilities. As discussed previously, we are implementing a consistent drug payment methodology for all ESRD provider settings. In this way, we believe we have resolved the concerns expressed by these commenters in a manner consistent with the statute. a. Recalculation of the CY 2005 Drug Add-on Adjustment For CY 2006, we proposed to use the same method that we used to develop the drug add-on adjustment for CY 2005 to recalculate the 2005 adjustment to reflect the proposed revision to the ESRD drug payment methodology from acquisition costs to ASP+6 percent. That is, we proposed to calculate the spread based on the difference in aggregate payments between estimated payment based on AWP pricing and estimated VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 payment based on ASP+6 pricing. Although we proposed to use pricing data from the second quarter of CY 2005, we indicated that all of the data used to develop the proposed add-on adjustment would be updated for the final rule with comment, as more current data would be available. (1) Historical Drug Expenditure Data To develop the drug add-on adjustment for this final rule with comment, we used historical total aggregate payments for separately billed ESRD drugs for calendar years 2001, 2002, 2003, and 2004. For EPO, these payments were broken down according to type of ESRD facility (hospital-based versus independent). We also used the number of dialysis treatments performed by these two types of facilities over the same period. (2) ASP+6 Percent Prices In the proposed rule we used the ASP+6 percent prices for the second quarter of CY 2005. However, we indicated that we would use all four quarters of CY 2005 prices to develop the CY 2005 ASP payments. Comment: One commenter raised concerns regarding using four quarters of the ASP to determine an annual average. This commenter indicated that the most recent available quarter, specifically, the fourth quarter ASP prices of any CY represents the ASP for the entire year. This commenter recommended that, instead of using all four quarter of CY 2005, we use only the fourth quarter of CY 2005 ASP to calculate the difference in the aggregate payments based on 95 percent AWP pricing and the estimated payment based on ASP+6 percent. Response: We do not agree with this recommendation and have used the average of ASP prices in all four quarters of 2005 to calculate the add-on adjustment. The fourth quarter of the ASP represents only the most current ASP prices, and does not represent an aggregate annual average. Therefore, our calculation for ASP+6 percent includes not only the most current quarter (that is, the fourth quarter ASP) but also the previous three quarters of ASP pricing data for 2005). We believe this calculation provides the most accurate estimation of 2005 actual ASP+6 percent payments. We used four quarters of 2005 ASP+6 percent prices for the drugs listed in Table 17. We averaged these to develop prices representing the average 2005 ASP payments. PO 00000 Frm 00050 Fmt 4701 Sfmt 4700 TABLE 17 Average sales price plus 6% 2005 Drug Epogen ........................... Calcitriol .......................... Doxercalciferol ................ Iron dextran .................... Iron sucrose .................... Levocarnitine .................. Paricalcitol ...................... Sodium ferric glut ........... Alteplase, Recombinant .. Vancomycin .................... $9.30 0.75 2.19 11.21 0.36 12.30 3.92 4.74 30.61 2.95 (3) Estimated Medicare Payments Using 95 Percent of AWP In the proposed rule, we used the first quarter 2005 AWP prices and updated them to the second quarter by applying, for drugs other than EPO, an estimated AWP quarterly growth of approximately 0.74 percent. In order to estimate AWP payments for this final rule with comment, we used 4 quarters of 2005 AWP prices and averaged them to obtain prices representative of 2005 payment amounts. This methodology was not applied to the price for Epogen since payment was maintained at $10.00 per thousand units prior to MMA (see Table 18). TABLE 18 Drugs Epogen ........................... Calcitriol .......................... Doxercalciferol ................ Iron dextran .................... Iron sucrose .................... Levocarnitine .................. Paricalcitol ...................... Sodium ferric glut ........... Alteplase, Recombinant .. Vancomycin .................... 2005 average estimated medicare payments using 95% of AWP $10.00 1.36 3.98 17.91 0.65 36.48 5.32 8.17 31.89 3.79 (4) Dialysis Treatments In the proposed rule, using the most complete data available at the time, we estimated total dialysis treatments for 2005 at 34.5 million. Comment: We received comments suggesting that our estimate of dialysis treatments was overstated. Response: Using more recent data that has become available since we issued the proposed rule, we increased our projection of total number of dialysis treatments based on actuarially projected growth in the number of ESRD beneficiaries. Since Medicare covers a maximum of three treatments per week, utilization growth is limited, and, therefore, any increase in the number of E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations treatments should be due to beneficiary enrollment. The actual 2004 data we used in this final rule with comment, showed higher treatment counts than we had projected for 2004 in the proposed rule. Therefore, for CY 2005, we estimate there will be a total of 34.7 million treatments performed. (5) Drug Payments In the proposed rule, we updated drug payments for both EPO and non-EPO drugs using the estimated trend factor for EPO of 9.0 percent. We proposed using the EPO 9.0 percent trend factor for all drugs (not just for EPO) because EPO constitutes the largest proportion of drugs furnished by ESRD facilities and because we determined that the extremely varied growth in spending for non-EPO drugs between 2000 and 2003 prohibited a reliable trend analysis. As we indicated we would do in the proposed rule, we used later 2004 drug payment data for the final rule with comment and trended those data forward to 2005. Comment: We received a number of comments concerning our use of the EPO trend factor to update drug payments to 2005. These comments expressed concern that this resulted in understating the growth in ESRD drug payments. We also received comments that we should correlate the growth of EPO and other separately billable ESRD drugs. Response: Since we now have 2004 data, we have modified the trend factor to more accurately reflect the growth in drug payments. In addition, we have calculated trend factors for non-EPO drugs independently of those for EPO. We updated the total aggregate EPO drug payments for both hospital-based and independent facilities by using historical trend factors using data from 2001 through 2004. For CY 2005, the CY 2004 payment level was increased by a trend factor of 11.0 percent. Similarly, we updated the aggregate spending for separately billable drugs, other than EPO, for both hospital-based and independent facilities by using a historical trend factor of 15 percent. In addition, we deducted 50 cents for each administration of EPO from the total EPO spending for both hospitalbased and independent facilities to account for payment for syringes that were included in the EPO payments prior to the implementation of the MMA drug payment provisions. In the proposed rule, we estimated the cost of syringes at $1.6 million for hospital-based facilities and $26.8 million for independent facilities. Comment: We received comments that the proposed $26.8 million dollars estimated for syringe payments to independent facilities was too high, because the estimated number of administrations of EPO exceeded the number of treatments. Response: We have re-estimated the syringe payments to take into account problems we encountered related to the administrations field on the dialysis bills. Thus for the final rule with comment, we are calculating syringe payments as 50 cents multiplied by 90 percent of estimated treatments for 2005. The 90 percent represents the percent of dialysis patients that receive EPO. Since we only pay for one administration per treatment we applied this 90 percent to total treatments in order to estimate the number of EPO administrations. Using this methodology, for CY 2005, we estimate payments for these syringes will amount to $1.8 million for hospitalbased facilities and $13.8 million for independent facilities. For CY 2005, we estimate that total spending for separately billable drugs will reach $462 million for drugs provided in hospital-based facilities ($217 million for EPO and $245 million for other drugs), and $3.102 billion for drugs provided in independent facilities ($2.082 billion for EPO and $1.019 billion for other drugs). Comment: One comment indicated that we were eliminating separate payments for syringes. Response: We believe the commenter misunderstood our payment policy. We currently pay separately for syringes used to administer ESRD drugs, and will 70165 continue to do so. We began paying separately for the syringes associated with administration of EPO when EPO payment was revised from payment at $10 per 1,000 units in 2005. While the previous $10 payment included payment for syringes, the new payment methodology does not. We have not modified our approach to paying for syringes in general, but now also pay separately for syringes associated with the administration of EPO. (6) Add-On Calculation and Budget Neutrality In the August 8, 2005 proposed rule (70 FR 45789), we acknowledged a mistake in our calculation of the proposed drug add-on adjustment. The proposed 2005 recalculated add-on adjustment was 10.4 percent. In addition, we indicated in the proposed rule that we intended to include more recent 2004 billing data in the calculation of the final drug add-on adjustment. Comment: We received a number of comments commending us for responding to industry concerns by making the corrections to the proposed add-on calculation and urging us to use the most accurate, up-to-date data and trends available to compute the 2005 budget-neutral add-on adjustment. Response: We have taken these comments into consideration and have updated all of the data and assumptions used to calculate the add-on adjustment as described below. For each of the top ten drugs, we calculated the percent by which ASP+6 percent is projected to be less than payment amounts under the 95 percent of AWP pricing system for 2005. We then calculated a weighted average of the percentages by which ASP+6 percent would be below 95 percent of AWP payment amounts, for the top 10 ESRD drugs for independent facilities. We weighted these percentages by using the 2005 estimated Medicare payment amounts for the top ten drugs. This procedure resulted in a weighted average payment difference of 16 percent. TABLE 19 2005 estimated medicare payment weights as a percentage of total drug expenditures Drugs Percent by which ASP+6% prices are below 95% of AWP prices 67.96 0.45 3.62 0.11 7.79 7.03 44.74 44.94 37.40 44.50 Epogen ......................................................................................................................................................... Calcitriol ....................................................................................................................................................... Doxercalciferol ............................................................................................................................................. Iron dextran .................................................................................................................................................. Iron sucrose ................................................................................................................................................. VerDate Aug<31>2005 15:52 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00051 Fmt 4701 Sfmt 4700 E:\FR\FM\21NOR2.SGM 21NOR2 70166 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations TABLE 19—Continued 2005 estimated medicare payment weights as a percentage of total drug expenditures Drugs Percent by which ASP+6% prices are below 95% of AWP prices 1.11 13.38 4.64 0.75 0.20 66.27 26.44 41.96 4.00 22.20 Levocarnitine ................................................................................................................................................ Paricalcitol .................................................................................................................................................... Sodium ferric glut ......................................................................................................................................... Alteplase, Recombinant ............................................................................................................................... Vancomycin ................................................................................................................................................. Since we estimate that these 10 drugs represent nearly 98 percent of total 2005 drug payments to both hospital-based and independent facilities, we applied the weighted average to 100 percent or all of aggregate drug spending projections for hospital-based and independent facilities, producing a projected difference of $585 million (the sum of $76 million for hospital-based and $509 for independent facilities). Since we do not currently have reliable data on dosing units from hospitalbased bills, we believe it is reasonable, as discussed above, to proxy the drug spread for hospital-based facilities using the spread for independent facilities. The weighted average is applied to 100 percent of drug spending projections for hospital-based and independent facilities. Distributing the total 2005 figure of $585 million over a total projected 34.7 million treatments results in a revised 2005 add-on to the per treatment composite rate of 13.1 percent. This compares to the proposed adjustment of 10.4 percent. By making this adjustment to the composite rate, we estimate that the aggregate payments to ESRD facilities would be budget neutral for drug payments for 2005, as required by the MMA. We note that, beginning January 1, 2006, this 13.1 percent adjustment replaces the 8.7 percent adjustment currently in effect for CY 2005. b. Calculation of the Proposed CY 2006 Inflation Update to the Drug Add-On Adjustment The proposed rule described the approach we proposed to use to update the drug add-on adjustment to account for the estimated growth in drug expenditures between 2005 and 2006. Based on the most recent, complete data that was available at the time, we proposed a 2006 inflation adjustment of 0.8 percent to the drug add-on to the composite payment to reflect the estimated growth in drug expenditures between 2005 and 2006. While we received no comments specific to the VerDate Aug<31>2005 15:52 Nov 18, 2005 Jkt 208001 add-on inflation adjustment, we did receive comment about our growth projections used to calculate the adjustment. Those comments were addressed in the previous section. (1) Drug Payments and Dialysis Treatments Similar to the above mentioned process, we updated the total aggregate EPO drug spending for hospital-based and independent facilities using historical trend factors. For 2006, the EPO payment level was increased from 2005 by a trend factor of 11.0 percent. We also updated aggregate spending for separately billable drugs, other than EPO, for both hospital-based and independent facilities by a trend factor of 15 percent. This procedure resulted in projected drug expenditures of $523 million for drugs provided in hospital based facilities ($240 million for EPO and $283 million for other drugs) and $3.481 billion for drugs provided in independent facilities ($2.306 billion for EPO and $1.175 billion for other drugs). These numbers include an estimated reduction for the 50 cent payment for syringes of $1.9 million for hospitalbased facilities and $14.1 million for independent facilities. We also updated the projected number of dialysis treatments using actuarial enrollment projections. This resulted in total of 35.6 million treatments for 2006. (2) Adjustment to Composite Rate AddOn The proposed computation of the 2006 inflation adjustment to the composite rate was 0.8 percent. We have updated our projected inflation adjustment for the drug add-on and have included data for non-EPO hospital-based drugs into the computation. Since EPO is updated at an average trend of 11 percent and other separately billable drugs are updated by a trend factor of 15 percent, for both hospitalbased and independent facilities, for 2006 we computed a combined weighted average growth in total drug PO 00000 Frm 00052 Fmt 4701 Sfmt 4700 expenditures of 12.3 percent, based on the relative proportions of EPO and nonEPO drugs. We then applied the 12.3 percent projected growth in aggregate drug expenditures between 2005 and 2006 to the 2005 drug add-on figure of $585 million. This resulted in a projected incremental increase in the drug spread for 2006 of $72 million ($9 million for drugs furnished by hospitalbased facilities and $63 million for drugs furnished by independent facilities). We distributed the $72 million over 35.6 million projected treatments, resulting in a 1.4 percent increase to the 2005 composite payment rate. Comment: We received a number of comments regarding an annual update factor. Several comments recommended that we should provide an annual update to the composite rate. The specific recommendation suggested an annual market basket update in the composite rate equivalent to the MedPAC recommendation of an increase to the composite payment rate of 2.5 percent in 2006. The comments further acknowledged that the creation of an annual market basket update requires Congressional action. Response: Because Congressional action is required, there is no specific provision in the current statute or regulations for an annual update for the composite payment rate based on the ESRD market basket rate of increase. However, the statute does, in effect, provide for an annual update to the drug add-on to the composite payment rate. As discussed previously, the statute requires that we annually update the amount of the drug spread included in the composite payment rate, based on the projected growth in drug expenditure between 2005 and 2006. We are providing an inflation adjustment to the composite payment rate of 1.4 percent. Even though this inflation adjustment is part of the overall add-on adjustment, the overall effect for 2006 is equal to an update of 1.4 percent. E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations In addition, we note that as part of our work on the development of a fully bundled prospective payment system (PPS) for ESRD facilities, we will be developing an update framework that would include an ESRD market basket factor. We expect to include a discussion of this update framework as part of a Report to Congress on a fully bundled PPS for outpatient ESRD facilities. This report is still under development. Comment: One comment stated that the add-on adjustment to the composite rate should be reflected as an absolute dollar amount rather than a percentage, stating that there is no logical reason why the drug add-on component should be adjusted by a wage index. Response: Section 1881(b)(12)(A) of the Act which was added by the MMA, required the establishment of a ‘‘casemix adjusted prospective payment system for dialysis services’’ that included: (1) The composite rate; (2) case-mix adjustment for a limited number of patient characteristics; and (3) a drug add-on adjustment to the composite rate to account for the difference in drug payments compared to the previous drug pricing methodology. Section 1881(b)(12)(D) requires that payments under this system be adjusted by a geographic index. Therefore, we are required to apply the wage index to all components of the case-mix adjusted composite rate system. c. Drug Add-On Adjustment for 2006 With the CY 2005 add-on to the per treatment composite rate being 13.1 percent and the additional increment for expenditures in CY 2006 being 1.4 percent, the combined drug add-on adjustment for 2006 is 14.7 percent (1.131 × 1.014). 3. Revisions to Geographic Designations and Wage Indexes Applied to the ESRD Composite Payment Rate Section 1881(b)(12)(D) of the Act, as added by section 623(d) of the MMA, gave the Secretary the discretionary authority to revise the current wage index incorporated in the ESRD composite payment rates. That provision also requires that any revised wage index be phased in over a multiyear period. We proposed to adopt OMB’s revised geographic definitions (announced in OMB Bulletin No. 03–04, issued June 6, 2003) to determine urban and rural locales for purposes of calculating ESRD composite payment rates, beginning January 1, 2006. In conjunction with using OMB’s geographic designations, we proposed to recalculate the ESRD wage index based VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 on acute care hospital wage and employment data for FY 2002, as reported to us in connection with development of the wage index used in the inpatient hospital prospective payment system (IPPS). We also proposed to update the labor portion of the ESRD composite rate to which the wage index is applied. Below we discuss comments we received on these proposals and our final determinations regarding CY 2006 revisions to the wage index adjustment as it is applied to the ESRD composite payment rate. a. Use of Revised OMB Geographic Area Designations To Determine Urban and Rural Locales for ESRD Composite Payment Rates In the August 8, 2005 proposed rule, we proposed to use OMB’s revised corebased statistical area (CBSA)-based definitions for Metropolitan Statistical Areas, New England County Metropolitan Areas, and Micropolitan Statistical Areas, announced in OMB Bulletin 03–04 (June 6, 2003) as the basis for revising the urban/rural locales and corresponding wage index values reflected in the composite payment rates. The definitions we proposed are the same urban and rural definitions used for the Medicare IPPS, but without regard to geographic reclassifications authorized under section 1886(d)(8) and (d)(10) of the Act. In conjunction with adopting OMB’s geographic classifications, we proposed replacing the current weighted wage index based on a 60/40 blend of Bureau of Labor Statistics (BLS) and hospital wage index values with one developed exclusively from acute care hospital wage and employment data obtained from the Medicare hospital cost reports. We proposed to update the wage index annually. For a full discussion of our proposals, see the August 8, 2005 proposed rule (70 FR 45793 through 45800). The following section contains a summary of the comments that we received on the proposed wage index revisions. Comment: Several commenters, generally those representing independent ESRD facilities located in rural areas, opposed implementation of the CBSA based wage index. The commenters expressed concern that the proposed wage index would jeopardize beneficiary access to care, and left little protection for rural facilities. Some commenters pointed out the amount of the reduction in composite payments that specific providers would incur based on the proposed urban/rural definitions and revised wage index values. PO 00000 Frm 00053 Fmt 4701 Sfmt 4700 70167 Response: The current urban/rural definitions reflected in the composite payment rates have been in effect for over 20 years, and needed to be updated. By revising those definitions to conform with the latest available OMB geographic designations as explained in the August 8, 2005 proposed rule, we believe that we are complying with the express intent of the Congress permitting revision of those designations, as set forth in section 1881(b)(12)(D) of the Act. While our authority to revise the current ESRD wage index is discretionary, we believe this revision is essential if the composite rates are to reflect accurately the costs of providing ESRD services. None of the commenters proposed an alternative to our proposed geographic classification system. Because we must have a national classification system built on clear objective standards, we are adopting the CBSA based urban/ rural definitions, as described in our proposed rule. As to commenters’ concerns about any reductions in the base composite payment rates, we have taken these concerns into consideration and have adopted a transition policy concerning the wage index. We address commenter’s comments and provide a more detailed discussion of our transition policy in section II.3.c. of this final rule with comment. Comment: While several commenters supported the implementation of the new CBSA based wage index, they expressed concern over the potential impact on independent ESRD facilities, particularly those located in rural areas. The most frequent recommendations to reduce the impact of any payment reductions were to extend the proposed transition period from 2 to 5 years, and provide annual updates of the wage index in each of those years. Response: We agree that the new CBSA based wage index should be revised periodically to account for not only changes in labor market conditions, but also any future revisions in the definitions of the Metropolitan Statistical Areas and other geographic designations which may be announced by OMB. We will revise the ESRD wage index annually using the most recent Medicare cost report data as is used in the Medicare hospital IPPS. We also agree that the proposed transition period of 2 years may not be sufficiently long to provide ESRD facilities with enough time to adapt to the new wage index and have extended the transition period to 4 years. For a more complete discussion of our policies to help ESRD facilities adapt to the OMB geographic designations and wage index revisions E:\FR\FM\21NOR2.SGM 21NOR2 70168 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations we have adopted for ESRD purposes (see section C of this preamble). Comment: Several commenters endorsed our adoption of the proposed wage index based on the revised OMB definitions. However, the commenters were critical of what they perceived to be a lack of transparency in the data and methodology used to develop the new wage index, especially the budget neutrality adjustment. The commenters requested that we provide the data and methodology used to calculate the new wage index values and BNF. Response: For purposes of adjusting the labor-related portion of the CY 2006 ESRD composite rate, we are using the most recent hospital wage data applicable to FY 2006 payments as discussed previously in this section. We start with the wage index used by the Skilled Nursing Home Prospective Payment System (SNF PPS) and multiply this index by a numeric factor, which is the budget neutrality adjustment. We use the SNF PPS wage index because we believe it reflects the most recent data, and is consistent with all other non-acute care facility payment systems. As explained earlier in this section, we begin with the same wage index values as those used by the SNF and multiply those values by the BNF (See Tables 21 and 22). The methodology for creating this wage index BNF is explained in further detail below. The wage index measures relative differences in the average hourly wage for the hospitals in each labor market area compared to the national average hourly wage. As stated previously, for ESRD payment purposes the wage index values are based on wage data as reported by hospitals on their Medicare cost reports. The wage data used to construct the wage index are updated annually, based on the most current data available. Accordingly, 2002 wage data were used to construct the wage index values used in this final rule with comment and 2003 wage data will be used to construct the wage index that we intend to use for the ESRD composite rate for CY 2007. For each geographic area, wage data for all providers in that area are combined. The sum of all wages for all providers in that geographic area is divided by the total hours for all providers in that geographic area. The result is the average hourly rate for that geographic area. This data can be found at the following link: https:// www.cms.hhs.gov/providers/hipps/ ippswage.asp. The data will be found under the section labeled, ‘‘FY 2006 Wage Index Public Use Files’’, and contains average VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 hourly rate data and wage index. The index is computed by dividing the average hourly rate for each geographic area within the CBSA by the national average hourly wage. As we noted earlier, for the ESRD wage index we are using hospital wage data without regard to any approved geographic reclassification authorized under sections 1886(d)(8) and (d)(10) of the Act or other provision that only applies to hospitals paid under the IPPS. For purposes of the ESRD wage index methodology, the data we use is pre-reclassified, pre-floor hospital data and unadjusted by occupational mix. The final step is to multiply each wage index value by the wage index budget neutrality factor (BNF) (see section 4 for details about this adjustment). Comment: One commenter strongly objected to our proposed implementation of the CBSA based wage index. The commenter maintained that we have failed to examine the entire dialysis patient delivery system taken as a whole. Specifically, we have not recognized that rural facilities generally have lower utilization, and consequently higher costs per treatment, especially for overhead and supplies, compared to urban facilities. The commenter offered three options for consideration-the establishment of one composite rate for all dialysis facilities, the creation of a special composite rate adjustment factor that compensates rural facilities for their higher overhead costs due to lower utilization, or the creation of an explicit exception for higher rural facility overhead costs. Response: We recognize that large chain dialysis providers operate with the benefit of economies of scale, and may be better able to adapt to the impact of policy changes to the composite payment rates. However, we have no evidence to indicate that rural facilities have higher overhead and supply costs per treatment. Payments to rural facilities are lower compared to urban facilities because rural facility composite rate costs, including labor costs, are generally lower. We do not believe our use of a CBSA-based wage index would change our conclusion, however, as noted below, we will continue to monitor provider cost data. Moreover, section 623(b) of the MMA and section 422(a)(2) of BIPA prohibit the granting of new exceptions for the composite rate, except for pediatric ESRD facilities. b. Revised Labor-Related Portion The current composite rate wage index is applied to two different laborrelated shares, 40.65 percent for PO 00000 Frm 00054 Fmt 4701 Sfmt 4700 independent facilities and 36.78 percent for hospital-based facilities. Given the age of the cost data used to develop these shares, we proposed revising the labor-related portion of the composite rate based on the ESRD composite rate market basket contained in our May 2003 Report to Congress on developing a bundled outpatient ESRD payment system. We proposed the use of a single labor-related share of 53.711 percent that would apply to both hospital-based and independent facilities. This proportion was based on the sum of the labor-related categories of costs that comprise the ESRD market basket. (70 FR 45796 through 45798). We received the following comments on this proposal. Comment: One commenter criticized our use of the ESRD composite rate market basket developed from CY 1997 data to revise the labor related-portion of composite rate costs subject to wage index adjustment. The commenter maintained that the use of more recent cost report data to develop a revised labor-related share would be more reflective of current economic realities. Another commenter recommended that we use the hospital market basket, which was developed from fiscal year 2002 data, instead. The commenter reasoned that the hospital market basket would be a more appropriate measure, not only because it reflects more recent data, but also because ESRD facilities compete with hospitals for labor and use the same vendors for supplies. Response: Calendar year 1997 was the most recent year for which relatively complete data were available when the ESRD composite rate market basket was developed in 2003. Until the ESRD market basket is rebased to incorporate later data, we believe it is proper to use the 1997-based ESRD composite rate market basket to determine the laborrelated share because it reflects the cost structures of ESRD facilities serving Medicare beneficiaries. We will continue to evaluate the available data on ESRD facilities and expect to periodically rebase the ESRD market basket when appropriate. We disagree with the commenter’s recommendation to use the 2002-based hospital market basket to determine the labor-related share for ESRD facilities. We believe the 1997-based ESRD market basket best reflects the types of medical services and cost structures used by ESRD facilities. This is consistent with other payment systems that use individually tailored market baskets to determine their labor-related share. Comment: One commenter attempted to replicate the basic composite payment rate (that is, the payment rate E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations prior to application of the drug add on and patient specific case-mix adjustments) for the Orlando, Florida MSA. The commenter inquired whether the proposed revised wage index for each urban/rural area is applied to 40 percent or 100 percent of the wage adjustment reflected in the current composite payment rates. Response: The published wage index applicable to each urban/rural area is neither applied to 40 percent nor 100 percent of the composite payment rate’s current wage adjustment. We currently multiply the current wage index by one of two different labor-related portions of the composite payment rates, depending on the type of ESRD facility. The portion is 40.65 percent for independent facilities and 36.78 percent for hospitalbased facilities. However, the composite rate wage index itself is a blend of two separate wage index values. Of the current measure, 40 percent, is based on the hospital wage index calculated from fiscal year 1986 data, and 60 percent is based on the hospital wage index calculated from 1980 BLS data. However, in our August 8, 2005 proposed rule, we proposed making the labor-related portion the same for both hospital-based and independent ESRD facilities. That proportion (53.711 percent) was developed from the laborrelated components of the ESRD composite rate market basket. Moreover, the proposed wage index is not a blended measure. It was developed exclusively from hospital wage and employment data for fiscal year 2002 obtained from the Medicare hospital cost reports. We proposed to apply the proposed wage index values to 100 percent of the 53.711 percent laborrelated share. The revised labor-related shares applicable to hospital-based and independent ESRD facilities were contained in Table 26 of our proposed rule. Using data contained in Table 26 in our proposed rule, we calculated that the basic composite payment rate for hospital-based ESRD facilities in the Orlando MSA would have been $71.12 × 0.9677 + $61.29 or $130.11. For independent facilities the rate would have been $68.94 × 0.9677 + $59.41 or $126.12. c. Adoption of Floor/Ceiling Wage Index Values and Transition Policies for Implementation of Revised Wage Index The wage index values in the current composite payment rates reflect a floor of 0.90 and a cap of 1.30. In the August 8, 2005 rule, we proposed eliminating the cap because of the effect it has had on restricting payments in high wage areas. While we stated that we would like to remove the floor as well, we were VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 concerned that its immediate elimination could adversely affect beneficiary access to dialysis. To mitigate any potential adverse impact, we proposed a gradual reduction in the floor to 0.85 for 2006 and 0.80 in 2007, with a reevaluation of continued need for the floor in 2008. We also proposed a 2-year transition for implementation of the new composite payment rates, but only for those facilities whose CBSA based payment decreased. Under the proposed transition, facilities would be paid the higher of the new wage adjusted composite rate, or a 50–50 blend of the current wage adjusted rate and the new wage adjusted rate (70 FR 45798 through 45799). We received the following comments regarding the proposed ceiling and floor wage index values and the 2-year transition period. Comment: Several commenters representing facilities whose payment rates would increase as a result of the revised urban/rural definitions and wage index values, endorsed the immediate introduction of the new basic composite payment rates. Other commenters either supported the proposed 2-year transition period, or recommended longer transitions of varying duration to mitigate further the impact of reduced composite payments. Response: Most commenters endorsed our proposal to provide for a transition period to mitigate the impact of the revised CBSA based composite payment rates, but believed that a 2-year transition was too short. The recommended transition periods, generally ranged from 3 to 5 years, with several commenters supporting a transition period of 5 years. We agree that a longer transition period is appropriate to allow ESRD facilities sufficient time to adjust to the new CBSA based wage index, and have selected 4 years as a reasonable compromise among the recommended alternatives. While a 4-year transition is longer than the transition in other payment systems, we believe it is justified in the case of ESRD facilities because the wage data currently used for the wage index is over 20 years old. Thus, facilities need more than the usual transition. However, we will apply the 4-year transition period to all ESRD facilities, those whose base composite payment rates compared to those currently in effect increase as well as decrease. This represents a change from our proposed policy of applying a transition period only to those facilities whose composite payment rates decreased. We believe that a transition period of 4 years applied to all ESRD facilities achieves a reasonable balance PO 00000 Frm 00055 Fmt 4701 Sfmt 4700 70169 between cushioning the impact for providers whose CBSA based composite payment rates decrease, and implementing the CBSA based wage index as quickly as possible. Comment: We received several comments on our proposal to reduce gradually the wage index floor from its current level of 0.90, to 0.85 in 2006 and 0.80 in 2007. The comments included keeping the floor at 0.90, maintaining the floor at 0.90 but simultaneously increasing the ceiling from its current level of 1.30 to 1.40, and phasing out the floor as proposed, but also extending the phase out to the wage index ceiling as well. Response: We recognize that only immediate elimination of the 0.90 floor could substantially reduce composite payments in locales where prevailing labor costs are lower. Although ESRD facilities in areas with wage levels below 0.90 have benefited from the application of the floor, we are concerned that its sudden elimination could adversely affect ESRD beneficiary access to care. In the August 8, 2005 rule, we proposed lifting the wage index cap of 1.30 entirely in 2006 because it has restricted payments in areas with high labor costs. Under our proposal ESRD facilities whose base composite payment rate increased would receive the full payment amount per treatment without regard to the cap. We have carefully reconsidered our proposal in light of concerns over the potential impact of the use of new CBSA-based geographic designations and wage index values on ESRD facilities that will experience a decrease in their composite payments. We believe that it would be more consistent and equitable for all ESRD facilities if we phased out the wage index floor and eliminated the ceiling. Accordingly, we are implementing a 4-year transition period that will apply to all ESRD facilities, those experiencing either an increase or decrease in their base composite payment rate for 2006. Although the present wage index ceiling of 1.30 will be eliminated in 2006, facilities whose payments have been restricted by the ceiling would not receive 100 percent of their otherwise applicable base composite payment per treatment without the ceiling until 2009. This occurs as a result of blending the proportion of old MSA and new CBSA based wage adjusted composite rates over the 4-year transition period as shown in Table 20. By applying blended shares during the 4-year transition period to all ESRD facilities, we believe we can achieve a balance between our goals of preserving access to care in low E:\FR\FM\21NOR2.SGM 21NOR2 70170 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations wage areas and the ultimate elimination of constraints on the wage index. The wage index floors, caps, and blended shares of the base composite payment rates applicable to all ESRD facilities for CYs 2006 through 2009 are detailed in Table 20. TABLE 20.—WAGE INDEX TRANSITION BLEND CY payment 2006 2007 2008 2009 ......................... ......................... ......................... ......................... Floor Ceiling 0.85 * ......................................................... 0.80 * ......................................................... Reassess ................................................... Reassess ................................................... None None None None Old MSA .......................................................... .......................................................... .......................................................... .......................................................... New CBSA 75 50 25 0 25 50 75 100 * Each wage index floor is multiplied by a budget neutrality adjustment factor. For CY 2006 the budget neutrality adjustment is 1.045287 resulting in an actual wage index floor of .8885. We plan to reassess the continuing application of the wage index floor in connection with the 2008 update to the composite payment rates. An example of how the base composite payment rates would be blended during the 4 year transition period to reflect the old MSA and new CBSA based geographic designating follows. Assume an ESRD facility whose base composite payment rate (that is, without regard to any case-mix adjustments) is $135.00 per treatment in 2005. Based on the new CBSA wage index designations, its base composite payment rate is $145.00 for 2006. This facility’s blended rate during each year of the 4 year transition period would be as follows: CY 2006—.75 × $135.00 + .25 × $145.00 = $137.50 CY 2007—.50 × $135.00 + .50 × $145.00 = $140.00 CY 2008—.25 × $135.00 + .75 × $145.00 = $142.00 CY 2009—0 × $135.00 + 1.0 × $145.00 = $145.00 Of course, this hypothetical assumes that the calculated rate of $145.00 for 2006 will not change in 2007 and the following years. In actuality, it would because of annual revisions to the wage index. However, the example serves to illustrate how the new CBSA-based composite payment rates will be phased-in during the 4 year transition period, regardless of whether an ESRD facility’s base composite payment increases or decreases in 2006 compared to 2005. Comment: One commenter endorsed our proposed elimination of the wage index cap, but was concerned that isolated rural ESRD facilities, whose wage levels are generally lower than those prevailing in urban locales, could be adversely affected, even with the proposed floor wage index values. The commenter recommended that these facilities continue to be permitted to receive the isolated essential facility exception to their otherwise applicable VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 composite payment rate under § 413.186. Response: ESRD facilities which have been granted exceptions to their composite payment rates, including those granted under the authority of § 413.186, have the option of either retaining their exceptions, or becoming subject to the case-mix adjusted composite payments, at any time. Beyond this option, we have no discretion to grant new exceptions under § 413.186. Section 422(a)(2) of BIPA, as amended by section 623(b) of the MMA, eliminated the granting of new exceptions to the composite payment rates except for ESRD facilities qualifying as pediatric facilities. We believe that the wage index floors of 0.85 for 2006 and 0.80 for 2007, the extension of the transition period from 2 to 4 years, and affording facilities the option of retaining previously granted exceptions, should help cushion any potential adverse impact to ESRD facilities located in isolated rural areas. Comment: Several commenters expressed particular concern over the relatively large reduction in payment rates for dialysis facilities in certain rural areas and in certain States. While most of these locales were unspecified, some commenters used Ohio out as an example, noting that implementation of the revised wage index would reduce payment rates in Ohio by more than $14.00 per treatment. The commenters requested that we provide a State specific impact analysis, delay implementation of the proposed revised composite payment rates for a 6-month period, and engage in dialysis community discussions to determine whether changes to the proposed wage index floor values and modification of the proposed 2-year transition period, would be necessary. Response: We strive to engage in discussions with the dialysis community concerning ESRD payment policies, such as our open door forums where the dialysis community can provide input to CMS on ESRD issues. PO 00000 Frm 00056 Fmt 4701 Sfmt 4700 Moreover, as noted previously, based in part on the comments received we are implementing revisions to our proposed policies regarding continuation of the wage index floor and ceiling, and the duration of the transition period. These changes should lessen the impact of our adoption of CBSA-based geographic designations and revised wage index values for ESRD services. We believe that no 6-month delay in implementing the revised composite payment rates is necessary. To respond to the commenter’s suggestion that we provide a State-specific impact analysis, we have provided this information in Table 52. We are extending the proposed 2year transition to a 4-year transition to allow affected facilities to adjust to the revised wage indices. Comment: We received several comments which endorsed a phase in of the new CBSA based wage index based on a 50/50 split, similar to the wage index adopted in connection with the FY 2006 SNF PPS. Response: The FY 2006 SNF PPS, published in the Federal Register on August 4, 2005 (70 FR 45026), adopted a wage index consisting of a blend of 50 percent of the FY 2006 MSA-based wage index, and 50 percent of the FY 2006 CBSA-based wage index, both of which were developed from FY 2002 hospital wage data (70 FR 45041). This blended wage index is effective for a 1 year period. As the current ESRD wage index is obsolete, we see no reason to use it as a part of a blended measure which would then reflect an outdated wage index as part of a transition mechanism. 4. ESRD Wage Index Budget Neutrality Section 623(d) of MMA added section 1881(b)(12)(E)(i) to the Act which requires that any revisions to the ESRD composite rate payment system as a result of the MMA provision (including the geographic adjustment) be made in a budget neutral manner. This means that aggregate payments to ESRD facilities in CY 2006 should be the same aggregate payments that would have E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations been made if we had not made any changes to the geographic adjusters. We proposed to apply a budget neutrality adjustment factor directly to the revised ESRD wage index values, rather than applying the adjustment to the base composite payment rates. We believe this is the simplest approach since it allows us to maintain a base composite rate for hospital-based facilities and one for independent facilities during the transition from the current wage adjustments to the revised wage adjustments. The proposed budget neutrality adjustment was 1.023024. For CY 2006, we will apply the budget neutrality adjustment factor directly to the revised ESRD wage index values. Since we will be transitioning to the new wage index over a 4-year period, the computation of the adjustment factor varies slightly from our proposal. However, the basic method and concept is still the same as we proposed. In order to compute the proposed wage index BNF, we used treatment counts from CY 2004 billing data and facility-specific CY 2005 composite payment rates. For purposes of adjusting the labor-related portion of the CY 2006 ESRD composite rate, we are using the most recent hospital wage data applicable to FY 2006 payments as discussed previously in this section. Using treatment counts from the 2004 claims and facility-specific CY 2005 composite payment rates, we computed the estimated dollar amount each ESRD provider would have received had there been no changes to the ESRD wage VerDate Aug<31>2005 15:52 Nov 18, 2005 Jkt 208001 index. This becomes the target amount of expenditures for all ESRD facilities. Then we computed the estimated dollar amount that would have been paid to the same ESRD facilities using the revised ESRD wage index (including the 4-year transition). In the first year of the transition, ESRD facilities receive 25 percent of the CBSA wage adjusted composite rate and 75 percent of the current composite rate. This becomes the first year new amount of expenditures for all ESRD facilities. After comparing these two dollar amounts (target amount divided by first year new amount), we calculate an adjustment factor that, when multiplied by the ESRD wage index, will result in the target amount of expenditures for all ESRD facilities. Since the ESRD wage index is only applied to the laborrelated portion of the composite rate payment, we computed the adjustment based on that proportion (53.711 percent). We apply the estimated budget neutrality adjustment factor to the revised wage index values for CY 2006 to ensure that estimated aggregate payments to ESRD facilities would remain budget neutral. The final wage index BNF adjustment factor is 1.045287. Applying this budget neutrality to the wage index floor of 0.8500, results in a wage index floor for 2006 of 0.8885. As stated earlier, the data used to compute the BNF are the wage index values in Table 21 and 22, the 2004 100 percent Outpatient Standard Analytic File (SAF) Claims, and geographic location information for each facility PO 00000 Frm 00057 Fmt 4701 Sfmt 4700 70171 which may be found through Dialysis Facility Compare. Comment: Several commenters requested that we provide the data and methodology used to compute the wage index BNF. Response: The purpose of the wage index BNF is to achieve budget neutrality as required by section 623(d) of the MMA, which added section 1881(b)(12)(E)(i) to the Act. That provision of the Act requires that any revisions to the ESRD composite rate payment system (including the geographic adjustment) must be made in a budget neutral manner. This means that aggregate payments to ESRD facilities in CY 2006 should be the same as aggregate payments that would have been made if we had not made any changes to the geographic adjusters. The methodology for computing the wage index BNF is described earlier in this section. The data used to compute the BNF are the wage index values in Tables 21 and 22, the 2004 100 percent Outpatient Standard Analytic File (SAF) Claims, and geographic location information for each provider which may be found through Dialysis Facility Compare. Dialysis Facility Compare can be found by going to the following link: https:// www.medicare/Download/ DOWNLOADDB.asp. d. Wage Index Table The following two tables show the ESRD wage indexes for urban areas (Table 21) and rural areas (Table 22). BILLING CODE 4120–01–U E:\FR\FM\21NOR2.SGM 21NOR2 VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00058 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.012</GPH> 70172 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00059 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70173 ER21NO05.013</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00060 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.014</GPH> 70174 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00061 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70175 ER21NO05.015</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00062 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.016</GPH> 70176 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00063 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70177 ER21NO05.017</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00064 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.018</GPH> 70178 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00065 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70179 ER21NO05.019</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00066 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.020</GPH> 70180 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00067 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70181 ER21NO05.021</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00068 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.022</GPH> 70182 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00069 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70183 ER21NO05.023</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00070 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.024</GPH> 70184 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00071 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70185 ER21NO05.025</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00072 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.026</GPH> 70186 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00073 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70187 ER21NO05.027</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00074 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.028</GPH> 70188 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00075 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70189 ER21NO05.029</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00076 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.030</GPH> 70190 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00077 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70191 ER21NO05.031</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00078 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.032</GPH> 70192 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00079 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70193 ER21NO05.033</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00080 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.034</GPH> 70194 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00081 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70195 ER21NO05.035</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00082 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.036</GPH> 70196 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00083 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70197 ER21NO05.037</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00084 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.038</GPH> 70198 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00085 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70199 ER21NO05.039</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00086 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.040</GPH> 70200 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00087 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70201 ER21NO05.041</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00088 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.042</GPH> 70202 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00089 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70203 ER21NO05.043</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00090 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.044</GPH> 70204 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00091 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70205 ER21NO05.045</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00092 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.046</GPH> 70206 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00093 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70207 ER21NO05.047</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00094 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.048</GPH> 70208 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00095 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70209 ER21NO05.049</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00096 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.050</GPH> 70210 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00097 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70211 ER21NO05.051</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70212 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00098 Fmt 4701 Sfmt 4700 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.052</GPH> BILLING CODE 4120–01–C Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 4. Miscellaneous Comments on ESRD Issues We propose to make no changes to the existing case-mix adjustment system. We proposed to maintain the existing system as established in the CY 2005 final rule (69 FR 66238) and implemented on April 1, 2005. Comment: One commenter recommended that we stop the implementation of the basic case-mix adjustment. The commenter was critical of the case-mix adjustment because this commenter could not calculate the impact on their payment of one of the case-mix variables, specifically, weight. This commenter did not want to report weight as a case-mix variable because of the fluctuations in this variable, that is, weight changes. Response: Section 623(d)(1) of the MMA added section 1881(b)(12)(A) of the Act requiring that the outpatient dialysis services included in the composite rate be case-mix adjusted. Case-mix variables are characteristics of the patients served that enable payment systems to reflect the resources needed by patients. The statute required adjustments to the composite payment rate for a limited number of patient characteristics. We implemented the case-mix adjustments required by the statute in April 2005, using research on case-mix variables to support our selection of a limited number of casemix adjusters. A report on that research, entitled, ‘‘Methodology for Developing a Basic Case-mix Adjustment for the Medicare ESRD Prospective Payment System’’ is available on www.sph.umich.edu/kecc. The selected case-mix adjusters are age, low body mass index (BMI), and body surface area (BSA). BSA and low BMI were selected because they are a better predictor of cost of care than using weight alone. Height and weight are the case-mix variables that we use to calculate BMI and BSA adjusters. For this reason, and because we think that facilities should be easily able to report a case-mix variable that should be part of each patient’s ongoing care plan, we will continue to require reporting of the patient’s weight for purposes of calculating the case-mix adjusters. Comment: There were several comments recommending that we explore the option of adding variables to the existing basic case-mix adjustments. Commenters recommended including variables that measured improved survival rates, creating a new code for ESRD patients with diabetes, and adding measures that reflect improvements in the quality of life for ESRD patients. Comments indicated that VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 the current case-mix adjustments do not adequately compensate providers for resources used or the intensity of care that is required to provide services to the frail elderly, and patients with ambulatory limitations or selected comorbid conditions. In addition, commenters recommended that we should consider a variable that adjusts for time in treatment; specifically recommending that we consider the potential predictive power of a variable that exported the interval following the initial 6 months of ESRD treatments because the intensity of care and resources could increase. Response: We indicated in the proposed rule that we anticipated maintaining the basic case-mix adjustment as established in the CY 2005 final rule (69 FR 66238) and implemented on April 1, 2005. Although we understand the comments that we explore additional case-mix variables, we do not currently have the data that would be necessary to analyze the current case-mix adjustment variables and refine the basic system. Therefore, we believe that it is premature at this time to add additional variables to the basic case-mix adjustment system. Several of the variables recommended, including intensity of care, survival rates and quality of life improvement, are excellent recommendations as variables for exploration. As we stated in the CY 2005 final rule, the basic case-mix system is adjusts for a limited number of patient characteristics, consistent with the provisions of section 1881(b)(12)(A) of the Act as added by section 623 of the MMA. The MMA legislation anticipated that work would continue toward the development of a more fully bundled case-mix payment system for ESRD. We are continuing to work towards a more fully bundled case-mix system through ongoing research and development of a demonstration project required by the MMA. We have a contract with the University of Michigan to continue the research that was initiated in 2001 to explore a number of variables that could be predictive of resource use in a fully bundled case-mix adjusted system. This research will include exploring the predictive potential of variables available from existing data sources, including assessing the potential impact of comorbid conditions to predict payments. Several of the suggestions, specifically, survival rates, assessing improvements in the quality of life for ESRD patients, developing frailty/ ambulatory limitation measures, require the construction of classification PO 00000 Frm 00099 Fmt 4701 Sfmt 4700 70213 measures of functioning for disability and health. These are beyond the scope of our existing research efforts; however, over time, HHS may include efforts to develop classifications of functioning for disability and health measures, as well as add quality measurements as part of our payment systems. In addition, we will be assessing the data submitted under the existing basic case-mix system. As the analysis of this data progresses, we will consider potential refinements to the basic casemix system. We are also working on a demonstration project that will assess the use of a fully case-mix adjusted payment system. Both the demonstration and the ongoing research will examine the impact of comorbid conditions on case-mix and payment. Regarding the comment that we should create a reimbursement code for ESRD patients with diabetes, we note that we did analyze comorbid conditions as part of the research for the basic case-mix system. At that time diabetes was not found to be a significant predictor. In addition, our staff found that the reporting of comorbid conditions, including diabetes, was frequently limited. Therefore, as part of our training effort, we have encouraged facilities to report all comorbid conditions, and plan to use the reported data in our ongoing research related to refining the basic case-mix system. Thus, we will continue to assess the impact of diabetes as a case-mix variable and a predictor of resource use, but we will not be requesting, at this time, the creation of a new code for diabetic ESRD patients for payment. Comment: One commenter expressed concern regarding the reporting of height and weight for individuals who are double amputees. The comments indicated because of the case-mix adjustments for these individuals, the average reimbursement was reduced by an average of $20 per treatment even though these patients generally require the same or additional treatment because they could be in a wheel chair or possibly transported by stretcher. Response: We concur that there may be issues surrounding the reporting of the height and weight variables associated with double amputees. We have explored a number of reporting options for these patients in an attempt to resolve both clinical and operational issues related to the reporting of these values. We agree that requiring that the height for double amputees be measured ‘‘as they present’’ may not accurately measure the necessary dialysis dose, we also believe that the reported weight for E:\FR\FM\21NOR2.SGM 21NOR2 70214 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations these patients would require adjusting if we instructed facilities to report height ‘‘pre-amputation.’’ Based on the available literature related to height and weight measurements for double amputees, we believe there is sufficient data from which to appropriately adjust weight if height is reported pre-amputation. We relied on the methodology in the KDOQI ‘‘Guidelines for Peritoneal Dialysis Adequacy.’’ Appendix E, Guideline 9 contains instructions related to adjustments to weight for amputees. Based on those guidelines, we are adopting the following formula for adjusting weight using the adjustment factor for below the knee (BKA) double amputees which is the most common type of double amputation: Pre-Amputation Weight = Actual Weight × 1.15 Therefore, for dialysis treatments provided on or after January 1, 2006, we will revise our claims processing instructions related to the reporting of height and weight for double amputee dialysis patients. Height would be reported ‘‘pre-amputation’’ and weight would be adjusted by 1.15 to reflect the ‘‘pre-amputation’’ weight. Comment: We received a number of comments from ESRD patients expressing concern regarding the impact that any reductions in payment could have on their care. One ESRD patient expressed concern that if there were payment cuts, the facilities could be adversely impacted resulting in facilities closing. Response: The intent of the changes in payments to ESRD facilities was to appropriately pay facilities based on the characteristics of the patients they treat, as well as the wage levels for the areas in which they are located. We note that all of the changes in payments as a result of the MMA legislation were done in a budget neutral manner. That is, aggregate payments to ESRD facilities remain constant. While the result of the changes we have made to the wage adjustment will result in redistributing payments to individual facilities, these changes more accurately pay facilities based on local wage levels. We understand the concerns expressed by these patients and have provided for a transition from the old, outdated wage adjustment to the revised adjustment to help mitigate any adverse impact to individual facilities. In addition, we have provided a 1.4 percent increase to the payment facilities receive for 2006 based on the projected increase in drug expenditure between 2005 and 2006. VerDate Aug<31>2005 15:52 Nov 18, 2005 Jkt 208001 5. Revisions to the Composite Payment Rate Exceptions Process In response to the changes made by section 422 of BIPA and section 623 of MMA, in the August 8, 2005 proposed rule (70 FR 45840 through 45842), we proposed changes to the existing regulations at § 413.180 through § 413.192 (42 CFR Part 413, Subpart H) regarding criteria and application procedures for requesting an exception to the ESRD composite rate payment. We also proposed to revise § 413.170(b) to specify that subpart H provides procedures and criteria under which only a pediatric ESRD facility as specified in the statute may receive an exception. a. Pediatric ESRD Facility Exception Existing exception rates are protected under section 422(a)(2)(C) of BIPA. The ‘‘protection’’ clause for existing exception rates provides that exception rates in effect on December 1, 2000 (or approved based on an application by July 1, 2001) remain in effect as long as the facility’s exception rate is higher than the updated composite rate. Pediatric ESRD facility exception rates granted under the provisions of section 623 of the MMA (hereinafter referred to as ‘‘pediatric facility exception rates’’) are not subject to the ‘‘protection’’ clause for existing exception rates. However, we proposed to change our regulations to continue pediatric facility exception rates in the same way as existing nonpediatric exception rates. Specifically, we proposed that both nonpediatric and pediatric facility exception rates would remain in effect until the facility notifies its fiscal intermediary that it wishes to give up its rate because its case-mix adjusted composite rate is higher. As section 422(a)(2)(B) of BIPA allows existing nonpediatric exception rates to continue in effect as long as the exception rate exceeds the facility’s updated composite payment rate, we expected that each facility would compare its existing exception rates to its basic case-mix adjusted composite rates to determine which is the higher rate. We believe the determination as to whether an ESRD facility’s exception rate per treatment will exceed its average case-mix adjusted composite rate per treatment is best left to the affected entity. In the past, an ESRD facility could request an exception to its prospective composite payment rate within 180 days of the effective date of its new composite rate (s) or the date on which we opened a specific exception window. We proposed to revise § 413.180(d) to remove the requirement PO 00000 Frm 00100 Fmt 4701 Sfmt 4700 that an application for an exception must be filed within the 180-day window because we believe that the small volume of applications will make it feasible for us to accept applications on a rolling basis. Therefore, we proposed to revise § 413.180(d) to state that a pediatric ESRD facility may request an exception to its composite payment rate at any time after it has been in operation for at least 12 consecutive months. For a full discussion of our proposal, see the August 8, 2005 proposed rule (70 FR 45840 through 45842). We received the following comments on these issues: Comment: Several commenters asked for clarification that CMS will continue to recognize the exceptions status of non pediatric ESRD facilities. The commenters stated that the proposed rule presents conflicting statements about the continuing validity of these exceptions. Response: We agree, and we are revising proposed § 413.180(i) to include the statement that ‘‘ESRD facilities electing to retain their nonpediatric or pediatric exception rates (including self-dialysis training) do not need to notify their intermediaries.’’ An ESRD facility may notify its fiscal intermediary at any time if it wishes to give up its nonpediatric or pediatric exception rate. Thirty days after written notice is received by the intermediary, the facility will become subject to the new basic case-mix adjusted composite payment rate methodology. A facility’s decision to give up its exception rate can not be subsequently rescinded or reversed. Comment: One commenter is concerned that the composite rate as modified by the MMA will be maintained for patients under age 18 in many facilities that do not qualify for a pediatric exception because the pediatric population is below 50 percent of all patients dialyzed. Patients under age 18 require additional resources. The commenter recommends that a facility should qualify for a pediatric exception if 25 percent of its patients are under 21 years of age. Response: Section 623 of the MMA amended BIPA to allow a pediatric ESRD facility that did not have an approved exception rate as of October 1, 2002, to file for an exception to its updated prospective payment rate. To apply for the exception rate, the MMA requires that the pediatric facility has to demonstrate that at least 50 percent of its patients are individuals under 18 years of age. We believe the statute is very specific regarding the criteria a pediatric ESRD facility must satisfy in order to apply for E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations an exception rate. We have incorporated these statutory provisions in our proposed regulatory changes to § 413.170, § 413.182, and § 413.184. However, we note, that regardless of whether the pediatric exception is available to a facility, pediatric ESRD patients (defined as those under the age of 18) receive a specific case-mix adjustment factor when the composite payment rate is determined. None of the other case-mix adjustors that apply to nonpediatric patients (that is, the five age groups, low BMI, and BSA) is applicable to pediatric ESRD patients. Comment: We received two comments supporting the proposed change to allow pediatric ESRD facilities to file an exception at anytime after it is in operation for at least 12 consecutive months. Response: Previously, a pediatric ESRD facility that has been denied its exception would have to wait until a subsequent exception request. We have revised § 413.180(d) to provide that a pediatric ESRD facility that has been denied an exception may immediately file another exception request. However, a subsequent exception request must address the deficiencies cited in our determination letter. b. Pediatric Facility Exception Request Process Section 422 of BIPA prohibited CMS from providing exceptions to ESRD facilities on or after December 31, 2000. Section 623 of the MMA amended BIPA by restoring the exception process, but only for pediatric facilities that that did not have an approved exception rate as of October 1, 2002. To file for an exception, the pediatric facility would have to demonstrate that at least 50 percent of its patients are individuals under 18 years of age. Since the MMA restored the exception process only for pediatric facilities, we proposed to remove existing exception criteria that are not applicable to the newly defined pediatric facilities, including exceptions for isolated essential facilities, extraordinary circumstances, and frequency of dialysis as specified in regulations at § 413.182(b), (c), and (e). However, we proposed to retain the exception criterion for self-dialysis training costs under § 413.182(d) because some pediatric facilities may qualify for an exception on that basis. For a full discussion of our proposal, see the August 8, 2005 proposed rule (70 FR 45841). The comments received on these issues and our response to those comments are as follows: Comment: Several commenters asked that we retain the exceptions process for all five previous exception criteria in VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 order to preserve access to care for dialysis patients and to foster evolution in the patterns of dialysis care. Commenters pointed out that the recent experience with Hurricane Katrina underscores the need for an exception process to provide for continuity of dialysis care during extraordinary circumstances. Commenters included a recommendation that self-dialysis and more frequent dialysis should be preserved as exception options, noting that patients with congestive heart failure may require four dialysis treatments per week, and this is a growing segment of the ESRD population. Finally, the commenters stated that the exception for isolated essential facilities should be retained because of the potential impact on access to care resulting from the proposed changes in the composite payment rate wage index and reimbursement for ESRD drugs. Response: We have determined that pediatric facilities would not qualify for an exception under most of the existing exception criteria because of the uniqueness of their patient population (at least 50 percent under age 18). In the past, ESRD facilities with high percentages of pediatric patients only qualified for exceptions under the ‘‘atypical patient mix’’ criterion specified at § 413.182(a) and § 413.184. We have, therefore, proposed to replace the ‘‘atypical patient mix’’ criteria with a more specific ‘‘pediatric patient mix’’ criteria and to retain this exception at proposed §§ 413.182 and 413.184. We proposed to eliminate the exception criteria that we believe do not apply to facilities with large numbers of pediatric patients (that is, exceptions on the basis of isolated essential facilities, extraordinary circumstances, and frequency of dialysis). Based on our experience in granting ESRD exceptions, we do not believe that a situation exists where any newly defined pediatric facility with the required volume of pediatric patients would qualify for an exception under the isolated essential facilities criterion. Further, we note that previous exception requests for ‘‘frequency of dialysis’’ were granted to ESRD facilities that dialyzed their patients less frequently than 3 times a week and not more frequently as suggested by the commenter. However, we proposed to retain the exception criterion for self-dialysis training costs under § 413.182(d) because we have found that some pediatric facilities may qualify for an exception on that basis. With respect to Hurricane Katrina, we have taken into consideration that, in this type of emergency (an extraordinary circumstance), alternatives exist to PO 00000 Frm 00101 Fmt 4701 Sfmt 4700 70215 ensure that ESRD patients will have continuing access to services in other ESRD facilities. Any ESRD facility that has adequate treatment capacity, and is located close to a displaced patient’s home, would be glad to offer its dialysis services. However, if there are no remaining ESRD facilities nearby to voluntarily accept displaced patients, dialysis service will be made available to these patients that have been temporarily relocated to a local shelter or to another town. Displaced patients relocated to another town that are healthy enough to drive or to be driven to a dialysis facility, will receive dialysis services there. Displaced patients in temporary shelters will receive dialysis from providers or suppliers that will send the necessary equipment, personnel, and supplies to the shelter. We are finalizing the changes to § 413.180 through § 413.192 as proposed. However, we have added language to § 413.180 regarding the intermediary notification discussed above. In addition, we are adding a technical clarification to proposed § 413.170 to cross-reference § 413.184 which specifies pediatric patient-mix requirements that pediatric ESRD facilities must meet to qualify for an exception. H. Payment for Covered Outpatient Drugs and Biologicals Medicare Part B covers a limited number of prescription drugs and biologicals. For the purposes of this rule, the term ‘‘drugs’’ will hereafter refer to both drugs and biologicals. Medicare Part B covered drugs not paid on a cost or prospective payment basis generally fall into three categories: • Drugs furnished incident to a physician’s service. • DME drugs. • Drugs specifically covered by statute (immunosuppressive drugs, for example). Beginning in CY 2005, the vast majority of Medicare Part B drugs not paid on a cost or prospective payment basis are paid under the ASP methodology. The ASP methodology is based on data submitted to us quarterly by manufacturers. In addition to the payment for the drug, Medicare currently pays a dispensing fee for inhalation drugs, a furnishing fee for blood clotting factors, and a supplying fee for certain Part B drugs. In this section of the preamble we discuss the August 8, 2005 (70 FR 45843) proposed changes and issues related to the determination of the payment amounts for covered Part B drugs and the separate payments E:\FR\FM\21NOR2.SGM 21NOR2 70216 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations allowable for dispensing inhalation drugs, furnishing blood clotting factor, and supplying certain other Part B drugs. We also discussed proposed changes in how manufacturers calculate the ASP and in the ASP data reported to us. 1. ASP Issues Section 303(c) of the MMA amended Title XVIII of the Act by adding new section 1847A. This new section establishes the use of the ASP methodology for payment for most drugs and biologicals not paid on a cost or prospective payment basis furnished on or after January 1, 2005. The ASP reporting requirements are set forth in section 1927(b) of the Act. Manufacturers must submit ASP data to us quarterly. The manufacturers’ submissions are due to us not later than 30 days after the last day of each calendar quarter. The methodology for developing Medicare drug payment allowances based on the manufacturers’ submitted ASP data is specified in the regulations in part 414, subpart K. Based on the data we receive, we update the Part B drug payment amounts quarterly. In this section of the preamble, we discuss: Our proposed changes related to the methodology manufacturers use to calculate the ASP and apply the estimate of lagged price concessions in the ASP calculation; the reporting of ASP data; the weighting methodology we follow to establish the Medicare payment amounts using the ASP data; the comments received and our responses; and our final policy with respect to these issues. a. Estimation Methodology for Lagged Price Concessions Section 1847A(c)(5)(A) of the Act states that the ASP is to be calculated by the manufacturer on a quarterly basis. As a part of that calculation, manufacturers are to take into account price concessions such as— • Volume discounts. • Prompt pay discounts. • Cash discounts. • Free goods that are contingent on any purchase requirement. • Chargebacks. • Rebates (other than rebates under the Medicaid drug rebate program). If the data on these price concessions are lagged, then the manufacturer is required to estimate costs attributable to these price concessions. Specifically, the manufacturer sums the price concessions for the most recent 12month period available associated with all sales subject to the ASP reporting requirements. The manufacturer then calculates a percentage using this VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 summed amount as the numerator and the corresponding total sales data as the denominator. This results in a 12-month rolling average price concession percentage that is applied to the total in dollars for the sales subject to the ASP reporting requirement for the quarter being submitted to determine the price concession estimate for the quarter. The methodology is specified in § 414.804(a)(3). We identified a refinement of the ASP calculation and lagged price concession estimation methodology related to chargebacks that we believe improves the accuracy of the estimate. As a result, we proposed to clarify the ASP calculation in the August 8, 2005 proposed rule (70 FR 5843). b. Price Concessions: Wholesaler Chargebacks Wholesaler chargebacks are a type of price concession, generally paid on a lagged basis, that apply to sales to customers (for example, physicians) via a wholesaler (or distributor). Wholesaler chargeback arrangements may vary in scope and complexity. Under the current estimation methodology for lagged price concessions, total lagged price concessions, including lagged wholesaler chargebacks, for the 12month period are divided by total sales for that same period to determine a ratio that is applied to the total sales for the reporting period. The ratio of lagged price concessions to sales is calculated over all sales, both indirect sales (sales to wholesalers and distributors and other similar entities that sells to others in the distribution chain) and direct sales (sales directly from manufacturer to providers, such as hospitals or HMOs). To the extent that the relationship between total dollars for indirect sales and total dollars for all sales is different for the reporting quarter and the 12-month period used, the current ratio methodology for estimating lagged price concessions may overstate or understate wholesaler chargebacks expected for the reporting period. A more accurate estimation of lagged price concessions would minimize the effect of quarter to quarter variations in the relationship between indirect sales and all sales. As a result, we proposed to revise § 414.804 to require manufacturers to calculate the ASP for direct sales independently from the ASP for all other sales subject to the ASP reporting requirement (indirect sales). Then, the manufacturer would calculate a weighted average of the direct sales ASP and the indirect sales ASP to submit to us. We believed that the weighted average of direct sales ASP and indirect sales PO 00000 Frm 00102 Fmt 4701 Sfmt 4700 ASP would improve the overall accuracy of the ASP calculation, particularly for NDCs with significant fluctuations in the percentage of sales that are direct sales. We proposed conforming changes to § 414.804 for the methodology for calculating the lagged price concessions percentage. We also proposed to revise the regulation to clarify that the estimation ratio methodology relates to lagged price concessions and also define ‘‘direct sales’’ and ‘‘indirect sales’’ in § 414.802. In addition, we requested comments about the advisability and potential effects of requiring manufacturers to calculate the ASP for direct sales, including price concessions, independently from the ASP for indirect sales and then calculating a weighted average of these ASPs to submit to us, as well as the proposed definitions of direct sales and indirect sales. Comment: We received many comments on our proposed refinement to the ASP calculation. Nearly all of these commenters opposed this proposal and many asked for clarification of the proposed terminology. All but one of the comments received from drug manufacturers stated that the proposed change to the ASP calculation would require significant modifications to manufacturers’ accounting and reporting data systems while resulting in minimal change or benefit to the ASP-based payment. Many commenters stated that the proposed modification to the ASP calculation would not result in more accurate payments. Further, comments from groups representing drug and biological manufacturers stated that they do not believe the proposed methodology will have a material impact on the overall ASP or the accuracy of the calculation. Many of the commenters opposing the proposal stated that the expense and burden of implementing the proposed change to the ASP calculation would be unjustified because direct and indirect sales and price concessions for a given product are stable over time, particularly for generic products, and further breakdown of the calculation would not have a significant impact on the ASP calculation. Many commenters also noted that implementing the proposed weighted average approach would increase both the complexity of the ASP calculation and the potential for calculation error. We received comments from manufacturers of oncology, inhalation, contrast media, and other drugs and biologicals that included estimates of the potential impacts of the proposed E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations modification to the ASP calculation for a limited number of NDCs chosen as examples. These estimates ranged from a slight decrease (less than one half of a percent) to a 4.3 percent increase in the overall ASP for the NDC. One manufacturer estimated that sales would have to vary 20 percent from the 12month lag period to change the ASP by more than 1 percent. Notwithstanding the potential change in the overall ASP, all but one manufacturer, which reports ASP for a single product, recommended that we not adopt the proposed change. However, some of these commenters suggested that the weighted average approach be voluntary or applicable only in cases where significant fluctuations exist in the proportion of sales that are direct and indirect and there is a compelling need to apply the proposed methodology. Other commenters from the manufacturing community were concerned about consistency across manufacturers and recommended that we not leave it up to each manufacturer to choose whether to use the proposed methodology or not. One commenter suggested that the proposed methodology be mandatory for a manufacturer that has at least one NDC with direct sales of 33 percent or more of gross sales for the prior year. The manufacturer would then be required to calculate the ASP for all of its NDCs using the proposed methodology. Several commenters expressed concern that the proposed definitions of direct and indirect sales were unclear and required further clarification to ensure consistent application across manufacturers. Several commenters noted that our use of the term supplier was confusing; that it was unclear whether GPO sales would be considered direct or indirect; and it was unclear how utilization rebates to PBMs should be categorized. Several commenters noted that certain purchasers (for example, specialty pharmacies) may purchase both directly and indirectly during a given reporting period. Similarly, we received a comment from a drug manufacturer requesting greater clarification on how to allocate price concessions across direct and indirect sales when a customer purchases under both of these channels. Several manufacturers noted that their current data systems were not capable of capturing data at the level of detail necessary to accurately segregate sales into the direct and indirect categories. Other commenters noted that, in general, manufacturers do not track price concessions associated with direct or indirect sales. As a result, several VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 commenters recommended that, if the proposed methodology is adopted, we implement the change prospectively to allow for a phase-in period and to delay implementation until April 2006 or later to provide time for systems changes to be implemented and tested. We received a few comments from drug manufacturers expressing their belief that other market issues cause fluctuation in the ASP, and that it would be more beneficial to receive guidance on how to resolve these issues. A few commenters were concerned with the time frame for implementation of the proposed modification of the ASP calculation. These commenters recommended that we consider delaying implementation until after a trial period or at least until April 2006. We also received comments from providers who have experienced difficulty acquiring drugs at or below the payment amount. These commenters, as well as comments from physician organizations, support changes to the ASP calculation insofar as they will result in more appropriate reimbursements for Part B drugs. Response: Our goal is to ensure continued beneficiary access to care through implementation of accurate and sufficient payment systems. To this end, we proposed to refine the ASP calculation because the weighted average of direct sales ASP and indirect sales ASP could potentially improve the overall accuracy of the ASP calculation. We greatly appreciate the efforts undertaken by commenters to examine the potential impacts of the proposed method on the overall ASP calculation. Based on the comments received, we find compelling the commenters’ concerns about the challenges and increased burden associated with calculating the ASP independently for direct and indirect sales and then calculating the weighted average ASP. Although we continue to have interest in the potential impacts of quarter to quarter variations in estimates of price concessions, we will not adopt the proposed change at this time. In reaching our decision, we noted that all of the drug manufacturers that submitted comments reported that the impact of the proposed refinement of the ASP calculation would be minimal or not material. We note that these commenters are in a position to assess the impacts of the proposed methodology on their customers and to weigh the potential benefits and burdens inherent with the proposed change. In all but one case (a manufacturer which reports ASP for only one product), they did not support PO 00000 Frm 00103 Fmt 4701 Sfmt 4700 70217 the proposal because they believe the burden would outweigh the benefit. Among the comments received that specified potential percentage changes in the overall ASP, a range of potential impacts was reported. One of the examples submitted suggested that the impact could extend to upwards of a 4 percent increase in the ASP for an NDC, while another example showed a slight decrease. We cannot determine whether the reported examples are representative of other or all NDCs subject to the ASP reporting requirements. We also noted the concerns expressed by manufacturers regarding the significant additional burdens associated with the proposed methodology, the potential for inconsistent application of the proposed methodology across manufacturers, and the potential effects of the proposed methodology on manufacturers’ systems. In addition, we carefully considered the comments from the physician community in support of refinements to the ASP calculation that would increase payments. Although we are not implementing the proposed refinement to the ASP calculation at this time, we will continue to work with manufacturer to better understand the instances in which the proposed methodology may benefit the program and the potential for appropriate use of that methodology for certain or all NDCs, and whether such an approach would be sustainable. We did not receive any comments on our proposal to revise the regulations at § 414.804 to clarify that the estimation ratio methodology published on September 16, 2004 (69 FR 55763), relates to lagged price concessions; therefore, we will implement the revised regulatory language as proposed. c. Determining the Payment Amount Based on ASP Data As explained in the August 8, 2005 proposed rule (70 FR 45844) in response to inquiries we have received related to the formula we use to calculate the payment amount for each billing code we posted information on our web site (https://www.questions.cms.hhs.gov) earlier this year. We included this information (which follows) in the proposed rule to ensure greater public access to this information. • For each billing code, we calculate a weighted ASP using the ASP data submitted by manufacturers. • Manufacturers submit ASP data at the 11-digit NDC level. • Manufacturers submit the number of units of the 11-digit NDC sold and the ASP for those units. E:\FR\FM\21NOR2.SGM 21NOR2 70218 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations • We convert the manufacturers’ ASP for each NDC into the ASP per billing unit by dividing the manufacturer’s ASP for that NDC by the number of billing units in that NDC. For example, a manufacturer sells a box of 4 vials of a drug. Each vial contains 20 milligrams (mg). The billing code is per 10 mg. The conversion formula is: manufacturer’s ASP/[(4 vials × 20 mg)/10 mg = 8 billable units per NDC]. • Then, the ASP per billing unit and the number of units (11-digit NDCs) sold for each NDC assigned to the Billing Code are used to calculate a weighted ASP for the billing code. We sum the ASP per billing unit times the number of 11-digit NDCs sold for each NDC assigned to the billing code, and then divide by the total number of NDCs sold. The ASP per billing unit for each NDC is weighted equally regardless of package size. Comment: Several manufacturers and other commenters representing the manufacturing community recommended that the formula be revised so that the payment limit is calculated based on the weighted ASP of the number of billing units sold rather than the number of NDCs sold. These commenters noted that products are available in different package sizes and that a billing code may encompass multiple NDCs. As a result, these commenters contend that weighting the ASP payment amount by NDCs sold does not reflect the true weighted average price per billing unit. Several commenters, including manufacturers and their trade associations, noted that altering the formula to weight by the number of billing units sold may increase or decrease the overall ASP. Nonetheless, these commenters recommend adoption of their recommended alternative formula. One commenter suggested that the alternative formula be adopted along with an exception process that would be applicable to billing codes that represent therapies of differing weights or dosage. We also received comments from manufacturers that supported continued use of the current formula. Response: In establishing the formula used to calculate the payment amounts based on the manufacturers’ ASP data, we considered various approaches, including the alternative approach recommended by some commenters. For the initial implementation of the ASP methodology, we operationalized the calculation of ASP by weighting the formula by the number of NDCs sold. As we gain more experience with the ASP data and other sources of information become available about the purchasing patterns of providers and their VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 acquisition costs, we may consider altering the methodology or establishing exceptions, if we find good reason to do so. If we decided such a change is warranted, we would implement the change at the next quarterly update. Comment: Although not directly related to the formula used to calculate the ASP payment amounts, we received several comments from oncology physician practices and other commenters related to the adequacy of the ASP+6 percent payment methodology and other topics. We received several comments from oncology and other providers contending that the Medicare payment amount does not always cover their acquisition costs for certain drugs. A mid-sized oncology practice reported that it is unable to obtain nearly half of the drugs it administers at a price below the Medicare reimbursement rate. This commenter believes that larger practices may not face drug acquisition costs that exceed ASP+6 percent. One oncology practice reported that the ASP+6 percent payment would cover its drug costs if beneficiaries could always afford their cost sharing amounts. A large oncology practice stated that its average Medicare reimbursement, which is 2 percent more than its acquisition costs, was insufficient and would cause it to discontinue treatment for beneficiaries. On the topic of price concessions, several commenters, including a drug manufacturer, suggested that prompt pay and other discounts given to wholesalers and distributors should not be included in the calculation of the manufacturers’ ASP so that the payment amounts would be increased. Response: It is true for all payment systems based on averages that the payment amount may not equal a specific provider’s cost for every service. Section 1847A of the Act specifies that the Medicare payment is at 106 percent of ASP for the majority of Part B drugs and biologicals not paid on a cost or prospective payment basis. The statute requires use of the ASP+6 percent payment methodology except in limited instances. Although several commenters (most of which represent oncology practices) reported that the ASP+6 percent methodology was insufficient to cover their drug acquisition costs for certain drugs, these commenters also acknowledged that the Medicare payment exceeds their drug acquisition costs for other drugs. This is consistent with the findings of recent studies by the General Accountability Office (GAO) (GAO–05–142R), Office of Inspector General (OIG) (‘‘Adequacy of Medicare Part B Drug Reimbursement to Physician Practices for the Treatment of PO 00000 Frm 00104 Fmt 4701 Sfmt 4700 Cancer Patients’’, (A–06–05–00024), and MedPAC (October 6, 2005, public meeting report on oncology site visits). These studies have found that physicians generally can obtain oncology drugs for prices below Medicare reimbursement. We did not propose a change to the price concessions manufacturers must include in the ASP calculation. Section 1847A(c)(3) of the Act specifically identifies prompt pay discounts as a type of price concession that must be included in the manufacturer’s calculation of the ASP. Comment: We received comments from a few drug manufacturers requesting clarification and more detailed guidance on the treatment of administrative fees, service fees, and data fees in the ASP calculation. Response: These issues are beyond the scope of this rule. We will continue to work with manufacturers to more fully understand these issues. We expect to publish a final rule on the ASP reporting requirements and will consider these comments in the course of preparing that rule. Comment: We received comments from oncology practices, ESRD facilities and retail pharmacies, as well as IVIG manufacturers and stakeholders, indicating that manufacturer price increases are not reflected timely in the ASP+6 percent payment amounts due to the necessary lag time for calculating the rates and updating the payment systems. One commenter suggested that we implement a ‘‘true up’’ mechanism that immediately reconciles the historic reimbursement rate to reflect manufacturer price increases. Several IVIG stakeholders suggested that we issue payment rates on a retroactive basis. Response: Section 1847A(c)(5)(B) specifies a prospective update in the payment amounts. We agree with the commenters’ observations that there is a necessary time frame after the close of a calendar quarter for manufacturers to calculate and submit the ASP data to CMS, for CMS to prepare and issue the payment rates, and for the claims processing contractors to implement the updated payment files. As we stated in the CY 2005 final rule (69 FR 66300), we implement these new prices through program instructions or otherwise at the first opportunity after we receive the data, which is the calendar quarter after receipt. Comment: Several commenters, including patient and industry representatives and physicians as well as manufacturers, requested that we take steps to improve the availability of IVIG. Many of these commenters noted their E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ongoing collaboration with the Congress, HHS, CMS and others to better understand the market forces and dynamics influencing the current IVIG situation. These commenters reported that numerous patients and physician practices have been adversely impacted by the change in reimbursement to the ASP+6 percent methodology. These impacts include postponed infusions, increasing intervals between infusions, having to receive treatment in the hospital setting rather than in the physician office, possible unintended reactions as a result of switching brands of IVIG, and increased level of effort to obtain product and schedule services. Several commenters restated suggestions previously communicated to us, including concerns about our proposed changes for IVIG reimbursement in the outpatient setting. Comments from an industry group referenced its new study that it is conducting to help clarify the marketplace and provide insight into the costs for providing IVIG services. The study will examine IVIG acquisition costs and related services. Citing the adverse effects of patients migrating from physician offices to hospitals for treatment, several commenters requested that we consider an interim add-on payment for the complex activities related to furnishing IVIG until the industry study is completed. These commenters noted that the addon payment would ensure that providers are paid sufficiently for IVIG under Part B so that their provision of IVIG remains viable and beneficiaries’ access to IVIG is not reduced. Response: We will continue to work with the IVIG community, manufacturers, the Congress, and other entities to seek better understanding of the supply and market issues influencing the current IVIG market. We look forward to learning of the industry’s study findings as that work progresses. We have discussed the accuracy of the ASP data with the manufacturers and have been assured by these manufacturers that their ASPs have been developed in accordance with applicable guidance and that the resulting price reflects the current IVIG market in aggregate. At the same time, the IVIG manufacturers’ association, the Plasma Protein Therapeutics Association, reports that the overall supply of IVIG is adequate and has improved in the past several months. However, based on the comments received and our ongoing work with manufacturers, patient groups, and other stakeholders, we continue to be concerned about reports of patients VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 experiencing difficulties in accessing timely IVIG treatments and reports of providers experiencing difficulties in obtaining adequate amounts of IVIG products on a consistent basis to meet their patients’ needs in the current marketplace. Most brands of IVIG have been put on allocation by manufacturers and some manufacturers have reported allocating products to a smaller number of distributors and reducing the size of inventories. In addition, there have been reports of diversion of products to the secondary market and secondary distributors raising prices markedly. The Secretary’s Advisory Committee on Blood Safety and Availability has recommended immediate steps be taken to ensure access to IVIG so that patients’ needs are being met. However, the complexity of the IVIG marketplace makes it unclear what particular systematic approaches would be most effective in addressing the many individual circumstances that have been shared with us while not exacerbating what appears to be a temporary disruption in the marketplace. IVIG is a complicated biological product that is purified from human plasma obtained from human plasma donors. Its purification is a complex process that occurs along a very long timeline, and only a small number of manufacturers provide commercially available products. Historically, numerous factors, including decreased manufacturing capacity, increased usage, more sophisticated processing steps, and low demand for byproducts from IVIG fractionation have affected the supply of IVIG. For CY 2006, there are 2 HCPCS codes that describe all IVIG products, based on their lyophilized versus liquid preparation. The recent patterns of utilization of IVIG also are unusual in comparison with most other drugs and biologicals. Different IVIG products are FDAapproved in a number of therapeutic areas for various specific conditions which include: anti-infective therapy (bone marrow transplant); immune globulin replacement therapy (primary immune deficiencies and chronic lymphocytic leukemia); antiinflammatory therapy (Kawasaki disease); and immunomodulation therapy (idiopathic thrombocytopenic purpura). IVIG therapy, which has been available for about 25 years, was initially reserved for the treatment of these FDA-approved indications. More recently, IVIG has been increasingly used off-label so that off-label uses now significantly exceed on-label uses. Many of these off-label uses are for autoimmune, neurological, or systemic inflammatory conditions. Some off-label PO 00000 Frm 00105 Fmt 4701 Sfmt 4700 70219 uses of IVIG are supported by a robust evidence base, while for other medical conditions the evidence has not demonstrated that IVIG infusions are of significant therapeutic benefit. There are also new emerging indications for IVIG treatment, including those based on recommendations from various professional associations and advisory groups. In addition, despite the growing uses of IVIG there are definite risks associated with IVIG treatment, including both early inflammatory reactions and more rare but serious renal and thromboembolic complications, as well as the inherent risk associated with receipt of any biological product even with the ongoing improvements in the safety of these types of products. Medicare currently has one national coverage determination in place since CY 2002 regarding IVIG infusions to treat autoimmune blistering diseases, and there are numerous local coverage policies that describe Medicare coverage for specific off-label indications. In the context of these national and local coverage policies, IVIG use in hospital outpatient departments has climbed steeply over the most recent years for which data are available, from about 40,000 infusion days in CY 2002, to 60,000 days in CY 2003, and again to over 70,000 days in CY 2004. The infusion of IVIG in physician offices increased from about 2.3 million grams in CY 2003 to 4.0 million grams in CY 2004. In the face of growing demand for IVIG in the absence of significant changes in the prevalence of medical conditions for which there is high quality evidence regarding the effectiveness of IVIG therapy, we are concerned that all patients with medical need for IVIG continue to have access to this expensive and valuable therapy. Over the upcoming year, we will be using our historical claims databases to study the epidemiology of IVIG treatment of Medicare beneficiaries in outpatient settings. We expect that the health system as a whole should encourage an accountable and scientifically-grounded use of IVIG, and we welcome discussions with industry, providers, and other interested entities regarding efforts to ensure that IVIG is responsibly utilized for evidence-based clinical indications so that optimal benefit is obtained. Commenters have indicated to us that the infusion of IVIG in physician offices is more complex and resource intensive, particularly during the actual infusion, than many other types of infusions currently reported using the same drug administration CPT codes. They have described the specific resources E:\FR\FM\21NOR2.SGM 21NOR2 70220 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations required for initiating and monitoring infusions of IVIG for patients under various clinical circumstances. We encourage commenters to discuss their concerns with the CPT Editorial Panel to assess whether alternative coding or additional CPT guidance would be appropriate. In addition, they may wish to discuss their resource concerns with the AMA/Specialty Society RVS Update Committee that provides advice regarding the resources associated with physician services. Based on the potential access concerns, the growing demand for IVIG, and the unique features of IVIG detailed above, as we seek to gain improved understanding of the contemporary volatile IVIG marketplace, we will employ a two-pronged approach during CY 2006 to help ensure the availability of IVIG to physicians and hospital outpatient departments who care for Medicare beneficiaries and will be paid ASP+6 percent for the IVIG products. First, in addition to the ongoing monitoring and outreach activities within the HHS, the Office of the Inspector General (OIG) is studying the availability and pricing of IVIG as part of its monitoring of market prices pursuant to section 1847A(d)(2)(A) of the Act. We expect the OIG’s work to provide a significant contribution to the analysis of the current situation with respect to the specific activities of manufacturers and distributors that may be contributing to possible access problems for IVIG as we move to the ASP methodology in both physician office and hospital outpatient settings. We hope to understand those particular market behaviors that may have led to such public alarm about the availability of IVIG and the adequacy of our payment rate of ASP+6 percent, concerns that have been particularly strong and persistent for IVIG in comparison with other drugs paid under the same ASP methodology. Second, we will provide additional payment in CY 2006. Presently the IVIG marketplace is a dynamic one, where a significant portion of IVIG products previously available in CY 2005 are being discontinued and other products are expected to enter the market over the next year. In light of this temporary market instability, we understand that manufacturers have continued allocation procedures aimed at stabilizing the supply of IVIG. Even so, we understand that providers may face purchasing whichever brand of IVIG is available, even if it is not a brand the patient is known to tolerate. Many patients treated with IVIG receive regular infusions on a predictable schedule. To meet this need, physicians’ VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 office staff must conduct significant preadministration services prior to IVIG infusions to monitor and manage their inventory, locate available IVIG products, reschedule infusions according to product availability and patients’ needs, and implement physicians’ determinations regarding whether the available formulations are appropriate for patients and whether specific dosing adjustments are required. Product-specific factors must be evaluated in light of patients’ clinical indications for the IVIG infusions, their underlying medical conditions, and their past reactions to various IVIG products, and office staff must locate appropriate doses of IVIG products in light of these considerations. If the appropriate IVIG product formulations were more widely and reliably available, we do not believe that routine IVIG infusions would require these extensive preadministration-related services prior to each infusion. To continue to ensure appropriate patient access to IVIG in CY 2006 during this short-term period of market instability for IVIG, beginning for dates of service on or after January 1, 2006 through December 31, 2006, we will temporarily allow a separate payment to physicians to reflect the substantial additional resources that are associated with locating and acquiring adequate IVIG product and preparing for an office infusion of IVIG in the current environment. We expect that making separate payment for these additional necessary services will help insure that physicians are able to continue to provide IVIG infusions to their patients who depend upon them. We will also provide an additional payment to hospital outpatient departments for these special services, to ensure that patients continue to have access to IVIG infusions in the most medically appropriate settings, without undesirable shifts in sites of service for their care. Because the resources associated with the preadministration-related services for intravenous infusion of immunoglobulin are not accounted for in the physician office practice expense associated with the CY 2006 drug administration codes that will be billed for IVIG infusions, we are creating a temporary G-code to describe these additional preadministration services related to the intravenous infusion of immunoglobulin. We have established the following G-code for physician office billing for CY 2006: G0332; Preadministration-related services for intravenous infusion of immunoglobulin, per infusion encounter (This service is to be billed in PO 00000 Frm 00106 Fmt 4701 Sfmt 4700 conjunction with administration of immunoglobulin). Physicians may bill this service once per day in association with a patient encounter for administration of IVIG, in addition to billing for the appropriate drug administration service(s) and for appropriate units of the HCPCS code that describes the IVIG product infused. In addition, physicians may also bill for any significant and separately identifiable evaluation and management (E/M) service they perform at a level 2 through 5 in association with the infusion encounter, appending modifier –25 to the E/M service. We have established the payment level for this service in physician offices by crosswalking the RVUs for the new G-code to the practice expense RVUs of 1.90 for G0319, ESRD related services during the course of treatment, for patients 20 years of age and over; with 1 face-to-face physician visit per month. We do not believe there is increased preadministration physician work associated with preparation for intravenous infusion of immunoglobulin, so we have not allocated the physician work RVUs assigned to G0319 to G0332. Physician work associated with preparation for the intravenous infusion of immunoglobulin is already included in the physician work allocated to the drug administration services associated with the infusion and to the evaluation and management services (including the preand post-work already included in the relative values for evaluation and management services) provided to patients receiving intravenous immunoglobulin treatments. However, we think G0332 requires additional resources from the physician practice, particularly clinical labor, that are comparable to the practice expense for the ESRD management code. We expect that in many cases IVIG infusions will be provided once per month, with activities in preparation for the infusion, including consulting with patients and distributors, conducted over the course of a month as are the ESRD related services described by G0319. In addition, preparation for the IVIG infusion will generally not require a face-to-face visit with the patient prior to the infusion, so we have selected the ESRD related services G code that includes only one physician visit for the practice expense crosswalk. We believe that this temporary separate payment provided through G0332 in CY 2006 for the physician office and hospital outpatient resources associated with additional IVIG preadministration-related services due to the present significant fluctuations in E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations the IVIG marketplace will ensure that Medicare beneficiaries depending on IVIG experience no adverse health consequences from the market instability for IVIG products. In the meantime, we will continue to evaluate the market factors affecting the pricing and availability of IVIG products in the context of our ASP+6 percent payment methodology and our separate payment for G0332 in CY 2006. We expect that in CY 2006 with continued collection of updated ASP data for IVIG; improved understanding of the IVIG marketplace; more focused attention on the medical necessity of the utilization of IVIG; ongoing collaboration between CMS, the IVIG community, manufacturers, providers, and other interested entities; and this temporary separate payment for hospital and physician office resources required for the intensive preadministration services related to IVIG infusion, the IVIG marketplace should stabilize over the upcoming year. Substantial preadministration-related services for IVIG infusions should no longer be required of physician offices and hospital outpatient departments that provide IVIG infusions to patients who need them. Therefore, this additional payment for G0332 is effective for CY 2006 only. Thus, we will be closely monitoring this issue once again in the context of our rulemaking for CY 2007. Comment: Several commenters representing providers of community cancer care and manufacturers noted that physicians do not receive separate payment for pharmaceutical management and related pharmacy and handling costs (such as drug inventory, disposal of toxic waste, and spillage and breakage), and that in the 2006 proposed rule for HOPD we proposed a 2 percent add-on payment to the ASP+6 percent payment for drugs. These commenters stated the costs for handling pharmaceuticals are similar across settings and that physicians should receive the same add-on. Response: The costs for handling pharmaceuticals are paid through the PE RVUs for the drug administration code. d. Reporting WAC As explained in the August 8, 2005 proposed rule (70 FR 45844) we have provided information on our web site (https://www.questions.cms.hhs.gov) concerning reporting WAC. We state that manufacturers must report the WAC for a single source drug or biological if it is less than the ASP for a quarter and in cases where the ASP during the first quarter of sales is unavailable. Upon further review, we have determined that the WAC must be VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 reported each quarter if required for payment to be made under section 1847A of the Act, in addition to the ASP, if available. Section 1927(b)(3)(A)(iii) of the Act specifies the ASP data manufacturers must report. Section 1927(b)(3)(A)(iii)(II) of the Act specifies that the manufacturer must report the WAC, if it is required in order for payment to be made under section 1847A of the Act. Under section 1847A of the Act, the payment is based on WAC (as opposed to ASP) in the following cases: • For a single source drug or biological, when the WAC-based calculated payment is less than the ASP-based calculated payment for all NDCs assigned to such drug or biological product. (See section 1847A(b)(4) of the Act.) • During an initial period in which data on the prices for sales for the drug or biological is not sufficiently available from the manufacturer to compute an ASP. (See section 1847A(c)(4) of the Act.) In these instances, we must make the determination of whether the payment amount is based on ASP or WAC. Therefore, WAC is required for payment in all of these instances. As explained in the August 8, 2005 proposed rule (70 FR 45844), we had previously published a template which manufacturers must use to report ASP data to us; however, the WAC was not included in that template. Therefore, because of the requirement to report the WAC and the confusion manufacturers have experienced in submitting the WAC data we proposed, in a separate information collection notice published August 19, 2005 (70 FR 48770), to revise the reporting template to include a place to report WAC. To clarify the instances when manufacturers are required to report the WAC, in the August 8, 2005 proposed rule (70 FR 45844), we stated that manufacturers are required to report quarterly both the ASP and the WAC for NDCs assigned to a single source drug or biological billing code. Manufacturers are also required to report the WAC for use in determining the payment during the initial period under section 1847A(c)(4) of the Act. That is, the WAC is reported for the reporting period prior to reporting the ASP based on a full quarter of sales. Because the WAC could change during a reporting period, we proposed that in reporting the WAC, manufacturers would be required to report the WAC in effect on the last day of the reporting period. PO 00000 Frm 00107 Fmt 4701 Sfmt 4700 70221 Comment: Some commenters noted that requiring manufacturers to report WAC for all single source drugs each quarter encompasses the requirement for manufacturers to report WAC for new drugs during the initial period. Separately specifying these instances in the preamble led some commenters to request clarification of how the proposed policy differs from the existing requirements posted on our web site. Several manufacturers requested that we clarify in the final rule with comment that the WAC in effect on the last day of the reporting period is the value to be submitted for that reporting period. Response: We agree with the commenters who noted that new drugs are a subset of single source drugs. We separately specified the requirements for reporting WAC in these two instances so that manufacturers would be aware of the reporting requirement and because we have discussed these instances separately in past rulemaking. The proposed change is different from existing guidance previously posted on our web site in that we clarify that submission of the WAC in these instances is always necessary for payment to be made. The manufacturer does not decide if the WAC is to be submitted and the WAC is not submitted only if it is less than the ASP as previously posted on our web site. We interpret section 1927(b)(3)(A)(iii)(II) of the Act to apply to all NDCs of single source drugs. Final Decision Manufacturers must report WAC for all single source drugs (including new drugs) each reporting period. In submitting the WAC, manufacturers must report the WAC in effect on the last day of the reporting period. We will update our web site to include this decision. e. Revised Format for Submitting ASP Data The August 8, 2005 proposed rule (70 FR 45845) included a discussion of the format manufacturers are required to use to report the ASP data to us. However, as discussed above, the current template does not provide adequate instructions for manufacturers to report both the ASP and the WAC. Therefore, we published a separate information collection notice on August 19, 2005 (70 FR 48770) and proposed to revise the ASP reporting format to accommodate submission of both, the ASP and the WAC as well as collect the following additional information: • Drug name. E:\FR\FM\21NOR2.SGM 21NOR2 70222 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations • Package size (strength of product, volume per item, and number of items per NDC). • Expiration date for last lot manufactured. • Date the NDC was first marketed (for products first marketed on or after October 1, 2005). • Date of first sale for products first sold on or after October 1, 2005. Comment: We received several comments in response to the proposed rule related to our separate information collection notice on the proposed changes to the ASP reporting format (CMS–10110; see 70 FR 48770). The commenters generally supported inclusion of the WAC and drug name within the reporting format. Some commenters expressed concerns related to the level of burden that would be necessary to report some of the proposed additional data elements, particularly the date the NDC was first marketed. Some commenters suggested refinements to the definitions of the proposed data elements and the frequency of their collection. In addition, commenters suggested that we consider using data elements collected by Medicaid in lieu of the proposed data elements pertaining to first marketing date, first date of sale, and expiration date. In addition, commenters stated that they were uncertain when the proposed changes to the reporting requirements would be effective. Response: We appreciate receiving the comments on the proposed additional data elements and the proposed revisions to Addendum A used to report ASP data. To be considered timely, comments on the proposed modification to ASP reporting format must have been mailed within 60 days of that notice (by October 18, 2005). All timely comments were not available for consideration at the time of the preparation of this final rule with comment. Changes to the ASP information collection (CMS–10110; OMB control number 0938–0921), if adopted by CMS and approved by the OMB, would be effective as of the approval date of the information collection submission Manufacturers would begin reporting the additional data elements with the next reporting deadline. f. Limitations on ASP Section 1847A(d)(1) of the Act states that ‘‘the Inspector General of HHS shall conduct studies, which may include surveys to determine the widely available market prices (WAMP) of drugs and biologicals to which this section applies, as the Inspector General, in consultation with the Secretary determines to be appropriate.’’ VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Section 1847A(d)(2) of the Act states that ‘‘Based upon such studies and other data for drugs and biologicals, the Inspector General shall compare the ASP under this section for drugs and biologicals with— • The widely available market price (WAMP) for these drugs and biologicals (if any); and • The average manufacturer price (AMP) (as determined under section 1927(k)(1) of the Act for such drugs and biologicals.’’ Section 1847A(d)(3)(A) of the Act states that ‘‘The Secretary may disregard the ASP for a drug or biological that exceeds the WAMP or the AMP for such drug or biological by the applicable threshold percentage (as defined in subparagraph (B)).’’ The applicable threshold is specified as 5 percent for CY 2005. For CY 2006 and subsequent years, section 1847A(d)(3)(B) of the Act establishes that the applicable threshold is ‘‘the percentage applied under this subparagraph subject to such adjustment as the Secretary may specify for the WAMP or the AMP, or both.’’ For CY 2006, we proposed to specify an applicable threshold percentage of 5 percent for both the WAMP and AMP. We did not receive the OIG’s final report in time for consideration before developing the proposed rule. Thus, we believe that continuing the CY 2005 threshold percentage applicable to both the WAMP and AMP is most appropriate. Comment: One commenter stated its support of credible drug rates that are based upon widely accepted health care industry standards, and that are established using methodologies that are clear and readily understood by persons with health care industry knowledge. In this context, the commenter expressed concern about how well the terms WAMP and AMP are understood across the health care industry. Several commenters supported our proposal to retain 5 percent as the applicable threshold for 2006, while strongly urging that we not implement the provisions relating to substitution of the ASP until notice and comment rulemaking is conducted. Many commenters referred to the language in the Conference Report accompanying the MMA that discusses rulemaking in connection with this issue and requested that we follow the intent of that language and provide the public the opportunity to evaluate the validity of the processes used and the data obtained by OIG. Response: We appreciate the commenter’s acknowledgement that we are required to specify the threshold percentage applicable in 2006. Section PO 00000 Frm 00108 Fmt 4701 Sfmt 4700 1847A(d)(3)(B)(i) of the Act specified the applicable threshold percentage for 2005. Section 1847A(d)(1) of the Act requires that the OIG conduct studies to determine the WAMPs, and the OIG began its study activities shortly after the passage of the MMA. Upon completion, the OIG’s findings and methodology will be available to the public. We are aware of the Conference Report language; however, given the statutory requirements in section 1847A(d), we do not believe rulemaking is appropriate at this time. Final Decision We will establish 5 percent as the applicable threshold for 2006. 2. Payment for Drugs Furnished During CY 2006 in Connection With the Furnishing of Renal Dialysis Services if Separately Billed by Renal Dialysis Facilities Section 1881(b)(13)(A)(iii) of the Act indicates that payment for a drug furnished during CY 2006 and subsequent years in connection with the furnishing of renal dialysis services, if separately billed by renal dialysis facilities, will be based on the acquisition cost of the drug as determined by the OIG report to the Secretary as required by section 623(c) of the MMA or, the amount determined under section 1847A of the Act for the drug, as the Secretary may specify. In the report entitled, ‘‘Medicare Reimbursement for Existing End Stage Renal Disease Drugs,’’ the OIG obtained the drug acquisition costs for the top 10 ESRD drugs for the 4 largest ESRD chains as well as a sampling of the remaining independent facilities. Based on the information obtained from this report, for CY 2005, payment for the top 10 ESRD drugs billed by freestanding facilities and payment for EPO billed by hospital-based facilities was based on acquisition costs as determined by the OIG. Due to the lag in the data obtained by the OIG, we updated the acquisition costs for the top 10 ESRD drugs to 2005 by the PPI. The separately billable ESRD drugs not contained in the OIG report were paid at the ASP+6 percent for freestanding facilities. The payment allowances for these remaining drugs were updated on a quarterly basis during 2005. Section 1881(b)(13)(A)(iii) of the Act gives the Secretary the authority to establish the payment amounts for separately billable ESRD drugs beginning in 2006 based on acquisition costs or the amount determined under section 1847A of the Act. As discussed in the proposed rule, we do not believe that it is appropriate to continue to use E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 2002 acquisition costs updated by the PPI for another year as the basis for payment. The acquisition costs are based on 2002 data which, despite updates by the PPI do not necessarily reflect current market conditions. Thus, the chances increase that Medicare payments will either overpay or underpay for drugs resulting in payments that are inconsistent with the goal of making accurate payments for drugs. We also considered whether actual acquisition cost data could be periodically updated. However, we do not believe that it would be feasible to base Medicare payments over the long term on continually acquiring data on actual acquisition costs from ESRD facilities. This approach would provide incentives for manufacturers and facilities to increase acquisition costs without constraint. It also would not necessarily provide data regarding current market rates. Therefore, we proposed that the payment methodology for all ESRD drugs when separately billed by freestanding ESRD facilities during CY 2006 be the amount determined under section 1847A of the Act. This payment amount is the ASP+6 percent rate. Based on an analysis of the 2002 acquisition costs for the top 10 separately billable ESRD drugs, when updated by the PPI for CY 2006, it is our contention that relying on 2002 acquisition cost data updated for a number of years as would be necessary to establish a payment amount for 2006 is not the most appropriate option for determining Medicare payment rates when other drug-specific pricing is available. Further, we contend that relying on the ASP+6 percent as the payment rate for all separately billable ESRD drugs when billed by freestanding ESRD facilities for CY 2006 is a more reliable indicator of the market transaction prices for these drugs. The ASP is reflective of manufacturer sales for specific drug products and is more indicative of market and sales trends for those specific products than the 2002 OIG acquisition cost data. We also note MedPAC’s recommendation in its June 2005 report that the ASP be the basis of payment for all separately billable ESRD drugs provided by both freestanding and hospital-based facilities in CY 2006 (MedPAC, ‘‘Report to the Congress: Issues in a Modernized Medicare Program,’’ June 2005). In making this recommendation, MedPAC states that the ASP data are more current (updated quarterly) and more likely to reflect actual transaction prices when compared with acquisition cost data which are not regularly collected by the VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 OIG or CMS. Furthermore, the report indicated that utilizing the same payment policy for both freestanding and hospital-based facilities would ensure uniformity across the various settings irrespective of the site of care. In addition, MedPAC recommends in its report that we obtain, ‘‘* * * data to estimate hospitals’’ costs and Medicare’s payment per unit for these drugs. No published source identifies the unit payment for these drugs because Medicare pays hospitals their reasonable costs.’’ MedPAC further states: ‘‘We attempted to calculate the unit payment from 2003 claims data, but the accuracy of the data fields we needed to make this calculation was unclear, particularly the number of units furnished and Medicare’s payment to the hospital.’’ MedPAC also recommends that CMS or the OIG collect acquisition cost data periodically in the future to gauge the appropriate percentage of ASP for the payment amount. We acknowledged MedPAC’s recommendations regarding uniformity across the various settings irrespective of the site of care and believe it is more appropriate to pay for separately billed drugs furnished in hospital-based facilities under the ASP+6 percent methodology rather than on a reasonable cost basis. Therefore, for CY 2006, we proposed that payment for a drug furnished in connection with renal dialysis services and separately billed by freestanding renal dialysis facilities and EPO billed by hospital-based facilities be based on section 1847A of the Act. We proposed to update the payment allowances quarterly based on the ASP reported to us by drug manufacturers. We sought comment on our proposed decision to revise the payment methodology for separately billable ESRD drugs and about the potential method we have discussed in other sections of this final rule with comment which would permit us to pay hospital-based facilities under the ASP+6 percent methodology for 2006. We also sought comment on how this proposed decision could affect beneficiaries’ or providers’ access to these drugs. We received numerous comments regarding our proposal to pay for drugs furnished in connection with renal dialysis services and separately billed by free-standing renal dialysis facilities as well as EPO billed by hospital-based facilities at the ASP+6 percent payment methodology. We also received comments on our proposal to continue to pay hospital-based facilities reasonable cost for separately billable PO 00000 Frm 00109 Fmt 4701 Sfmt 4700 70223 ESRD drugs. Those comments and responses are provided below. Comment: Several commenters agreed with our proposal to use the ASP+6 percent methodology as the basis for payment for drugs furnished in connection with renal dialysis services and separately billed by free-standing renal dialysis facilities as well as EPO billed by hospital-based facilities and our decision to update the payment allowances on a quarterly basis. These commenters viewed the ASP+6 percent payment methodology as superior to the average acquisition payment methodology as the ASP+6 percent methodology enables payment to reflect the actual market transaction prices for ESRD drugs. Commenters stated that reliance on the ASP+6 percent methodology will lead to a more uniform payment policy across care settings. These commenters strongly recommended that we finalize our proposal to pay all ESRD drugs when separately billed by freestanding ESRD facilities, as well as EPO when furnished in hospital-based facilities at ASP+6 percent. It was noted that the ASP+6 percent methodology is easier for us to administer as we already collect and update ASP data on a quarterly basis. Other commenters were cautious in regards to the ASP system, indicating that although the shift from average acquisition cost to ASP+6 percent appeared rational, the ASP would be largely influenced by the lower large provider price. As a result, the ASP prices would not reflect the acquisition costs for all providers. Small dialysis facilities would be unable to purchase ESRD drugs at the proposed prices and would be at risk of being paid well below their acquisition costs, as they lack the same buying power or economics of scale that larger facilities possess. Some commenters focused on statements we made in the past in which we stated that we expected smaller providers to join buying groups in order to reduce acquisition costs. These commenters stated that although almost all small dialysis providers belong to such buying groups, such arrangements have not reduced the disparity between the large providers’ acquisition prices and the small providers’ acquisition prices. Commenters suggested that this ‘‘market dynamic’’ with extremely different buying power among providers does not exist in any other market where we have established drug payment policies. Response: We agree with the commenters who suggested that we establish the 2006 payment rates for drug furnished in connection with renal dialysis services and separately billed E:\FR\FM\21NOR2.SGM 21NOR2 70224 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations by freestanding renal dialysis facilities and EPO billed by hospital-based facilities using the ASP, rather than use the 2002 average acquisition costs updated by the PPI. We also agree for 2006 to apply the quarterly update of ASP data to payment for drugs furnished by freestanding renal dialysis facilities and EPO billed by hospitalbased facilities. After consideration of the feasibility of continuing to use 2002 acquisition costs updated by the PPI for another year, we have determined that the ASP+6 percent methodology is the most accurate measure for paying for EPO furnished in hospital-based facilities and for separately billable ESRD drugs provided in freestanding dialysis facilities. Implemented in 2005 by the MMA of 2003, the ASP methodology is based on data submitted by manufacturers of Medicare Part B drugs. The ASP for all drug products included within the same billing and payment code is the volumeweighted average of the manufacturers’ ASPs reported to us across all the NDCs assigned to the billing or payment code. Therefore, the ASP is a more accurate indicator of market trends for specific drugs. We do not agree with commenters who suggest that varying buying power only exists among providers of ESRD drugs. Other purchasers of Part B drugs have expressed concerns to us regarding a variation in buying power. We will continue to support groups representing Medicare Part B drug purchasers, especially small and rural purchasers, to help them identify the most favorable drug prices possible. Comment: Many commenters requested that if we implemented the ASP-based methodology for separately billable ESRD drugs, we should utilize the most recently available ASP data and update that data quarterly. These commenters expressed concern about the significant lag time apparent in the current ASP methodology, indicating the lag time results in a decrease in payment that no dialysis facility has the ability to make up. Commenters encouraged us to provide retrospective payments to dialysis facilities, particularly small or independent dialysis providers to prevent such facilities from reducing services or from closing. One large drug manufacturer suggested that we consider an alternative drug payment option for small providers and we assure that these providers are not negatively affected by changes in the payment policy for drugs. Commenters suggested that we utilize a methodology that uses average acquisition price for small providers as VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 the marker for ESRD drug reimbursement, citing section 1881(b)(13)(A)(ii) of the Act as the authority. Under this system, we would collect acquisition cost data from small providers, update the data for the current year and establish payment rates on these acquisition costs. Other commenters suggested that we consider establishing an exception process whereby rural or inner city ESRD facilities could request an alternate payment based on their actual drug acquisition costs as a result of unique economic circumstances. Some commenters suggested that we exclude EPO from the ASP payment methodology, stating that EPO has only one manufacturer and accounts for a large proportion of drug payment to independent dialysis facilities. Some commenters suggested that contracts of large providers are able to influence the ASP for EPO and for these providers; the acquisition price will be close to ASP. The inclusion of EPO in the ASP methodology will create disparity in patient care. Response: In response to concerns regarding the significant lag time apparent in the ASP methodology, the ASP methodology is based on ASPs reported by manufacturers quarterly. Manufacturers must report to us no later than 30 days after the close of the quarter. We implement these new prices through program instructions or otherwise at the first opportunity after we receive the data, which is the calendar quarter after receipt. We do not agree with commenters who suggested that we permit small, rural, or inner city ESRD facilities to request an alternate payment based on their actual drug acquisition costs, or that we exclude EPO from the ASP payment methodology. We do not have that authority. Section 1881(b)(13)(A)(iii) of the Social Security Act states that the Secretary chooses the methodology to determine payment rates for all drugs separately billed by ESRD facilities. The language refers to the choice of acquisition costs as determined by the Inspector General of the ASP rates. Section 1881(b)(13)(A)(ii) does not provide authority for individual providers to choose whether to be paid on the basis of costs or the ASP method. Comment: Several organizations stated that payment differences should be eliminated for separately billable drugs furnished in independent and hospital-based facilities and the ASP payment methodology should be used for all drugs provided in hospital-based facilities. One commenter agreed with our concerns regarding the lack of PO 00000 Frm 00110 Fmt 4701 Sfmt 4700 available data from hospital claims and recommended that the Secretary collect data on the acquisition cost and payment per unit for drugs furnished by hospital-based providers, or consider using the unit dosing information obtained from claims submitted by freestanding dialysis facilities and consult with clinical experts regarding the appropriateness of the dose data. Response: We agree with commenters who suggested that we utilize the same payment methodology for separately billable drugs furnished in independent facilities and hospital-based facilities. For reasons discussed in the ESRD section of this final rule with comment, we believe it is appropriate to implement the ASP payment methodology for all drugs provided in hospital-based facilities. Comment: Prompt pay discounts are included in the calculation of the ASP; however, commenters stated that small customers do not normally receive such discounts. Rather, these customers are charged an additional service fee to the price of the product. Thus, by including prompt pay discounts in the calculation of the ASP, the ASP is lowered, but the small providers are not privy to such discounts. Commenter also stated that sales to cutomers outside of independent dialysis facilities are included in the calculation of the ASP and thus, contribute to the difference between manufacturer-provided ASPs and provider acquisition costs. They stated that we have established a distinct methodology for drug payment for hospital-based dialysis facilities, and therefore, it is inappropriate to include such customers in the ASP payment system for independent dialysis facilities. Response: In the calculation of the ASP, as specified in Section 1847A(c)(3), a manufacturer should include volume discounts, prompt pay discounts, cash discounts, free goods that are contingent on any purchase requirements, chargebacks, and rebates (other than rebates under the Medicaid rebate statute). We lack the statutory authority to permit manufacturers to exclude prompt pay discounts from the calculation of the ASP. Further, the statute does not permit the exclusion of or differentiation by classes of trade in the calculation of the ASP payment rates, except for the specific statutory exceptions described in the Medicaid best price calculation under sections 1927(c)(1)(C)(i) and 1927(c)(1)(C)(ii)(III) of the Act. Comment: Several commenters stated that the ASP methodology does not take into consideration provider costs for storage, handling, and wastage. Small E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations providers will be disadvantaged as they have less efficient and more costly systems for storage and handling. Response: The ASP+6 percent payment methodology was not intended to cover the handling and storage of drugs. 3. Clotting Factor Furnishing Fee Section 303(e)(1) of the MMA added section 1842(o)(5) of the Act which requires the Secretary, beginning in CY 2005, to pay a furnishing fee in an amount the Secretary determines to be appropriate to hemophilia treatment centers and homecare companies for the items and services associated with the furnishing of blood clotting factor. In the CY 2005 final rule (69 FR 66236), we established a furnishing fee of $0.14 per unit of clotting factor for CY 2005. Section 1842(o)(5) of the Act specifies that the furnishing fee for clotting factor for years after CY 2005 will be equal to the fee for the previous year increased by the percentage increase in the consumer price index (CPI) for medical care for the 12-month period ending with June of the previous year. The percent increase for the 12 months ending June 2005 is 4.2 percent. Consequently, the furnishing fee will be $0.146 per unit clotting factor for CY 2006. While the furnishing fee payment rate is calculated at 3 digits, the actual amount paid to providers and suppliers is rounded to 2 digits. The requests to publish the 2006 furnishing fee in the final rule with comment were the only comments we received on the clotting factor section in the proposed rule. 4. Payment for Inhalation Drugs and Dispensing Fee Medicare Part B pays for inhalation drugs administered via a nebulizer, a covered item of DME. Beginning in CY 2006, coverage for inhalation drugs administered through metered dose inhalers will generally be available through the Medicare Part D benefit. This represents an important expansion in the options available to beneficiaries for inhalation drug coverage under Medicare. We expect that both modes of inhalation drug delivery will play an important role in the Medicare program in the years to come. Prior to CY 2004, most Medicare Part B covered drugs, including inhalation drugs administered by a nebulizer (hereafter referred to as inhalation drugs), were paid at 95 percent of the AWP. Numerous studies by the OIG and GAO indicated that 95 percent of AWP substantially exceeded suppliers’ acquisition costs for Medicare Part B drugs, particularly for the high volume inhalation drugs, albuterol and VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 ipratropium bromide.1 The MMA changed the Medicare payment methodology for many Part B covered drugs, including inhalation drugs. As an interim step, in CY 2004, Medicare paid a reduced percentage of AWP, 80 percent of AWP in the case of albuterol and ipratropium bromide. Beginning with CY 2005, Medicare paid for inhalation drugs at 106 percent of the average sales price (ASP+6 percent). In addition to making payment for the drug itself, Medicare also pays a dispensing fee to suppliers of inhalation drugs. Prior to CY 2005, Medicare paid a monthly $5 dispensing fee for each covered inhalation drug or combination of drugs used. In the August 5, 2004 proposed rule (69 FR 47488), we sought comment on an appropriate dispensing fee level to cover the shipping, handling, compounding, and other pharmacy activities required to get these medications to beneficiaries. We received many comments asserting that a substantial fee was needed to compensate suppliers for a wide range of costs associated with dispensing drugs to beneficiaries, with many citing a 2004 report prepared by a consultant for the American Association for Homecare (AAH) that recommended a $68 fee.2 The 2004 AAH report provided information for 10 cost categories: clinical intake; establishing/revising the plan of care; delivery of services; compliance monitoring/refill calls; billing/collections; other direct costs; patient education; caregiver training; care coordination; and in-home visits. In addition, as discussed in the August 8, 2005, proposed rule, a 2004 study by the GAO showed substantial variation in supplier costs of dispensing inhalation drugs.3 With the wide variation in the reported costs and services provided by inhalation drug suppliers suggested by the comments and the GAO study, we stated in the CY 2005 final rule (69 FR 66338) that we would establish an interim dispensing fee for inhalation drugs applicable for CY 2005 and reconsider the issue for CY 2006. The 2005 dispensing fee for a 30-day supply of inhalation drugs was based on the industry recommended $68 fee from the 2004 AAH study, excluding certain costs that Medicare generally does not reimburse regardless of the Medicare 1 GAO, ‘‘Medicare Payment for Covered Outpatient Drugs Exceed Providers’ Costs,’’ September 2001. OIG, ‘‘Excessive Medicare Reimbursement for Albuterol,’’ March 2002. 2 Muse & Associates Report for the American Assoication for Homecare, ‘‘The Cost of Delivering Inhalation Drug Services to Medicare Beneficiaries,’’ August 2004. 3 GAO, ‘‘Appropriate Dispensing Fee Needed for Suppliers of Inhalation Therapy Drugs,’’ GAO–050– 72, October 2004. PO 00000 Frm 00111 Fmt 4701 Sfmt 4700 70225 Part B benefit category (that is, sales and marketing, bad debt, and an explicit profit margin). The resulting fee established for a 30-day supply of inhalation drugs was $57 for CY 2005. Because the 2004 AAH study did not establish a fee for a 90-day supply, we applied the methodology used in the 2004 GAO report to convert the 30-day fee to a 90-day fee. Accordingly, the 2005 fee established for a 90-day supply was $80. In establishing the dispensing fee rates for 2005, we indicated in the CY 2005 final rule that although the AAH study contained costs related to services that may be of potential benefit to our beneficiaries, we were concerned that these services may be outside the scope of a dispensing fee. We indicated that we would consider this issue further in order to establish an appropriate dispensing fee for CY 2006. As discussed in the August 8, 2005 proposed rule (70 FR 45847), we indicated that we intend to establish a dispensing fee amount for 2006 that is appropriate to cover the costs of those services that fall within the scope of a dispensing fee. Furthermore, we indicated that we thought this fee amount likely would be lower than the current fee of $57 per 30-day period in 2005. In the proposed rule we solicited public comments and information on a number of issues including the following: • What services appropriately fall within the scope of a dispensing fee; the cost of providing those services; and, whether any of the services being provided by inhalation drug suppliers may be covered through another part of the Medicare program, such as the PFS or the DME benefit. • An appropriate dispensing fee level for 2006 as well as data and information on the various services inhalation drug suppliers are currently providing to Medicare beneficiaries and the associated costs, and typical dispensing costs for an efficient, high-quality supplier. • The extent to which inhalation drug suppliers have utilized the newly available 90-day scripts in order to reduce unit shipping costs and any reasons as to why 90-day supplies may not have been utilized. • How revised guidelines regarding the timeframe for delivery of refills has affected the need for overnight delivery services as well as the extent to which suppliers have shifted their shipping to ground services. • Comments on the potential impact on beneficiaries and providers of possible changes to the inhalation drug dispensing fee in 2006, as well as the E:\FR\FM\21NOR2.SGM 21NOR2 70226 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations impact of the new drug benefit on inhalation drug access. Comment: Many commenters suggested that dispensing inhalation drugs to Medicare beneficiaries involves a wide range of services that should be compensated through the dispensing fee. A number of commenters referenced a 2005 report by an industry consultant sponsored by the AAH.4 The 2005 AAH report indicated that suppliers provide services in seven broad categories: Intake; compounding, dispensing, and pharmacy assessment; delivery, set-up, and patient education; follow-up and compliance monitoring; quality assurance, accreditation, licensing, and regulatory compliance; Medicare billing and compliance; and other direct and indirect costs and expenses. Within these seven categories, the 2005 AAH report indicated that there were ‘‘117 discrete services’’ provided to or on behalf of Medicare beneficiaries. The 2005 report surveyed 82 homecare pharmacies. The vast majority of survey respondents thought the 117 discrete services outlined by the consultant fell within the scope of a dispensing fee, and the vast majority of respondents indicated they were providing these services. Several commenters suggested that the survey demonstrated there was widespread agreement that the standard of care for inhalation drug suppliers involved a wide range of services. In addition, one commenter asserted that the 117 services identified in the 2005 AAH report encompassed all of the functions identified in the 2004 AAH report prepared by the same consultant, which formed the basis of the 2005 fee. Response: We established the interim dispensing fee for 2005 based on cost data from the 2004 AAH report. That report provided cost data for 10 service categories: Clinical intake; establishing/ revising the plan of care; delivery of services; compliance monitoring/refill calls; billing/collections; other direct costs; patient education; caregiver training; care-coordination; and in-home visits. In using this data to establish the 2005 fee in the CY 2005 final rule, we indicated that we were concerned that some of the services in the industry cost data may be outside the scope of a dispensing fee and we would revisit this issue further in order to establish an appropriate dispensing fee for CY 2006. As discussed in the August 8, 2005, proposed rule, we continue to have 4 Muse Associates Report Prepared for the American Association for Homecare, ‘‘Examination of Inhalation Drug Services to Medicare Beneficiaries Under the Average Sales Price Reimbursement Methodology In Response to the CMS Notice of Proposed Rule Making (CMS–1502– P),’’ September 2005. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 concerns with respect to what services should be included within the dispensing fee payment. Authority for a dispensing fee for inhalation drugs is based on section 1842(o)(2) of the Act, which provides that if payment is made to a licensed pharmacy for a drug or biological under Medicare Part B, the Secretary may pay a dispensing fee (less the applicable deductible and coinsurance) to the pharmacy. The statute did not define the term dispensing fee or set parameters as to what activities should be included within the scope of that definition. However, as discussed below, we do not believe the Congress intended us to adopt the broad reading of dispensing fee suggested by commenters. We are not persuaded by suggestions that Medicare should broadly define the definition of dispensing fees for inhalation drugs to include pharmacy care management services such as patient education, caregiver training, care coordination, and in-home visits. A number of commenters suggested the dispensing fee be based on the total costs of supplying inhalation drugs indicated by the 2004 AAH report data. That data indicated that suppliers expend on average 63.5 minutes per new patient and 50 minutes per established patient per month on patient education, caregiver training, care coordination, and in-home visits. Such services represent pharmacy care management services, which (if included in dispensing fee payments) would extend the definition of dispensing fee beyond what we believe should be reasonably included within the scope this benefit. As an initial matter, we do not believe that there is any indication that the Congress intended these care management activities to be included in the definition of dispensing fees. Where the Congress wished for us to cover the costs of such training and management services under Medicare, it specifically directed us to do so (for example, by amending the statute to recognize diabetes outpatient self management training under Medicare Part B and medication therapy management programs under Medicare Part D (see sections 1861(qq) and 1860D–4(c) of the Social Security Act). Therefore, in accordance with our interpretation of the statute, we do not believe it is reasonable for us to define the term dispensing fee under Medicare Part B to include the costs of such services. In addition, we also believe that the inclusion of beneficiary education and training about use of nebulizers would raise duplicate payment issues. Payment PO 00000 Frm 00112 Fmt 4701 Sfmt 4700 for DME is based on fee schedule amounts which include, in part, amounts for training beneficiaries on the use of nebulizer equipment. Thus, the equipment supplier is responsible for educating the beneficiary on the use of the DME or ensuring that ‘‘another qualified party’’ has done so as specified in § 424.57(c)(12). In addition, under the physician fee schedule Medicare makes a separate payment for beneficiary training by a physician or physician’s staff regarding use of a nebulizer (CPT code 94664, demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device). We believe that physicians can play an important role in beneficiary training concerning the use of nebulizers, as they are ultimately responsible for directing beneficiary care, and determining what drug treatment regimen is most effective for an individual patient. Accordingly, because payment for education, training, and management concerning use of nebulizer equipment may be separately recognized under Medicare, we are concerned that the inclusion of such services within the definition of dispensing fee would increase the potential for double billing. We are also not persuaded by commenters’ suggestions that the 2005 AAH report demonstrates that the standard of care for supplying inhalation drugs includes a broad range of services. The 2005 AAH report presented results from a survey of homecare companies, in which the companies were asked whether 117 activities or overhead items should be included in the dispensing fee and whether the companies currently provide or undertake each activity/item (although the frequency and extent to which each activity/item was provided was not asked). The 2005 report identified services provided but failed to provide any information on the proportion of beneficiaries actually receiving various services (for example, patient education, caregiver training, inhome visits). It also did not provide any information on the cost of various services (other than delivery), or the amount of time involved in providing these services to the typical beneficiary. Consequently, the 2005 AAH report fails to demonstrate that the 117 activities/ overhead items outlined in the 2005 report translate into an average of 63.5 minutes per new patient and 50 minutes per established patient each month for the care management services of patient education, caregiver training, in-home visits, and care coordination in the 2004 AAH report. Since the 2005 report did E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations not include information on costs, the 2004 AAH report is the only information we have on average cost and time per activity. However, even the 2004 AAH report does not contain information on the proportion of beneficiaries that actually receive the care management services. Accordingly, given the data identified in the reports, we are not persuaded by the AAH reports that the standard of care for supplying inhalation drugs includes extensive care management services for patient education, caregiver training, inhome visits, and care coordination. Furthermore, a September 2005 OIG study entitled ‘‘Review of Services Provided by Inhalation Drug Suppliers’’ 5 found little evidence that inhalation drug suppliers provide care management services to many beneficiaries. The OIG report sought to ascertain the nature and extent of services provided by inhalation drug suppliers. The OIG examined services such as clinical intake, revising the plan of care, patient/caregiver education, responding to patient/caregiver inquiries about the drug, contacting the physician’s office, contacting a patient for a refill, reviewing medication compliance, and other certain services. The OIG did not focus on certain core activities such as filling prescriptions, delivery, and billing that they indicated were necessary for suppliers to dispense drugs and receive reimbursement. They also indicated that they excluded equipment related services because Medicare pays suppliers separately for equipment. The OIG report concluded that beneficiaries receive few services from their inhalation drug supplier beyond calls to ask if they need a drug refill. The OIG report found that among beneficiaries with at least 2 months of claims in 2003, 16 percent received no services (that is, no educational services, refill calls, or other adjunct services the OIG examined) from their inhalation drug supplier during the entire year. The OIG found that refill calls accounted for the majority of services provided by inhalation drug suppliers. In addition, the OIG found that only 16 percent of beneficiaries received an educational service from their drug supplier, 8 percent made a non-billing inquiry to their drug supplier, 8 percent received an in-home visit, 5 percent had a care plan revision, and 3 percent received a respiratory assessment from their drug supplier at least once during 2003. Furthermore, 5 Office of the Inspector General, ‘‘Review of Services Provided by Inhalation Drug Suppliers,’’ September 2005, OEI–01–05–00090. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 the OIG report indicated that only 27 percent of beneficiaries had their medication compliance reviewed by drug supplier at least once in 2003, with 89 percent of these reviews occurring during refill calls. Accordingly, in light of the OIG findings regarding services actually provided, we remain unconvinced regarding the standard of care contentions set forth in comments concerning the 2004 and 2005 AAH reports. As mentioned previously, we do not believe it is appropriate to include care management services such as patient education, caregiver training, care coordination, and in-home visits in the inhalation drug dispensing fee. Furthermore, the OIG found that few care management services were actually provided to a typical beneficiary. While it is possible that some types of care management services may be of potential benefit to some beneficiaries, at this time there is not clear evidence that such services are widely provided to beneficiaries nor have there been studies evaluating the effect of such services on beneficiary outcomes. Given such concerns, we do not believe it is appropriate for us to define dispensing fee under Medicare Part B to include care management services. However, we believe it is very important that the Medicare program support better patient care outcomes, particularly for beneficiaries with chronic respiratory conditions. We plan to explore how the Medicare program can engage physicians and their partners on issues of quality and performance to foster high quality of care for Medicare beneficiaries using respiratory drugs. For example, we believe there may be an opportunity under our demonstration authority to implement a demonstration program to test whether care management and care coordination services by physicians and their partners can improve health outcomes and reduce Medicare costs for beneficiaries who use inhalation drugs. Comment: Some commenters criticized the OIG report as being too narrow in scope. A few commenters suggested that the OIG study excluded many essential services such as drug deliveries and billing activity that account for the bulk of services and costs. Another commenter suggested that the study did not capture all the services inhalation drug suppliers provide, including many that are required by State and Federal regulations (for example, Food and Drug Administration and State Pharmacy Boards), and standards of care for pharmacy practice. The commenters also criticized the OIG report for PO 00000 Frm 00113 Fmt 4701 Sfmt 4700 70227 excluding billing services and not taking into account the substantial amounts of time spent doing the following: Collecting and processing the relevant billing information from the beneficiary and beneficiary’s physician, which the commenter indicated often requires multiple on-site visits to doctors offices; verifying eligibility and processing reimbursement from secondary insurers responsible for payment of coinsurance; and researching and on-site verification of beneficiary financial and living circumstances in order to validate a waiver of coinsurance for hardship. The commenters also criticized the OIG report for not taking into account nonpayment of coinsurance by Medicaid, the costs of Medicare billing requirements, and costs of oversight by multiple carriers. Furthermore, several commenters suggested that the OIG study undercounted services because the OIG survey instrument requested documentation for each service provided and the report focused on documented services. Some commenters suggested that this approach left out those services for which suppliers did not have documentation, either because they had discarded the documentation after it was no longer useful or because they had not documented services since there was no requirement to do so. Some commenters indicated that the mandatory refill calls require two telephone contacts on average before contact is made with the beneficiary. One commenter indicated that it maintains documentation of failed call attempts only for several months, and is not required to maintain long-term documentation of repeated calls and visits to patient homes and physicians’ offices to gather documentation and information. In addition, one commenter noted that the OIG report expanded the categories of services it analyzed in its report based on information submitted by respondents in the survey instrument’s ‘‘other’’ category. The commenter believed that this meant participants in the OIG report may not have always been explicitly asked about certain types of services. This commenter also criticized the OIG report for not conducting field work to observe the activities of inhalation drug suppliers, and indicated its belief that the GAO and 2004 AAH report included a more thorough analysis. Another commenter stated that the OIG report does not address the issue that the costs of dispensing drugs are higher than the current $57 fee for high quality suppliers in compliance with applicable requirements. Furthermore, the commenter stated that E:\FR\FM\21NOR2.SGM 21NOR2 70228 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations the service levels suggested in the OIG report are not representative of high quality suppliers. The commenter also stated that the behavior of noncompliant suppliers should not serve as a basis for reducing the fee because they contend the various services are required to comply with the regulations of Medicare, other government entities, and accrediting or quality assurance organizations. Response: We do not find the criticisms of the OIG report persuasive. While a number of commenters criticized the methodology and findings of the OIG study, we believe that the results of the OIG study are credible. The OIG study examined the extent to which certain services such as patient/ caregiver education, responding to patient/caregiver inquiries about drugs, revising the plan of care, contacting the physician’s office, contacting a patient for a refill, reviewing medication compliance, and certain other services were actually being provided to beneficiaries by inhalation drug suppliers. The OIG failed to find evidence that many beneficiaries received such services from their inhalation drug suppliers, with the exception of drug refill calls. Although some commenters criticized the OIG report for not including core dispensing activities such as filling the prescription and billing, the OIG report indicated that it did not focus on those activities because it did not have cause to question that they are necessary to dispense drugs and be reimbursed. The OIG instead focused on those services where less was known about the extent to which the services were actually being provided to beneficiaries. The OIG report examined a set of services that accounted for 60 percent of costs included in the 2004 AAH data. In addition, some costs cited by one commenter as being improperly excluded from the OIG study, such as non-payment of coinsurance by Medicaid, costs associated with waivers of coinsurance for indigent beneficiaries, and assessment of the beneficiary’s situation for coinsurance waiver, are not generally reimbursed under Medicare Part B as a matter of general policy. We are not persuaded by those commenters who suggested that the OIG study should be disregarded because the OIG undercounted the number of services suppliers actually provide due to the OIG’s focus on documented services. Although the OIG focused its analysis on documented services, the OIG report indicated that if they had included undocumented services reported by suppliers in their analysis, VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 the average number of services per beneficiary would still have been low (increasing from an average of 1.2 to 1.59 services per beneficiary per month). In addition, if various services are essential to dispensing these drugs to beneficiaries as some have suggested, we would have expected that suppliers would have documented the content and frequency of the services in patient records in order to track patient progress and maintain continuity of care. Furthermore, although some contend that the OIG study suggests that some suppliers are non-compliant in their provision of required services, as commenters pointed out, the OIG study did not generally collect information on the core services required to furnish inhalation drugs, with the exception of refill recalls. The OIG report found that not all beneficiaries who should have received a refill call actually got one. We plan to study the issue of refill call compliance further, and we believe it is important to reflect the costs of refills call in the dispensing fee. In terms of the comment that the OIG study added several service categories based on information submitted by commenters, the survey instrument included an ‘‘other’’ category under which suppliers could report any services that were not captured by the categories provided. We do not view the opportunity for suppliers to elaborate on the types of services provided to be a weakness but rather a strength of the study. Although the OIG study was criticized by some for not conducting field work, the OIG adopted a methodology that was designed to provide information on a representative sample of beneficiaries receiving inhalation drugs. While the OIG report does not provide information on supplier costs, that was not the objective of the OIG study. The OIG report provides information on the percent of beneficiaries that received various services from their drug suppliers, and as a result, and we believe it offers helpful information in our consideration of the inhalation drug dispensing fee. Comment: We received a number of comments recommending either an increase or no reduction in the dispensing fee for 2006. Several commenters suggested the 2005 AAH report provided an appropriate fee for 2006. For that report, a consultant surveyed homecare pharmacies about what fee level they thought was appropriate for 2006. Survey respondents on average suggested a fee of $66.55 for a 30-day supply and a fee of $138.80 a 90-day supply. Suggested fees from other commenters ranged from PO 00000 Frm 00114 Fmt 4701 Sfmt 4700 $57 to $68, with a few commenters suggesting an inflation adjustment on top of those levels. One insurer commented that the current dispensing fee appears high. Some commenters provided cost information as part of their contention that the fee should not be reduced or should be increased. One large supplier indicated that its costs were about $75 per beneficiary for a 30-day period, with the 3 cost categories accounting for the largest share being delivery, setup, and patient education ($20); clinical intake ($15); and compounding, dispensing, and assessment ($14). Another supplier indicated its costs broke out as follows: delivery, set-up, and patient education (27.3 percent); compounding, dispensing, pharmacy assessment (19.0 percent); patient intake (17.8 percent); follow-up and compliance monitoring (11.6 percent); quality assurance, accreditation, licensing and regulatory compliance (9.1 percent), other direct and indirect costs (4.2 percent). The supplier indicated that its costs were largely for salaries, freight and other delivery charges, and business infrastructure. A number of commenters stated that the dispensing fee should not be based on retail pharmacy costs, stating that retail pharmacies do not provide the array of services that homecare pharmacies do. One retail pharmacy clarified its comments from the prior year cited in the proposed rule. By suggesting a fee of 5 to 6 times the current fee last year, the retail pharmacy said they meant 5 to 6 times the $10 proposed supplying fee (for immunosuppressive, oral anticancer, and oral anti-emetic drugs) for 2005 (that is, $50 to $60). In addition, a respiratory company stated that a comment received on the August 5, 2004 proposed rule from another retail pharmacy, which was cited in the August 8, 2005 proposed rule, may have been intended to mean $25 per prescription rather than $25 per 30-day period. Also, the commenter stated that the prior cost data was irrelevant because it preceded experience with the ASP system. Comments from retail pharmacies and a pharmacy association indicated support for the dispensing fee level urged by the 2005 AAH report. A number of commenters stated there would be adverse effects on beneficiary access to inhalation drugs if the fee were reduced. Some suppliers asserted that they would reduce the services offered to beneficiaries or cease supplying inhalation drugs to Medicare beneficiaries. A number of commenters pointed to the 2005 AAH survey, which indicated that 45 percent of providers E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations would not accept Medicare patients if the dispensing fee were reduced more than a nominal amount, while 50 percent indicated they would reduce services provided to beneficiaries, and 2.5 percent indicated they would close. One commenter maintained that some providers had already closed or are seeking acquisition by other companies under current reimbursement rates. Another commenter speculated that a reduction in the dispensing fee would cause a shift away from small home care pharmacies to retail pharmacies, and asserted that these pharmacies would have to gear up by increasing inventories or directing patients to their mail order pharmacies. Some commenters suggested that a fee reduction could lead to adverse health effect for beneficiaries, reduced quality, or use of more intensive Medicare services. Others raised concerns that a reduction could create adverse incentives for substituting MDIs for nebulizers, even for patients where nebulizers are the preferred delivery mechanism. Some commenters suggested that it is premature to reduce the dispensing fee. Some of these commenters asserted that CMS did not provide any new cost data in the proposed rule that would warrant a reduction. Several commenters stated costs had increased due to higher fuel prices, unforeseen natural disasters, and wage inflation. Several commenters pointed to the 2005 AAH study which indicated that the average cost of shipping increased from $12.13 in 2004 to $14.41 in 2005. One commenter indicated that its overnight shipping costs were between $27 to $40 per shipment. Another commenter cited a 12.5 percent increase in the fuel surcharge cap for one large shipping company, which they indicated would cause their delivery costs to increase an additional 4 percent on top of prior increases. One commenter indicated that its cost per shipment had increased by $0.40 due to increased fuel costs in 2005, and it expected additional future increases. In urging an increase in the fee to take into account inflation, another commenter mentioned that it had consolidated the number of pharmacies it operated to increase efficiency, but indicated that the number of costs that could be reduced was limited. Another commenter stated that we should not reduce the fee because the agency indicated in a October 8, 2004 letter to GAO that a fee of $55 to $64 was a reasonable range for a 2005 fee. Other commenters asserted that experience with the ASP system and the current dispensing fee is too VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 limited to conclude there are overpayments. One commenter stated that the payment reduction in 2005 was greater than the Congressional Budget Office or the CMS Actuaries Office had projected prior to passage of the Medicare Modernization Act. This commenter suggested actual levels in 2005 claims data be compared to original estimates before taking any action. Response: As noted previously, we established the 2005 dispensing fee using data from the 2004 AAH report. That report included costs for a wide range of services beyond basic dispensing, such as patient education, caregiver training, care coordination, and in-home visits. As discussed previously, we believe these activities represent care management services that should not fall within the scope of a dispensing fee. Furthermore, the September 2005 OIG report found little evidence that many beneficiaries receive these care management services. Consequently, we are establishing a dispensing fee for 2006 using the 2004 AAH cost data excluding separable costs for care management services. We believe this interpretation represents an appropriate reading of the statute. Based on the 2004 AAH data for homecare pharmacies, excluding costs for care coordination, in-home visits, patient education, and caregiver training (as well as sales, marketing, bad debt and profit which were also excluded last year because Medicare does not generally reimburse those costs with respect to Part B services), we are establishing a dispensing fee of $33 for a 30-day supply of inhalation drugs. Because greater levels of effort may be involved in dispensing inhalation drugs when a patient begins these drugs for the first time, we have decided to maintain the current $57 dispensing fee for the first 30-day period in which an individual uses inhalation drugs as a Medicare beneficiary. Thus, beginning in 2006, we will pay a dispensing fee of $57 for the first month an individual uses inhalation drugs as a Medicare beneficiary, and $33 for a 30-day supply of inhalation drugs for all other months. Although some commenters urged an inflation adjustment, we do not believe it is warranted for 2006 because we do not believe it is clear that total dispensing costs have increased since the 2004 industry cost data was collected. Although data from the 2004 industry report may not reflect wage inflation or increased delivery costs due to fuel price increases, it would also not include any efficiencies that providers may have achieved as they have adjusted to the new payment system in PO 00000 Frm 00115 Fmt 4701 Sfmt 4700 70229 2005. The 2005 AAH report did not provide updated cost data for the service categories included in the 2004 AAH report. Given that the 2004 AAH cost data would not reflect inflationary pressures, nor increased efficiencies in business operations, it is uncertain whether an upward or downward adjustment to the 2004 cost data should be made. As a result, we believe it is best to use the 2004 AAH data as is. We will consider the appropriateness of an inflation adjustment for the future. Regarding concerns raised by some commenters about beneficiary access, we believe, as discussed previously, that the fee level we are establishing is appropriate to cover suppliers’ dispensing costs, and beneficiaries will maintain good access to inhalation drugs. The fee amount is based on the 2004 AAH cost data for clinical intake, establishing/revising the plan of care, delivery of services, refill calls/ compliance monitoring, billing/ collections, ‘‘other’’ direct costs, and indirect costs, excluding sales, marketing, bad debt, and profit which are not reimbursed by Medicare. Having based the 2006 dispensing fee on industry cost data for those activities that we believe fall within the scope of a dispensing fee, we believe the fees are appropriate to cover providers’ costs and will not impair access. In addition, we will continue to monitor access to care. Regarding concerns raised by some commenters about CMS lowering the fee without the benefit of new cost data, we believe it is our fiduciary responsibility to establish an appropriate payment for 2006. As discussed previously, our decision is based on our determination that certain services should not fall within the scope of the dispensing fee and the OIG report which found that these services are furnished infrequently to beneficiaries. We believe our decision to lower the fee for 2006 is consistent with our October 8, 2004 letter to the GAO, in which we stated that a dispensing fee in the range of $55 to $64 would be appropriate for the interim 2005 fee. Regarding the comment that the savings from the ASP system are greater for inhalation drugs than the savings projected by CBO or the CMS actuaries prior to enactment of the MMA, we recognize the concerns regarding the shift from a payment system based on AWP; however, we do not believe such concerns are an appropriate consideration in determining the dispensing fee for 2006. Medicare does not generally establish payment rates based on budget projections. Rather, we use the most reliable cost data available to establish E:\FR\FM\21NOR2.SGM 21NOR2 70230 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations a payment rate that is consistent with the statute and appropriate for Medicare covered services. Comment: In response to our request for comments on providers’ experience with the dispensing fee for a 90-day supply, we received a number of comments. One commenter pointed to the 2005 AAH survey, which found that most respondents (77 percent) do not provide a 90-day supply, and among those that do it represents 3 percent of their business. Reasons cited by survey respondents for non-use of a 90-day supply included—(1) 30-day supply promotes more contact with patients and compliance monitoring; (2) patient prescriptions often change; and (3) many suppliers believed the 90-day dispensing fee ($80 in 2005) was not adequate to cover costs. Less than 1 percent indicated they do not provide a 90-day supply because it is less profitable than a 30-day supply. A few other commenters raised concerns about the 90-day dispensing fee and provided similar reasons for non-use of the 90day supply as the 2005 AAH survey. In addition, one commenter cited Medicare’s refund requirements for unused drugs as being another reason for non-use of the 90-day supply. However, one commenter suggested that the 90-day supply is not used because it receives less reimbursement overall than using the 30-day supply. A physician specialty group supported the 90-day prescription because it reduces paperwork and redundant efforts by patients, physicians, and DME suppliers. Response: We agree with the physician specialty group that dispensing a 90-day supply has merit; thus, we have continued the 90-day dispensing fee for 2006. As cited by respondents to the 2005 AAH study, a 30-day supply may be most appropriate for certain beneficiaries such as those with changing prescriptions. However, for those situations where it is medically appropriate, we believe it is important to have a 90-day option available. In the CY 2005 final rule, we calculated the 90-day dispensing fee by taking direct costs for the 30-day fee and tripling indirect costs (which was based on the methodology used in the October 2004 GAO report). However, as discussed, some commenters voiced concern about the adequacy of the 2005 90-day dispensing fee. Some commenters supported the reimbursement amounts suggested by respondents in the 2005 AAH survey. In that survey, respondents suggested an average fee for a 90-day supply ($138.80) that was roughly twice the VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 amount they suggested for a 30-day supply ($66.55). For 2006 using a 2 to 1 ratio for the 90-day versus 30-day fee would yield a 90-day fee about 40 percent higher than our previous methodology. We believe it is important that adequate reimbursement be available for the 90-day option, as well as, the 30-day option. Therefore, using the 2 to 1 ratio recommended by commenters for the 90-day versus 30day supply payment rates, we are establishing a fee of $66 for a 90-day supply of inhalation drugs for 2006. Although we established two levels of dispensing fees for a 30-day supply, an initial 30-day fee of $57 and a 30-day fee of $33 for all other months, we do not believe a higher initial fee is warranted for a 90-day supply given that we do not believe a 90-day supply is generally used when a beneficiary first begins inhalation drugs. A number of commenters noted that the 90-day supply is not well-suited for patients whose prescriptions are likely to change. We recognize that beneficiaries who begin using inhalation drugs for the first time are more likely than established patients to experience changes in drugs or dosages, or to discontinue use altogether. Accordingly, we do not believe it is appropriate to encourage use of a 90-day supply when a beneficiary first begins using inhalation drugs by establishing a higher initial 90-day fee. Consequently, given such concerns, we have not provided two levels of dispensing fees with the 90-day option. Comment: Some commenters noted that refill calls are a service required by Medicare. Response: We agree that Medicare requires that a supplier confirm that a beneficiary needs a refill before sending a new shipment, and we have included the costs of refill calls from the 2004 AAH report within the dispensing fee. Comment: A few commenters suggested that many of the activities they carry out are required to maintain compliance with FDA, Medicare, and State regulations, and with standards imposed by accrediting bodies such as JCAHO. Some commenters noted that CMS has issued draft supplier quality standards, and that they are required to provide certain services as part of those standards. The commenters suggested that the dispensing fee should accommodate their costs in these areas. Response: With the exception of certain guidelines concerning compounding, we do not believe that the requirements applicable to inhalation drug suppliers are in general substantially different from the requirements applicable to pharmacies PO 00000 Frm 00116 Fmt 4701 Sfmt 4700 dispensing other drugs. Furthermore, we view costs such as regulatory compliance and quality assurance as part of overhead, which we have included in the dispensing fee based on the 2004 AAH cost data for overhead and other direct costs. We also do not believe that the costs associated with regulatory requirements applicable to equipment suppliers should be compensated through the inhalation drug dispensing fee. The Medicare program makes separate payments to equipment suppliers for rental/purchase of nebulizers and maintenance, and regulatory requirements applicable to equipment suppliers would be covered through the basic payment rates for the equipment, not the Medicare payment rate for drugs or dispensing. Regarding the draft supplier quality standards that have been released for comment, we note that the agency has adopted a two-step process for developing those standards. An initial document with draft quality standards for suppliers of several types of durable medical equipment has been released for public comment. We expect to release a second document that will clarify which quality standards apply to inhalation drug suppliers. We expect that the standards applying to inhalation drug suppliers will be consistent with accepted quality standards for pharmacies. Furthermore, the standards will establish minimum requirements for being a supplier, which we consider to be part of the standard cost of doing business that is covered through our basic payment rates. As with conditions of participations (COP) for providers, we do not increase our payment rate as a result of a change in COP requirements. Comment: One commenter stated that section 1842(b)(3) of the Act requires Medicare payments be reasonable. The commenter asserted that the agency has established in § 405.502(a) criteria for determining what is reasonable, and stated that Medicare has a history of recognizing and reimbursing services related to patient care. Response: We recognize the commenter’s concern regarding the reasonableness of Medicare payments. We have based the dispensing fee payment rates on industry cost data from the 2004 AAH report, which was submitted as part of comments by AAH on the CY 2005 proposed rule, and used in the CY 2005 final rule, to establish the 2005 dispensing fee. To establish the 2006 dispensing fee, we have used the 2004 AAH cost data excluding those services that fall outside the scope of a dispensing fee. E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations Comment: Some commenters cited Medicare’s drug payment rates (ASP+6 percent) as a reason the dispensing fee should remain the same or be increased. One homecare pharmacy indicated that it could not obtain drugs at ASP+6 percent. A few commenters stated that their costs exceed reimbursement for drugs in cases where a physician writes brand medically necessary and the drug is in a billing code that contains both brand and generic drugs. An inhalation drug supplier indicated that for three inhalation drugs its acquisition costs exceeded Medicare reimbursement. Some commenters indicated Medicare drug payments (ASP+6 percent) were inadequate for a variety of reasons such as exclusion of wholesaler markup from ASP, the lag time between sales for a quarter and the inclusion of such information in the Medicare ASP+6 drug payment rates, volatility in ASP+6 reimbursement from quarter to quarter, and class of trade differences in pricing. One commenter suggested that Medicare had addressed concerns about the adequacy of ASP+6 percent reimbursement for oncology patients by implementing the Demonstration of Improved Quality of Care for Cancer Patients Undergoing Chemotherapy. They also suggested that the ASP+6 percent cap on reimbursement for the upcoming Part B drug competitive acquisition program (CAP) was a reason for its delay, because they asserted vendors did not want to commit to a program where ASP+6 percent was the reimbursement limit. The commenter stated that the issues it has encountered with ASP+6 percent are similar to the issues faced by oncologists and vendors under CAP program and therefore should be addressed through the inhalation drug dispensing fee. In addition, a few commenters suggested that Medicare payments for equipment were inadequate, necessitating a substantial dispensing fee. Response: Although some commenters stated that the dispensing fee should account for drug acquisition costs in excess of the ASP+6 percent payment, we disagree. Section 1847A of the Act specifies that the Medicare payment for inhalation drugs is at 106 percent of the ASP. We believe the Congress established the ASP based payment for inhalation drugs and separate authority for dispensing of these drugs for good reason, namely to pay appropriately for each service and to eliminate cross subsidization of services. Similarly, we believe payment for nebulizer equipment is a distinct policy separate from the dispensing fee, and one should not cross subsidize the VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 other. In establishing the dispensing fee of $33 for a 30-day supply of inhalation drugs (and higher first month payment), we are focusing on what we believe is the appropriate scope and payment for the dispensing fee. Although one commenter suggested that we had addressed perceived issues about ASP+6 percent payment adequacy by implementing the Demonstration of Improved Quality of Care for Cancer Patients Undergoing Chemotherapy, we disagree. The purpose of the demonstration program is to promote improvements in quality by measuring patient outcomes in several areas of concern often cited by patients undergoing chemotherapy, which can then be traced to treatments and outcomes. In addition, we believe that the commenter’s statement that the change in the timeframe for implementation of the Medicare Part B drug CAP was a result of the ASP+6 percent cap on vendor reimbursement is not accurate and not related to the inhalation drug dispensing fee. Comment: A few commenters expressed concern that the 30-day dispensing fee is the same regardless of the number of prescriptions dispensed. They noted that if a prescription is changed in the middle of the 30-day period they do not receive an additional fee. They suggested CMS consider a per script fee. Response: The dispensing fee amount we have established is based on the 2004 AAH report data, which presented average costs for a month. Consequently, we believe our payment rate should be adequate to cover situations where multiple prescriptions are provided. We will consider the suggestion of a per script fee in future rulemaking, as necessary. Comment: Several commenters indicated that our revised guidelines concerning the timeframe for shipping refills had not reduced their need to use of overnight shipping. An industry association indicated that several factors often force overnight shipping such as hospitals giving beneficiaries only a one or two dose supply and beneficiaries waiting until they are out of medication to reorder. The 2005 AAH survey indicated that the percent of shipments that were overnight increased slightly from 56.3 percent in 2004 to 56.9 percent in 2005. One commenter indicated that 60 percent of its shipments occur on an overnight basis because of several factors such as needing multiple calls to reach a beneficiary and new prescriptions reportedly needing to be shipped overnight. The commenter urged us to permit refill calls as needed to be ready PO 00000 Frm 00117 Fmt 4701 Sfmt 4700 70231 to ship refill orders at least 7 days before the patient’s medication runs out. The commenter believes that this would allow for ground shipping in most cases, including refill dates that fall on weekends and 3-day holidays. One commenter suggested that the 30-day dispensing fee reimbursement guideline had reduced the amount of drugs that they could ship in a month, necessitating more use of overnight shipping. In addition, one commenter asserted if beneficiaries come in for a refill before the end of the month, then the pharmacy would receive no fee. While most commenters indicated that the revised delivery timeframes had not had a substantial impact on their delivery practices, one commenter indicated that 70 percent of its shipment through the third quarter of 2005 were ground deliveries, and they hoped to transition an additional 20 percent of shipments to ground delivery in the fourth quarter of 2005 as a result of Medicare’s extension of the patient notification and shipment window. Response: In the CY 2005 final rule, we made several administrative changes aimed at reducing inhalation drug supplier costs, including providing more flexible refill timeframes. We currently allow refills to be sent up to approximately 5 days before the end of the current usage period. To further facilitate the use of ground delivery, we are in the process of working to expand this timeframe to allow refills to be sent up to 7 days before the end of the current usage period. Under this new delivery timeframe, we will allow a dispensing fee to be paid up to 7 days before the end of current usage period, with up to 12 months of dispensing fees payable per year per beneficiary. In addition, we note that for 2006, we are establishing a dispensing fee of $57 for the first month an individual uses inhalation drugs as a Medicare beneficiary because greater levels of effort may be involved in dispensing inhalation drugs when a patient begins these drugs for the first time, for example, following hospital discharge. Comment: Many commenters responded to our request for comments on the impact of Medicare Part D coverage of metered dose inhalers on beneficiary access to care. A number of commenters asserted that they did not believe there would be a substantial shift to MDIs when they become covered under Medicare Part D. One commenter said that MDIs are not a substitute for nebulizers, as many patients require nebulizers due to inability to use MDIs properly, or physicians’ experience has shown nebulizers are more effective than MDIs. E:\FR\FM\21NOR2.SGM 21NOR2 70232 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations Another commenter said that although research has not been able to demonstrate the superiority of nebulizers to MDIs, nebulizers are the standard of care for COPD and chronic lung diseases in the moderate to severe stages. Other reasons commenters cited for their belief that there would not be a substantial shift to MDIs include: Physician inability to properly train patients on MDIs; patient familiarity with nebulizer use gained during hospital stays; research suggesting patient preference for nebulizers; potential use of nebulizers and MDIs by the same patient; and potential differences in cost-sharing across Medicare Part B and Part D. However, one physician specialty group said that it anticipates many Medicare beneficiaries will migrate to MDIs, and those that remain on nebulizers will be more frail and in need of more personalized service. Response: We believe expansion of Medicare coverage of inhalation drugs to include MDIs under Medicare Part D will provide additional options for treatment and positively impact access to care. As we indicated in the proposed rule, we recognize that nebulizers are required by many beneficiaries because of their individual circumstances. We believe that physicians will choose the treatment option that best meets a beneficiary’s needs, and both nebulizers and MDIs will play an important role in the Medicare program in the years to come. Comment: A health professional association asserted that individuals that provide patient education on use of nebulizers, MDIs, and dry powder inhalers (DPIs) should be qualified by virtue of education, training, and competency testing. It also urged CMS to pay a separate education fee to physicians when prescribing an MDI or dry powder inhaler. The commenter also proposed various levels of fees for initial and follow-up services. Another commenter raised concerns about what it asserts is a trend toward drop shipping respiratory related devices. The commenter expressed concern that contact between a respiratory patient and provider may disappear, raising potential concerns about correct usage of the respiratory device. Response: We agree that it is important that beneficiaries are properly trained in the use of nebulizers. The Medicare program provides that equipment suppliers either directly train the beneficiary in the use of the nebulizer or ensure that the beneficiary has been trained by other qualified individuals (§ 424.57(c)(12)). In VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 addition, under the physician fee schedule, Medicare will pay physicians to train the beneficiary in the use of a nebulizer, MDI, or inhalation device (CPT code 94664, demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device). Comment: One commenter stated that CMS evaded its notice and comment rulemaking obligations under the Administrative Procedures Act (APA) to collect meaningful data in support of an appropriate dispensing fee. The commenter urged us to publish data in a subsequent rule, and seek comment, before publishing a final payment rate for 2006. Response: In the August 8, 2005 proposed rule, we identified and reviewed available studies and data on the cost of providing inhalation drugs, sought comment as well as additional data and information concerning an appropriate payment amount and scope, and indicated that we thought it likely that the payment amount for 2006 would be lower than the current amount. Furthermore, in establishing the 2006 dispensing fee, we analyzed the available studies and data in response to comments received on the proposed rule and based on that analysis have continued to use the 2004 AAH data that was identified in the proposed rule and also used to establish the 2005 fee. Furthermore, as discussed previously, it is our opinion that the rates established in this rule are appropriate in light of the statute and our understanding of Congressional intent. We believe, therefore, this met our obligations under the APA. Comment: One commenter took issue with our description in the proposed rule of inhalation drugs as supplies. Response: Medicare coverage of inhalation drugs is derived from their use in covered nebulizers. For Medicare coverage purposes, they are considered covered supplies. Comment: A few commenters expressed concern about precedents Medicare Part B will set for Medicare Part D. They asserted that 90-day scripts are not appropriate for nursing home patients. Response: The Medicare Part B policy concerning a 90-day dispensing fee does not carry over to Medicare Part D. Comment: Although the assignment of benefits form (AOB) has been eliminated, one commenter noted that the requirement to obtain a payment authorization signed by the beneficiary before submitting the claim diminishes the benefit of eliminating the AOB. The commenter urged CMS to eliminate the requirement for signed payment PO 00000 Frm 00118 Fmt 4701 Sfmt 4700 authorization for providers and those reimbursed based on assignment only. Response: We thank the commenter for the comment. CMS is reviewing the beneficiary signature requirement for claims submission in light of the elimination of the AOB form in instances of mandatory assignment. However, CMS currently requires a beneficiary signature for claims submission. Comment: One drug manufacturer suggested that compounding that attempts to mimic production of commercially available products threatens patient safety. The commenter urged CMS to structure the dispensing fee to reduce the likelihood of inappropriate compounding. The commenter also suggested code modifiers for pharmacy-compounded medications to help identify their occurrence. Another drug manufacturer suggested that reducing the dispensing fee could spur suppliers to provide compounded versions of commercially available products without physician or patient authorization. The commenter suggested that we review supplier documentation to ensure compounded solutions are only furnished where documentation supports medical necessity of a customized product. Response: The inclusion of costs for pharmacy compounding in the dispensing fee is not in any way an endorsement of compounding that is inconsistent with FDA guidelines. Furthermore, Medicare expects that pharmacies comply with FDA guidelines irrespective of the dispensing fee payment amount established. We understand the concerns the commenters raised and will consider the issues further. Comment: One commenter urged us to require code modifiers for claims associated with patient compounding of inhalation drugs. The commenter asserts that when a physician writes a prescription for a compounded drug, the inhalation drug supplier has an incentive to dispense the drugs separately in order to obtain two dispensing fees. The commenter asserts that implementing the modifiers would allow us to pay only one dispensing fee, instead of two, under these circumstances. Response: Medicare pays only one dispensing fee per 30-day (or 90-day) period, regardless of the number of drugs dispensed. As a result, these modifiers would not affect Medicare expenditures. Comment: We received some comments in response to our request for information about why there is substantial variation in costs across E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations suppliers. A few commenters suggested that many beneficiaries receive services from small providers who may have higher costs. Response: We appreciate the comments. We note that the GAO report, which showed wide cost variation, found that larger suppliers did not necessarily have lower costs than small suppliers. We continue to believe that this is an issue that might benefit from further study. 5. Supplying Fee Section 303(e)(2) of the MMA added section 1842(o)(6) of the Act which requires the Secretary to pay a supplying fee (less applicable deductible and coinsurance) to pharmacies for certain Medicare Part B drugs and biologicals, as determined appropriate by the Secretary. The types of Medicare Part B drugs and biologicals eligible for a supplying fee are immunosuppressive drugs described in section 1861(s)(2)(J) of the Act, oral anticancer chemotherapeutic drugs described in section 1861(s)(2)(Q) of the Act, and oral anti-emetic drugs used as part of an anticancer chemotherapeutic regimen described in section 1861(s)(2)(T) of the Act. Beginning with CY 2005, Medicare established a supplying fee of $24 per prescription for these categories of drugs, with a higher fee of $50 for the initial oral immunosuppressive prescription supplied in the first month after a transplant. When multiple drugs are supplied to a beneficiary, a separate supplying fee is paid for each prescription, except when different strengths of the same drug are supplied on a single day. When we established the $24 supplying fee in the CY 2005 final rule (69 FR 66236), we indicated that we were establishing a rate higher than that of other payers due to the additional costs associated with Medicare Part B’s lack of online claims adjudication. As part of the August 8, 2005 proposed rule (70 FR 45848), we proposed changes to the supplying fee for multiple prescriptions supplied during the same month. We proposed to continue paying $24 for the first prescription supplied during a month (or $50 for the first oral immunosuppressive prescription supplied in the first month after a transplant) and a supplying fee of $8 for each additional prescription the pharmacy supplied to the beneficiary during the same month. Each pharmacy supplying these drugs to a beneficiary during a month would be entitled to one $24 supplying fee per beneficiary during that month. In making this proposal, we VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 indicated that when a pharmacy supplies multiple drugs to a beneficiary during the same month, many of which are likely to be supplied on the same day, we were concerned that we were overpaying for the costs associated with our lack of online claims adjudication. Furthermore, we indicated that we believe that the $24 supplying fee for the first prescription would adequately compensate a supplier for the billing costs associated with the lack of on-line claims adjudication, and that the cost of supplying additional prescriptions in the same month should be comparable to that of other payers. We also proposed to expand the circumstances under which we pay supplying fees for multiple prescriptions filled on the same day. Currently, we pay a supplying fee for each prescription supplied on the same day as long as the prescriptions are for different drugs. We proposed to pay a supplying fee for each prescription, even if the prescriptions are for different strengths of the same drug. We requested comments about the appropriateness of our proposed supplying fee for multiple prescriptions supplied during a single month along with data and information about the incremental costs of supplying additional prescriptions to a Medicare beneficiary during a single month. We also asked for comments about how pharmacy costs and reimbursement for supplying oral drugs under Medicare compares to that of other payers. We received numerous comments regarding our supplying fee proposals. Those comments and responses are provided below. Comment: Numerous commenters were supportive of our proposal to expand the circumstances under which we pay a supplying fee to include paying separate fees when multiple strengths of the same drug are supplied on the same day. However, many commenters expressed concern about our proposal to pay a supplying fee of $24 to a pharmacy for the first prescription and $8 for all subsequent prescriptions supplied in a 30-day period. Commenters generally urged no reduction in the supplying fee when multiple prescriptions are provided in the same month, and a few urged a payment increase. In opposing the $8 subsequent fee, some commenters stated that the agency had included no new cost data in the proposed rule to support a reduction. At the same time, some commenters provided cost information as part of their comments. A few commenters indicated that the cost of supplying a drug for an insurer with online claims adjudication had PO 00000 Frm 00119 Fmt 4701 Sfmt 4700 70233 increased from $8 (as cited in the proposed rule) to $9 to $10 based on new studies. An association representing chain drug stores provided information from a few large chains indicating that the average cost to supply a Medicare Part B prescription was between $19 and $21, noting that small chains or independent pharmacies may have higher costs. The association asserted that the current $24 fee was reasonable considering the fact that Medicare currently does not pay separate supplying fees for different strengths of the same drug supplied on the same day. The association urged us to consider an increase in the $24 fee to take into account inflation, and an increase in the $50 fee for the first prescription after a transplant to compensate for the intense patient monitoring that the association indicated was needed. A large chain pharmacy indicated its average cost of supplying a Medicare prescription was $19.02, which included $5.54 for bad debt. An association for specialty transplant pharmacies submitted data suggesting that Medicare’s reimbursement (combined payment for the drug and supplying fee) to these pharmacies for 2 large volume immunosuppressive drugs is comparable or lower than that of Medicaid or private payers. This association pointed to a 2004 report prepared by a consultant, which indicated that specialty pharmacy costs for immunosuppressive drugs for Medicare patients averaged about $35. This association also indicated that transplant pharmacies have higher costs because they offer more extensive services, routinely stock specialty medicines and maintain regular and consistent contact with their Medicare clients. The association suggested that these services should be compensated through the supplying fee. In addition, this association also claimed that chain pharmacy data collected in a similar manner to the specialty pharmacy data yield costs of $21. The group asserted that the chain costs appear lower than the specialty pharmacy costs in part because chains supply items such as diabetic test-strips, which they indicate cost less to supply. In opposing a reduction in the supplying fee for subsequent prescriptions in a month, a number of commenters took issue with the rationale provided in the proposed rule for the reduction, saying that there are not economies of scale in processing Medicare claims when multiple prescriptions are provided in the same month. Many commenters outlined costs associated with billing Medicare. E:\FR\FM\21NOR2.SGM 21NOR2 70234 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations Because of the lack of online claims adjudication, some stated that there was more bad debt associated with Medicare Part B claims. Other commenters indicated that it takes longer to process a Medicare claim because of the requirement of a signed order from the physician as well as the lack of online claims adjudication. Some commenters indicated that without online claims adjudication, pharmacies must call the DMERC to check the beneficiary’s deductible as well as verify whether the beneficiary is still enrolled in traditional Medicare as opposed to Medicare Advantage. Other commenters indicated that the lack of online claims adjudication and automatic cross over claims means that they may have to refund a beneficiary’s coinsurance if it is later determined that the beneficiary has supplemental insurance. Other billing activities and requirements that commenters cited as creating added costs include: contracting with a special entity to convert Medicare Part B claims from the NCPDP format to ANSI X837; working with physicians to determine whether oral anticancer or anti-emetic drugs are being prescribed for Medicare Part B covered indications; having to submit the unique physician identifying number (UPIN) on the claim; and Medicare’s requirement that the date of service and date of prescription be the same. Although most commenters did not support the proposal for a reduced fee when multiple prescriptions are supplied in a month, one health insurer commented that the current supplying fee payment amounts appear high, and put upward pressure on commercial rates. Response: As we indicated in the CY 2005 final rule (69 FR 66236), we recognize that the cost of supplying Medicare Part B drugs is somewhat higher than that of other payers because of the lack of on-line claims adjudication for Medicare Part B claims. We believe it is appropriate for Medicare’s supplying fee to compensate for the Medicare billing costs associated with the lack of online claims adjudication. However, as we indicated last year, we do not believe the supplying fee for these drugs should be higher than other payers for reasons other than the lack of on-line claims adjudication. The comments included information on the costs of supplying Medicare Part B drugs for some chain pharmacies. One chain reported Medicare costs of $14.48 ($19.02 – $5.54 non-reimbursed bad debt). A retail pharmacy association commented that a few chains had indicated that their costs of supplying a VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Medicare Part B prescription were between $19–$21 per prescription (without indicating whether bad debt was included). Furthermore, as we indicated in the August 14, 2004 final rule (69 FR 66236), our analysis of data from a 2004 survey of specialty pharmacies yields a supplying fee in the range of $13–$27 depending on the proportion of personnel costs assumed to be associated with Medicare billing. This range was developed by using a figure of $5 or $10 for the payment rates of payers with on-line adjudication, and adding to that Medicare claims processing costs from the specialty pharmacy data ($8), and a portion of personnel costs from the specialty pharmacy data (total was $9) assumed to be related to Medicare billing. This results in supplying fee between $13 ($5 + $8) and $27 ($10 + $8 + $9), depending on the portion of personnel costs associated with Medicare billings. Based on this information from chains and specialty pharmacies, we agree that an $8 fee for subsequent prescriptions is too low. However, as discussed in more detail subsequently, our analysis of the cost information from the comments has led us to believe that a subsequent prescription supplying fee that is slightly lower than $24 would be appropriate. Based on our analysis, we believe that a $24 fee for the first prescription in a 30-day period, and a $16 fee per prescription for all subsequent prescriptions in the 30-day period would be consistent with the cost information included in the comments. Under this fee structure, reimbursement to a pharmacy for the supplying fee would average $24 for a patient with 1 prescription in a 30-day period, $20 per prescription for patients with 2 prescriptions, $18.67 per prescription for a patient with 3 prescriptions, and $18 per prescription for a patient with 4 prescriptions, for example. Our claims data currently indicate that beneficiaries receiving immunosuppressive, oral anticancer, or oral anti-emetic drugs under Medicare Part B average 2.2 prescriptions per month, with a majority receiving 4 or fewer. We believe average supplying fee payments ranging from $18 to $24 are consistent with the chain drug store costs indicated in the comments and falls within the mid-range of the potential supply fee amounts we calculated based on the specialty pharmacy data survey. Because we continue to believe that there are some economies of scale for Medicare billing costs when multiple prescriptions are supplied in the same month, particularly when they are billed on the same claim form, we believe it is PO 00000 Frm 00120 Fmt 4701 Sfmt 4700 appropriate to pay a higher fee for the first prescription in a 30-day period, and the somewhat lower fee for all subsequent prescriptions in the 30-day period. For example, several activities related to Medicare billing that commenters cited as being costly including calling the DMERC to verify the beneficiary’s Medicare fee for service eligibility, locating the physician’s UPIN to include on the Medicare Part B claim form, handling coinsurance refunds for crossover claims, and completing other information on the claim form would only have to be performed once, rather than twice, when multiple prescriptions are submitted on the same claim. Moreover, following through on our proposal to expand payment of the supplying fee to include paying separate fees when multiple strengths of the same drug are supplied on the same day, we believe it is important that the subsequent prescription supplying fee reflect lower incremental costs. Consequently, beginning in 2006, we are establishing a supplying fee of $24 for the first prescription in a 30-day period, and $16 for each subsequent prescription in the period. Each pharmacy will be eligible for one $24 fee per beneficiary per 30-day period. As mentioned previously, beginning in 2006 we are also expanding the circumstances under which we pay the supplying fee to include paying separate fees for different strengths of the same drug that are a supplied on the same day. We are not altering the current policy of paying a $50 supplying fee for the first immunosuppressive prescription after a transplant. If a supplier receives a $50 supplying fee for the initial prescription after a transplant, a supplying fee of $16 will be paid for all subsequent prescriptions, after the initial prescription, furnished by that supplier to the beneficiary during that 30-day period. We are making conforming changes to § 414.1001(b) to reflect this policy concerning subsequent prescriptions supplied during the same 30-day period as the initial immunosuppressive prescription after a transplant. Comment: A number of commenters expressed concerns about beneficiary access if the supplying fee were reduced. Some suggested that pharmacies may stop providing these drugs to beneficiaries if the supplying fee is lowered. Others believe that a reduction in the fee could lead specialty pharmacies to stop providing support services to transplant patients, which they assert could adversely impact transplant success for some patients. E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations Response: We believe the supplying fee payment amounts we have established are appropriate based on the cost information available from the comments, and beneficiaries will continue to have good access to these drugs. Furthermore, we note that the reduction in Medicare payments resulting from the supplying fee changes are expected to represent at most 1 percent of Medicare total payments to pharmacies for these drugs. Comment: Some commenters expressed concern about the reduction in reimbursement that would result from the subsequent prescription supplying fee in certain situations (for example, for drugs that have a 3-week prescription cycle or for patients with 3 prescriptions per month). Response: Under the supplying fee rates established for 2006, Medicare reimbursement for the supplying fee would in the majority of cases average from $24 (patient with 1 Medicare Part B prescription) to $18 (patient with 4 Medicare Part B prescriptions). As mentioned previously, we believe this range of average reimbursement is consistent with the chain pharmacy cost information in the comments and falls near the mid-range of the potential supplying fee payment amounts we calculated based on the 2004 survey data for specialty pharmacies. Furthermore, we believe the supplying fee payment rates appropriately reflect the potential for economies of scale when multiple prescriptions are supplied in the same month. Comment: A few commenters stated that a lower subsequent prescription fee may encourage pharmacies to send patients to affiliate locations in order to receive the $24 fee. Response: We disagree. As mentioned previously, we believe that the supplying fee payment rates established are adequate to cover pharmacies’ supplying costs based on the cost information included in the comments. We do not believe that these reimbursement changes would spur pharmacies to take actions that would cause inconvenience to the beneficiaries they serve. Comment: Some commenters maintained Medicare’s drug payment rates (the average sales price + 6 percent) were below their acquisition costs for certain drugs, and stated that the current $24 per prescription supplying fee should be unchanged or increased to compensate for this. Response: Although some commenters stated that the supplying fee should account for drug acquisition costs in excess of the ASP+6 percent payment, we disagree. Section 1847A of VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 the Act specifies that the Medicare payment for these drugs is at 106 percent of the ASP. We believe the Congress established the ASP based payment for these drugs and separate payment for the supplying of these drugs for good reason, namely to pay appropriately for each distinct service. In expanding the circumstances under which we pay a supplying fee and establishing the supplying fee payment amounts ($24 for the first prescription in a 30-day period and $16 for all subsequent prescriptions in a 30-day period, as well as the $50 fee for first immunosuppressive prescription after a transplant), we are focusing on the appropriate scope and payment for the supplying fee. Comment: A few commenters suggested that for 2006 the current supplying fee payment amounts ($50 for initial prescription after a transplant, and $24 per prescription otherwise) be increased for inflation or to ensure adequate reimbursement for services provided by suppliers. Response: We believe that the supplying fee payment amounts we have established for 2006 are consistent with the cost information from the comments this year. We will consider an inflation adjustment for the future. Comment: Some commenters raised concern that if a beneficiary sought a refill before the end of the month, the pharmacy would not be eligible for a $24 fee for that refill. Response: We understand the commenters’ concern. We are taking several steps to address this potential issue. First, we have decided to use a 30-day period rather than a calendar month as the basis for determining whether a $24 or $16 supplying fee is payable. Thus, we will pay a $24 supplying fee for the first prescription supplied by a pharmacy in a 30-day period (or a $50 supplying fee for the first immunosuppressive prescription after a transplant), and a $16 supplying fee for each subsequent prescription supplied by that pharmacy to the beneficiary in the 30-day period. We believe using a 30-day period avoids arbitrary fluctuations in payment that might otherwise occur as a result of variation in the number of days per month. In addition, in our instructions to implement the 2006 supplying fee, we will allow a $24 supplying fee to be paid for a refill prescription up to 7 days before the end of the 30-day period for which the last $24 supplying fee was paid to that pharmacy, with up to twelve $24 supplying fees payable per beneficiary per year. Comment: A number of commenters expressed concern that the assignment PO 00000 Frm 00121 Fmt 4701 Sfmt 4700 70235 of benefits (AOB) forms, which the August 14, 2004 final rule indicated would be eliminated, has not yet been eliminated. Response: The requirement that a pharmacy obtain an AOB form when supplying drugs to a beneficiary was eliminated for dates of services on or after January 1, 2005. Because of technical issues, the claims processing contractors did not immediately implement this change. We published a change request in August 2005 clarifying that the requirement for an AOB form was eliminated effective January 1, 2005 for pharmacies supplying Medicare Part B drugs to beneficiaries (as well as in other circumstances where assignment is mandatory). This change request will be implemented on November 14, 2005. The change request can be found at: https://www.cms.hhs.gov/manuals/ pm_trans/R643CP.pdf. Comment: Several commenters expressed concern that the DMERC Information Form (DIF), which the August 14, 2004 final rule indicated would be eliminated, had not been eliminated yet. A commenter also mentioned some suppliers having difficulty with the rejection of claims for immunosuppressives for ‘‘DIFs not on file,’’ when they are on file. In addition, one commenter urged us to not only eliminate the DIF, but also to eliminate the requirement that pharmacies collect and submit the DIF information with each claim. The commenter suggests that most of this information can be obtained by information submitted to Medicare by the transplant facility or transplant physician, and the requirement for pharmacies to submit the information is duplicative. Response: The elimination of the DIF will be implemented with the quarterly systems release that occurs April 2006. A number of systems issues makes the elimination of the DIF more involved than anticipated. We regret the delay in the elimination of this requirement, and remain committed to implementing the change in April 2006. Regarding the other issues concerning the DIF raised in the comments, these billing issues are outside the scope of this final rule; however, we encourage commenters to continue to bring these concerns to our attention. Comment: A specialty pharmacy group indicated that some pharmacies had encountered situations where Medicaid or other third party payers were not covering the beneficiary’s coinsurance on the supplying fee. The commenter requested that the final rule include an explanation of these parties’ E:\FR\FM\21NOR2.SGM 21NOR2 70236 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations responsibilities concerning beneficiary coinsurance on the supplying fee. Response: The supplying fee is covered under Medicare Part B. Like all other Medicare Part B benefit categories, standardized Medigap plans are responsible for paying all (plans A–J) or a specified proportion (plans K and L) of a beneficiary’s Part B coinsurance once the Part B deductible has been met. With some exceptions, State Medicaid programs are responsible for beneficiary cost-sharing for the supplying fee for beneficiaries who are dually eligible for both Medicare and Medicaid. State Medicaid programs can limit coinsurance payments to the extent that any payment, when combined with Medicare payments, equals the amount of reimbursement payable under the State Medicaid program. A State Medicaid program may deem a pharmacy to be paid in full even if it has received either no coinsurance payment or a reduced payment from the State. Beneficiaries have no liability beyond the State’s payment amount as set forth in section 1902(n)(2) of the Act. Comment: One commenter suggested that physicians be allowed to bill for the supplying fee for immunosuppressive, oral anti-cancer, and oral anti-emetic drugs. The commenter suggested we could define a pharmacy, for the purposes of the supplying fee, to include physicians acting as pharmacists. As another approach, they suggested we could use our inherent reasonableness authority to extend the supplying fee to physicians. Response: As we indicated in the CY 2005 final rule, given our understanding of Congressional intent, we do not believe it would be appropriate to pay a supplying fee to physicians. In addition, at this time, we do not have sufficient data to determine if our inherent reasonableness authority would apply in this instance. Comment: A specialty pharmacy group requested that we include clarification in the final rule concerning whether temporary billing codes for the supplying fee G0369 and G0370 will be replaced with permanent codes. Response: Effective January 2006, we intend to replace the G-codes for the supplying fee with Q-codes. 6. Competitive Acquisition of Outpatient Drugs and Biologicals Under Part B In this section of the preamble, we discuss the Competitive Acquisition Program (CAP) for Part B drugs; summarize the requirements established in the July 6, 2005 interim final rule with comment titled ‘‘Competitive Acquisition of Outpatient Drugs and VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Biologicals Under Medicare Part B’’ (70 FR 39022); respond to comments on selected issues in that rule and finalize the associated policies; and discuss the next steps in the implementation of the CAP program. We are addressing the issue of inclusion of CAP drug units in the ASP calculation in separate rulemaking. General Overview of CAP Section 303(d) of the MMA amended the Act by adding a new section 1847B, which establishes a program for the acquisition of and payment for competitively biddable Part B covered drugs and biologicals furnished on or after January 1, 2006. Implementation of the CAP will provide physicians with a choice between— • Obtaining these drugs from entities selected to participate in the CAP in a competitive bidding process; or • Acquiring and billing for Part B covered drugs under the ASP drug payment methodology. In our July 6, 2005 interim final rule with comment, we finalized provisions set forth in the Competitive Acquisition of Outpatient Drugs and Biologicals Under Part B proposed rule published on March 4, 2005 in the Federal Register (70 FR 10746), but also provided the public an additional opportunity to comment on the final provisions established for the CAP. We codified the requirements and provisions for the CAP in regulations at 42 CFR part 414, subpart K, with § 414.906 through § 414.920 containing requirements for payment under the CAP as follows: • Section 414.906 (Competitive acquisition program as the basis for payment). This section specifies how payment for CAP drugs is determined, including vendor responsibilities for billing, shipment and delivery; computation of the payment amount; substitution of CAP drugs and resupply of a participating CAP physician’s drug inventory. • Section 414.908 (Competitive acquisition program). This section specifies the process for a physician to select an approved CAP vendor and the responsibilities of a participating CAP physician, including the specific information that must be included on the prescription order as well as notification and the timeframe for submission of claims. This section also specifies the process for selecting approved CAP vendors, as well as factors that are considered in the selection process such as exclusion under section 1128 of the Act from participation in Medicare or other Federal health care programs. PO 00000 Frm 00122 Fmt 4701 Sfmt 4700 • Section 414.910 (Bidding process). This section outlines the specific criteria for submission of a bidding price for a CAP drug, and specifies what costs should be included in the bid price. • Section 414.912 (Conflicts of interest). This section discusses requirements and standards for conflict of interest that applicants that bid to participate and approved CAP vendors must meet. • Section 414.914 (Terms of contract). This section outlines the contract provisions between CMS and the approved CAP vendor including contract length and termination, and specific requirements the approved CAP vendor must comply with. • Section 414.916 (Dispute resolution for vendors and beneficiaries). This section discusses the process available to an approved CAP vendor and beneficiaries for resolution of denied drug claims, outlining the steps, timeframes and requirements that must be met. • Section 414.917 (Dispute resolution and process for suspension or termination of approved CAP contract). This section discusses the process available to participating CAP physicians for resolution of quality or service issues concerning an approved CAP vendor, including steps and timeframes that are to be followed. • Section 414.918 (Assignment) and § 414.920 (Judicial review). Application of assignment and administrative and judicial review for the CAP are discussed in these sections of the regulation, respectively. In the July 6, 2005, interim final rule with comment for the CAP published as CMS 1325–IFC, we also defined terms used for the CAP in § 414.902. We also established that for initial implementation, the competitive acquisition area, in which approved CAP vendors supply drugs, will be on a national level and include all 50 States, the District of Columbia, Puerto Rico, and the U.S. territories. In addition, we established a single drug category consisting of approximately 180 drugs commonly provided ‘‘incident to’’ a physician’s service and included these in the addenda to the July 6, 2005 interim final rule with comment. These drugs represent about 40 percent of the approximately 440 drugs that may be billed ‘‘incident to’’ physician services and about 85 percent of physicians’ Part B drugs by billed charges, as reflected in our Part B billing data. Effective August 3, 2005, we suspended the vendor bidding process that began with publication of the July E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 6, 2005 interim final rule with comment to allow us more time to fully review public comments on the interim final rule with comment and also to further refine the bidding process. We provided notification of the suspension on the CMS Web site https://www.cms.hhs.gov/ providers/drugs/compbid/ and through the pharmacy and physician Listservs. We also announced the suspension of the bid process in the Competitive Acquisition of Outpatient Drugs and Biologicals Under Part B: Interpretation and Correction interim final rule with comment, published on September 6, 2005 in the Federal Register (70 FR 52930). In that document, we stated we would publish a final rule for implementing the CAP after we analyzed the additional comments on the July 6, 2005 interim final rule with comment and determined the best manner for improving the efficiency of the CAP and increasing potential participation of both vendors and physicians in the program. We also indicated that we would announce the dates for the new vendor bidding period as well as a special physician election period with the publication of the final rule. As noted earlier in this section of the preamble and as discussed in more detail below, in this final rule with comment, we are addressing certain issues raised by commenters responding to the July 6, 2005 interim final rule with comment. We believe it is critical to address these specific concerns we have identified through review of the comments and finalize or clarify specific policy issues raised to allow us to effectively implement the CAP. Other issues raised by commenters that are not addressed in this final rule with comment will be addressed in future rulemaking, once we have fully reviewed all of the comments not addressed in this rulemaking. Specific information concerning implementation of the CAP, including vendor bidding and physician election are discussed later in this section. Analysis of and Response to Public Comments We received a total of 225 timely comments in response to the July 6, 2005 interim final rule with comment (70 FR 39022). Commenters included trade associations, medical societies and organizations, a health insurance company, pharmaceutical manufacturers and wholesalers, specialty pharmacies and pharmacy benefits management groups, as well as practitioners, private citizens and patient advocates, and a member of the Congress. All public comments were reviewed and grouped by related topics VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 and focused on various aspects of the CAP interim final rule with comment. In this final rule with comment, we are responding to comments related to certain aspects of the CAP, and making modifications to the regulation text where necessary so that an improved implementation can be achieved. We will be responding to the remaining comments and issues raised in future rulemaking after we have had the opportunity to fully review those comments and issues. The specific areas being addressed are discussed below. a. Design of the Program In this section, we discuss the policy and process for changes to the original CAP Single Drug Category List (Addendum A) and changes in the original New Drugs for the CAP Bidding for 2006 (Addendum B). These changes are reflected in Addendum F and Addendum G of this final rule with comment. We also clarify issues related to drugs included in the CAP and updated certain requirements for bidding. We discuss the process for when and how an approved CAP vendor may request that we approve a change to its CAP drug list. Finally we discuss CAP drug weighting for the single drug category. (1) Changes to the List of Drugs Supplied Under the CAP The CAP is intended to provide beneficiaries with access to Medicare Part B drugs and maintain physician flexibility when prescribing medications. In the July 6, 2005 interim final rule with comment, we described how the single drug category list was developed and how newer agents and substitute products could be incorporated into the CAP. In this section of the preamble, we will respond to comments relating to drugs supplied under the CAP. We developed the single drug category list by developing criteria based on Part B drug utilization. This list was published in Addendum A of the July 6, 2005 interim final rule with comment and contains the majority of drugs that a prospective CAP vendor will bid on. Newer drugs without utilization data were listed in Addendum B—New Drugs for CAP Bidding in 2006 in the July 6, 2005 interim final rule with comment. Development of these lists began with the statutory definition of competitively biddable drugs and biologicals (section 1847B(a)(2) of the Act) and then the application of specific steps described in the July 6, 2005 interim final rule with comment (70 FR 39030) to narrow the list of possible drugs based on PO 00000 Frm 00123 Fmt 4701 Sfmt 4700 70237 utilization and other factors, as described in the interim final rule with comment, that we believe made inclusion of the drug in the CAP drug category appropriate for the initial implementation stage of the CAP. Section 1847B(a)(1)(B) of the Act requires that the Secretary establish categories of drugs that will be included under the CAP, and requires the Secretary to phase-in the program with respect to these categories. The statute also defines ‘‘competitively biddable drugs and biologicals’’ for the purposes of the CAP by referring to section 1842(o)(1)(C) of the Act. Relying on our authority to phase in the CAP drug categories as appropriate, we narrowed our focus to drugs furnished ‘‘incident to’’ a physician’s service. In response to comments, and in an effort to offer the CAP to as many physicians as possible, we chose not to phase-in the CAP on the basis of drugs typically used by any one particular specialty; however, we realized that certain types of drugs may be better suited for inclusion in early stages of the CAP than others. During our review of comments on the July 6, 2005 interim final rule with comment and subsequent review of the single drug category list published in Addendum A, we became aware of supply issues with one specific drug. These issues have prompted us to make changes to the Single Drug Category List in Addendum A of the interim final rule with comment (included with this rule as Addendum F). We have deleted a HCPCS code (J1710) for a drug that is being phased out of the market and revised the addenda that comprise the CAP drug category to account for upcoming changes to HCPCS codes. Also, before the CAP is implemented, several new permanent HCPCS codes will be approved and several others modified. A number of these newly approved codes would have been included in the CAP drug category identified in our July 6, 2005 interim final rule with comment, had permanent HCPCS codes been available at that time. Therefore, we are amending the list of drugs published in the New Drugs for CAP Bidding for 2006 in Addendum B of the interim final rule with comment to account for drugs in the new HCPCS codes, and to account for HCPCS codes that appeared in Addendum A of the July 6, 2005 interim final rule with comment that have since been split into separate HCPCS codes for which we are unable to calculate new weights. Updated lists of drugs that are included in the initial CAP drug category appear E:\FR\FM\21NOR2.SGM 21NOR2 70238 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations in Addendum F and Addendum G of this rule. (a) Changes to the Single Drug Category List—Addendum A of the July 6, 2005 Interim Final Rule With Comment The July 6, 2005 interim final rule with comment discussed criteria for developing the Single Drug Category List (Addendum A of the interim final rule with comment). In the following section, we describe factors that led us to revise this list. After suspending the bidding process, we reviewed the drugs included in the Single Drug Category List that was published in Addendum A of the July 6, 2005 interim final rule with comment (70 FR 39101). During this process, we found that the brand name product under HCPCS code J1710 (hydrocortisone sodium phosphate injection) was withdrawn from the market and that generic products for this code are not reliably available. This drug’s weight in the CAP’s Single Drug Category List as published in Addendum A is 0.000060285401. Because of the availability issue associated with this drug we will remove J1710 from the Single Drug Category List and recalculate weights for the remaining drugs. The impact on other drugs’ weights will be minimal because of J1710’s very low weight. Yearly updates to the HCPCS codes also impacted the CAP drug lists in several ways. One code J7051 Sterile saline or water up to 5cc (CAP weight = 0.006953978284) was modified to A4218 Sterile saline or water, metered dose dispenser, 10 ml. ‘‘A codes’’ are primarily medical and surgical supplies, and we believe that the change reflects usage that is primarily through a means other than incident to a physician’s service. Therefore, we will remove this code from the Single Drug Category list and recalculate weights for the remaining drugs. Revisions to the Single Drug list also reflect modifications to several HCPCS codes. These modifications will not affect the weighting calculation because they are either changes in names or consolidation of multiple codes into one. The previous codes’ utilization data will be used in the updated calculation. Table 23 illustrates the affected HCPCS codes. TABLE 23 New HCPCS code New description J0881 ....................................... Injection, darbepoetin alfa, 1 microgram (non-esrd use) ....................................................... J0885 ....................................... J7318 ....................................... Injection, epoetin alfa, (for non-esrd use), 1000 units ............................................................ Hyaluronan (Sodium Hyaluronate) or derivative, intra-articular injection, 1 mg .................... The changes to the HCPCS codes also affected iron dextran. A discussion of iron dextran’s removal from the single drug category list and the addition of the two new iron dextran HCPCS codes to the Revised New Drugs for CAP Bidding For 2006 appears in the following section. (b) Changes to New Drugs for CAP Bidding for 2006—Addendum B of July 6, 2005 Interim Final Rule With Comment (See Addendum G in This Final Rule With Comment) Addendum B, published in the July 6, 2005 interim final rule with comment (70 FR 39102), was developed in response to comments on the proposed rule that urged us to provide a means to include newer drugs. We are updating Addendum B with drugs that have been recently assigned new HCPCS codes, and drugs that were previously listed in Addendum A of the July 6, 2005 interim final rule with comment, but because of HCPCS code changes, cannot be reweighted. These changes appear in Addendum G of this rule. Further details are provided below. Comment: We received numerous comments asking that individual drugs that were recently approved and introduced to the United States market be included in the CAP. Improving the selection of products that could be supplied through the CAP was VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 commonly given as a reason for the request. Response: We agree that it is desirable for the CAP to include a wide variety of drugs and to maintain the flexibility to adapt to a rapidly changing marketplace. Therefore, we are adding additional procedures to the CAP that will allow approved CAP vendors to adjust and update their drug lists. These changes are described below. In the July 6, 2005 interim final rule with comment, we stated that we intended to provide the physician with choice and flexibility within groups of drugs that might be used by different specialties for the treatment of various conditions. The drugs available under the CAP are intended to accommodate a variety of physician practice patterns and a variety of specialties. As discussed in other sections of this rule, the CAP also seeks to provide access to new drug therapies. As a part of the annual HCPCS code update, several new permanent HCPCS codes were issued. Billing with these codes will begin on January 1, 2006. In order to keep the CAP list of drugs as comprehensive and complete as possible, we have updated the New Drugs for CAP Bidding that was originally published in Addendum B of the July 6, 2005 interim final rule with comment to account for the coding changes. This list of newly issued HCPCS codes provided us with an PO 00000 Frm 00124 Fmt 4701 Sfmt 4700 Old HCPCS code J0880 Q0137 Q0136 J7317 J7320 opportunity to add drugs to the CAP drug category; the additions include several recently approved drugs. Examination of the new HCPCS codes also revealed that several codes for drugs listed in Addendum A of the July 6, 2005 interim final rule with comment had undergone modification. For example, beginning in January 2006, the HCPCS code for iron dextran will be split into two codes, and the HCPCS code for darbepoetin alfa when used for non-end stage renal disease will be revised. We are unable to recalculate the weights for these split HCPCS codes because it is not possible to estimate the new codes’ utilization. Therefore, we are including these drugs in a revised version of Addendum B—New Drugs for CAP Bidding 2006, which was published in the July 6, 2005 in the interim final rule with comment. The list of New Drugs for CAP Bidding 2006 is now Addendum G of this rule. We believe this change is appropriate because we had already decided to include these drugs in the CAP drug category, and adding them to Addendum G will avoid a recalculation of the other CAP drugs’ weights based on an imprecise estimate of utilization. Addenda F and G published in this final rule with comment supersede Addenda A and B from the July 6, 2005 interim final rule with comment. Note that HCPCS code modifications as they E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations relate to the Single Drug Category list were discussed in section II.H.6.a.(1).(a) of this final rule with comment. In order to be included in Addendum G—Revised List of New Drugs for CAP Bidding for 2006, we determined that a drug must not appear in the Revised Single Drug Category List (Addendum F of this rule) and must meet at least one of the following three criteria: • Criterion 1: The drug must have been listed in Addendum B of the July 6, 2005 interim final rule with comment, ‘‘New drugs for CAP Bidding for 2006’’. • Criterion 2: The drug must have a new J or Q HCPCS code effective January 1, 2006, and meet the three following conditions: + Be administered incident to a physician’s service. + Have had a previous C, S or ‘‘NOC’’ (Not Otherwise Classified or Miscellaneous) code. + Have one national published ASP payment price and not meet either of the following two conditions: ++ Be primarily billed through the DME process. ++ Be primarily used as a diagnostic agent. • Criterion 3: The drug must be listed in Addendum A—Single Drug Category List published in the July 6, 2005 interim final rule with comment, but had its HCPCS code terminated effective January 1, 2006 and split into J or Q Codes that become effective January 1, 2006. Criterion 1 describes drugs listed in Addendum B of the July 6, 2005 interim final rule with comment. Tables 24 and 25 list drugs that meet criteria 2 and 3. Table 24 lists drugs that will have new HCPCS codes beginning January 1, 2006 and Table 25 is a list of drugs that were previously included in Addendum A but whose HCPCS codes were split. Combining these three lists will yield Addendum G—Revised New Drugs for CAP Bidding for 2006, which is published in this rule. TABLE 24.—CAP DRUGS WITH NEW HCPCS CODES EFFECTIVE JANUARY 1, 2006 HCPCS (effective 1/1/2006) J0128 J0180 J0878 J1931 J2357 J2469 J2794 J9035 J9041 ........ ........ ........ ........ ........ ........ ........ ........ ........ VerDate Aug<31>2005 Long description Abarelix injection. Agalsidase beta injection. Daptomycin injection. Laronidase injection. Omalizumab injection. Palonosetron HCl. Risperidone, long acting. Bevacizumab injection. Bortezomib injection. 14:28 Nov 18, 2005 Jkt 208001 70239 TABLE 24.—CAP DRUGS WITH NEW (c) Process for Adding NDCs Within a HCPCS CODES EFFECTIVE JANU- HCPCS Code in an Approved CAP Vendor’s Drug List ARY 1, 2006—Continued HCPCS (effective 1/1/2006) Long description J9055 ........ J9305 ........ J9264 ........ Cetuximab injection. Pemetrexed injection. Paclitaxel protein bound particles. Pegaptanib. Amikacin. Histrelin implant. J2503 ........ J0278 ........ J9225 ........ TABLE 25.—HCPCS CODES FROM ADDENDUM A THAT HAVE BEEN SPLIT HCPCS (effective 1/1/ 2006) J1751 .. J1752 .. 2006 Long description Discontinued HCPCS Iron Dextran 165. Iron Dextran 267. J1750 J1750 The drugs identified in Addendum G will be bid and paid for as described in the July 6, 2005 interim final rule with comment (70 FR 39072). In the July 6, 2005 interim final rule with comment, we stated that we will require that prospective vendors include bids for all of these drugs in their submissions and provide these drugs to physicians who elect to participate in the CAP. However, we will not incorporate the bids for these drugs into the composite bid methodology, because we lack sufficient utilization data to compute appropriate weights for these drugs. Instead, we will consider these bids separately from, but parallel to, evaluation of the composite bid for the other drugs for which we have adequate utilization data. Specifically, we will require bidders to submit a separate bid for each drug in the list. We will also impose a ceiling on acceptable bids. As in the case of the composite bids, that ceiling will be tied to the ASP payment methodology. Specifically, we will not accept any bid for a drug listed in Addendum G that is higher than 106 percent of the ASP for that drug (as determined at the time when the bidding begins). In order to be eligible for selection as an approved CAP vendor, a bidder must meet all of the criteria outlined in § 414.908 of the regulation text and must submit acceptable bids on each of the drugs listed in Addenda F and G of this final rule with comment. PO 00000 Frm 00125 Fmt 4701 Sfmt 4700 We acknowledge that given the 3-year CAP contract duration, some changes to the approved CAP vendors’ CAP drug lists are anticipated during the life of the contract. In the July 6, 2005 interim final rule with comment (70 FR 39075), we described a mechanism where approved CAP vendors could request CMS approval to add new drugs to their CAP drug lists once the drug had a permanent HCPCS code. We also described a mechanism (70 FR 39044 and § 414.906(f)(2)(i)) where, if a particular NDC becomes unavailable or goes through a period of short supply an approved CAP vendor could substitute a different NDC within the HCPCS code for the NDC currently supplied by the approved CAP vendor for an extended period of time (2 weeks or longer) if the approved CAP vendor identifies the replacement product, CMS approval for the substitution is obtained, and all participating CAP physicians who have selected the approved CAP vendor are notified of the change. Comment: Numerous commenters recommended that we develop a mechanism to allow approved CAP vendors to add drug products (identified by an NDC) to those already supplied within a HCPCS code during the CAP contract period. Potential vendors indicated in their comments that they would like the flexibility to add NDCs because, as experience with the CAP grows, they may encounter situations where the addition of certain drugs supplied under a HCPCS code may improve beneficiary access, reduce waste, and improve the vendor’s cost efficiency. Response: We agree that additional mechanisms to expand an approved CAP vendor’s drug list at the NDC level are desirable. The current requirements state that an approved CAP vendor must offer at least one NDC within each HCPCS code in the CAP drug category. We encourage potential vendors to bid more than the minimum of one NDC per HCPCS code. However, we also understand that, as the 3-year contract period progresses, opportunities to modify the initial list of NDCs supplied under a HCPCS code will occur. Examples of these opportunities could include introduction of a new package size, the introduction of a new manufacturer’s products (including new multisource products), and price changes in existing NDCs. We believe that in order for an approved CAP vendor to continue to meet participating CAP physicians’ E:\FR\FM\21NOR2.SGM 21NOR2 70240 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations needs, it is in the approved CAP vendor’s best interest to provide and maintain a satisfactory range of products, and to improve the range of available products as experience with the program increases. We agree that a mechanism to increase the number of CAP drugs offered by an approved CAP vendor is expected to improve access to Part B drugs and to improve prescribing flexibility for physicians who obtain drugs through the CAP. We believe that the process to add NDCs to the existing list of NDCs supplied by an approved CAP vendor is appropriate, provided that the additions to the approved CAP vendor’s list undergo an approval process. In the July 6, 2005 interim final rule with comment, in § 414.906(f)(2), we stated that the designated carrier’s medical director will approve long-term substitutions to the list of drugs supplied by an approved CAP vendor ‘‘on behalf of CMS.’’ As described in the following sections of this rule and based on comments on the interim final rule with comment, we have expanded this request and approval process for incorporating changes into the list of drugs supplied by the CAP vendor to include new NDCs, and new HCPCS codes. In addition, beginning in 2007, approved CAP vendors will be able to request approval to add newly approved drugs to their CAP drug list before the drug is assigned a HCPCS code. In order to provide flexibility for managing this task and consistency for these processes, we are amending § 414.906 to allow CMS or its designee to approve long-term substitutions and additions to approved CAP vendors’ CAP drug lists. We are also revising § 414.906(f)(4)(iii) to specify that substitutions that are due to a drug shortage, or other exigent circumstance, may become effective immediately provided that the approved CAP vendor’s participating CAP physicians are notified of the substitution immediately following CMS approval. We are modeling the process of adding new NDCs within a HCPCS code on the substitution mechanism described in the July 6, 2005 interim final rule with comment (70 FR 39044) and specified in § 414.906(f). We note that because this is a mechanism for the addition of drugs to an approved CAP vendor’s CAP drug list, the approved CAP vendor will be required to continue supplying all NDCs from its most recently updated CAP drug list. (The substitution process should be used if the approved CAP vendor is seeking approval to remove an NDC from its CAP drug list and replace it with another NDC.) In order to add a new VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 NDC within a HCPCS code being offered in the approved CAP vendor’s CAP drug list, the approved CAP vendor must make a written request to CMS or its designee. Requests for approval must include a rationale and discussion of impact on the CAP, including safety, waste, and potential for cost savings. The requests will be reviewed and, if approved, changes will become effective as of the beginning of the next quarter. Like the substitution procedure, the addition of new NDCs to an approved CAP vendor’s CAP drug list will not affect the CAP payment amount for that particular HCPCS, as the payment amount will have been set during the initial bidding (or approval process for adding an additional HCPCS code) and, if applicable, updated as outlined in § 414.906. This application process is reflected in the amended § 414.906(f)(2)(ii). Participating CAP physicians who have selected the approved CAP vendor must be notified of additions to the approved CAP vendor’s CAP drug list at least on a quarterly basis (at least 30 days or earlier before the approved changes are due to take effect). Both the approved CAP drug vendor and CMS (or its designee) will be responsible for maintaining this information and disseminating it. Approved CAP vendors must provide direct (for example, mail or e-mail) notification of updates to the participating CAP physicians enrolled with them on a quarterly basis. The entire list of drugs supplied by the approved CAP vendor should be disseminated at least once yearly; and approved CAP vendors must make a complete list that incorporates the most recent updates available to participating CAP physicians on an ongoing basis. We will post the updated drug lists on our web site. The approved CAP vendor may also post the complete, updated, and approved list on its web site. We have added these requirements to new § 414.914(f)(15). We will issue additional instructions for this process at a later date. (d) Process for Expediting the Addition of Newly Approved Drugs to the CAP (‘‘NOC’’ Codes) The July 6, 2005 interim final rule with comment outlined a process that approved CAP vendors can use to add new drugs to the list of drugs supplied under the CAP once the new drug has been assigned a permanent HCPCS code, provided the drug would have been properly assigned to the single drug category and that CMS determines that the drug is appropriate for inclusion. This mechanism was intended to provide an opportunity for PO 00000 Frm 00126 Fmt 4701 Sfmt 4700 vendors to supply drugs that were introduced too late to be incorporated into the Addendum B—New Drugs for CAP bidding for 2006 published in the July 6, 2005 interim final rule with comment. Comment: Several commenters have requested that we develop a process to further expedite the addition of newly approved or marketed drugs to an approved CAP vendor’s drug list. Commenters stated that access to newly approved drugs should be immediate. These commenters further stated that participating CAP physicians should not have to go outside of the CAP to acquire new drugs. Several commenters suggested a mechanism that uses the miscellaneous (‘‘NOC’’) HCPCS codes for physicians and vendors to bill CAP drugs that do not have a permanent HCPCS code. Certain commenters also suggested that approved CAP vendors be required to offer the new drugs as soon as they are on the market. Response: We agree with the commenters that the earlier addition of newly approved or newly marketed drugs to the CAP is desirable, to the extent these drugs are appropriate for inclusion in the CAP. The tight timeframe for CAP implementation and the requirement for additional system changes prevent us from implementing the process suggested by the commenters at this time. In 2007, approved CAP vendors will be able to request CMS approval to add new drugs without a permanent HCPCS code to their CAP drug lists. This process will be similar to the process established in the July 6, 2005 interim final rule with comment that allows approved CAP vendors to add new drugs that are assigned a permanent HCPCS code to their CAP drug lists. Approved CAP vendors will submit a request to add these drugs, and CMS or its designee will determine whether the particular drugs are appropriate for inclusion in the CAP using a process that parallels the development of the Single Drug Category List and the List of New Drugs for CAP bidding for 2006. Updates to the approved CAP vendors’ CAP drug lists will be made on a quarterly basis; we anticipate that all approved CAP vendors’ updates will be posted on the CMS Web site simultaneously. Payment for new CAP drugs approved for inclusion in the approved CAP vendor’s CAP drug list before they are assigned a HCPCS code would be at the price published in the ASP’s ‘‘not otherwise classified’’ (NOC) price file consistent with the next quarterly update. And we note that these drugs would be considered for inclusion in the CAP only if CMS is able to identify E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations a single ASP payment amount for the drug. At a future date, we will issue additional guidance to approved CAP vendors on the application procedures for requesting approval to add these changes to the approved CAP vendor’s CAP drug list, and we will issue additional guidance to participating CAP physicians on how to order these particular drugs once they are added to the approved CAP vendor’s CAP drug list. We do not believe that requiring approved CAP vendors to add all new drugs to their CAP lists is advisable. Instead, we believe that a request and approval process as described for other changes to an approved CAP vendor’s drug list would be appropriate because it would allow for flexibility while ensuring that only those that are appropriate for inclusion in the CAP are added to an approved CAP vendor’s CAP drug list. As discussed in the July 6, 2005 interim final rule with comment (70 FR 39027 through 39031) some drugs may not be good candidates for the CAP, for instance, some new drugs are not typically administered ‘‘incident to’’ a physician’s services, some new drugs may have very low utilization, and some may have special storage, distribution, or handling requirements that would make these drugs inappropriate for inclusion in the CAP. The existing procedures for adding new NDCs within the HCPCS codes that are on an approved CAP vendor’s CAP drug list, and the new procedures for adding new HCPCS codes to an approved CAP vendor’s CAP drug list also rely on approved CAP vendors’ voluntary requests and our approval of these requests. Simply put, we want to expand the number of CAP drugs that approved CAP vendors offer, but we do not believe that all new drugs should be added to the CAP, or that addition of certain drugs should be mandatory, especially at the beginning of this program. As we gain experience with the program we may consider other approaches to the addition of drugs that a vendor supplies under the CAP. Beginning in 2007, approved CAP vendors will be able to request approval to add new ‘‘NOC’’ drugs to their CAP drug lists. The procedures will parallel those for addition of new HCPCS codes and new NDCs within a HCPCS code, as specified in § 414.906(f)(2)(iv). In each case, the approved CAP vendor must make a written request to CMS (or its designee). Requests for approval must include a rationale and discussion of impact on the CAP, including safety, waste, and potential for cost savings. The requests will be reviewed and, if VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 approved, changes will become effective on a quarterly basis. We remind physicians that an approved CAP vendor’s CAP drug list is subject to change over the contract period. Upon electing to participate in the CAP and selecting an approved CAP vendor, participating CAP physicians are agreeing to accept, in most cases, the particular NDCs listed and shipped by the selected approved CAP vendor for the duration of the participating CAP physician’s election period with the approved CAP vendor. By electing to participate with a particular approved CAP vendor, the participating CAP physician also is agreeing to accept the approved changes to the approved CAP vendor’s CAP drug list and drugs supplied under the updated and approved lists. We believe that the changes in the approved CAP vendor’s CAP drug list will improve (or at least maintain) a participating CAP physician’s selection of available drugs and will likewise improve (or maintain) Medicare beneficiaries’ access to drugs supplied under the CAP. We are revising § 414.908(a)(3)(vi) to state this requirement. We remind physicians that routine orders for CAP drugs should be placed at the HCPCS level, unless the participating CAP physician determines that a particular product that is on the approved CAP vendor’s CAP drug list is medically necessary for a patient. In this case, a participating CAP physician may order that specific NDC from the approved CAP vendor under the ‘‘furnish as written’’ process. Documentation of medical necessity in the medical record is also required; this information may be subject to medical review. We are revising § 414.908(a)(3)(vii) to reflect this requirement. (e) Process for Adding Drugs With a New HCPCS Code to the CAP In the July 6, 2005 interim final rule with comment (70 FR 39075), we stated that we would allow approved CAP vendors to petition CMS to add drugs with a new HCPCS code to their CAP drug lists; however, we did not include regulation text to implement this section. In order to implement this process we are amending regulation text at § 414.906(f)(2)(iii). (f) Process for Adding Single Indication Orphan Drugs to the CAP Table 26 is a brief summary of methods that an approved vendor may use to amend the list of drugs it supplies under the CAP. Please note that all of these methods require approval from CMS or its designee. PO 00000 Frm 00127 Fmt 4701 Sfmt 4700 70241 Comment: We received several comments from manufacturers requesting inclusion of their single indication orphan drugs in the CAP. Most commenters stated that these low volume products were quite suitable for the CAP because availability through the CAP would minimize the associated administrative burden for physicians who choose to administer them. Inclusion of one product (thyrotropin alfa) was also requested by a number of physicians who treat patients with thyroid cancer and by patients who had been treated for thyroid cancer. One manufacturer specifically requested that its orphan drug (azacitidine) not be included in the CAP, citing concern about timely access to the drug. Response: We appreciate the comments that we received regarding single indication orphan drugs. Improving access to Part B drugs is a desirable quality for this program. For example, we have endeavored to improve access by allowing the addition of new NDCs and new HCPCS codes to a drug vendor’s list. During this initial stage of the CAP, as described in the July 6, 2005 interim final rule with comment (70 FR 39032), we also have sought to strike a balance that would allow for a sufficiently sized market volume for approved CAP vendors, while making the CAP a meaningful alternative for most physician specialties. In order to decrease the inventory burden for approved CAP vendors, we wanted to minimize the number of drugs included in the CAP drug category that are billed in very low volumes, so we applied dollar value thresholds to the CAP. As noted by commenters, the addition of the single indication orphan drugs to the CAP drug category may decrease administrative burden on the participating CAP physicians, and we agree that a decreased burden is desirable. We are persuaded by the number of commenters that asked us to include single indication orphan drugs in the CAP drug category that a mechanism for their addition to an approved CAP vendor’s CAP drug list is desirable. However, for the reasons that prompted us not to include single indication orphan drugs in the initial drug category (as described in the July 6, 2005 interim final rule with comment), we continue to believe that we should not require approved CAP vendors to supply these drugs. Therefore, we are specifying that approved CAP vendors may request CMS approval to add single indication orphan drugs (as described in the July 6, 2005 interim final rule with comment) to their CAP drug lists. The E:\FR\FM\21NOR2.SGM 21NOR2 70242 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations single indication drugs covered by this provision are the following: J0205, J0256. J9300, J1785, J2355, J3240, J7513, J9010, J9015, J9017, J9160, J9216 and their successor codes. Payment for single indication orphan drugs that vendors voluntarily add to the CAP will be based on ASP+6 percent. TABLE 26.—METHODS FOR CHANGING AN APPROVED CAP VENDOR’S CAP DRUG LIST Description Regulation text Substitution: Approved CAP vendor may request approval to replace one or more NDCs in a HCPCS code supplied by the approved CAP vendor with one or more other NDCs. Add newly issued HCPCS Codes: Approved CAP vendor may request that CMS allow it to supply additional HCPCS codes under the CAP. Additional NDCs: Approved CAP vendor may request that CMS allow it to supply additional NDCs under a HCPCS code that the approved CAP vendor already supplies under the CAP. Newly approved drugs without HCPCS codes (‘‘NOC’’ dugs’’): Beginning in 2007, approved CAP vendor may request that CMS allow it to supply a newly approved drug under the CAP before a permanent HCPCS code is assigned to the drug. Single Indication Orphan Drugs: Approved CAP vendor may request that CMS allowed it to supply single indication orphan drugs under the CAP. (g) Other Issues Related to Drugs Supplied Under the CAP (i) Addition of Other Specific Drugs We received comments regarding the addition of low volume drugs, and dermal tissue biologicals to the CAP. Specific comments and responses for each type of drug follow. Comment: One commenter asked whether we would allow approved CAP vendors to voluntarily supply drugs with low utilization volumes through the CAP. The commenter was specifically referring to drugs that were not included in the CAP category because of utilization criteria described in the interim final rule with comment (70 FR 39031–39032). Response: Drugs included in the initial CAP drug category account for about 85 percent of Part B drugs billed by physicians. In other sections of this rule we have described methods that an approved CAP vendor may use to request the addition of new NDCs or new HCPCS codes to the CAP. Although we appreciate the request to add drugs with low utilization volumes to the CAP drug category, we believe it is appropriate to allow additions to an approved CAP vendor’s CAP drug list through the case-by-case approval process we have described above and specified in § 414.906. Once we gain experience with the CAP, we anticipate being able to consider broadening the scope of drugs included in future CAP drug categories. Comment: The manufacturers of two dermal tissue products expressed concern about language in the July 6, 2005 interim final rule with comment that stated ‘‘tissues are not considered drug products.’’ One manufacturer asked that its product be included in the CAP, while the other stated other reasons for excluding its product were VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 § 414.906(f)(2)(i). § 414.906(f)(2)(iii). § 414.906(f)(2)(ii). § 414.906(f)(2)(iv). § 414.906(f)(2)(iii). appropriate and did not ask that its product be included in the CAP. Response: We thank the commenters for providing us with the opportunity to clarify the discussion about dermal tissue found in the July 6, 2005 interim final rule with comment (70 FR 39031). During development of the criteria used to create Addendum A—Single Drug Category List of the July 6, 2005 interim final rule with comment, we attempted to allow for a sufficiently sized market for approved CAP vendors, while making the CAP a meaningful alternative for most physician specialties. The statement that the commenter references above was intended to explain why we did not include dermal tissue products in the initial CAP drug category and was not intended to reflect overall Medicare policy for dermal tissue products. We are not including tissues in the initial CAP drug category at this time because the products do not have sufficient documented utilization, and some products may require specialized handling. As we gain experience with the CAP, we anticipate reevaluating exclusion criteria applied to bidding for the initial phase of this program. (ii) Formularies and the CAP In the July 6, 2005 interim final rule with comment, we responded to comments on the subject of formularies. We respond to additional comments on the subject from the July 6, 2005 interim final rule with comment below. Comment: We received several comments that encouraged us to refrain from creating formularies in the CAP and to avoid situations where a formulary-like process could be created. Commenters raised concerns about a formulary’s likelihood to limit beneficiaries’ access to a wide selection of drugs and the impact on a physician’s choice in prescribing medications. Response: In the July 6, 2005 interim final rule, we stated that we were not accepting the recommendation that vendors be permitted to establish formularies because the statute expressly requires that for multiple source drugs, a competition be conducted for the acquisition of at least one drug per billing code within that category (70 FR 39034). We agree that in an effort to provide physicians with maximum flexibility in prescribing, we should avoid the use of formularies in the CAP. Furthermore, we believe that making the CAP less restrictive will increase physician interest and, therefore, improve vendor participation. In the July 6, 2005 interim final rule with comment (70 FR 39033 through 39034 and 39068), we stated that ‘‘we do not expect there to be a creation of a drug formulary,’’ and we further discussed our belief that vendors would find it prudent to structure their bids in a way to supply more than one NDC per HCPCS code. We wish to emphasize that this is still our position on formularies in the CAP. It is our opinion that approved CAP vendors who offer more than one product per HCPCS code would be selected by a greater number of participating CAP physicians. (iii) Physicians Regulatory Issues Team Drugs The July 6, 2005 interim final rule with comment also discussed issues regarding drugs that have posed acquisition problems for some physicians under the ASP system. We received additional comments on this topic. Comment: Commenters asked whether drugs included on the Physicians Regulatory Issues Team (PRIT) list (drugs reported to be difficult for physicians to obtain for less than ASP+6 percent) have been included in the CAP. Commenters also asked that PO 00000 Frm 00128 Fmt 4701 Sfmt 4700 E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations the PRIT list be made available to the public. Response: The PRIT is a group of CMS subject matter experts who work to reduce the regulatory burden on Medicare physicians. Since the inception of the ASP payment system, individual physicians have reported difficulty in acquiring certain drugs for less than ASP+6 percent. At the request of the Physicians Practice Advisory Committee, the PRIT began compiling reports of these situations. More information about the PRIT may be found at the following web site: https://www.cms.hhs.gov/physicians/ prit/. Because the PRIT list is based on voluntary reporting, and information is received on an ad-hoc, nonrepresentative basis, the PRIT list may not fully describe overall drug pricing or availability patterns; therefore, we have chosen not to use the PRIT list as a specific criterion for the CAP. However, as stated in of the July 6, 2006 interim final rule with comment (70 FR 39033), we did review drugs that had been associated with access problems under the ASP payment system during the development of the CAP single drug category and we have subsequently examined the PRIT list during the writing of this rule. We have found that the CAP includes most drugs reported to the PRIT. PRIT list drugs not in the CAP are drugs that were not included for specific reasons described in the July 6, 2005 interim final rule with comment, such as -single indication orphan drugs, drugs without permanent HCPCS codes, oral medications, and drugs with low utilization. (iv) Discussion of Intrathecal Pain Management The July 6, 2005 interim final rule with comment’s discussion of specific drugs contained a comment and response on ziconotide (Prialt). Comment: One commenter stated that, in our discussion of intrathecal pain management, we mischaracterized ziconotide as an opioid analgesic. The commenter points out our inconsistency in referring to ziconotide as an opioid, but following with a discussion that demonstrates understanding that ziconotide is not an opiate. The commenter asked if non-opiate pain medications administered intrathecally through an implanted pump or external infusion device would be suitable for inclusion in the CAP. The commenter also asked whether ziconotide could be added to Addendum B—New Drugs for CAP Bidding for 2006 of the drug bidding list if a permanent HCPCS code VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 were assigned in the Fall of 2005. The commenter also noted that baclofen and clonidine, two other medications that can be administered intrathecally through a pump, are included in the CAP drug category. Response: We appreciate the opportunity to clarify our discussion. Ziconotide is not an opiate analgesic and it is not a controlled substance. Neither the comment nor the corresponding response were intended to describe ziconotide as an opioid or to limit the discussion to intrathecally administered opioids. Our response to the comment in the interim final rule with comment was intended to address two points. First, we did not consider opioids and ziconotide for inclusion into the bid list for different reasons. Opioids are controlled substances and are subject to extra record keeping requirements as stated in the July 6, 2005 interim final rule with comment (70 FR 39028); ziconotide was not included in the CAP drug category because it had not yet been assigned a HCPCS code. Second, we agreed in principle that opioid medications administered intrathecally through implanted variable-rate infusion devices could be included under the CAP, when they are administered by physicians in their offices incident to their services. Although we specifically referred to opioid medications in this discussion, the statement applies to non-opioid medications as well. However in the interim final rule with comment, we described our methodology for determining whether a drug would be included in the initial CAP drug category. (70 FR 39028 and 39031 through 39032). Although ziconotide generally appears to meet the criteria for inclusion in the initial CAP drug category, we have become aware of an unresolved payment methodology issue with this drug resulting in the lack of a consistent ASP for ziconotide. It is important that drugs included in the CAP drug category have an ASP that we can determine, because a drug’s ASP is used to calculate the overall price ceiling for the composite bid and the maximum payment amount for CAP drugs not included in the composite bidding process. For this reason, we are not including this drug in the CAP at this time. (v) Leuprolide and Related Drugs During the development of the Single Drug Category List published in Addendum A of the July 6, 2005 interim final rule with comment, we chose not to include injectable forms of leuprolide PO 00000 Frm 00129 Fmt 4701 Sfmt 4700 70243 acetate (J9217 and J9218) in the initial CAP drug category. We provide a discussion of local coverage determinations (LCDs) and LCA policy as it relates to the CAP in the July 6, 2005 interim final rule with comment (70 FR 39039). We note that leuprolide acetate implant (J9219) remains in the CAP’s Single Drug Category List. Comment: We received several comments about leuprolide and other luteinizing hormone-releasing hormone (LHRH) analogues, which include goserelin, triptorelin, and histrelin. Commenters acknowledged the complexity of applying LCA policies to the CAP for both physicians and vendors. They also questioned whether all regions of the United States were subject to LCA policies for this leuprolide, and commenters expressed concern that the policies may extend to LHRH other than leuprolide and goserelin, such as histrelin and triptorelin. Two commenters suggested that the CAP not use LCA policies, and failing that the commenter suggested that drugs covered by LCA policies be ‘‘carved out’’ of the CAP. Another commenter stated that LCA policies varied so much that not including leuprolide in the CAP drug category was an incomplete solution to the LCA issue because the entire group of LHRH analogues was in the process of becoming affected by LCAs, and that continuing price changes could not guarantee that goserelin would remain the least costly alternative drug among the LHRH analogues. Response: We appreciate the concerns raised by the commenters. However, we do not believe that we have the authority to specify that CAP prices supersede an LCA policy. As we stated in the July 6, 2005 interim final rule with comment, nothing in this rule is intended to disrupt the longstanding ability of contractors to apply an LCA policy under section 1862(a)(1)(A) of the Act. Section 1862(a)(1)(A) of the Act provides that notwithstanding any other provision in the Medicare statute (that is, including section 1847B of the Act), no payment may be made under Part A or Part B for any expenses incurred for items and services that are not medically necessary. As a result, if a carrier applies an LCA policy to a particular drug, a claim submitted to the carrier for that drug is subject to LCA. After considering the comments, we continue to believe that the decisions outlined in the July 6, 2005 interim final rule with comment pertaining to which drugs are included in the CAP drug category maintain a balance between physician access to LHRH analogues E:\FR\FM\21NOR2.SGM 21NOR2 70244 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations b. Vendor/Bidding Issues and vendor risk associated with the application of LCAs for these drugs. (h) Drug Weighting In the July 6, 2005 interim final rule with comment (70 FR 39069), we finalized our proposal to employ a ‘‘composite bid’’ for selecting bidders. The composite bid will be constructed by weighting each HCPCS bid by the HCPCS code’s share of volume (measured in HCPCS units) of drugs in our single drug category during the prior year. Within the single category, the drugs weights will sum to one. Comment: Some commenters suggested that instead of using only utilization data to derive weights, we should use both utilization and allowed charges data so that products with high utilization, but low charges, are not over weighted. Response: We appreciate the suggestion of an alternative weighting methodology, and we recognize that the weighting methodology could be developed in a number of ways. We are also aware that changing the weighting methodology from utilization volume to dollar volume could impact overall weighting. For the initial bidding cycle, we chose to use a relatively simple weighting methodology based on claims volume, but corrected for the appearance of multiple identical claim lines on a given day of service. We also believe that the creation of a single drug category further minimizes some effects associated with using utilization data as the only weighting parameter. We do not believe that a change in weighting methodology would result in significantly different weights than those derived under the current weighting methodology for the majority of drugs in the single drug category list. Therefore, we will implement CAP using the same weighting methodology described in the July 6, 2005 interim final rule with comment (70 FR 39069 through 39071) and will consider alternatives for future bidding cycles. Earlier in this section we have discussed the need to make changes to the Single Drug Category List published in Addendum A of the July 6 2005 interim final rule with comment. The resulting change in the composition of the Single Drug List required us to recalculate the drug weights. A complete discussion of the reasons for this revision is included in section II.H.6.a.(1)(a), Changes to the Single Drug Category List—Addendum A of the July 6, 2005 interim final rule with comment. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 In this section we discuss issues related to vendor bidding such as drug quality, vendor subcontracting, confidentiality of the bids, vendor call center requirements, the inclusion of prompt pay discounts in vendor net acquisition costs, and the mechanics of the bidding process. (1) Quality/Product Integrity In the July 6, 2005 interim final rule with comment (70 FR 390660 through 390662), we discussed product integrity and the requirement to comply with existing State and Federal laws regarding adulteration, misbranding, spoilage, contamination, expiration, and counterfeiting of products. We stated that although we do not propose to require applicants or potential CAP vendors to employ measures beyond those required for licensure and regulatory compliance, we believe these measures set a minimum standard, and we requested that applicants discuss any additional measures they have taken to ensure product integrity. We also provided examples of additional measures that pose minimal burden but enhance the ability to detect adulterated, misbranded, or counterfeit drugs. We further stated that the approved CAP vendor application process, the maintenance of appropriate licensure, and Medicare supplier status form the framework for product integrity. We also noted that potential CAP vendors are required to submit a compliance plan as part of the bidding process that contains policies and procedures for the prevention of fraud, waste, and abuse, and provides detailed information on steps to ensure product integrity as specified in § 414.914. Comment: Many commenters supported the steps outlined in the July 6, 2005 interim final rule with comment to ensure quality and product integrity. There were some commenters, however, who expressed concern that the provisions in the interim final rule with comment will not be adequate to prevent fraud and abuse and ensure product integrity. One commenter believed that patient health and safety could be compromised by the imposition of a third party (the approved CAP vendor) for drug acquisition, preparation, and delivery. This commenter was also concerned about the possibility that certain drugs could be reconstituted in their vials by the approved CAP vendor. Another commenter suggested that the VerifiedAccredited Wholesale Distributors TM Program could play a key role in adherence to quality and performance PO 00000 Frm 00130 Fmt 4701 Sfmt 4700 standards among approved CAP vendors. This is a program developed by the Task Force on Counterfeit Drugs and Wholesale Distributors that was convened in 2003 by the National Association of Boards of Pharmacy to ensure that a wholesale distribution facility is licensed and operating under best practices for drug distribution. Response: We appreciate and share the commenters’ concerns about ensuring quality and product integrity. However, we do not agree that the approved CAP vendor’s role in drug acquisition, preparation, and delivery will compromise patient health and safety. We addressed the issue of reconstituted vials in the July 6, 2005 interim final rule with comment (70 FR 39061) by stating that approved CAP vendors may split vial trays, but cannot ship opened vials. As we gain more experience with the CAP, we will explore the VerifiedAccredited Wholesale Distributors TM Program and other options to further protect product integrity. Comments: Several commenters recommended that CMS establish standards and survey procedures for approved CAP vendors and their subcontractors to inspect the chain of custody of the drugs delivered to participating CAP physicians. These commenters also requested that CMS establish and disseminate information about the procedure that participating CAP physicians should follow to report a suspected delivery of counterfeit drugs, and suggested that a web-based quality reporting system be available on various aspects of the approved CAP vendor’s performance. These commenters also wanted clarification that one substantiated instance of purchase or distribution of a counterfeit drug by an approved CAP vendor will result in the automatic termination of the vendor’s Part B supplier contract and the CAP contract. Response: We continue to believe that existing Federal and State requirements, along with the specific requirements for approved CAP vendors outlined in the bidding and selection process, provide an adequate framework for protecting product integrity. Participating CAP Physicians should notify the approved CAP vendor immediately if there are any questions regarding the integrity of a CAP drug, and report any violations to the appropriate Federal and State authorities, as well as to the designated carrier’s dispute resolution staff. In addition, the designated carrier will act promptly to investigate CAP quality complaints under the process outlined for dispute resolution as described in § 414.916. E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations As we gain experience with the CAP, we will assess whether additional steps are needed to ensure product quality. We are committed to ensuring that approved CAP vendors ship only high quality products and any reports of compromised quality will be addressed promptly. (2) Subcontracting In the July 6, 2005 interim final rule with comment (70 FR 39060, 39064, and 39065), we stated that a vendor could subcontract with another entity as long as that entity met all of our approved CAP vendor requirements, is in compliance with all applicable laws and regulations, has a demonstrable record of integrity regarding fraud and abuse and conflict of interest, and has adequate administrative arrangements in place to ensure effective operations. Information on specific requirements for subcontractors was provided in the July 6, 2005 interim final rule with comment and is a required part of the vendor’s CAP application. In § 414.914(f)(9), we also stated that it is the approved CAP vendor’s responsibility to determine that subcontractors remain compliant with these standards. It was further noted that we intend that subcontractors or other entities associated with furnishing CAP drugs under an approved CAP vendor’s contract maintain the same standards as the approved CAP vendor for the role that they play in supplying CAP drugs. Comment: Many commenters expressed support that we intend to hold any subcontractors to the same standards as the approved CAP vendors. However, some commenters requested clarification on certain aspects of subcontracts or requested more stringent requirements. Two commenters requested that approved CAP vendors include in their subcontractor agreements a covenant binding on the subcontractor to comply with all rules applicable to approved CAP vendors, including those rules regarding product integrity and drug pedigree, and that HHS be a third party beneficiary to these agreements with the right to enforce any of the provisions relating to CAP compliance. One commenter wanted assurance that a contract between a large distributor and a specialty pharmacy would not be considered a conflict of interest. Another commenter requested that we require full disclosure of a potential CAP vendor’s corporate relationships and specifically prohibit potential CAP vendor subsidiaries from bidding against their parent company or other VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 subsidiaries with the same parent company. Response: We appreciate the commenters’ interest in maintaining quality of the CAP by ensuring integrity in all aspects of the approved CAP vendor and subcontractor relationship. We believe that we have stated clearly our intention to hold all subcontractors to the same rigorous standards that we require of approved CAP vendors. We also believe that we have the necessary authority to review, enforce, and take any needed action to ensure that quality and integrity of the subcontractor relationship is maintained. Because an approved CAP vendor is ultimately responsible for any activity of its subcontractor and risks termination of its CAP contract if quality or integrity are compromised, we believe that the approved CAP vendor will take adequate steps to ensure compliance with all requirements. Therefore, we will not require a binding covenant between approved CAP vendors and subcontractors, although we would expect that an approved CAP vendor may want to include this type of provision in its subcontracts for its own protection. Contracts between a distributor and a specialty pharmacy are not automatically problematic. However, these arrangements would be subject to the same requirements as specified in the CAP statute and regulations that apply to all other subcontracting arrangements. Approved CAP vendors may wish to consult with legal counsel to determine whether there exists unique circumstances that could present a conflict of interest. We also appreciate the commenters’ concern about corporate relationships and the possibility of a potential CAP vendor’s subsidiaries bidding against their parent company or other subsidiaries with the same parent company. However, because of the complexity of many corporate relationships, we believe that rejecting bids based on a test such as the commenter suggests could exclude some legitimate and qualified entities from participating in the CAP. We will not prohibit any qualified bidder from submitting a bid to be an approved CAP vendor, but we expect applicants to submit any relevant information, including information about their corporate relationships. We will review all this information as part of the application and bidding process described in this final rule with comment and the July 6, 2005 interim final rule with comment. PO 00000 Frm 00131 Fmt 4701 Sfmt 4700 70245 (3) Confidentiality of the Bids (Potential CAP Vendor Information) In both the March 4, 2005 proposed rule (70 FR 10746) and the July 6, 2005 interim final rule with comment (70 FR 39065), we affirmed that all cost information will be confidential and not made available for public display, and that bid prices will be kept confidential in accordance with section 1927(b)(3)(D) of the Act. We also stated that section 1847B(a)(1)(C) of the Act provides that, in implementing the CAP, the Secretary may waive provisions of the Federal Acquisition Regulation (FAR), ‘‘other than provisions relating to the confidentiality of information.’’ The confidentiality provisions of the FAR apply to the data submitted by bidders and potential CAP vendors under the CAP. However, we noted that what is confidential for FAR purposes may not necessarily be protected under the provisions of the Freedom of Information Act (FOIA), and that if a FOIA request is received for pricing information, the request will be processed in accordance with 5 U.S.C section 552(b) and 45 CFR part 5, subpart F to determine whether any of the FOIA’s exemptions to mandatory disclosure may apply to protect the information. Comment: One commenter expressed concern that drug pricing information may be subject to disclosure under FOIA and suggested that it is protected from disclosure under FOIA exemption (b)(4). This commenter also suggested that drug pricing information provided under the CAP be treated the same as the drug pricing information provided for Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Part D prescription drug benefit. Another commenter wanted assurance that all potential CAP vendor cost data will be protected as proprietary and will remain confidential and unidentifiable by manufacturer or wholesaler. Response: We again affirm that, to the extent permitted by law, all cost information submitted during the bidding process and as part of the contract’s price adjustment process will remain confidential and not made available, and that potential CAP vendor pricing information will be kept confidential. The FAR directly addresses the government’s obligation to protect contractor information submitted in response to a solicitation for competitive bids. If a FOIA request is received seeking disclosure of a bidder’s pricing data, that request would E:\FR\FM\21NOR2.SGM 21NOR2 70246 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations be forwarded to the CMS FOIA officer for review in accordance with FOIA requirements. To the extent allowed by Federal law, we will assert applicable FOIA exemptions to protect confidential cost and pricing information. The FOIA exemptions are set forth in Department of Health & Human Services Freedom of Information regulations at 45 CFR part 5, subpart F. (4) Approved CAP Vendor Requirements/Call Center Hours of Operation In the July 6, 2005 interim final rule with comment (70 FR 39065), we stated that the approved CAP vendor would be required to— • Maintain the operation of a grievance process so that participating CAP physician, beneficiary, and beneficiary caregiver complaints can be addressed; • Provide a prompt response to any inquiry as outlined in the vendor application form; • Maintain business hours on weekdays and weekends with staff available to provide customer assistance for the disabled, including the hearing impaired, and to Spanish speaking inquirers; and • Provide toll-free emergency assistance when the call center is closed. We also required that approved CAP vendors maintain a formal mechanism for responding to complaints from participating CAP physicians, beneficiaries, and their caregivers (if applicable) (70 FR 39065). Additionally, we stated that customer service is of primary importance and approved CAP vendors must demonstrate the ability to respond to inquiries on both weekdays and weekends (70 FR 39085). Comment: We received no objections to any of the requirements. A commenter noted that although vendors are required to have procedures to resolve complaints and inquiries about CAP drug shipments, there were no clear standards for systems or procedures that approved CAP vendors must maintain. This commenter supported the establishment of a call center or other patient support center to answer patients’ questions about billing, payment schedules, and other matters. Response: We believe that customer service is of primary importance and that approved CAP vendors must demonstrate the ability to respond promptly and satisfactorily to inquiries from providers, beneficiaries, and caregivers. We believe that approved CAP vendors should have the flexibility to develop standards and systems that meet our requirements. However, we VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 note that an approved CAP vendor will be required to respond to inquiries from a wide variety of sources, including beneficiaries and physician office staff, and that inquiries could come from a variety of time zones. Therefore, we are finalizing this policy and revising § 414.914 to reflect that an approved CAP vendor will be required to— • Maintain the operation of a grievance process so that participating CAP physician, beneficiary, and beneficiary caregiver complaints can be addressed. • Respond within 2 business days to any inquiry, or sooner if the inquiry is related to drug quality. • Staff a toll-free line from 8:30 a.m. or earlier and until 5 p.m. or later for all time zones served in the continental United States by the approved CAP vendor on business days (Monday through Friday excluding Federal holidays) to provide customer assistance, and establish reasonable hours of operation for Hawaii, Alaska, Puerto Rico, and the other U.S. territories. • Staff a toll-free emergency line for weekend and evening access when the call center is closed, and determine which hours on Saturdays and Sundays the call center will be staffed and which hours a toll-free emergency line will be activated. • Include assistance for the disabled, the hearing impaired, and Spanish speaking inquirers in all customer service operations. We also recommend that all approved CAP vendors have arrangements in place to obtain translation services in other languages if serving a sizable population of beneficiaries or caregivers whose language is other than English or Spanish and who do not have access to translator assistance. When a beneficiary has a question about a coinsurance bill from an approved CAP vendor, the beneficiary is directed to contact the approved CAP vendor or his or her supplemental insurance provider (if applicable). If the beneficiary has no supplemental insurance, and believes he or she is not liable for the coinsurance bill, but is unable to resolve the situation on their own, the beneficiary may contact the designated carrier’s customer service staff for assistance. The dispute resolution process is described in § 414.916(d) and in the July 6, 2005 interim final rule with comment (70 FR 39098). (5) Prompt Pay Discounts In the July 6, 2005 interim final rule with comment, we stated that prompt pay discounts should be disclosed by PO 00000 Frm 00132 Fmt 4701 Sfmt 4700 the approved CAP vendor and included in determining reasonable, net acquisition costs for purposes of section 1847B(c)(7) of the Act, and that we were interested in receiving comments about how these discounts are arranged and whether they are indeed different from other price concessions and discount arrangements. Comment: Some commenters questioned the inclusion of prompt pay discounts in the determination of approved CAP vendors’ reasonable net acquisition costs. They argued that so long as prompt pay discounts truly represent the time value of money and the fair market value of the distribution and financial services that are provided and are not passed on to providers, they should not be included in the approved CAP vendor’s net acquisition costs. The commenters also raised issues with the treatment of prompt pay discounts under the ASP system. Response: We disagree that prompt payment discounts should be excluded from the determination of an approved CAP vendor’s reasonable, net acquisition costs. Section 1847B(c)(7) of the Act makes reference to an approved CAP vendor’s ‘‘reasonable, net acquisition costs’’. The statute’s use of the word ‘‘net’’ indicates these costs should reflect discounts the approved CAP vendor has received. Further, we believe it is appropriate that ‘‘net acquisition costs’’ be calculated in a manner consistent with the calculation of ASP. Prompt pay discounts are price concessions that must be included in a manufacturer’s calculation of ASP. Please see section II.H.1 of this preamble, ASP Issues, for further discussion of prompt pay discounts under the ASP payment methodology. (6) Bidding Process In the July 6, 2005 interim final rule with comment, we stated that the composite bid ceiling will be determined on the basis of ASP prices in effect during the quarter in which the bids are generated, and that the single price for each drug (HCPCS code) will be initially determined on the basis of the median of the bids submitted during the second quarter of CY 2005 for that drug. We further stated that the price of each drug will then be updated to the mid-point of CY 2006 (five quarter increase) Producer Price Index (PPI) for prescription preparations. Given the 6 month delay in implementation and the corresponding change in the bidding period, we will be making certain adjustments to the bidding process to account for more recent data. In general, we will retain the process described in the July 6, 2005 E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations interim final rule with comment (§ 414.904). However, we will require bidders to base their bid on the October ASP file which accounts for the most recent ASP data available and can be found at https://www.cms.hhs.gov/ providers/drugs/asp. As a result of the use of the updated drug pricing data and the delay in the implementation, we will no longer need to update the bid price by 5 quarters of PPI. Instead, we will update prices by 4 quarters of PPI. This allows the data to be trended forward from the period in which bidding is conducted (the fourth quarter of CY 2005) to the period in which the single prices will actually be in effect (second half of CY 2006). Specifically, the price of each CAP drug will be updated to the mid-point of the 2006 payment period on the basis of projecting the overall change in PPI prices for prescription preparations. Bidding for potential CAP vendors will commence upon publication of this final rule with comment. Bidders will have at least 30 days to submit an application. Upon publication of the final rule, CAP bidding forms and additional information regarding bidding timelines, and other related material, can be found at https:// www.cms.hhs.gov/providers/drugs/ compbid/bid_form_announ.asp. c. Operational Issues In this section, we address drug product waste and returns, and when unused portions of single-use drugs may be billable to Medicare under the CAP. We address billing issues and timing of claims processing and payment. We address comments regarding coinsurance and collection of Advanced Beneficiary Notice forms (ABNs) and arrangements between approved CAP vendors and participating CAP physicians for services relating to the CAP. We also address several CAP drugordering issues. We describe the resupply option and emergency use within the CAP. We clarify when a Medicare beneficiary’s height and weight are needed for ordering a CAP drug. We also clarify the ‘‘furnish as written’’ option. Finally, we address patient confidentiality. (1) Unused Drug Product (Waste and Returns) In the July 6, 2005 interim final rule with comment (70 FR 39062), we responded to commenters asking for specific guidance on how to manage drug waste and returns as follows: Although a variety of situations may create quantities of unused drugs at the place of administration, we believe the VerDate Aug<31>2005 15:52 Nov 18, 2005 Jkt 208001 unused CAP drugs will come in the following 3 forms: • An unopened vial (or vial package) as shipped by the approved CAP vendor. • An opened vial (that may or may not be reconstituted or partly used). • A drug that has been removed from a vial or package and is in a syringe, IV bag, or other device or container used for drug administration. Unused quantities of a drug may increase the risk of waste, fraud and abuse, and attempts to use the excess drug may violate applicable pharmacy law or may compromise product integrity. We expect that approved CAP vendors will furnish drugs in a manner that will minimize unused drugs. We also expect that participating CAP physicians and approved CAP vendors will both make an effort to label, ship, and store CAP drugs in a manner that will allow the legally permissible reuse of an unopened and intact container of a CAP drug. Returns of unused products through a distribution system may be acceptable, but many States prohibit reusing drugs that have been dispensed by a pharmacy (For further information, see FDA Office of Regulatory Affairs (ORA) Compliance Policy Guides Manual Sec. 460.300, Return of Unused Prescription Drugs to Pharmacy Stock, CPG 7132.09). We are aware of situations when an approved CAP vendor may label a vendor-supplied outer container for prescriptions to keep the actual manufacturer’s packaging intact and unlabelled. We further expect approved CAP vendors to offer and ship units of a drug that match the beneficiary’s dosing requirements and HCPCS billing amount as closely as practical. In this way, a degree of waste will be prevented. Specific details, including how waste, returns, and their cost burden are handled, will depend on State law and regulation as well as the individual situations. Approved CAP vendors should establish policies on these issues (making sure that they comply with applicable laws and regulations) and make the policies available for physicians to review during the election period and through the term of the approved CAP vendor’s participation in the CAP. Approved CAP vendors will supply CAP drugs to participating CAP physicians’ offices in unopened vials. However, in situations where a CAP drug is dosed by body weight or BSA, the amount of drug in vials may not match the Medicare patient’s actual dose, and the approved CAP vendor will be forced to ship excess drug. In certain States, pharmacy law may prevent the use of excess CAP drug for another PO 00000 Frm 00133 Fmt 4701 Sfmt 4700 70247 Medicare beneficiary if the order must be labeled as a prescription. The return process is guided by the following: • Federal Law and guidelines (such as the FDA/ORA CPG 460.300), State law, Medicare requirements (such as the Claims Processing Manual), drug stability, and appropriate standards (such as United States Pharmacopoeia Chapter 797, Pharmaceutical Compounding—Sterile Preparations) will be used to determine how an extra drug product(s) may be used for subsequent dosing on the same beneficiary or for use on another beneficiary. • If excess drug product remaining in a vial shipped by an approved CAP vendor must be returned, the approved CAP vendor is expected to accept excess CAP drugs for disposal and is expected to pay for shipping. The participating CAP physician is responsible for appropriately packing the drug. Consolidating shipping into larger and less frequent packages by the participating CAP physician would be encouraged. We do not intend for this process to be used as a vehicle for routine disposal of empty or nearly empty vials, disposal of any drug product not shipped by an approved CAP vendor, or disposal of drugs mixed in IV bags, syringes, associated needles and tubing, or other devices used in the administration of the drug product to a beneficiary. The approved CAP vendor bills Medicare only for the amount of CAP drug administered to the Medicare beneficiary and the beneficiary’s coinsurance amount will be calculated from the quantity of drug that is administered. Because the CAP statute authorizes us to pay the approved CAP vendor only upon administration of the CAP drug, any discarded drug (or drug that is considered waste) will not be eligible for payment. We also stated that the CAP dispute resolution process will be available to resolve any associated disputes. Comment: Most commenters objected to our payment policy for the unused portion of drugs. Most commenters perceived that the payment policy for the unused portion of a drug under the CAP was more restrictive than the payment policy for the unused portion of a drug under the ASP payment system. Many, but not all, commenters on this issue supported the general concept of payment for the unused portion of drugs contingent upon good faith efforts on the part of the participating CAP physician and approved CAP vendor to minimize unused drugs. However, some commenters indicated that payment to E:\FR\FM\21NOR2.SGM 21NOR2 70248 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations the approved CAP vendor for the unused portion of CAP drugs should not be contingent on good faith efforts by the participating CAP physician, but only good faith efforts by the approved CAP vendor in furnishing the drug. Response: Under the ASP payment system, physicians may bill the program for the unused portion of a drug remaining in an opened single-use vial if the physician made good faith efforts to minimize the unused portion of the drug in how he or she scheduled patients and how he or she ordered, accepted, stored, and used the drug. This policy does not apply to the unused portion of drugs from multiple use vials. We expect that approved CAP vendors and participating CAP physicians will act and interact in a manner that will minimize unused drugs. Section 1847B(a)(3)(A)(iii) of the Act states that payment for CAP drugs is conditioned upon the administration of these drugs. We are clarifying that we consider the unused portion of a drug remaining in an opened single-use vial to be administered for the limited purpose of section 1847B(a)(3)(A)(iii)(II) of the Act, but only if the participating CAP physician has made good faith efforts to minimize the unused portion of the CAP drug in how he or she scheduled patients and how he or she ordered, accepted, stored, and used the drug, and only if the approved CAP vendor has made good faith efforts to minimize the unused portion of the drug in how it supplied the drug. This policy does not apply to the unused portion of drugs from multiple use vials. We disagree with commenters who indicated that payment for the unused portion of drugs should not be contingent on good faith efforts by the participating CAP physician, but only on good faith efforts by the approved CAP vendor in supplying the drug. The program should not pay for the unused portion of a drug resulting from circumstances that were avoidable through good faith efforts. However, in response to these comments, we are including a new obligation in participating CAP physicians’ CAP election agreement that requires the participating CAP physician to make good faith efforts to minimize the unused portion of CAP drugs in how he or she schedules patients and how he or she orders, accepts, stores, and uses the drugs. The requirement stated in the July 6, 2005 interim final rule with comment (70FR 39048) still applies, that when a participating CAP physician does not administer a CAP drug during the time frame specified on the prescription order, or administers a VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 smaller amount of the drug than was originally ordered, the participating CAP physician must contact the approved CAP vendor to discuss what to do. If it is permissible under State law, and if the CAP drug is unopened and both the participating CAP physician and the approved CAP vendor are in agreement, then the participating CAP physician may retain the drug for administration to another Medicare beneficiary. However, before the drug could be administered to another Medicare beneficiary, the participating CAP physician would need to provide the approved CAP vendor with a new prescription order for the drug, and the approved CAP vendor would need to provide the participating CAP physician with a new beneficiary-specific prescription order number. If the unused portion of the CAP drug is from a single-use vial, and all of the other conditions are met, the approved CAP vendor may bill for the unused portion of the CAP drug in the singleuse vial. However, if the unused portion of the CAP drug is from a multi-use vial or an unopened vial, the participating CAP physician and approved CAP vendor must come to an arrangement on what to do with the unused CAP drug consistent with statute, the CAP regulations, and all applicable State and Federal laws and regulations. We note that unused CAP drugs are the property of the approved CAP vendor. Comment: Some commenters asked for clarification of wastage, spillage or spoilage. Response: Any drug or portion of a CAP drug that is not administered to a Medicare patient is considered wastage, spillage or spoilage. We note that if the other conditions described in the previous response are met, the unused portion of a CAP drug from a single-use vial is considered to have been administered for purposes of section 1847B(a)(3)(A)(iii)(II) of the Act, and, therefore, would not be considered wastage, spillage, or spoilage. Comment: One commenter indicated that totally unopened or unused vials or packages ordered by the participating CAP physician should be purchased by the participating CAP physician for his or her own inventory. Response: We expect participating CAP physicians will make good faith efforts to minimize unused CAP drugs. One of the goals of the CAP program is to allow physicians a choice between obtaining CAP drugs from approved CAP vendors selected in a competitive bidding process or acquiring and billing for Part B covered drugs under the ASP drug payment methodology. We do not believe that requiring participating CAP PO 00000 Frm 00134 Fmt 4701 Sfmt 4700 physicians to purchase totally unopened or unused vials or packages for their own inventory is consistent with this goal. Comment: One commenter stated that many neurology practices that administer botox infusions split vials of the medication between two patients in cases where the patient does not need the full vial. The commenter indicated that the interim final rule with comment would prohibit this practice. Response: We indicated in the interim final rule with comment that unused quantities of a drug may increase the risk of waste, fraud and abuse, and attempts to use the excess drug may violate pharmacy law and may compromise product integrity. However, we also indicated that specific details will depend on State law and regulation as well as the individual situations. Approved CAP vendors will establish policies on these issues (making sure that they comply with applicable laws and regulations) and make the policies available for physicians to review during the election period and through approved CAP vendor’s participation in the CAP. Note also our policy regarding unused portions of a CAP drug from a single-use vial, which is described above. (2) Timing of Approved CAP Vendor Billing/Payment of Claims In the July 6, 2005 interim final rule with comment, we stated the participating CAP physician must file his or her drug administration claim within 14 days of administration (70 FR 39050 and 39095), and that the approved CAP vendor could not bill the beneficiary for drug product coinsurance until the claims matched and the approved CAP vendor received payment from the designated carrier (70 FR 39052 and 39097). Comment: Potential vendors have proposed ways to shorten the time frame of the approved CAP vendor’s payment window. One suggested that approved CAP vendors should be permitted to bill and be paid for drugs upon delivery to a participating CAP physician. Another suggested that the participating CAP physician be deemed to have ‘‘purchased’’ the drug if the participating CAP physician has not filed his or her claim within 14 days of delivery. These potential vendors are concerned about the viability of the CAP from a cash flow perspective. Response: In most cases, assuming the participating CAP physician and the approved CAP vendor have promptly and properly submitted their claims, the approved CAP vendor should be paid by CMS within two to three weeks from the E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations date of drug administration. The anticipated sequence of events for the majority of CAP claims that are in compliance with local coverage determinations (LCDs) is described in the timeline in Diagram 1. VerDate Aug<31>2005 15:52 Nov 18, 2005 Jkt 208001 This timeline (diagram 1) is offered as an illustration of how the approved CAP vendor’s drug claim and the participating CAP physician’s administration claim would travel through the Medicare claims processing PO 00000 Frm 00135 Fmt 4701 Sfmt 4700 70249 system using the month of October as an example. The claims depicted here are assumed to have passed ‘‘front end edits’’ and been considered ‘‘clean claims.’’ BILLING CODE 4120–01–U E:\FR\FM\21NOR2.SGM 21NOR2 70250 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 15:52 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00136 Fmt 4701 Sfmt 4700 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.053</GPH> BILLING CODE 4120–01–C Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations In the July 6, 2005 interim final rule with comment, we asked the approved CAP vendor to submit its drug claim to the designated carrier no earlier than the first day of the anticipated week of administration as indicated on the drug order (70 FR 39040). After performing initial ‘‘front end’’ edits to validate the claim, the designated carrier will forward the approved CAP vendor’s claim to the CMS central claims processing system. If there is not an immediate match between the approved CAP vendor’s drug product claim and the participating CAP physician’s drug administration claim in the CMS central claims system on the day the approved CAP vendor’s claim is received, then the approved CAP vendor’s claim goes into a recycling phase and will be reviewed for a match regularly thereafter. Section 1842(c)(3)(A) of the Act requires that no payment on an electronic claim shall be issued in less than 13 days. We add one day for mailroom and check handling and refer to this 14-day period as the ‘‘payment floor.’’ The payment floor clock starts on the day the approved CAP vendor’s claim is received by the designated carrier as long as the claim passes all edits and is classified as a ‘‘clean claim’’. In the July 6, 2005 interim final rule with comment, we stated that participating CAP physicians are required to file their claims for drug administration services within 14 days of the date of administration (70 FR 39050). Statistics obtained from Medicare claims filing data indicate that 75 percent of physician claims are filed within 14 days of the date of service, and that 95.6 percent of all Part B claims are considered clean when first filed. Within 3 days of receipt of a participating CAP physician’s clean claim that has not been suspended for medical review, the CMS central claims processing system will generate a match between the participating CAP physician’s claim and the approved CAP vendor’s claim and permit payment of the approved drug vendor’s drug product claim, provided the 14-day payment floor has been satisfied. In the July 6, 2005 interim final rule with comment, we stated that drug administration claims will undergo electronic medical review for compliance with LCDs (70 FR 39038). Historically, approximately 5 percent of Part B drug claims are suspended for manual review, and approximately 7 percent of all claims (that is, not just those for Part B drugs) are denied. We expect that a small number of CAP drug claims will be reviewed for off-label use. As for the 20 percent coinsurance portion of the bill, about 80 percent of VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Medicare beneficiaries have a supplemental insurance policy that covers the beneficiary’s cost sharing obligation. Approved CAP vendors will know which beneficiaries have a supplemental policy because that information is required to be included on the prescription order. Approved CAP vendors will also be able to verify the beneficiary’s supplemental coverage by contacting the supplemental insurer. If the supplemental insurer has an arrangement with CMS as part of the automatic coordination of benefits process, the approved CAP vendor’s claim will automatically cross over to the supplemental insurer after Medicare has paid its 80 percent share of the claim. In addition, under the mandatory Medigap crossover process, claims will be forwarded to the supplemental insurers for their use calculating their financial liability after Medicare if the approved CAP vendor properly coded the claim with the trading partner (for example, supplemental insurers) information. In both of these situations, after the supplemental insurer receives the claim it will issue applicable payment to the approved CAP vendor. When an approved CAP vendor has supplied a CAP drug for administration to a beneficiary without supplemental insurance, the approved CAP vendor may bill the beneficiary upon receipt of Medicare’s payment from the designated carrier or upon administration of the drug, if the approved CAP vendor has received notice of administration from the participating CAP physician. The approved CAP vendor may enter into a voluntary arrangement with a participating CAP physician to receive notification that the drug has been administered. The approved CAP vendor may also enter into a voluntary arrangement with the participating CAP physician to arrange for the collection of the beneficiary’s coinsurance after the drug is administered, or to deliver information and notices on coninsurance assistance. (3) Arrangements Between Approved CAP Vendors and Participating CAP Physicians for the Collection of Coinsurance and ABNs In the July 6, 2005 interim final rule with comment, we stated that nothing in the CAP statute or regulations prohibited an approved CAP vendor and a participating CAP physician from entering into an agreement governing their arrangements for the provision of CAP drugs or other items or services (70 FR 39050). We added that parties to these agreements must ensure that the arrangements do not violate the physician self-referral (‘‘Stark’’) PO 00000 Frm 00137 Fmt 4701 Sfmt 4700 70251 prohibition (section 1877 of the Act), the Federal anti-kickback statute (section 1128B(b) of the Act), or any other Federal or State law or regulation governing billing or claims submission. Comment: Some commenters requested that we state explicitly that approved CAP vendors and participating CAP physicians are allowed to enter into these arrangements. They suggested that drug industry relationships commonly include supplier/physician arrangements. These commenters believed that approved CAP vendor/ participating CAP physician arrangements will promote more participation in the CAP, stimulate greater cooperation between the parties, and generate fiscal efficiencies. Physician and manufacturer commenters requested that we implement the CAP with safeguards that preserve the participating CAP physician’s prescribing authority in the presence of these arrangements. They asked us to ensure that approved CAP vendors have no incentive and no regulatory pathway by which to restrict, limit, or change a participating CAP physician’s access to specific drug and biological therapy. Response: We are stating explicitly that nothing in the CAP statute or regulations prohibits approved CAP vendors and participating CAP physicians from entering into voluntary written arrangements that include— • An arrangement between a participating CAP physician and an approved CAP vendor to notify the approved CAP vendor after the CAP drug has been administered to the beneficiary; • An arrangement between a participating CAP physician and an approved CAP vendor to communicate with the beneficiary about coinsurance for CAP drugs on behalf of the approved CAP vendor; • An arrangement between a participating CAP physician and an approved CAP vendor to issue an ABN on behalf of the approved CAP vendor; • An arrangement between a participating CAP physician and an approved CAP vendor to collect applicable coinsurance and deductible on behalf of the approved CAP vendor from the beneficiary with no supplemental insurance coverage after the drug has been administered; and • Any other appropriate and legal arrangement between a participating CAP physician and an approved CAP vendor. (We note that the provisions of § 414.914(h) also allow the participating CAP physician and the approved CAP vendor to enter into an arrangement for E:\FR\FM\21NOR2.SGM 21NOR2 70252 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations the participating CAP physician to deliver notices related to the vendor’s coinsurance assistance program.) We will not dictate the breadth of use or the specific obligations contained in these arrangements, other than to note that they must comply with applicable law and to prohibit approved CAP vendors from coercing participating CAP physicians into entering any of these arrangements, as noted below. All written arrangements between approved CAP vendors and participating CAP physicians must comply with the requirements discussed below. These arrangements should be carefully scrutinized by the parties to ensure that these arrangements are not disguised payments for referrals for items or services payable by a Federal health care program. These arrangements are subject to the physician self-referral (‘‘Stark’’) prohibition, the Federal anti-kickback statute or any other Federal or State law or regulation governing billing or claims submission. Arrangements should be at fair market value for actual services provided and should not take into account the volume or value of referrals. Percentage compensation arrangements or per item arrangements for billing and collection services between participating CAP physicians and approved CAP vendors would be highly suspect under the fraud and abuse laws. Approved CAP vendors who enter into these arrangements with participating CAP physicians remain subject to liability for improper waivers of deductibles and coinsurance, including violations of the Federal antikickback statute and liability under section 1128A(a)(5) of the Act. Costsharing waivers are permitted under certain conditions for financially needy beneficiaries as specified in section 1128A(i)(6) of the Act. Parties should monitor these arrangements to ensure that waivers are made appropriately and create safeguards to ensure that these arrangements are not used by approved CAP vendors or participating CAP physicians as inappropriate marketing tools. A participating CAP physician’s decision to enter into an arrangement with an approved CAP vendor must be completely voluntary. An approved CAP vendor may not refuse to do business with a participating CAP physician because the participating CAP physician has declined to enter into an arrangement with the approved CAP vendor. Approved CAP vendors must accept all participating CAP physicians who choose to enroll with that approved CAP vendor. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Comment: Some commenters proposed that approved CAP vendors should have authority to obtain beneficiary credit card authorization before shipping drugs for them. One commenter suggested that Medicare withhold the approved CAP vendor’s 20 percent coinsurance from the participating CAP physician’s drug administration claim payment. The participating CAP physician would then collect both the administration coinsurance together with the drug product coinsurance from the beneficiary and/or the beneficiary’s supplemental insurer. The approved CAP vendor would be paid the full amount. Response: The CAP statute requires that we develop a process for the sharing of information between the participating CAP physician and the approved CAP vendor related to the payment of deductible and coinsurance (section 1847B(a)(3)(C) of the Act). In the July 6, 2005 interim final rule with comment, we interpreted this to mean beneficiary contact information, Medicare information, and third party insurance information (70 FR 39041). In the interim final rule with comment, we stated that we will not ask the participating CAP physician to collect the beneficiary’s credit card information and share it with the approved CAP vendor because this information is not necessary to complete the drug ordering process, nor is it part of any supplemental insurance coverage that the beneficiary may have. We maintain that position in this final rule with comment. We do not ask the participating CAP physician to collect and forward credit card information to a third party supplier in any other Medicare setting. The beneficiary will have supplemental insurance approximately 80 percent of the time, rendering beneficiary payment information unnecessary in most cases. We do not believe it is appropriate to require participating CAP physicians to secure drug coinsurance payment information from beneficiaries with no supplemental insurance, since provisions of section 1847B(a)(3)(A)(ii) of the Act make the collection of coinsurance the responsibility of the approved CAP vendor. However, as discussed previously, the participating CAP physician and the approved CAP vendor may enter into a voluntary arrangement, whereby the participating CAP physician, on the approved CAP vendor’s behalf, would collect coinsurance from beneficiaries with no supplemental insurance coverage. PO 00000 Frm 00138 Fmt 4701 Sfmt 4700 (4) Resupply Option/Definition of Emergency As stated in the July 6, 2005 interim final rule with comment (70 FR 39037 and 39047), the four criteria that govern the resupply option are contained in section 1847B(a)(5) of the Act, which says that a participating CAP physician may acquire drugs under the CAP to resupply his or her private inventory if all of the following requirements are met: • The drugs were required immediately. • The participating CAP physician could not have anticipated the need for the drugs. • The approved CAP vendor could not have delivered the drugs in a timely manner. • The participating CAP physician administered the drugs in an emergency situation. As we also stated in the July 6, 2005 interim final rule with comment, these criteria are set forth in the CAP statute, and, therefore, we do not have the authority to change them, or to allow that some of them be optional. In the July 6, 2005 interim final rule with comment, we defined ‘‘delivery in a timely manner’’ for the resupply provisions of the CAP as the ability to meet emergency delivery standards for timely delivery as defined in § 414.902. We also defined ‘‘emergency situation’’ for the purposes of the resupply provisions of the CAP in § 414.902 as an unforeseen occurrence or situation determined by the participating CAP physician, in his or her clinical judgment, to require prompt action or attention for purposes of permitting the participating CAP physician to use a drug from his or her own stock, if the other requirements of § 414.906(e) are met. In the July 6, 2005 interim final rule with comment, we stated that we anticipated that the local carrier would, at times, conduct a post-payment review of claims for emergency drug replacement in order to determine whether participating CAP physicians were complying with conditions for emergency drug replacement. The local carrier would use the emergency replacement modifier code to identify claims for emergency drug replacement for random post-payment review. Comment: Numerous commenters expressed concern that the emergency resupply provisions were too restrictive and would have a negative impact on patient care. These commenters stated that, particularly for oncology treatment, health status changes are common, resulting in frequent changes in drug E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations dosage or medication(s). These commenters believe that the requirements regarding emergency resupply would result in delayed treatment for patients already ill, and increase the burden on the patient and their caregivers. The impact on people in rural areas who may live several hours from where they receive treatment was mentioned by many commenters, and it was suggested that the patient’s driving distance be considered in the ability of a participating CAP physician to provide drugs out of office supply and be resupplied by the approved CAP vendor. One commenter also noted that acute and infectious disease patients could be at risk if there was any delay in treatment. Some commenters expressed concern that participating CAP physicians who use the emergency resupply option might be subjected to unwarranted audits. Others expressed concern that frequent use of the emergency resupply option would result in adverse consequences for the participating CAP physician. There were also questions about the approved CAP vendor’s ability to withhold shipment if the approved CAP vendor did not agree that an emergency existed or if they believe the drug that was used in the emergency situation would not be covered. Response: As stated in the July 6, 2005 interim final rule with comment, we believe that the definition of emergency used in this situation should be one that enables the participating CAP physician to use his or her clinical judgment to determine when his or her patient needs immediate treatment. We have defined emergency for purposes of this provision as a situation determined by the participating CAP physician’s clinical judgment to be an unforeseen situation that requires prompt action or attention. If the approved CAP vendor’s emergency delivery timeframe would result in delivery of the drug after the time necessary to meet the patient’s clinical need, it would be considered that the CAP drug could not have been delivered in a timely manner. We are firm in our view that the determination of clinical need rests with the participating CAP physician and we leave it to the participating CAP physician to determine the scope of the clinical need. As previously stated, the participating CAP physician will assess whether all of the criteria are applicable and will document the patient’s medical record accordingly. However, we do not believe that driving distance in itself should be a determining factor in the use of the emergency supply provision. Rather, the participating CAP physician should evaluate the entire clinical VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 situation of the patient and make an appropriate determination based on all relevant information. Approved CAP vendors do not have the authority to override a participating CAP physician’s determination of what constitutes an emergency situation for purposes of the resupply provision. Policies regarding the shipment of CAP drugs are the same for the emergency resupply provision as they are for routine ordering and shipping of CAP drugs and for the ‘‘furnish as written’’ procedures. In all of these cases, the approved CAP vendor is required to deliver CAP drug(s) upon receipt of a prescription order, ensuring that the participating CAP physician’s judgment about the appropriate treatment is the final determining factor in the decisionmaking process. The same principle applies to the emergency replacement process. If a participating CAP physician orders a CAP drug to resupply inventory on the basis of an emergency administration, the approved CAP vendor must ship it, unless the conditions of § 414.914(h) are met. As stated in the July 6, 2005 interim final rule with comment, we anticipate that at times the local carrier would conduct a post payment review of emergency drug replacement in order to determine whether participating CAP physicians were complying with conditions for emergency drug replacement. We acknowledge that there may be some participating CAP physicians that may have legitimate reasons for more frequent use of the emergency resupply option. The post payment review process will also provide us with information on participating CAP physicians’ use of the emergency resupply provision and help to distinguish between appropriate and inappropriate use of this provision. As we gain more experience with the CAP, we will assess whether the emergency resupply provision is working as intended, and whether further refinement is necessary. (5) Order Form Information on Patient’s Height and Weight In the July 6, 2005 interim final rule with comment (70 FR 39095), we stated that the participating CAP physician would agree to provide specific information to the approved CAP vendor from whom he or she has elected to receive drugs information. The specific information required included the Medicare beneficiary’s height and weight. We also stated that abbreviated information could be sent for repeat patient orders. We received comments regarding the patient’s height and weight. PO 00000 Frm 00139 Fmt 4701 Sfmt 4700 70253 Comment: Some commenters stated that including the patient’s height and weight on the CAP order form should not be required. Response: It is possible for an approved CAP vendor to be a wholesaler distributor, a specialty pharmacy or a combination of both. State and Federal laws that govern specialty pharmacy operations may be different from those that govern wholesale distributor operations. For example, State laws, regulations, and recognized professional practice standards may require that specialty pharmacy services be provided by a qualified pharmacist. If the approved CAP vendor is a specialty pharmacy or distributor with an arrangement with a specialty pharmacy to supply drugs to a participating CAP physician, then information on patient height and weight may be required in order for a pharmacist to check a dispensed dose. If the approved CAP vendor operates solely as a drug wholesaler this information may not be necessary. To reflect the different requirements that may apply to different potential types of approved CAP vendors, we are amending § 414.908(a)(3)(v)(M) to specify that height and weight should be provided only if necessary. (6) Furnish as Written In the July 6, 2005 interim final rule with comment (70 FR 39043), we stated that we would allow the participating CAP physician to obtain a drug and bill Medicare under the ASP system using the ‘‘furnish as written’’ (FAW) option when medical necessity requires that a specific formulation of a drug be furnished to the patient, and that formulation is not provided by the approved CAP vendor. Documentation of the medical necessity must be maintained in the Medicare patient’s medical record. The participating CAP physician would use a FAW modifier to identify that he or she was allowed to bill Medicare under the ASP system in this limited circumstance. Comment: One commenter stated the examples given under the description of FAW were very narrow and would keep a participating CAP physician from using the FAW option proactively. Response: If the approved CAP vendor does not carry a specific NDC that is medically necessary for a patient, the participating CAP physician may purchase the drug, bill for it and use the FAW modifier on the drug claim. In this situation, the local carrier will pay the participating CAP physician under the ASP payment system. We remind physicians that the FAW process E:\FR\FM\21NOR2.SGM 21NOR2 70254 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations requires documentation of medical necessity. Although the July 6, 2005 interim final rule with comment contained several examples of when the FAW process may be used, we did not intend to imply that these were exhaustive. The examples were meant to be illustrative, and were not meant to exclude other situations where FAW could legitimately be used in order to furnish a patient with the most appropriate therapy. Rather, we wished to indicate two points—(1) Participating CAP physicians who use FAW must appropriately document clinical judgment in support of the use of FAW; and (2) FAW is not intended to provide participating CAP physicians with an ‘‘end run’’ around their decision to participate in the CAP. The CAP is in no way intended to bar access to a medically necessary therapy. However, where medical necessity is served by the drug formulation supplied by the approved CAP vendor, coverage is available only if the participating CAP physician obtains the drug from the approved CAP vendor. We again remind physicians that routine orders for CAP drugs should be placed at the HCPCS level. Specific products not on an approved CAP vendor’s drug list that are medically necessary for the beneficiary may be obtained through the ASP system. Please note that the approved CAP vendor has the ability to request CMS approval to add new drugs to its CAP drug list. This process was discussed in the July 6, 2005 interim final rule with comment (70 FR 39075) and further described previously in this section. (7) Patient Data Confidentiality In the July 6, 2005 interim final rule with comment (70 FR 39065), we stated that approved CAP vendors would be required to comply with the HIPAA Administrative Simplification Rules, including the Privacy Rule. Comment: One commenter requested that CMS explicitly prohibit approved CAP vendors from using, sharing, or selling patient information for any purpose other than that which is strictly related to fulfilling CAP orders. Another commenter wanted assurance that approved CAP vendor subcontractors would be subject to the same confidentiality requirements as the approved CAP vendor. Response: We concur with the commenters that patient information must be protected from misuse, and believe that this requirement is adequately addressed by the requirement that approved CAP vendors comply with the HIPAA Privacy and VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Security rules. We also note that subcontractors are held to the same requirements and standards as the approved CAP vendor, including those pertaining to confidentiality. d. Beneficiary Issues In this section we discuss the policy permitting an approved CAP vendor to stop supplying drugs for a beneficiary who is not meeting their coinsurance obligations. We also discuss the ABN process as it pertains to the CAP. Finally, we respond to comments about the financial liability of a Medicare/ Medicaid dual eligible beneficiary who receives a CAP drug. (1) Coinsurance In the July 6, 2005 interim final rule with comment, we specified requirements at § 414.914(g) to include a provision requiring approved CAP vendors to provide information on sources of cost-sharing assistance available to beneficiaries on request (70 FR 39096). We noted that routine waiver of deductibles and coinsurance could violate the Federal anti-kickback statute, as well as, the civil prohibition on offering inducements to beneficiaries at section 1128A(a)(5) of the Act (70 FR 39050). However, cost-sharing waivers are permitted under certain conditions for beneficiaries who are experiencing financial hardship. We also stated in the July 6, 2005 interim final rule with comment that we would not require an approved CAP vendor to continue to supply CAP drugs for beneficiaries who do not pay their deductible or coinsurance. Rather, we would allow the approved CAP vendor to refuse to make further shipments to the participating CAP physician for that beneficiary as long as the requirements of § 414.914(h) are met. In instances where a beneficiary failed to meet his or her obligation to pay coinsurance or deductible for a CAP drug, and the approved CAP vendor refused to continue providing the drug, we stated that we would permit the participating CAP physician to opt out of that drug category for the CAP. Comment: Commenters from the community of potential CAP vendors expressed support for the approved CAP vendor’s right to refuse to ship drugs for beneficiaries who do not meet their deductible and coinsurance obligations. They recommend removal of the requirement that the approved CAP vendor wait up to 60 days before discontinuing shipment of drugs on behalf of beneficiaries who do not meet their coinsurance obligations. The commenters offer that their exposure for PO 00000 Frm 00140 Fmt 4701 Sfmt 4700 additional uncollected coinsurance during the waiting period represents a risk so great that it renders participation in CAP untenable, and they should be permitted to collect coinsurance amounts on the day they ship the drugs. Physicians and some drug manufacturers commented that the 45 to 60 day waiting period is too short, suggesting the period after the vendor’s referral to a specific, bona fide charitable organization should be extended to permit the beneficiary sufficient time to apply for the aid, and the charitable organization time to process the request. A longer period was requested for cognitively impaired beneficiaries. Response: Approved CAP vendors who become concerned about additional drug coinsurance exposure during the waiting period may make reasonable contact with the beneficiary for assurance that he or she is making timely and meaningful efforts to secure additional sources of funding. The additional 15-day waiting period after the specific, bona fide charitable organization referral represents a safety valve, and is not suggested as the starting point for the beneficiary’s effort to secure alternative funding. The regulatory time periods set up a framework for an enforceable remedy. However, in light of the comments, and to reflect our policy change that an approved CAP vendor may make an arrangement with a participating CAP physician to collect coinsurance on its behalf, we are making modifications to § 414.914(h) to reflect that the 45-day period will begin on the date that the bill for coinsurance is delivered to the beneficiary whether it is mailed by the approved CAP vendor or delivered by the participating CAP physician on the behalf of the approved CAP vendor. We are also clarifying that the delivery of the coinsurance bill need not be subsequent to Medicare payment if the approved CAP vendor has received notice of drug administration from the participating CAP physician and the beneficiary lacks supplemental insurance. Because we believe the regulatory provision with this technical modification appropriately balances the interests of all involved, we are not going to change the length of the waiting period in § 414.904(h). Comment: Some physician commenters have indicated that they waive coinsurance for indigent beneficiaries in some cases and expect that vendors should do likewise as a matter of routine. Response: Approved CAP vendors and participating CAP physicians must conduct their business in compliance E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations with the requirements of sections 1128A(a)(5) and 1128A(i)(6) of the Act. In the July 6, 2005 interim final rule with comment (70 FR 39053) we stated that we were modifying the program requirements at § 414.914(g) to include a provision requiring approved CAP vendors to provide information on sources of cost-sharing assistance available to beneficiaries on request. It is important to note that routine waiver of deductibles and coinsurance can violate the Federal anti-kickback statute, as well as the civil prohibition on offering inducements to beneficiaries at section 1128A(a)(5) of the Act. However, cost-sharing waivers are permitted under certain conditions for beneficiaries who are experiencing financial hardship. The assistance offered by the approved CAP vendor must take the form of one of the following: A referral to a bona fide and independent charitable organization, implementation of a reasonable payment plan, or a full or partial waiver of the cost-sharing amount based on the individual financial need of the patient, provided that the waiver meets all of the requirements in § 1003.101(1) (Definition of ‘‘Remuneration’’). The availability of waivers may not be advertised or be made as part of a solicitation; however, approved CAP vendors may inform beneficiaries generally of the various categories of assistance noted in the preceding sentence. In no event may the approved CAP vendor include or make any statements or representations that promise or guarantee that beneficiaries will receive cost-sharing waivers. We will evaluate the procedures that applicant vendors propose to implement to make cost-sharing assistance referrals as part of the approved CAP vendor application review process. Comment: Some physician commenters opposed the vendor’s right to refuse further shipment because they believe it will fall to the physician to communicate to the beneficiary that his or her drugs are not being delivered, even though the decision to refuse shipment was the approved CAP vendor’s. Response: We understand the commenters’ concern. However, when notifying the beneficiary of the approved CAP vendor’s refusal to ship CAP drugs, the participating CAP physician need not justify the approved CAP vendor’s decision. Instead, the participating CAP physician need only direct the beneficiary to the approved CAP vendor’s grievance process. We believe it is the responsibility of the approved CAP vendor to notify the beneficiary about the conditions VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 (specified in § 414.914(h)) under which the approved CAP vendor could permissibly cease delivery of CAP drugs for a beneficiary. Comment: A few physician commenters expressed concern that an approved CAP vendor could use the refusal to ship for nonpayment of coinsurance as a way to influence the participating CAP physician’s treatment plan, such as forcing the participating CAP physician to admit the beneficiary to a hospital. Response: In order to preserve the flexibility of the participating CAP physician as required by the statute we have significantly limited the instances in which an approved CAP vendor can refuse to ship. However, we have a very specific process to provide the approved CAP vendor with some economic protection, and we will monitor the instances where an approved CAP vendor refuses to ship for nonpayment of coinsurance to ensure it is not being abused. The participating CAP physician may seek assistance from the CAP designated carrier in working out disputes where the participating CAP physician believes the approved CAP vendor is abusing the process under § 414.917. Comment: One physician group commented that the regulation should be revised to require that the approved CAP vendor must provide information on cost sharing assistance to needy beneficiaries. The commenter stated that because the regulation at § 414.914(g)(3) and § 414.914(h)(3) state that the approved CAP vendor may inform beneficiaries that they generally make available categories of assistance such as referral to a bona fide charitable organization, implementation of a payment plan, or a full or partial waiver of the cost sharing amount that they were not required to do so. Response: In the July 6, 2005 interim final rule with comment (70 FR 39086), we stated that the approved CAP vendor would be required on request, to provide information to beneficiaries on sources of coinsurance assistance. The regulations at § 414.914(g) state that the ‘‘approved CAP vendor must provide assistance to beneficiaries experiencing financial difficulty in paying their cost sharing amounts * * *’’ However, § 414.914(g)(3) and § 414.914(h)(3) state that approved CAP vendors may inform beneficiaries that they generally make cost sharing assistance available. It was our intention as reflected in the language in the preamble and § 414.914(g) and § 414.914(h)(3) to require approved CAP vendors to have a cost sharing assistance program PO 00000 Frm 00141 Fmt 4701 Sfmt 4700 70255 available if the beneficiary expressed a need for one. Section 14.914(g)(3) and § 414.914(h)(3) were intended to convey that approved CAP vendors may generally inform beneficiaries of the existence of this program rather than waiting for the beneficiary to request assistance. It was not our intention to convey that the approved CAP vendor had the option not to provide this assistance. In order to resolve any confusion we are revising § 414.914(g)(3) and § 414.914(h)(3) to reflect our original intent. The revision now reads, ‘‘Approved CAP vendors must inform beneficiaries,’’ that they generally make available the categories of assistance described in paragraphs § 414.914(g)(1), (g)(2), and (g)(3) of this section.’’ Comment: One manufacturer commented that the vendor should be required to document ‘‘reasonable collection efforts’’ before being allowed to cut off a beneficiary. Response: Because approximately 80 percent of beneficiaries have a Medicare supplemental policy that includes coverage for Part B cost sharing, their coinsurance and deductible payments should be made automatically in most cases by their supplemental insurer under the coordination of benefits process. Some beneficiaries without supplemental insurance may have difficulty making their coinsurance and deductible payments at times, and may seek assistance from the approved CAP vendor or some other third party. As we stated previously in this final rule and in the July 6, 2005 interim final rule with comment and consistent with the requirements of section 1128A(a)(5) of the Act and § 414.914(g) of the regulations, at the time of billing, the approved CAP vendor must inform the beneficiary generally of the types of cost-sharing assistance that may be available. If the beneficiary is unable to pay the coinsurance or deductible, he or she may request assistance from the approved CAP vendor as described above. The approved CAP vendor has an obligation to provide the information requested, and to take one of the actions specified in § 414.914(g). However, if the beneficiary has not requested financial assistance and if after a period of 45 days from delivery date of the approved CAP vendor’s bill to the beneficiary whether by the approved CAP vendor or by the participating CAP physician on the behalf of the approved CAP vendor, the beneficiary’s coinsurance obligation remains unpaid, the approved CAP vendor may refuse to make further shipments of drugs to the participating CAP physician for that E:\FR\FM\21NOR2.SGM 21NOR2 70256 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations beneficiary. (We note that these provisions assume that the approved CAP vendor bills the beneficiary after payment is received from Medicare and his or her supplemental insurance provider (if applicable).) If the beneficiary requests cost-sharing assistance and the approved CAP vendor refers the beneficiary to a bona fide independent charitable organization for assistance or offers a payment plan, the approved vendor must wait an additional 15 days from the date of delivery (which would be the postmark date when mailed and received date when hand delivered) of the approved CAP vendor’s response to the beneficiary’s request for cost-sharing assistance. If at the end of the 15-day time period, the approved CAP vendor has not received a cost-sharing payment (either from the charitable organization or from the beneficiary under the payment plan), the approved CAP vendor may refuse to ship additional drugs to the physician on behalf of that beneficiary. Further, if the approved CAP vendor implements a reasonable payment plan, it must continue to ship CAP drugs for the beneficiary, so long as the beneficiary remains in compliance with the payment plan. Finally, if the approved CAP vendor waives the cost-sharing in accordance with section 1128A(i)(6)(A) of the Act and § 1003.101 and § 414.914(g)(3) of the regulations, it may not refuse to ship CAP drugs for the beneficiary. At this time, we believe that sufficient safeguards are built into the system to protect the beneficiary. Beneficiaries who believe that the approved CAP vendor is not adhering to these standards may use the vendor’s grievance process. If that does not resolve the issue to their satisfaction they may request assistance from the designated carrier under the dispute resolution process. We will monitor the implementation of this provision to see whether a requirement that the approved CAP vendor document collection efforts should be implemented at a later date. Comment: A beneficiary advocacy group requested that the approved CAP vendor be required to assess the beneficiary’s financial condition and waive coinsurance for beneficiaries who meet a prescribed poverty test. Response: Any beneficiary who is unable to meet his or her cost-sharing obligations is free to request assistance from the approved CAP vendor. We assume that if the approved CAP vendor administers its own plan rather than referring the beneficiary to a charitable organization for assistance, it will develop eligibility guidelines for the VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 plan. We do not require any provider to waive coinsurance on a routine basis. (2) Advance Beneficiary Notices (ABNs) In the July 6, 2005 interim final rule with comment, we stated that the approved CAP vendor could issue an ABN to the beneficiary if the approved CAP vendor and the participating CAP physician did not agree about whether the drug administration service claim would be paid as a medically necessary service (70 FR 39058). We also stated that the approved CAP vendor may ask the participating CAP physician to deliver an ABN. If the participating CAP physician agrees to do so, he or she will describe both the administration of the drug and the drug product on the ABN, together with the estimated cost for each that the beneficiary must pay if he or she receives the drug and Medicare does not pay. We also noted that if the participating CAP physician declined to issue the ABN, then the approved CAP vendor could issue the ABN to the beneficiary before the drug was administered. In the July 6, 2005 interim final rule with comment, we used the phrase ‘‘signed ABN’’ where we meant to say ‘‘enforceable ABN’’ (70 FR 39039 and 39051). We wish to clarify this point because there are circumstances under which an ABN issued via telephone can be enforced. The requirements for delivery of ABNs can be found in the Medicare Claims Processing Manual, Pub. 100–4, Chapter 30, Section 40.3.4. These requirements may be accessed electronically at https:// cms.hhs.gov/manuals/104_claims/ clm104c30.pdf. Comment: Some physicians commented that an obligation to collect an ABN on behalf of the approved CAP vendor represented an unwelcomed administrative burden. Others expressed concern that approved CAP vendors would overuse the ABN process, issuing ABNs even when the approved CAP vendor had no reasonable belief that the physician’s drug administration claim or the vendor’s claim for the drug would be denied. A commenter stated that it would be a logical anomaly for the approved CAP vendor to ask a participating CAP physician to collect an ABN in cases where the physician believes the drug administration services and, consequently, the drug product will be covered. The commenter believes this puts the participating CAP physician in an untenable situation and will serve to confuse the beneficiary unnecessarily. Commenters from the community of potential vendors requested that we allow the approved CAP vendor to refuse to ship the CAP drug if the PO 00000 Frm 00142 Fmt 4701 Sfmt 4700 approved CAP vendor believes the applicable coverage policy prohibits payment and the participating CAP physician refuses to collect an ABN for the CAP drug on behalf of the vendor, suggesting that, in this case, the participating CAP physician should be allowed to use the furnish as written process. One commenter requested that we allow the approved CAP vendor to terminate CAP business with a participating CAP physician who refused to issue an ABN on behalf of the approved CAP vendor when the underlying claim was not paid. Response: In response to the commenters’ concerns, we reemphasize that the participating CAP physician’s decision to issue an ABN on behalf of the approved CAP vendor is completely voluntary. An approved CAP vendor is always free to contact the beneficiary and issue an ABN on its own. Because the participating CAP physician’s decision to issue an ABN is voluntary, the approved CAP vendor may not penalize the participating CAP physician who refuses to do so by refusing to ship the drug or attempting in some other way to force the participating CAP physician to obtain it. We note that, approved CAP vendors will have a disincentive to abuse the ABN process. Should an approved CAP vendor issue an ABN that is not consistent with CMS requirements, and the claim for the drug is denied and appealed to an Administrative Law Judge (ALJ), the ALJ could review the case and determine that the use of the ABN was inappropriate or invalid, thereby shifting liability to the approved CAP vendor. In addition, if an approved CAP vendor frequently seeks ABNs in cases where the participating CAP physician’s local carrier routinely determines a particular drug to be covered, the approved CAP vendor may not be seen as a good business partner by the participating CAP physician and could lose his or her business at the next CAP election period. After careful consideration of the comments we have received, and balancing all the policy implications we have decided to maintain the policy with respect to ABNs set forth in the July 6, 2005 interim final rule with comment. (3) Dual Eligibles In the July 6, 2005 interim final rule with comment, we addressed the situation of beneficiaries who are dually eligible for the Medicare and Medicaid programs. We stated that Medicaid coinsurance payments would vary by State and that we had no authority to change the coinsurance amount based E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations on who was responsible for payment of the coinsurance (70 FR 39054). Comment: Several commenters requested that we specifically state that dual eligible, Medicare/Medicaid beneficiaries may not be held responsible for more coinsurance than what the Medicaid State Agency pays. They have asked us to make clear that approved CAP vendors may not balance bill the beneficiary for that portion of the 20 percent Medicare coinsurance that is above the given State’s Medicaid upper payment limit. Response: State Medicaid programs can limit coinsurance payments to the extent that any payment for a covered Medicaid benefit, when combined with Medicare payments, equals the amount of reimbursement payable under the Medicaid program. A State Medicaid program may deem an approved CAP vendor to be paid in full even if it has received either no coinsurance payment or a reduced payment from the State. Dual eligible beneficiaries have no liability for a covered Medicaid benefit beyond the State’s payment amount as set forth in section 1902(n)(2) of the Act. e. Physician Election Issues and Education In the July, 6, 2005 interim final rule with comment (70 FR 39079), we stated that section 1847B(a)(1)(A) of the Act specifies that each physician be given the opportunity annually to elect to participate in the CAP. Physicians who do not elect to participate in the CAP would continue to buy the drugs they provide to beneficiaries ‘‘incident to’’ their service and bill the Medicare program for them under section 1847A of the Act, the ASP system. Section 1847B(a)(5)(A) of the Act requires that we develop a process that physicians who wish to participate in the CAP may use to select an approved CAP vendor. This election is to occur on an annual basis. The statute requires that we coordinate this process with the Medicare Participating Physician Process described in section 1842(h) of the Act. Additionally, we stated that physicians who elect to participate in the CAP would be required to complete a CAP election agreement and would agree to the participating CAP physician requirements as established in the July 6, 2005 interim final rule with comment (70 FR 39079 through 39083). In the July 6, 2005 interim final rule with comment, we also stated that the participating CAP physician election process would operate from October 1 to November 15 of each calendar year. In the September 6, 2005 interim final rule with comment interpretation and correction notice (70 FR 52930), we VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 announced a delay in CAP implementation to approximately July 1, 2006. We anticipate that the bidding for the initial round of CAP will commence upon the publication of this rule. Thus, for this first CAP year the participating CAP physician election process will occur for approximately 6 weeks in early to mid-spring. Exact dates and election procedures will be announced on our web site. Later in 2006, we will conduct the annual participating CAP physician election for CY 2007. The election period for 2007 will occur from October 1, 2006 to November 15, 2006, with subsequent annual participating CAP physician election periods running from October 1 to November 15 of each calendar year thereafter. In the July 6, 2005 interim final rule with comment, we stated that participating CAP physicians who wish to continue their participation in the CAP into subsequent years would do so by executing an abbreviated agreement, which would, if applicable, indicate a preference to change approved CAP vendors or, if applicable, CAP drug category. We also described specific instances in which participating CAP physicians will be permitted to select another approved CAP vendor or leave the CAP mid-year. These instances are when the selected approved CAP vendor ceases to participate in the CAP because its contract is terminated or suspended or if the participating CAP physician leaves the group practice that had selected the given approved CAP vendor or relocates to another competitive area (if multiple CAP competitive areas are implemented). Additionally, physicians newly enrolled in Medicare have 90 days from the date of enrollment to elect to participate in the CAP. The election process was summarized in the July 6, 2005 interim final rule with comment (70 FR 39083). We also stated that when a physician bills as a member of a group using the group’s Provider Identification Number (PIN), he or she must follow the group’s election to participate or not to participate in the CAP. Thus, members of a group practice would elect to participate in the CAP as a group when billing under the group PIN. We also stated that if a group practice physician maintains a separate solo practice, he or she could make a separate determination of whether to participate in the CAP for the solo practice if using his or her individual PIN for the solo practice. PO 00000 Frm 00143 Fmt 4701 Sfmt 4700 70257 (1) Group vs. Individual Participation in CAP We received several comments on the CAP participation of physicians who are in a group practice. Comment: Several commenters suggest that when a physician is part of a group practice that the choice to elect the CAP should be made by the individual physician or by the physician specialty. Commenters sought clarification on the ability of physicians to be able to make their own, independent decisions related to the CAP so as not to affect the continuity of the group practices. One commenter specifically sought clarification on whether a physician within a group practice could opt out of CAP while his partners within the group opted in. The commenter believed that the language allows one physician within a group to continue with the ‘‘buy and bill’’ method while the others within the group opt to elect the CAP as long as the physician bills all of his or her professional services rendered to group patients under his or her own individual PIN. Response: In the July 6, 2005 interim final rule with comment (70 FR 39082), we stated that we were required to coordinate the selection of the approved CAP vendor with agreements entered into under section 1842(h) of the Act (agreements to become a Medicare participating physician). The Medicare participating physician enrollment process coordinates the Medicare payment for the health care services delivered to a Medicare beneficiary. When payments for services are made to a health care provider, they are made based on the PIN. In order for a physician to ‘‘buy and bill’’ separately from the group he or she must not have reassigned his or her benefits to the group. By reassigning his or her benefits to the group practice, the physician will be billing Medicare using the group’s PIN. Thus, the group will make the choice about whether to participate in the CAP. Comment: Another commenter sought clarification on whether a nonparticipating physician who joined the CAP will be able to accept assignment for CAP drug administration. Response: When a Medicare physician is a non-participating physician, he or she may still accept assignment on a case-by-case basis for his or her services. However, he or she must agree to accept assignment for all Medicare Part B drug payment as specified in section 1842(o)(3)(A) of the Act. If the non-participating physician elects to participate in the CAP he or E:\FR\FM\21NOR2.SGM 21NOR2 70258 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations she will no longer be billing Medicare for the Part B drugs that he or she obtains through CAP, but he or she will still be able to bill Medicare for the administration of those drugs. Thus, if a non-participating physician elects to participate in the CAP, he or she must agree to accept assignment for drug administration for all CAP drugs to allow for the Medicare beneficiary’s and approved CAP vendor’s appeal rights. (2) Practitioners in CAP-Clarification In the July, 6, 2005 interim final rule with comment, we stated that physicians would have a choice to participate in the CAP or continue to buy the drugs they provide to beneficiaries ‘‘incident to’’ their service and bill the Medicare program for them under the ASP system as specified in section 1847A of the Act. We would like to clarify that for the purposes of the CAP, a physician includes all practitioners that meet the definition of a ‘‘physician’’ in section 1861(r) of the Act. (3) Physician Choice of Approved CAP Vendor Comment: One commenter believes that approved CAP vendors will be entirely dependent on physicians for various actions including—filing claims, appealing a denial, obtaining beneficiary information, and, where necessary, obtaining an ABN. The commenter asserts that approved CAP vendors should be allowed the right to decline to work with a participating CAP physician who has— • Previously failed to pay for drugs on a timely basis. • Materially breached his or her contractual obligations to the approved CAP vendor or his or her CAP election agreement with CMS. • Acted in a manner that obstructs the purpose or intent of the CAP, or otherwise hinders its effectiveness. • Otherwise acted in bad faith. The commenter is concerned that as long as a participating CAP physician is not currently suspended, the participating CAP physician may select any approved CAP vendor he or she wishes, including an approved CAP vendor that might have generated a suspension request for that participating CAP physician. The commenter further asserts that because of the critical reliance of approved CAP vendors on participating CAP physician’s compliance with CAP requirements that in the event of the participating CAP physician’s noncompliance the approved CAP vendors should have the right not to work with a participating CAP physician if it has a reasonable VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 basis for concern. The commenter also believes it is important for the approved CAP vendor to have some recourse when it will potentially be selling drug products to the physician, and, thus, potentially be owed significant amounts by a physician in certain situations. Response: The commenter’s reference to a vendor ‘‘selling’’ drugs to a physician appears to be expressing concern about an approved CAP vendor’s relationship with a participating CAP physician outside the scope of the CAP. These relationships are beyond the scope of this rule. Currently, physicians purchase the drugs they administer to their Medicare beneficiary patients and are reimbursed for those drugs through the ASP payment system. The CAP is an alternative way for physicians to obtain drugs. In the CAP, the participating CAP physician does not purchase CAP drugs, but rather orders them. Because participating CAP physicians will not own the CAP drugs they order from the approved CAP vendor, the approved CAP vendor will not be ‘‘selling’’ the drug to the participating CAP physician. Instead, the approved CAP vendor will ship CAP drugs to the participating CAP physician and bill Medicare for them upon administration. In addition, as we have stated in this final rule with comment and the July 6, 2005 interim final rule with comment, an approved CAP vendor must accept any participating CAP physician who selects it. However, in developing the CAP, we recognized that the approved CAP vendor, as the owner of the CAP drugs, would have significant financial risk. We developed a dispute resolution process to assist the approved CAP vendor if there were occurrences of participating CAP physician noncompliance within the program. In the July 6, 2005 interim final rule with comment (70 FR 39054), we detailed the dispute resolution process for addressing participating CAP physician’s non-compliance with CAP obligations. We believe the dispute resolution process is the appropriate forum for addressing these concerns. (4) Participating CAP Physician Mid Year Opt-Out In this section, we discuss the comments received concerning the ability of a participating CAP physician to opt-out of the CAP prior to the end of the year and our responses to those comments. Comment: We received a number of comments requesting that participating CAP physicians have the ability to optout of CAP for any approved CAP PO 00000 Frm 00144 Fmt 4701 Sfmt 4700 vendor issues, including quality and delivery issues. Response: We understand the commenters’ concerns. We believe that we have provided for a sound method to ensure the quality of the CAP and to resolve these issues. As discussed in the July 6, 2005 interim final rule with comment (70 FR 39058), we established financial and quality standards to ensure that we choose reputable and experienced vendors to participate in the CAP. Participating CAP physicians will have the option of changing approved CAP vendors or opting out of the CAP program on an annual basis. We also provided the circumstances, as specified in § 414.908(a)(2), under which a participating CAP physician may choose a different approved CAP vendor midyear or opt-out of the CAP. These circumstances are: (1) If the selected approved CAP vendor ceases to participate in the CAP; (2) if the participating CAP physician leaves the group practice that had selected the approved CAP vendor; (3) if the participating CAP physician relocates to another competitive acquisition area (once multiple CAP competitive areas are developed); or, (4) for other exigent circumstances defined by CMS. We identified a separate exigent circumstance relating to instances in which an approved CAP vendor declines to ship CAP drugs (when the conditions of § 414.914(h) are met) in § 414.908(a)(5). We note that in all these cases, while there is only one drug category for CAP, the participating CAP physician would be allowed to opt-out of the CAP altogether. In the July 6, 2005 interim final rule with comment, we also discussed how the participating CAP physician would use the approved CAP vendor’s grievance process for drug quality and service issues and turn to the designated carrier for assistance in developing solutions (70 FR 39057). If a participating CAP physician is dissatisfied with the drug quality or drug delivery performance of an approved CAP vendor, we expect the participating CAP physician to attempt to resolve the issue with the approved CAP vendor informally, and then to use the approved CAP vendor’s grievance procedure. The next step is to ask for the designated carrier’s assistance in developing a solution with cooperation from both parties. The designated carrier will act promptly to investigate quality and service issues. If these are not resolved, the designated carrier may recommend to CMS the suspension or termination of the approved CAP vendor’s contract. We will act on that E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations recommendation after gathering any necessary, or additional information from the participating CAP physician and approved CAP vendor. If the approved CAP vendor is suspended from the program, that vendor will be unable to participate in the CAP for the remainder of that year. The ultimate sanction for service and quality issues is termination of the approved CAP vendor’s 3-year contract upon exhaustion of the reconsideration process as specified in § 414.917. If the approved CAP vendor contract is suspended or terminated, the participating CAP physician would be able to choose another approved CAP vendor or leave the CAP altogether. (5) Participating CAP Physician Opt-Out for Non-Payment of Coinsurance In the July 6, 2005 interim final rule with comment (70 FR 39053), we stated that in instances where a beneficiary has failed to meet his or her obligation to pay the coinsurance or the deductible for a drug, the conditions of § 414.914(h) were met, and the approved CAP vendor has refused to continue shipping CAP drugs to the participating CAP physician for the beneficiary, we will permit the participating CAP physician to opt-out of that drug category for the CAP. We noted that for the initial implementation of the CAP, there is only one CAP drug category. Thus, a participating CAP physician exercising this option will be opting out of the entire CAP program until the next opportunity to elect to participate. We are making a technical change to § 414.908(a)(5) to state that if the approved CAP vendor refuses to ship to the participating CAP physician because the conditions of § 414.914(h) have been met; the participating CAP physician can withdraw from the applicable CAP drug category for the remainder of the year immediately upon notice to CMS and to the approved CAP vendor. We note again, that for the initial implementation of the CAP, there is only one CAP drug category. Thus, a participating CAP physician exercising this option will, in effect, be opting out of the entire CAP program until the next opportunity to elect to participate. Comment: We received numerous comments on the exigent circumstance that allows a participating CAP physician to opt-out of CAP if an approved CAP vendor were to stop providing a drug to a Medicare beneficiary due to non-payment of the coinsurance to the approved CAP vendor. Commenters requested that we allow the participating CAP physician to opt-out of CAP for only that one Medicare beneficiary allowing the VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 participating CAP physician to continue in CAP for the other Medicare beneficiaries. Response: We do not believe that allowing a participating CAP physician to opt-out of CAP on a beneficiary-bybeneficiary basis is consistent with the CAP statute. When a physician elects to obtain drugs through the CAP that physician will no longer be able to bill Medicare for drugs under the ASP methodology that is available from the approved CAP vendor unless permitted under the ‘‘furnish as written’’ option. The approved CAP vendor will bill Medicare for the CAP drugs administered by the participating CAP physician. Therefore, if an approved CAP vendor has refused to ship the CAP drug as specified in § 415.914(h), we will permit the participating CAP physician to opt-out of CAP for that category. However, we note that for the initial implementation of CAP there is only one drug category. (6) Physician Education In the July 6, 2005 interim final rule with comment, we stated that we would instruct the Medicare carriers to use various communication channels at the local and national levels to disseminate information about the CAP and assist approved CAP vendors and participating CAP physicians in understanding the Medicare program’s operations, policy, and billing and administration procedures regarding the CAP in conjunction with use (70 FR 39084). The Medicare carriers will be instructed to use data analyses in tailoring their outreach and educational efforts for potential vendors and physicians regarding identified areas of confusion about the CAP. Additionally, we specified that the Medicare carriers would be instructed to use mass media, as well as educational and outreach products, services, forums, and partnerships in an effort to disseminate information about, and provide assistance regarding, the CAP to potential vendors and healthcare practitioner communities. We stated that the goal of our outreach and education would be to ensure that those who provide services to Medicare beneficiaries receive the information they need to understand the Medicare program so that they can administer it and bill it correctly. Comment: There were comments requesting assistance and education for the CAP. One commenter was concerned with the availability of assistance and education to the participating CAP physician discussed in the July 6, 2005 interim final rule with comment. The commenter asserted PO 00000 Frm 00145 Fmt 4701 Sfmt 4700 70259 that we have not elaborated on how physicians would be able to obtain education and assistance on CAP throughout the year. The commenter believed that physicians will have questions related to the CAP processes or other technical aspects not clear at the beginning of the program. The commenter also believed that we might make changes during the course of the year once the program is implemented and improvements are instituted. The commenter encouraged us to anticipate the need for on-going, real-time assistance to the participating CAP physician utilizing the CAP, particularly in the first year and implement a proactive education strategy. Another commenter requested that given the short time frame allowed for the CAP election, we ensure that physicians are properly educated and informed about CAP before they make an election. They suggested that we require approved CAP vendors to provide participating CAP physicians with a disclosure form and to certify that they have accurately disclosed all program features including administrative requirements, technical/ software requirements, penalties, restrictions on delivery and transporting of drugs. Response: The commenter is correct to note that there will be changes in the CAP during the course of the year. As we previously discussed, approved CAP vendors will have the opportunity to request approval to change their drug lists in several ways. Physicians should be aware of this before electing to participate in the CAP, but CMS and approved CAP vendors will inform participating CAP physicians of these and other changes on a timely basis, as described in a previous section of this preamble. In the July 6, 2005 interim final rule with comment, we stated that we would post on our Web site, the approved CAP vendors we have selected for the CAP, their categories of drugs (and specific NDCs), and the geographic areas within which they would operate (70 FR 39081). (See https://www.cms.hhs.gov/ providers/drugs/compbid/). We stated that we would publicize the participating CAP physician election information on our Web site, listservs, Medicare fee-for-service contractors’ Web sites, and newsletters. We stated our intention to coordinate with physician specialty organizations to inform their members that the participating CAP physician election information is available. We also stated that we would provide a CAP fact sheet so that the carriers can disseminate it to their physicians and that there would be an education campaign to inform E:\FR\FM\21NOR2.SGM 21NOR2 70260 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations physicians about the CAP Web site and the election process. We described our plan to make available, the participating CAP physician election agreement forms with instruction on how to download, complete, and sign them and return them to the local carrier. The local carrier will note the physician’s decision to participate in the CAP, the approved CAP vendor and the selected categories of drugs (when multiple categories of drugs become available). The local carrier will forward information from the participating CAP physician election agreement to the CAP designated carrier. The designated carrier will compile a master list of all participating CAP physicians’ approved CAP vendor and drug category selections. In addition, the designated carrier will notify each approved CAP vendor of the participating CAP physicians who have elected to enroll with that approved CAP vendor. Throughout the year we will continue to provide participating CAP physician assistance through the participating CAP physician’s local carrier and the designated carrier. Both the participating CAP physician’s local carrier and the designated carrier will have toll free numbers for participating CAP physicians to use in requesting assistance. f. Brief Summary of Comments We Are Not Addressing In response to the July 6, 2005 interim final rule with comment, we received comments on a wide variety of issues related to the CAP. This final rule with comment addresses those issues that are most urgent to begin CAP implementation. Other issues raised in the comments will be fully considered and addressed at a later time. Among the comments we are not addressing at this time are comments related to rural operational issues, the impact of CAP delivery times on satellite clinics, restrictions on transporting drugs, the 14 day participating CAP physician billing requirement, impact on clinical research, and licensure requirements for CAP pharmacies and distributors. I. Private Contracts and Opt-Out Provision Section 4507 of the BBA of 1997 amended section 1802 of the Act to permit certain physicians and practitioners to opt-out of Medicare if certain conditions were met, and to provide through private contracts services that would otherwise be covered by Medicare. When a physician or practitioner fails to maintain the conditions necessary for VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 opt-out and does not take good faith efforts to correct his or her failure to maintain opt-out, current regulations at § 405.435(b) specify the consequences to that physician or practitioner for the remainder of that physician’s or practitioner’s 2-year opt-out period. However, § 405.435(b) describes a situation where the Medicare carrier notifies the physician or practitioner that he or she is violating the regulations and the statute. As explained in the August 8, 2005 proposed rule, the current regulations do not address the consequences to physicians and practitioners in situations when a condition resulting in failure to maintain opt-out occurs during the 2-year opt-out period, but a Medicare carrier does not discover or give notice of a physician’s or practitioner’s failure to maintain opt-out during the 2-year opt-out period. We proposed to amend § 405.435 in order to clarify that the consequences specified in § 405.435(b) for the failure on the part of a physician or practitioner to maintain opt-out will apply regardless of whether or when a carrier notifies a physician or practitioner of the failure to maintain opt-out. We also proposed to add a new paragraph (d) to clarify that in situations where a violation of § 405.435(a) is not discovered by the carrier during the 2-year opt-out period when the violation actually occurred, then the requirements of § 405.435(b)(1) through (b)(8) would be applicable from the date that the first violation of § 405.435(a) occurred until the end of the opt-out period during which the violation occurred (unless the physician or practitioner takes good faith efforts to restore opt-out conditions, for example, by refunding the amounts in excess of the charge limits to beneficiaries with whom he or she did not sign a private contract). These good faith efforts must be made within 45 days of any notice by the carrier that the physician or practitioner has failed to maintain optout (where the carrier discovers the failure after the 2-year opt-out period has expired), or within 45 days after the physician or practitioner has discovered the failure to maintain opt-out, whichever is earlier. Comment: One commenter stated that having physicians suffer regulatory consequences for failure to maintain opt-out status, even when they are not notified of their status, would be unfair and discouraging. They recommended that Medicare carriers be required to notify physicians of their opt-out status 60 days before any actions are taken against them. Response: The revision to § 405.435 does not instruct Medicare carriers to PO 00000 Frm 00146 Fmt 4701 Sfmt 4700 take action against physicians without sufficient notice to the physician. In situations where a physician or practitioner fails to maintain opt-out and the carrier discovers that violation either during the physician’s or practitioner’s opt-out period or after it expires, carriers will notify the physician or practitioner of the violation and the physician or practitioner will have 45 days from the date of the carrier’s notice to correct that violation. Similarly, in the situation where the physician or practitioner discovers that he or she has failed to maintain opt-out, the physician or practitioner will be on notice that unless he or she takes corrective action within 45 days the provisions of § 405.435(b)(1)–(b)(8) are applicable. We do not agree with the commenter’s suggestion that the 45-day period for taking corrective action should begin in all cases until the carrier sends a notice, that is, including situations in which the physician or practitioner discovers the failure to maintain opt-out. If physicians and practitioners were permitted to intentionally violate their opt-out responsibilities, or ignore unintentional violations that they discovered subsequently, until the carrier notifies the physician or practitioner of the violation, harm to both beneficiaries and the program could result. For example, beneficiaries could enter into private contracts that do not meet the notice requirements of § 405.415 or the Medicare program could make mistaken payments due to the physician or practitioner billing Medicare in violation of § 405.425. In order to minimize these harms when a physician or practitioner discovers a failure to maintain opt-out, we believe the 45-day period should begin on the date the failure to maintain opt-out is discovered, not at some later date when a carrier discovers the failure and gives notice. Comment: One commenter stated that the proposed rule would establish regulations that address situations where a physician or practitioner that has opted out of the Medicare program fails to maintain the requirements of their status. In particular, the proposed regulatory language would provide physicians or practitioners that have opted out of the Medicare program 45 days to correct the violation. The commenter believes these regulations are reasonable as proposed. However, the commenter urges the agency to establish standardized language for the violation notice and clear guidelines for carriers to execute timely notice of optout violation. E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations Response: The CMS Internet-Only Manual (Publication 100–2, chapter 15, section 40.12) currently provides Medicare’s carriers with standardized guidelines regarding the notice to physicians and practitioners, and the actions to take, in cases of failure to maintain opt out status. We are finalizing our proposed changes to § 405.435 (b) and adding new paragraph (d) as proposed. J. Multiple Procedure Payment Reduction for Diagnostic Imaging As explained in the August 8, 2005 proposed rule (70 FR 45849), diagnostic imaging procedures are priced in the following three ways: • The professional component (PC) represents the physician work, that is, the interpretation. • The technical component (TC) represents PE, that is, clinical staff, supplies, and equipment. • The global service represents both PC and TC. Under the resource-based PE methodology, specific PE inputs of clinical labor, supplies, and equipment are used to calculate PE RVUs for each individual service. We do not believe these same inputs are needed to perform subsequent procedures. When multiple images are taken in a single session, most of the clinical labor activities and most supplies are not performed or furnished twice. In addition, equipment time and indirect costs are allocated based on clinical labor time; therefore, these inputs should be reduced accordingly. Excluding these PE inputs, which we believe are duplicative, supports a 50 percent reduction in the payment for the TC of subsequent procedures. A reduction of 50 percent is also currently used in the multiple procedure payment reduction for surgery, which has been a longstanding policy. Therefore, we proposed extending the multiple procedure payment reduction to the TC of specific procedures listed in Table 29 of the August 8, 2005 proposed rule (70 FR 45850). Table 29 identified 11 families of imaging procedures by imaging modality (ultrasound, CT and computed tomographic angiography (CTA), MRI and magnetic resonance angiography (MRA)), and contiguous body area (for example, CT and CTA of Chest/Thorax/ Abdomen/Pelvis). We proposed applying the reduction only to procedures involving contiguous body areas within a family of codes, not across families, and to those multiple procedures that were provided in one session. We also proposed only to apply the multiple procedure payment VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 reduction to the TC of certain procedures because, while we believe there may be some reduction in physician work associated with the performance of multiple diagnostic imaging procedures on contiguous body areas, we have no specific plans to extend the proposal to the PC. In addition, since the global service payment equals the combined PC and TC components, when the global service code is billed for these procedures, the TC would be reduced to the same as above, but the PC would be paid in full. We proposed making full payment for the TC of the highest priced procedure and payment at 50 percent of the TC for each additional procedure. Comment: Several commenters supported our proposal, and described it as appropriate, reasonable, justified, rational, and consistent with the private sector. One commenter suggested extending the proposal to the professional component. Two other commenters stated that it should not be applied to the professional component. One commenter suggested applying the reduction to noncontiguous body areas imaged using the same modality. Another commenter indicated an understanding of the rationale for the proposal but did not want it extended to traditional radiographs. Response: We appreciate the commenters’ support. We currently have no plans to extend our proposal to incorporate the commenters’ suggestions (that is, to include noncontiguous body areas, other radiologic examinations, or the professional component of imaging services). We are not certain whether and to what degree a multiple procedure payment reduction policy would be appropriate in these types of situations. Comment: Several commenters opposed our proposal on the basis that diagnostic imaging is not comparable to surgery. For example, they noted that diagnostic imaging is not paid as part of a global package of services; its pre and post activities and resources are typically not as extensive as those required for surgery, and so should comprise a much smaller portion of the payment than for surgery; and it is highly capital intensive compared to surgery. One commenter stated that nuclear medicine procedures were inappropriately discounted and should not serve as precedent for discounting diagnostic imaging procedures. Response: We agree that diagnostic imaging procedures are not comparable to surgical procedures and did not base the development of the multiple imaging procedure payment reduction policy on specific comparisons with the PO 00000 Frm 00147 Fmt 4701 Sfmt 4700 70261 reductions applicable to multiple surgical procedures. Instead, with findings from the MedPAC recommendation about a multiple imaging procedure reduction, detailed information regarding current imaging reduction payment policies in the private insurance industry, and our analysis of PE data, we believe that the rationale for the proposed reduction is sound. The 50 percent reduction was specifically founded upon wellestablished and professionally accepted data we examined from the PEAC, as described below, and was not based simply on the fact that a 50 percent reduction is applied to multiple surgical procedures. In addition, the reduction for six nuclear medicine procedures has been in effect for 11 years. During that time, we have received no evidence to indicate that it is not appropriate. Nevertheless, we did not base our multiple imaging procedure reduction policy on comparisons with nuclear medicine procedures. Comment: Numerous commenters agreed that some clinical labor activities, supplies, and equipment are not duplicated for subsequent procedures. Other commenters indicated exactly the opposite (that is, that these items, including some portion of scanning time, are duplicated). In addition, some commenters indicated that where equipment adjustments are required between studies, clinical labor time could actually increase when multiple imaging procedures are performed on the same patient during a single session. The majority of commenters agreed that there are some efficiencies when multiple procedures are performed but disagreed that all the activities we listed above are never duplicated. Therefore, they disagreed that the efficiencies achieved in subsequent procedures support a 50 percent reduction. Many commenters indicated that a 50 percent reduction is arbitrary and that we provided no supporting data. Several commenters suggested that the reduction should be somewhere between 5 and 25 percent. The ACR offered several suggestions on the relative level of reduction among families of procedures, for example, that the reduction for the procedures in family four should be less than for family two; and that the reduction for procedures in family seven should be less than for family two, but greater than for family four. However, they provided no specific percentages for the reductions in each family. A few commenters recommended varying the percentage reduction by modality because efficiencies are not E:\FR\FM\21NOR2.SGM 21NOR2 70262 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations uniform across all families of procedures. Two commenters indicated that the proposal was inconsistent with the mandate to make resource-based PE payments. Specific comments included the following: • For ultrasound procedures, all clinical labor activities except for greeting the patient, are duplicated. • For some CTs, repositioning the patient is necessary. Some CTs require multi-phasic contrast injections that are separately scanned. • For CTs, MRIs and MRAs, the number of prior exams for review before the studies are performed has increased significantly. • Some CTs, CTAs, MRIs, and MRAs require more images, slices or pulse sequences. • For brain MRIs and neck MRAs, it is necessary to remove the patient; change from a head coil to a neurovascular coil; retune the coil; enter multiple new scan parameters; reposition the patient; and run a new set of pulse sequences. The patient often requests a break between procedures. Several commenters recommended delaying implementation of the proposal for 1 year pending further study. Their reasons included: postponing until the PE inputs are fully implemented and clearly defined; deferring until the entire PFS methodology is reassessed; and delaying until MedPAC’s other imaging study recommendations are implemented. Two commenters suggested that we phase-in the reduction. The ACR offered to work with CMS to reexamine the procedures subject to the reduction; reconfigure the families of procedures; and, determine appropriate reductions based on modality family. Response: We indicated in the proposed rule that the following activities are not duplicated for subsequent procedures: • Greeting the patient. • Positioning and escorting the patient. • Providing education and obtaining consent. • Retrieving prior exams. • Setting up the IV. • Preparing and cleaning the room. In addition, we consider supplies, with the exception of film, are not duplicated for subsequent procedures. Therefore, the 50 percent reduction for subsequent procedures is based on eliminating the time for the clinical labor activities noted above, plus supplies, with the exception of film. We do not assume any reduction in procedure (scanning) time or equipment for subsequent procedures. However, as noted in the proposed rule, equipment, VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 time, and indirect costs are allocated based on clinical labor time; therefore, these inputs were reduced accordingly. The 50 percent reduction was determined based on the examination of multiple pairs of procedure codes from the families representing all modalities (that is, ultrasound, CT/CTA, and MRI/MRA studies) that were frequently performed on a single day based on historical claims data. Using PE input data provided by the RUC, we factored out the clinical staff minutes for the activities we indicated are not duplicated for subsequent procedures, and the supplies, other than film, which we consider are not duplicated for subsequent procedures. As noted previously, equipment time and indirect costs are allocated based on clinical labor time; therefore, these inputs were reduced accordingly. Removing the PE inputs for activities that are not duplicated, and adjusting the equipment time and indirect costs for the individual pairs of procedures studied, supports payment reductions ranging from 40 to 59 percent for the subsequent services. Because we found a relatively narrow range of percentage payment reductions across modalities and families, and taking into consideration that we did not eliminate any duplicative image acquisition time for subsequent procedures in our analysis, we decided that an across-the-board reduction for all 11 families of 50 percent (which is approximately the midpoint of the range established through our analysis) was both justified and conservative. We believe this payment reduction policy represents an appropriate reduction for the typical delivery of multiple imaging services in all 11 families. Because the reduction is based on eliminating the specific practice expense inputs that are not duplicated, we believe the proposal is consistent with the resource-based practice expense methodology. While various alternative reduction percentages were suggested, no evidence was presented to support specific alternative percentages. However, we recognize that many commenters raised significant objections and we appreciate their comments indicating their specific concerns regarding the appropriate reductions for each family and specific combinations of services within families. To allow for a transition of the changes in payments for these services attributable to this reduction policy, and provide a further opportunity for comment, we have decided to phase-in the policy over 2 years. We will implement a 25 percent payment PO 00000 Frm 00148 Fmt 4701 Sfmt 4700 reduction in CY 2006 and a 50 percent reduction for all 11 families in CY 2007 for all code families, unless we find upon further review during the upcoming year that modifications to this policy are appropriate. To enhance our review, we are soliciting, from providers of diagnostic imaging services, comprehensive data regarding the efficiencies associated with different combinations of imaging services in the 11 families. We welcome the opportunity to have other discussions with the physician community on these issues. Comment: One commenter noted that a patient having both a pelvic and transvaginal ultrasound often needs a break between procedures and requires repositioning, along with the use of a different probe for the second study. The commenter also noted that breast and pelvic ultrasounds are often performed in different locations and by different physicians. Response: The commenter has raised some serious questions concerning whether any payment reduction is appropriate for the procedures indicated. Therefore, we have decided to delete transvaginal ultrasound and ultrasound of the breast(s) (CPT codes 76830 and 76645, respectively) from the list of procedures in family one subject to the payment reduction, pending further study. We believe there may be common clinical scenarios where these services are provided in combination with other ultrasound studies where payment reduction may not be appropriate. These typical efficiencies associated with these services when provided in combination with other studies in family one require further study. Comment: Many commenters asked how ‘‘single session’’ is defined and what mechanism will be used to distinguish single and multiple sessions. One commenter indicated that multiple procedures are frequently performed in separate rooms within the radiology department or in different areas within the hospital. In these cases, the patient must be transported from one room to another and the process restarted. One commenter noted the potential for abuse by self-referring physicians writing separate prescriptions for studies on different days. Another commenter indicated that the proposal will force providers to schedule further studies on additional days. Response: We consider a single session to be one encounter where a patient could receive one or more radiological studies. If more than one of the imaging services in a single family E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations is provided to the patient during one encounter, then this would constitute a single session and the lower-priced procedure(s) would be reduced. On the other hand, if a patient has a separate encounter on the same day for a medically necessary reason and receives a second imaging service from the same family, we consider these multiple studies in the same family on the same day to be provided in separate sessions. In the latter case, we have established that the physician should use modifier -59 to indicate multiple sessions, and that the multiple procedure reduction does not apply. Medicare carriers will establish edits to ensure that separate sessions are not inappropriately scheduled for contiguous body area imaging in attempts to bypass the reduction. Use of the modifier where not medically necessary in order to bypass the payment reduction constitutes fraud. Comment: One commenter suggested that the proposal required multiple body area imaging whenever a procedure in a particular family was performed, resulting in unnecessary imaging. Another commenter stated that grouping procedures to justify lower reimbursement provides no medical or monetary benefit and is detrimental to patient care. Response: It appears the commenters have misinterpreted our proposal. The proposal in no way requires the performance of unnecessary multiple imaging procedures when only a single study is medically necessary. The families of procedures are based on claims data indicating that these procedures are often done in combination, most likely in a single session. We believe that the payment reduction for the lower-priced imaging procedures from one family performed on contiguous body areas provides the most appropriate payments for the services provided. Comment: A few commenters recommended that we apply the budget neutrality adjustment only to PE RVUs and not to work RVUs. Response: The commenters are correct that, because the payment reduction applies only to PE RVUs, the savings should likewise only apply to PE RVUs. We agree with this comment and have made the necessary adjustment. Comment: One commenter indicated that we should request a statutory 70263 change to exempt the proposal from budget neutrality. Response: We believe it is up to the Congress to decide whether it wants to make adjustments to the application of budget neutrality. We have no plans to request this change. Final Decision We have revised our proposal as follows: • Phase in the payment reduction, with a 25 percent reduction in CY 2006 and a 50 percent reduction in CY 2007. Our review of the multiple imaging payment reduction policy will be ongoing. • Deleting CPT codes 76830 and 76645 from the list of procedures in family one subject to the reduction, pending further study. • Applying the budget neutrality adjustment only to PE RVUs, rather than to both work and PE RVUs. An example of the current and CY 2006 payments is summarized in Table 26, and the revised lists of procedures subject to the reduction, are set forth in Table 27: TABLE 26.—EXAMPLE OF PAYMENTS Procedure 1 74183 PC ............................ TC ............................ Global ....................... Procedure 2 72196 $117.00 978.00 1,095.00 Current total payment $90.00 529.00 619.00 CY 2006 total payment $207.00 1,507.00 1,714.00 CY 2006 payment calculation $207.00 1,374.75 1,581.75 no reduction. 978 + (.75 × $529). $207 + $978 + (0.75 × $529). BILLING CODE 4120–01–U VerDate Aug<31>2005 15:52 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00149 Fmt 4701 Sfmt 4700 E:\FR\FM\21NOR2.SGM 21NOR2 VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00150 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.054</GPH> 70264 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70265 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00151 Fmt 4701 Sfmt 4700 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.055</GPH> BILLING CODE 4120–01–C 70266 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations K. Therapy Cap As discussed in the August 8, 2005 proposed rule, section 1833(g)(1) of the Act applies an annual, per beneficiary combined cap on outpatient physical therapy and speech-language pathology services, and a similar separate cap on outpatient occupational therapy services under Medicare Part B. While Section 624 of the MMA placed a moratorium on the application of these caps from December 8, 2003 through December 31, 2005, the caps will become effective again beginning January 1, 2006. (The caps were last implemented from September 1, 2003 through December 7, 2003.) Section 1833(g)(2) of the Act provides that, for 1999 through 2001, the caps were $1500, and for years after 2001, the caps are equal to the preceding year’s cap increased by the percentage increase in the MEI (except that if an increase for a year is not a multiple of $10, it is rounded to the nearest multiple of $10). All of the comments we received questioned the use of therapy caps as a way to ensure beneficiaries get needed service while constraining the growth in spending. The large majority also pointed out the negative effects the therapy caps had on beneficiaries and providers when they were last implemented. However, most of the commenters recognized that we do not have the authority to change the caps. Commenters also wrote in support of an extended moratorium; separating physical therapy and speech-language pathology into two caps; a conditionbased payment system; a pay-forperformance system; and a demonstration to assess one or more alternative limitation methods. We will implement therapy caps on January 1, 2006 according to the statute. We note that significant progress has been made toward the challenging goal of establishing a payment policy ‘‘based on the classification individuals’’ as required by the Congress in the BBA section 4541(d)(2) and again in the BBRA section 221(c)(2)(B). First, in order to evaluate Medicare payments for therapy services, we developed a method of identifying therapy services and their individual costs on Medicare claim lines. Then, we identified classification groups and conducted initial analyses of the type and amount of treatment utilized by each group. These 21 classification groups consisted of patients whose conditions were similar based on ICD–9 diagnosis codes, utilization patterns, published research and clinical opinion that indicated they may have similar health risk and require similar level of care and expenditures VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 for service. For example, spinal cord injury, hip fracture, and musculoskeletal disorders form classifications that include many similar diagnoses. This demonstrated that if the expected need for service can be determined for subsets of each classification group, system edits that limit spending based on expected needs are feasible and would result in cost savings. To implement a payment method based on the conditions described by classification groups, additional information is needed on the claim about the patient’s need for therapy services. Indicators or measurements that represent need, such as severity and acuity of a patient’s condition, are not available on the current Medicare claim form and are not consistently gathered or reported by therapists. In order to be useful, these factors must be obtained from a sufficiently large database of patients to predict patients’ needs with statistical validity and reliability. We currently have studies underway to extend the progress made in prior studies to explore the potential for using patient condition information to predict therapy needs and likely outcomes. We expect these studies to be completed in 2006. After issuance of this rule, we will issue instructions to contractors related to the implementation of therapy caps. We will consider comments received in response to the August 8, 2005 proposed rule as we develop those instructions. Since 2003, we have maintained, and we recently updated, a web site that describes therapy caps. We encourage providers and beneficiaries to review that information at www.cms.hhs.gov/ medlearn/therapy (Therapy Cap Status). Based on the formula established in 1883(g)(2) of the Act, the therapy caps will be implemented January 1, 2006. The dollar amount for the therapy caps for CY 2006 is $1,740. L. Chiropractic Demonstration Discussion Section 1861(r)(5) of the Act limits current Medicare coverage for chiropractic treatment by means of the manual manipulation of the spine for the purpose of correcting a subluxation, defined generally as a malfunction of the spine. Specifically, Medicare covers three CPT Codes provided by chiropractors: 98940 (manipulative treatment, 1–2 regions of the spine); 98941 (manipulative treatment, 3–4 regions of the spine); and 98942 (manipulative treatment, 5 regions of the spine). Treatment must be provided for an active subluxation only, and not for prevention or maintenance. Additionally, treatment of the PO 00000 Frm 00152 Fmt 4701 Sfmt 4700 subluxation must be related to a neuromusculoskeletal condition where there is a reasonable expectation of recovery or functional improvement. In the August 8, 2005 proposed rule, we included a discussion of the 2-year demonstration authorized by Section 651 of the MMA to evaluate the feasibility and advisability of covering additional chiropractic services under Medicare. These services extend beyond the current coverage for manipulation to care for neuromusculoskeletal conditions typical among eligible beneficiaries, and cover diagnostic and other services that a chiropractor is legally authorized to perform by the State or jurisdiction in which the treatment is provided. Physician approval will not be required for these services. The demonstration is being conducted in four sites, two rural and two urban. One site of each area type must be a health professional shortage area (HPSA). The demonstration must also be budget neutral. The statute requires the Secretary to ensure that aggregate payments made under the Medicare program do not exceed those that would be paid in the absence of this demonstration. Ensuring budget neutrality requires that the Secretary develop a strategy for recouping funds should the demonstration result in costs higher than would occur in the absence of the demonstration. In this case, we would make adjustments in the national chiropractor fee schedule to recover the costs of the demonstration in excess of the amount estimated to yield budget neutrality. We will assess budget neutrality by determining the change in costs based on a pre/post comparison of costs and the rate of change for specific diagnoses that are treated by chiropractors and physicians in the demonstration sites and control sites. We will not limit our analysis to reviewing only chiropractor claims, because the costs of the expanded chiropractor services may have an impact on other Medicare costs. Any needed reduction would be made in the CY 2010 and CY 2011 fee schedules as it will take approximately 2 years to complete the claims analysis. If we determine that the adjustment for budget neutrality is greater than 2 percent of spending for the chiropractor fee schedule codes (comprised of the 3 currently covered CPT codes 98940, 98941 and 98942), we will implement the adjustment over a 2-year period. However, if the adjustment is less than 2 percent of spending under the chiropractor fee schedule codes, we will implement the adjustment over a 1-year period. We will include the detailed E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations analysis of budget neutrality and any proposed offset in the CY 2009 Federal Register publication of the PFS. We also noted in the proposed rule that PT services performed by chiropractors under the demonstration will be included under the PT cap described in section II.K. of the preamble to this final rule with comment. These services are included under the cap because chiropractors are subject to the same rules as medical doctors for therapy services under the demonstration. The following is a summary of the comments received and our responses. Comment: Several commenters expressed concern regarding specific aspects of the demonstration project, including PT services being provided by chiropractors and including the PT services provided by chiropractors under the demonstration under the therapy cap. Response: A discussion of the chiropractic demonstration was included in the PFS proposed rule because of the potential for a budget neutrality adjustment that will be discussed in the CY 2009 Federal Register publication of the PFS. Issues concerning the demonstration project itself were outside the scope of the proposed rule. We are including PT services provided by chiropractors under the therapy cap because under the demonstration, we are subjecting chiropractors to the same rules as physicians for therapy services. Comment: One commenter suggested that in the calculation of the budget neutrality of the demonstration project that the therapy rendered by the chiropractors or their therapists is a ‘‘trade off’’ of associated costs that would have required evaluation, order and recertification by a medical doctor. They also suggested that the management of neuromuscular conditions is more efficient when all contributing factors are identified and addressed simultaneously by the combined skills of each specialty. The patient would normally learn to function more rapidly through concurrent multidisciplinary management than with any limited single approach. In addition, the commenters noted that to accurately assess the demonstration a variety of variables, such as medical services that were not required or services directly replaced by another provider, need to be considered. Response: Section 651(a)(1) specified that the chiropractic services provided under the demonstration should include diagnostic and other services that a chiropractor is legally authorized to VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 perform by the State or jurisdiction in which the treatment is provided. There is no requirement for concurrent multidisciplinary management of neuromuscular conditions. We recognize that covering additional services by chiropractors could have an impact on currently covered Medicare services. For this reason, we plan to assess budget neutrality by examining the total Medicare costs for specific diagnoses, and not just the chiropractor costs. As we noted previously, we will provide a detailed analysis of budget neutrality and any proposed offset in the CY 2009 Federal Register publication of the PFS. Comment: Commenters requested that we clarify plans for making reductions to maintain budget neutrality and identify claims we will analyze. The commenters also requested that we provide information on how this will impact the SGR, particularly if the chiropractic demonstration results in increased spending on physicians’ services, since this could result in reductions in reimbursement for all physicians, not just chiropractors. Another commenter opposed the application of any adjustments to the national chiropractic fee schedule instead of an adjustment to the overall fee schedule. This commenter believes that the totality of funds under part B and not subset of services within it should finance the demonstration program and that this is reflected in section 651(f)(A)of the MMA. Response: Section 651(f)(A) requires that ‘‘* * * the Secretary shall ensure that the aggregate payment made by the Secretary under the Medicare program do not exceed the amount which the Secretary would have paid under the Medicare program if the demonstrations projects under this section were not implemented.’’ The legislation does not specify a specific methodology for ensuring budget neutrality. Our methodology meets the legislative intent, and appropriately impacts the profession that is directly affected by the demonstration. Because the demonstration is located in only four sites in which the expansion of services is permitted, we anticipate that the impact on the SGR would be negligible. M. Supplemental Payments to Federally Qualified Health Centers (FQHCs) Subcontracting With Medicare Advantage (MA) Plans Section 237 of the MMA amended section 1833(a)(3) of Act to provide supplemental payments to FQHCs that contract with Medicare Advantage (MA) organizations to cover the difference, if PO 00000 Frm 00153 Fmt 4701 Sfmt 4700 70267 any, between the payment received by the FQHC for treating enrollees in MA plans offered by the MA organization and the payment that the FQHC is entitled to receive under the cost-based all-inclusive payment rate as set forth in part 405, subpart X. The supplemental payment for covered Medicare FQHC services furnished to MA enrollees augments the direct payments made by MA plans to FQHCs for covered Medicare FQHC services. In order to implement this new payment provision, we must determine whether the Medicare cost-based payments to which the FQHC would be entitled exceed the amount of payments received by the center from the MA organization and, if so, pay the difference to the FQHC. The proposed supplemental payment for FQHC covered services rendered to MA enrollees is equal to the difference between 100 percent of the FQHC’s allinclusive cost-based per-visit rate and the average per-visit rate received by the FQHC from the MA plan in which the enrollee is enrolled, less any amount the FQHC may charge as described in section 1857(e)(3)(B) of the Act. A supplemental payment will be made every time a face-to-face encounter occurs between an MA enrollee and any one of the FQHC’s core practitioners: physician, nurse practitioner, physician assistant, clinical nurse midwife, clinical psychologist, or clinical social worker. The supplemental payment is made directly to each FQHC through the Medicare Fiscal Intermediary (FI). In the August 8, 2005 proposed rule, we proposed conforming changes to our regulations to add § 405.2469 to provide a supplemental payment, based on a per-visit calculation, to FQHCs under contract (directly or indirectly) with MA organizations. We received comments on the portion of the proposed rule addressing the FQHC supplemental payment provision of section 237 of the MMA. A summary of those comments and our responses follows: Comment: One commenter asked how the Medicare contractor will know the amount the health plan paid when FQHCs bill the Medicare contractor for the supplemental payment. Response: The Medicare contractor will know the amount paid by the MA plan based on the required MA payment estimate furnished by the FQHC to the contractor. The payment amount difference between the interim FQHC all-inclusive cost based rate and the average interim MA rate will be reported on the FQHC claim form every time the FQHC submits a bill to the E:\FR\FM\21NOR2.SGM 21NOR2 70268 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations contractor to collect an FQHC supplemental payment. The Medicare contractor will pay FQHCs the difference between the interim FQHC all-inclusive rate and the interim MA rate on a per-visit basis. Comment: A commenter requested clarification regarding cost sharing rules for MA enrollees as referenced in § 405.2469(a)(ii), which stipulates that FQHCs may charge Medicare patients as described in section 1857(e)(3)(B) of the Act. Response: Section 1857(e)(3)(B) of the Act provides that a FQHC must accept the MA payment and the Federal supplemental payment (that is, the payment decribed in section 1833(a)(3)(B)) as payment in full for services covered by the agreement, except that the FQHC may collect any amount of cost-sharing permitted under the MA contract, so long as the amounts of any deductible, coinsurance, or copayment comply with the requirements under section 1854(e) of the Act. In general, an MA plan offered by an MA organization satisfies section 1854(e) of the Act beginning in 2006 if the monthly basic MA premium and the actuarial value of the cost sharing charged to enrollees for services covered under Parts A and B of original Medicare do not exceed the actuarial value of cost sharing charged to beneficiaries in original Medicare. MA plans must also disclose cost sharing amounts to their members. Comment: Two commenters urged us to deduct from the supplemental payment calculation only the amount of cost-sharing actually collected by the FQHC. Furthermore, the commenters asked that we recognize any uncollected cost-sharing amounts as ‘‘bad debt’’ on the FQHC cost report. Response: The supplemental payment calculation shall deduct the cost sharing amounts set forth in the formal contract between the FQHC and MA plan, not the actual amounts collected by the FQHC. Section 1833(a)(1)(B) states that the supplemental payment is to be calculated net of any amount the FQHC ‘‘may charge’’ as described in section 1857(e)(3)(B) of the Act. Thus the language of the statute plainly states that the supplemental payment is to be based on what the FQHC could charge as cost sharing, not cost sharing amounts that the FQHC actually collects. Rules regarding what may constitute ‘‘bad debt’’ for purposes of a FQHC’s cost report are beyond the scope of this final rule with comment. Furthermore, the rules we are finalizing pertain to section 237 of the MMA which addresses a supplemental payment to VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 FQHCs that contract, directly or indirectly, with an MA organization. Thus, arrangements pertaining to ‘‘bad debt’’ for uncollected cost sharing owed by an MA plan enrollee, if any, would be governed by the contract between the FQHC and the MA organization. Comment: A commenter questioned whether the upper payment limit would apply in determining the supplemental payment. Response: For FQHCs operating below the FQHC national payment limit, we will use their actual per-visit allinclusive rate to determine the FQHC supplemental. For FQHCs operating at or above the national payment limit, we will use the applicable national FQHC urban or rural upper limit to calculate the FQHC supplemental payment. The amount of the supplemental payment will be the amount by which the original FQHC payment exceeds the MA plan payment. Section 237 of the MMA clearly requires the use of a cost-based rate or based on other tests of reasonableness as the Secretary may prescribe in regulations. The longstanding national FQHC payment limit is an integral part of the FQHC payment methodology as set forth in regulations. Comment: A commenter questioned whether the provider types listed on page 45853 (Proposed Payment Methodology Section) of the August 8, 2005 proposed rule is broader than the original FQHC benefit. Response: In the proposed rule, we explained that an FQHC supplemental payment is made only when a face-toface encounter occurs between a core FQHC practitioner and an MA enrollee. This list of core FQHC practitioners is identical to the practitioner list for the original FQHC Medicare benefit. Furthermore, these FQHC practitioners must meet all applicable qualification requirements as set forth in section 405 and 491 of the CFR in order to qualify for the supplemental payment. Comment: A commenter requested that we amend the regulatory definition of eligible centers for the FQHC supplemental payments to allow payments for health centers for the homeless. The preamble of the proposed rule states that eligible FQHCs include all centers receiving grants under Section 330 except those centers that receive funds pursuant to Section 330(h) of the Public Health Service Act (that is, Health Care for the Homeless grantees). The commenter specifically requested that we recognize these centers for supplemental payments, or at a minimum, be prepared to do so as soon as legislation is passed. PO 00000 Frm 00154 Fmt 4701 Sfmt 4700 Response: We currently do not have the statutory authority to recognize as Medicare FQHCs any entity that does not meet statutory requirements for designation as an FQHC. Consequently, we cannot provide centers that are not FQHCs with Medicare FQHC supplemental payments for treating MA enrollees. If changes were made to the statute, we would implement regulations, as necessary, consistent with statutory requirements. Comment: A commenter asked for clarification regarding the statement in the rule that FQHCs under contract (indirectly or directly) with MA organizations are eligible for supplemental payments. The commenter requested specific confirmation that the term ‘‘indirect’’ is intended to include arrangements under which the health center contracts with another organization, which in turn, contracts with the MA organization in order to provide Medicare services. Response: We interpreted section 237 of the MMA to mean that any Medicare FQHC furnishing covered FQHC services to MA plan enrollees would be eligible for supplemental payments regardless of whether they have a direct contract with an MA organization or contract with another entity (for example, a medical group) that has a direct contract with the MA organization to treat its enrollees. Comment: A commenter asked whether a health center with an MA contract can bill Medicare directly on a fee-for-service basis if the center provides services to plan enrollees that are not FQHC services. For example, can they directly bill for services the FQHC could otherwise bill as Part B services if it were not providing the service to an MA plan enrollee? A commenter requested clarification whether a health center will be allowed to bill original Medicare for extended hours of operation not included under the center’s MA arrangement. Another commenter asked whether a health center that utilizes a specialist, who is not included in the MA plan’s specialty panel, to provide an FQHC core service will be permitted to bill Medicare for these services. Response: The FQHC should bill original Medicare only for covered services rendered to original Medicare beneficiaries that are ‘‘not’’ enrolled in an MA plan. In accordance with section 1851(i) of the Act, with limited exceptions, only the MA organization is entitled to receive Medicare payments for services furnished to its enrollees. Therefore, FQHCs under direct or indirect contract with an MA organization must look to the MA E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations organization for payment. The additional payment permitted by section 1833(a)(3)(B) of the Act applies only to FQHC services described in section 1832(a)(2)(D)(ii) of the Act. Comment: A commenter questioned whether services not covered under original Medicare, but offered and paid for by the MA plan, such as dental, are included in determining the CMS wraparound payment to the center. Response: Only services meeting the definition of an FQHC service as defined under section 1832(a)(2)(D) of the Act are included in the determination of the FQHC supplemental payment. Thus, services other than those defined under section 1832(a)(2)(D), such as dental services, are not included in the determination of the supplemental payment. Comment: A commenter requested that we modify our proposed FQHC supplemental payment methodology to include Medicare FQHC covered services that are not necessarily performed as a face-to-face encounter. Response: All covered Medicare FQHCs services are eligible for supplemental payments regardless of whether these services trigger a billable FQHC visit. For purposes of consistency, we adopt the longstanding FQHC visit definition under original Medicare, which would provide a supplemental payment every time there is a face-to-face encounter between an MA enrollee and one or more of the following FQHC covered core practitioners: physicians, nurse practitioners, physician assistants, clinical nurse midwives, clinical psychologists, or clinical social workers. The costs of services incidental to the professional services of the above core FQHC practitioners would be bundled into the calculation of the supplemental payment. In light of the fact that all incidental services and costs are recognized, we believe that the use of the FQHC encounter definition for the supplemental payment provision is reasonable and appropriate. Comment: A commenter requested clarification regarding the interim rate that should be utilized for these health centers in light of the fact that centers have yet to have their annual reconciliation from 2004 performed. Response: The interim rate for MA payments will be based on estimates from the contracting FQHC until actual MA payments and visits are captured on the FQHC cost report. We will use these estimates until actual MA payments and visits are captured on the FQHC cost reports. At that point, payments will be adjusted accordingly. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Comment: A commenter asked for clarification regarding which fiscal year would apply to the rate calculation methodology for services rendered on or after January 1, 2006—the Federal fiscal year, the health center, or the MA plan. Furthermore, clarification was requested regarding the transition process for reconciling differences between centers’ fiscal year and the MA contract year. Response: The FQHC supplemental payment calculation shall be based on the FQHC’s cost report year. For the initial year, if the MA plan’s contract year and the FQHC’s fiscal year do not coincide, the FQHC supplemental payment calculation shall be based on a weighted average of MA payments based on the number of MA visits expected in each respective MA contract year. In subsequent FQHC cost report years, actual MA payments and visits will be used to calculate final FQHC supplemental payments as well as the interim supplemental payments for the following year. Since actual payments and visits already reflect the differences between the FQHC fiscal year and the MA contract year, no transition process is necessary. Comment: A commenter requested clarification whether payments will be aggregated across multiple MA plans or whether the payments will be plan specific. Response: In cases where an FQHC has multiple arrangements in place with different MA plans, payments will be aggregated across multiple plans to determine final Medicare program liability. In other words, at cost settlement MA payments will be aggregated for all MA enrollees treated by the FQHC. Comment: A commenter expressed concern that the required detailed MA payment estimates from FQHCs will result in a significant increase in administrative time. In light of this new requirement, they suggested that we develop standard forms and information requests to ease the burden as much as possible. Response: Each eligible FQHC seeking the supplemental payment is required to submit (for the first two rate years) to the Medicare Fiscal Intermediary (FI) an estimate of the average MA payments (per-visit basis) for covered FQHC services provided to MA enrollees. Every eligible FQHC seeking the supplemental payment is required to submit a documented estimate of its average per-visit payment for MA enrollees in each MA plan offered by the MA organization and any other information as may be required to enable the FI to accurately establish an interim supplemental payment. PO 00000 Frm 00155 Fmt 4701 Sfmt 4700 70269 Expected payments from the MA organization would be used only until actual MA revenue and visits collected on the FQHC’s cost report can be used to establish the amount of the supplemental payment. Until we modify the FQHC cost report form to identify and capture MA payments and visits, each eligible FQHC requesting supplemental payments will be required to submit estimates to CMS. Comment: A commenter urged us to calculate and provide supplemental payments on a per-visit basis to ensure adequate cash flow to contracting FQHCs. Response: Under the proposed rule, we added § 405.2469 to specify that the FQHC supplemental payment methodology is on a per-visit basis. Comment: A commenter requested timely annual system reviews of cost reports to ensure that the health centers are provided with a continuous cash flow of Medicare funding. Response: The Medicare contractors responsible for processing FQHC claims and reviewing cost reports will use all available resources for timely cost report settlement. Comment: A commenter requests that we provide guidance under this rule regarding the methods of enforcing the statutory requirement that MA plan payments to contracting FQHCs must be comparable to other contracting health care providers furnishing similar services. Response: Generally, we will examine contracts and attendant fee schedules between MA organizations and FQHCs and between MA organizations and other providers to ensure that payment levels for similar services are comparable. Comment: A commenter requested clarification regarding how our crossover system will work for MA enrollees who are dually-eligible for the Medicare and Medicaid programs. They asked if claims for dually-eligible patients will be forwarded to the Medicaid agency by the MA plan or by CMS. Response: Our crossover processes do not apply to MA claims but rather to claims that are processed under original Medicare, fee-for-service contractor operations. Therefore, claims for persons who have enrolled in an MA plan will not be crossed over by CMS. The MA plan would need to coordinate with Medicaid. Comment: A commenter expressed concern about the appeals process for circumstances under which the MA plan denies a claim, which would result in our denial of the supplemental payment. They asked what procedures E:\FR\FM\21NOR2.SGM 21NOR2 70270 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations the health center should follow when faced with this situation. Response: If an FQHC signs a waiver of liability, the FQHC may utilize the MA appeals process at 42 CFR part 422, subpart M to contest an MA organization’s payment denial. If the MA organization’s claim denial is overturned upon appeal, CMS will make a supplemental payment to a FQHC. Comment: A commenter requested that we work with MA plans on establishing an expedited credentialing process to ensure that all health center providers are credentialed on a timely basis, preferably prior to January 1, 2006. Response: The requirements related to credentialing MA plan providers are found in subpart E the Part 422. Note that with limited exceptions, the credentialing process that MA organizations follow for providers is at the MA organization’s discretion (see § 422.204). Comment: A commenter requested clarification that supplemental payments are available for Medicarecovered services provided by FQHCs under non-traditional managed care approaches, such as Preferred Provider Organization (PPOs). Response: FQHCs contracting with any MA organization are eligible for supplemental payments. MA organizations can offer various types of MA plans, including PPOs. We are revising § 405.2469 as proposed with one change, the first use of the term ‘‘Medicare Advantage plans’’ is revised to read ‘‘Medicare Advantage organizations.’’ N. National Coverage Decisions Timeframes We have established requirements concerning the administrative review of local coverage determinations (LCDs) and National Coverage Determinations (NCDs) at 42 CFR part 426, with subpart C specifically addressing the general provisions for the review of LCDs and NCDs. We are updating these requirements as they apply to NCDs to reflect changes in the statute. Under our existing regulations in part 426, Subpart C, the Departmental Appeals Board may stay the adjudicatory proceedings in certain circumstances to allow CMS to consider significant new evidence that is submitted in the context of a challenge to an NCD. Our previous regulations at § 426.340(e), permitted a brief stay of the adjudicatory proceedings (not more than 90 days), for CMS to complete its reconsideration of the NCD. Those timeframes, although short, were consistent with the previous process for VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 making NCDs that did not require publication of a proposed decision memorandum and an opportunity for public comment on the proposed decision memorandum. As discussed in the August 8, 2005 proposed rule (70 FR 45853), based on the provisions of section 731 of the MMA of 2003, we proposed to amend § 426.340 to state that if the CMS informs the Board that a revision or reconsideration was or will be initiated, then the Board will stay the proceedings and set appropriate timeframes by which the revision or reconsideration will be completed, that reflects sufficient time for the publication of a proposed determination, a 30-day public comment period, and time for CMS to prepare a final determination that responds to public comments as specified in section 1862(l) of the Act. We also proposed to eliminate the reference to the 90-day reconsideration period in § 426.340(e)(3) for NCD appeals to reflect the new timeframes in the MMA. Comment: We received 7 comments regarding the proposed NCD timeframes. All commenters supported the change. However, a few commenters raised concerns about the delays regarding a specific NCD that was initiated before the December 8, 2003 effective date for the statutory change. Response: We will finalize the changes to § 426.340 as proposed with minor technical edits, and will continue to work diligently to assure that all NCDs submitted after the December 8, 2003 effective date for the statutory change are developed within the set timeframes. O. Coverage of Screening for Glaucoma On January 1, 2002, we implemented regulations at § 410.23(a)(2), Conditions for and limitations on coverage of screening for glaucoma, requiring that the term ‘‘eligible beneficiary’’ be defined to include individuals in the following high risk categories: Individuals with diabetes mellitus; individuals with a family history of glaucoma; or African-Americans age 50 and over. As discussed in the August 8, 2005 proposed rule (70 FR 45853) based on our review of the current medical literature, we believe that there are other beneficiaries who are at risk for glaucoma and should be included in the definition of eligible beneficiary for purposes of the glaucoma screening benefit. We believe the evidence is adequate to conclude that Hispanic persons age 65 and older are at high risk and could benefit from glaucoma screening. PO 00000 Frm 00156 Fmt 4701 Sfmt 4700 Therefore in § 410.23(a)(2), we proposed to revise the definition of an eligible beneficiary to include Hispanic Americans age 65 and over. In view of the possibility that it may be appropriate to include other individuals in the definition of those at ‘‘high risk’’ for glaucoma, we also requested comments on this issue, including documentation from the peer-reviewed medical literature in support of suggested changes. We received seven comments on the proposal to expand coverage of the glaucoma screening benefit to include Hispanic Americans within the category of those individuals at ‘‘high risk’’ for glaucoma. The following is a summary of the comments received and our responses. Comment: One commenter stated that it might be appropriate to include other individuals (and not only HispanicAmericans over age 65) in the definition of those at ‘‘high risk’’ for glaucoma. The commenter cited the Los Angeles Latino Eye Study and the research conducted by the Eye Diseases Prevalence Research Group as illustrating a sharp rise in the prevalence of glaucoma among Hispanic-Americans beginning at age 60 (Archives of Ophthalmology 2004; 122:532–538). The commenter indicated that according to the latter research, the risk of developing glaucoma among Hispanics between the ages 50–59 is 2.92 percent, and that this number increases significantly to 7.36 percent for Hispanics between the ages 60–69. In view of this increase in the prevalence of glaucoma in the Hispanic population between the ages 60–69, the commenter recommended that CMS reduce the proposed screening coverage age from 65 to 60 years of age, suggesting that this lowering of the age would allow for medical intervention at an earlier stage during this critical period for glaucoma development. Response: We note that the commenter relied on the results of a major study (See the Archives Ophthalmology 2004; 122:532–538) in offering their suggestion for revising the proposal. That, in turn, relied on the results of another major study (See Archives of Ophthalmology 2001; 119:1819–1826) for data on incidence and prevalence of primary open angle glaucoma in Hispanic-Americans. The latter study (Quigley, et al.) contains a graph on page 1822 which, in addition to stating the same data that the commenter referenced, shows an acceleration in prevalence of open angle glaucoma in Hispanic-Americans as compared to White persons beginning at age 65. This study by Quigley et al. E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations yields data supporting a higher incidence of open angle glaucoma in Hispanics as compared to Whites beginning at age 65 (Quigley, HA et al). The prevalence of glaucoma in a population based study of Hispanic subjects: proyecto VER. (Annals of Ophthalmology 2001; 119:1819–1825). Though they are not statistically significant in that age group, the data strongly favors our conclusion. However, for ages under 65 years, the evidence is poor for any differences in these 2 groups for an incidence of open angle glaucoma. Therefore, we have chosen a coverage baseline for the glaucoma screening benefit of age 65 and older for Hispanic-Americans. Comment: One commenter stated that they did not support the proposal to expand the definition of those individuals at ‘‘high risk’’ for glaucoma because they do not believe there is sufficient evidence in the medical literature to recommend for or against screening adults for glaucoma, including Hispanic-Americans age 65 and older. The commenter cited the United States Preventive Services Task Force (USPSTF) recommendation that concluded that there is insufficient evidence to recommend for or against screening adults for glaucoma. The commenter also noted that while the USPSFT clinical considerations section of its recommendation states that increased ocular pressure, family history, older age, and being of AfricanAmerican descent place an individual at risk for glaucoma, it makes no mention of Hispanic-Americans. Therefore, the commenter concluded that CMS should not make any changes to the current definition. Response: As stated previously, the articles in Archives of Ophthalmology, show that the prevalence of glaucoma in Hispanics begins to increase at age 65 markedly when compared to Whites. While the USPSTF concluded that there is insufficient evidence to recommend either for or against screening any adult for glaucoma, section 1861(s)(2)(K) of the Act mandates coverage of screening for glaucoma for individuals determined to be at high risk for glaucoma, individuals with a family history of glaucoma and individuals with diabetes. Based on our review of the two published studies, we believe that the evidence is adequate to conclude that Hispanics age 65 and older meet the definition of individuals at high risk for glaucoma and could benefit from glaucoma screening. Further, since glaucoma is prevalent in Hispanics, we would rather be inclusive rather than exclusive for the screening benefit. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Comment: Two commenters urge CMS to help educate providers and Hispanic beneficiaries to ensure that they are aware of the benefits associated with the new coverage when it is included in the final rule. Response: We agree and will release appropriate manual and transmittal instructions and information from our educational components for the medical community, including a MedLearn Matters article and fact sheets. We also encourage the medical community to join this effort in educating physicians and beneficiaries by distributing their own communications, bulletins, or other publications. In addition, we have specifically included information on the expanded glaucoma screening benefit in the 2006 English and Spanish versions of the Medicare and You Handbook, and we plan to revise the booklet, Medicare’s Preventive Services, and the bilingual brochure for Hispanic beneficiaries, to reflect the expanded benefit as well. Comment: One commenter expressed concern that at the present time, if a glaucoma screening is performed and a disease or condition other than glaucoma is discovered the screening examination will no longer be considered to be a covered service, which may leave providers open to additional financial liability unless they ensure that the patient sign an ABN. The commenter recommends that Medicare should cover screening examinations without regard to the diagnosis that is determined as a result of the screening in a particular case. Response: The availability of coverage under the screening benefit does not depend on whether or not a disease condition is discovered during the annual screening examination. Medicare covers the screening examination regardless of the findings at the time of the screening examination, but if the provider decides to perform and bill Medicare for the more comprehensive eye exam, the cost of the screening examination is considered bundled into the Medicare payment for the more expensive comprehensive eye examination. For example, if a disease, cataract, or a macular degeneration condition is discovered at the time of the glaucoma screening, the provider may decide to perform a medically necessary comprehensive eye examination and bill Medicare Part B for that more expensive covered service. In this example, it would be inappropriate for the provider to bill Medicare for the less expensive glaucoma screening service as well as the more comprehensive and expensive service because it would be duplicative PO 00000 Frm 00157 Fmt 4701 Sfmt 4700 70271 for Medicare to pay for both services. In this situation, the only eye service that may be billed Medicare is the comprehensive eye examination and it would be presumed that the glaucoma screening service is bundled into the Medicare payment for the comprehensive eye service. Comment: One commenter suggested that CMS work with the Secretary of HHS to add on beneficiary eligibility for all Medicare covered screening tests to the ASC X12N 270/271 eligibility transaction. Response: This issue does not fall within the scope of the Medicare PFS regulations; and therefore, we are unable to address it in this final rule with comment. Comment: Two commenters expressed concern about the statement in the Regulatory Impact Analysis (70 FR 45870) of the proposed rule that stated that the expansion of the benefit to include Hispanic persons age 65 and older ‘‘is not expected to have a significant cost impact on the Medicare program.’’ The commenters urge CMS to make available to the public it’s calculation of the impact on spending that would result from the proposed increase in glaucoma screening coverage and to reflect these spending increases in the SGR, including increases due to the initial test and all related and follow-up care. Response: Based on the projected utilization of the expanded glaucoma screening coverage to include Hispanic persons age 65 and older, we estimated in the proposed rule that the expanded benefit would result in an increase in Medicare payments to ophthalmologists or optometrists who will provide these screening tests and related follow-up tests and treatment. However, we noted that this change was not expected to have a significant cost impact on the Medicare program. Based on Medicare Part B carrier claims processing data, we estimate that the program paid for about 1,100 glaucoma screening services in CY 2004 at a cost of about $47,000 for the same time period. While it is not possible to predict how many HispanicAmericans might take advantage of the new coverage that will be available to them, judging from the impact of the present glaucoma screening benefit on the Medicare costs in CY 2004, we do not believe the expansion will have a significant impact on program costs in CY 2005 and subsequent years. Comment: One commenter suggested that CMS seek to improve its coverage web site in the future to reflect all changes being considered by the agency—both regulatory and NCD developments—that relate to Medicare E:\FR\FM\21NOR2.SGM 21NOR2 70272 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations coverage of various preventive services. The commenter stated that providing references to all matters affecting Medicare coverage in one place would provide the pubic with a better understanding of the extent of the agency’s efforts in this area. Response: We note that the regulation and the NCD processes are two separate methods specified in the Medicare statute for developing and publishing national coverage policies. However, we plan to review the commenter’s suggestion for providing references on the CMS Coverage web site to all matters—both regulatory and NCD developments—affecting Medicare coverage in the preventive services area. Final Decision We are revising the definition of an eligible beneficiary who is at ‘‘high risk’’ for glaucoma to include HispanicAmericans age 65 and older as proposed. P. Additional Issues 1. Corrections to Conditions for Medicare Payment (§ 424.22) Two typographical errors in 42 CFR 424.22 were discovered. First, § 424.22(d) erroneously refers to the definition of ‘‘financial relationship’’ in ‘‘§ 411.351’’ instead of ‘‘§ 411.354’’. In addition, footnote 1 of § 424.22(a)(1)(iv) contains an error in the spelling of the word ‘‘hospital.’’ Therefore, we are revising § 424.22 to correct these errors. 2. Chemotherapy Demonstration Project CMS seeks to encourage quality care in all facets of cancer treatment and care by encouraging best clinical practices and quality care. In the CY 2005 final rule, we announced the initiation of a 1 year demonstration project for CY 2005 for office-based oncology services. The authority for this demonstration is based on sections 402(a)(1)(B) and 402(b) of the Social Security Act Amendments of 1967 (Pub. L. 90–248). These provisions allow the Secretary to develop and engage in experiments and demonstration projects to provide incentives for economy while maintaining or improving quality in the provision of health services. This CY 2005 project focused on three areas of concern often cited by patients undergoing chemotherapy: controlling pain; minimizing nausea and vomiting; and reducing fatigue. Participating practitioners are reporting standardized assessments of patient symptoms at the time of chemotherapy encounters. We are collecting data based on these assessments over the course of chemotherapy treatment to trace VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 changes in patient symptoms, quality of life, and medical responses associated with standardized physician assessment of these important areas. To facilitate the collection of information, we established new Billing Codes, that is, G–codes, to be reported by practitioners in the demonstration. The codes correspond to four patient assessment levels for each of the three patient symptom areas: Nausea and vomiting; pain; and fatigue. These levels, based on the Rotterdam scale, have already proven effective in measuring patient symptoms associated with cancer care, are easily understood by patients, and are in widespread use. Practices reporting data on all three factors to Medicare qualify for an additional payment of $130 per encounter. By billing the designated codes, the practitioner self–enrolls in the project. Although we did not include a discussion item or demonstration proposal in the August 8, 2005, proposed physician fee schedule rule, we did release a fact sheet on August 1, 2005, titled, ‘‘Demonstration of Improved Quality of Care for Cancer Patients Undergoing Chemotherapy’’ which was posted on our web site. The fact sheet provided background on the demonstration project, shared preliminary data on the results of the demonstration, and indicated that we would continue to consult with its stakeholders about the merits of the program and the utility of the data captured. We received comments on the proposed rule on the demonstration itself and the specific items in the fact sheet. Some commenters pointed out what they perceived as limitations of the demonstration itself, such as the application of the Part B coinsurance to the demonstration codes. Almost all commenters urged CMS to extend the demonstration project in its current form or revise it to capture better data on quality and outcomes. Several commenters favored extending the demonstration to services provided by other physician specialties, such as rheumatology, gastroenterology, urology, or infectious disease; or to those services currently not included in the framework of the demonstration, such as chemotherapy administration to hospital outpatients or chemotherapy services provided through oral anticancer drugs. One major specialty group opposed the continuation of the demonstration project stating that it is inconsistent with current efforts to build evidencebased medicine into the delivery of high quality care to Medicare patients. PO 00000 Frm 00158 Fmt 4701 Sfmt 4700 Following extensive discussions with various groups representing the interests of oncologists and advocates for patient care, we have decided to retain the demonstration project for one more year, but we will revise the G-codes for reporting in order to take a further step toward encouraging quality care and promoting best clinical practices that should lead to improved patient outcomes. We will eliminate the CY 2005 G-codes specific to the assessment of patient symptoms, while maintaining our focus on quality cancer care, including the management of debilitating symptoms, to assure the best possible quality of life for cancer patients. Reconfiguration of the Demonstration for CY 2006 The new 1 year oncology demonstration, applicable to services furnished in CY 2006, will build on the use of G codes to gather more specific information relevant to the quality of care for cancer patients, their treatments, and the spectrum of care they receive from their doctors, and whether or not the care follows clinical guidelines. The project will emphasize evidence-based practice guidelines that have been shown to lead to better patient outcomes as the source for standard of care, permitting us to monitor and encourage quality care to cancer patients. Reporting will no longer be specific to chemotherapy administration services, but instead will be associated with physician E/M visits for established patients with cancer, visits that are frequent and essential to assuring quality of care and life for patients. The demonstration is available to office-based hematologists/oncologists who provide an E/M service of level 2, 3, 4, or 5 to an established patient, when the service is delivered to a patient with a primary diagnosis of cancer belonging to one of the following major diagnostic categories: • Breast cancer (invasive). • Colon cancer. • Rectal cancer. • Prostate cancer. • Lung cancer (either non-small cell or small cell). • Stomach cancer. • Esophageal cancer. • Pancreatic cancer. • Ovarian cancer. • Non-Hodgkins Lymphoma. • Chronic myelogenous leukemia. • Multiple myeloma. • Cancer of the head and neck. E/M services furnished by hematologists/oncologists for patients with other cancers as the principal E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations diagnosis will not qualify under the demonstration. We are establishing a 2006 payment amount of $23 for the 1 year oncology demonstration payment. To qualify for the $23 oncology demonstration payment, the physician must submit one G-code from each of the following three categories when an E/M service of level 2, 3, 4, or 5 is billed: (1) The primary focus of the E/M service; (2) the current disease state; and (3) whether current management adheres to clinical guidelines. We will inform the public on more details of this demonstration through a fact sheet and information on our Web site at www.cms.hhs.gov/. III. Refinement of Relative Value Units for Calendar Year 2006 and Response to Public Comments on Interim Relative Value Units for 2005 [If you choose to comment on issues in this section, please include the caption ‘‘Interim Relative Value Units’’ at the beginning of your comments.] A. Summary of Issues Discussed Related to the Adjustment of Relative Value Units Section III.B. and III.C. of this final rule with comment describes the methodology used to review the comments received on the RVUs for physician work and the process used to establish RVUs for new and revised CPT codes. Changes to codes on the PFS reflected in Addendum B are effective for services furnished beginning January 1, 2006. B. Process for Establishing Work Relative Value Units for the 2005 Physician Fee Schedule Our CY 2005 final rule (69 FR 66236) contained the work RVUs for Medicare payment for existing procedure codes under the PFS and interim RVUs for new and revised codes beginning January 1, 2005. We considered the RVUs for the interim codes to be subject to public comment under the annual refinement process. In this section, we summarize the refinements to the interim work RVUs published in the CY 2005 final rule and our establishment of the work RVUs for new and revised codes for the 2006 PFS. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 C. Work Relative Value Unit Refinements of Interim Relative Value Units 1. Methodology (Includes Table Titled ‘‘Work Relative Value Unit Refinements of the 2004 Interim and Related Relative Value Units’’) Although the RVUs in the CY 2005 PFS final rule were used to calculate 2005 payment amounts, we considered the RVUs for the new or revised codes to be interim. We accepted comments for a period of 60 days. We received substantive comments for 7 CPT codes with interim work RVUs. To evaluate these comments, we used a process similar to the process used since 1997. (See the October 31, 1997 final rule (62 FR 59084) for the discussion of refinement of CPT codes with interim work RVUs.) We convened a multispecialty panel of physicians to assist us in the review of the comments. The comments that we did not submit to panel review are discussed at the end of this section, as well as those that were reviewed by the panel, which are contained in Table 28, Codes Reviewed Under the Refinement Process. We invited representatives from the organizations from which we received substantive comments to attend a panel for discussion of the code on which they had commented. The panel was moderated by our medical staff, and consisted of the following voting members: • One or two clinicians representing the commenting organization. • One primary care clinician nominated by the American Academy of Family Physicians. • Three carrier medical directors. • Two clinicians with practices in related specialties who were expected to have knowledge of the service under review. The panel discussed the work involved in the procedure under review in comparison to the work associated with other services under the PFS. We assembled a set of 75 reference services and asked the panel members to compare the clinical aspects of the work of the service a commenter believed was incorrectly valued to one or more of the reference services. In compiling the set, we attempted to include: (1) Services that are commonly performed whose work RVUs are not controversial; (2) services that span the entire spectrum from the easiest to the most difficult; and (3) at least three services performed by each of the major specialties so that each specialty would be represented. PO 00000 Frm 00159 Fmt 4701 Sfmt 4700 70273 The intent of the panel process was to capture each participant’s independent judgment based on the discussion and his or her clinical experience. Following the discussion, each participant rated the work for the procedure. Ratings were individual and confidential, and there was no attempt to achieve consensus among the panel members. We then analyzed the ratings based on a presumption that the interim RVUs were correct. To overcome this presumption, the inaccuracy of the interim RVUs had to be apparent to the broad range of physicians participating in each panel. Ratings of work were analyzed for consistency among the groups represented on each panel. In addition, we used statistical tests to determine whether there was enough agreement among the groups of the panel and whether the agreed-upon RVUs were significantly different from the interim RVUs published in Addendum C of the final rule. We did not modify the RVUs unless there was a clear indication for a change. If there was agreement across groups for change, but the groups did not agree on what the new RVUs should be, we eliminated the outlier group and looked for agreement among the remaining groups as the basis for new RVUs. We used the same methodology in analyzing the ratings that we first used in the refinement process for the 1993 PFS. The statistical tests were described in detail in the November 25, 1992 final rule (57 FR 55938). Our decision to convene multispecialty panels of physicians and to apply the statistical tests we described was based on our need to balance the interests of those who commented on the work RVUs against the redistributive effects that would occur in other specialties. Table 28 lists those interim codes reviewed under the refinement panel process described in this section. This table includes the following information: • CPT Code. This is the CPT code for a service. • Description. This is an abbreviated version of the narrative description of the code. • 2005 Work RVU. The work RVUs that appeared in the CY 2005 final rule are shown for each reviewed code. • Requested Work RVU. This column identifies the work RVUs requested by commenters. • 2006 Work RVU. This column contains the final RVUs for physician work. E:\FR\FM\21NOR2.SGM 21NOR2 70274 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations TABLE 28.—CODES REVIEWED UNDER THE REFINEMENT PANEL PROCESS CPT code* Mod Descriptor 2005 work RVU 97605 ................ 97606 ................ .................... .................... Neg press wound tx, < 50 cm ................................................... Neg press wound tx, > 50 cm ................................................... Requested work RVU Bundled ............ Bundled ............ 0.55 0.60 2006 work RVU 0.55 0.60 * All CPT codes and descriptions copyright 2005 AMA. All rights reserved and applicable FARS/DFARS clauses apply. 2. Interim 2005 Codes CPT codes 97605 Negative pressure wound therapy (e.g., vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters and 97606 Negative pressure wound therapy (e.g., vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters. The RUC HCPAC review board recommended 0.55 work RVUs for CPT code 97605 and 0.60 work RVUs for CPT code 97606, which we did not accept. We disagreed with their recommendation that these services contained physician work and did not assign work RVUs. Further, when the negative pressure wound therapy service does not encompass selective debridement, we consider the service to represent a dressing change and will not make separate payment. When the negative pressure wound therapy service includes the need for selective debridement, we consider the services represented by CPT codes 97605 and 97606 to be bundled into CPT codes 97597 or 97598. We assigned a status indicator of ‘‘B’’ to CPT code 97605 and 97606, meaning that we would not make separate payment for these services. Comment: Commenters disagreed with our decision not to accept the RUC HCPAC recommended work RVU of 0.55 for CPT code 97605 and 0.60 work RVU for CPT code 97606 and with our decision not to make separate payment for these services. Based on these comments, we referred these codes to the multispecialty validation panel for review. Response: As a result of the statistical analysis of the 2005 multispecialty validation panel ratings, we have assigned 0.55 work RVUs to CPT code 97605 and 0.60 work RVUs to CPT code 97606. CPT codes 32855 Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 pulmonary artery, and bronchus; unilateral; 32856 Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; bilateral; 33933 Backbench standard preparation of cadaver donor heart/lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, and trachea for implantation; Backbench standard preparation of cadaver donor heart allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior vena cava, pulmonary artery, and left atrium for implantation; 44715 Backbench standard preparation of cadaver or living donor intestine allograft prior to transplantation, including mobilization and fashioning of the superior mesenteric artery and vein; 47143 Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; without trisegment or lobe split; 47144 Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with trisegment split of whole liver graft into two partial liver grafts (ie, left lateral segment (segments II and III) and right trisegment (segments I and IV through VIII)); 47145 Backbench standard preparation of cadaver donor whole liver graft prior to allotransplantation, including cholecystectomy, if necessary, and dissection and removal of surrounding soft tissues to prepare the vena cava, portal vein, hepatic artery, and common bile duct for implantation; with lobe split of whole liver graft into two partial liver grafts (ie, left lobe (segments II, III, and IV) and right lobe PO 00000 Frm 00160 Fmt 4701 Sfmt 4700 (segments I and V through VIII)); 48551 Backbench standard preparation of cadaver donor pancreas allograft prior to transplantation, including dissection of allograft from surrounding soft tissues, splenectomy, duodenotomy, ligation of bile duct, ligation of mesenteric vessels, and Y-graft arterial anastomoses from iliac artery to superior mesenteric artery and to splenic artery; 50323 Backbench standard preparation of cadaver donor renal allograft prior to transplantation, including dissection and removal of perinephric fat, diaphragmatic and retroperitoneal attachments, excision of adrenal gland, and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary; and 50325 Backbench standard preparation of living donor renal allograft (open or laparoscopic) prior to transplantation, including dissection and removal of perinephric fat and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary. These codes, all of which were approved in 2004 for inclusion in the 2005 CPT, were designated by us as carrier-priced. Comment: Commenters believed these codes describe services which are not payable under the Medicare PFS because they are hospital organ acquisition costs reimbursed under Part A of Medicare. The commenters requested that we change the designation of the standard backbench services from carrier priced to ‘‘excluded by law’’, to be consistent with deceased donor procurement codes thereby indicating that they are not included in the definition of physician services for PFS purposes. Commenters also requested that we clarify that these services are included in the definition of hospital organ acquisition costs. Response: The backbench standard preparation codes describe procedures that are performed by physicians to prepare donor organs for implantation. The procedure is usually performed at the same hospital by the same surgical transplant team where the recipient transplant operation occurs, often in the same or adjacent operating room. It is usually completed shortly prior to or during the recipient transplant operation (especially for the heart and E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations lung) although more time is available to complete the transplant operations for the liver, kidney, and pancreas. This procedure is a necessary component for completion of the recipient transplant operation. With the exception of living donors, these services are rarely rendered at the hospital where the donor organs are procured. Hospital organ acquisition costs primarily consist of charges for services rendered by the hospital, Organ Procurement Organization (OPO), and the physicians related to retrieving the cadaveric donor organs at the ‘‘donor hospital’’ location. By virtue of its proximate timing and spatial association with the recipient transplant operation, this group of backbench standard preparation procedures are similar to other transplant surgery procedures that are performed by physicians and paid under the Medicare PFS. Therefore, we do not see how they would be considered as hospital organ acquisition costs (as suggested by the commenter). Since the codes for these backbench procedures do not represent deceased donor procurement codes, they would not appropriately be designated as ‘‘excluded by law’’ as requested by the commenter. It would be more appropriate to pay for these services under the PFS. In the specific case of living donors, both the ‘‘donor hospital’’ and the ‘‘recipient hospital’’ are obviously the same, although both operations are performed simultaneously by different surgical teams. In these cases, the backbench standard preparation procedures may be performed by physician members of either the donor team, the recipient team, or even a third surgical team. It is recognized that on occasion a donor organ will not be used for transplant at the facility where the backbench standard preparation procedure is performed (often because the intended recipient is found to be medically unsuitable after completion of the backbench work). In these situations, the donor organ may be sent to a different facility for another potential transplant recipient. Even in these situations, the physician performing the backbench procedure has no particular association with the initial donor procurement operation, the OPO, or the ‘‘donor hospital’’ site. Therefore, this physician’s work is still a physician service that should be paid under the Medicare PFS. CPT codes 36475 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated and VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 36476 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; second and subsequent veins treated in a single extremity, each through separate access sites. We accepted the RUC recommendation of 6.72 work RVUs for 36475 and 3.38 work RVUs for 36476. Comment: We received a comment expressing concerns that we assigned endovenous radiofrequency (RF) ablation procedures (CPT code 36475 and 36476) the same work RVUs as were assigned to endovenous laser procedures (CPT codes 36478 and 36479). The commenter strongly urged us to reevaluate the work RVUs for RF ablation procedures. The commenter also noted that the vignette developed for the RF procedure was used for the laser procedure with one modification— the word radiofrequency was changed to ‘‘laser’’ and as a result, the vignette for the laser procedure was inaccurate, misleading, and created the impression that the work for the laser procedure is as intense as the work for the RF procedure. The commenter believed the mistaken description likely blurred the distinctions between the two procedures in terms of work and procedure time. The commenter also believed the flawed survey is evidence that the work RVUs for RF procedures were not appropriate and should be reexamined. Response: We believe the RUC appropriately valued these codes based upon the information that was provided to them during the RUC survey process and suggest the commenter contact the specialty society to have these codes reexamined by the RUC. In the CY 2005 final rule (69 FR 66370), we also responded to the RUC recommendations on the PE inputs for the new and revised CPT codes for 2005. Comments received on the PE inputs were addressed earlier in this preamble in the PE proposals for CY 2006 with the exception of comments received on CPT codes 36475 and 36476. As noted in the previous discussion concerning refinement of interim work RVUs, the commenter indicated the vignette was incorrect and therefore we believe the concerns about PE should also be handled through the RUC process by the specialty society. PO 00000 Frm 00161 Fmt 4701 Sfmt 4700 70275 D. Establishment of Interim Work Relative Value Units for New and Revised Physician’s Current Procedural Terminology (CPT) Codes and New Healthcare Common Procedure Coding System Codes (HCPCS) for 2006 (Includes Table titled ‘‘American Medical Association Specialty Relative Value Update Committee and Health Care Professionals Advisory Committee Recommendations and CMS’s Decisions for New and Revised 2006 CPT Codes’’) One aspect of establishing RVUs for 2006 was to assign interim work RVUs for all new and revised CPT codes. As described in our November 25, 1992 notice on the 1993 PFS (57 FR 55951) and in section III.B. of the November 22, 1996 final rule (61 FR 59505), we established a process, based on recommendations received from the AMA’s RUC, for establishing interim work RVUs for new and revised codes. This year we received work RVU recommendations for 175 new and revised CPT codes from the RUC. Our staff and medical officers reviewed the RUC recommendations by comparing them to our reference set or to other comparable services for which work RVUs had previously been established. We also considered the relationships among the new and revised codes for which we received RUC recommendations and agreed with the majority of the relative relationships reflected in the RUC values. In some instances, although we agreed with the relationships, we nonetheless revised the work RVUs to achieve work neutrality within families of codes. That is, the work RVUs were adjusted so that the sum of the new or revised work RVUs (weighted by projected frequency of use) for a family will be the same as the sum of the current work RVUs (weighted by projected frequency of use) for the family of codes. We reviewed all the RUC recommendations and accepted approximately 94 percent of the RUC recommended values. For approximately 6 percent of the recommendations, we agreed with the relativity established by the RUC, but needed to adjust work RVUs to retain budget neutrality. We received 9 recommendations from the Health Care Professional Advisory Committee (HCPAC). We agreed with seven of these recommendations and disagreed with two of them. Table 29, titled ‘‘AMA RUC and HCPAC Recommendations and CMS Decisions for New and Revised 2006 CPT Codes,’’ lists the new or revised CPT codes, and their associated work RVUs, that will be interim in 2006. This E:\FR\FM\21NOR2.SGM 21NOR2 70276 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations table includes the following information: • A ‘‘#’’ identifies a new code for 2006. • CPT code. This is the CPT code for a service. • Modifier. A ‘‘26’’ in this column indicates that the work RVUs are for the professional component of the code. VerDate Aug<31>2005 15:52 Nov 18, 2005 Jkt 208001 • Description. This is an abbreviated version of the narrative description of the code. • RUC recommendations. This column identifies the work RVUs recommended by the RUC. • HCPAC recommendations. This column identifies the work RVUs recommended by the HCPAC. • CMS decision. This column indicates whether we agreed or we PO 00000 Frm 00162 Fmt 4701 Sfmt 4700 disagreed with the RUC recommendation. Codes for which we did not accept the RUC recommendation are discussed in greater detail following this table. An ‘‘(a)’’ indicates that no RUC recommendation was provided. • 2006 Work RVUs. This column establishes the interim 2006 work RVUs for physician work. BILLING CODE 4120–01–U E:\FR\FM\21NOR2.SGM 21NOR2 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00163 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70277 ER21NO05.056</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00164 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.057</GPH> 70278 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00165 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70279 ER21NO05.058</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations BILLING CODE 4120–01–C Table 30, which is titled ‘‘AMA RUC ANESTHESIA RECOMMENDATIONS AND CMS DECISIONS FOR NEW AND REVISED 2006 CPT CODES’’, lists the new or revised CPT codes for anesthesia and their base units that will be interim in 2006. This table includes the following information: VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 • CPT code. This is the CPT code for a service. • Description. This is an abbreviated version of the narrative description of the code. • RUC recommendations. This column identifies the base units recommended by the RUC. • CMS decision. This column indicates whether we agreed or we PO 00000 Frm 00166 Fmt 4701 Sfmt 4700 disagreed with the RUC recommendation. Codes for which we did not accept the RUC recommendation are discussed in greater detail following this table. • 2006 Base Units. This column establishes the 2006 base units for these services. E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.059</GPH> 70280 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70281 TABLE 30.—AMA RUC ANESTHESIA RECOMMENDATIONS AND CMS DECISIONS FOR NEW AND REVISED CPT CODES * CPT CODE RUC recommendation Description #01965 .............. #01966 .............. ANESTH, INC/MISSED AB PROC ............................................................ ANESTH, INDUCED AB PROCEDURE .................................................... 4.00 4.00 CMS decision Agree ................ Agree ................ 2006 base units 4.00 4.00 * All CPT codes copyright 2005 AMA. # New CPT code. E. Discussion of Codes for Which There Were No RUC Recommendations or for Which the RUC Recommendations Were Not Accepted The following is a summary of our rationale for not accepting particular RUC work RVUs, base unit recommendations, or for accepting RUC recommendations with an intention to continue to monitor and reexamine the code(s) in the near future. It is arranged by type of service in CPT order. This summary refers only to work RVUs or Base Units. New and Revised Codes for 2006 CPT codes 61630 Balloon angioplasty, intracranial (e.g., atherosclerotic stenosis), percutaneous; 61635 Transcatheter placement of intravascular stent(s), intracranial (e.g., athersosclerotic stenosis), including balloon angioplasty if performed; 61640 Balloon dilatation of intracranial vasospasm, percutaneous, initial vessel; 61641 Balloon dilatation of intracranial vasospasm, percutaneous, initial vessel; each additional vessel in same vascular family; and 61642 Balloon dilatation of intracranial vasospasm, percutaneous, initial vessel; each additional vessel in different vascular family.—The RUC recommended 21.08 work RVUs for 61630, 23.08 work RVUs for 61635, 12.32 work RVUs for 61640, 4.33 work RVUs for 61641 and 8.66 work RVUs for 61642. We are assigning a status indicator of N for these services because they are noncovered under Medicare due to a National Coverage Decision. CPT codes 76376 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound or other tomographic modality; not requiring image post-processing on an independent workstation and 76377 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound or other tomographic modality; requiring image post processing on an independent workstation.—The CPT Editorial Panel created CPT codes 76376 and 76377 to describe the new technology of volumetric acquisition of advanced cross-sectional imaging. The RUC VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 recommended 0.20 work RVUs for CPT code 76376 and 0.79 work RVUs for CPT code 76377. These services were previously reported using CPT code 76375 Coronal, sagittal, multiplanar, oblique, 3-dimensional and/or holographic reconstruction of computed tomography, magnetic resonance imaging, or other tomography modality. —According to the specialty society of the services reported for 76375, 80 to 90 percent reflected two-dimensional multiplanar reformatting and only 10 to 20 percent reflected three-dimensional rendering described in codes 76376 and 76377. Although we are accepting the utilization crosswalks recommended by the specialty society and the work RVUs recommended by the RUC, we will continue to evaluate the work and utilization associated with these services over the next year and reexamine these codes in the future. CPT code 88334 Pathology consultation during surgery; cytologic examination (e.g., touch prep, squash prep), each additional site.—The RUC recommended a work RVU of 0.80 for this service based on a comparison of this procedure to CPT code 88332 Pathology consultation during surgery; each additional tissue block, with frozen section(s). The RUC reviewed the specialty society’s survey data and noted that the surveyed code 88334, when compared to the reference code 88332 has higher intensity/complexity measures and an additional five minutes of intra-service time, 20 minutes and 15 minutes, respectively. Although 88334 has an additional five minutes of intraservice time, we believe that 88334 is very similar in work to 88332 and, therefore, should be valued the same. We have assigned 0.59 work RVUs to 88334. CPT codes 88384 Array-based evaluation of multiple molecular probes; 11 through 50 probes, 88385 Array-based evaluation of multiple molecular probes; 51 through 250 probes and 88386 Array-based evaluation of multiple molecular probes; 251 through 500 probes.—The RUC recommended that the base code (88384) be carrier priced and recommended 1.50 work RVUs for 88385 and 1.88 work RVUs for 88386. PO 00000 Frm 00167 Fmt 4701 Sfmt 4700 We will allow the base code to be carrier priced and are accepting the RUC recommended values for 88385 and 88386. We will continue to evaluate the work and utilization associated with all of these services over the next year and reexamine these codes in the future. CPT code 90773 Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intraarterial.—We did not receive a final RUC recommendation for this code. This code replaces CPT code 90783 Therapeutic, prophylactic or diagnostic injection (specify material injected); intra-arterial, which has been deleted and was assigned 0.17 work RVUs. On an interim basis, we have assigned 0.17 work RVUs to 90773 since it replaces 90783. CPT code 92630 Auditory rehabilitation, pre-lingual hearing loss and 92633 Auditory rehabilitation, postlingual hearing loss.—CPT codes 92630 and 92633 represent speech language pathology and audiology services. These CPT codes describe rehabilitative or therapeutic services. When speechlanguage pathologists (SLPs) provide these services, they may bill for them by using CPT code 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual, as appropriate. According to the Medicare statute, section 1861(ll)(2) of the Act, audiologists are recognized for purposes of providing diagnostic testing services to Medicare beneficiaries. Therefore, we will not recognize CPT codes 92630 and 92633 under Medicare and have assigned a status indicator of I because these services represent therapeutic services rather than diagnostic tests. CPT code 95251 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for up to 72 hours; physician interpretation and report.— The RUC recommended a work RVU of 0.85 for this service. We disagree with the RUC’s recommendation because we believe the work for this service is similar to CPT code 93268 Patient demand single or multiple event recording with presymptom memory loop, 24-hour attended monitoring, per 30 day period of time; includes E:\FR\FM\21NOR2.SGM 21NOR2 70282 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations transmission, physician review and interpretation, which involves the review of data over a 30 day period. Therefore, we have assigned 0.52 work RVUs to 95251. CPT codes 95873 Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure) and 95874 (Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure).—The RUC recommended a work RVU of 0.56 for CPT codes 95873 and 95874. The RUC examined reference code 95860 (Needle electromyography; one extremity with or without related paraspinal areas) and determined that the intensity for the new procedures and the reference procedure were the same so a proper value for both new codes should be based on the ratio of time with the reference code. We believe that the work involved with 95873 and 95874 is very similar to 95870 and therefore should be valued the same. We have assigned 0.37 work RVUs to CPT codes 95873 and 95874. CPT codes 96116 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities); per hour of the psychologist’s or physician’s time, both face-to-face time with the patient and time preparing the report and 96118 Neuropsychological testing (e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test); per hour of the psychologist’s or physician’s time, both face-to-face time with the patient and time preparing the report.—The HCPAC recommended 2.05 work RVUs for CPT codes 96116 and 96118. We disagree with the HCPAC’s recommendation and believe the physician work associated with these services is similar to 96101, as reflected by the technical skill, judgment and complexity of these services. Therefore, we have assigned 1.86 work RVUs to 96116 and 96118. CPT codes 98960 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient; 98961 Education and training for patient selfmanagement by a qualified, nonphysician health care professional using a standardized curriculum, faceto-face with the patient (could include VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 caregiver/family) each 30 minutes; 2–4 patients; and 98962 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 5–8 patients.—We are assigning a status indicator of N for these services because they are noncovered under Medicare. CPT codes 99143 Moderate sedation services (other than those services described by codes 00100–01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status, under 5 years of age; first 30 minutes intra-service time, 99144 Moderate sedation services (other than those services described by codes 00100–01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status, age 5 years or older; first 30 minutes intra-service time, 99145 Moderate sedation services (other than those services described by codes 00100–01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status, age 5 years or older; each additional 15 minutes intra-service time, 99148 Moderate sedation services (other than those services described by codes 00100–01999) provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports, under 5 years of age; first 30 minutes intra-service time, 99149 Moderate sedation services (other than those services described by codes 00100–01999) provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports, age 5 years or older; first 30 minutes intraservice time, 99150 Moderate sedation services (other than those services described by codes 00100–01999) provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports, each additional 15 minutes intra-service time.—The CPT PO 00000 Frm 00168 Fmt 4701 Sfmt 4700 Editorial Panel created six new codes to accurately report 2 separate families of moderate sedation. One family describes the provision of moderate sedation services by the physician who is performing the diagnostic or therapeutic service and supervising an independent trained observer while the other family describes moderate sedation services performed by a physician (other than an anesthesiologist) other than the physician performing a diagnostic or therapeutic service. These new codes replace CPT codes 99141 Sedation with or without analgesia (conscious sedation); intravenous, intra-muscular or inhalation and 99142 Sedation with or without analgesia (conscious sedation); oral, rectal and/or intranasal, which were bundled under the PFS. The RUC recommended 0.70 work RVUs for 99143, 0.66 work RVUs for 99144, 0.23 work RVUs for 99145, 1.75 work RVUs for 99148, 1.65 work RVUs for 99149 and 0.47 work RVUs for 99150. We are uncertain whether the RUC assigned values are appropriate and have carrier priced these codes in order to gather information for utilization and proper pricing. F. Establishment of Interim PE RVUs for New and Revised Physician’s Current Procedural Terminology (CPT) Codes and New Healthcare Common Procedure Coding System (HCPCS) Codes for 2006. We have developed a process for establishing interim PE RVUs for new and revised codes that is similar to that used for work RVUs. Under this process, the RUC recommends the PE direct inputs (the staff time, supplies and equipment) associated with each new code. We then review the recommendations in a manner similar to our evaluation of the recommended work RVUs. The RUC recommendations on the PE inputs for the new and revised 2006 codes were submitted to us as interim recommendations. We have accepted, in the interim, the PE recommendations submitted by the RUC for the codes listed in the table titled ‘‘AMA RUC and HCPAC RVU Recommendations and CMS Decisions for New and Revised 2006 CPT Codes.’’ CPT code 28890 Extracorporeal shock wave, high energy, performed by a physician, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia.— We accepted the work RVUs for CPT 28890. However, we disagree with the RUC’s recommendation to value this procedure only in the facility setting. We believe that this procedure is being performed in the nonfacility setting and are assigning the following PE inputs based on information that the RUC E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations provided for informational purposes: (a) Total clinical labor time of 133 minutes consisting of 16 minutes for pre-service, 36 minutes for the service period, and 81 minutes for the post-service period; (b) supplies consist of 4 multispecialty supply packages (1 each for the procedure and each of the 3 post visits), 1 fenestrated drape, 3 18–24 gauge needles, 1 10cc syringe, 5cc of lidocaine 1 percent, 5cc of marcaine 0.5 percent, and 2 alcohol swabs; and (c) equipment includes ESW machine used for the procedure for 36 minutes and a power table and an exam lamp each for 117 minutes (includes the 36 minute procedure and 81 minutes for the post visits). CPT 89049 Caffeine halothane contracture test (CHCT) for malignant hyperthermia susceptibility, including interpretation and report.—While we accepted the work RVUs for this procedure, we disagreed with a PE recommendation regarding 30 minutes clinical labor—provided by a staff blend comprised of a combination laboratory technician and histotechnologist—that was requested to prepare the registry report. Because we do not pay for the clinical labor necessary to prepare registry reports in any other procedure codes, we have deleted the 30 minutes report preparation time from the total service period time in the practice labor expense database. The net result for the clinical labor service period is 274 minutes for CPT 89049. IV. Five-Year Refinement of RVUs— Status Update In the CY 2005 final rule (69 FR 66236), we solicited comments on the work RVUs that may be inappropriately valued. Since we recognized that this process generally elicits comments focusing on undervalued codes, we also indicated that we would identify codes (especially high-volume codes across specialties) that: • Are valued as being performed in the inpatient setting, but that are now predominantly performed on an outpatient basis; and • Were not reviewed by the RUC, (that is, Harvard RVUs are still being used, or there is no information). We received comments on potentially misvalued services from approximately 35 specialty organizations and individuals involving over 500 codes. We shared these comments with the RUC and also identified approximately 160 additional codes for review. As explained in the CY 2005 final rule (69 FR 66236), we proposed to utilize a process similar to that established for the assignment of RVUs for new and revised CPT codes where the RUC VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 makes recommendations on work RVUs for services. This process was used during the last 5-year review, and we believe that it was beneficial. The RUC’s perspective is helpful because of its experience in recommending RVUs for new and revised CPT codes since we implemented the PFS. Furthermore, the RUC, by virtue of its multispecialty membership and consultation with approximately 65 specialty societies, involves the medical community in the refinement process. We will consider all comments on all work RVUs in the development of a proposed rule that we will publish 2006. In that rule, we will propose the revisions to work RVUs that we believe are needed. We will then review and analyze the comments received in response to our proposed revisions and publish our decisions in the final rule for CY 2007. V. Physician Self-Referral Prohibition: Nuclear Medicine and Annual Update to the List of CPT/HCPCS Codes A. General Section 1877 of the Act prohibits a physician from referring a Medicare beneficiary for certain designated health services (DHS) to a health care entity with which the physician (or a member of the physician’s immediate family) has a financial relationship, unless an exception applies. Section 1877 of the Act also prohibits the DHS entity from submitting claims to Medicare or billing the beneficiary or any other entity for Medicare DHS that are furnished as a result of a prohibited referral. As specified in our regulations at § 411.351, the following services are DHS: • Clinical laboratory services. • Physical therapy, occupational therapy, and speech-language pathology services. • Radiology and certain other imaging services. • Radiation therapy services and supplies. • Durable medical equipment and supplies. • Parenteral and enteral nutrients, equipment, and supplies. • Prosthetics, orthotics, and prosthetic devices and supplies. • Home health services. • Outpatient prescription drugs. • Inpatient and outpatient hospital services. B. Nuclear Medicine In the August 8, 2005 rule, we proposed to include diagnostic and therapeutic nuclear medicine procedures under the DHS categories for PO 00000 Frm 00169 Fmt 4701 Sfmt 4700 70283 radiology and certain other imaging services and radiation therapy services and supplies, respectively. The DHS categories of radiology and certain other imaging services and radiation therapy services and supplies are defined by a list of CPT and HCPCS codes that is updated annually and posted on our web site. In the August 8, 2005 proposed rule (70 FR 45764), we stated that we would revise the list of CPT and HCPCS codes (List of CPT/HCPCS Codes) that identifies the items and services that are included in each of these DHS categories. Addendum G of the proposed rule set forth a list of codes for all diagnostic nuclear medicine procedures, all therapeutic nuclear medicine procedures, and the radiopharmaceuticals used in diagnostic and therapeutic nuclear medicine procedures. Additionally, we stated our intention to include diagnostic nuclear medicine services on the revised List of CPT/HCPCS Codes under ‘‘Radiology and Certain Other Imaging Services’’ and to include therapeutic nuclear medicine services on the revised List of CPT/HCPCS Codes under ‘‘Radiation Therapy Services and Supplies’’. We stated that some radiopharmaceuticals may be included in both categories. We requested comments concerning whether the list was accurate and complete. In addition, we requested comments as to whether, or how, to minimize the impact on physicians who are currently parties to arrangements that involve nuclear medicine services and supplies (that is, by specifying a delayed effective date or by grandfathering certain arrangements). 1. Response to Comments We received many comments in response to our proposal to add diagnostic and therapeutic nuclear medicine services and supplies to the list of designated health services subject to the physician self-referral prohibition. Comments were submitted by or on behalf of numerous specialty societies, individual physicians, physician group practices, manufacturers, hospitals, the AMA and other trade associations, diagnostic imaging centers, and the Medicare Payment Advisory Commission (MedPAC). We received a few general comments, but the vast majority of comments centered on five specific issues. We address the comments in the following order: • General Comments. • Authority to Include Nuclear Medicine Services and Supplies as Designated Health Services. • Overutilization or Abuse. • Beneficiary Access to Care. E:\FR\FM\21NOR2.SGM 21NOR2 70284 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations • Quality of Care. • Grandfathering Existing Arrangements or Delaying the Effective Date. a. General Comments Comment: One commenter questioned how our proposal would affect a physician’s ability to refer patients to a positron emission tomography (PET) center that purchases radiopharmaceuticals (which are DHS under our proposal) from a company with which the referring physician has a financial relationship. Response: The effect of this final rule with comment on a physician who has a financial relationship with a company that produces and supplies radiopharmaceuticals for PET scanning will depend on the nature of the physician’s financial relationship with the supplying company and the supplying company’s financial relationship with the PET center to which the physician wishes to refer. Depending on the facts, the arrangement described by the commenter could constitute an indirect compensation arrangement (as defined in § 411.354(c)(2). If an indirect compensation arrangement exists between the referring physician and the PET center, the physician may not refer to the PET center unless the arrangement complies with the indirect compensation arrangement exception at § 411.357(p). Comment: One commenter expressed concern about our proposal and requested that we maintain the ability of radiation oncologists to order, perform and use as needed, diagnostic and therapeutic nuclear medicine services for radiation treatment planning and treatment delivery. Response: We do not believe this final rule with comment will prohibit a radiation oncologist from ordering or performing diagnostic and therapeutic nuclear medicine services for purposes of radiation treatment planning and delivery. A ‘‘referral’’ does not include the request by a radiation oncologist for radiation therapy, including therapeutic nuclear medicine, if the request results from a consultation initiated by another physician and the services are furnished by or under the supervision of the radiation oncologist, or under the supervision of another radiation oncologist in the same group practice. In the March 26, 2004 final rule (69 FR 16065), we stated that the radiation oncologist exception in the definition of ‘‘referral’’ would also protect ‘‘necessary and integral ancillary services requested, and appropriately supervised, by the radiation oncologist.’’ VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 We believe that diagnostic nuclear medicine procedures that are necessary and integral to the provision of radiation therapy fall within the scope of this protection. Accordingly, we are modifying the definition of ‘‘Referral’’ in § 411.351. Comment: Two commenters suggested that the in-office ancillary services exception be modified or amended to prevent referring physicians from circumventing the physician selfreferral law and its provisions. Response: We understand the commenter’s viewpoint, but the commenter’s request goes beyond the scope of this rulemaking. We believe the in-office ancillary services exception strikes an appropriate balance between preventing program abuse without unduly interfering with the practice of medicine. However, we will continue to monitor the potential for abuse with respect to existing exceptions. Comment: One commenter requested that we create a new exception for a physician’s investment or ownership in a health care entity which provides nuclear medicine services and supplies, if the physician who refers patients to these entities directly supervises (onsite) the technicians or other personnel performing the nuclear medicine procedures on patients referred by that physician. Response: Under section 1877(b)(4) of the Act, we may create a regulatory exception only if we determine that the exception would pose no risk of program or patient abuse. The commenter seems to believe that the potential for program and patient abuse would be eliminated by having an owner physician on-site when a technician performs a nuclear medicine procedure that the physician has ordered. We do not see how this requirement would eliminate the risk of overutilization or other program or patient abuse that arises when a physician self-refers to an entity with which he or she has a financial relationship. b. Authority To Include Nuclear Medicine Services and Supplies as a Designated Health Services (DHS) The physician self-referral statute, at section 1877(h)(6) of the Act, includes within the list of DHS, ‘‘radiology services, including magnetic resonance imaging, computerized axial tomography, and ultrasound services,’’ and ‘‘radiation therapy services and supplies.’’ We proposed to include diagnostic and therapeutic nuclear medicine as DHS because we believe they are within the statute’s meaning of radiology services and radiation therapy PO 00000 Frm 00170 Fmt 4701 Sfmt 4700 services and supplies. We did not receive any comments disputing the assertion that therapeutic nuclear medicine services are radiation therapy services and supplies. However, regarding diagnostic nuclear medicine services, we received some comments that disagreed with our interpretation of the statute as well as some that agreed with our interpretation. Comment: Three commenters noted that we proposed to include diagnostic nuclear medicine procedures within our definition of ‘‘radiology and certain other imaging services’’ in § 405.351. These commenters stated that ‘‘other imaging services’’ does not appear in the statute, and they asserted that the Congress rejected virtually identical (in their view) statutory phrasing. The commenters noted that when the Congress initially included radiology as a DHS in the Omnibus Budget Reconciliation Act of 1993, the language read ‘‘radiology and other diagnostic services’’ and that the Congress amended the statute in the Social Security Amendments of 1994 to delete the phrase ‘‘and other diagnostic services.’’ The commenters also asserted that if the Congress had meant to include nuclear medicine within the DHS category of radiology, it would have specifically mentioned diagnostic nuclear medicine, as it did magnetic resonance imaging (MRIs), computerized axial tomography (CT scans), and ultrasound services. Response: We are including diagnostic nuclear imaging services in our definition of ‘‘radiology and certain other imaging services’’ because we believe they are radiology services within the meaning of section 1877(h)(6)(D) of the Act. We disagree with the commenter’s assertion that we lack statutory authority to include certain imaging services in the DHS category described at section 1877(h)(6)(D) of the Act. We believe that the Congress meant to include all forms of radiology, that is, those that have traditionally been considered to be radiology, as well as certain other imaging services, such as ultrasound that may or may or not be considered to be radiology in the traditional sense. Further, we believe the Congress meant to include all forms of radiology, regardless of whether the particular form existed or was covered by Medicare on the date the statutory language was enacted or became effective. We believe that, by describing the DHS category as ‘‘[r]adiology services, including [MRI, CAT scans], and ultrasound services,’’ the Congress merely provided examples (rather than an exhaustive list) of some of the most E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations common forms of radiology other than x-rays. Comment: Three commenters stated that nuclear medicine should not be considered a DHS because it is clinically and technically distinct from the services that the Congress enumerated when it defined the scope of radiology services. The commenters noted that the American Board of Nuclear Medicine defines nuclear medicine as ‘‘the medical specialty that employs radionuclides to evaluate metabolic, physiologic and pathologic conditions of the body for purposes of diagnosis, therapy and research.’’ According to the commenters, the introduction of radiolabeled, biologically active compounds into patients distinguishes nuclear medicine from radiology, which may involve the administration of biologically inert contrast agents, such as barium sulfate, iodine or gadolinium. One of these commenters stated that the mere use of radioactive material does not render a service radiology because radioactive materials are used in non-radiology services such as the performance of radioimmunoassay and irradiation of blood products. Response: We are not persuaded that the common definitions of ‘‘radiology’’ cited in our proposed rule (70 FR 45854–55) are incorrect or do not include diagnostic nuclear imaging. As we stated in the proposed rule (70 FR 45855–56), radiology is ‘‘that branch of the health sciences dealing with radioactive substances and radiant energy and with the diagnosis and treatment of disease by means of both ionizing (that is, x-rays) and nonionizing (that is, ultrasound) radiations.’’ (quoting Dorland’s Illustrated Medical Dictionary). We noted in the proposed rule (70 FR 45855–56) that, ‘‘[i]n more recent years, radiology has come also to embrace diagnosis by a method of organ scanning with the use of radioactive isotopes and non-ionizing radiation, such as ultrasound and nuclear magnetic resonance.’’ (quoting Encyclopaedia Britannica outline). Diagnostic nuclear medicine services involve the use of radioactive substances and ionizing radiation for purposes of diagnosis. Like the other services the Congress identified in describing ‘‘radiology services,’’ the final product is an image used for purposes of diagnosis. We believe that the Congress intended to include as ‘‘radiology services’’ all forms of radiological imaging, regardless of whether exposure to radioactive materials or radiation is achieved through ingestion or eternal application and regardless of whether the form of VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 radiation is ionizing or non-ionizing. We also note that certain professional medical organizations such as the AMA and the ACR consider diagnostic nuclear imaging to be a subspecialty of radiology. We agree that the use of radioactive substances to perform a particular service does not, by itself, render that service ‘‘radiology’’ within the meaning of section 1877(h)(6)(D). We are not including as ‘‘radiology and certain other imaging services’’ any diagnostic nuclear medicine services that are not imaging services. We note that radioimmunoassay is a clinical laboratory service for purposes of section 1877, and irradiation of blood products is not a DHS. Comment: We received several comments addressing whether nuclear medicine is a subspecialty of radiology. MedPAC stated that it strongly supports the proposal to include nuclear medicine services in the definition of ‘‘radiology and certain other imaging services.’’ MedPAC further stated its belief that the proposal is justified because physician groups such as the ACR and the AMA consider nuclear medicine to be a subspecialty of radiology. (We note that although the AMA objected to our proposal on the grounds that overutilization has not been shown for nuclear medicine services, the AMA did not assert that diagnostic nuclear medicine is not a subspecialty of radiology.) Another commenter stated that it is reasonable to include nuclear medicine as a DHS, but took exception to our statement in the proposed rule that diagnostic nuclear medicine is a subset of radiology. This commenter stated that the Nuclear Regulatory Commission (NRC) recognizes multiple alternative pathways to becoming a medical authorized user of isotopes in addition to certification from the American Board of Radiology. The commenter also noted that many different subspecialties, in addition to radiology, are recognized stakeholders with voting rights at the NRC Advisory Committee on the Medical Use of Isotopes. Two other commenters stated that according to the American Board of Medical Specialties, nuclear medicine and radiology are separate medical specialties, and that each is one of only 26 distinct medical disciplines subject to Primary Board Certification. These commenters stated that, although it is true that some nuclear medicine training is incorporated into the diagnostic radiology training program, and that the American Board of Radiology does include questions on nuclear medicine in its certification examination, PO 00000 Frm 00171 Fmt 4701 Sfmt 4700 70285 physicians become eligible to take the American Board of Nuclear Medicine examination only after successfully completing a nuclear medicine residency program. Finally, one commenter objected to the proposal to include nuclear medicine as a DHS insofar as the proposal relates to the subspecialty of nuclear cardiology. According to this commenter, nuclear cardiology is the science of performing cardiac stress testing with the interpretation of nuclear images for purposes of determining a patient’s diagnosis and prognosis; therefore, nuclear cardiology is not simply the interpretation of images, which the commenter stated is the case in nuclear medicine. The commenter asserted that the great majority of physicians certified by the Certification Board of Nuclear Cardiology are cardiologists rather than radiologists. Response: We recognize that there is some difference of opinion, including among competing certification organizations, as to whether nuclear medicine is a subspecialty of radiology or whether it: (1) Is a subspecialty of both radiology and some other area of medicine; or (2) has achieved some type of independent status. However, even if nuclear medicine has achieved some type of independent status, it, nevertheless, is a form of radiology (as that term is commonly defined) and that therapeutic nuclear medicine is a form of radiation therapy. Likewise, the fact that cardiologists have found nuclear imaging to be particularly useful for evaluating heart disease and have developed a subspecialty in nuclear cardiology does not alter the essential fact that nuclear imaging employs radioactive material and is a form of radiology. Comment: One commenter stated that our January 4, 2001 final rule clearly and permanently established the principle that nuclear medicine services are not radiology services. The commenter believes that the January 2001 rule fairly interpreted the law and that it is inappropriate to change the regulation in the absence of specific direction from the Congress in the form of a statutory change. Response: We disagree with the commenter’s belief that our regulations remain fixed for all time absent a change in the statute. As stated in the August 8, 2005 proposed rule, we believe that a better reading of the statute is that the radiology and radiation therapy DHS categories, as set forth in section 1877(h)(6) of the Act, encompass diagnostic and therapeutic nuclear medicine services, respectively. Therefore, we believe it is appropriate to E:\FR\FM\21NOR2.SGM 21NOR2 70286 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations amend our regulations to include diagnostic and therapeutic nuclear medicine services within the respective DHS categories of radiology services and radiation therapy services and supplies. c. Overutilization or Abuse In the August 8, 2005 proposed rule, we cited several studies that suggest that a physician’s referral patterns and utilization of nuclear medicine services and supplies closely correlate to whether the physician has a financial interest in the entity providing the services and supplies. We received several comments representing divergent views as to whether nuclear medicine services and supplies are at risk for abuse and overutilization when physicians have financial interests in the entities that provide the services and supplies. Comment: One commenter supported our proposal to include nuclear medicine as a DHS and believed that there has been significant overutilization and abuse of this imaging modality in his State. The commenter believes that the problems have become more acute with the proliferation of PET and PET/CT imaging centers set up as joint ventures between select groups of referring physicians and venture capitalists in the State and requested that we prohibit these types of ventures. Response: We welcome the commenter’s observations regarding the impact on the utilization of PET and PET/CT imaging when physicians enter into arrangements with non-physician investors to own these imaging centers. Inclusion of nuclear medicine services and supplies as DHS likely will have an impact on these ventures (and potentially the utilization of PET and PET/CT imaging). However, whether or not PET joint ventures are abusive is not a determinative factor in our decision to include diagnostic and therapeutic nuclear medicine as DHS. Rather, our decision is based on our belief that these services and supplies properly are categorized as ‘‘radiology and certain other imaging services’’ and ‘‘radiation therapy services and supplies’’ within the meaning of the statute. Comment: One commenter provided a summary of the findings from its own clinical and financial database regarding the incidence of physician self-referral for nuclear medicine services. The commenter asserted that the data show that self-referring providers are much more likely to order these types of services than those who do not selfrefer. Response: We appreciate the commenter’s willingness to share its VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 data regarding the incidence of physician self-referral for one specific type of nuclear imaging service (nuclear cardiology). The commenter’s findings are consistent with the information we already have, including the studies cited in the August 8, 2005 proposed rule, that nuclear medicine services and supplies pose the same risk of abuse that the Congress intended to eliminate for other types of radiology, imaging and radiation therapy services and supplies. Comment: Two commenters supported the expansion of the physician self-referral provisions to include nuclear medicine services and supplies. One of the commenters stated his or her belief that the proliferation of imaging units in non-hospital environments has contributed significantly to the increase in diagnostic imaging costs. This commenter urged that, although the advancement of PET technology has proven to be a clinically effective diagnostic imaging tool, the physician self-referral law should have equal extension and universal application to all imaging providers. The other commenter stated that recent studies of the effects of physician self-referral have shown that, when physicians have an investment interest in imaging equipment and have the opportunity to self-refer, their utilization is significantly higher than among physicians who refer their patients to a provider in which the referring physician has no financial interest. This commenter added that nuclear medicine services and supplies should have been included in the original listing, because the potential for abuse is no different than for CT scans or MRI scans. Both this commenter and MedPAC contend that our policy change will help limit referrals for nuclear medicine services that are based on financial, rather than clinical, reasons. Response: We believe that the position advocated by these commenters is consistent with the studies we cited in the August 8, 2005 proposed rule. As we stated in the proposed rule, although we believe that diagnostic and therapeutic nuclear medicine services are radiology and radiation therapy services and supplies within the meaning of the statute, we would resolve any doubt as to this matter in favor of including them as DHS. After careful review of the information available to us currently, we believe it is appropriate to include diagnostic and therapeutic nuclear medicine services and supplies as DHS. Comment: One commenter asserted that the risk of anti-competitive behavior would increase by limiting the PO 00000 Frm 00172 Fmt 4701 Sfmt 4700 parties that may provide nuclear medicine services, which is contrary to our rationale of protecting against abuse and ensuring quality patient care. In contrast, MedPAC referred to the 1994 GAO report (GAO/HEHS–95–2) and supported the inclusion of nuclear medicine as DHS. MedPAC contended that physician self-referral to nuclear medicine facilities undermines fair competition among these facilities because physician investors have a financial incentive to refer patients to the facility they own. Response: We agree with MedPAC regarding potential anti-competitive behavior. Moreover, we do not agree with the other commenter’s assertion that the inclusion of nuclear medicine services and supplies as DHS would limit the types of entities that may provide nuclear medicine services. Rather, the inclusion of these services and supplies as DHS merely limits the type of investors in the entities providing nuclear medicine services and supplies (that is, except for investors in either rural providers (as defined at § 411.356(c)(1) or entities that furnish the services in compliance with the in-office ancillary services exception, our proposal would limit physician investors to those who will not refer patients to the entity). Comment: Several commenters asserted (but did not provide data or other proof) that nuclear medicine services are not at risk for the kind of overutilization that the physician selfreferral law is designed to prevent. Other commenters disagreed with the proposal to include nuclear medicine services and supplies (and, in particular, nuclear cardiology) as DHS. The commenters stated that it is not possible to know if the rise in utilization of nuclear medicine services is due to abuse and believed that we must show evidence that these services are currently being abused before including nuclear medicine services and supplies as DHS. Response: In the August 8, 2005 proposed rule, we referenced several studies concerning overutilization and increases in imaging services being performed in physician offices. We received comments, both data-driven and anecdotal, to support our belief that nuclear medicine services are subject to overutilization when physician selfinterest is present, as is the case in many (but not all) office-based (or nonhospital) imaging procedures. We must emphasize, however, that our decision to include nuclear medicine as a DHS is based upon our current knowledge of nuclear medicine. We believe it is appropriate to interpret the DHS E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations categories described in section 1877(h)(6)(D) and (E) of the Act to include diagnostic nuclear medicine services and supplies and therapeutic nuclear medicine services and supplies, respectively. Although we are conscious of a possible correlation between increased utilization and a showing of abuse, in the January 4, 2001 final rule with comment (66 FR 860), we stated that we did not believe the Congress intended us to review every possible service within a DHS category to determine its potential for overutilization. The Congress has already made the determination that the services in each of the eleven DHS categories are potentially subject to overutilization or other abuse. The risk of abuse and the potential for anti-competitive behavior inherent in physician self-referrals for nuclear medicine services simply provide additional support in favor of including nuclear medicine as DHS. Comment: One commenter claimed that the increase in utilization of nuclear imaging services and supplies is due, at least in part, to the shift in site of service from the hospital setting to the physician office as well as a change in the standard of care in the treatment of patients due to improved technology and its applications. The commenter asserted that physician self-referral does not appear to be the primary driver of growth in imaging services, citing a study that shows that access to imaging technology, even in the absence of financial incentives, will result in increased utilization. The commenter contended that ‘‘eliminating the ability of specialty physicians to perform and interpret imaging tests in their offices is not protection against the growth in utilization.’’ Response: We are aware of the apparent shift in the site of service. However, we do not believe that the change in site of service accounts for all, or even most, of the increase in Medicare payments for nuclear medicine services. In fact, in its March 2005 ‘‘Report to the Congress: Medicare Payment Policy’’, MedPAC indicated that about 80 percent of the increase in the volume and intensity of imaging services, including nuclear medicine, between 1999 and 2002, was unrelated to any shift in service setting. We disagree with the commenter that inclusion of nuclear medicine services and supplies as DHS necessarily will prohibit physicians from performing and interpreting imaging tests in their offices. Certain arrangements and referrals may qualify for protection under existing provisions of the physician self-referral law and VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 regulations (for example, the in-office ancillary services exception). In addition, even if we assume the commenter’s sources are correct and utilization will increase with access to technology regardless of financial incentives for the referring physician, this does not affect the definition of radiology and radiation therapy, nor does it affect the proper inclusion of nuclear medicine services and supplies in these categories of DHS. We also note that, even if not the main ‘‘driver’’ of overutilization, self-interested referrals that cause any overutilization are problematic. d. Beneficiary Access We received numerous comments regarding the impact of our provision on beneficiary access to care. Our responses to these comments follow. Comment: Several commenters expressed concern that our proposal would limit beneficiary access to nuclear medicine services. The AMA expressed concern about the potential impact of our proposal with regard to disruption of patient care, as well as access to these services. One of the commenters believes that our proposal will have a negative impact on the availability of PET scans, which constitute an important share of Medicare-covered nuclear imaging. In addition, another commenter raised concerns about where physicians would send patients for PET/CT scans. Response: We recognize that the inclusion of nuclear medicine as a DHS may cause some changes in physician ownership of, or investment interests in PET centers; however, we do not agree with the commenters’ assertions that our proposal would disrupt patient care and limit access to nuclear medicine services such as PET scans. We believe that most patients will continue to receive nuclear medicine services in the same location or vicinity where those services had been provided before. We see no reason why other providers or entities in the vicinity of existing PET centers would not be available or become available to furnish these services should a physician choose to divest any ownership or investment interest in an entity that furnishes nuclear medicine services. Alternatively, by restructuring their arrangements to comply with an existing exception, physicians may be able to continue referring patients to the same location for nuclear medicine services. In other words, whereas this rule may affect a physician’s ability to refer to a PET center with which he or she has a financial relationship, there should be either alternative entities PO 00000 Frm 00173 Fmt 4701 Sfmt 4700 70287 available to provide the services in the same setting or alternative business structures that would permit the physician to continue furnishing the services to his or her own patients. Other commenters, such as MedPAC, have also noted that there are a large number and variety of settings in which nuclear medicine services are available (such as hospitals, freestanding centers that are not owned by physicians, and physician offices). Therefore, we believe there would be no decrease in beneficiary access to care. Nevertheless, we have taken steps, as described in our discussion of the delayed effective date, to minimize any potential disruption of patient care or access to these services. Comment: One commenter stated that there were not many PET scanners in the State of Oklahoma, and thus, patients would have to travel long distances for testing. Response: We do not believe that this regulatory change will cause any significant disruption in patient care. The only referrals for PET scans that our proposal would prohibit are those made by physicians whose financial relationship with the entity furnishing the PET scans does not satisfy an exception such as the in-office ancillary services exception or the rural provider exception. If the financial relationship is an ownership interest in a non-rural provider, the physician may: (1) Divest the interest; (2) restructure the financial relationship so that it complies with an exception; or (3) maintain the interest and refer his or her patients to another entity for PET scans. If the physician chooses to divest or appropriately restructure his interest in the PET center, the physician’s subsequent referrals to the PET center would not be prohibited under section 1877 of the Act, provided that the physician has no other financial relationship with the entity that fails to comply with an exception. We believe that the rural provider exception will ensure that beneficiaries in rural areas have continued access to nuclear medicine services. Comment: One commenter expressed concern that if PET services are reclassified as DHS, physicians will be prevented from performing this service in mobile coaches due to the exclusion of mobile settings from the in-office ancillary exception. The commenter contended that beneficiary access will be limited where physicians cannot afford to operate PET services at fixed locations. The commenter requested that the final rule exclude PET services from DHS, or, in the alternative, create an exemption for physician ownership arrangements of PET units that contain E:\FR\FM\21NOR2.SGM 21NOR2 70288 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations certain intrinsic checks against overutilization. Response: The commenter is correct that nuclear medicine services such as PET furnished in mobile coaches would not satisfy the ‘‘same building’’ element of the in-office ancillary services exception. However, if the entity furnishing the mobile services furnishes at least 75 percent of all the DHS it furnishes is to residents of a rural area (as defined in § 411.356(c)(c)(1)), it could meet the requirements of the rural provider exception. The commenter did not specify the nature of any intrinsic checks against overutilization and as we noted in Phase I (66 FR 861), medical necessity reviews and other efforts may not be sufficient to control overutilization. The statute permits us to create an exception only when there is no risk of fraud or program abuse. We have concluded that internal controls or medical necessity reviews are not necessarily effective controls on overutilization, unfair competition, or other abuse. Therefore, we decline to adopt the requested exception. Additionally, we do not agree with the commenter’s assertion that where physicians cannot afford to operate PET centers at fixed locations, the result will be to limit access to beneficiaries. As we have noted above, PET services are furnished in various settings other than physicianowned entities. Therefore, we do not believe our proposal will have a negative impact on beneficiary access. e. Quality of Care Comment: Two physicians disagreed with the proposal to include nuclear medicine services because they believed that the inclusion of nuclear medicine would reduce quality of care to patients. One of the physicians expressed specific concern about the timeliness of diagnosis and initiation of therapy. The physician recommended that we disseminate evidence-based guidelines on the appropriate use of nuclear medicine procedures for diagnosis and treatment, and measurement of the quality of the service provided. Additionally, the commenter suggested that Medicare reimbursement should be site-neutral, ownership-neutral, and based on the clinical appropriateness, safety, and quality of the service provided. Response: We do not believe that the inclusion of nuclear medicine as a DHS would reduce quality of care. We have no data, and the commenter furnished no data or anecdotal evidence, to support the physician’s contention that nuclear medicine facilities owned by non-physicians furnish lower quality of care, as may be evidenced by delays in VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 diagnosis and the initiation of treatment. Regarding the commenter’s other recommendations, this regulation is not the appropriate vehicle for addressing the development of evidence-based guidelines, measurement of the quality of the service, and changes in Medicare reimbursement. Comment: One commenter stated that the increased referrals and physician investment may not be attributable to financial incentives but rather may be attributable to improved services and diagnosis achieved by utilizing better equipment. The commenter expressed concern that the adoption of this provision could have a negative impact on the future provision of quality health care as physicians may hesitate to invest in new technology or services. The commenter contended that patient care has improved due to physician investment in entities providing nuclear medicine and PET services. Specifically, the commenter stated that the ability to invest in new technology has led to improved diagnostic and treatment ability, and lower costs and improved patient care. In addition, the commenter stated that physician investment has led to increased access to these services. According to the commenter, nuclear medicine and PET scan services require more expensive equipment than traditional radiology services and therefore physician investment in this equipment fills a necessary gap where large care providers have been unable to afford such equipment or choose not to acquire such equipment. Response: We recognize that in some instances, new technology has led to improved diagnostic and treatment lower costs, and improved patient care; however, this final rule with comment does not prevent physicians from furnishing nuclear medicine services or utilizing better nuclear medicine equipment. Rather, and consistent with the purposes of the statute, the provisions of this final rule with comment restrict the circumstances under which physicians can financially benefit from DHS they order. Moreover, we believe that many non-physician owned entities will invest in new technology or new services and that quality of care will not be affected because most physicians will continue to refer patients for medically necessary services even where there is no potential for personal profit. Finally, we note that the commenters offered no evidence to support their claim that physician ownership of nuclear medicine facilities results in improved quality of care. PO 00000 Frm 00174 Fmt 4701 Sfmt 4700 Comment: Some commenters opposed our proposal as it related to nuclear cardiology services, which the commenters asserted are integral to the diagnosis of heart disease and are performed primarily by cardiologists. One commenter stated that our proposal would prevent cardiologists from referring their patients for these services, thus causing primary care practitioners to refer these same patients directly to radiologists for nuclear testing, effectively bypassing a cardiologist’s input on the appropriate approach to cardiac testing. The commenter asserted that nuclear medicine services performed in hospitals will be interpreted by radiologists who do not possess the specialized skills of cardiologists, and that our proposal would, therefore, negatively affect patient care. Response: We are not persuaded by the commenters’ concerns. First, our proposal would not prohibit a cardiologist from referring patients for nuclear medicine services; it would merely prohibit the physician from referring patients for these services to entities with which the physician has a financial relationship if that financial relationship does not comply with an existing exception. Second, we do not believe that patient care would be negatively affected if a cardiologist had to refer patients to a hospital for nuclear cardiology tests that would be interpreted by a radiologist. We are not convinced that cardiologists are the only individuals qualified to interpret these tests. Moreover, we believe that hospitals have every incentive to ensure that such tests are interpreted by qualified physicians (including cardiologists, if necessary). Comment: Another commenter suggested that the inclusion of nuclear medicine as a DHS will limit the development of diagnostic testing facilities and thereby make the hospital setting the only permissible setting for nuclear cardiology. Response: We do not agree that the effect of this rule will be to make the hospital setting the only permissible setting for nuclear cardiology. Physician-owned diagnostic testing facilities are not prohibited if the physician owners do not refer patients to the facilities or if the financial relationship complies with another exception, such as the rural provider or in-office ancillary services exceptions. Additionally, as MedPAC noted, there are numerous other types of nonhospital entities or non-physician owned entities that currently furnish these services. E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations f. Grandfathering Existing Arrangements or Delaying the Effective Date In the August 8, 2005 proposed rule, we requested comments as to whether, or how, to minimize the impact on physicians who are currently parties to arrangements that involve nuclear medicine services and supplies (that is, by grandfathering certain arrangements, or by specifying a delayed effective date). Most commenters addressed this aspect of the proposed rule and either requested that current financial arrangements be grandfathered or recommended a delay in the effective date of our proposal. Comment: Many commenters supported a delayed effective date for our proposal. Commenters suggested various lengths of delay in implementing our proposal. Several commenters favored delaying the effective date for three to six months. One of the commenters suggested that physicians should have at least five years to divest themselves of existing ownership or investment interests. This commenter believed that this would be the minimum period for physicians to recover a fair share of their capital investments and dispose of their assets without having to resort to ‘‘bargain basement’’ sales. The Society of Nuclear Medicine strongly encouraged a phasedin implementation over two to three years to decrease the chances that patient access would be compromised. The ACR recommended an effective date of January 1, 2006 with a 1-year ‘‘grace period’’ prior to enforcement. Response: We have carefully considered the impact of our proposal on both beneficiaries and physicians. We have also considered our duty to implement the statute. Given our conclusion that nuclear medicine services and supplies are radiology and radiation therapy services and supplies, we do not believe we can delay the effective date beyond a reasonable period of time. After weighing these considerations, we have decided to delay the effective date of this regulatory change until January 1, 2007. We believe this delay provides adequate notice to the general public and a reasonable length of time for physicians to divest any existing ownership interests or to restructure their financial relationships with nuclear medicine VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 entities so that they comply with a statutory or regulatory exception (if that is the course of action they choose to take), without unduly delaying our statutory duty to implement the statute. We are aware that many of the financial arrangements concerning nuclear medicine entities are complex and involve ownership, investment, and leasing arrangements. Accordingly, we are rejecting commenters’ suggestions for a shorter or longer delay in implementation as being impractical or unreasonable. Comment: Many commenters recommended that current financial arrangements be grandfathered and that the process be clearly implemented with as little administrative burden as possible. For example, some commenters urged us to grandfather existing PET joint ventures. The AMA stated its belief that CMS has the authority to implement a grandfather clause, and urged us to use it to avoid ‘‘fire sales’’ wherein physicians may not be able to recover the initial costs of their investment due to much greater supply than demand. Another commenter expressed a similar belief that the sales prices will reflect the forced nature of an immediate need to sell and be significantly below the prices that could be obtained in the absence of a grandfather provision. The commenter stated that ‘‘even if CMS allowed a three to five year period to divest, investors may still not receive the full value of their investment.’’ A physician stated that he and other physicians took risk by investing in nuclear medicine entities and believed that they should not have to divest their interest. Therefore, the physician advocated that we grandfather existing establishments and present ownership structures. Another commenter suggested that we grandfather financial relationships that were established prior to the effective date of the proposed rule. A few commenters objected to grandfathering for several reasons including—(1) There was no precedent for grandfathering; (2) the statute does not permit grandfathering; and (3) to do so would negate the intent of the proposal. Response: After reconsidering the issue, we question whether we have the PO 00000 Frm 00175 Fmt 4701 Sfmt 4700 70289 authority to grandfather existing arrangements. Grandfathering existing arrangements would essentially require the creation of a new exception for physician financial relationships with certain nuclear medicine facilities. We have authority to create exceptions only for arrangements that pose no risk of patient or program abuse. We believe that physician self-referrals for diagnostic and therapeutic nuclear medicine services and supplies pose a risk of abuse, and we do not believe this risk is mitigated or eliminated simply because financial relationship was acquired before a particular date. Therefore, we have decided not to grandfather existing financial relationships between physicians and nuclear medicine facilities. However, we believe our decision to specify a delayed effective date will provide physicians with sufficient time to divest their ownership interests or to restructure appropriately existing financial arrangements. 2. Revisions to the List of Codes Identifying Nuclear Medicine Services We have carefully reviewed the list of codes identifying nuclear medicine services and supplies (Nuclear Medicine Code List), as published in Addendum G of the August 8, 2005 PFS proposed rule. We have identified various additions and deletions. Table 31 reflects the addition of new CPT and HCPCS codes that become effective January 1, 2006 or that became effective since the publication of the proposed rule. Table 31 also reflects the addition of codes that will be recognized by Medicare for payment purposes effective January 1, 2006. Table 31 reflects the deletions necessary to conform the Nuclear Medicine Code List to the most recent publications of CPT and HCPCS codes. We have also deleted all C codes listed in the proposed rule because these are hospital outpatient services and are thus included in a different DHS category. Table 31 identifies the nuclear medicine codes that will be included (effective January 1, 2007) in the DHS categories of radiology and certain other imaging services and radiation therapy services and supplies. BILLING CODE 4120–01–U E:\FR\FM\21NOR2.SGM 21NOR2 VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00176 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.060</GPH> 70290 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00177 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70291 ER21NO05.061</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00178 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.062</GPH> 70292 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00179 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70293 ER21NO05.063</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00180 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.064</GPH> 70294 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70295 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00181 Fmt 4701 Sfmt 4700 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.065</GPH> BILLING CODE 4120–01–C 70296 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations C. Annual Update to the Code List In § 411.351, we specify that the entire scope of four DHS categories is defined in a list of CPT/HCPCS codes (the Code List), which is updated annually to account for changes in the most recent CPT and HCPCS publications. The DHS categories defined and updated in this manner are: • Clinical laboratory services. • Physical therapy, occupational therapy, and speech-language pathology services. • Radiology and certain other imaging services. • Radiation therapy services and supplies. The updated Code List appears as Addendum H in this PFS final rule with comment and is available on our Web site at https://cms.hhs.gov/medlearn/ refphys.asp. We also include in the Code List those items and services that may qualify for either of the following two exceptions to the physician selfreferral prohibition: • EPO and other dialysis-related drugs furnished in or by an ESRD facility (§ 411.355(g)). VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 • Preventive screening tests, immunizations or vaccines (§ 411.355(h)). The Code List was last updated in the CY 2005 PFS final rule (69 FR 66236). The updated all-inclusive Code List effective January 1, 2006 (except as otherwise noted for specific nuclear medicine codes) is presented in Addendum H of this final rule with comment. 1. Response to Comments We received the following comment: Comment: One commenter suggested incorporating the Code List in the National Physician Fee Relative Value File as discussed in the CY 2005 PFS final rule (69 FR 66373). Response: We have decided not to incorporate the Code List into the National Physician Fee Relative Value File as suggested by the commenter. That file is updated quarterly and would entail a quarterly update to the PFS. In discussions with the commenter (an association representing medical group practices), we learned that its primary goal was to have the Code List in a format that could be downloaded. The previous Code Lists were generally posted on our web site as PDF files that PO 00000 Frm 00182 Fmt 4701 Sfmt 4700 could not be downloaded. Therefore, we will be posting the updated Code List on our physician self-referral Web site in an Excel spreadsheet that may be downloaded. 2. Revisions Effective for 2006 Tables 32 and 33, in this section, identify the additions and deletions, respectively, to the comprehensive Code List published in Addendum L of the CY 2005 PFS final rule. Tables 32 and 33 also identify the additions and deletions to the lists of codes used to identify the items and services that may qualify for the exceptions in § 411.355(g) (regarding EPO and other dialysis-related outpatient prescription drugs furnished in or by an ESRD facility) and in § 411.355(h) (regarding preventive screening tests, immunizations and vaccines). We will consider comments for the codes listed in Tables 32 and 33, if we receive them by the date specified in the DATES section of this final rule with comment. We will not consider any comment that advocates a substantive change to any of the DHS defined in § 411.351. BILLING CODE 4120–01–U E:\FR\FM\21NOR2.SGM 21NOR2 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00183 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70297 ER21NO05.066</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations BILLING CODE 4120–01–C The additions specified in Table 32 generally reflect new CPT and HCPCS codes that become effective January 1, 2006 or that became effective since our last update. Table 32 also reflects the addition of codes that will be recognized by Medicare for payment purposes effective January 1, 2006. It does not reflect the addition of the nuclear medicine codes that were discussed in section V.B.2 of this preamble. For the convenience of physicians and DHS entities, nuclear medicine codes appear on Addendum H with an asterisk to indicate that they will become effective on January 1, 2007 for physician self-referral purposes. As a result of reviewing nuclear medicine codes as set forth in the CPT, we are adding CPT 78267 and 78268 for VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 urea breath tests and analyses to the DHS category of clinical laboratory services. Although these codes appear under the nuclear medicine subheading in the CPT, they do not represent imaging services. Therefore, we do not consider CPT 78267 and 78268 radiology or other imaging services. We are adding these codes to the Code List under the clinical laboratory services category. This is consistent with our payment policy, since these codes are reimbursed under the clinical laboratory fee schedule. We note that there are other tests involving the use of radiopharmaceuticals (for example, CPT 83519) that are identified by the Code List as clinical laboratory services. Additionally, we are adding CPT code 92506 for the evaluation of speech, PO 00000 Frm 00184 Fmt 4701 Sfmt 4700 language, voice, communication, and/or auditory processing. We had deleted this code in the Phase II physician selfreferral interim final rule published on March 26, 2004 (69 FR 16054) because it represented an audiology service. However, Medicare does not provide reimbursement for CPT code 92506 as an audiology service. Under Medicare, that code is only reimbursed as a speech-language pathology service and therefore must be added to the Code List. VI. Physician Fee Schedule Update for CY 2006 A. Physician Fee Schedule Update The PFS update is determined using a formula specified by statute. Under section 1848(d)(4) of the Act, the update E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.067</GPH> 70298 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations is equal to the product of 1 plus the percentage increase in the Medicare Economic Index (MEI) (divided by 100) and 1 plus the update adjustment factor (UAF). For CY 2006, the MEI is equal to 2.8 percent (1.028). The UAF is ¥7.0 percent (0.930). The product of the MEI (1.028) and the UAF (0.930), equals the CY 2006 update of ¥4.4 percent (0.95604). Our calculations of these figures are explained in this section. B. The Percentage Change in the Medicare Economic Index (MEI) The MEI measures the weightedaverage annual price change for various inputs needed to produce physicians’ services. The MEI is a fixed-weight input price index, with an adjustment for the change in economy-wide multifactor productivity. This index, which has 2000 base year weights, is VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 comprised of two broad categories: physician’s own time and physician’s PE. The physician’s own time component represents the net income portion of business receipts and primarily reflects the input of the physician’s own time into the production of physicians’ services in physicians’ offices. This category consists of two subcomponents: (1) Wages and salaries; and (2) fringe benefits. The physician’s PE category represents nonphysician inputs used in the production of services in physicians’ offices. This category consists of wages and salaries and fringe benefits for nonphysician staff and other nonlabor inputs. The physician’s PE component also includes the following categories of nonlabor inputs: Office expense; medical materials and supplies; PO 00000 Frm 00185 Fmt 4701 Sfmt 4700 70299 professional liability insurance; medical equipment; and other expenses. The components are adjusted to reflect productivity growth in physicians’ offices by the 10-year moving average of productivity in the private nonfarm business sector. Table 34 presents a listing of the MEI cost categories with associated weights and percent changes for price proxies for the 2006 update. For CY 2006, the increase in the MEI is 2.8 percent, which includes a 1.0 percent productivity offset based on the 10-year moving average of multifactor productivity. This is the result of a 3.2 percent increase in physician’s own time and a 4.4 percent increase in physician’s PE. Within the physician’s PE, the largest increase occurred in professional liability insurance, which increased 13.7 percent. BILLING CODE 4120–01–U E:\FR\FM\21NOR2.SGM 21NOR2 70300 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00186 Fmt 4701 Sfmt 4700 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.068</GPH> BILLING CODE 4120–01–C Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations C. The Update Adjustment Factor Section 1848(d) of the Act provides that the PFS update is equal to the product of the MEI and the UAF. The UAF is applied to make actual and target expenditures (referred to in the statute as ‘‘allowed expenditures’’) equal. Allowed expenditures are equal to actual expenditures in a base period updated each year by the sustainable growth rate (SGR). The SGR sets the annual rate of growth in allowed expenditures and is determined by a formula specified in section 1848(f) of the Act. 1. Calculation Under Current Law Under section 1848(d)(4)(B) of the Act, the UAF for a year beginning with 2001 is equal to the sum of the following— • Prior Year Adjustment Component. An amount determined by— + Computing the difference (which may be positive or negative) between the amount of the allowed expenditures for physicians’ services for the prior VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 year (the year prior to the year for which the update is being determined) and the amount of the actual expenditures for those services for that year; + Dividing that difference by the amount of the actual expenditures for those services for that year; and + Multiplying that quotient by 0.75. • Cumulative Adjustment Component. An amount determined by— + Computing the difference (which may be positive or negative) between the amount of the allowed expenditures for physicians’ services from April 1, 1996, through the end of the prior year and the amount of the actual expenditures for those services during that period; + Dividing that difference by actual expenditures for those services for the prior year as increased by the SGR for the year for which the UAF is to be determined; and + Multiplying that quotient by 0.33. Section 1848(d)(4)(E) of the Act requires the Secretary to recalculate allowed expenditures consistent with PO 00000 Frm 00187 Fmt 4701 Sfmt 4700 70301 section 1848(f)(3) of the Act. Section 1848(f)(3) specifies that the SGR (and, in turn, allowed expenditures) for the upcoming CY (2006 in this case), the current CY (2005) and the preceding CY (2004) are to be determined on the basis of the best data available as of September 1 of the current year. Allowed expenditures are initially estimated and subsequently revised twice. The second revision occurs after the CY has ended (that is, we are making the final revision to 2004 allowed expenditures in this final rule with comment). Once the SGR and allowed expenditures for a year have been revised twice, they are final. Table 35 shows annual and cumulative allowed expenditures for physicians’ services from April 1, 1996 through the end of the current CY, including the transition period to a CY system that occurred in 1999. Also shown is the SGR corresponding with each period. The calculation of the SGR is discussed in detail below. BILLING CODE 4120–01–P E:\FR\FM\21NOR2.SGM 21NOR2 VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00188 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.069</GPH> 70302 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70303 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00189 Fmt 4701 Sfmt 4700 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.070</GPH> BILLING CODE 4120–01–C 70304 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations Consistent with section 1848(d)(4)(E) of the Act, Table 35 includes our final revision of allowed expenditures for 2004, a recalculation of allowed expenditures for 2005, and our initial estimate of allowed expenditures for 2006. To determine the UAF for 2006, the statute requires that we use allowed UAF = and actual expenditures from April 1, 1996 through December 31, 2005 and the 2006 SGR. Consistent with section 1848(d)(4)(E) of the Act, we will be making further revisions to the 2005 and 2006 SGRs and 2005 and 2006 allowed expenditures. Because we have incomplete actual expenditure data for 2005, we are using an estimate for this period. Any difference between current estimates and final figures will be taken into account in determining the UAF for future years. We are using figures from Table 35 in the statutory formula illustrated below: T arg et 05 − Actual05 T arg et 4 / 96 −12 / 05 − Actual4 / 96 −12 / 05 × .75 + × .33 Actual05 Actual05 × SGR 06 UAF = Update Adjustment Factor Target05 = Allowed Expenditures for 2005 or $80.4 billion Actual05 = Estimated Actual Expenditures for 2005 = $93.3 billion Target 4/96–12/05 = Allowed Expenditures from 4/1/1996–12/31/2005 = $611.8 billion Actual 4/96–12/05 = Estimated Actual Expenditures from 4/1/1996–12/31/ 2005 = $642.5 billion SGR06 = 1.7 percent (1.017) VII. Allowed Expenditures for Physicians’ Services and the Sustainable Growth Rate A. Medicare Sustainable Growth Rate The SGR is an annual growth rate that applies to physicians’ services paid by Medicare. The use of the SGR is intended to control growth in aggregate Medicare expenditures for physicians’ services. Payments for services are not withheld if the percentage increase in actual expenditures exceeds the SGR. Rather, the PFS update, as specified in section 1848(d)(4) of the Act, is adjusted based on a comparison of allowed expenditures (determined using the SGR) and actual expenditures. If actual expenditures exceed allowed expenditures, the update is reduced. If actual expenditures are less than allowed expenditures, the update is increased. Section 1848(f)(2) of the Act specifies that the SGR for a year (beginning with 2001) is equal to the product of the following four factors: VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 (1) The estimated change in fees for physicians’ services; (2) The estimated change in the average number of Medicare fee-forservice beneficiaries; (3) The estimated projected growth in real gross domestic product (GDP) per capita; and (4) The estimated change in expenditures due to changes in statute or regulations. In general, section 1848(f)(3) of the Act requires us to publish SGRs for 3 different time periods, no later than November 1 of each year, using the best data available as of September 1 of each year. Under section 1848(f)(3)(C)(i) of the Act, the SGR is estimated and subsequently revised twice (beginning with the FY and CY 2000 SGRs) based on later data. (There were also provisions in the Act to adjust the FY 1998 and FY 1999 SGRs. See the February 28, 2003 Federal Register (68 FR 9567) for a discussion of these SGRs). Under section 1848(f)(3)(C)(ii) of the Act, there are no further revisions to the SGR once it has been estimated and subsequently revised in each of the 2 years following the preliminary estimate. In this final rule with comment, we are making our preliminary estimate of the 2006 SGR, a revision to the 2005 SGR, and our final revision to the 2004 SGR. B. Physicians’ Services Section 1848(f)(4)(A) of the Act defines the scope of physicians’ services covered by the SGR. The statute indicates that ‘‘the term ‘physicians’ services’ includes other items and PO 00000 Frm 00190 Fmt 4701 Sfmt 4700 services (such as clinical diagnostic laboratory tests and radiology services), specified by the Secretary, that are commonly performed or furnished by a physician or in a physician’s office, but does not include services furnished to a Medicare+Choice plan enrollee.’’ We published a definition of physicians’ services for use in the SGR in the Federal Register (66 FR 55316) on November 1, 2001. We defined physicians’ services to include many of the medical and other health services listed in section 1861(s) of the Act. For purposes of determining allowed expenditures, actual expenditures, and SGRs, we have specified that physicians’ services include the following medical and other health services if bills for the items and services are processed and paid by Medicare carriers (and those paid through intermediaries where specified): • Physicians’ services. • Services and supplies furnished incident to physicians’ services. • Outpatient physical therapy services and outpatient occupational therapy services. • Antigens prepared by, or under the direct supervision of, a physician. • Services of physician assistants, certified registered nurse anesthetists, certified nurse midwives, clinical psychologists, clinical social workers, nurse practitioners, and certified nurse specialists. • Screening tests for prostate cancer, colorectal cancer, and glaucoma. E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.000</MATH> Section 1848(d)(4)(D) of the Act indicates that the UAF determined under section 1848(d)(4)(B) of the Act for a year may not be less than ¥0.070 or greater than 0.03. Since ¥0.210 is less than ¥0.070, the UAF for 2005 will be ¥0.070. Section 1848(d)(4)(A)(ii) of the Act indicates that 1 should be added to the UAF determined under section 1848(d)(4)(B) of the Act. Thus, adding 1 to ¥0.070 makes the UAF equal to 0.930. ER21NO05.001</MATH> $80.4 − $93.3 $611.8 − $642.5 × .75 + × .33 = − 0.210 $93.3 $93.3 × 1.017 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations • Screening mammography, screening pap smears, and screening pelvic exams. • Diabetes outpatient selfmanagement training services. • Medical nutrition therapy services. • Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests (including outpatient diagnostic laboratory tests paid through intermediaries). • X-ray, radium, and radioactive isotope therapy. • Surgical dressings, splints, casts, and other devices used for the reduction of fractures and dislocations. • Bone mass measurements. • An initial preventive exam. • Cardiovascular screening blood tests. • Diabetes screening tests. • Telehealth services. • Physician work and resources to establish and document the need for a power mobility device (see 70 FR 50940). Telehealth services and the power mobility device related services have been added because they meet the statutory criteria for services to be included in the SGR (that is, these services are commonly performed or furnished by a physician or in a physician’s office). We appreciate the tremendous number of comments we received expressing concern about the negative update for 2006. Those comments are summarized below, along with our responses. Comment: Commenters noted that physicians’ costs are rising, while fees are being cut. The cumulative impact of the projected reductions from 2006 to 2012 will be about ¥27 percent, while the MEI increase over this same period is projected to be 19 percent. Commenters predict that, based on the MEI alone, payments should increase by 3.5 percent in 2006. Instead, payments are being reduced. Because commercial insurance carriers base their payment updates upon Medicare’s PFS, the overall negative impact is compounded. Many comments predict that costs to provide care will soon exceed reimbursement. The result will be that patient quality of care will be compromised, with doctors taking drastic measures to cut costs of health care delivery to remain solvent. Eventually, physicians will be unable to absorb the losses, and they will refuse or limit Medicare patients, resulting in reduced access to care. Costs will shift to inpatient settings, which will be more costly for Medicare, less efficient in delivering care, and yield worse health outcomes for beneficiaries. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Commenters recommend that the SGR be replaced with an appropriate inflation rate (for example, the projected change in prices or the MEI). Updates should be linked to changes in the actual costs of medical practice. Response: We are fully cognizant of the potential implications of seven years of negative physician updates, remain concerned regarding those trends, and are closely monitoring physicians’ participation in the Medicare program, as well as beneficiaries’ access to care. At the same time, simply increasing spending by adding larger updates into the current volume-based payment system that is already experiencing increases of 12 to 13 percent or more per year would have an adverse effect from the standpoint both Medicare’s finances and beneficiary premiums and costsharing, and therefore would not promote better quality care. However, it is clear, under our current system, that there is much potential for physicians to improve the value of our health care spending. Under the current system, there are substantial variations in resources and in spending growth for the same medical condition in different practices and in different parts of the country, without apparent differences in quality and outcomes, and without a clear basis in existing medical evidence. A study published in 2003 looked at regional variations in the number of services received by Medicare patients who were hospitalized for hip fractures, colorectal cancer, and acute myocardial infarction.6 The researchers found that patients in higher spending areas received approximately 60 percent more care, but that quality of care in those regions was no better on most measures and was even worse for several preventive care measures. Further, there are many examples of steps that physicians can take to improve quality while helping to keep overall costs down (for example, management of diabetic patients may result in reduced hospital admissions). Because it is critical for CMS payment systems to support better outcomes for our beneficiaries while safeguarding Medicare’s finances, we are working closely and collaboratively with medical professionals and the Congress to consider changes to increase the effectiveness of the payment methodology Medicare uses to 6 Fisher, Elliott S., MD, MPH; David E. Wennberg, MD, MPH; Therese A. Stukel, Ph.D.; Daniel J. Gottlieb, MS; F.L. Lucas, Ph.D.; and Etoile L. Pinder, MS, ‘‘The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care,’’ in The Annals of Internal Medicine, February 18, 2003, Vol 138, Issue 4. PO 00000 Frm 00191 Fmt 4701 Sfmt 4700 70305 compensate physicians for providing services to Medicare beneficiaries. We are engaging physicians on issues of quality and performance with the goal of supporting the most effective clinical and financial approaches to achieve better health outcomes for Medicare beneficiaries. We are committed to developing reporting and payment systems that enable us to support and reward quality, and to improve care without increasing overall Medicare costs. When clear, valid and widely accepted quality measures are in place, pay-for-performance is a tool that can enable our reimbursement methodology to better support efforts to improve quality and to avoid unnecessary costs. Currently, hospitals and physicians are paid under separate systems. Under these systems, physicians do not receive credit for avoiding unnecessary hospitalizations by providing better care to their patients. However, in our physician group practice demonstration project, physicians could receive performance-based payments derived from savings from preventing chronic disease complications, avoiding hospitalizations, and improving quality of care. The evidence is increasing that when healthcare providers are given incentives for achieving higher quality care, they respond by taking a range of steps from the simple to the high-tech to improve care and reduce costs (for example, by avoiding unnecessary hospital care). This is not surprising, as our health professionals are dedicated, and they want to do everything in their power to get the best care to their patients. So when we support high quality care, we enable professionals to do what they do best. We have seen this approach work first-hand with hospital payments where we have tied the annual hospital payment update to quality measure reporting. It has had a positive impact on the availability of quality information, with about 98 percent of the hospitals subject to this provision reporting quality data. Reporting clinically valid quality measures is an important step toward achieving major improvements in quality. If you cannot measure something, it is hard to take steps to improve it. We have been working hard in close collaboration with health professionals and other stakeholders to promote the development of better measures for reporting on the quality of care. Comment: Most commenters support the overall development of measures related to the quality and efficiency of care furnished by physicians, but many E:\FR\FM\21NOR2.SGM 21NOR2 70306 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations are concerned that the promotion of high quality health care is incompatible with the current SGR system. Any performance measures may involve additional services or administrative actions, and will exacerbate the problems with the current volume-based update formula. Some commenters note that many electronic health record systems with decision support tools specifically prompt physicians to perform additional diagnostic tests and screenings, which, in turn, could offset any projected savings. Overall, pay-forperformance will drive spending over the target, negatively impacting future updates, and thereby penalizing physicians for participating in pay-forperformance. Commenters also expressed the concern that health information technology systems, a key component of many pay for performance programs, will be unaffordable to physicians facing payment cuts. Response: Medicare needs to encourage and reward efficiency and high quality care, and not simply pay for more services, regardless of the quality of those services or of the impact that those services have on patient health. Currently, the physician payment system does not always recognize clinically appropriate care. For example, Medicare will pay for a duplicate x-ray or blood test right before surgery if a hospital does not coordinate care adequately with the physician’s office. The physician payment system should support, encourage, and provide an incentive for physicians to improve quality and reduce unnecessary Medicare costs by avoiding unnecessary services (like duplicate tests). Another way the current physician payment system fails to encourage clinically appropriate care is the way in which it tends to steer patient care decisions. Oncologists, for example, are paid less for transitioning a terminal patient to palliative care and focusing on quality of life issues, than for recommending and providing intensive procedures, even if the side effects of those procedures are significant and the benefits negligible. In addition, the current payment system does not reward physicians who actively prevent readmissions for patients with heart failure or diabetes. Linking a portion of Medicare payments to valid measures of quality and effective use of resources could give physicians more direct incentives to implement the innovative ideas and approaches that actually result in improvements in both the value and VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 quality of care that people with Medicare receive. We have been working on the technical methods for supporting effective, simple, and least burdensome reporting and payment based on these measures. In the years ahead, it is expected that electronic record systems can be developed that would provide information that is needed to measure and report on quality while fully protecting patient confidentiality. However, while electronic health records would greatly facilitate the accurate and efficient use of information on quality measures and quality improvement, progress on supporting quality improvement should not be delayed until electronic health records are widely used. Indeed, taking steps now to promote quality reporting and improvement also could promote the adoption of and investment by physicians in electronic records, which would facilitate more efficient quality reporting and quality improvement activities. In the short term, there is considerable evidence that information on a broad range of quality measures can be obtained adequately via information transmitted on existing claims. Steps will be taken to ensure patient confidentiality when obtaining these quality measures. In addition, we believe that several Federal government actions are creating favorable market conditions for the adoption of health information technology. First, HHS, through the Office of the National Coordinator for Health Information Technology, is leading a public-private partnership to reduce the risk of Health Information Technology investment by: harmonizing health information standards; certifying health IT products to ensure consistency with standards; addressing variations in privacy and security policies that can pose challenges to interoperability; and, developing an architecture for nationwide sharing of electronic health information. Second, two recently proposed rules discussed an exception to the Stark statute and a safe harbor to the anti-kickback statute for eprescribing technology and electronic health records, which would create opportunities for physicians to acquire health information technology free or at a reduced cost. In January 2006, we will start the process of collecting quality information on services provided by physicians in certain specialties and subspecialties through the voluntary reporting of GCodes for quality indicators. The Gcodes were established by Medicare to supplement claims data with clinical data pertinent to a variety of quality PO 00000 Frm 00192 Fmt 4701 Sfmt 4700 measures, without the burdens of chart abstraction. Those quality measures have been achieved through a process of study and consensus with input from physicians and others. Comment: Commenters suggested that we should assume the leadership in pushing the Congress to enact legislation preventing a negative update for 2006, and to replace the SGR with a more sustainable system. They stated that it would be a show of good faith and leadership for CMS to take the administrative action to remove drugs from the SGR and levels of allowed expenditures retroactively to 1996, even prior to legislative action. The commenters opined that if CMS makes the administrative changes now, worth about $111 billion, then the legislative price tag will drop and will increase the likelihood of Congressional action to fix the SGR permanently. Response: We are concerned about the projections of seven years of negative updates to physician payments and are closely monitoring the current volumebased payment system for physicians’ services. The CMS Office of the Actuary (OACT) estimated under its Mid-Session Baseline that removing drugs from the SGR and allowed expenditures retroactively to 1996 would cost $111 billion. We note that our current estimate is that removing drugs prospectively would not provide relief to the negative updates projected for 2006 and the succeeding several years. OACT estimates removing drugs prospectively would cost an additional $36 billion over 10 years. These changes would also have significant impacts on beneficiary premiums. Consequently, while we have carefully reviewed our authority to make this administrative change, we also have been working with the Congress and health professional organizations on payment reforms that would improve the effectiveness of the payment methodology for physicians without increasing overall Medicare costs. Comment: Many commenters indicated that they support removing the costs of Part B covered drugs from the calculation of the SGR, and provided or referenced legal opinions and Congressional support for this view. Some commented that they find no basis in the statute for ever including drugs in the definition of physicians’ services, and CMS is therefore obligated to remove them retroactively from the SGR. Commenters contend that the rapid increase in the price of drugs is a major contributor to increased spending on physician-administered drugs. Therefore, it is not logical to include E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations drugs in calculating the target, because the growth in expenditures on these drugs is not controlled by physicians and reduced payments to physicians will not affect future spending on Part B drugs provided incident to physicians’ services. Some commenters noted that including drugs in the SGR has not led to controls on drug spending and, as a result, removing them would not lead to increased spending on drugs. These commenters opined that spending on drugs is rising far more rapidly than spending on physicians’ and other practitioners’ services. According to these commenters, in 1996 drugs represented 3.7 percent of the physician spending portion of the SGR calculation, but in 2004, drugs represented 9.8 percent. Commenters stated that growth in Medicare spending on drugs is driven primarily by the introduction of expensive new drugs to the Medicare population and extensive marketing (including direct-to-consumer advertising), and that prices are set by drug companies that are not impacted by negative updates to the Medicare physician fee schedule. Some commenters indicated that the increase in drug spending is due to government policies that encourage the rapid development of drugs. Response: The statute provides the Secretary with clear authority to specify the services that are included in the SGR. Section 1848(f)(4)(A) of the Act indicates that the term ‘‘physicians services’’ includes other items and services specified by the Secretary that are commonly performed or furnished by a physician or in a physician’s office. We disagree with the comments suggesting that the Secretary does not have the authority to include drugs in the definition of physicians’ services for purposes of determining allowed expenditures, actual expenditures, and the SGR. We define ‘‘physicians’ services’’ to include many of the medical and other health services listed in section 1861(s) of the Act that meet the criterion of being commonly performed by a physician or furnished in a physicians’ office. Because ‘‘incident to’’ drugs covered under 1861(s) of the Act are commonly furnished in physicians’ offices, we include these items in the calculation of the SGR and allowed expenditures. We have indicated in the past that retrospective removal of drugs from the SGR is statutorily difficult. For example, the statute requires the estimated SGR be refined twice based on actual data. We do not see a legal basis to reestimate the SGR and allowed VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 expenditures for a year after it has been estimated and revised twice. Further, as noted previously, our current estimate is that removing drugs retroactively from the SGR would not result in a positive update for 2006 or the succeeding few years. Comment: CMS has clearly excluded drugs from physicans’ services for purposes of administering other Medicare payment provisions. For example, in the December 13, 2002 Inherent Reasonableness rule (67 FR 76684), CMS applied inherent reasonableness to certain Part B items and services other than physicians’ services as defined and paid for under section 1848 of the Act, stating that drugs are paid under section 1842(o) of the Act and not section 1848 of the Act. In response to comments, CMS asserted that the inherent reasonableness provision should therefore be applied to drugs administered in physicians’ offices. Response: As we pointed out in the December 13, 2002 Federal Register, the statute specifies that inherent reasonableness applies to certain Part B items and services other than physicians’ services as defined and paid for under section 1848 of the Act. Drugs are paid under section 1842(o) of the Act and not section 1848 of the Act. The application of inherent reasonableness to payments for drugs relates to the payment methodology for drugs, not to whether they are physicians’ services. Accordingly, our decision to permit the application of inherent reasonableness to compute the payment amounts for Part B drugs is not inconsistent with our determination that it is appropriate to include drugs furnished incident to a physician’s services in the definition of physicians’ services for purposes of computing the SGR and actual and allowed expenditures under the physician fee schedule. Comment: We received many comments criticizing the ability of the current SGR methodology to appropriately reflect many factors affecting physician spending. For example, malpractice insurance continues to escalate; there is a general increase in overhead and inflation; and there are additional expenses associated with regulatory compliance for which the SGR is not adjusted. The SGR does not account for trends in utilization attributable to important technological improvements, improved quality of care, and efficiency in the health care system overall. Also, commenters stated that payment updates under the SGR formula are tied to GDP, which bears little relationship to patients’ health care needs or PO 00000 Frm 00193 Fmt 4701 Sfmt 4700 70307 physicians’ practice costs because medical needs of individual patients are not related to the overall economy. Patients’ needs do not diminish in slower economies, and are therefore wholly unrelated to measures of GDP. In addition, Medicare patients have more chronic diseases and require more medications, tests, counseling, and education than the average health care consumer; therefore, the time required to see a Medicare patient is disproportionately high relative to the Medicare payment received. Commenters are concerned that services to Medicare beneficiaries are not adequately reflected in GDP because they are disproportionately more expensive than services provided to the rest of the population. Commenters believe that reliance on GDP makes the SGR an inherently unstable system, and unnecessarily detracts from an appropriate focus on an analysis of actual data regarding the increasing costs of providing physicians’ services to Medicare beneficiaries. The formula fails to consider the growth in beneficiary population and utilization factors unrelated to economic trends. The GDP is a factor beyond physicians’ control and it is inappropriate to use it as a means to control growth in Medicare spending. Response: Under section 1848(d)(4) of the Act, the PFS update is equal to the product of the percentage increase in the MEI and the UAF. The UAF is determined by comparing allowed and actual expenditures from prior years and the current year, and adjusting the update to account for the difference. The SGR is used to calculate allowed expenditures, and the GDP is one of the components used to calculate the SGR. Change in enrollment in fee-for-service Medicare is one of the factors used in computing the SGR. (See section 1848(f)(2)(B) of the Act.) The percentage change in the MEI is one of the key components used to update the PFS CF. In accounting for the weighted average price change for various inputs involved with producing physicians’ services, the MEI measures inflation in physician practice costs and general wage levels. Elements of the MEI include measures of physicians’ PEs, including nonphysician employee compensation, office expenses, medical material and supplies, professional liability insurance, and medical equipment. As noted above in this section, professional liability insurance experienced the largest percentage increase of any component of the MEI for 2006. E:\FR\FM\21NOR2.SGM 21NOR2 70308 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations The GDP is a general measure of economic growth. It is not intended to reflect factors specific to operating a medical practice because these are captured in the MEI. Currently, the statute requires that we use the GDP as a component of the SGD, which is then used to calculate the target level of expenditures. We disagree with the comment that use of GDP makes the SGR inherently unstable. The SGR is based on the 10 year average of GDP, so year-to-year changes are averaged over a significant period, modulating any fluctuations from one year to the next. Comment: Some commenters stated that physicians are penalized with pay cuts when Medicare spending on physicians’ services exceeds the SGR spending target, yet the SGR is not adjusted to take into account many factors beyond physicians’ control, including government policies that, although good for patients, promote Medicare spending on physicians’ services. Specifically, governmentinduced increases in spending on physicians’ services should be accurately reflected in the SGR target. The impact of these government policies on spending for physicians’ services is ignored or underestimated in calculating the target. New government policies often result not only in direct expenditures, but can also lead to ancillary new expenditures that are not appropriately reflected in the target. For example, new preventive benefits can lead to additional physician services, such as office visits. CMS has not provided details as to how its estimates of costs for new benefits are calculated under section 1848(f)(2)(D) of the Act, making it impossible to judge the accuracy of its target adjustments. Commenters also contend there have been a number of regulatory changes that encouraged growth in spending on physicians’ services by shifting services from facilities to physicians’ offices. Services previously provided by facilities (and not included in the calculation of actual and allowed expenditures in the base year) are now provided in physicians’ offices, and are not reflected in the current level of allowed expenditures. For example, the growth in therapy services was influenced by the elimination of costbased reimbursement to many facilities. This led many rehabilitation agencies to terminate their provider numbers and enroll as physical therapists in private practice. It also provided incentives for hospitals to discharge patients sooner, leading to increased therapy services paid under the physician fee schedule. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Commenters urge CMS to adjust for other spending increases attributable to quality improvement programs that trigger physicians’ services. Commenters provided examples of increased administrative demands and costs being imposed upon physicians through Federal program requirements including: transition of new and dually eligible beneficiaries into Medicare Part D drug plans; electronic prescribing; national demonstration on pay for performance; and Medicare policies on competitive acquisition for outpatient drugs and biologicals under Part B. Response: As described previously, the calculation of the SGR is determined by statute. Policy changes due to statute or regulation are required to be accounted for in the SGR calculation. For example, past changes that were expected to result in increased spending for therapy were reflected in prior years’ SGR calculations. (See the CY 2002 Final Rule (66 FR 55320).) Similarly, last year we made an adjustment to the SGR to account for increased Medicare spending for physicians’ services as a result of the MMA provisions providing for Medicare coverage of an initial preventive physical examination, cardiovascular, and diabetes screening tests. (See the CY 2005 Final Rule (69 FR 66388).) Based on subsequent data, we will revise these estimates and adjust the SGR as discussed in section F. of this preamble. Comment: We received many public comments that argued for adjusting the SGR for changes in expenditures resulting from national coverage determinations (NCDs). According to these comments, any changes in national Medicare coverage policy, such as a Program Memorandum or an NCD, constitute regulatory changes for purposes of computing the SGR. The commenters indicate that, because the statute provides the authority to adjust the SGR for statutory or regulatory changes, any new coverage initiative should be taken into account in determining the SGR. Commenters noted that CMS has previously stated that it is very difficult to estimate any costs or savings associated with specific coverage decisions. Additionally, CMS has stated that adjustments to the target for NCDs would likely be of such a small magnitude that it would have little effect on future projected updates. Commenters noted that CMS adjusts Medicare Advantage payments to account for NCDs, so clearly CMS has some means to estimate the costs of NCDs. Some commenters contracted with a private research firm to estimate the costs of several NCDs, to illustrate PO 00000 Frm 00194 Fmt 4701 Sfmt 4700 that it is possible to make such estimates and to provide a sense of their magnitude. These studies indicated that although certain individual NCDs do not significantly increase Medicare spending, some NCDs do have a significant impact. Furthermore, even if individually, the impacts of new NCDs are relatively minor, taken in the aggregate, even those NCDs with marginal impact contribute to rising utilization. Response: The large majority of Medicare spending is for services that are covered at local carrier discretion. While we may establish national coverage (or noncoverage) for a new item or service with a defined statutory benefit category, the NCD does not necessarily increase Medicare spending to the extent that the service has or would have been covered at local carrier discretion in the absence of a NCD. Because Medicare would cover these services without an NCD, it is unclear whether there are any additional costs associated with the NCDs. We may also issue an NCD to clarify Medicare coverage for existing items or services. This decision may establish national policy that replaces differing local practices. In these cases, there may not have been consistency among Medicare carriers as to whether an item or service qualified for coverage based on existing statute or regulation. Thus, our NCD would replace differing local practices with a national determination which, based on existing law and regulations, clarifies Medicare coverage for an item or service. Spending may or may not increase or decrease depending upon the degree to which the particular item or service is currently being covered by Medicare carriers and whether the decision is to establish coverage or noncoverage of the item or service. As a result, at this time, we do not intend to make any adjustment to the SGR to account for new NCDs. We will examine this issue further, for example, to determine the impact of new NCDs on Medicare spending for physicians’ services above and beyond what would happen with LCDs, though we expect that these NCDs would have, at most, a limited impact. Comment: In response to the discussion in the proposed rule about substantial growth in Medicare spending in certain areas, commenters suggested that growth may be due to previously unmet needs that are only now being met. The commenters pointed out that nothing in the data presented suggested that the increased levels of service were inappropriate. Some commenters noted that since the introduction of the SGR methodology E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations many procedures have begun to move from settings, such as outpatient facilities, to physicians’ offices. As a result, the full cost of these procedures is not reflected in either the SGR or allowed expenditures. Commenters believe CMS must recognize this shift in site of service and make appropriate adjustments to the target. Response: We are taking collaborative steps to better understand these trends, including what changes in utilization are likely to be associated with important health improvements and which have limited or questionable health benefits. We have been reviewing the technical aspects of this situation in detail with health policy experts as well as the AMA and various specialty societies. Generally, our analysis indicates that while there are some identifiable factors that have contributed to higher spending, these factors do not account for a substantial part of the growth in spending on physicians’ services. Major contributors to the rapid increase in spending are more frequent and more intensive following visits, more frequent and more complex imaging, more frequent and more intensive minor procedures such as physical therapy, more frequent and more complex laboratory tests, and increased use of drugs in physicians’ offices. There is also a lot of evidence of much variation in the use of these services without much evidence of impact on health outcomes. This variation reinforces our commitment to continuing to develop better evidence on what additional spending is effective as well as to moving our payment system toward recognizing better quality 70309 care. Moreover, the statute does not provide a mechanism for us to recognize additional expenditures on physicians’ services resulting from changes in medical practice that are not also changes in law and regulation. As a result, we do not see any legal basis to make adjustment to the SGR to reflect the additional expenditures associated with these factors. C. Preliminary Estimate of the SGR for 2006 Our preliminary estimate of the 2006 SGR is 1.7 percent. We first estimated the 2006 SGR in March and made the estimate available to the Medicare Payment Advisory Commission and on our web site. Table 36 shows that March 2005 and our current estimates of the factors included in the 2006 SGR. TABLE 36.—2006 SGR CALCULATION Statutory factors March estimate Fees ................................................................................... Enrollment ......................................................................... Real Per Capita GDP ........................................................ Law and Regulation .......................................................... 2.8 percent (1.028) ........................................................... ¥2.5 percent (0.975) ....................................................... 2.3 percent (1.023) ........................................................... 0.0 percent (1.000) ........................................................... 2.7 percent (1.027). ¥3.1 percent (0.969). 2.2 percent (1.022). 0.0 percent (1.000). Total ........................................................................... 2.5 percent (1.025) ........................................................... 1.7 percent (1.017) Note: Consistent with section 1848(f)(2) of the Act, the statutory factors are multiplied, not added, to produce the total (that is, 1.027 × 0.969 × 1.022 × 1.000 = 1.017). A more detailed explanation of each figure is provided in section VII.F.1 of this preamble. D. Revised Sustainable Growth Rate for 2005 Our current estimate of the 2005 SGR is 4.6 percent. Table 37 shows our preliminary estimate of the 2005 SGR Current estimate that was published in the CY 2005 Final Rule (69 FR 66386) and our current estimate. TABLE 37.—2005 SGR CALCULATION Statutory factors Estimate from CY 2005 Final Rule Fees ................................................................................... Enrollment ......................................................................... Real Per Capita GDP ........................................................ Law and Regulation .......................................................... 1.3 percent (1.013) ........................................................... ¥0.3 percent (0.997) ....................................................... 2.2 percent (1.022) ........................................................... 1.0 percent (1.010) ........................................................... 0.8 0.3 2.2 1.2 Total ........................................................................... 4.3 percent (1.043) ........................................................... 4.6 percent (1.046). A more detailed explanation of each figure is provided in section VII.F.2 of this preamble. E. Final Sustainable Growth Rate for 2004 The SGR for 2004 is 6.6 percent. Table 38 shows our preliminary estimate of Current estimate percent percent percent percent (1.008). (1.003). (1.022). (1.010). the 2004 SGR from the CY 2004 Final Rule (68 FR 63249), our revised estimate from the CY 2005 Final Rule (69 FR 66387) and the final figures determined using the latest available data. TABLE 38.—2004 SGR CALCULATION Statutory factors Estimate from CY 2004 Final Rule Fees ................................................... Enrollment .......................................... Real Per Capita GDP ........................ Law and Reg ...................................... Total ............................................ VerDate Aug<31>2005 14:28 Nov 18, 2005 2.7 1.7 2.8 0.0 percent percent percent percent (1.027) (1.017) (1.028) (1.000) ........................... ........................... ........................... ........................... 7.4 percent (1.074) ........................... Jkt 208001 PO 00000 Frm 00195 Fmt 4701 Estimate from CY 2005 Final Rule 1.4 1.7 2.2 1.5 percent percent percent percent (1.014) (1.017) (1.022) (1.015) ........................... ........................... ........................... ........................... 7.0 percent (1.070) ........................... Sfmt 4700 E:\FR\FM\21NOR2.SGM 21NOR2 Final 1.3 1.3 2.1 1.7 percent percent percent percent (1.013). (1.013). (1.021). (1.017). 6.6 percent (1.066). 70310 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations A more detailed explanation of each figure is provided in section VII.F.3. F. Calculation of 2006, 2005, and 2004 Sustainable Growth Rates 1. Detail on the 2006 SGR All of the figures used to determine the 2006 SGR are estimates that will be revised based on subsequent data. Any differences between these estimates and the actual measurement of these figures will be included in future revisions of the SGR and allowed expenditures and incorporated into subsequent PFS updates. • Factor 1—Changes in Fees for Physicians’ Services (Before Applying Legislative Adjustments) for 2006 This factor is calculated as a weighted-average of the 2006 fee increases for the different types of services included in the definition of physicians’ services for the SGR. Medical and other health services paid using the PFS are estimated to account for approximately 83.1 percent of total allowed charges included in the SGR in 2006 and are updated using the MEI. The MEI for 2006 is 2.8 percent. Diagnostic laboratory tests are estimated to represent approximately 7.2 percent of Medicare allowed charges included in the SGR for 2006. Medicare payments for these tests are updated by the Consumer Price Index for Urban Areas (CPI–U). However, section 629 of the MMA specifies that diagnostic laboratory services will receive an update of 0.0 percent from 2004 through 2008. Drugs are estimated to represent 9.7 percent of Medicare allowed charges included in the SGR in 2006. Sections 303 and 304 of the MMA require Medicare to pay for most drugs at 106 percent of ASP beginning January 1, 2005. We estimated a weighted-average change in fees for drugs included in the SGR (using the ASP plus 6 percent pricing methodology) of 4.1 percent for 2006. Table 39 shows the weightedaverage of the MEI, laboratory and drug price changes for 2006. TABLE 39 Weight Physician ...................... Laboratory ..................... Drugs ............................ Weighted-average ........ Update 0.831 0.072 0.097 1.000 2.8 0.0 4.1 2.7 We estimate that the weighted-average increase in fees for physicians’ services in 2006 under the SGR (before applying any legislative adjustments) will be 2.7 percent. • Factor 2—The Percentage Change in the Average Number of Part B Enrollees From 2005 to 2006 This factor is our estimate of the percent change in the average number of fee-for-service enrollees from 2005 to 2006. Services provided to Medicare Advantage (MA) plan enrollees are outside the scope of the SGR and are excluded from this estimate. OACT estimates that the average number of Medicare Part B fee-for-service enrollees will decrease by ¥3.1 percent from 2005 to 2006. Table 40 illustrates how this figure was determined. TABLE 40 2005 Overall ..................................................................................... Medicare Advantage (MA) ...................................................... Net .......................................................................................... Percent Increase ..................................................................... An important factor affecting fee-forservice enrollment is beneficiary enrollment in MA plans. Because it is difficult to estimate the size of the MA enrollee population before the start of a calendar year, at this time we do not know how actual enrollment in MA plans will compare to current estimates. For this reason, the estimate may change substantially as actual Medicare fee-forservice enrollment for 2006 becomes known. 39.536 million ......................................................................... 5.070 million ........................................................................... 34.466 million ......................................................................... ................................................................................................ information on economic performance becomes available to us in 2006. • Factor 4—Percentage Change in Expenditures for Physicians’ Services Resulting From Changes in Statute or Regulations in 2006 Compared With 2005 • Factor 3—Estimated Real Gross Domestic Product Per Capita Growth in 2006 We estimate that the growth in real GDP per capita from 2005 to 2006 will be 2.2 percent (based on the 10-year average GDP over the ten years of 1997– 2006). Our past experience indicates that there have also been changes in estimates of real per capita GDP growth made before the year begins and the actual change in GDP computed after the year is complete. Thus, it is possible that this figure will change as actual The statutory and regulatory provisions that will affect expenditures in CY 2006 relative to CY 2005 are estimated to have an impact on expenditures of less than 0.05 percent. These provisions include the expiration of the temporary higher payments to physicians in Alaska, the new powered wheelchair code for physicians, and the impact of the new IVIG service discussed elsewhere in this final rule with comment. 2. Detail on the 2005 SGR VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 A more detailed discussion of our revised estimates of the four elements of the 2005 SGR follows. PO 00000 Frm 00196 2006 Fmt 4701 Sfmt 4700 40.059 million. 6.654 million. 33.405 million. ¥3.1 percent. • Factor 1—Changes in Fees for Physicians’ Services (Before Applying Legislative Adjustments) for 2005 This factor was calculated as a weighted-average of the 2005 fee increases that apply for the different types of services included in the definition of physicians’ services for the SGR. We estimate that services paid using the PFS account for approximately 84.3 percent of total allowed charges included in the SGR in 2005. These services were updated using the 2005 MEI of 3.1 percent. We estimate that diagnostic laboratory tests represent approximately 7.0 percent of total allowed charges included in the SGR in 2005. Medicare payments for these tests are updated by the CPI–U. However, section 629 of the MMA specifies that diagnostic laboratory services will receive an update of 0.0 percent from 2004 through 2008. We estimate that drugs represent 8.7 percent of Medicare allowed charges included in the SGR in 2005. Sections 303 and 304 of the MMA require E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations Medicare to pay for most drugs at 106 percent of ASP beginning January 1, 2005. We now estimate a weightedaverage change in fees for drugs included in the SGR of ¥21.1 percent for 2005. The estimated weightedaverage change in the CY 2005 Final Rule was ¥14.7 percent. The decline in the estimate is due to updated ASP data. Table 41 shows the weighted-average of the MEI, laboratory and drug price changes for 2005. TABLE 41 Weight Physician .......... Laboratory ......... Drugs ................ Weighted-average ................ 0.843 0.070 0.087 70311 Final Rule was 1.3 percent. The reduction from 1.3 percent to our current estimate of 0.8 percent is Update primarily due to application of the drug 3.1 pricing changes required by sections 0.0 303 and 304 of the MMA. ¥21.1 0.8 • Factor 2—The Percentage Change in the Average Number of Part B Enrollees From 2004 to 2005 After taking into account the elements described in Table 41, we estimate that the weighted-average increase in fees for physicians’ services in 2005 under the SGR (before applying any legislative adjustments) will be 0.8 percent. Our estimate of this factor in the CY 2005 OACT estimates that the average number of Medicare Part B fee-forservice enrollees (excluding beneficiaries enrolled in M+C plans) increased by 0.3 percent in 2005. Table 42 illustrates how we determined this figure. 1.000 TABLE 42 2004 Overall ..................................................................................... Medicare+Choice .................................................................... Net .......................................................................................... Percent Increase ..................................................................... OACT’s estimate of the 0.3 percent change in the number of fee-for-service enrollees, net of M+C enrollment for 2005 compared to 2004, is greater than our original estimate of ¥0.3 percent in the CY 2005 Final Rule (69 FR 66388). While our current projection based on data from 8 months of 2005 is greater than our original estimate of ¥0.3 percent when we had no data, it is still possible that our final estimate of this figure will be different once we have complete information on 2005 fee-forservice enrollment. • Factor 3—Estimated Real Gross Domestic Product Per Capita Growth in 2005 We estimate that the growth in real GDP per capita will be 2.2 percent for 2005 (based on the 10-year average GDP over the ten years of 1996–2005). Our past experience indicates that there have also been differences between our estimates of real per capita GDP growth made prior to the year’s end and the actual change in this factor. Thus, it is possible that this figure will change further as complete actual information on 2005 economic performance becomes available to us in 2006. • Factor 4—Percentage Change in Expenditures for Physicians’ Services Resulting From Changes in Statute or Regulations in 2005 Compared With 2004 There are a number of statutory provisions that affect the 2005 SGR. As mentioned previously in the preamble, sections 303 and 304 of the MMA VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 39.048 million ......................................................................... 4.683 million ........................................................................... 34.366 million ......................................................................... ................................................................................................ changed Medicare payment for drugs. These provisions also changed Medicare payments for the administration of drugs. Section 303(a)(1) of the MMA amended section 1848(c)(2) of the Act to require the Secretary to make a number of changes that increased Medicare payment for drug administration beginning January 1, 2004. These changes permanently increased Medicare payments for drug administration by a weighted-average of 110 percent. Section 303(a)(4) of the MMA required an additional transitional adjustment (temporary increase) to Medicare’s payment for drug administration of 32 percent for 2004 and 3 percent for 2005. The change in the transitional adjustment of 32 percent for 2004 to 3 percent for 2005 would reduce Medicare payments for drug administration between 2004 and 2005. However, some of this reduction will be lessened because we also adopted changes to the codes and payment amounts for drug administration based on recommendations from the AMA’s CPT Editorial Panel and Relative Value Update Committee (RUC), under the authority of section 1848(c)(2)(J) of the Act. We further increased PFS payments by paying separately for injections provided on the same day as another PFS service. We estimate that changes to our policy on injections and the changes to our drug administration payments taken together increased physician spending by 0.8 percent. There are several other statutory provisions that are estimated to increase PO 00000 Frm 00197 2005 Fmt 4701 Sfmt 4700 39.536 million. 5.070 million. 34.466 million. 0.3 percent. Medicare spending for physicians’ services under the SGR. Section 413(a) of the MMA establishes a 5 percent increase in the PFS payment for services provided in physician scarcity areas. Section 413(b) of the MMA improves the procedures for paying the 10 percent PFS bonus payment for services provided in health professional shortage areas. We estimate that the provisions of section 413 of the MMA will increase Medicare PFS payments by 0.1 percent. Sections 611 through 613 of the MMA provide Medicare coverage for an initial preventive physical examination, cardiovascular and diabetes screening tests. We estimate that new Medicare coverage for these preventive services will increase spending for physicians’ services under the SGR by 0.3 percent. Taken together, we estimate that all of the statutory provisions for 2005 will increase Medicare spending for physicians’ services by 1.2 percent. 3. Detail on the 2004 SGR A more detailed discussion of our final revised estimates of the four elements of the 2004 SGR follows. • Factor 1—Changes in Fees for Physicians’ Services (Before Applying Legislative Adjustments) for 2004 This factor was calculated as a weighted-average of the 2004 fee increases that apply for the different types of services included in the definition of physicians’ services for the SGR. Services paid using the PFS accounted for approximately 83.3 E:\FR\FM\21NOR2.SGM 21NOR2 70312 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations percent of total Medicare allowed charges included in the SGR for 2004 and are updated using the MEI. The MEI for 2004 was 2.9 percent. Diagnostic laboratory tests represented approximately 6.8 percent of total 2004 Medicare allowed charges included in the SGR and are updated by the CPI–U. However, section 629 of the MMA specifies that diagnostic laboratory services will receive an update of 0.0 percent from 2004 through 2008. Drugs represented approximately 9.9 percent of total Medicare allowed charges included in the SGR for 2004. Historically, Medicare paid for drugs under section 1842(o) of the Act at 95 percent of average wholesale price (AWP). However, with some exceptions, sections 303 and 304 of the MMA generally require Medicare to pay for drugs at 85 percent of the AWP determined as of April 1, 2003, or a specified percentage of AWP based on studies by the Government Accountability Office and the Office of the Inspector General in 2004. We implemented section 303 and 304 of the MMA in an interim final rule making changes to the PFS for 2004, which appeared in the Federal Register on January 7, 2004 (see 69 FR 1086). Taking sections 303 and 304 of the MMA into account, we estimate a weighted-average change in fees for drugs included in the SGR of ¥11.5 percent for 2004. Table 43 shows the weighted-average of the MEI, laboratory, and drug price increases for 2004. TABLE 43 Weight Physician .......... Laboratory ......... Drugs ................ 0.833 0.068 0.099 TABLE 43—Continued Weight Weighted-average ................ Update 1.000 1.3 After taking into account the elements described in Table 43, we estimate that the weighted-average increase in fees for physicians’ services in 2004 under the SGR (before applying any legislative adjustments) was 1.3 percent. • Factor 2—The Percentage Change in the Average Number of Part B Enrollees From 2003 to 2004 We estimate the increase in the number of fee-for-service enrollees (excluding beneficiaries enrolled in Update M+C plans) from 2003 to 2004 was 1.3 2.9 percent. Our calculation of this factor is 0.0 based on complete data from 2004. ¥11.5 Table 44 illustrates the calculation of this factor. TABLE 44 2003 Overall ..................................................................................... Medicare+Choice .................................................................... Net .......................................................................................... Percent Increase ..................................................................... • Factor 3—Estimated Real Gross Domestic Product Per Capita Growth in 2004 We estimate that the growth in real per capita GDP was 2.1 percent in 2004 (based on the 10-year average GDP over the ten years of 1995–2004). This figure is a final one based on complete data for 2004. • Factor 4—Percentage Change in Expenditures for Physicians’ Services Resulting From Changes in Statute or Regulations in 2004 Compared With 2003 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 38.465 million ......................................................................... 4.655 million ........................................................................... 33.810 million ......................................................................... ................................................................................................ Act. We estimate the section 303 and 304 provisions increased spending for physicians’ services by 1.0 percent in 2004. Taken together, we estimate that statutory provisions increased 2004 spending for physicians’ services by 1.7 percent (after accounting for rounding). VIII. Anesthesia and Physician Fee Schedule Conversion Factors (CF) for CY 2006 The 2006 PFS CF will be $36.1770. The 2006 national average anesthesia CF is $16.9591. There are four statutory provisions that increased 2004 Medicare spending relative to 2003. Section 412 of the MMA established a floor of 1.0 on adjustments to the physician work relative value unit for the GPCI for the years 2004 through 2006. Section 602 of the MMA increased the GPCIs for work, PE, and malpractice in Alaska to 1.67. We estimate that sections 412 and 602 of the MMA increased 2004 Medicare spending included in the SGR by 0.6 percent. Sections 303 and 304 of the MMA increased Medicare’s payments for drug administration in 2004. It further exempted the increases in payment from the budget neutrality provisions of section 1848(c)(2) of the A. Physician Fee Schedule Conversion Factor Under section 1848(d)(1)(A) of the Act, the PFS CF is equal to the CF for the previous year multiplied by the update determined under section 1848(d)(4) of the Act. Under section 1848(c)(2) of the Act, adjustments to RVUs may not cause the amount of expenditures to differ by more than $20 million from the amount of expenditures that would have resulted without such adjustments. As described earlier, we are implementing several changes to the work RVUs that would result in a change in expenditures that would exceed $20 million if we made no offsetting PO 00000 Frm 00198 2004 Fmt 4701 Sfmt 4700 39.048 million. 4.683 million. 34.366 million. 1.3 percent. adjustments to either the conversion factor or RVUs. With respect to the work RVUs, our policy has been to meet the budgetneutrality requirements in the statute by making an adjustment to the conversion factor. That is, we estimate the aggregate number of work RVUs that will be paid under current and revised policy in CY 2006. We apply a uniform adjustment factor to the conversion factor to make the aggregate payments under the revised work RVUs equal the aggregate payments under the current work RVUs. As a result of the 2006 work RVU changes described earlier, we will be making an adjustment of .9985 percent to the conversion factor to meet the budget neutrality requirements in the statute. Note that this adjustment is also being applied to the anesthesia fee schedule as shown in table 46. We illustrate the calculation for the 2006 PFS CF in Table 45. TABLE 45 2005 Conversion Factor .... 2006 Update ...................... 2006 Adjustment for Work RVU Changes. 2006 Conversion Factor .... E:\FR\FM\21NOR2.SGM 21NOR2 $37.8975. ¥4.4 percent. .9985. $36.1770. Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations B. Anesthesia Fee Schedule Conversion Factor Anesthesia services do not have RVUs like other PFS services. Therefore, we account for any necessary RVU adjustments through an adjustment to the anesthesia fee schedule CF to simulate changes to RVUs. We modeled the resource-based practice expense methodology using imputed anesthesia RVUs that were made comparable to other physician fee schedule services. As a result of modeling practice expense changes, we are incorporating a 1.00039 adjustment to the anesthesia fee schedule conversion factor. We used the following figures to determine the anesthesia fee schedule CF (see Table 46). TABLE 46 2005 Anesthesia Conversion Factor 2006 Update 2006 Adjustment for Work RVU Changes 2006 Adjustment for PE Changes 2006 Anesthesia Conversion Factor $17.7594. ¥4.4 percent. .9985. 1.00039. $16.9591. IX. Telehealth Originating Site Facility Fee Payment Amount Update Section 1834(m) of the Act establishes the payment amount for the Medicare 70313 telehealth originating site facility fee for telehealth services provided from October 1, 2001 through December 31 2002, at $20. For telehealth services provided on or after January 1 of each subsequent calendar year, the telehealth originating site facility fee is increased by the percentage increase in the MEI as defined in section 1842(i)(3) of the Act. The MEI increase for 2006 is 2.8 percent. Therefore, for CY 2006, the payment amount for HCPCS code ‘‘Q3014, telehealth originating site facility fee’’ is 80 percent of the lesser of the actual charge or $22.47. The Medicare telehealth originating site facility fee and MEI increase by the applicable time period is shown in Table 47. TABLE 47 MEI increase (percent) Facility fee $20.00 $20.60 $21.20 $21.86 $22.47 ................................................................................................................................................ ................................................................................................................................................ ................................................................................................................................................ ................................................................................................................................................ ................................................................................................................................................ X. Provisions of the Final Rule With Comment The provisions of this final rule with comment restate the provisions of the August 2005 proposed rule, except as noted elsewhere in the preamble. XI. Waiver of Proposed Rulemaking We ordinarily publish a notice of proposed rulemaking in the Federal Register and invite public comment on the proposed rule. The notice of proposed rulemaking includes a reference to the legal authority under which the rule is proposed, and the terms and substances of the proposed rule or a description of the subjects and issues involved. This procedure can be waived, however, if an agency finds good cause that a notice-and-comment procedure is impracticable, unnecessary, or contrary to the public interest and incorporates a statement of the finding and its reasons in the rule issued. As discussed in sections III. and V. of this final rule with comment, we utilize HCPCS codes for Medicare payment purposes. The HCPCS is a national drug coding system comprised of Level I (CPT) codes and Level II (HCPCS National Codes) that are intended to provide uniformity to coding procedures, services, and supplies across all types of medical providers and suppliers. Level I (CPT) codes are copyrighted by the AMA and consist of VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 several categories, including Category I codes which are 5-digit numeric codes, and Category III codes which are temporary codes to track emerging technology, services and procedures. The AMA issues an annual update of the CPT code set each Fall, with January 1 as the effective date for implementing the updated CPT codes. The HCPCS, including both Level I and Level II codes, is similarly updated annually on a CY basis. Annual coding changes are not available to the public until the Fall immediately preceding the annual January update of the PFS. Because of the timing of the release of these new codes, it is impracticable for CMS to provide prior notice and solicit comment on these codes and the RVUs assigned to them in advance of publication of the final rule that implements the PFS. Yet, it is imperative that these coding changes be accounted for and recognized timely under the PFS for payment because services represented by these codes will be provided to Medicare beneficiaries by physicians during the CY in which they become effective. Moreover, regulations implementing HIPAA (42 CFR parts 160 and 162) reguire that the HCPCS be used to report health care services, including services paid under the PFS. We also assign interim RVUs to any new codes based on a review of the RUC recommendations for valuing these services. By reviewing these RUC PO 00000 Frm 00199 Fmt 4701 Sfmt 4700 N/A 3.0 2.9 3.1 2.8 Period 10/01/2001–12/31/2002 01/01/2003–12/31/2003 01/01/2004–12/31/2004 01/01/2005–12/31/2005 01/01/2006–12/31/2006 recommendations for the new codes, we are able to assign RVUs to services based on input from the medical community and to establish payment for them, on an interim basis, that corresponds to the relative resources associated with providing the services. If we did not assign RVUs to new codes on an interim basis, the alternative would be to either not pay for these services during the initial CY or have each carrier establish a payment rate for these new codes. We believe both of these alternatives are contrary to the public interest, particularly since the RUC process allows for an assessment of the valuation of these services by the medical community prior to our establishing payment for these codes on an interim basis. Therefore, we believe it would be contrary to the public interest to delay establishment of fee schedule payment amounts for these codes. For the reasons outlined above, we find good cause to waive the notice of proposed rulemaking for the interim RVUs for selected procedure codes identified in Addendum C and to establish RVUs for these codes on an interim final basis. We are providing a 60-day public comment period. XII. Collection of Information Requirements Under the Paperwork Reduction Act of 1995, we are required to provide 60- E:\FR\FM\21NOR2.SGM 21NOR2 70314 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations day notice in the Federal Register and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues: • The need for the information collection and its usefulness in carrying out the proper functions of our agency. • The accuracy of our estimate of the information collection burden. • The quality, utility, and clarity of the information to be collected. • Recommendations to minimize the information collection burden on the affected public, including automated collection techniques. We are soliciting public comment on each of these issues for the following sections of this document that contain information collection requirements: Section 413.180 Procedures for Requesting Exceptions to Payment Rates Paragraph (b) specifies the criteria for a pediatric ESRD facility requesting an exception to payment rates. Paragraph (e) outlines the documentation that a pediatric ESRD facility must submit to CMS when requesting an exception to its payment rates. Paragraph (i) discusses the period of approval for payment exception requests. A prospective exception payment rate approved by CMS applies for the period from the date the complete exception request was filed with its intermediary until thirty days after the intermediary’s receipt of the facility’s letter notifying the intermediary of the facility’s request to give up its exception rate. The burden associated with the requirements in paragraph (e) is the time and effort required by the facility to prepare and submit the exception request to CMS. The burden associated with the requirement in paragraph (i) is the time and effort required by the facility to draft and mail the letter that notifies the intermediary of the facilities request to give up its exception rate. The collection requirement in this section has not changed. While this requirement is subject to the PRA, this requirement is currently approved in OMB No. 0938–0296. Section 413.184 Payment Exception: Pediatric Patient Mix Paragraph (b) specifies the documentation requirements that a pediatric ESRD facility must meet in order to qualify for an exception to its VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 prospective payment rate based on its pediatric patient mix. In addition to the other qualifications specified in this section, this section states that a facility must submit a listing of all outpatient dialysis patients (including all home patients) treated during the most recently completed and filed cost report. The burden associated with this requirement is the time and effort for the facility to submit a listing of all outpatient dialysis patients (including all home patients) treated during the most recently completed and filed cost report. The collection requirement in this section has not changed. While this requirement is subject to the PRA, this requirement is currently approved in OMB No. 0938–0296. Section 413.186 Payment Exception: Self-Dialysis Training Costs in Pediatric Facilities In summary, this section outlines the requirements a pediatric ESRD facility must meet to qualify for an exception to the prospective payment rate based on self-dialysis training costs. Paragraph (e) states that a facility must provide specific information to support its exception request. Paragraph (f) states that in addition to the other qualifications outlined in this section, pediatric ESRD facility must submit with its exception request a list of patients, by modality, trained during the most recent cost report period, in order to justify its accelerated training exception request. The burden associated with these requirements is the time and effort for the facility to prepare and submit the required information to support its exception request, and the time and effort for the pediatric ESRD facility to prepare and submit with its exception request a list of patients, by modality, trained during the most recent cost report period. The collection requirements in this section have not changed. While these requirements are subject to the PRA, they are currently approved in OMB No.0938–0296. Section 414.804 Basis of Payment In summary, this section requires manufacturers to report ASP data to CMS. This section details the process a manufacturer must follow to calculate the ASP. The ASP reporting requirements are discussed in further detail in the interim final rule with comment, Medicare Program; Manufacturer Submission of Manufacturer’s Average Sales Price (ASP) Data for Medicare Part B Drugs and Biologicals, that published on April PO 00000 Frm 00200 Fmt 4701 Sfmt 4700 2, 2004 in the Federal Register (69FR17935–17941). The burden associated with these requirements is the time and effort required by manufacturers of Medicare Part B Drugs and biologicals to prepare and submit to the required ASP data to CMS. While these requirements are subject to the PRA, the requirements are currently approved in OMB No. 0938– 0921, with a current expiration date of September 30, 2007. We intend to revise this information collection to include adequate instructions for manufacturers to report the ASP, the WAC, and other data elements. These revisions will be addressed in detail in a revised information collection request in accordance with the Paperwork Reduction Act of 1995. We have submitted a copy of this proposed rule to OMB for its review of the information collection requirements described above. These requirements are not effective until they have been approved by OMB. If you comment on these information collection and recordkeeping requirements, please mail copies directly to the following: Centers for Medicare & Medicaid Services, Office of Strategic Operations and Regulatory Affairs, Regulations Development Group, Attn: Jim Wickliffe, [CMS–1502–P], Room C4–26– 05, 7500 Security Boulevard, Baltimore, MD 21244–1850; and Office of Information and Regulatory Affairs, Office of Management and Budget, Room 10235, New Executive Office Building, Washington, DC 20503, Attn: Brenda Aguilar, CMS Desk Officer, CMS–1502–P, Brenda.Aguilar@omb.eop.gov. Fax (202) 395–6974. XIII. Response to Comments Because of the large number of public comments we normally receive on Federal Register documents, we are not able to acknowledge or respond to them individually. We will consider all comments we receive by the date and time specified in the DATES section of this preamble, and, when we proceed with a subsequent document, we will respond to the comments in the preamble to that document. XIV. Regulatory Impact Analysis We have examined the impact of this rule as required by Executive Order 12866 (September 1993, Regulatory Planning and Review), the Regulatory Flexibility Act (RFA) (September 19, 1980 Pub. L. 96–354), section 1102(b) of the Social Security Act, the Unfunded E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations Mandates Reform Act of 1995 (Pub. L. 104–4), and Executive Order 13132. Executive Order 12866 (as amended by Executive Order 13258, which merely reassigns responsibilities of duties) directs agencies to assess all costs and benefits of available regulatory alternatives and, when regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis must be prepared for final rules with economically significant effects (that is, a final rule that would have an annual effect on the economy of $100 million or more in any one year, or would adversely affect in a material way the economy, a sector of the economy, productivity, competition, jobs, the environment, public health or safety, or State, local, or tribal governments or communities). As indicated in more detail below, we estimate that the PFS provisions included in this final rule with comment will redistribute more than $100 million in one year. We are considering this final rule with comment to be economically significant because its provisions are estimated to result in an increase, decrease or aggregate redistribution of Medicare spending that will exceed $100 million. Therefore, this final rule with comment is a major rule and we have prepared a regulatory impact analysis. The RFA requires that we analyze regulatory options for small businesses and other entities. We prepare a regulatory flexibility analysis unless we certify that a rule would not have a significant economic impact on a substantial number of small entities. The analysis must include a justification concerning the reason action is being taken, the kinds and number of small entities the rule affects, and an explanation of any meaningful options that achieve the objectives with less significant adverse economic impact on the small entities. Section 1102(b) of the Act requires us to prepare a regulatory impact analysis for any rule that may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 604 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside a Metropolitan Statistical Area and has fewer than 100 beds. We have determined that this final rule with comment would have minimal impact on small hospitals located in rural areas. Of 227 hospital-based ESRD facilities located in rural areas, only 40 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 are affiliated with hospitals with fewer than 100 beds. For purposes of the RFA, physicians, nonphysician practitioners, and suppliers are considered small businesses if they generate revenues of $6 million or less. Approximately 95 percent of physicians are considered to be small entities. There are about 875,000 physicians, other practitioners and medical suppliers that receive Medicare payment under the PFS. For purposes of the RFA, approximately 90 percent of suppliers of durable medical equipment (DME) and prosthetic devices are considered small businesses according to the Small Business Administration’s (SBA) size standards. We estimate that 106,000 entities bill Medicare for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) each year. Total annual estimated Medicare revenues for DME suppliers exceed approximately $8.5 billion in 2004. Of this amount, approximately $1.4 billion were for nebulizer drugs in 2004. The vast majority, 95 percent, of retail pharmacy companies are small businesses as measured by the SBA size standard. Approximately, 16,000 pharmacies billed Medicare for immunosuppressive, oral anti-cancer, or oral anti-emetic drugs in 2004. Pharmacies received Medicare revenues for those drugs of approximately $350 million in 2004. In addition, most ESRD facilities are considered small entities, either based on nonprofit status or by having revenues of $29 million or less in any year. We consider a substantial number of entities to be affected if the final rule is estimated to impact more than 5 percent of the total number of small entities. Based on our analysis of the 957 nonprofit ESRD facilities considered small entities in accordance with the above definitions, we estimate that the combined impact of the changes to payment for renal dialysis services included in this final rule with comment would have a 1.5 percent decrease in payments relative to current payments. The impact of the CAP provisions included in this final rule with comment on an individual physician is dependent on whether the drugs they provide to Medicare beneficiaries are included in the list of CAP drugs and whether the physician chooses to obtain drugs administered to Medicare beneficiaries through the CAP. In addition, the CAP provisions in this rule will have a potential impact on entities, either existing or formed specifically for this purpose, that are involved in the dispensing or PO 00000 Frm 00201 Fmt 4701 Sfmt 4700 70315 distribution of drugs. The impact is dependent on the ability of potential vendors to successfully compete on a national level and receive approval as a vendor under the CAP. The analysis and discussion provided in this section, as well as elsewhere in this final rule with comment, complies with the RFA requirements. Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule that may result in expenditures in any year by State, local, or tribal governments, in the aggregate, or by the private sector, of $120 million. Medicare beneficiaries are considered to be part of the private sector for this purpose. We have examined this final rule with comment in accordance with Executive Order 13132 and have determined that this regulation would not have any significant impact on the rights, roles, or responsibilities of State, local, or tribal governments. A discussion concerning the impact of this rule on beneficiaries is found later in this section. We have prepared the following analysis, which, together with the information provided in the rest of this preamble, meets all assessment requirements. It explains the rationale for and purposes of the rule; details the costs and benefits of the rule; analyzes alternatives; and presents the measures we plan to use to minimize the burden on small entities. As indicated elsewhere in this final rule with comment, we are making a variety of changes to our regulations, payments, or payment policies to ensure that our payment systems reflect changes in medical practice and the relative value of services. We provide information for each of the policy changes in the relevant sections of this final rule with comment. We are unaware of any relevant Federal rules that duplicate, overlap or conflict with this rule. The relevant sections of this final rule with comment contain a description of significant alternatives if applicable. A. Resource-Based Work and PE RVUs Under section 1848(c)(2) of the Act, adjustments to RVUs may not cause the amount of expenditures to differ by more than $20 million from the amount of expenditures that would have resulted without such adjustments. We are implementing several changes that would result in a change in expenditures that would exceed $20 million if we made no offsetting adjustments to either the CF or RVUs. With respect to the work RVUs, our policy has been to meet the budgetneutrality requirements in the statute by E:\FR\FM\21NOR2.SGM 21NOR2 70316 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations making an adjustment to the CF. That is, we estimate the aggregate number of work RVUs that will be paid under current and revised policy in CY 2006. We apply a uniform adjustment factor to the CF to make the aggregate payments under the revised work RVUs equal the aggregate payments under the current work RVUs. As a result of the 2006 work RVU changes described earlier, we will be making an adjustment of ¥0.6 percent to the CF to meet the budget neutrality requirements in the statute. For PE RVUs, our policy has been to meet the budget-neutrality requirements in the statute by incorporating a rescaling adjustment in the PE methodologies. That is, we estimate the aggregate number of PE RVUs that will be paid under current and revised policy in CY 2006. We apply a uniform adjustment factor to make the aggregate number of revised PE RVUs equal the number estimated that would be paid under current policy. While we are continuing to apply this policy for general changes in coding and RVUs, we are increasing aggregate PFS payments to account for the higher payments for drug administration services resulting from the incorporation of the survey data submitted by the AUA. These increases in payment are being made under the authority of section 1848(c)(2)(J) of the Act that exempts the changes in payments for drug administration from the budget neutrality requirements of section 1848(c)(2)(B)(iv) of the Act. As described earlier, we will base PE payments in 2006 on the current 2005 PE RVUs to the extent practicable after making changes required by law, such as the incorporation of the urology survey for the drug administration codes. In the situation where a code is new in 2006 and we do not have 2005 PE RVUs, we created new PE RVUs to use as the basis for 2006 payments. Table 49, Impact of CY 2006 RVU Changes, Multiple Imaging Discount, and Conversion Factor Update on Total Medicare Allowed Charges by Specialty, shows the percentage impact by specialty of the PE changes in combination with other changes being implemented. The ¥4 percent decrease in payment for clinical psychology shown in the PE refinements column in Table 49 is attributable to the deletion of several codes and creation of new codes for certain psychological testing services. The deleted codes had reflected the practitioner’s work in the PE RVUs. As indicated in Table 29 of section III.D., we accepted the recommendation of the RUC’s HCPAC for work RVUs for the new codes. Thus, there is a shift in payment from the PE RVUs to the work RVUs for these psychological testing codes. We note that the increase in the payment in the work RVUs exceeds the decrease in payment in the PE RVUs, causing an overall net increase in payments to clinical psychologists of 2 percent as a result of the shift from the PE RVUs to the work RVUs for these new codes. While not included in table 49, we estimate that temporary payment associated with IVIG described previously will result in approximately $10 million in additional CY 2006 allowed charges under the PFS. B. Malpractice RVUs As discussed in section II C. of this final rule with comment, we are making technical changes to the calculation of the malpractice RVUs. We are removing the malpractice data for specialties that occur less than 5 percent of the time in our data for a procedure code; adopting several changes to the crosswalks used to assign risk factors to specialties for which we did not otherwise have data; using the lowest risk factor of 1.00 for clinical psychology, licensed clinical social work, chiropractors, and physical therapists; and adding cardiology catheterization and angioplasty codes to the list of codes for which we apply surgical rather than nonsurgical risk adjustment factors. Table 49 shows the combined impact of these changes. The impact of these methodological changes in the calculation of resource-based malpractice expense RVUs is negligible as malpractice RVUs account for less than 4 percent of total payments. C. Multiple Imaging Procedures As discussed in section II.J of this final rule with comment, we are reducing payments for TCs of certain multiple imaging procedures performed in the same session within the same imaging families. In order to calculate the impact of this change, we examined 2004 PFS carrier claims processed through March 31, 2005. We extracted all claims that were billed on the same day, for the same beneficiary, at the same provider, for multiple diagnostic imaging procedures within the same family of codes. For each subset of claims, the procedures were arrayed based on the pricing of the TC of these services. In the proposed rule, we simulated the effect of the multiple procedure payment reduction by accounting for 100 percent of the highest priced TC, and 50 percent of all other TCs. In this final rule with comment, we simulated the effect of the multiple procedure payment reduction by accounting for 100 percent of the highest priced TC, and 25 percent of all other TCs. This change is the result of public comments described more fully in section II.J. of this rule. Note that if the procedure was billed globally, the professional component was always calculated at 100 percent of the professional component (modifier-26) value. The simulated total allowed charges for each family of codes includes all global, technical, and professional utilization for the family of codes (for example, the sum of claims where the multiple procedure payment reduction would have been in effect, in addition to claims that would not have been subject to the multiple procedure payment reduction). These simulated totals were then compared to the actual allowed charges for each family of codes within the same time period to calculate the impacts of the change. Table 48 shows the actual 2004 allowed charges by family of imaging procedures and lists the percentage impact by family if this policy had been in effect. Family 2 has the largest ¥9.5 percent impact, while Family 11 has the smallest ¥0.7 percent impact. TABLE 48.—IMPACT OF MULTIPLE PROCEDURE REDUCTION FOR DIAGNOSTIC IMAGING BY FAMILY OF IMAGING SERVICES Family 01 02 03 04 05 ...................... ...................... ...................... ...................... ...................... VerDate Aug<31>2005 2004 Medicare allowed charges ($ in millions) Description of family of imaging procedures Ultrasound (Chest/Abdomen/Pelvis—Non-Obstetrical) ............................................................ CT and CTA (Chest/Thorax/Abd/Pelvis) .................................................................................. CT and CTA (Head/Brain/Orbit/Maxillofacial/Neck) ................................................................. MRI and MRA (Chest/Abd/Pelvis) ............................................................................................ MRI and MRA (Head/Brain/Neck) ............................................................................................ 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00202 Fmt 4701 Sfmt 4700 E:\FR\FM\21NOR2.SGM 21NOR2 $138 563 97 105 532 Percentage impact ¥3.4 ¥9.5 ¥1.3 ¥2.4 ¥3.1 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70317 TABLE 48.—IMPACT OF MULTIPLE PROCEDURE REDUCTION FOR DIAGNOSTIC IMAGING BY FAMILY OF IMAGING SERVICES— Continued Family 2004 Medicare allowed charges ($ in millions) Description of family of imaging procedures Percentage impact ...................... ...................... ...................... ...................... ...................... ...................... MRI and MRA (spine) ............................................................................................................... CT (spine) ................................................................................................................................. MRI and MRA (lower extremities) ............................................................................................ CT and CTA (lower extremities) ............................................................................................... MR and MRI (upper extremities and joints) ............................................................................. CT and CTA (upper extremities) .............................................................................................. 540 24 166 5 107 2 ¥2.2 ¥2.1 ¥1.6 ¥1.0 ¥1.4 ¥0.7 Total for all procedures subject to multiple imaging reductions ............................................... 06 07 08 09 10 11 2,276 ¥4.2 Using the same data, we also summarized the dollar value of the reductions by specialty. Specialtyspecific percentage impacts were calculated by comparing each specialty’s 2004 allowed charges for all Medicare allowed services to the reduced allowed charges that would have occurred had this policy been in effect. As expected, the most significant impacts occur among radiologists, who would experience a ¥1 percent impact. Diagnostic testing facilities also experience a ¥1 percent impact. Most other specialties experience a very small (0.1 percent) payment increase as a result of the budget neutrality adjustment. (Because this multiple procedure reduction adjustment would otherwise reduce overall payments by 0.1 percent, it is necessary to include a budget neutrality adjustment to the PE RVUs, resulting in positive impacts for most specialties.) Table 49 shows the percentage impact by specialty in combination with other changes being implemented. D. Combined Impacts Our estimates of changes in Medicare revenues for PFS services compare payment rates for 2006 with payment VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 rates for 2005 using 2004 Medicare utilization for both years. We are using 2004 Medicare claims processed and paid through June 30, 2005, that we estimate are 98.5 percent complete, and have adjusted the figures to reflect a full year of data. Thus, because we are using a single year of utilization, the estimated changes in revenues reflect payment changes only between 2005 and 2006. To the extent that there are year-to-year changes in the volume and mix of services provided by physicians, the actual impact on total Medicare revenues will be different than those shown here. The payment impacts reflect averages for each specialty based on Medicare utilization. The payment impact for an individual physician would be different from the average, based on the mix of services the physician provides. The average change in total revenues would be less than the impact displayed here because physicians furnish services to both Medicare and non-Medicare patients and specialties may receive substantial Medicare revenues for services that are not paid under the PFS. For instance, independent laboratories receive approximately 80 percent of their PO 00000 Frm 00203 Fmt 4701 Sfmt 4700 Medicare revenues from clinical laboratory services that are not paid under the PFS. Table 49 shows only the payment impact on PFS services. Table 49 shows the specialty level impact on payment of the work RVU changes, practice expense RVU changes, malpractice RVU changes, and multiple imaging payment changes being implemented for CY 2006. The column labeled ‘‘Final Rule Impacts’’ shows the combined effect of the changes in payment attributable to the work RVU changes, practice expense RVUs, malpractice RVUs, and the multiple imaging policy. The column labeled ‘‘Impact of Update and Drug Admin. Transition shows the impact of these changes, and reflects the expiration of the transitional adjustment required by section 303 of the MMA for drug administration services. This adjustment was set at 32 percent for 2004 and 3 percent for 2005. In addition, this column reflects a ¥4.4 percent payment update to the CF described in section VI. of this final rule with comment and the budget neutrality scaler required by the changes in the work RVUs. BILLING CODE 4120–01–U E:\FR\FM\21NOR2.SGM 21NOR2 VerDate Aug<31>2005 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00204 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.071</GPH> 70318 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00205 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70319 ER21NO05.072</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations BILLING CODE 4120–01–C Table 50 shows the impact on total payments for selected high-volume procedures of all of the changes previously discussed. We selected these VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 procedures because they are the most commonly provided by a broad spectrum of physician specialties. There are separate columns that show the change in the facility rates and the PO 00000 Frm 00206 Fmt 4701 Sfmt 4700 nonfacility rates. For an explanation of facility and nonfacility PE refer to section II.A. in the preamble of this final rule with comment. BILLING CODE 4120–01–U E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.073</GPH> 70320 VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00207 Fmt 4701 Sfmt 4725 E:\FR\FM\21NOR2.SGM 21NOR2 70321 ER21NO05.074</GPH> Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations BILLING CODE 4120–01–C In the CY 2005 final rule, we showed the combined impact of PFS and drug payment changes on the total revenues for specialties that perform a significant volume of drug administration services. (69 FR 66406) Although we have not performed a similar combined impact analysis this year for all of the specialties considered last year, we have VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 undertaken a similar analysis of hematology/oncology. In last year’s final rule, we announced a 1 year demonstration to collect information about symptoms for cancer patients receiving chemotherapy (69 FR 66308). In this final rule with comment, we are announcing a new demonstration project again focused on improving the quality of care provided to beneficiaries PO 00000 Frm 00208 Fmt 4701 Sfmt 4700 stricken with cancer. Although both of these demonstrations are implemented through the Secretary’s authority under sections 402(a)(1)(B) and 402(b) of the Social Security Act Amendments of 1967 (Pub. L. 90–248), we discussed the impacts of the additional payments from the 2005 demonstration in last year’s final rule impact analysis. Therefore, we are also including an analysis of the E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.075</GPH> 70322 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70323 impact on payments to oncologists as the 2005 demonstration project ends and the new demonstration project begins. We have updated the analysis from the proposed rule using more recent data. As indicated in Table 51, PFS services account for approximately 25 percent of Medicare revenues for oncologists. The current demonstration accounts for approximately 3 percent of Medicare revenues for oncologists. If we assume no growth in the volume of PFS services, the combined 2006 impact of changes in Medicare payments for all PFS and demonstration services provided by oncologists is –10 percent. We estimate that approximately 70 percent of total Medicare revenues for oncologists are attributed to drugs. If we again assume no growth in the volume of PFS services and additionally assume no growth in Medicare Part B drug spending (price or volume), we project total Medicare revenues to oncologists would decline by –3 percent. If we assume historical growth for the volume of PFS services and continue to assume no growth in Medicare Part B drug spending, we estimate total Medicare revenues to oncologists would remain unchanged between 2005 and 2006. If we assure historical growth for the volume of PFS services and for the volume of Medicare Part B drugs, we estimate total Medicare revenues to oncologists would increase by 6 percent between 2005 and 2006. We estimate that the revised chemotherapy demonstration project discussed earlier will result in additional allowed charges to oncologists of approximately $150 million in CY 2006. E. Medicare Telehealth Services G. ESRD–MMA Related Provisions The ESRD related provisions in this final rule with comment are discussed in section II.G. To understand the impact of the changes affecting payments to different categories of ESRD facilities, it is necessary to compare estimated payments under the current payment system (current payments) to estimated payments under the revisions to the composite rate payment system as set forth in this final rule with comment (final payments). To estimate the impact among various classes of ESRD facilities, it is imperative that the estimates of current payments and final payments contain similar inputs. Therefore, we simulated payments only for those ESRD facilities for which we are able to calculate both current 2005 payments and final 2006 payments. Due to data limitations, we are unable to estimate current and final payments for 171 facilities that bill for ESRD dialysis treatments. ESRD providers were grouped into the categories based on characteristics provided in the Online Survey and Certification and Reporting (OSCAR) file and the most recent cost report data from the Healthcare Cost Report Information System (HCRIS). We also used the June 2005 update of CY 2004 Standard Analytical File (SAF) claims as a basis for Medicare dialysis treatments and separately billable drugs and biologicals. As we stated in the proposed rule, this is an updated version of the 2004 SAF file compared to the December 2004 version of the file we used in the proposed rule. F. Contractor Pricing of CPT Codes 97039 and 97139 As discussed earlier in the preamble of this final rule with comment (section II.E.), we will have the contractors value CPT codes 97039 and 97139. This will make the pricing methodology for these services consistent with our policy for other unlisted services and should not have a significant impact on Medicare expenditures. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00209 Fmt 4701 Sfmt 4700 BILLING CODE 4120–01–U E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.076</GPH> In section II.D. of this final rule with comment, we are adding individual medical nutrition therapy, as represented by HCPCS codes G0270, 97802, and 97803, to the list of telehealth services. We believe that this change will have little effect on Medicare expenditures. Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations BILLING CODE 4120–01–C Table 52 shows the impact of CY 2006 changes to payments to hospital based and independent ESRD facilities. We have included both composite rate payments as well as payments for VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 separately billable drugs and biologicals because both are affected by the CY 2006 changes. The first column of Table 52 identifies the type of ESRD provider, the second column indicates the number of ESRD facilities for each type, PO 00000 Frm 00210 Fmt 4701 Sfmt 4700 and the third column indicates the number of dialysis treatments. The fourth column shows the effect of changes to the ESRD wage index as it affects the composite rate payments to ESRD facilities. Composite rate E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.077</GPH> 70324 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations payments account for about 60 percent of revenues to ESRD facilities. The fourth column compares aggregate wage adjusted composite rate payments using the revised ESRD wage index compared to the current ESRD wage adjusted composite rate payments. Since CY 2006 is the first year of the 4-year transition to the revised ESRD wage index, ESRD facilities receive 25 percent of the revised CBSA-based wage adjusted composite rate and 75 percent of the current composite rate. The overall effect to all ESRD providers in aggregate is zero because the CY 2006 ESRD wage index has been multiplied by a BNF to comply with the statutory requirement that any wage index revisions be done in a manner that results in the same aggregate amount of expenditures as would have been made without any changes in the wage index. The percent changes shown in the fifth and sixth columns are the result of the increase to the drug add-on and the changes in drug prices which are explained in section XIV.G. of this final rule with comment. The fifth column shows the effect of the changes in drug payments to ESRD providers between CY 2006 and CY 2005. Drug payments account for about 40 percent of revenues to ESRD providers. Current payments for drugs represent 2005 Medicare reimbursement using AAP prices for the top ten drugs (as discussed earlier in this preamble). Current Medicare spending for the top ten drugs is estimated using 2005 AAP prices times actual drug utilization from 2004 claims. (EPO units are estimated using payments because the units field on bills represents the number of EPO administrations rather than the number of EPO units). Spending for CY 2006 is VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 estimated by using the average of the four quarters of 2005 ASP +6 percent for the top ten drugs times actual drug utilization from 2004 claims. The prices for these top ten drugs are discussed earlier in this preamble and the average of the four quarters of 2005 are shown in Table 52. We did not have hospitalbased facilities utilization data for top ten drugs other than EPO. Therefore, we needed a proxy to estimate CY 2006 payments to hospital-based facilities under ASP +6 pricing. We estimated these drugs by using the weighted spread of the difference between ASP +6 and AWP prices from independent facilities and applying it to payments to hospital-based facilities for top ten drugs other than EPO. Payment for drugs in 2006 also includes the 14.7 percent drug add-on to the composite rate. This amount is computed by multiplying the wage adjusted composite rate for each provider and the dialysis treatments from 2004 claims. Column 5 is computed by comparing spending under the CY 2006 payment for drugs (4 quarter average of 2005 ASP +6) including the 14.7 percent drug add-on amount to spending under current payments for drugs with the current drug add-on of 8.7 percent. We did not simulate any case mix in this impact table (Table 52) because 2004 claims data do not include the new data fields (height and weight) that are needed to calculate case mix. These data fields were not required to be reported by providers until January 1, 2005. However, we have not made any changes to case mix for CY 2006. Column 6 shows the overall effect of all changes in drug and composite rate payments to ESRD providers. The PO 00000 Frm 00211 Fmt 4701 Sfmt 4700 70325 overall effect is measured as the difference between CY 2006 payment with all MMA changes in this final rule with comment and current payment. CY 2006 payment is computed by multiplying the composite rate for each provider (with both the CY 2006 ESRD wage index and the 14.7 percent drug add-on) times dialysis treatments from 2004. In addition, the CY 2006 payment includes payments for separately billable drugs under the ASP +6 drug pricing using a 4 quarter average of 2005 ASP +6. Current payment is the current wage adjusted composite rate for each provider times dialysis treatments from 2004 claims plus current AAP priced drug payments for separately billable drugs with the current 8.7 percent drug add-on. The overall impact on ESRD providers in the aggregate is 1.2 percent increase. At first it may not seem obvious how the growth rates in columns 4 and 5 combine to result in the overall growth effect in column 6. While the wage index changes are budget neutral in aggregate, the drug payments to all ESRD providers have increased by 2.9 percent. Since drug payments to ESRD providers account for about 40 percent of revenues and the composite payment rate payment account for the other 60 percent of revenues, the 2.9 percent growth in drugs combined with the budget neutral composite rate payments result in the overall 1.2 percent growth in payment to all ESRD providers. Some commenters expressed concern regarding the reduction in payment rates for dialysis facilities in certain States and requested that we provide a State-specific impact analysis. Table 53 lists the impact for each State. BILLING CODE 4120–01–U E:\FR\FM\21NOR2.SGM 21NOR2 70326 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00212 Fmt 4701 Sfmt 4700 E:\FR\FM\21NOR2.SGM 21NOR2 ER21NO05.078</GPH> BILLING CODE 4120–01–C Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations H. Payment for Covered Outpatient Drugs and Biologicals, and CAP Provisions As discussed in section II.H of this final rule with comment, the changes to the supplying fee for immunosuppressive, oral anticancer, and oral anti-emetic drugs are estimated to reduce total Federal expenditures by $2 million in 2006, and $14 million over the 5-year period, CY 2006 to 2010. The changes to the inhalation drug dispensing fee are expected to reduce total Federal expenditures by $120 million in 2006, and $720 million over the 5-year period, CY 2006 to 2010. For the CAP provisions contained in this final rule with comment, the purpose of the CAP program is to provide choices to physicians and potentially achieve budgetary savings to Medicare and beneficiaries through a competitive bidding approach to determining Medicare payment rates for selected drugs. In addition the CAP will provide physicians with an alternative way to obtain these selected drugs that they use for treating their Medicare beneficiaries in their offices. As discussed in the July 6, 2005 interim final rule (70 FR 39091), we have estimated the impact of the costs of furnishing or administering drugs through the CAP on the Medicare program and expect it to be negligible, at the beginning until participating CAP physicians, approved CAP vendors and CMS gain more experience with the program. During the first year, we anticipate no significant additional cost savings or increases associated with the CAP, relative to the ASP payment system. The CAP program will provide alternatives to physicians who do not wish to purchase drugs directly or collect coinsurance. I. Private Contracts and Opt-Out Provision The changes discussed in section II.I. of this final rule with comment, with respect to private contracts and the optout provision, are estimated to have no significant impact on Medicare expenditures. However, we believe the changes will clarify that the consequences for the failure to maintain opt-out will apply regardless of whether the physician or practitioner was notified by the carrier. J. FQHC Supplemental Payment Provision Section 237 of the MMA amended section 1833(a)(3) of Act to provide supplemental payments to FQHCs that contract with Medicare Advantage (MA) organizations to cover the difference, if VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 any, between the payment received by the health center for treating MA enrollees and the payment to which the FQHC would be entitled to receive under its cost-based all-inclusive payment rate. We estimate that this new MMA payment provision for FQHC services will not increase Medicare payments. In other words, this MMA provision will have no budgetary impact on the Medicare trust fund due to the fact that a supplemental payment will only be made when the MA payment to the health center is less than its original FQHC cost based rate. Consequently, no additional Medicare expenditures will be needed to pay the center up to what it would have received under original Medicare. K. National Coverage Decisions Timeframes The changes to § 426.340 discussed in section II.N. of this final rule with comment, are made in order to conform certain timeframes in the regulation to meet legislative changes made by the MMA of 2003. These changes to the regulation meet Congressional intent in the development of NCDs, and conform the regulation to the overall NCD process. There are no budget implications as a result of these changes. L. Coverage of Screening for Glaucoma As discussed in section II.O. of the preamble to this final rule with comment, we are expanding the definition of an eligible beneficiary under the glaucoma screening benefit to include Hispanic Americans age 65 and over, effective January 1, 2006, subject to certain frequency and other limitations on coverage. At present, § 410.23(a)(2) (Conditions for and limitations on coverage of screening for glaucoma) defines the term ‘‘eligible beneficiary’’ to include individuals in the following high risk categories: • Individual with diabetes mellitus. • Individual with a family history of glaucoma. • African-Americans age 50 and over. Based on the projected utilization of these screening services and related medically necessary follow-up tests and treatment that may be required for the additional beneficiaries screened, we estimate that this expanded benefit will result in an increase in Medicare payments to ophthalmologists or optometrists who will provide these screening tests and related follow-up tests and treatment. However, as discussed in earlier in section II.O. this is not expected to have a significant cost impact on the Medicare program. PO 00000 Frm 00213 Fmt 4701 Sfmt 4700 70327 M. Physician Referral for Nuclear Medicine Services As discussed earlier in section V., we are revising the regulations at 411.351 to include all diagnostic and therapeutic nuclear medicine services and supplies furnished or referred on or after January 1, 2007, in the definitions of ‘‘radiology and certain other imaging services’’ and ‘‘radiation therapy services and supplies,’’ respectively. As stated in the proposed rule, the inclusion of nuclear medicine as a designated health service (DHS) primarily would affect physicians and health care entities that furnish these types of items and services to Medicare beneficiaries. We are unable to quantify the number of physicians who have either an ownership or an investment interest in entities that furnish nuclear medicine services and/or supplies. Even if we assume that a substantial number of physicians have ownership or investment interests in these types of entities, we believe that, in general, the economic impact on these physicians would not necessarily be substantial, for the reasons stated below. Physician owners/investors of entities that furnish nuclear medicine services and supplies in a manner that satisfies the requirements of the in-office ancillary services exception would not be affected by this proposed rule. Similarly, a physician’s ownership of, or investment in, a rural provider of nuclear medicine services and supplies would not be affected by this rule if the financial relationship complies with the rural provider exception at § 411.356(c)(1), which allows a physician to own and refer to an entity at least 75 percent of all DHS that it furnishes to residents of a rural area, as defined in the physician self-referral statute. We also do not know the extent to which equipment (such as a PET scanner) that was purchased by an entity in which a physician has an ownership or investment interest will be fully depreciated (or mostly so) or functionally obsolete by the time this rule is effective. Although the impact on an individual physician may be significant, we do not believe that physicians, in general, will be significantly affected if they are required to stop making referrals to an entity in which they have an ownership interest. We believe that the majority of physicians receive most of their income from the services they personally provide, and not from nuclear medicine services performed by entities that they own or invest in. In addition, we assume that, unless the physician established the entity to serve only his E:\FR\FM\21NOR2.SGM 21NOR2 70328 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations or her patients, the entity receives referrals from other physicians. Thus, the physician may still receive a return on the ownership or investment. Likewise, we do not believe that a physician’s divestiture of his or her ownership interest would necessarily have a significant economic effect. We assume, that, from an economic standpoint, most physicians invest in entities because they are income producing. If an investment is successful, a physician should have little difficulty finding new investors willing to acquire the physician’s investment. We are unable to quantify the number of physicians who would wish to divest his or her ownership interest as a result of this rule, nor are we able to ascertain the degree to which these physicians would sell their ownership interests at a loss or profit. We believe the cost of divestiture will vary from situation to situation. Also, since the rule is not effective until January 1, 2007, this will give those physicians who wish to divest additional time to find a suitable buyer and will allow those physicians an additional year in which to depreciate their nuclear medicine equipment. We expect that this change may result in savings to both the Medicare and Medicaid programs by minimizing anticompetitive business arrangements as well as financial incentives that encourage over-utilization of costly nuclear medicine services. We cannot gauge with any certainty the extent of these savings to either program at this time. N. Alternatives Considered This final rule with comment contains a range of policies, including some which are related to specific MMA provisions. The preamble provides descriptions of the statutory provisions that are addressed, identifies those policies when discretion has been exercised, presents rationale for our decisions and, where relevant, alternatives that were considered. We considered making our proposal to include diagnostic and therapeutic nuclear medicine services and supplies as a DHS effective immediately; however, we are persuaded that delaying the effective date until January 1, 2007 would be less disruptive to physicians who may choose to divest their investment and to beneficiaries who may need to receive services and supplies at another location. O. Impact on Beneficiaries There are a number of changes made in this final rule with comment that VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 would have an effect on beneficiaries. In general, we believe these changes will improve beneficiary access to services that are currently covered or will expand the Medicare benefit package to include new services. As explained in more detail below, the regulatory provisions may affect beneficiary liability in some cases. Any changes in aggregate beneficiary liability from a particular provision will be a function of the coinsurance (20 percent if applicable for the particular provision after the beneficiary has met the deductible) and the effect of the aggregate cost (savings) of the provision on the calculation of the Medicare Part B premium rate (generally 25 percent of the provision’s cost or savings). To illustrate this point, under this final rule with comment the 2006 national payment amount in the nonfacility setting for CPT code 99203, as shown in Table 50, is $92.61 which means that, in 2006, the beneficiary coinsurance for this service would be $18.52. In addition, as with the 2005 chemotherapy demonstration project, the Medicare beneficiaries, or their supplemental insurers, who receive office-based cancer treatment, will be liable for the 20 percent Part B coinsurance on the G codes billed under the 2006 oncology demonstration. The service linking the payment of the demonstration fee has changed from a chemotherapy infusion or push service in 2005 to an established office visit of level 2, 3, 4, or 5 in 2006. The demonstration fee payment will be lower per unit of service for the Medicare beneficiary in 2006 than 2005 thus, we expect that the coinsurance liability for a Medicare beneficiary will be reduced. However, the total impact on a beneficiary will depend upon the specific services received during 2006. Very few of the changes we are making impact overall payments and therefore will affect Medicare beneficiaries’ coinsurance liability. Changes discussed above that do affect overall spending would similarly impact beneficiaries’ coinsurance. For example, we have tried to ensure that the rule concerning physician selfreferral for nuclear medicine services would not adversely impact the medical care of Medicare or Medicaid patients. We recognize that our proposal may have an impact on current arrangements under which patients are receiving medical care, and that some financial arrangements may have to be restructured for patients to continue receiving medically necessary nuclear PO 00000 Frm 00214 Fmt 4701 Sfmt 4700 medicine services and supplies at the same location or from the same entity. Therefore, we are delaying the effective date of this provision until January 1, 2007. Implementation of this rule is consistent with the statutory intent of section 1877(h) of the Act. This final rule with comment may help minimize anti-competitive behavior that can affect where a beneficiary receives health care services. It may also reduce the potential for overutilization, and thus, decrease the number of unnecessary tests or procedures to which Medicare and Medicaid patients are subjected. With respect to the CAP provisions, we do not expect, during the first year of the program, that there will be an appreciable difference to the beneficiaries if their drugs were to be administered by a physician participating in the CAP or purchasing them and being reimbursed for them within the ASP payment system. At least initially, until approved CAP vendors, participating CAP physicians, and CMS gain more experience with this new program, we do not anticipate there would be any significant additional costs or savings to a beneficiary whose physician participates in the CAP. The CAP should be largely transparent to the beneficiary population. The only change should be the entity that bills the beneficiary for the coinsurance. We also do not believe that beneficiaries would experience drug access issues as a result of implementation of the CAP. However, we intend to monitor beneficiary access closely and may propose additional changes to our payment system in the future, if necessary. P. Accounting Statement As required by OMB Circular A–4 (available at https:// www.whitehouse.gov/omb/circulars/ a004/a-4.pdf), in Table 54 we have prepared an accounting statement showing the classification of the expenditures associated with the provisions of this final rule with comment. Table 54 includes the impact of the changes in this rule on providers and suppliers and encompasses the ¥4.4 percent negative update to the PFS based on the statutory SGR formula. Expenditures are classified as transfers to Medicare providers or suppliers (that is, ESRD facilities and physicians, other practitioners and medical suppliers, including CAP vendors, that receive payment under the PFS or Medicare Part B). E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70329 TABLE 54.—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM CY 2005 TO THE CY 2006 [In millions] Category Transfers Annualized Monetized Transfers .............................................................. From Whom To Whom? ........................................................................... Negative transfer—Estimated decrease in expenditures $2668. Federal Government To ESRD Medicare Providers; physicians, other practitioners and suppliers, including CAP vendors that receive payment under the Medicare Physician Fee Schedule; and Medicare Suppliers billing for Part B drugs. In accordance with the provisions of Executive Order 12866, this final rule with comment was reviewed by the Office of Management and Budget. List of Subjects Administrative practice and procedure, Health facilities, Health professions, Kidney diseases, Medical devices, Medicare, Reporting and recordkeeping requirements, Rural areas, X-rays. Subpart D—Private Contracts 2. Section 405.435 is amended by— A. Revising paragraph (b) introductory text. I B. Adding paragraph (d). The revision and addition read as follows: I I 42 CFR Part 410 Health facilities, Health professions, Kidney diseases, Laboratories, Medicare, Reporting and recordkeeping requirements, Rural areas, X-rays. 42 CFR Part 411 § 405.435 Failure to maintain opt-out. * Kidney diseases, Medicare, Physician Referral, Reporting and record keeping requirements. 42 CFR Part 413 Health facilities, Kidney diseases, Medicare, Reporting and recordkeeping requirements. 42 CFR Part 414 Administrative practice and procedure, Health facilities, Health professions, Kidney diseases, Medicare, Reporting and recordkeeping requirements. 42 CFR Part 424 Emergency medical services, Health facilities, Health professions, Medicare, Reporting and recordkeeping requirements. 42 CFR Part 426 Administrative practice and procedure, Medicare, Reporting and recordkeeping requirements. For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services amends 42 CFR chapter IV as set forth below: I 14:28 Nov 18, 2005 1. The authority citation for part 405 continues to read as follows: I Authority: Secs. 1102, 1861, 1862(a), 1871, 1874, 1881, and 1886(k) of the Social Security Act (42 U.S.C. 1302, 1395x, 1395y(a), 1395hh, 1395kk, 1395rr, and 1395ww(k)), and sec. 353 of the Public Health Service Act (42 U.S.C. 263a). 42 CFR Part 405 VerDate Aug<31>2005 PART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Jkt 208001 * * * * (b) If a physician or practitioner fails to maintain opt-out in accordance with paragraph (a) of this section, then, for the remainder of the opt-out period, except as provided by paragraph (d) of this section— * * * * * (d) If a physician or practitioner demonstrates that he or she has taken good faith efforts to maintain opt-out (including by refunding amounts in excess of the charge limits to beneficiaries with whom he or she did not sign a private contract) within 45 days of a notice from the carrier of a violation of paragraph (a) of this section, then the requirements of paragraphs (b)(1) through (b)(8) of this section are not applicable. In situations where a violation of paragraph (a) of this section is not discovered by the carrier during the 2-year opt-out period when the violation actually occurred, then the requirements of paragraphs (b)(1) through (b)(8) of this section are applicable from the date that the first violation of paragraph (a) of this section occurred until the end of the opt-out period during which the violation occurred (unless the physician or practitioner takes good faith efforts, within 45 days of any notice from the carrier that the physician or practitioner failed to maintain opt-out, or within 45 PO 00000 Frm 00215 Fmt 4701 Sfmt 4700 days of the physician’s or practitioner’s discovery of the failure to maintain optout, whichever is earlier, to correct his or her violations of paragraph (a) of this section. Good faith efforts include, but are not limited to, refunding any amounts collected in excess of the charge limits to beneficiaries with whom he or she did not sign a private contract. Subpart X—Rural Health Clinic and Federally Qualified Health Center Services I 3. Add § 405.2469 to read as follows: § 405.2469 Federally Qualified Health Centers supplemental payments. Federally Qualified Health Centers under contract (directly or indirectly) with Medicare Advantage organizations are eligible for supplemental payments for covered Federally Qualified Health Center services furnished to enrollees in Medicare Advantage plans offered by the Medicare Advantage organization to cover the difference, if any, between their payments from the Medicare Advantage plan and what they would receive under the cost-based Federally Qualified Health Center payment system. (a) Calculation of supplemental payment. (1) The supplemental payment for Federally Qualified Health Center covered services provided to Medicare patients enrolled in Medicare Advantage plans is based on — (i) The difference between payments received by the center from the Medicare Advantage plan as determined on a per visit basis; (ii) The Federally Qualified Health Center’s all-inclusive cost-based per visit rate as set forth in this subpart; (iii) Less any amount the FQHC may charge as described in section 1857(e)(3)(B) of the Act. (2) Any financial incentives provided to Federally Qualified Health Centers under their Medicare Advantage contracts, such as risk pool payments, bonuses, or withholds, are prohibited from being included in the calculation of supplemental payments due to the Federally Qualified Health Center. E:\FR\FM\21NOR2.SGM 21NOR2 70330 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations (b) Per visit supplemental payment. A supplemental payment required under this section is made to the Federally Qualified Health Center when a covered face-to-face encounter occurs between a Medicare Advantage enrollee and a practitioner as set forth in § 405.2463. PART 410—SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS 4. The authority citation for part 410 continues to read as follows: Subpart B—Medical and Other Health Services 5. Section 410.23 is amended by— A. Revising paragraphs (a)(2)(i) through (iii). I B. Adding a new paragraph (a)(2)(iv). The revision and addition read as follows: I I § 410.23 Screening for glaucoma: Conditions for and limitations on coverage. (a) * * * (2) * * * (i) Individual with diabetes mellitus. (ii) Individual with a family history of glaucoma. (iii) African-Americans age 50 and over. (iv) Hispanic-Americans age 65 and over. * * * * * I 6. Section 410.78 is amended by— I A. Revising paragraph (b) introductory text. I B. Adding paragraph (b)(2)(viii). The revision and addition read as follows: Telehealth services * * * * (b) General rule. Medicare Part B pays for office and other outpatient visits, professional consultation, psychiatric diagnostic interview examination, individual psychotherapy, pharmacologic management, end stage renal disease related services included in the monthly capitation payment (except for one visit per month to examine the access site), and individual medical nutrition therapy furnished by an interactive telecommunications system if the following conditions are met: * * * * * (2) * * * (viii) A registered dietitian or nutrition professional as described in § 410.134. * * * * * VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). 8. Section 411.351 is amended by — A. Revising the definition of ‘‘Radiation therapy services and supplies’’. I B. Revising the definition of ‘‘Radiology and certain other imaging services’’. I C. Revising the introductory text of paragraph (2) of the definition of ‘‘Referral’’. The revisions read as follows: I I Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). * 7. The authority citation for part 411 continues to read as follows: I Subpart J—Financial Relationships Between Physicians and Entities Furnishing Designated Health Services I § 410.78 PART 411—EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT § 411.351 Definitions. * * * * * Radiation therapy services and supplies means those particular services and supplies, including (effective January 1, 2007) therapeutic nuclear medicine services and supplies, so identified on the List of CPT/HCPCS Codes. All services and supplies so identified on the List of CPT/HCPCS Codes are radiation therapy services and supplies for purposes of this subpart. Any service or supply not specifically identified as radiation therapy services or supplies on the List of CPT/HCPCS Codes is not a radiation therapy service or supply for purposes of this subpart. The list of codes identifying radiation therapy services and supplies is based on section 1861(s)(4) of the Act and § 410.35 of this chapter. Radiology and certain other imaging services means those particular services so identified on the List of CPT/HCPCS Codes. All services so identified on the List of CPT/HCPCS Codes are radiology and certain other imaging services for purposes of this subpart. Any service not specifically identified as radiology and certain other imaging services on the List of CPT/HCPCS Codes is not a radiology or certain other imaging service for purposes of this subpart. The list of codes identifying radiology and certain other imaging services includes the professional and technical components of any diagnostic test or procedure using x-rays, ultrasound, computerized axial tomography, magnetic resonance imaging, nuclear medicine (effective January 1, 2007), or other imaging services. All codes identified as radiology and certain other PO 00000 Frm 00216 Fmt 4701 Sfmt 4700 imaging services are covered under section 1861(s)(3) of the Act and § 410.32 and § 410.34 of this chapter, but do not include— (1) X-ray, fluoroscopy, or ultrasound procedures that require the insertion of a needle, catheter, tube, or probe through the skin or into a body orifice; and (2) Radiology procedures that are integral to the performance of a nonradiological medical procedure and performed— (i) During the nonradiological medical procedure; or (ii) Immediately following the nonradiological medical procedure when necessary to confirm placement of an item placed during the nonradiological medical procedure. Referral— * * * * * (2) Does not include a request by a pathologist for clinical diagnostic laboratory tests and pathological examination services, by a radiologist for diagnostic radiology services, and by a radiation oncologist for radiation therapy or ancillary services necessary for, and integral to, the provision of radiation therapy, if— * * * * * PART 413—PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES 9. The authority citation for part 413 continues to read as follows: I Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i), and (n), 1871, 1881, 1883, and 1886 of the Social Security Act (42 U.S.C. 1302, 1395D(D), 1395f(b), 1395g, 13951(a), (i), and (n), 1395hh, 1395rr, 1395tt, and 1395ww). Subpart H—Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs 10. Section 413.170 is amended by revising paragraph (b) to read as follows: I § 413.170 Scope. * * * * * (b) Providing procedures and criteria under which a pediatric ESRD facility (an ESRD facility with at least a 50 percent pediatric patient mix as specified in § 413.184 of this subpart) may receive an exception to the prospective payment rates; and * * * * * I 11. Section 413.174 is amended by— I A. Revising paragraph (f). E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations I B. Removing paragraph (g). The revision reads as follows: § 413.174 Prospective rates for hospitalbased and independent ESRD facilities. * * * * * (f) Additional payment for separately billable drugs. CMS makes an additional payment for certain drugs furnished to ESRD patients by a Medicare-approved ESRD facility. CMS makes this payment directly to the ESRD facility. Payment for these drugs is made— (1) Only on an assignment basis, directly to the facility which must accept, as payment in full, the amount that CMS determines; (2) Subject to the Part B deductible and coinsurance; (3) Effective January 1, 2006, to hospital-based ESRD facilities in accordance with the methodology specified in § 414.904 of this subchapter. (4) To independent ESRD facilities in accordance with the methodology specified in § 405.517 of this subchapter. I 12. Section 413.180 is amended by— I A. Revising paragraphs (b) and (d) I B. Removing paragraphs (e) and (k). I C. Redesignating paragraphs (f) through (j) as paragraphs (e) through (i). I D. Revising newly redesignated paragraph (i). I E. Redesignating paragraphs (l) and (m) as paragraphs (j) and (k). I F. Revising newly redesignated paragraph (k). The revisions read as follows: § 413.180 Procedures for requesting exceptions to payment rates. * * * * * (b) Criteria for requesting an exception. If a pediatric ESRD facility projects on the basis of prior year costs and utilization trends that it has an allowable cost per treatment higher than its prospective rate set under § 413.174, and if these excess costs are attributable to one or more of the factors in § 413.182, the facility may request, in accordance with paragraph (e) of this section, that CMS approve an exception to that rate and set a higher prospective payment rate. * * * * * (d) Payment rate exception request. Effective October 1, 2002, CMS may approve exceptions to a pediatric ESRD facility’s updated prospective payment rate, if the pediatric ESRD facility did not have an approved exception rate as of October 1, 2002. A pediatric ESRD facility may request an exception to its payment rate at any time after it is in operation for at least 12 consecutive months. * * * * * VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 70331 (i) Period of approval: Payment exception request. A prospective exception payment rate approved by CMS applies for the period from the date the complete exception request was filed with its intermediary until 30 days after the intermediary’s receipt of the facility’s letter notifying the intermediary of the facility’s request to give up its exception rate and be subject to the basic case-mix adjusted composite payment rate methodology. ESRD facilities electing to retain their nonpediatric or pediatric exception rates (including self-dialysis training) do not need to notify their intermediaries. Once a facility notifies its fiscal intermediary in writing that it cannot retain its current exception rate, that decision cannot be subsequently reversed. * * * * * (k) Criteria for refiling a denied exception request. A pediatric ESRD facility that was denied an exception request may immediately file another exception request. Any subsequent exception request must address and document the issues cited in CMS’ denial letter. I 13. Section 413.182 is revised to read as follows: (3) The additional nursing hours per treatment are not the result of an excess number of employees; (4) Its pediatric patients require a significantly higher staff-to-patient ratio than typical adult patients; and (5) These services, procedures, or supplies and their per treatment costs are clearly prudent and reasonable when compared to those of pediatric facilities with a similar patient mix. (b) Documentation. (1) A pediatric ESRD facility must submit a listing of all outpatient dialysis patients (including all home patients) treated during the most recently completed and filed cost report (in accordance with cost reporting requirements under § 413.198) showing— (i) Age of patients and percentage of patients under the age of 18; (ii) Individual patient diagnosis; (iii) Home patients and ages; (iv) In-facility patients, staff-assisted, or self-dialysis; (v) Diabetic patients; and (vi) Patients isolated because of contagious disease. * * * * * § 413.182 Criteria for approval of exception requests. § 413.188 (a) CMS may approve exceptions to a pediatric ESRD facility’s prospective payment rate if the pediatric ESRD facility did not have an approved exception rate as of October 1, 2002. (b) The pediatric ESRD facility must demonstrate, by convincing objective evidence, that its total per treatment costs are reasonable and allowable under the relevant cost reimbursement principles of part 413 and that its per treatment costs in excess of its payment rate are directly attributable to any of the following criteria: (1) Pediatric patient mix, as specified in § 413.184. (2) Self-dialysis training costs in pediatric facilities, as specified in § 413.186. I 14. Section 413.184 is amended by revising paragraphs (a) and (b)(1) to read as follows: § 413.184 Payment exception: Pediatric patient mix. (a) Qualifications. To qualify for an exception to its prospective payment rate based on its pediatric patient mix a facility must demonstrate that— (1) At least 50 percent of its patients are individuals under 18 years of age; (2) Its nursing personnel costs are allocated properly between each mode of care; PO 00000 Frm 00217 Fmt 4701 Sfmt 4700 § 413.186 I I [Removed] 15. Section 413.186 is removed. [Removed] 16. Section 413.188 is removed. § 414.190 [Redesignated as § 413.186] 17. Redesignate § 413.190 as § 413.186 and revise the newly designated § 413.186 to read as follows: I § 413.186 Payment exception: Self-dialysis training costs in pediatric facilities. (a) Qualification. To qualify for an exception to the prospective payment rate based on self-dialysis training costs, the pediatric ESRD facility must establish that it incurs per treatment costs for furnishing self-dialysis and home dialysis training that exceed the facility’s payment rate for the training sessions. (b) Justification. To justify its exception request, a facility must— (1) Separately identify those elements contributing to its costs in excess of the composite training rate; and (2) Demonstrate that its per treatment costs are reasonable and allowable. (c) Criteria for determining proper cost reporting. CMS considers the pediatric ESRD facility’s total costs, cost finding and apportionment, including its allocation of costs, to determine if costs are properly reported by treatment modality. (d) Limitation of exception requests. Exception requests for a higher training rate are limited to those cost E:\FR\FM\21NOR2.SGM 21NOR2 70332 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations components relating to training such as technical staff, medical supplies, and the special costs of education (manuals and education materials). These requests may include overhead and other indirect costs to the extent that these costs are directly attributable to the additional training costs. (e) Documentation. The pediatric ESRD facility must provide the following information to support its exception request: (1) A copy of the facility’s training program. (2) Computation of the facility’s cost per treatment for maintenance sessions and training sessions including an explanation of the cost difference between the two modalities. (3) Class size and patients’ training schedules. (4) Number of training sessions required, by treatment modality, to train patients. (5) Number of patients trained for the current year and the prior 2 years on a monthly basis. (6) Projection for the next 12 months of future training candidates. (7) The number and qualifications of staff at training sessions. (f) Accelerated training exception. (1) A pediatric ESRD facility may bill Medicare for a dialysis training session only when a patient receives a dialysis treatment (normally 3 times a week for hemodialysis). Continuous cycling peritoneal dialysis (CCPD) and continuous ambulatory peritoneal dialysis (CAPD) are daily treatment modalities; ESRD facilities are paid the equivalent of three hemodialysis treatments for each week that CCPD and CAPD treatments are provided. (2) If a pediatric ESRD facility elects to train all its patients using a particular treatment modality more often than during each dialysis treatment and, as a result, the number of billable training dialysis sessions is less than the number of actual training sessions, the facility may request a composite rate exception, limited to the lesser of the— (i) Facility’s projected training cost per treatment; or (ii) Cost per treatment the facility receives in training a patient if it had trained patients only during a dialysis treatment, that is, three times per week. (3) An ESRD facility may bill a maximum of 25 training sessions per patient for hemodialysis training and 15 sessions for CCPD and CAPD training. (4) In computing the payment amount under an accelerated training exception, CMS uses a minimum number of training sessions per patient (15 for hemodialysis and 5 for CAPD and CCPD) when the facility actually VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 provides fewer than the minimum number of training sessions. (5) To justify an accelerated training exception request, an ESRD facility must document that a significant number of training sessions for a particular modality are provided during a shorter but more condensed period. (6) The facility must submit with the exception request a list of patients, by modality, trained during the most recent cost report period. The list must include each beneficiary’s— (i) Name; (ii) Age; and (iii) Training status (completed, not completed, being retrained, or in the process of being trained). (7) The total treatments from the patient list must be the same as the total treatments reported on the cost report filed with the request. § 413.192 I [Removed] 18. Section 413.192 is removed. PART 414—PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES 19. The authority citation for part 414 continues to read as follows: I Authority: Secs. 1102, 1871, and 1881(b)(1) of the Social Security Act (42 U.S.C. 1302, 1395hh, and 1395rr(b)(1)). Subpart B—Physicians and Other Practitioners 20. Section 414.65 is amended by revising paragraph (a)(1) to read as follows:. I § 414.65 Payment for telehealth services (a) * * * (1) The Medicare payment amount for office or other outpatient visits, consultation, individual psychotherapy, psychiatric diagnostic interview examination, pharmacologic management, end stage renal disease related services included in the monthly capitation payment (except for one visit per month to examine the access site), and individual medical nutrition therapy furnished via an interactive telecommunications system is equal to the current fee schedule amount applicable for the service of the physician or practitioner. * * * * * Subpart J—Submission of Manufacture’s Average Sales Price Data 21. Section 414.804(a) is amended by revising paragraph (a)(3)(iv) to read as follows: I PO 00000 Frm 00218 Fmt 4701 Sfmt 4700 § 414.804 Basis of payment. (a) * * * (3) * * * (iv) Example. The total lagged price concessions (discounts, rebates, etc.) over the most recent 12-month period available associated with direct sales for National Drug Code 12345–6789–01 subject to the ASP reporting requirement equal $200,000. The total in dollars for the sales subject to the average sales price reporting requirement for the same period equals $600,000. The lagged price concessions percentage for this period equals 200,000/600,000 = .33333. The total in dollars for the direct sales subject to the average sales price reporting requirement for the quarter being reported equals $50,000 for 10,000 units sold. Assuming no non-lagged price concessions apply, the manufacturer’s average sales price calculation for this National Drug Code for this quarter is: $50,000¥(0.33333 × $50,000) = $33,334 (net total sales amount); $33,334/10,000 = $3.33 (average sales price). * * * * * I 22. Section 414.904 is amended by— I A. Revising paragraph (a) introductory text. I B. Adding a new paragraph (d)(2)(iii). I C. Revising paragraphs (d)(3) and (e)(2). The revisions and additions read as follows: § 414.904 Basis of payment (a) Method of payment. Payment for a drug furnished on or after January 1, 2005 is based on the lesser of— * * * * * (d) * * * (2) * * * (iii) Effective for drugs and biologicals furnished in 2006, the payment for such drugs and biologicals furnished in connection with renal dialysis services and separately billed by freestanding and hospital-based renal dialysis facilities not paid on a cost basis is 106 percent of the average sales price. (3) Widely available market price and average manufacturer price. If the Inspector General finds that the average sales price exceeds the widely available market price or the average manufacturer price by 5 percent or more in calendar year 2006, the payment limit in the quarter following the transmittal of this information to the Secretary is the lesser of the widely available market price or 103 percent of the average manufacturer price. (e) * * * (2) Infusion drugs furnished through a covered item of durable medical equipment. The payment limit for an E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations infusion drug furnished through a covered item of durable medical equipment is calculated using 95 percent of the average wholesale price in effect on October 1, 2003 and is not updated in 2006. * * * * * I 23. Section 414.906 is amended by revising paragraph (f) to read as follows: § 414.906 Competitive acquisition program as the basis for payment. * * * * * (f) Substitution or addition of drugs on an approved CAP vendor’s CAP drug list. (1) Short-term substitution of a CAP drug. On an occasional basis (for a period of time less than 2 weeks), an approved CAP vendor may agree to furnish a substitute NDC within a HCPCS code on the approved CAP vendor’s CAP drug list if the approved CAP vendor— (i) Is willing to accept the payment amount that was established for the HCPCS code under this section; and (ii) Obtains the participating CAP physician’s prior approval. (2) Long-term substitution or addition of a CAP drug. An approved CAP vendor may submit a request, as specified in paragraph (f)(3) of this section, for approval to substitute an NDC supplied by the approved CAP vendor for another NDC within the same HCPCS code or to add an NDC to the approved CAP vendor’s drug list, if at least one of the following criteria is met: (i) Proposed substitution of an NDC for a period of 2 weeks or longer. (ii) Proposed addition of one or more NDCs within a HCPCS code included in the CAP drug category specified by CMS or on the approved CAP vendor’s approved CAP drug list. (iii) Proposed addition of— (A) One or more newly issued HCPCS codes; or (B) One of the following single indication orphan drug J codes or their updates: J0205, J0256, J9300, J1785, J2355, J3240, J7513, J9010, J9015, J9017, J9160, J9216. (iv) Beginning January 1, 2007, the proposed addition of a drug(s) that has not yet been assigned a HCPCS code, but for which a HCPCS code must be established. (3) Requesting the addition or substitution of CAP drug. An approved CAP vendor that meets the one of the criteria specified in paragraph (f)(2) must submit a written request to CMS or its designee. The request must— (i) Specify the NDC(s) and the respective HCPCS code that is to be added or substituted. (ii) Address the rationale for the substitution or addition of the NDC(s) or VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 the addition of the HCPCS code(s) as applicable; and (iii) Address the impact of the substitution of the NDC(s) or the addition of the NDC(s) or HCPCS code(s), or both on— (A) Patient and drug safety; (B) Drug waste; and (C) The potential for cost savings. (4) Approval of a request(s). CMS or its designee notifies the approved CAP vendor of its decision. (i) Except as specified in paragraph (f)(4)(ii) of this section, an approved request is effective at the beginning of the next calendar quarter. (ii) Approved substitutions for request based on a drug shortage or other exigent circumstance may become effective immediately provided that— (A) CMS approves the immediate substitution; and (B) The approved CAP vendor’s notifies its CAP participating physicians of the substitution immediately following CMS approval. (5) Payment for an approved drug change(s). The payment for— (i) Substituted or added CAP drugs that are within a HCPCS code for which payment is computed under paragraph (c)(1) of this section is the single payment for that HCPCS code, as determined and updated in accordance with paragraph (c)(1) of this section; or (ii) Added CAP drugs that are not within a HCPCS code for which payment is computed under paragraph (c)(1) of this section is specified under paragraph (c)(2) of this section. I 24. Section 414.908 is amended by— I A. Revising paragraphs (a)(3)(v)(M). I B. Redesignating paragraphs (a)(3)(vi) through (a)(3) (xii) as (a)(3)(viii) through (a)(3)(xiv). I C. Adding new paragraphs (a)(3)(vi) and (a)(3)(vii). I D. Revising paragraph (a)(5). The revisions and additions read as follows: § 414.908 program. Competitive acquisition (a) * * * (3) * * * (v) * * * (M) Additional patient information: date of birth, allergies, height/weight, ICD–9–CM (if necessary). (vi) Agrees to accept the particular National Drug Codes (NDCs) supplied by the approved CAP vendor for the duration of the participating CAP physician’s enrollment with the approved CAP vendor, subject to paragraphs (a)(3)(vii) and (a)(3)(xiv) of this section. By electing to participate with an approved CAP vendor, the participating CAP physician also agrees PO 00000 Frm 00219 Fmt 4701 Sfmt 4700 70333 to accept the changes to the approved CAP vendor’s CAP drug list that have been approved in accordance with § 414.906(f). (vii) Agrees to place routine orders for CAP drugs at the HCPCs level, except when medical necessity requires a particular formulation on the approved CAP vendor’s CAP drug list. Medical necessity must be documented. When the conditions of this paragraph are met, the participating CAP physician may submit a prescription order to the approved CAP vendor that specifies the NDC. * * * * * (5) Additional opt out provision. In addition to the circumstances listed in paragraph (a)(2) of this section, if the approved CAP vendor refuses to ship to the participating CAP physician because the conditions of § 414.914(h) were met, the physician can withdraw from the CAP category for the remainder of the year immediately upon notice to CMS and the approved CAP vendor. * * * * * I 25. Section 414.914 is amended by— I A. Redesignating paragraphs (f)(9) through (f)(11) as paragraphs (f)(14) through (f)(16). I B. Redesignating (f)(5) through (f)(8) as paragraphs (f)(9) through (f)(12) and paragraphs. I C. Adding new paragraphs (f)(5) through (f)(8) and (f)(13). I D. Revising paragraph (g)(3). I E. Revising paragraphs (h)(1) through (h)(3), (h)(5) and (h)(6), and (h)(8). The revisions and additions read as follows: § 414.914 Terms of contract. * * * * * (f) * * * (5) Respond within 2 business days to any inquiry, or sooner if the inquiry is related to drug quality; (6) Staff a toll-free telephone line from 8:30 a.m. or earlier and until 5 p.m. or later for all time zones served in the continental United States by the CAP vendor on business days (Monday through Friday excluding Federal holidays) to provide customer assistance, and establish reasonable hours of operation for Hawaii, Alaska, Puerto Rico, and the other U.S. territories; (7) Staff an emergency toll-free telephone line for weekend and evening access when the call center is closed, and determine what hours on Saturday and Sunday the call center is staffed and which hours a toll-free emergency line is activated; and (8) Include assistance for the disabled, the hearing impaired, and Spanish- E:\FR\FM\21NOR2.SGM 21NOR2 70334 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations speaking inquirers in all customer service operations. * * * * * (13) Provide direct notification to participating CAP physicians enrolled with them of updates to the approved CAP vendor’s CAP drug list on a quarterly basis. Changes must be disseminated at least 30 days before the approved changes are due to take effect, unless immediate notification as described in § 414.906(f)(4) is required. The approved CAP vendor’s entire CAP drug list must be disseminated at least once yearly; and approved CAP vendors must make a complete list that incorporates the most recent updates available to physicians on an ongoing basis. CMS posts on its web site the updated CAP drug lists for each approved CAP vendor. * * * * * (g) * * * (3) A full or partial waiver of the costsharing amount after determining in good faith that the individual is in financial need or the failure of reasonable collection efforts, provided that the waiver meets all of the requirements of section 1128A(i)(6)(A) of the Act and the corresponding regulations at paragraph (1) of the definition of ‘‘Remuneration’’ in § 1003.101 of this title. The availability of waivers may not be advertised or be made as part of a solicitation. Approved CAP vendors must inform beneficiaries that they generally make available the categories of assistance described in paragraphs (g)(1), (g)(2), and (g)(3) of this section. In no event may the approved CAP vendor include or make any statements or representations that promise or guarantee that beneficiaries receive cost-sharing waivers. (h) * * * (1) Subsequent to receipt of final payment by Medicare, or the verification of drug administration by the participating CAP physician, the approved CAP vendor must bill any applicable supplemental insurance policies. (2) If a balance remains, after the supplemental insurer pays their share of the bill, or if there is no supplemental insurance, the approved CAP vendor may bill the beneficiary. (3) At the time of billing the beneficiary, or the participating CAP physician’s presentation of the bill on behalf of the approved CAP vendor, the approved CAP vendor must inform the beneficiary of any types of cost-sharing assistance that may be available consistent with the requirements of section 1128A(a)(5) of the Act and § 414.914(g). VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 (4) * * * (5) For purposes of paragraph (h) delivery means postmark date, or the date the coinsurance bill or notice was presented to the beneficiary by the participating CAP physician on behalf of the approved CAP vendor. (i) Except as specified in paragraph (h)(5)(ii), if after 45 days from delivery of the approved CAP vendor’s bill to the beneficiary, the beneficiary’s costsharing obligation remains unpaid, the approved CAP vendor may refuse further shipments to the participating CAP physician for that beneficiary. (ii) If the beneficiary has requested cost-sharing assistance within 45 days of receiving delivery of the approved CAP vendor’s bill, provisions of paragraphs (h)(6), (h)(7), or (h)(8) of this section, apply. (6) If the approved CAP vendor implements a reasonable payment plan, as specified in § 414.914(g)(2), the approved CAP vendor must continue to ship CAP drugs for the beneficiary, as long as the beneficiary remains in compliance with the payment plan and makes an initial payment under the plan within 15 days after the delivery of the approved CAP vendor’s written notice to the beneficiary offering the payment plan. (7) * * * (8) If the approved CAP vendor refers the beneficiary to a bona fide and independent charity in accordance with § 414.914(g)(1), the approved CAP vendor may refuse to ship drugs if the past due balance is not paid 15 days after the date of delivery of the approved CAP vendor’s written notice to the beneficiary containing the referral for cost-sharing assistance. * * * * * Subpart L—Supplying and Dispensing Fees 26. Section 414.1001 is revised to read as follows: I § 414.1001 Basis of payment. (a) Supplying fees. Beginning in CY 2006— (1) A supplying fee of $24 is paid to a pharmacy for the first prescription of drugs and biologicals described in sections 1861(s)(2)(J), 1861(s)(2)(Q), and 1861(s)(2)(T) of the Act, that the pharmacy provided to a beneficiary during a 30-day period. (2) A supplying fee of $16 is paid to a pharmacy for each prescription following the first prescription (as specified in paragraph (a)(1) of this section) of drugs and biologicals described in sections 1861(s)(2)(J), 1861(s)(2)(Q), and 1861(s)(2)(T) of the PO 00000 Frm 00220 Fmt 4701 Sfmt 4700 Act, that the pharmacy provided to a beneficiary during a 30-day period. (3) A separate supplying fee is paid to a pharmacy for each prescription of drugs and biologicals described in sections 1861(s)(2)(J), 1861(s)(2)(Q), and 1861(s)(2)(T) of the Act. (b) Supplying fees following transplant. Beginning CY 2006—(1) A supplying fee of $50 is paid to pharmacy for the initial supplied prescription of drugs and biologicals described in section 1861(s)(2)(J) of the Act, that the pharmacy provided to a patient during the first 30-day period following a transplant. (2) A supplying fee of $16 is paid to a pharmacy for each prescription following an initial prescription after a transplant (as specified in paragraph (b)(1) of this section) of drugs and biologicals describe in section 1861(s)(2)(J) of the Act, that the pharmacy provided to a beneficiary during a 30-day period. (c) 30-day dispensing fees. Beginning CY 2006—(1) A dispensing fee of $57 is paid to a supplier to the extent that the prescription is for the initial dispensed 30-day supply of inhalation drugs furnished through durable medical equipment covered under section 1861(n) of the Act, regardless of the number of partial shipments of that 30day supply. (2) Except for supplied inhalation drugs that meet criteria described in paragraph (c)(1) of this section, a dispensing fee of $33 is paid for each dispensed 30-day supply of inhalation drugs furnished through durable medical equipment covered under section 1861(n) of the Act, regardless of the number of partial shipments of that 30-day supply. (d) 90-day dispensing fee. Beginning CY 2006, a dispensing fee of $66 is paid to a supplier for each dispensed 90-day supply of inhalation drugs furnished through durable medical equipment covered under section 1861(n) of the Act, regardless of the number of partial shipments of that 90-day supply. PART 424—CONDITIONS FOR MEDICARE PAYMENT 27. The authority citation for part 424 continues to read as follows: I Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). § 424.22 [Amended] 28. In § 424.22— A. The footnote for paragraph (a)(1)(iv), the term ‘‘hosptial’’ is removed and the term ‘‘hospital’’ is added in its place. I I E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations B. Paragraph (d), remove the reference to ‘‘§ 411.351’’ and add in its place the reference ‘‘§ 411.354’’. I PART 426—REVIEW OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL COVERAGE DETERMINATIONS 29. The authority citation for part 426 continues to read as follows: I Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). 30. The heading for Part 426 is revised to read as set forth above. I Subpart C—General Provisions for the Review of LCDs and NCDs 31. Section 426.340 is amended by revising paragraphs (e)(2) and (f)(2) to read as follows: I § 426.340 Procedures for review of new evidence. * * * * * (e) * * * (2) Sets a reasonable timeframe— (i) For LCDs, of not more than 90 days, by which the contractor completes the reconsideration; or (ii) For NCDs, in compliance with the timeframes specified in section 1862(1) of the Act, by which CMS completes the reconsideration. (f) * * * (2) Does not meet— (i) For LCDs, the 90-day reconsideration timeframe; or (ii) For NCDs, the reconsideration timeframe specified by the Board, in compliance with section 1862(1) of the Act. * * * * * (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program) Dated: October 26, 2005. Mark B. McClellan, Administrator, Centers for Medicare & Medicaid Services. Approved: November 1, 2005. Michael O. Leavitt, Secretary. Note: These addenda will not appear in the Code of Federal Regulations. Addendum A: Explanation and Use of Addenda B The addenda on the following pages provides various data pertaining to the Medicare fee schedule for physicians’ services furnished in 2006. Addendum B contains the RVUs for work, nonfacility PE, facility PE, and malpractice VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 expense, and other information for all services included in the PFS. In previous years, we have listed many services in Addendum B that are not paid under the PFS. To avoid publishing as many pages of codes for these services, we are not including clinical laboratory codes and most alpha-numeric codes (Healthcare Common Procedure Coding System (HCPCS) codes not included in CPT) in Addendum B. Addendum B—2006 Relative Value Units and Related Information Used in Determining Medicare Payments for 2006 This addendum contains the following information for each CPT code and alphanumeric HCPCS code, except for: alphanumeric codes beginning with B (enteral and parenteral therapy), E (durable medical equipment), K (temporary codes for nonphysicians’ services or items), or L (orthotics); and codes for anesthesiology. Please also note the following: • An ‘‘NA’’ in the ‘‘Non-facility PE RVUs’’ column of Addendum B means that CMS has not developed a PE RVU in the non-facility setting for the service because it is typically performed in the hospital (for example, an open heart surgery is generally performed in the hospital setting and not a physician’s office). • Services that have an ‘‘NA’’ in the ‘‘Facility PE RVUs’’ column of Addendum B are typically not paid using the PFS when provided in a facility setting. These services (which include ‘‘incident to’’ services and the technical portion of diagnostic tests) are generally paid under either the outpatient hospital prospective payment system or bundled into the hospital inpatient prospective payment system payment. 1. CPT/HCPCS code. This is the CPT or alphanumeric HCPCS number for the service. Alphanumeric HCPCS codes are included at the end of this addendum. 2. Modifier. A modifier is shown if there is a technical component (modifier TC) and a professional component (PC) (modifier –26) for the service. If there is a PC and a TC for the service, Addendum B contains three entries for the code. A code for: the global values (both professional and technical); modifier –26 (PC); and, modifier TC. The global service is not designated by a modifier, and physicians must bill using the code without a modifier if the physician furnishes both the PC and the TC of the service. Modifier –53 is shown for a discontinued procedure. There will be PO 00000 Frm 00221 Fmt 4701 Sfmt 4700 70335 RVUs for the code (CPT code 45378) with this modifier. 3. Status indicator. This indicator shows whether the CPT/HCPCS code is in the PFS and whether it is separately payable if the service is covered. A = Active code. These codes are separately payable under the PFS if covered. There will be RVUs for codes with this status. The presence of an ‘‘A’’ indicator does not mean that Medicare has made a national coverage determination regarding the service. Carriers remain responsible for coverage decisions in the absence of a national Medicare policy. B = Bundled code. Payments for covered services are always bundled into payment for other services not specified. If RVUs are shown, they are not used for Medicare payment. If these services are covered, payment for them is subsumed by the payment for the services to which they are incident (an example is a telephone call from a hospital nurse regarding care of a patient). C = Carrier-priced code. Carriers will establish RVUs and payment amounts for these services, generally on an individual case basis following review of documentation, such as an operative report. D = Deleted/discontinued code. These codes are deleted effective with the beginning of the CY and are always subject to a 90 day grace period. E = Excluded from the PFS by regulation. These codes are for items and services that CMS choses to exclude from the PFS payment by regulation. No RVUs are shown, and no payment may be made under the PFS for these codes. Payment for them, when covered, continues under reasonable charge procedures. F = Deleted/discontinued codes. (Code not subject to a 90-day grace period.) These codes are deleted effective with the beginning of the CY and are never subject to a grace period. This indicator is no longer effective with the 2006 PFS as of January 1, 2006. G = Code not valid for Medicare purposes. Medicare does not recognize codes assigned this status. Medicare uses another code for reporting of, and payment for, these services. (Code subject to a 90 day grace period.) This indicator is no longer effective with the 2006 PFS as of January 1, 2006. H = Deleted modifier. For 2000 and later years, either the TC or PC component shown for the code has been deleted and the deleted component is shown in the data base with the H status indicator. I = Not valid for Medicare purposes. Medicare uses another code for the E:\FR\FM\21NOR2.SGM 21NOR2 70336 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations reporting of, and the payment for these services. (Code not subject to a 90-day grace period.) N = Noncovered service. These codes are noncovered services. Medicare payment may not be made for these codes. If RVUs are shown, they are not used for Medicare payment. P = Bundled or excluded code. There are no RVUs for these services. No separate payment is made for them under the PFS. —If the item or service is covered as incident to a physician’s service and is furnished on the same day as a physician’s service, payment for it is bundled into the payment for the physician’s service to which it is incident (an example is an elastic bandage furnished by a physician incident to a physician’s service). —If the item or service is covered as other than incident to a physician’s service, it is excluded from the PFS (for example, colostomy supplies) and is paid under the other payment provisions of the Act. R = Restricted coverage. Special coverage instructions apply. If the service is covered and no RVUs are shown, it is carrier-priced. T = There are RVUs for these services, but they are only paid if there are no VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 other services payable under the PFS billed on the same date by the same provider. If any other services payable under the PFS are billed on the same date by the same provider, these services are bundled into the service(s) for which payment is made. X = Exclusion by law. These codes represent an item or service that is not within the definition of ‘‘physicians’ services’’ for PFS payment purposes. No RVUs are shown for these codes, and no payment may be made under the PFS. (Examples are ambulance services and clinical diagnostic laboratory services.) 4. Description of code. This is an abbreviated version of the narrative description of the code. 5. Physician work RVUs. These are the RVUs for the physician work for this service in 2006. Codes that are not used for Medicare payment are identified with a ‘‘+.’’ 6. Non-facility practice expense RVUs. These are the resource-based PE RVUs for non-facility settings. 7. Facility practice expense RVUs. These are the resource-based PE RVUs for facility settings. 8. Malpractice expense RVUs. These are the RVUs for the malpractice expense for the service for 2006. PO 00000 Frm 00222 Fmt 4701 Sfmt 4700 9. Non-facility total. This is the sum of the work, non-facility practice expense, and malpractice expense RVUs. 10. Facility total. This is the sum of the work, facility PE, and malpractice expense RVUs. 11. Global period. This indicator shows the number of days in the global period for the code (0, 10, or 90 days). An explanation of the alpha codes follows: MMM = The code describes a service furnished in uncomplicated maternity cases including antepartum care, delivery, and postpartum care. The usual global surgical concept does not apply. See the 1999 Physicians’ Current Procedural Terminology for specific definitions. XXX = The global concept does not apply. YYY = The global period is to be set by the carrier (for example, unlisted surgery codes). ZZZ = Code related to another service that is always included in the global period of the other service. (Note: Physician work and PE are associated with intra service time and in some instances the post service time.) E:\FR\FM\21NOR2.SGM 21NOR2 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70337 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION CPT 1 HCPCS 2 0001F 0003T 0005F 0008T 0016T 0017T 0018T 0019T 0021T 0024T 0026T 0027T 0028T 0029T 0030T 0031T 0032T 0041T 0042T 0043T 0044T 0045T 0046T 0047T 0048T 0049T 0050T 0051T 0052T 0053T 0054T 0055T 0056T 0058T 0059T 0060T 0061T 0062T 0063T 0064T 0065T 0066T 0066T 0066T 0067T 0067T 0067T 0068T 0069T 0070T 0071T 0072T 0073T 0074T 0075T 0075T 0075T 0076T 0076T 0076T 0077T 0078T 0079T 0080T 0081T 0082T 0083T 0084T 0085T 0086T 0087T 0088T 0089T 0090T 0091T .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... Status I C I C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C N N N C C C C C C C C A N C C C C C C C C C C C C C C C C C C C C C Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.07 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Heart failure assessed ....................................... Cervicography .................................................... Osteoarthritis assessed ...................................... Upper gi endoscopy w/suture ............................ Thermotx choroid vasc lesion ............................ Photocoagulat macular drusen .......................... Transcranial magnetic stimul ............................. Extracorp shock wv tx,ms nos ........................... Fetal oximetry, trnsvag/cerv ............................... Transcath cardiac reduction ............................... Measure remnant lipoproteins ............................ Endoscopic epidural lysis ................................... Dexa body composition study ............................ Magnetic tx for incontinence .............................. Antiprothrombin antibody ................................... Speculoscopy ..................................................... Speculoscopy w/direct sample ........................... Detect ur infect agnt w/cpas .............................. Ct perfusion w/contrast, cbf ............................... Co expired gas analysis ..................................... Whole body photography ................................... Whole body photography ................................... Cath lavage, mammary duct(s ........................... Cath lavage, mammary duct(s) .......................... Implant ventricular device .................................. External circulation assist ................................... Removal circulation assist .................................. Implant total heart system .................................. Replace component heart syst .......................... Replace component heart syst .......................... Bone surgery using computer ............................ Bone surgery using computer ............................ Bone surgery using computer ............................ Cryopreservation, ovary tiss ............................... Cryopreservation, oocyte ................................... Electrical impedance scan ................................. Destruction of tumor, breast ............................... Rep intradisc annulus;1 lev ................................ Rep intradisc annulus;>1lev ............................... Spectroscop eval expired gas ............................ Ocular photoscreen bilat .................................... Ct colonography;screen ..................................... Ct colonography;screen ..................................... Ct colonography;screen ..................................... Ct colonography;dx ............................................ Ct colonography;dx ............................................ Ct colonography;dx ............................................ Interp/rept heart sound ....................................... Analysis only heart sound .................................. Interp only heart sound ...................................... U/s leiomyomata ablate <200 ............................ U/s leiomyomata ablate >200 ............................ Delivery, comp imrt ............................................ Online physician e/m .......................................... Perq stent/chest vert art ..................................... Perq stent/chest vert art ..................................... Perq stent/chest vert art ..................................... S&i stent/chest vert art ....................................... S&i stent/chest vert art ....................................... S&i stent/chest vert art ....................................... Cereb therm perfusion probe ............................. Endovasc aort repr w/device .............................. Endovasc visc extnsn repr ................................. Endovasc aort repr rad s&i ................................ Endovasc visc extnsn s&i .................................. Stereotactic rad delivery ..................................... Stereotactic rad tx mngmt .................................. Temp prostate urethral stent .............................. Breath test heart reject ....................................... L ventricle fill pressure ....................................... Sperm eval hyaluronan ...................................... Rf tongue base vol reduxn ................................. Actigraphy testing, 3-day .................................... Cervical artific disc ............................................. Lumbar artific disc .............................................. Malpractice RVUs 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.13 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00223 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.20 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Facility Total 0.00 0.00 0.00 .00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70338 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 0092T 0093T 0094T 0095T 0096T 0097T 0098T 0099T 0100T 0101T 0102T 0103T 0104T 0105T 0106T 0107T 0108T 0109T 0110T 0111T 0115T 0116T 0117T 0120T 0123T 0124T 0126T 0130T 0133T 0135T 0137T 0140T 0141T 0142T 0143T 0144T 0145T 0146T 0147T 0148T 0149T 0150T 0151T 0152T 0153T 0154T 0500F 0501F 0502F 0503F 1000F 1001F 10021 10022 1002F 1003F 10040 1004F 1005F 10060 10061 1006F 1007F 10080 10081 1008F 10120 10121 10140 10160 10180 11000 11001 11004 11005 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 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 I I I I I I A A I I A I I A A I I A A I A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.27 1.27 0.00 0.00 1.18 0.00 0.00 1.17 2.40 0.00 0.00 1.17 2.45 0.00 1.22 2.69 1.53 1.20 2.25 0.60 0.30 10.31 13.75 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.16 2.55 0.00 0.00 1.01 0.00 0.00 1.21 1.83 0.00 0.00 3.11 4.08 0.00 2.18 3.52 1.78 1.60 2.99 0.58 0.23 NA NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.54 0.42 0.00 0.00 0.79 0.00 0.00 0.93 1.50 0.00 0.00 1.11 1.50 0.00 0.97 1.79 1.29 1.08 1.99 0.22 0.11 3.91 5.58 Artific disc addl ................................................... Cervical artific diskectomy .................................. Lumbar artific diskectomy .................................. Artific diskectomy addl ....................................... Rev cervical artific disc ...................................... Rev lumbar artific disc ........................................ Rev artific disc addl ............................................ Implant corneal ring ............................................ Prosth retina receive&gen .................................. Extracorp shockwv tx,hi enrg ............................. Extracorp shockwv tx,anesth ............................. Holotranscobalamin ............................................ At rest cardio gas rebreathe .............................. Exerc cardio gas rebreathe ................................ Touch quant sensory test ................................... Vibrate quant sensory test ................................. Cool quant sensory test ..................................... Heat quant sensory test ..................................... Nos quant sensory test ...................................... Rbc membranes fatty acids ............................... Med tx mngmt 15 min ........................................ Med tx mngmt subsqt ......................................... Med tx mngmt addl 15 min ................................ Fibroadenoma cryoablate, ea ............................ Scleral fistulization .............................................. Conjunctival drug placement .............................. Chd risk imt study .............................................. Chron care drug investigatn ............................... Esophageal implant injexn ................................. Perq cryoablate renal tumor ............................... Prostate saturation sampling .............................. Exhaled breath condensate ph .......................... Perq islet transplant ........................................... Open islet transplant .......................................... Laparoscopic islet transplnt ................................ CT heart wo dye; qual calc ................................ CT heart w/wo dye funct .................................... CCTA w/wo dye ................................................. CCTA w/wo, quan calcium ................................. CCTA w/wo, strxr ............................................... CCTA w/wo, strxr quan calc .............................. CCTA w/wo, disease strxr .................................. CT heart funct add-on ........................................ Computer chest add-on ...................................... Implant aneur sensor add-on ............................. Implant aneur sensor study ................................ 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 ........................... Level of activity assess ...................................... Acne surgery ...................................................... Clin symp vol ovrld assess ................................ Asthma symptoms evaluate ............................... Drainage of skin abscess ................................... Drainage of skin abscess ................................... Osteoarthritis assess .......................................... Anti-inflm/anlgsc otc assess ............................... Drainage of pilonidal cyst ................................... Drainage of pilonidal cyst ................................... Gi/renal risk assess ............................................ 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 ........................................... Malpractice RVUs 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.10 0.08 0.00 0.00 0.05 0.00 0.00 0.12 0.26 0.00 0.00 0.11 0.24 0.00 0.12 0.33 0.19 0.14 0.35 0.07 0.04 0.67 0.96 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00224 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.53 3.90 0.00 0.00 2.24 0.00 0.00 2.50 4.49 0.00 0.00 4.39 6.77 0.00 3.52 6.54 3.50 2.94 5.59 1.25 0.57 NA NA Facility Total 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.91 1.77 0.00 0.00 2.02 0.00 0.00 2.22 4.16 0.00 0.00 2.39 4.19 0.00 2.31 4.81 3.01 2.42 4.59 0.89 0.45 14.89 20.29 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 010 XXX XXX 010 010 XXX XXX 010 010 XXX 010 010 010 010 010 000 ZZZ 000 000 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70339 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 11006 11008 11010 11011 11012 11040 11041 11042 11043 11044 11055 11056 11057 11100 11101 11200 11201 11300 11301 11302 11303 11305 11306 11307 11308 11310 11311 11312 11313 11400 11401 11402 11403 11404 11406 11420 11421 11422 11423 11424 11426 11440 11441 11442 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 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A R R R A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A R A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 12.61 5.00 4.19 4.94 6.87 0.50 0.82 1.12 2.38 3.06 0.43 0.61 0.79 0.81 0.41 0.77 0.29 0.51 0.85 1.05 1.24 0.67 0.99 1.14 1.41 0.73 1.05 1.20 1.62 0.85 1.23 1.51 1.79 2.06 2.76 0.98 1.42 1.63 2.01 2.43 3.77 1.06 1.48 1.72 2.29 3.14 4.48 2.73 3.94 2.51 3.94 3.25 4.40 1.31 1.80 1.95 2.19 2.40 3.42 1.19 1.76 2.09 2.61 3.06 4.29 1.35 2.16 2.59 3.10 4.02 5.94 0.17 0.32 0.54 1.13 NA NA 6.89 8.18 12.14 0.52 0.66 0.97 3.39 4.46 0.56 0.64 0.74 1.25 0.33 1.04 0.16 0.99 1.11 1.30 1.58 0.85 1.10 1.29 1.45 1.11 1.23 1.42 1.81 2.00 2.06 2.23 2.40 2.71 3.07 1.77 2.07 2.26 2.59 2.81 3.49 2.21 2.34 2.55 2.92 3.48 4.05 5.04 6.62 5.12 6.84 5.07 6.72 2.64 2.71 2.83 3.08 3.38 4.07 2.60 2.71 2.97 3.34 3.75 4.64 2.66 3.03 3.41 3.81 4.69 5.77 0.25 0.34 0.44 1.03 4.86 2.03 2.63 2.35 3.85 0.21 0.33 0.44 2.60 3.76 0.17 0.23 0.30 0.37 0.19 0.76 0.12 0.21 0.38 0.46 0.52 0.27 0.42 0.49 0.59 0.32 0.49 0.55 0.72 0.88 1.02 1.08 1.32 1.40 1.65 0.93 1.11 1.33 1.45 1.60 2.11 1.31 1.49 1.57 1.82 2.19 2.78 2.03 2.55 2.02 2.69 2.27 2.77 0.97 1.22 1.26 1.33 1.39 1.74 0.95 1.24 1.39 1.58 1.78 2.40 1.11 1.53 1.71 1.97 2.46 3.48 0.07 0.12 0.21 0.43 Debride genit/per/abdom wall ............................ Remove mesh from abd wall ............................. Debride skin, fx .................................................. Debride skin/muscle, fx ...................................... Debride skin/muscle/bone, fx ............................. Debride skin, partial ........................................... Debride skin, full ................................................. Debride skin/tissue ............................................. Debride tissue/muscle ........................................ Debride tissue/muscle/bone ............................... Trim skin lesion .................................................. Trim skin lesions, 2 to 4 ..................................... Trim skin lesions, over 4 .................................... Biopsy, skin lesion .............................................. Biopsy, skin add-on ............................................ Removal of skin tags .......................................... Remove skin tags add-on .................................. Shave skin lesion ............................................... Shave skin lesion ............................................... Shave skin lesion ............................................... Shave skin lesion ............................................... Shave skin lesion ............................................... Shave skin lesion ............................................... Shave skin lesion ............................................... Shave skin lesion ............................................... Shave skin lesion ............................................... Shave skin lesion ............................................... Shave skin lesion ............................................... Shave skin lesion ............................................... Exc tr-ext b9+marg 0.5 < cm ............................. Exc tr-ext b9+marg 0.6-1 cm ............................. Exc tr-ext b9+marg 1.1-2 cm ............................. Exc tr-ext b9+marg 2.1-3 cm ............................. Exc tr-ext b9+marg 3.1-4 cm ............................. Exc tr-ext b9+marg > 4.0 cm ............................. Exc h-f-nk-sp b9+marg 0.5 < ............................. Exc h-f-nk-sp b9+marg 0.6-1 ............................. Exc h-f-nk-sp b9+marg 1.1-2 ............................. Exc h-f-nk-sp b9+marg 2.1-3 ............................. Exc h-f-nk-sp b9+marg 3.1-4 ............................. Exc h-f-nk-sp b9+marg > 4 cm .......................... Exc face-mm b9+marg 0.5 < cm ....................... Exc face-mm b9+marg 0.6-1 cm ........................ Exc face-mm b9+marg 1.1-2 cm ........................ Exc face-mm b9+marg 2.1-3 cm ........................ Exc face-mm b9+marg 3.1-4 cm ........................ Exc face-mm b9+marg > 4 cm .......................... Removal, sweat gland lesion ............................. Removal, sweat gland lesion ............................. Removal, sweat gland lesion ............................. Removal, sweat gland lesion ............................. Removal, sweat gland lesion ............................. Removal, sweat gland lesion ............................. Exc tr-ext mlg+marg 0.5 < cm ........................... Exc tr-ext mlg+marg 0.6-1 cm ............................ Exc tr-ext mlg+marg 1.1-2 cm ............................ Exc tr-ext mlg+marg 2.1-3 cm ............................ Exc tr-ext mlg+marg 3.1-4 cm ............................ Exc tr-ext mlg+marg > 4 cm .............................. Exc h-f-nk-sp mlg+marg 0.5 < ........................... Exc h-f-nk-sp mlg+marg 0.6-1 ............................ Exc h-f-nk-sp mlg+marg 1.1-2 ............................ Exc h-f-nk-sp mlg+marg 2.1-3 ............................ Exc h-f-nk-sp mlg+marg 3.1-4 ............................ Exc h-f-nk-sp mlg+mar > 4 cm .......................... Exc face-mm malig+marg 0.5 < ......................... Exc face-mm malig+marg 0.6-1 ......................... Exc face-mm malig+marg 1.1-2 ......................... Exc face-mm malig+marg 2.1-3 ......................... Exc face-mm malig+marg 3.1-4 ......................... Exc face-mm mlg+marg > 4 cm ......................... Trim nail(s) ......................................................... Debride nail, 1-5 ................................................. Debride nail, 6 or more ...................................... Removal of nail plate ......................................... Malpractice RVUs 1.28 0.61 0.66 0.74 1.16 0.06 0.10 0.13 0.32 0.43 0.05 0.07 0.10 0.03 0.02 0.04 0.02 0.03 0.04 0.05 0.07 0.07 0.07 0.07 0.13 0.04 0.05 0.06 0.10 0.06 0.10 0.13 0.17 0.21 0.32 0.09 0.13 0.16 0.20 0.25 0.44 0.08 0.13 0.16 0.22 0.30 0.43 0.34 0.53 0.32 0.54 0.40 0.58 0.10 0.12 0.12 0.16 0.20 0.36 0.09 0.12 0.14 0.20 0.27 0.45 0.11 0.16 0.19 0.26 0.37 0.61 0.02 0.04 0.07 0.14 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00225 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA 11.74 13.86 20.17 1.08 1.58 2.22 6.09 7.95 1.04 1.32 1.63 2.09 0.76 1.85 0.47 1.53 2.00 2.40 2.89 1.59 2.16 2.50 2.99 1.88 2.33 2.68 3.53 2.91 3.39 3.87 4.36 4.98 6.15 2.84 3.62 4.05 4.80 5.49 7.70 3.35 3.95 4.43 5.43 6.92 8.96 8.11 11.09 7.95 11.32 8.72 11.70 4.05 4.63 4.90 5.43 5.98 7.85 3.88 4.59 5.20 6.15 7.08 9.38 4.12 5.35 6.19 7.17 9.08 12.32 0.44 0.70 1.05 2.30 Facility Total 18.75 7.64 7.48 8.03 11.88 0.77 1.25 1.69 5.30 7.25 0.65 0.91 1.19 1.21 0.62 1.57 0.43 0.75 1.27 1.56 1.83 1.01 1.48 1.70 2.13 1.09 1.59 1.81 2.44 1.79 2.35 2.72 3.28 3.67 4.73 2.00 2.66 3.12 3.66 4.28 6.32 2.45 3.10 3.45 4.33 5.63 7.69 5.10 7.02 4.85 7.17 5.92 7.75 2.38 3.14 3.33 3.68 3.99 5.52 2.23 3.12 3.62 4.39 5.11 7.14 2.57 3.85 4.49 5.33 6.85 10.03 0.26 0.48 0.82 1.70 Global 000 ZZZ 010 000 000 000 000 000 010 010 000 000 000 000 ZZZ 010 ZZZ 000 000 000 000 000 000 000 000 000 000 000 000 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 090 090 090 090 090 090 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 000 000 000 000 70340 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 11732 11740 11750 11752 11755 11760 11762 11765 11770 11771 11772 11900 11901 11920 11921 11922 11950 11951 11952 11954 11960 11970 11971 11975 11976 11977 11980 11981 11982 11983 12001 12002 12004 12005 12006 12007 12011 12013 12014 12015 12016 12017 12018 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 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A R R R R R R R A A A N R N A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.57 0.37 1.86 2.67 1.31 1.58 2.89 0.69 2.61 5.73 6.97 0.52 0.80 1.61 1.93 0.49 0.84 1.19 1.69 1.85 9.07 7.05 2.13 +1.48 1.78 +3.30 1.48 1.48 1.78 3.30 1.70 1.86 2.24 2.86 3.66 4.11 1.76 1.99 2.46 3.19 3.92 4.70 5.52 2.62 1.84 2.15 2.47 2.92 3.42 4.04 4.66 2.37 2.74 3.14 3.63 4.24 4.64 2.47 2.77 3.12 3.45 4.42 5.23 5.95 3.12 3.91 1.24 3.30 4.32 1.44 3.78 5.94 2.19 3.80 4.44 0.44 0.55 2.17 3.00 1.57 2.63 2.89 1.79 3.49 5.66 7.52 0.65 0.66 3.71 3.97 1.14 1.14 1.49 1.86 2.45 NA NA 9.14 1.42 1.72 2.28 1.08 1.70 1.95 2.29 1.99 2.05 2.33 2.83 3.40 3.83 2.14 2.28 2.58 3.14 3.56 NA NA 3.83 1.83 2.29 3.85 3.20 5.21 5.57 6.11 2.55 3.27 3.22 5.28 6.52 6.36 3.28 3.23 3.25 3.57 4.49 6.77 6.15 4.06 4.67 1.17 4.15 4.86 1.51 4.37 5.92 1.66 4.88 4.81 0.22 0.35 1.76 3.00 0.77 1.79 2.35 0.76 1.50 3.32 5.08 0.21 0.35 1.09 1.27 0.25 0.39 0.51 0.68 0.90 10.42 6.15 3.80 0.57 0.68 1.26 0.54 0.68 0.83 1.47 0.77 0.90 1.01 1.20 1.51 1.82 0.78 0.93 1.06 1.25 1.52 1.90 2.26 1.93 1.41 0.96 1.80 1.45 2.16 2.55 2.97 1.13 1.46 1.60 2.29 2.76 3.09 1.45 1.43 1.53 1.63 2.13 3.06 3.76 2.31 2.69 0.57 2.35 2.80 0.63 2.69 4.17 1.03 2.77 3.15 Remove nail plate, add-on ................................. Drain blood from under nail ............................... Removal of nail bed ........................................... Remove nail bed/finger tip ................................. Biopsy, nail unit .................................................. Repair of nail bed ............................................... Reconstruction of nail bed ................................. Excision of nail fold, toe ..................................... Removal of pilonidal lesion ................................ Removal of pilonidal lesion ................................ Removal of pilonidal lesion ................................ Injection into skin lesions ................................... Added skin lesions injection ............................... Correct skin color defects .................................. Correct skin color defects .................................. Correct skin color defects .................................. Therapy for contour defects ............................... Therapy for contour defects ............................... Therapy for contour defects ............................... Therapy for contour defects ............................... Insert tissue expander(s) .................................... Replace tissue expander .................................... Remove tissue expander(s) ............................... Insert contraceptive cap ..................................... Removal of contraceptive cap ............................ Removal/reinsert contra cap .............................. Implant hormone pellet(s) .................................. Insert drug implant device .................................. Remove drug implant device ............................. Remove/insert drug implant ............................... Repair superficial wound(s) ................................ Repair superficial wound(s) ................................ Repair superficial wound(s) ................................ Repair superficial wound(s) ................................ Repair superficial wound(s) ................................ Repair superficial wound(s) ................................ Repair superficial wound(s) ................................ Repair superficial wound(s) ................................ Repair superficial wound(s) ................................ Repair superficial wound(s) ................................ Repair superficial wound(s) ................................ Repair superficial wound(s) ................................ Repair superficial wound(s) ................................ 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 .................................. Malpractice RVUs 0.07 0.04 0.22 0.35 0.14 0.21 0.36 0.08 0.33 0.74 0.89 0.02 0.03 0.24 0.29 0.07 0.06 0.11 0.16 0.25 1.31 1.05 0.32 0.17 0.21 0.37 0.13 0.12 0.17 0.23 0.15 0.17 0.21 0.27 0.35 0.45 0.16 0.18 0.23 0.29 0.37 0.47 0.64 0.30 0.24 0.17 0.16 0.25 0.39 0.55 0.66 0.19 0.17 0.27 0.41 0.54 0.58 0.20 0.17 0.23 0.30 0.45 0.59 0.56 0.26 0.26 0.13 0.26 0.25 0.15 0.26 0.32 0.18 0.34 0.31 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00226 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 1.08 0.96 4.25 6.02 3.02 4.42 6.14 2.56 6.43 12.13 15.38 1.19 1.49 5.56 6.19 1.70 2.04 2.79 3.71 4.55 NA NA 11.59 3.07 3.71 5.95 2.69 3.30 3.90 5.82 3.84 4.08 4.78 5.96 7.41 8.39 4.06 4.45 5.27 6.62 7.85 NA NA 6.75 3.91 4.61 6.48 6.37 9.02 10.16 11.43 5.11 6.18 6.63 9.32 11.30 11.58 5.95 6.17 6.60 7.32 9.36 12.59 12.66 7.44 8.84 2.54 7.71 9.43 3.10 8.41 12.18 4.03 9.02 9.56 Facility Total 0.86 0.76 3.84 6.02 2.22 3.58 5.60 1.53 4.44 9.79 12.94 0.75 1.18 2.94 3.49 0.81 1.29 1.81 2.53 3.00 20.80 14.25 6.25 2.22 2.67 4.93 2.15 2.28 2.78 5.00 2.62 2.93 3.46 4.33 5.52 6.38 2.70 3.10 3.75 4.73 5.81 7.07 8.42 4.85 3.49 3.28 4.43 4.62 5.97 7.14 8.29 3.69 4.37 5.01 6.33 7.54 8.31 4.12 4.37 4.88 5.38 7.00 8.88 10.27 5.69 6.86 1.94 5.91 7.37 2.22 6.73 10.43 3.40 6.91 7.90 Global ZZZ 000 010 010 000 010 010 010 010 090 090 000 000 000 000 ZZZ 000 000 000 000 090 090 090 XXX 000 XXX 000 XXX XXX XXX 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 ZZZ 010 010 ZZZ 010 010 ZZZ 010 010 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70341 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 13152 13153 13160 14000 14001 14020 14021 14040 14041 14060 14061 14300 14350 15000 15001 15040 15050 15100 15101 15110 15111 15115 15116 15120 15121 15130 15131 15135 15136 15150 15151 15152 15155 15156 15157 15170 15171 15175 15176 15200 15201 15220 15221 15240 15241 15260 15261 15300 15301 15320 15321 15330 15331 15335 15336 15340 15341 15360 15361 15365 15366 15400 15401 15420 15421 15430 15431 15570 15572 15574 15576 15600 15610 15620 15630 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 6.32 2.38 10.46 5.88 8.46 6.58 10.04 7.86 11.47 8.49 12.27 11.74 9.60 3.99 1.00 2.00 4.29 9.04 1.72 9.50 1.85 9.81 2.50 9.82 2.67 7.00 1.50 10.50 1.50 8.25 2.00 2.50 9.00 2.75 3.00 5.00 1.55 7.00 2.45 8.02 1.32 7.86 1.19 9.03 1.86 10.04 2.23 3.99 1.00 4.70 1.50 3.99 1.00 4.50 1.43 3.72 0.50 3.87 1.15 4.15 1.45 3.99 1.00 4.50 1.50 5.75 0.00 9.20 9.26 9.87 8.68 1.91 2.42 2.94 3.27 6.05 1.94 NA 7.87 9.44 8.63 10.01 8.83 10.62 8.81 11.63 11.16 NA 3.80 1.35 4.57 6.93 12.62 3.74 10.70 1.29 9.25 1.58 10.75 4.51 9.89 1.07 9.90 0.89 8.48 1.31 1.56 7.84 1.56 1.78 3.84 0.68 5.44 1.11 9.43 2.57 9.21 2.33 10.23 2.45 10.24 2.70 3.21 0.47 3.63 0.69 3.20 0.46 3.48 0.69 4.01 0.61 4.48 0.58 4.56 0.70 4.02 1.90 4.79 1.32 6.92 0.00 11.33 9.52 10.71 9.78 7.62 4.70 7.80 7.06 4.05 1.14 7.18 5.48 7.09 6.55 8.30 7.22 8.70 7.45 9.53 9.20 7.16 2.19 0.41 1.13 5.12 7.84 1.17 7.02 0.79 7.37 1.12 7.80 1.85 6.36 0.64 8.15 0.67 6.46 0.85 1.06 6.98 1.24 1.35 2.37 0.62 4.01 0.99 6.22 0.62 6.70 0.56 7.97 0.91 8.60 1.40 2.24 0.40 2.54 0.59 2.23 0.40 2.45 0.57 2.76 0.20 3.09 0.46 3.20 0.58 4.02 0.44 3.80 0.62 6.63 0.00 6.78 6.47 7.81 6.90 3.07 3.43 3.89 4.16 Repair of wound or lesion .................................. Repair wound/lesion add-on .............................. Late closure of wound ........................................ Skin tissue rearrangement ................................. Skin tissue rearrangement ................................. Skin tissue rearrangement ................................. Skin tissue rearrangement ................................. Skin tissue rearrangement ................................. Skin tissue rearrangement ................................. Skin tissue rearrangement ................................. Skin tissue rearrangement ................................. Skin tissue rearrangement ................................. Skin tissue rearrangement ................................. Wound prep, 1st 100 sq cm ............................... Wound prep, addl 100 sq cm ............................. Harvest cultured skin graft ................................. Skin pinch graft .................................................. Skin splt grft, trnk/arm/leg .................................. Skin splt grft t/a/l, add-on ................................... Epidrm autogrft trnk/arm/leg ............................... Epidrm autogrft t/a/l add-on ............................... Epidrm a-grft face/nck/hf/g ................................. Epidrm a-grft f/n/hf/g addl .................................. Skn splt a-grft fac/nck/hf/g ................................. Skn splt a-grft f/n/hf/g add .................................. Derm autograft, trnk/arm/leg .............................. Derm autograft t/a/l add-on ................................ Derm autograft face/nck/hf/g .............................. Derm autograft, f/n/hf/g add ............................... Cult epiderm grft t/arm/leg ................................. Cult epiderm grft t/a/l addl .................................. Cult epiderm graft t/a/l +% ................................. Cult epiderm graft, f/n/hf/g ................................. Cult epidrm grft f/n/hfg add ................................ Cult epiderm grft f/n/hfg +% ............................... Acell graft trunk/arms/legs .................................. Acell graft t/arm/leg add-on ................................ Acellular graft, f/n/hf/g ........................................ Acell graft, f/n/hf/g add-on .................................. Skin full graft, trunk ............................................ Skin full graft trunk add-on ................................. Skin full graft sclp/arm/leg .................................. Skin full graft add-on .......................................... Skin full grft face/genit/hf .................................... Skin full graft add-on .......................................... Skin full graft een & lips ..................................... Skin full graft add-on .......................................... Apply skinallogrft, t/arm/lg .................................. Apply sknallogrft t/a/l addl .................................. Apply skin allogrft f/n/hf/g ................................... Aply sknallogrft f/n/hfg add ................................. Aply acell alogrft t/arm/leg .................................. Aply acell grft t/a/l add-on .................................. Apply acell graft, f/n/hf/g .................................... Aply acell grft f/n/hf/g add .................................. Apply cult skin substitute .................................... Apply cult skin sub add-on ................................. Apply cult derm sub, t/a/l ................................... Aply cult derm sub t/a/l add ............................... Apply cult derm sub f/n/hf/g ............................... Apply cult derm f/hf/g add .................................. Apply skin xenograft, t/a/l ................................... Apply skn xenogrft t/a/l add ............................... Apply skin xgraft, f/n/hf/g .................................... Apply skn xgrft f/n/hf/g add ................................ Apply acellular xenograft .................................... Apply acellular xgraft add ................................... Form skin pedicle flap ........................................ Form skin pedicle flap ........................................ Form skin pedicle flap ........................................ Form skin pedicle flap ........................................ Skin graft ............................................................ Skin graft ............................................................ Skin graft ............................................................ Skin graft ............................................................ Malpractice RVUs 0.40 0.24 1.54 0.59 0.82 0.64 0.81 0.62 0.73 0.68 0.76 1.16 1.34 0.54 0.14 0.24 0.57 1.28 0.24 1.31 0.26 1.15 0.33 1.16 0.36 0.97 0.21 1.23 0.20 1.14 0.28 0.35 1.05 0.36 0.39 0.55 0.19 0.82 0.29 0.98 0.19 0.84 0.16 0.92 0.23 0.69 0.21 0.49 0.14 0.58 0.21 0.49 0.14 0.55 0.20 0.41 0.06 0.43 0.14 0.46 0.17 0.47 0.14 0.52 0.21 0.66 0.00 1.34 1.20 1.20 0.87 0.27 0.35 0.35 0.34 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00227 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 12.77 4.56 NA 14.34 18.72 15.85 20.86 17.31 22.82 17.98 24.66 24.06 NA 8.33 2.49 6.81 11.79 22.94 5.70 21.51 3.40 20.21 4.41 21.73 7.54 17.86 2.78 21.63 2.59 17.87 3.59 4.41 17.89 4.67 5.17 9.39 2.42 13.26 3.85 18.43 4.08 17.91 3.68 20.18 4.54 20.97 5.14 7.69 1.61 8.91 2.40 7.68 1.60 8.53 2.32 8.14 1.17 8.78 1.87 9.17 2.32 8.48 3.04 9.81 3.03 13.33 0.00 21.87 19.98 21.78 19.33 9.80 7.47 11.09 10.67 Facility Total 10.77 3.76 19.18 11.95 16.37 13.77 19.15 15.70 20.90 16.62 22.56 22.10 18.10 6.72 1.55 3.37 9.98 18.16 3.13 17.83 2.90 18.33 3.95 18.78 4.88 14.33 2.35 19.88 2.37 15.85 3.13 3.91 17.03 4.35 4.74 7.92 2.36 11.83 3.73 15.22 2.13 15.40 1.91 17.92 3.00 19.33 3.84 6.72 1.54 7.82 2.30 6.71 1.54 7.50 2.20 6.89 0.76 7.39 1.75 7.81 2.20 8.48 1.58 8.82 2.33 13.04 0.00 17.32 16.93 18.88 16.45 5.25 6.20 7.18 7.77 Global 010 ZZZ 090 090 090 090 090 090 090 090 090 090 090 000 ZZZ 000 090 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ ZZZ 090 ZZZ ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 010 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 090 090 090 090 090 090 090 70342 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 15650 15732 15734 15736 15738 15740 15750 15756 15757 15758 15760 15770 15775 15776 15780 15781 15782 15783 15786 15787 15788 15789 15792 15793 15819 15820 15821 15822 15823 15824 15825 15826 15828 15829 15831 15832 15833 15834 15835 15836 15837 15838 15839 15840 15841 15842 15845 15850 15851 15852 15860 15876 15877 15878 15879 15920 15922 15931 15933 15934 15935 15936 15937 15940 15941 15944 15945 15946 15950 15951 15952 15953 15956 15958 15999 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A R R A A A A A A R R R A A A A A A R R R R R A A A A A A A A A A A A A B A A A R R R R A A A A A A A A A A A A A A A A A A A C .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 3.96 17.81 17.76 16.25 17.89 10.23 11.39 35.18 35.18 35.05 8.73 7.51 3.95 5.53 7.28 4.84 4.31 4.28 2.03 0.33 2.09 4.91 1.86 3.73 9.37 5.14 5.71 4.44 7.04 0.00 0.00 0.00 0.00 0.00 12.38 11.57 10.62 10.83 11.65 9.33 8.42 7.12 9.37 13.24 23.23 37.90 12.55 +0.78 0.86 0.86 1.95 0.00 0.00 0.00 0.00 7.94 9.89 9.23 10.83 12.67 14.55 12.36 14.19 9.33 11.41 11.44 12.67 21.54 7.53 10.70 11.37 12.61 15.50 15.46 0.00 7.16 18.09 18.16 18.28 18.02 10.16 NA NA NA NA 10.05 NA 4.24 5.37 11.55 6.93 9.88 6.89 3.36 1.09 6.73 8.11 7.11 6.30 NA 6.99 7.37 5.85 7.87 0.00 0.00 0.00 0.00 0.00 NA NA NA NA NA NA 8.57 NA 8.85 NA NA NA NA 1.56 1.68 1.85 0.83 0.00 0.00 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 4.22 12.25 12.41 11.25 11.75 8.28 9.07 20.62 21.65 21.63 7.28 6.70 1.30 2.81 8.27 5.38 6.57 4.19 1.32 0.16 3.09 4.81 4.46 4.39 7.20 5.58 5.73 4.50 6.45 0.00 0.00 0.00 0.00 0.00 8.18 8.36 8.23 7.71 7.56 6.80 7.39 6.08 6.41 10.00 15.03 22.98 9.33 0.30 0.31 0.33 0.78 0.00 0.00 0.00 0.00 5.57 7.23 5.70 7.87 8.06 10.35 8.24 9.85 6.19 9.48 8.62 9.67 14.41 5.43 7.88 7.77 9.02 10.80 11.07 0.00 Transfer skin pedicle flap ................................... Muscle-skin graft, head/neck ............................. Muscle-skin graft, trunk ...................................... Muscle-skin graft, arm ........................................ Muscle-skin graft, leg ......................................... Island pedicle flap graft ...................................... Neurovascular pedicle graft ............................... Free myo/skin flap microvasc ............................ Free skin flap, microvasc ................................... Free fascial flap, microvasc ............................... Composite skin graft .......................................... Derma-fat-fascia graft ......................................... Hair transplant punch grafts ............................... Hair transplant punch grafts ............................... Abrasion treatment of skin ................................. Abrasion treatment of skin ................................. Abrasion treatment of skin ................................. Abrasion treatment of skin ................................. Abrasion, lesion, single ...................................... Abrasion, lesions, add-on ................................... Chemical peel, face, epiderm ............................ Chemical peel, face, dermal .............................. Chemical peel, nonfacial .................................... Chemical peel, nonfacial .................................... Plastic surgery, neck .......................................... Revision of lower eyelid ..................................... Revision of lower eyelid ..................................... Revision of upper eyelid ..................................... Revision of upper eyelid ..................................... Removal of forehead wrinkles ............................ Removal of neck wrinkles .................................. Removal of brow wrinkles .................................. Removal of face wrinkles ................................... Removal of skin wrinkles ................................... Excise excessive skin tissue .............................. Excise excessive skin tissue .............................. Excise excessive skin tissue .............................. Excise excessive skin tissue .............................. Excise excessive skin tissue .............................. Excise excessive skin tissue .............................. Excise excessive skin tissue .............................. Excise excessive skin tissue .............................. Excise excessive skin tissue .............................. Graft for face nerve palsy .................................. Graft for face nerve palsy .................................. Flap for face nerve palsy ................................... Skin and muscle repair, face ............................. Removal of sutures ............................................ Removal of sutures ............................................ Dressing change not for burn ............................ Test for blood flow in graft ................................. Suction assisted lipectomy ................................. Suction assisted lipectomy ................................. Suction assisted lipectomy ................................. Suction assisted lipectomy ................................. Removal of tail bone ulcer ................................. Removal of tail bone ulcer ................................. Remove sacrum pressure sore .......................... Remove sacrum pressure sore .......................... Remove sacrum pressure sore .......................... Remove sacrum pressure sore .......................... Remove sacrum pressure sore .......................... Remove sacrum pressure sore .......................... Remove hip pressure sore ................................. Remove hip pressure sore ................................. Remove hip pressure sore ................................. Remove hip pressure sore ................................. Remove hip pressure sore ................................. Remove thigh pressure sore .............................. Remove thigh pressure sore .............................. Remove thigh pressure sore .............................. Remove thigh pressure sore .............................. Remove thigh pressure sore .............................. Remove thigh pressure sore .............................. Removal of pressure sore .................................. Malpractice RVUs 0.42 1.99 2.61 2.45 2.65 0.63 1.42 4.61 3.89 4.23 0.85 1.05 0.52 0.72 0.67 0.34 0.34 0.28 0.11 0.04 0.11 0.20 0.13 0.19 0.97 0.40 0.45 0.37 0.50 0.00 0.00 0.00 0.00 0.00 1.75 1.66 1.49 1.61 1.60 1.34 1.18 0.58 1.22 1.32 2.54 4.93 0.81 0.05 0.06 0.09 0.27 0.00 0.00 0.00 0.00 1.04 1.42 1.25 1.52 1.78 2.09 1.76 2.06 1.31 1.66 1.65 1.84 3.16 1.04 1.49 1.60 1.79 2.21 2.25 0.00 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00228 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 11.54 37.89 38.53 36.98 38.56 21.02 NA NA NA NA 19.63 NA 8.71 11.62 19.50 12.11 14.53 11.45 5.50 1.46 8.93 13.22 9.10 10.22 NA 12.53 13.53 10.66 15.41 0.00 0.00 0.00 0.00 0.00 NA NA NA NA NA NA 18.17 NA 19.44 NA NA NA NA 2.39 2.60 2.80 3.05 0.00 0.00 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 Facility Total 8.60 32.05 32.78 29.95 32.29 19.14 21.88 60.41 60.72 60.91 16.86 15.26 5.77 9.06 16.22 10.56 11.22 8.75 3.46 0.53 5.29 9.92 6.45 8.31 17.54 11.12 11.89 9.31 13.99 0.00 0.00 0.00 0.00 0.00 22.31 21.59 20.34 20.15 20.81 17.47 16.99 13.78 17.00 24.56 40.80 65.81 22.69 1.13 1.23 1.28 3.00 0.00 0.00 0.00 0.00 14.55 18.54 16.18 20.22 22.51 26.99 22.36 26.10 16.83 22.55 21.71 24.18 39.11 14.00 20.07 20.74 23.42 28.51 28.78 0.00 Global 090 090 090 090 090 090 090 090 090 090 090 090 000 000 090 090 090 090 010 ZZZ 090 090 090 090 090 090 090 090 090 000 000 000 000 000 090 090 090 090 090 090 090 090 090 090 090 090 090 XXX 000 000 000 000 000 000 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70343 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 16000 16020 16025 16030 16035 16036 17000 17003 17004 17106 17107 17108 17110 17111 17250 17260 17261 17262 17263 17264 17266 17270 17271 17272 17273 17274 17276 17280 17281 17282 17283 17284 17286 17304 17305 17306 17307 17310 17340 17360 17380 17999 19000 19001 19020 19030 19100 19101 19102 19103 19110 19112 19120 19125 19126 19140 19160 19162 19180 19182 19200 19220 19240 19260 19271 19272 19290 19291 19295 19296 19297 19298 19316 19318 19324 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A R C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.89 0.80 1.85 2.08 3.74 1.50 0.60 0.15 2.79 4.58 9.15 13.18 0.65 0.92 0.50 0.91 1.17 1.58 1.79 1.94 2.34 1.32 1.49 1.77 2.05 2.59 3.20 1.17 1.72 2.04 2.64 3.21 4.43 7.59 2.85 2.85 2.85 0.95 0.76 1.43 0.00 0.00 0.84 0.42 3.56 1.53 1.27 3.18 2.00 3.69 4.29 3.66 5.55 6.05 2.93 5.13 5.98 13.51 8.79 7.72 15.47 15.70 15.98 15.42 18.87 21.52 1.27 0.63 0.00 3.63 1.72 6.00 10.67 15.60 5.84 0.86 1.29 1.77 2.18 NA NA 0.97 0.11 2.31 4.61 7.22 9.29 1.62 1.67 1.22 1.28 1.61 1.89 2.06 2.23 2.51 1.70 1.78 2.00 2.21 2.57 2.95 1.61 1.91 2.16 2.55 2.93 3.68 8.26 3.90 3.92 3.57 1.62 0.37 1.44 0.00 0.00 1.99 0.25 6.35 2.87 2.09 4.51 3.84 11.52 5.81 6.08 4.55 4.79 NA 7.16 NA NA NA NA NA NA NA NA NA NA 2.86 1.21 2.70 125.75 NA 42.28 NA NA NA 0.26 0.58 0.96 1.12 1.58 0.60 0.54 0.07 1.59 3.34 5.47 7.68 0.70 0.81 0.34 0.67 0.83 1.02 1.09 1.12 1.22 0.87 0.98 1.11 1.21 1.44 1.68 0.81 1.09 1.24 1.49 1.76 2.45 3.57 1.34 1.35 1.36 0.46 0.36 0.87 0.00 0.00 0.31 0.14 2.68 0.50 0.42 1.92 0.66 1.23 2.87 2.69 3.07 3.29 1.00 3.40 3.43 6.35 5.03 4.76 7.98 8.25 8.22 11.18 18.00 18.98 0.42 0.21 NA 1.53 0.64 2.42 7.53 11.20 4.90 Initial treatment of burn(s) .................................. Dress/debrid p-thick burn, s ............................... Dress/debrid p-thick burn, m .............................. Dress/debrid p-thick burn, l ................................ Incision of burn scab, initi .................................. Escharotomy; add’l incision ................................ Destroy benign/premlg lesion ............................. Destroy lesions, 2-14 ......................................... Destroy lesions, 15 or more ............................... Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruct lesion, 1-14 .......................................... Destruct lesion, 15 or more ................................ Chemical cautery, tissue .................................... Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. Destruction of skin lesions ................................. 1 stage mohs, up to 5 spec ............................... 2 stage mohs, up to 5 spec ............................... 3 stage mohs, up to 5 spec ............................... Mohs addl stage up to 5 spec ........................... Mohs any stage > 5 spec each .......................... Cryotherapy of skin ............................................ Skin peel therapy ............................................... Hair removal by electrolysis ............................... Skin tissue procedure ......................................... Drainage of breast lesion ................................... Drain breast lesion add-on ................................. Incision of breast lesion ..................................... Injection for breast x-ray .................................... Bx breast percut w/o image ............................... Biopsy of breast, open ....................................... Bx breast percut w/image .................................. Bx breast percut w/device .................................. Nipple exploration ............................................... Excise breast duct fistula ................................... Removal of breast lesion ................................... Excision, breast lesion ....................................... Excision, addl breast lesion ............................... Removal of breast tissue ................................... Partial mastectomy ............................................. P-mastectomy w/ln removal ............................... Removal of breast .............................................. Removal of breast .............................................. Removal of breast .............................................. Removal of breast .............................................. Removal of breast .............................................. Removal of chest wall lesion ............................. Revision of chest wall ........................................ Extensive chest wall surgery .............................. Place needle wire, breast ................................... Place needle wire, breast ................................... Place breast clip, percut ..................................... 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 .................................................... Malpractice RVUs 0.08 0.08 0.19 0.24 0.46 0.20 0.03 0.01 0.11 0.35 0.63 0.54 0.05 0.05 0.06 0.04 0.05 0.06 0.07 0.08 0.09 0.05 0.06 0.07 0.08 0.10 0.16 0.05 0.07 0.08 0.11 0.13 0.23 0.30 0.11 0.11 0.11 0.03 0.05 0.06 0.00 0.00 0.08 0.04 0.45 0.09 0.16 0.39 0.14 0.30 0.57 0.48 0.73 0.80 0.38 0.69 0.79 1.79 1.18 1.04 1.92 2.07 2.12 2.13 2.62 2.99 0.07 0.04 0.01 0.36 0.17 0.43 1.64 2.92 0.84 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00229 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 1.83 2.17 3.81 4.50 NA NA 1.60 0.27 5.21 9.54 17.00 23.01 2.32 2.64 1.78 2.23 2.83 3.53 3.92 4.25 4.94 3.07 3.33 3.84 4.34 5.26 6.31 2.83 3.70 4.28 5.30 6.27 8.34 16.15 6.86 6.88 6.53 2.60 1.18 2.93 0.00 0.00 2.91 0.71 10.36 4.49 3.52 8.08 5.98 15.51 10.67 10.22 10.83 11.64 NA 12.98 NA NA NA NA NA NA NA NA NA NA 4.20 1.88 2.71 129.74 NA 48.71 NA NA NA Facility Total 1.23 1.46 3.00 3.44 5.78 2.30 1.17 0.23 4.49 8.27 15.25 21.40 1.40 1.78 0.90 1.62 2.05 2.66 2.95 3.14 3.65 2.24 2.53 2.95 3.34 4.13 5.04 2.03 2.88 3.36 4.24 5.10 7.11 11.46 4.30 4.31 4.32 1.44 1.17 2.36 0.00 0.00 1.23 0.60 6.69 2.12 1.85 5.49 2.80 5.22 7.73 6.83 9.35 10.14 4.31 9.22 10.20 21.65 15.00 13.52 25.37 26.02 26.32 28.73 39.49 43.49 1.76 0.88 NA 5.52 2.53 8.85 19.84 29.72 11.58 Global 000 000 000 000 090 ZZZ 010 ZZZ 010 090 090 090 010 010 000 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 010 000 000 000 000 ZZZ 010 010 000 YYY 000 ZZZ 090 000 000 010 000 000 090 090 090 090 ZZZ 090 090 090 090 090 090 090 090 090 090 090 000 ZZZ ZZZ 000 ZZZ 000 090 090 090 70344 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 19325 19328 19330 19340 19342 19350 19355 19357 19361 19364 19366 19367 19368 19369 19370 19371 19380 19396 19499 20000 20005 2000F 2001F 2002F 2003F 2004F 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 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A C A A I I I I I A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 8.44 5.67 7.58 6.32 11.18 8.91 7.56 18.13 19.23 40.94 21.25 25.69 32.37 29.78 8.04 9.34 9.13 2.17 0.00 2.12 3.41 0.00 0.00 0.00 0.00 0.00 10.06 3.22 3.93 5.29 13.67 1.46 2.35 0.99 1.27 1.87 3.23 7.77 5.02 5.55 1.23 0.76 1.85 3.49 0.94 0.75 0.75 0.66 0.75 0.66 0.68 0.79 0.70 2.28 2.23 2.51 4.88 6.06 5.42 8.05 1.31 1.74 3.34 3.51 6.40 5.85 4.15 41.09 49.93 61.56 30.89 25.55 30.89 26.37 41.35 NA NA NA NA NA 13.88 10.28 NA NA NA NA NA NA NA NA NA NA 1.08 0.00 2.70 3.50 0.00 0.00 0.00 0.00 0.00 NA 5.94 7.48 8.60 NA 3.04 3.90 6.52 4.57 24.52 NA NA NA NA 2.27 2.92 2.92 9.17 0.97 0.71 0.68 0.72 0.82 0.65 0.76 0.95 0.71 3.52 2.37 3.06 NA NA NA NA 2.16 11.57 8.81 NA NA NA 7.16 NA NA NA NA NA NA NA NA 6.54 5.03 6.05 3.12 8.95 7.19 4.71 15.66 12.47 23.61 11.61 16.74 18.97 18.45 6.92 7.84 7.72 0.99 0.00 1.74 2.26 0.00 0.00 0.00 0.00 0.00 4.47 1.62 1.91 3.40 7.05 0.75 1.19 0.63 0.79 1.13 2.56 6.59 3.51 4.17 1.53 0.25 1.77 2.63 0.52 0.23 0.33 0.20 0.22 0.35 0.36 0.42 0.36 1.85 1.55 1.61 4.92 5.54 4.84 7.06 1.35 2.11 3.73 2.52 3.78 5.46 4.05 21.01 34.41 42.34 37.90 34.69 36.65 36.58 22.34 Enlarge breast with implant ................................ Removal of breast implant ................................. Removal of implant material .............................. Immediate breast prosthesis .............................. Delayed breast prosthesis .................................. Breast reconstruction ......................................... Correct inverted nipple(s) ................................... Breast reconstruction ......................................... Breast reconstruction ......................................... Breast reconstruction ......................................... Breast reconstruction ......................................... Breast reconstruction ......................................... Breast reconstruction ......................................... Breast reconstruction ......................................... Surgery of breast capsule .................................. Removal of breast capsule ................................ Revise breast reconstruction .............................. Design custom breast implant ............................ Breast surgery procedure ................................... Incision of abscess ............................................. Incision of deep abscess .................................... Blood pressure measure .................................... Weight record ..................................................... Clin sign vol ovrld assess .................................. Auscultation heart perform ................................. Initial exam involved joints ................................. Explore wound, neck .......................................... Explore wound, chest ......................................... Explore wound, abdomen .................................. Explore wound, extremity ................................... Excise epiphyseal bar ........................................ Muscle biopsy ..................................................... Deep muscle biopsy ........................................... Needle biopsy, muscle ....................................... Bone biopsy, trocar/needle ................................ Bone biopsy, trocar/needle ................................ Bone biopsy, excisional ...................................... Bone biopsy, excisional ...................................... Open bone biopsy .............................................. Open bone biopsy .............................................. Injection of sinus tract ........................................ Inject sinus tract for x-ray ................................... Removal of foreign body .................................... Removal of foreign body .................................... Ther injection, carp tunnel .................................. Inj tendon sheath/ligament ................................. Inj tendon origin/insertion ................................... Inj trigger point, 1/2 muscl .................................. Inject trigger points, =/> 3 .................................. Drain/inject, joint/bursa ....................................... Drain/inject, joint/bursa ....................................... Drain/inject, joint/bursa ....................................... Aspirate/inj ganglion cyst ................................... Treatment of bone cyst ...................................... Insert and remove bone pin ............................... Apply, rem fixation device .................................. Application of head brace .................................. Application of pelvis brace ................................. Application of thigh brace ................................... Halo brace application ........................................ Removal of fixation device ................................. Removal of support implant ............................... Removal of support implant ............................... Apply bone fixation device ................................. Apply bone fixation device ................................. Adjust bone fixation device ................................ Remove bone fixation device ............................. Replantation, arm, complete .............................. Replant forearm, complete ................................. Replantation hand, complete ............................. Replantation digit, complete ............................... Replantation digit, complete ............................... Replantation thumb, complete ........................... Replantation thumb, complete ........................... Replantation foot, complete ............................... Malpractice RVUs 1.33 0.91 1.26 1.06 1.83 1.41 0.92 2.93 2.92 6.22 3.24 4.03 5.52 4.50 1.29 1.62 1.44 0.30 0.00 0.25 0.46 0.00 0.00 0.00 0.00 0.00 1.21 0.44 0.49 0.75 2.03 0.23 0.33 0.07 0.08 0.22 0.44 1.31 1.02 1.15 0.12 0.04 0.21 0.51 0.13 0.09 0.08 0.05 0.04 0.08 0.08 0.11 0.10 0.20 0.31 0.59 1.14 0.56 0.94 1.74 0.19 0.28 0.56 0.59 1.05 0.98 0.71 3.81 4.84 6.86 4.52 4.18 4.61 3.66 1.12 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00230 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA 24.20 18.76 NA NA NA NA NA NA NA NA NA NA 3.55 0.00 5.07 7.37 0.00 0.00 0.00 0.00 0.00 NA 9.60 11.90 14.64 NA 4.73 6.58 7.58 5.92 26.61 NA NA NA NA 3.62 3.72 4.98 13.17 2.04 1.55 1.51 1.43 1.61 1.39 1.52 1.85 1.51 6.00 4.91 6.16 NA NA NA NA 3.66 13.59 12.71 NA NA NA 12.02 NA NA NA NA NA NA NA NA Facility Total 16.31 11.61 14.89 10.50 21.96 17.51 13.19 36.72 34.62 70.77 36.10 46.46 56.86 52.73 16.25 18.80 18.29 3.46 0.00 4.11 6.13 0.00 0.00 0.00 0.00 0.00 15.74 5.28 6.33 9.44 22.75 2.44 3.87 1.69 2.14 3.22 6.23 15.67 9.55 10.87 2.88 1.05 3.83 6.63 1.59 1.07 1.16 0.91 1.01 1.09 1.12 1.32 1.16 4.33 4.09 4.71 10.94 12.16 11.20 16.85 2.85 4.13 7.63 6.62 11.23 12.29 8.91 65.91 89.18 110.76 73.31 64.42 72.15 66.61 64.81 Global 090 090 090 ZZZ 090 090 090 090 090 090 090 090 090 090 090 090 090 000 YYY 010 010 XXX XXX XXX XXX XXX 010 010 010 010 090 000 000 000 000 000 010 010 010 010 010 000 010 010 000 000 000 000 000 000 000 000 000 010 010 000 090 090 090 090 010 010 090 090 090 090 090 090 090 090 090 090 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70345 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 20900 20902 20910 20912 20920 20922 20924 20926 20930 20931 20936 20937 20938 20950 20955 20956 20957 20962 20969 20970 20972 20973 20974 20975 20979 20982 20999 21010 21015 21025 21026 21029 21030 21031 21032 21034 21040 21044 21045 21046 21047 21048 21049 21050 21060 21070 21076 21077 21079 21080 21081 21082 21083 21084 21085 21086 21087 21088 21089 21100 21110 21116 21120 21121 21122 21123 21125 21127 21137 21138 21139 21141 21142 21143 21145 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A B A B A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 5.57 7.54 5.33 6.34 5.30 6.60 6.47 5.52 0.00 1.81 0.00 2.79 3.02 1.26 39.15 39.21 40.59 39.21 43.85 43.00 42.93 45.69 0.62 2.60 0.62 7.27 0.00 10.12 5.28 10.04 4.84 7.70 4.49 3.24 3.24 16.15 4.49 11.84 16.15 12.98 18.72 13.48 17.97 10.75 10.21 8.19 13.40 33.70 22.31 25.06 22.85 20.84 19.27 22.48 8.99 24.88 24.88 0.00 0.00 4.21 5.20 0.81 4.92 7.63 8.51 11.14 10.60 11.10 9.81 12.17 14.59 18.07 18.78 19.55 19.91 8.45 NA NA NA NA 7.56 NA NA 0.00 NA 0.00 NA NA 6.86 NA NA NA NA NA NA NA NA 0.69 NA 0.80 109.86 0.00 NA NA 12.28 7.88 9.40 6.35 5.18 5.36 15.97 6.41 NA NA NA NA NA NA NA NA NA 12.39 31.42 21.56 24.56 22.36 19.40 18.84 22.50 8.31 23.81 23.35 0.00 0.00 11.56 9.59 4.34 10.61 9.76 NA NA 55.38 42.92 NA NA NA NA NA NA NA 5.69 6.90 5.20 5.81 4.23 4.88 5.90 4.76 0.00 0.93 0.00 1.45 1.56 0.99 24.34 24.81 18.99 26.60 26.71 25.45 20.64 25.23 0.54 1.71 0.34 2.98 0.00 7.11 5.02 9.38 6.34 7.03 5.04 3.63 3.52 12.70 4.73 9.40 12.39 11.93 13.48 12.17 13.06 9.47 8.63 7.12 10.03 26.08 17.20 19.42 17.54 15.78 14.47 17.75 6.80 19.49 19.25 0.00 0.00 4.75 8.38 0.33 7.51 7.84 8.64 10.83 8.34 9.48 7.75 9.56 11.09 13.69 12.86 14.35 13.94 Removal of bone for graft .................................. Removal of bone for graft .................................. Remove cartilage for graft .................................. Remove cartilage for graft .................................. Removal of fascia for graft ................................. Removal of fascia for graft ................................. Removal of tendon for graft ............................... Removal of tissue for graft ................................. Spinal bone allograft .......................................... Spinal bone allograft .......................................... Spinal bone autograft ......................................... Spinal bone autograft ......................................... Spinal bone autograft ......................................... Fluid pressure, muscle ....................................... Fibula bone graft, microvasc .............................. Iliac bone graft, microvasc ................................. Mt bone graft, microvasc .................................... Other bone graft, microvasc ............................... Bone/skin graft, microvasc ................................. Bone/skin graft, iliac crest .................................. Bone/skin graft, metatarsal ................................ Bone/skin graft, great toe ................................... Electrical bone stimulation ................................. Electrical bone stimulation ................................. Us bone stimulation ............................................ Ablate, bone tumor(s) perq ................................ Musculoskeletal surgery ..................................... Incision of jaw joint ............................................. Resection of facial tumor ................................... Excision of bone, lower jaw ............................... Excision of facial bone(s) ................................... Contour of face bone lesion ............................... Excise max/zygoma b9 tumor ............................ Remove exostosis, mandible ............................. Remove exostosis, maxilla ................................. Excise max/zygoma mlg tumor .......................... Excise mandible lesion ....................................... Removal of jaw bone lesion ............................... Extensive jaw surgery ........................................ Remove mandible cyst complex ........................ Excise lwr jaw cyst w/repair ............................... Remove maxilla cyst complex ............................ Excis uppr jaw cyst w/repair .............................. Removal of jaw joint ........................................... Remove jaw joint cartilage ................................. Remove coronoid process ................................. Prepare face/oral prosthesis .............................. Prepare face/oral prosthesis .............................. Prepare face/oral prosthesis .............................. Prepare face/oral prosthesis .............................. Prepare face/oral prosthesis .............................. Prepare face/oral prosthesis .............................. Prepare face/oral prosthesis .............................. Prepare face/oral prosthesis .............................. Prepare face/oral prosthesis .............................. Prepare face/oral prosthesis .............................. Prepare face/oral prosthesis .............................. Prepare face/oral prosthesis .............................. Prepare face/oral prosthesis .............................. Maxillofacial fixation ........................................... Interdental fixation .............................................. Injection, jaw joint x-ray ...................................... Reconstruction of chin ........................................ Reconstruction of chin ........................................ Reconstruction of chin ........................................ Reconstruction of chin ........................................ Augmentation, lower jaw bone ........................... Augmentation, lower jaw bone ........................... Reduction of forehead ........................................ Reduction of forehead ........................................ Reduction of forehead ........................................ Reconstruct midface, lefort ................................ Reconstruct midface, lefort ................................ Reconstruct midface, lefort ................................ Reconstruct midface, lefort ................................ Malpractice RVUs 0.94 1.30 0.71 0.69 0.66 0.70 1.04 0.87 0.00 0.43 0.00 0.54 0.64 0.20 4.89 7.01 7.05 6.55 4.79 6.60 5.30 5.54 0.11 0.51 0.09 0.69 0.00 1.11 0.70 1.32 0.60 0.94 0.54 0.48 0.47 1.71 0.54 1.12 1.52 1.85 2.12 1.76 1.59 1.47 1.38 1.27 1.99 4.55 3.15 3.74 3.20 3.11 2.88 2.18 1.27 3.71 3.44 0.00 0.00 0.34 0.72 0.06 0.60 0.90 1.07 1.40 0.79 1.52 1.32 1.74 1.18 2.35 2.38 1.66 2.84 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00231 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 14.96 NA NA NA NA 14.86 NA NA 0.00 NA 0.00 NA NA 8.32 NA NA NA NA NA NA NA NA 1.42 NA 1.51 117.82 0.00 NA NA 23.64 13.32 18.04 11.38 8.90 9.07 33.83 11.44 NA NA NA NA NA NA NA NA NA 27.78 69.67 47.02 53.36 48.41 43.35 40.99 47.16 18.57 52.40 51.67 0.00 0.00 16.11 15.51 5.21 16.13 18.29 NA NA 66.77 55.54 NA NA NA NA NA NA NA Facility Total 12.20 15.74 11.24 12.84 10.19 12.18 13.41 11.15 0.00 3.17 0.00 4.78 5.22 2.45 68.38 71.03 66.63 72.36 75.35 75.05 68.87 76.46 1.27 4.82 1.05 10.94 0.00 18.34 11.00 20.74 11.78 15.67 10.07 7.35 7.23 30.56 9.76 22.36 30.06 26.76 34.32 27.41 32.62 21.69 20.22 16.58 25.42 64.33 42.66 48.22 43.59 39.73 36.62 42.41 17.06 48.08 47.57 0.00 0.00 9.30 14.30 1.20 13.03 16.37 18.22 23.37 19.73 22.10 18.88 23.47 26.86 34.11 34.02 35.56 36.69 Global 090 090 090 090 090 090 090 090 XXX ZZZ XXX ZZZ ZZZ 000 090 090 090 090 090 090 090 090 000 000 000 000 YYY 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 010 090 090 090 090 090 090 090 010 090 090 090 090 090 090 000 090 090 090 090 090 090 090 090 090 090 090 090 090 70346 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 21146 21147 21150 21151 21154 21155 21159 21160 21172 21175 21179 21180 21181 21182 21183 21184 21188 21193 21194 21195 21196 21198 21199 21206 21208 21209 21210 21215 21230 21235 21240 21242 21243 21244 21245 21246 21247 21248 21249 21255 21256 21260 21261 21263 21267 21268 21270 21275 21280 21282 21295 21296 21299 21300 21310 21315 21320 21325 21330 21335 21336 21337 21338 21339 21340 21343 21344 21345 21346 21347 21348 21355 21356 21360 21365 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 20.68 21.74 25.20 28.26 30.47 34.40 42.32 46.37 27.76 33.12 22.22 25.15 9.89 32.14 35.26 38.18 22.43 17.12 19.81 17.21 18.88 14.14 15.98 14.08 10.21 6.71 10.21 10.75 10.75 6.71 14.03 12.93 20.76 11.84 11.84 12.45 22.60 11.46 17.49 16.69 16.17 16.50 31.44 28.38 18.87 24.44 10.21 11.22 6.02 3.48 1.53 4.24 0.00 0.72 0.58 1.51 1.85 3.76 5.37 8.60 5.71 2.70 6.45 8.08 10.75 12.93 19.69 8.15 10.59 12.67 16.66 3.76 4.14 6.45 14.93 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 22.39 10.83 24.94 42.00 NA 9.87 NA NA NA NA 14.44 NA NA 12.17 16.77 NA NA NA NA NA NA NA 11.68 NA NA NA NA NA 0.00 2.37 2.29 4.24 3.92 NA NA NA NA 6.14 NA NA NA NA NA 9.87 NA NA NA 6.25 7.14 NA NA 15.37 15.09 16.81 23.02 23.19 23.96 29.16 27.55 13.79 17.84 14.17 15.42 7.48 19.17 20.89 22.00 18.92 12.69 13.79 14.86 15.74 12.74 9.14 12.67 9.61 8.09 9.38 9.39 8.06 6.43 12.08 11.54 17.48 12.13 9.88 9.07 17.40 9.43 12.73 16.18 11.85 12.80 24.30 19.13 19.83 20.27 7.27 8.18 5.94 4.49 2.54 4.92 0.00 0.26 0.15 1.89 1.62 8.64 9.73 9.65 9.64 3.58 14.06 13.94 8.42 15.51 16.55 7.19 12.24 16.24 11.14 3.49 4.56 5.95 10.86 Reconstruct midface, lefort ................................ Reconstruct midface, lefort ................................ Reconstruct midface, lefort ................................ Reconstruct midface, lefort ................................ Reconstruct midface, lefort ................................ Reconstruct midface, lefort ................................ Reconstruct midface, lefort ................................ Reconstruct midface, lefort ................................ Reconstruct orbit/forehead ................................. Reconstruct orbit/forehead ................................. Reconstruct entire forehead ............................... Reconstruct entire forehead ............................... Contour cranial bone lesion ............................... Reconstruct cranial bone ................................... Reconstruct cranial bone ................................... Reconstruct cranial bone ................................... Reconstruction of midface .................................. Reconst lwr jaw w/o graft ................................... Reconst lwr jaw w/graft ...................................... Reconst lwr jaw w/o fixation ............................... Reconst lwr jaw w/fixation .................................. Reconstr lwr jaw segment .................................. Reconstr lwr jaw w/advance .............................. Reconstruct upper jaw bone .............................. Augmentation of facial bones ............................. Reduction of facial bones ................................... Face bone graft .................................................. Lower jaw bone graft .......................................... Rib cartilage graft ............................................... Ear cartilage graft ............................................... Reconstruction of jaw joint ................................. Reconstruction of jaw joint ................................. Reconstruction of jaw joint ................................. Reconstruction of lower jaw ............................... Reconstruction of jaw ......................................... Reconstruction of jaw ......................................... Reconstruct lower jaw bone ............................... Reconstruction of jaw ......................................... Reconstruction of jaw ......................................... Reconstruct lower jaw bone ............................... Reconstruction of orbit ....................................... Revise eye sockets ............................................ Revise eye sockets ............................................ Revise eye sockets ............................................ Revise eye sockets ............................................ Revise eye sockets ............................................ Augmentation, cheek bone ................................ Revision, orbitofacial bones ............................... Revision of eyelid ............................................... Revision of eyelid ............................................... Revision of jaw muscle/bone ............................. Revision of jaw muscle/bone ............................. Cranio/maxillofacial surgery ............................... Treatment of skull fracture ................................. Treatment of nose fracture ................................. Treatment of nose fracture ................................. Treatment of nose fracture ................................. Treatment of nose fracture ................................. Treatment of nose fracture ................................. Treatment of nose fracture ................................. Treat nasal septal fracture ................................. Treat nasal septal fracture ................................. Treat nasoethmoid fracture ................................ Treat nasoethmoid fracture ................................ Treatment of nose fracture ................................. Treatment of sinus fracture ................................ Treatment of sinus fracture ................................ Treat nose/jaw fracture ...................................... Treat nose/jaw fracture ...................................... Treat nose/jaw fracture ...................................... Treat nose/jaw fracture ...................................... Treat cheek bone fracture .................................. Treat cheek bone fracture .................................. Treat cheek bone fracture .................................. Treat cheek bone fracture .................................. Malpractice RVUs 3.09 1.84 2.55 2.30 2.48 6.64 8.18 4.13 3.55 4.83 2.80 3.48 1.32 2.80 4.47 5.70 1.69 2.23 2.02 1.64 2.07 1.44 1.39 1.33 1.09 0.90 1.30 1.53 1.29 0.61 2.24 1.78 3.25 1.25 1.19 1.35 2.83 1.55 2.48 2.38 1.50 0.97 3.42 2.62 1.70 3.65 0.72 1.29 0.42 0.26 0.16 0.34 0.00 0.13 0.05 0.14 0.18 0.31 0.56 0.74 0.55 0.28 0.82 0.96 1.15 1.47 2.43 0.92 1.21 1.47 2.48 0.34 0.46 0.74 1.69 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00232 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 33.69 18.44 36.45 54.28 NA 17.19 NA NA NA NA 27.47 NA NA 25.18 36.74 NA NA NA NA NA NA NA 22.61 NA NA NA NA NA 0.00 3.22 2.92 5.89 5.95 NA NA NA NA 9.12 NA NA NA NA NA 18.94 NA NA NA 10.35 11.74 NA NA Facility Total 39.14 38.67 44.56 53.58 56.14 65.00 79.66 78.05 45.10 55.79 39.19 44.05 18.69 54.11 60.62 65.88 43.04 32.04 35.62 33.71 36.69 28.32 26.51 28.08 20.91 15.70 20.89 21.67 20.10 13.75 28.35 26.25 41.49 25.22 22.91 22.87 42.83 22.44 32.70 35.25 29.52 30.27 59.16 50.13 40.40 48.36 18.20 20.69 12.38 8.23 4.23 9.50 0.00 1.11 0.78 3.54 3.65 12.71 15.66 18.99 15.90 6.56 21.33 22.98 20.32 29.91 38.67 16.26 24.04 30.38 30.28 7.59 9.16 13.14 27.48 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY 000 000 010 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 010 010 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70347 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 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 21495 21497 21499 21501 21502 21510 21550 21555 21556 21557 21600 21610 21615 21616 21620 21627 21630 21632 21685 21700 21705 21720 21725 21740 21742 21743 21750 21800 21805 21810 21820 21825 21899 21920 21925 21930 21935 22010 22015 22100 22101 22102 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A C C A A A A A A C A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 17.74 9.15 9.15 9.69 10.11 12.66 1.40 3.26 7.00 8.60 12.36 5.13 8.31 10.38 7.04 8.60 25.31 17.22 28.00 2.70 5.37 2.97 4.86 1.98 5.53 6.45 8.08 9.78 11.89 15.32 0.61 3.98 11.84 5.68 3.85 0.00 3.80 7.11 5.73 2.06 4.34 5.56 8.87 6.88 14.59 9.86 12.02 6.78 6.80 17.35 18.11 12.98 6.18 9.59 5.67 6.98 16.48 0.00 0.00 10.75 0.96 2.75 6.85 1.28 7.40 0.00 2.06 4.48 4.99 17.93 11.05 10.94 9.72 9.80 9.80 NA NA NA NA NA NA 2.62 8.01 NA NA NA 9.36 NA NA NA NA NA NA NA 7.12 9.78 7.40 9.38 13.06 10.77 NA 24.53 27.69 NA NA 1.78 8.24 NA NA 8.47 0.00 6.44 NA NA 3.59 5.53 NA NA NA NA NA NA NA NA NA NA NA NA NA 2.47 NA NA 0.00 0.00 NA NA NA NA 1.83 NA 0.00 3.29 5.18 5.73 NA NA NA NA NA NA 11.36 8.30 7.09 8.98 7.82 9.05 1.88 3.50 6.10 6.88 8.91 8.33 8.10 9.35 9.55 8.08 16.45 12.74 18.27 6.18 8.39 6.89 8.42 4.62 10.76 6.28 12.70 12.75 9.84 12.05 0.19 7.68 9.72 8.44 7.66 0.00 3.83 5.65 5.68 1.72 3.20 4.11 5.37 5.75 8.89 6.70 8.04 5.99 6.32 11.87 11.14 10.00 4.45 5.60 2.47 5.46 8.54 0.00 0.00 6.13 1.34 3.21 4.98 1.77 6.41 0.00 1.47 3.25 3.41 9.65 8.91 8.85 7.55 7.77 8.13 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 ................................... Interdental wiring ................................................ Head surgery procedure .................................... Drain neck/chest lesion ...................................... Drain chest lesion ............................................... Drainage of bone lesion ..................................... Biopsy of neck/chest .......................................... Remove lesion, neck/chest ................................ Remove lesion, neck/chest ................................ Remove tumor, neck/chest ................................ Partial removal of rib .......................................... Partial removal of rib .......................................... Removal of rib .................................................... Removal of rib and nerves ................................. Partial removal of sternum ................................. Sternal debridement ........................................... Extensive sternum surgery ................................. Extensive sternum surgery ................................. Hyoid myotomy & suspension ............................ Revision of neck muscle .................................... Revision of neck muscle/rib ............................... Revision of neck muscle .................................... Revision of neck muscle .................................... Reconstruction of sternum ................................. Repair stern/nuss w/o scope .............................. Repair sternum/nuss w/scope ............................ Repair of sternum separation ............................. Treatment of rib fracture .................................... Treatment of rib fracture .................................... Treatment of rib fracture(s) ................................ Treat sternum fracture ........................................ Treat sternum fracture ........................................ Neck/chest surgery procedure ........................... Biopsy soft tissue of back .................................. Biopsy soft tissue of back .................................. Remove lesion, back or flank ............................. Remove tumor, back .......................................... I&d, p-spine, c/t/cerv-thor ................................... I&d, p-spine, l/s/ls ............................................... Remove part of neck vertebra ........................... Remove part, thorax vertebra ............................ Remove part, lumbar vertebra ........................... Malpractice RVUs 2.49 0.97 0.97 1.08 0.90 1.44 0.15 0.38 0.73 0.94 1.44 0.73 0.99 1.27 0.70 0.81 2.78 1.98 3.09 0.38 0.78 0.33 0.63 0.27 0.74 0.82 0.98 1.27 1.50 1.96 0.06 0.51 1.96 0.46 0.50 0.00 0.43 0.97 0.80 0.16 0.56 0.65 1.08 0.99 3.07 1.45 1.86 0.98 1.02 2.58 2.65 1.06 0.32 1.43 0.91 1.21 2.36 0.00 0.00 1.63 0.09 0.38 0.94 0.16 1.11 0.00 0.14 0.60 0.66 2.47 1.73 1.71 2.13 1.90 1.87 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00233 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA 4.17 11.65 NA NA NA 15.22 NA NA NA NA NA NA NA 10.20 15.93 10.70 14.87 15.31 17.04 NA 33.59 38.74 NA NA 2.45 12.73 NA NA 12.82 0.00 10.67 NA NA 5.81 10.43 NA NA NA NA NA NA NA NA NA NA NA NA NA 9.05 NA NA 0.00 0.00 NA NA NA NA 3.27 NA 0.00 5.49 10.26 11.38 NA NA NA NA NA NA Facility Total 31.59 18.42 17.21 19.75 18.83 23.15 3.43 7.14 13.83 16.42 22.71 14.19 17.40 21.00 17.29 17.49 44.54 31.94 49.36 9.26 14.54 10.19 13.91 6.87 17.03 13.55 21.76 23.80 23.23 29.33 0.86 12.17 23.52 14.58 12.01 0.00 8.06 13.73 12.21 3.94 8.10 10.32 15.32 13.62 26.55 18.01 21.92 13.75 14.14 31.80 31.90 24.04 10.95 16.62 9.05 13.65 27.38 0.00 0.00 18.51 2.39 6.34 12.77 3.21 14.92 0.00 3.67 8.33 9.06 30.05 21.69 21.50 19.40 19.47 19.80 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 090 090 090 090 YYY 090 090 090 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY 010 090 090 090 090 090 090 090 090 70348 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 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 22523 22524 22525 22532 22533 22534 22548 22554 22556 22558 22585 22590 22595 22600 22610 22612 22614 22630 22632 22800 22802 22804 22808 22810 22812 22818 22819 22830 22840 22841 22842 22843 22844 22845 22846 22847 22848 22849 22850 22851 22852 22855 22899 22900 22999 23000 23020 23030 23031 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A B A A A A A A A A A A A A C A C A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 2.34 12.72 12.79 12.79 2.32 23.78 19.39 19.42 6.03 21.34 21.49 21.49 6.03 2.05 2.61 8.83 21.47 23.96 18.27 19.56 19.17 4.60 1.87 8.90 8.33 4.30 8.94 8.54 4.47 23.96 23.09 5.99 25.78 18.59 23.42 22.25 5.52 20.48 19.36 16.12 16.00 20.97 6.43 20.81 5.22 18.22 30.83 36.22 26.23 30.22 32.65 31.78 36.39 10.83 12.52 0.00 12.56 13.44 16.42 11.94 12.40 13.78 5.99 18.48 9.51 6.70 9.00 15.11 0.00 5.79 0.00 4.35 8.92 3.42 2.74 NA NA NA NA NA NA NA NA NA NA NA NA NA 2.32 2.81 9.71 NA NA NA NA NA NA NA 61.84 56.13 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA 0.00 8.55 NA 7.41 7.88 1.21 9.19 9.30 9.28 1.17 15.45 13.31 13.85 3.14 13.66 11.16 14.26 3.10 1.93 2.36 7.35 13.42 14.75 12.11 12.74 12.40 2.27 0.94 5.11 4.96 1.68 5.92 5.71 2.28 14.86 13.63 3.04 15.85 12.38 14.77 13.33 2.80 13.36 12.87 11.22 11.44 14.24 3.36 13.64 2.67 12.81 19.65 22.76 16.35 18.41 20.12 18.92 20.11 7.98 6.51 0.00 6.52 6.62 8.78 6.09 6.35 7.04 3.19 11.76 7.01 3.37 6.81 9.69 0.00 3.23 0.00 4.43 7.58 2.91 2.73 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 ................................. Percut kyphoplasty, thor ..................................... Percut kyphoplasty, lumbar ................................ Percut kyphoplasty, add-on ................................ Lat thorax spine fusion ....................................... Lat lumbar spine fusion ...................................... Lat thor/lumb, add’l seg ...................................... Neck spine fusion ............................................... Neck spine fusion ............................................... Thorax spine fusion ............................................ Lumbar spine fusion ........................................... Additional spinal fusion ...................................... Spine & skull spinal fusion ................................. Neck spinal fusion .............................................. Neck spine fusion ............................................... Thorax spine fusion ............................................ Lumbar spine fusion ........................................... Spine fusion, extra segment .............................. Lumbar spine fusion ........................................... Spine fusion, extra segment .............................. Fusion of spine ................................................... Fusion of spine ................................................... Fusion of spine ................................................... Fusion of spine ................................................... Fusion of spine ................................................... Fusion of spine ................................................... Kyphectomy, 1-2 segments ................................ Kyphectomy, 3 or more ...................................... Exploration of spinal fusion ................................ Insert spine fixation device ................................. Insert spine fixation device ................................. Insert spine fixation device ................................. Insert spine fixation device ................................. Insert spine fixation device ................................. Insert spine fixation device ................................. Insert spine fixation device ................................. Insert spine fixation device ................................. Insert pelv fixation device ................................... Reinsert spinal fixation ....................................... Remove spine fixation device ............................ Apply spine prosth device .................................. Remove spine fixation device ............................ Remove spine fixation device ............................ Spine surgery procedure .................................... Remove abdominal wall lesion .......................... Abdomen surgery procedure .............................. Removal of calcium deposits ............................. Release shoulder joint ........................................ Drain shoulder lesion ......................................... Drain shoulder bursa .......................................... Malpractice RVUs 0.44 2.76 2.52 2.63 0.50 5.44 3.90 3.91 1.29 5.06 4.12 4.18 1.29 0.39 0.50 1.85 5.28 6.03 3.87 4.42 3.98 0.94 0.36 1.71 1.60 0.82 1.43 1.36 0.72 4.34 3.15 1.25 5.59 4.45 4.34 3.15 1.25 4.78 4.40 3.72 3.52 4.46 1.38 4.72 1.16 3.75 6.15 6.98 4.92 5.13 5.28 6.45 7.65 2.29 2.78 0.00 2.74 2.85 3.18 2.85 2.95 2.99 1.15 3.89 2.04 1.49 1.89 3.51 0.00 0.76 0.00 0.68 1.54 0.57 0.46 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00234 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA 4.76 5.92 20.39 NA NA NA NA NA NA NA 72.45 66.06 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA 0.00 13.58 NA 11.40 11.08 Facility Total 3.99 24.67 24.61 24.70 3.99 44.67 36.60 37.18 10.46 40.06 36.77 39.93 10.42 4.37 5.47 18.03 40.17 44.74 34.25 36.72 35.55 7.81 3.17 15.72 14.89 6.80 16.29 15.61 7.47 43.16 39.87 10.28 47.22 35.42 42.53 38.73 9.57 38.62 36.63 31.06 30.96 39.67 11.17 39.17 9.05 34.78 56.63 65.96 47.50 53.76 58.05 57.15 64.15 21.10 21.81 0.00 21.82 22.91 28.38 20.88 21.70 23.81 10.33 34.13 18.56 11.56 17.70 28.31 0.00 9.78 0.00 9.46 18.04 6.90 5.93 Global ZZZ 090 090 090 ZZZ 090 090 090 ZZZ 090 090 090 ZZZ 090 090 090 090 090 090 090 090 ZZZ 010 010 010 ZZZ 010 010 ZZZ 090 090 ZZZ 090 090 090 090 ZZZ 090 090 090 090 090 ZZZ 090 ZZZ 090 090 090 090 090 090 090 090 090 ZZZ XXX ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ 090 090 ZZZ 090 090 YYY 090 YYY 090 090 010 010 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70349 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 23035 23040 23044 23065 23066 23075 23076 23077 23100 23101 23105 23106 23107 23120 23125 23130 23140 23145 23146 23150 23155 23156 23170 23172 23174 23180 23182 23184 23190 23195 23200 23210 23220 23221 23222 23330 23331 23332 23350 23395 23397 23400 23405 23406 23410 23412 23415 23420 23430 23440 23450 23455 23460 23462 23465 23466 23470 23472 23480 23485 23490 23491 23500 23505 23515 23520 23525 23530 23532 23540 23545 23550 23552 23570 23575 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 8.60 9.19 7.11 2.27 4.15 2.39 7.62 16.07 6.02 5.57 8.22 5.95 8.61 7.10 9.38 7.54 6.88 9.08 7.82 8.47 10.33 8.67 6.85 6.89 9.50 8.52 8.14 9.37 7.23 9.80 12.06 12.47 14.54 17.71 23.88 1.85 7.37 11.60 1.00 16.82 16.11 13.52 8.36 10.77 12.43 13.29 9.96 13.28 9.97 10.46 13.38 14.35 15.35 15.28 15.83 14.20 17.12 21.07 11.16 13.41 11.84 14.19 2.08 3.68 7.40 2.16 3.59 7.30 8.00 2.23 3.25 7.23 8.44 2.23 4.05 NA NA NA 2.49 7.69 3.67 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 3.69 NA NA 3.47 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 2.88 4.42 NA 2.86 4.55 NA NA 2.87 4.20 NA NA 3.02 4.89 8.29 7.88 6.45 1.62 3.99 1.79 5.57 10.24 5.67 5.35 7.14 5.72 7.41 6.48 7.58 7.15 5.24 7.46 7.13 6.94 8.35 7.40 6.04 6.30 8.38 9.02 8.57 9.34 6.19 7.75 8.75 9.02 10.85 11.75 15.83 1.89 6.81 9.35 0.33 12.90 11.40 10.10 6.94 8.36 9.43 9.92 8.01 10.87 8.12 8.28 9.87 10.47 11.40 10.78 11.21 11.40 12.29 14.45 8.80 9.92 8.72 10.74 2.53 3.85 6.57 2.75 3.95 5.95 6.99 2.37 3.37 6.39 7.34 2.90 4.32 Drain shoulder bone lesion ................................ Exploratory shoulder surgery ............................. Exploratory shoulder surgery ............................. Biopsy shoulder tissues ..................................... Biopsy shoulder tissues ..................................... Removal of shoulder lesion ................................ Removal of shoulder lesion ................................ Remove tumor of shoulder ................................. Biopsy of shoulder joint ...................................... Shoulder joint surgery ........................................ Remove shoulder joint lining .............................. Incision of collarbone joint .................................. Explore treat shoulder joint ................................ Partial removal, collar bone ............................... Removal of collar bone ...................................... Remove shoulder bone, part .............................. Removal of bone lesion ..................................... Removal of bone lesion ..................................... Removal of bone lesion ..................................... Removal of humerus lesion ............................... Removal of humerus lesion ............................... Removal of humerus lesion ............................... Remove collar bone lesion ................................. Remove shoulder blade lesion ........................... Remove humerus lesion .................................... Remove collar bone lesion ................................. Remove shoulder blade lesion ........................... Remove humerus lesion .................................... Partial removal of scapula .................................. Removal of head of humerus ............................. Removal of collar bone ...................................... Removal of shoulder blade ................................ Partial removal of humerus ................................ Partial removal of humerus ................................ Partial removal of humerus ................................ Remove shoulder foreign body .......................... Remove shoulder foreign body .......................... Remove shoulder foreign body .......................... Injection for shoulder x-ray ................................. Muscle transfer,shoulder/arm ............................. Muscle transfers ................................................. Fixation of shoulder blade .................................. Incision of tendon & muscle ............................... Incise tendon(s) & muscle(s) ............................. Repair rotator cuff, acute ................................... Repair rotator cuff, chronic ................................. Release of shoulder ligament ............................ Repair of shoulder .............................................. Repair biceps tendon ......................................... Remove/transplant tendon ................................. Repair shoulder capsule .................................... Repair shoulder capsule .................................... Repair shoulder capsule .................................... Repair shoulder capsule .................................... Repair shoulder capsule .................................... Repair shoulder capsule .................................... Reconstruct shoulder joint .................................. Reconstruct shoulder joint .................................. Revision of collar bone ....................................... Revision of collar bone ....................................... Reinforce clavicle ............................................... Reinforce shoulder bones .................................. Treat clavicle fracture ......................................... Treat clavicle fracture ......................................... Treat clavicle fracture ......................................... Treat clavicle dislocation .................................... Treat clavicle dislocation .................................... Treat clavicle dislocation .................................... Treat clavicle dislocation .................................... Treat clavicle dislocation .................................... Treat clavicle dislocation .................................... Treat clavicle dislocation .................................... Treat clavicle dislocation .................................... Treat shoulder blade fx ...................................... Treat shoulder blade fx ...................................... Malpractice RVUs 1.47 1.60 1.24 0.20 0.63 0.34 1.13 2.33 1.04 0.96 1.42 0.99 1.49 1.23 1.62 1.30 1.08 1.49 1.35 1.32 1.80 1.50 1.12 1.01 1.65 1.47 1.37 1.63 1.17 1.70 1.93 2.02 2.48 3.05 3.94 0.24 1.27 2.02 0.06 2.93 2.73 2.29 1.45 1.87 2.16 2.31 1.73 2.31 1.73 1.82 2.32 2.49 2.66 2.59 2.76 2.46 2.98 3.66 1.94 2.33 1.47 2.46 0.30 0.61 1.28 0.34 0.46 1.20 1.38 0.29 0.35 1.25 1.46 0.36 0.59 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00235 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA 4.96 12.47 6.40 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 5.78 NA NA 4.53 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 5.26 8.71 NA 5.36 8.60 NA NA 5.39 7.80 NA NA 5.61 9.53 Facility Total 18.36 18.67 14.80 4.09 8.77 4.52 14.32 28.64 12.73 11.88 16.78 12.66 17.51 14.81 18.58 15.99 13.20 18.03 16.30 16.73 20.48 17.57 14.01 14.20 19.53 19.01 18.08 20.34 14.59 19.25 22.74 23.51 27.87 32.51 43.65 3.98 15.45 22.97 1.39 32.65 30.24 25.91 16.75 21.00 24.02 25.52 19.70 26.46 19.82 20.56 25.57 27.31 29.41 28.65 29.80 28.06 32.39 39.18 21.90 25.66 22.03 27.39 4.91 8.14 15.25 5.25 8.00 14.45 16.37 4.89 6.97 14.87 17.24 5.49 8.96 Global 090 090 090 010 090 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 010 090 090 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 70350 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 23585 23600 23605 23615 23616 23620 23625 23630 23650 23655 23660 23665 23670 23675 23680 23700 23800 23802 23900 23920 23921 23929 23930 23931 23935 24000 24006 24065 24066 24075 24076 24077 24100 24101 24102 24105 24110 24115 24116 24120 24125 24126 24130 24134 24136 24138 24140 24145 24147 24149 24150 24151 24152 24153 24155 24160 24164 24200 24201 24220 24300 24301 24305 24310 24320 24330 24331 24332 24340 24341 24342 24343 24344 24345 24346 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 8.95 2.93 4.86 9.34 21.24 2.40 3.92 7.34 3.38 4.56 7.48 4.46 7.89 6.04 10.04 2.52 14.14 16.58 19.69 14.59 5.48 0.00 2.94 1.79 6.08 5.81 9.30 2.08 5.20 3.91 6.29 11.74 4.92 6.12 8.02 3.60 7.38 9.62 11.79 6.64 7.88 8.30 6.24 9.72 7.98 8.04 9.17 7.57 7.53 14.18 13.25 15.56 10.04 11.52 11.71 7.82 6.22 1.76 4.55 1.31 3.74 10.18 7.44 5.97 10.54 9.59 10.63 7.44 7.88 7.89 10.60 8.64 13.98 8.64 13.98 NA 4.56 6.17 NA NA 3.62 4.95 NA 3.78 NA NA 5.35 NA 6.85 NA NA NA NA NA NA NA 0.00 6.34 5.93 NA NA NA 3.22 8.96 7.37 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 3.42 9.84 3.64 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 7.66 3.56 5.12 8.86 14.18 2.99 4.29 6.65 2.77 4.18 6.40 4.73 6.85 5.85 8.13 2.18 10.44 10.20 11.74 9.95 5.09 0.00 2.32 2.18 5.93 5.43 7.77 1.75 4.14 3.41 4.87 7.76 4.53 5.95 6.88 4.40 6.68 7.23 9.10 5.94 6.18 7.04 6.04 8.88 7.24 7.80 9.13 8.08 8.62 11.65 10.02 11.54 7.75 5.59 8.42 6.91 5.79 1.63 4.24 0.44 5.73 8.20 6.73 5.60 7.55 7.90 8.70 6.79 7.00 7.94 8.54 8.17 11.55 8.04 11.37 Treat scapula fracture ........................................ Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat shoulder dislocation .................................. Treat shoulder dislocation .................................. Treat shoulder dislocation .................................. Treat dislocation/fracture .................................... Treat dislocation/fracture .................................... Treat dislocation/fracture .................................... Treat dislocation/fracture .................................... Fixation of shoulder ............................................ Fusion of shoulder joint ...................................... Fusion of shoulder joint ...................................... Amputation of arm & girdle ................................ Amputation at shoulder joint .............................. Amputation follow-up surgery ............................. Shoulder surgery procedure ............................... Drainage of arm lesion ....................................... Drainage of arm bursa ....................................... Drain arm/elbow bone lesion ............................. Exploratory elbow surgery .................................. Release elbow joint ............................................ Biopsy arm/elbow soft tissue ............................. Biopsy arm/elbow soft tissue ............................. Remove arm/elbow lesion .................................. Remove arm/elbow lesion .................................. Remove tumor of arm/elbow .............................. Biopsy elbow joint lining ..................................... Explore/treat elbow joint ..................................... Remove elbow joint lining .................................. Removal of elbow bursa .................................... Remove humerus lesion .................................... Remove/graft bone lesion .................................. Remove/graft bone lesion .................................. Remove elbow lesion ......................................... Remove/graft bone lesion .................................. Remove/graft bone lesion .................................. Removal of head of radius ................................. Removal of arm bone lesion .............................. Remove radius bone lesion ............................... Remove elbow bone lesion ................................ Partial removal of arm bone ............................... Partial removal of radius .................................... Partial removal of elbow ..................................... Radical resection of elbow ................................. Extensive humerus surgery ................................ Extensive humerus surgery ................................ Extensive radius surgery .................................... Extensive radius surgery .................................... Removal of elbow joint ....................................... Remove elbow joint implant ............................... Remove radius head implant ............................. Removal of arm foreign body ............................. Removal of arm foreign body ............................. Injection for elbow x-ray ..................................... Manipulate elbow w/anesth ................................ Muscle/tendon transfer ....................................... Arm tendon lengthening ..................................... Revision of arm tendon ...................................... Repair of arm tendon ......................................... Revision of arm muscles .................................... Revision of arm muscles .................................... Tenolysis, triceps ................................................ Repair of biceps tendon ..................................... 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 ........................... Malpractice RVUs 1.54 0.48 0.84 1.62 3.69 0.40 0.67 1.27 0.30 0.69 1.29 0.71 1.36 1.01 1.75 0.44 2.35 2.70 3.18 2.46 0.78 0.00 0.43 0.28 1.05 0.97 1.50 0.17 0.80 0.56 0.95 1.72 0.85 1.03 1.33 0.61 1.28 1.67 2.05 1.10 1.06 1.16 1.04 1.64 1.38 1.34 1.51 1.25 1.30 2.34 2.32 2.59 1.48 0.74 1.92 1.30 1.03 0.20 0.72 0.08 0.65 1.66 1.15 0.96 1.73 1.60 1.77 1.23 1.36 1.36 1.85 1.43 2.36 1.44 2.33 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00236 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA 7.97 11.87 NA NA 6.42 9.54 NA 7.46 NA NA 10.52 NA 13.90 NA NA NA NA NA NA NA 0.00 9.71 8.00 NA NA NA 5.47 14.96 11.84 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 5.38 15.11 5.03 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 18.15 6.97 10.82 19.82 39.11 5.79 8.88 15.26 6.45 9.43 15.17 9.90 16.10 12.90 19.92 5.14 26.93 29.48 34.61 27.00 11.35 0.00 5.69 4.25 13.06 12.21 18.57 4.00 10.14 7.88 12.11 21.22 10.30 13.10 16.23 8.61 15.34 18.52 22.94 13.68 15.12 16.50 13.32 20.24 16.60 17.18 19.81 16.90 17.45 28.17 25.59 29.69 19.27 17.85 22.05 16.03 13.04 3.59 9.51 1.83 10.12 20.04 15.32 12.53 19.82 19.09 21.10 15.46 16.24 17.19 20.99 18.24 27.89 18.12 27.68 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 010 090 090 090 090 090 YYY 010 010 090 090 090 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 010 090 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70351 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 24350 24351 24352 24354 24356 24360 24361 24362 24363 24365 24366 24400 24410 24420 24430 24435 24470 24495 24498 24500 24505 24515 24516 24530 24535 24538 24545 24546 24560 24565 24566 24575 24576 24577 24579 24582 24586 24587 24600 24605 24615 24620 24635 24640 24650 24655 24665 24666 24670 24675 24685 24800 24802 24900 24920 24925 24930 24931 24935 24940 24999 25000 25001 25020 25023 25024 25025 25028 25031 25035 25040 25065 25066 25075 25076 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 5.24 5.90 6.42 6.47 6.67 12.32 14.06 14.97 18.46 8.38 9.12 11.04 14.80 13.42 12.79 13.15 8.73 8.11 11.90 3.21 5.16 11.63 11.63 3.49 6.86 9.42 10.44 15.67 2.80 5.55 7.78 10.64 2.86 5.78 11.58 8.54 15.19 15.14 4.22 5.41 9.41 6.97 13.17 1.20 2.16 4.39 8.13 9.48 2.54 4.71 8.79 11.18 13.67 9.59 9.53 7.06 10.23 12.70 15.54 0.00 0.00 3.37 3.37 5.91 12.94 9.49 16.52 5.24 4.13 7.35 7.17 1.99 4.12 3.73 4.91 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 4.86 6.62 NA NA 5.22 7.86 NA NA NA 4.49 6.63 NA NA 4.77 6.95 NA NA NA NA 4.87 NA NA NA NA 1.85 3.79 5.97 NA NA 4.12 6.02 NA NA NA NA NA NA NA NA NA 0.00 0.00 NA NA NA NA NA NA NA NA NA NA 3.23 NA NA NA 5.60 5.94 6.20 6.17 6.33 9.50 10.61 10.07 13.75 7.22 7.56 8.88 10.34 10.57 9.77 10.91 7.74 8.77 9.29 3.69 5.41 9.41 9.14 4.05 6.64 8.73 8.47 11.35 3.20 5.54 8.18 8.42 3.72 5.86 8.86 9.14 11.26 11.05 3.51 5.38 7.84 6.27 14.09 0.80 2.76 4.80 7.53 8.09 3.08 4.98 7.54 8.77 10.41 7.08 6.96 6.10 7.26 5.74 8.04 0.00 0.00 6.89 4.24 9.59 14.98 7.49 10.00 8.18 7.94 13.63 7.32 1.91 7.08 5.91 9.57 Repair of tennis elbow ....................................... Repair of tennis elbow ....................................... Repair of tennis elbow ....................................... Repair of tennis elbow ....................................... Revision of tennis elbow .................................... Reconstruct elbow joint ...................................... Reconstruct elbow joint ...................................... Reconstruct elbow joint ...................................... Replace elbow joint ............................................ Reconstruct head of radius ................................ Reconstruct head of radius ................................ Revision of humerus .......................................... Revision of humerus .......................................... Revision of humerus .......................................... Repair of humerus .............................................. Repair humerus with graft .................................. Revision of elbow joint ....................................... Decompression of forearm ................................. Reinforce humerus ............................................. Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat humerus fracture ....................................... Treat elbow fracture ........................................... Treat elbow fracture ........................................... Treat elbow dislocation ...................................... Treat elbow dislocation ...................................... Treat elbow dislocation ...................................... Treat elbow fracture ........................................... Treat elbow fracture ........................................... Treat elbow dislocation ...................................... Treat radius fracture ........................................... Treat radius fracture ........................................... Treat radius fracture ........................................... Treat radius fracture ........................................... Treat ulnar fracture ............................................. Treat ulnar fracture ............................................. Treat ulnar fracture ............................................. Fusion of elbow joint .......................................... Fusion/graft of elbow joint .................................. Amputation of upper arm ................................... Amputation of upper arm ................................... Amputation follow-up surgery ............................. Amputation follow-up surgery ............................. Amputate upper arm & implant .......................... Revision of amputation ....................................... Revision of upper arm ........................................ Upper arm/elbow surgery ................................... Incision of tendon sheath ................................... Incise flexor carpi radialis ................................... Decompress forearm 1 space ............................ Decompress forearm 1 space ............................ Decompress forearm 2 spaces .......................... Decompress forearm 2 spaces .......................... Drainage of forearm lesion ................................. Drainage of forearm bursa ................................. Treat forearm bone lesion .................................. Explore/treat wrist joint ....................................... Biopsy forearm soft tissues ................................ Biopsy forearm soft tissues ................................ Removal forearm lesion subcu .......................... Removal forearm lesion deep ............................ Malpractice RVUs 0.87 1.02 1.10 1.07 1.11 2.05 2.18 2.60 3.01 1.41 1.52 1.92 2.57 2.17 2.21 2.27 1.48 1.18 2.06 0.50 0.89 2.02 2.02 0.57 1.18 1.64 1.82 2.73 0.44 0.93 1.30 1.86 0.46 0.95 2.02 1.48 2.64 2.52 0.50 0.89 1.60 1.07 2.28 0.12 0.35 0.70 1.41 1.62 0.41 0.81 1.52 1.63 2.37 1.53 1.61 1.14 1.67 1.89 2.13 0.00 0.00 0.55 0.55 0.93 2.03 1.36 1.82 0.81 0.63 1.24 1.15 0.15 0.64 0.55 0.74 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00237 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 8.57 12.67 NA NA 9.28 15.90 NA NA NA 7.73 13.11 NA NA 8.09 13.68 NA NA NA NA 9.59 NA NA NA NA 3.17 6.30 11.06 NA NA 7.07 11.54 NA NA NA NA NA NA NA NA NA 0.00 0.00 NA NA NA NA NA NA NA NA NA NA 5.37 NA NA NA Facility Total 11.71 12.86 13.72 13.71 14.11 23.87 26.85 27.64 35.22 17.01 18.20 21.84 27.71 26.16 24.77 26.33 17.95 18.06 23.25 7.40 11.46 23.06 22.79 8.11 14.68 19.79 20.73 29.75 6.44 12.02 17.26 20.92 7.04 12.59 22.46 19.16 29.09 28.71 8.23 11.68 18.85 14.31 29.54 2.12 5.27 9.89 17.07 19.19 6.03 10.50 17.85 21.58 26.45 18.20 18.10 14.30 19.16 20.33 25.71 0.00 0.00 10.81 8.16 16.43 29.95 18.34 28.34 14.23 12.70 22.22 15.64 4.05 11.84 10.19 15.22 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY 090 090 090 090 090 090 090 090 090 090 010 090 090 090 70352 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 25077 25085 25100 25101 25105 25107 25110 25111 25112 25115 25116 25118 25119 25120 25125 25126 25130 25135 25136 25145 25150 25151 25170 25210 25215 25230 25240 25246 25248 25250 25251 25259 25260 25263 25265 25270 25272 25274 25275 25280 25290 25295 25300 25301 25310 25312 25315 25316 25320 25332 25335 25337 25350 25355 25360 25365 25370 25375 25390 25391 25392 25393 25394 25400 25405 25415 25420 25425 25426 25430 25431 25440 25441 25442 25443 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 9.75 5.49 3.89 4.68 5.84 6.42 3.91 3.38 4.52 8.81 7.10 4.36 6.03 6.09 7.47 7.54 5.25 6.88 5.96 6.36 7.08 7.38 11.07 5.94 7.88 5.22 5.16 1.45 5.13 6.59 9.56 3.74 7.79 7.81 9.87 5.99 7.03 8.74 8.49 7.21 5.28 6.54 8.79 8.39 8.13 9.56 10.18 12.31 10.75 11.39 12.86 10.15 8.77 10.15 8.42 12.38 13.34 13.02 10.38 13.63 13.93 15.85 10.38 10.90 14.36 13.33 16.31 13.19 15.80 9.24 10.42 10.42 12.88 10.83 10.37 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 3.45 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 12.12 7.14 5.29 5.91 7.32 8.36 7.07 4.71 5.27 14.07 13.18 5.76 7.62 12.12 12.88 13.05 6.44 7.53 6.61 12.09 8.23 12.76 15.19 6.81 8.78 6.16 6.97 0.48 8.54 6.12 7.94 5.74 13.35 13.30 14.35 12.06 12.83 13.66 7.60 12.67 15.03 12.19 8.47 8.08 13.07 13.98 14.44 16.27 11.42 9.20 11.62 11.11 14.01 14.65 13.91 15.69 16.12 16.47 14.62 16.60 16.01 17.63 8.08 15.23 17.32 16.56 18.32 21.45 16.60 7.36 8.42 9.43 10.03 8.91 8.80 Remove tumor, forearm/wrist ............................. Incision of wrist capsule ..................................... Biopsy of wrist joint ............................................ Explore/treat wrist joint ....................................... Remove wrist joint lining .................................... Remove wrist joint cartilage ............................... Remove wrist tendon lesion ............................... Remove wrist tendon lesion ............................... Reremove wrist tendon lesion ............................ Remove wrist/forearm lesion .............................. Remove wrist/forearm lesion .............................. Excise wrist tendon sheath ................................ Partial removal of ulna ....................................... Removal of forearm lesion ................................. Remove/graft forearm lesion .............................. Remove/graft forearm lesion .............................. Removal of wrist lesion ...................................... Remove & graft wrist lesion ............................... Remove & graft wrist lesion ............................... Remove forearm bone lesion ............................. Partial removal of ulna ....................................... Partial removal of radius .................................... Extensive forearm surgery ................................. Removal of wrist bone ....................................... Removal of wrist bones ...................................... Partial removal of radius .................................... Partial removal of ulna ....................................... Injection for wrist x-ray ....................................... Remove forearm foreign body ........................... Removal of wrist prosthesis ............................... Removal of wrist prosthesis ............................... Manipulate wrist w/anesthes .............................. Repair forearm tendon/muscle ........................... Repair forearm tendon/muscle ........................... Repair forearm tendon/muscle ........................... Repair forearm tendon/muscle ........................... Repair forearm tendon/muscle ........................... Repair forearm tendon/muscle ........................... Repair forearm tendon sheath ........................... Revise wrist/forearm tendon .............................. Incise wrist/forearm tendon ................................ Release wrist/forearm tendon ............................ Fusion of tendons at wrist .................................. Fusion of tendons at wrist .................................. Transplant forearm tendon ................................. Transplant forearm tendon ................................. Revise palsy hand tendon(s) ............................. Revise palsy hand tendon(s) ............................. Repair/revise wrist joint ...................................... Revise wrist joint ................................................ Realignment of hand .......................................... Reconstruct ulna/radioulnar ............................... Revision of radius ............................................... Revision of radius ............................................... Revision of ulna .................................................. Revise radius & ulna .......................................... Revise radius or ulna ......................................... Revise radius & ulna .......................................... Shorten radius or ulna ........................................ Lengthen radius or ulna ..................................... Shorten radius & ulna ........................................ Lengthen radius & ulna ...................................... Repair carpal bone, shorten ............................... Repair radius or ulna .......................................... Repair/graft radius or ulna ................................. Repair radius & ulna .......................................... Repair/graft radius & ulna .................................. 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 ........................................ Malpractice RVUs 1.42 0.85 0.59 0.75 0.92 0.99 0.62 0.53 0.70 1.31 1.11 0.68 0.96 1.00 1.06 1.27 0.80 1.02 1.03 1.01 1.14 1.18 1.77 0.88 1.19 0.79 0.81 0.09 0.72 1.01 1.26 0.62 1.19 1.18 1.47 0.95 1.11 1.36 1.31 1.08 0.82 1.00 1.26 1.29 1.21 1.41 1.58 1.74 1.61 1.83 1.92 1.61 1.46 1.73 1.41 2.15 2.28 2.26 1.65 2.21 2.10 2.76 1.59 1.82 2.32 2.17 2.61 2.08 2.54 1.27 1.90 1.63 2.07 1.53 1.37 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00238 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 4.99 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 23.29 13.48 9.77 11.34 14.08 15.77 11.60 8.62 10.49 24.19 21.39 10.80 14.61 19.21 21.41 21.86 12.49 15.43 13.60 19.46 16.45 21.32 28.03 13.63 17.85 12.17 12.94 2.02 14.39 13.72 18.76 10.10 22.33 22.29 25.69 19.00 20.97 23.76 17.40 20.96 21.13 19.73 18.52 17.76 22.41 24.95 26.20 30.32 23.78 22.42 26.40 22.87 24.24 26.53 23.74 30.22 31.74 31.75 26.65 32.44 32.04 36.24 20.05 27.95 34.00 32.06 37.24 36.72 34.94 17.87 20.74 21.48 24.98 21.27 20.54 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70353 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 25444 25445 25446 25447 25449 25450 25455 25490 25491 25492 25500 25505 25515 25520 25525 25526 25530 25535 25545 25560 25565 25574 25575 25600 25605 25611 25620 25622 25624 25628 25630 25635 25645 25650 25651 25652 25660 25670 25671 25675 25676 25680 25685 25690 25695 25800 25805 25810 25820 25825 25830 25900 25905 25907 25909 25915 25920 25922 25924 25927 25929 25931 25999 26010 26011 26020 26025 26030 26034 26035 26037 26040 26045 26055 26060 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 11.13 9.68 16.53 10.35 14.47 7.86 9.48 9.53 9.95 12.31 2.45 5.20 9.17 6.25 12.22 12.96 2.09 5.13 8.89 2.44 5.62 7.00 10.43 2.63 5.80 7.76 8.54 2.61 4.52 8.42 2.88 4.38 7.24 3.05 5.35 7.59 4.75 7.91 5.99 4.66 8.03 5.98 9.77 5.49 8.33 9.75 11.26 10.55 7.44 9.26 10.04 9.00 9.11 7.79 8.95 17.05 8.67 7.41 8.45 8.79 7.58 7.80 0.00 1.54 2.19 4.66 4.81 5.92 6.22 9.50 7.24 3.33 5.55 2.69 2.81 NA NA NA NA NA NA NA NA NA NA 3.58 6.56 NA 6.88 NA NA 3.77 6.03 NA 3.70 6.72 NA NA 4.10 7.25 NA NA 4.28 6.32 NA 4.19 5.96 NA 4.32 NA NA NA NA NA 5.67 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 5.58 8.84 NA NA NA NA NA NA NA NA 14.39 NA 9.06 8.01 11.95 8.68 10.70 10.22 10.89 13.77 14.50 15.34 2.72 5.44 7.48 6.08 10.02 13.54 2.87 5.31 7.68 2.61 5.44 7.22 9.54 2.98 6.24 8.99 7.28 3.11 5.08 7.84 2.95 3.91 6.65 3.18 5.50 7.02 4.72 7.01 6.17 4.66 7.32 4.75 7.82 5.52 7.11 9.12 10.28 9.93 7.87 9.26 14.45 12.60 12.33 11.79 12.31 18.93 7.87 7.07 8.11 11.71 5.89 11.49 0.00 1.63 2.33 5.37 5.13 5.74 6.37 7.89 6.34 4.06 5.66 3.95 3.52 Reconstruct wrist joint ........................................ Reconstruct wrist joint ........................................ Wrist replacement .............................................. Repair wrist joint(s) ............................................ Remove wrist joint implant ................................. Revision of wrist joint ......................................... Revision of wrist joint ......................................... Reinforce radius ................................................. Reinforce ulna .................................................... Reinforce radius and ulna .................................. Treat fracture of radius ....................................... Treat fracture of radius ....................................... Treat fracture of radius ....................................... Treat fracture of radius ....................................... Treat fracture of radius ....................................... Treat fracture of radius ....................................... Treat fracture of ulna .......................................... Treat fracture of ulna .......................................... Treat fracture of ulna .......................................... Treat fracture radius & ulna ............................... Treat fracture radius & ulna ............................... Treat fracture radius & ulna ............................... Treat fracture radius/ulna ................................... Treat fracture radius/ulna ................................... Treat fracture radius/ulna ................................... Treat fracture radius/ulna ................................... Treat fracture radius/ulna ................................... Treat wrist bone fracture .................................... Treat wrist bone fracture .................................... Treat wrist bone fracture .................................... Treat wrist bone fracture .................................... Treat wrist bone fracture .................................... Treat wrist bone fracture .................................... Treat wrist bone fracture .................................... Pin ulnar styloid fracture .................................... Treat fracture ulnar styloid ................................. Treat wrist dislocation ........................................ Treat wrist dislocation ........................................ Pin radioulnar dislocation ................................... Treat wrist dislocation ........................................ Treat wrist dislocation ........................................ Treat wrist fracture ............................................. Treat wrist fracture ............................................. Treat wrist dislocation ........................................ Treat wrist dislocation ........................................ Fusion of wrist joint ............................................ Fusion/graft of wrist joint .................................... Fusion/graft of wrist joint .................................... Fusion of hand bones ........................................ Fuse hand bones with graft ............................... Fusion, radioulnar jnt/ulna .................................. Amputation of forearm ........................................ Amputation of forearm ........................................ Amputation follow-up surgery ............................. Amputation follow-up surgery ............................. Amputation of forearm ........................................ Amputate hand at wrist ...................................... Amputate hand at wrist ...................................... Amputation follow-up surgery ............................. Amputation of hand ............................................ Amputation follow-up surgery ............................. Amputation follow-up surgery ............................. Forearm or wrist surgery .................................... Drainage of finger abscess ................................ Drainage of finger abscess ................................ Drain hand tendon sheath .................................. Drainage of palm bursa ...................................... Drainage of palm bursa(s) ................................. Treat hand bone lesion ...................................... Decompress fingers/hand .................................. Decompress fingers/hand .................................. Release palm contracture .................................. Release palm contracture .................................. Incise finger tendon sheath ................................ Incision of finger tendon ..................................... Malpractice RVUs 1.71 1.55 2.47 1.61 2.21 1.36 0.96 1.43 1.60 2.14 0.35 0.90 1.59 1.08 2.12 2.19 0.34 0.89 1.53 0.35 0.93 1.21 1.81 0.42 1.00 1.34 1.42 0.41 0.76 1.37 0.45 0.74 1.20 0.45 0.86 1.21 0.58 1.28 1.00 0.62 1.34 0.78 1.60 0.88 1.32 1.57 1.80 1.67 1.22 1.41 1.55 1.30 1.40 1.10 1.44 2.93 1.35 1.12 1.32 1.27 1.14 1.15 0.00 0.18 0.33 0.73 0.76 0.92 1.01 1.47 1.13 0.53 0.93 0.43 0.45 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00239 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA 6.38 12.66 NA 14.21 NA NA 6.20 12.05 NA 6.49 13.27 NA NA 7.15 14.05 NA NA 7.30 11.60 NA 7.52 11.08 NA 7.82 NA NA NA NA NA 10.95 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 7.30 11.36 NA NA NA NA NA NA NA NA 17.51 NA Facility Total 21.90 19.24 30.95 20.64 27.38 19.44 21.33 24.73 26.05 29.79 5.52 11.54 18.24 13.41 24.36 28.69 5.30 11.33 18.10 5.40 11.99 15.43 21.78 6.03 13.04 18.09 17.24 6.13 10.36 17.63 6.28 9.03 15.09 6.68 11.71 15.82 10.05 16.20 13.16 9.94 16.69 11.51 19.19 11.89 16.76 20.44 23.34 22.15 16.53 19.93 26.04 22.90 22.84 20.68 22.70 38.91 17.89 15.60 17.88 21.77 14.61 20.44 0.00 3.35 4.85 10.76 10.70 12.58 13.60 18.86 14.71 7.92 12.14 7.07 6.78 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY 010 010 090 090 090 090 090 090 090 090 090 090 70354 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 26070 26075 26080 26100 26105 26110 26115 26116 26117 26121 26123 26125 26130 26135 26140 26145 26160 26170 26180 26185 26200 26205 26210 26215 26230 26235 26236 26250 26255 26260 26261 26262 26320 26340 26350 26352 26356 26357 26358 26370 26372 26373 26390 26392 26410 26412 26415 26416 26418 26420 26426 26428 26432 26433 26434 26437 26440 26442 26445 26449 26450 26455 26460 26471 26474 26476 26477 26478 26479 26480 26483 26485 26489 26490 26492 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 3.68 3.78 4.23 3.66 3.70 3.52 3.85 5.52 8.54 7.53 9.28 4.60 5.41 6.95 6.16 6.31 3.15 4.76 5.17 5.24 5.50 7.69 5.14 7.09 6.32 6.18 5.31 7.54 12.41 7.02 9.08 5.66 3.97 2.50 5.98 7.67 8.06 8.57 9.13 7.10 8.75 8.15 9.18 10.24 4.62 6.30 8.33 9.36 4.24 6.76 6.14 7.20 4.01 4.55 6.08 5.81 5.01 8.15 4.30 6.99 3.66 3.63 3.45 5.72 5.31 5.17 5.14 5.79 5.73 6.68 8.28 7.69 9.54 8.40 9.61 NA NA NA NA NA NA 13.13 NA NA NA NA NA NA NA NA NA 12.41 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 3.37 3.79 4.86 4.14 4.24 4.05 4.78 6.02 7.08 6.98 8.88 2.45 5.36 6.48 6.06 6.07 4.13 4.95 5.43 6.05 5.37 6.91 5.44 6.33 5.93 5.83 5.34 6.45 9.40 6.20 6.19 5.35 4.32 4.89 14.65 15.40 18.42 15.68 16.69 15.15 16.58 16.09 13.32 16.77 11.97 13.31 11.81 14.63 12.36 13.67 13.20 13.90 10.29 10.82 11.57 11.60 13.47 15.99 13.18 15.82 7.35 7.30 7.16 11.27 11.42 10.96 11.09 11.87 11.59 15.08 15.54 15.40 12.09 12.86 13.64 Explore/treat hand joint ...................................... Explore/treat finger joint ..................................... Explore/treat finger joint ..................................... Biopsy hand joint lining ...................................... Biopsy finger joint lining ..................................... Biopsy finger joint lining ..................................... Removal hand lesion subcut .............................. Removal hand lesion, deep ............................... Remove tumor, hand/finger ................................ Release palm contracture .................................. Release palm contracture .................................. Release palm contracture .................................. Remove wrist joint lining .................................... Revise finger joint, each ..................................... Revise finger joint, each ..................................... Tendon excision, palm/finger ............................. Remove tendon sheath lesion ........................... Removal of palm tendon, each .......................... Removal of finger tendon ................................... Remove finger bone ........................................... Remove hand bone lesion ................................. Remove/graft bone lesion .................................. Removal of finger lesion .................................... Remove/graft finger lesion ................................. Partial removal of hand bone ............................. Partial removal, finger bone ............................... Partial removal, finger bone ............................... Extensive hand surgery ...................................... Extensive hand surgery ...................................... Extensive finger surgery ..................................... Extensive finger surgery ..................................... Partial removal of finger ..................................... Removal of implant from hand ........................... Manipulate finger w/anesth ................................ Repair finger/hand tendon .................................. Repair/graft hand tendon ................................... Repair finger/hand tendon .................................. Repair finger/hand tendon .................................. Repair/graft hand tendon ................................... Repair finger/hand tendon .................................. Repair/graft hand tendon ................................... Repair finger/hand tendon .................................. Revise hand/finger tendon ................................. Repair/graft hand tendon ................................... Repair hand tendon ............................................ Repair/graft hand tendon ................................... Excision, hand/finger tendon .............................. Graft hand or finger tendon ................................ Repair finger tendon ........................................... Repair/graft finger tendon .................................. Repair finger/hand tendon .................................. Repair/graft finger tendon .................................. Repair finger tendon ........................................... Repair finger tendon ........................................... Repair/graft finger tendon .................................. Realignment of tendons ..................................... Release palm/finger tendon ............................... Release palm & finger tendon ........................... Release hand/finger tendon ............................... Release forearm/hand tendon ............................ Incision of palm tendon ...................................... Incision of finger tendon ..................................... Incise hand/finger tendon ................................... Fusion of finger tendons .................................... Fusion of finger tendons .................................... 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 .................................. Malpractice RVUs 0.48 0.53 0.66 0.54 0.59 0.53 0.59 0.84 1.26 1.17 1.43 0.70 0.94 1.07 0.92 0.97 0.49 0.69 0.78 0.81 0.88 1.20 0.79 0.98 1.01 0.95 0.81 1.07 1.68 1.01 1.14 0.88 0.59 0.39 0.93 1.13 1.21 1.33 1.38 1.12 1.40 1.23 1.40 1.57 0.73 0.97 0.98 0.79 0.67 1.07 0.95 1.09 0.64 0.72 0.93 0.89 0.75 1.20 0.65 1.06 0.59 0.58 0.55 0.88 0.76 0.79 0.81 0.90 0.92 1.02 1.26 1.15 1.26 1.21 1.40 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00240 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA 17.57 NA NA NA NA NA NA NA NA NA 16.05 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 7.53 8.10 9.75 8.34 8.53 8.10 9.22 12.38 16.88 15.68 19.59 7.75 11.71 14.50 13.14 13.35 7.77 10.40 11.38 12.10 11.75 15.80 11.37 14.40 13.26 12.96 11.46 15.06 23.49 14.23 16.41 11.89 8.88 7.78 21.56 24.20 27.69 25.58 27.20 23.37 26.73 25.47 23.90 28.58 17.32 20.58 21.12 24.78 17.27 21.50 20.29 22.19 14.94 16.09 18.58 18.30 19.23 25.34 18.13 23.87 11.60 11.51 11.16 17.87 17.49 16.92 17.04 18.56 18.24 22.78 25.08 24.24 22.89 22.47 24.65 Global 090 090 090 090 090 090 090 090 090 090 090 ZZZ 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70355 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 26494 26496 26497 26498 26499 26500 26502 26504 26508 26510 26516 26517 26518 26520 26525 26530 26531 26535 26536 26540 26541 26542 26545 26546 26548 26550 26551 26553 26554 26555 26556 26560 26561 26562 26565 26567 26568 26580 26587 26590 26591 26593 26596 26600 26605 26607 26608 26615 26641 26645 26650 26665 26670 26675 26676 26685 26686 26700 26705 26706 26715 26720 26725 26727 26735 26740 26742 26746 26750 26755 26756 26765 26770 26775 26776 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 8.46 9.58 9.56 13.98 8.97 5.95 7.13 7.46 6.00 5.42 7.14 8.82 9.01 5.29 5.32 6.68 7.90 5.23 6.36 6.42 8.61 6.77 6.91 8.91 8.02 21.21 46.51 46.20 54.87 16.61 47.19 5.37 10.90 14.98 6.73 6.81 9.07 18.15 14.03 17.93 3.25 5.30 8.94 1.96 2.85 5.35 5.35 5.32 3.93 4.40 5.71 7.59 3.68 4.63 5.51 6.97 7.93 3.68 4.18 5.11 5.73 1.66 3.33 5.22 5.97 1.94 3.84 5.80 1.70 3.10 4.38 4.16 3.02 3.70 4.79 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 3.62 4.57 NA NA NA 4.58 5.18 NA NA 4.27 5.49 NA NA NA 3.77 5.35 NA NA 2.79 4.78 NA NA 3.14 5.00 NA 2.49 4.43 NA NA 3.44 5.21 NA 13.01 13.27 13.61 16.21 13.08 11.47 12.05 12.62 11.71 11.37 12.27 13.54 13.43 13.93 14.01 6.16 7.14 3.75 9.68 11.90 13.43 12.06 12.17 15.07 12.89 17.63 32.53 22.75 37.64 18.23 33.42 9.83 12.38 17.19 12.04 11.98 15.47 13.68 9.24 13.98 9.65 11.16 8.85 2.66 3.66 6.29 6.27 5.32 3.54 4.20 6.71 6.63 2.95 4.48 6.71 6.16 6.92 2.87 4.31 5.10 5.53 2.06 3.51 6.25 5.57 2.71 3.89 5.58 2.02 3.01 5.74 4.40 2.42 3.82 6.02 Hand tendon/muscle transfer ............................. Revise thumb tendon ......................................... Finger tendon transfer ........................................ Finger tendon transfer ........................................ Revision of finger ............................................... Hand tendon reconstruction ............................... Hand tendon reconstruction ............................... Hand tendon reconstruction ............................... Release thumb contracture ................................ Thumb tendon transfer ....................................... Fusion of knuckle joint ....................................... Fusion of knuckle joints ...................................... Fusion of knuckle joints ...................................... Release knuckle contracture .............................. Release finger contracture ................................. Revise knuckle joint ........................................... Revise knuckle with implant ............................... Revise finger joint ............................................... Revise/implant finger joint .................................. Repair hand joint ................................................ Repair hand joint with graft ................................ Repair hand joint with graft ................................ Reconstruct finger joint ...................................... Repair nonunion hand ........................................ Reconstruct finger joint ...................................... Construct thumb replacement ............................ Great toe-hand transfer ...................................... Single transfer, toe-hand .................................... Double transfer, toe-hand .................................. Positional change of finger ................................. Toe joint transfer ................................................ Repair of web finger ........................................... Repair of web finger ........................................... Repair of web finger ........................................... Correct metacarpal flaw ..................................... Correct finger deformity ...................................... Lengthen metacarpal/finger ................................ Repair hand deformity ........................................ Reconstruct extra finger ..................................... Repair finger deformity ....................................... Repair muscles of hand ..................................... Release muscles of hand ................................... Excision constricting tissue ................................ Treat metacarpal fracture ................................... Treat metacarpal fracture ................................... Treat metacarpal fracture ................................... Treat metacarpal fracture ................................... Treat metacarpal fracture ................................... Treat thumb dislocation ...................................... Treat thumb fracture ........................................... Treat thumb fracture ........................................... Treat thumb fracture ........................................... Treat hand dislocation ........................................ Treat hand dislocation ........................................ Pin hand dislocation ........................................... Treat hand dislocation ........................................ Treat hand dislocation ........................................ Treat knuckle dislocation .................................... Treat knuckle dislocation .................................... Pin knuckle dislocation ....................................... Treat knuckle dislocation .................................... Treat finger fracture, each .................................. Treat finger fracture, each .................................. Treat finger fracture, each .................................. 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 .......................................... Malpractice RVUs 1.28 1.45 1.41 2.10 1.35 0.90 1.13 1.24 0.98 0.79 1.10 1.41 1.35 0.80 0.81 1.04 1.17 0.71 0.96 0.99 1.28 1.02 1.05 1.44 1.20 2.45 7.96 2.41 9.41 2.48 2.57 0.85 1.45 2.23 1.00 1.04 1.49 2.28 1.53 2.77 0.48 0.78 1.43 0.30 0.49 0.87 0.88 0.86 0.39 0.67 0.94 0.90 0.39 0.77 0.91 1.09 1.24 0.35 0.66 0.81 0.91 0.24 0.53 0.84 0.95 0.31 0.58 0.91 0.22 0.42 0.71 0.66 0.27 0.54 0.77 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00241 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 5.88 7.91 NA NA NA 8.90 10.25 NA NA 8.34 10.89 NA NA NA 7.80 10.19 NA NA 4.69 8.64 NA NA 5.39 9.42 NA 4.41 7.95 NA NA 6.73 9.45 NA Facility Total 22.75 24.30 24.58 32.29 23.40 18.32 20.31 21.32 18.69 17.58 20.51 23.77 23.79 20.02 20.14 13.88 16.21 9.69 17.00 19.31 23.32 19.85 20.13 25.42 22.11 41.29 87.00 71.36 101.92 37.32 83.18 16.05 24.73 34.40 19.77 19.83 26.03 34.11 24.80 34.68 13.38 17.24 19.22 4.92 7.00 12.51 12.50 11.50 7.86 9.27 13.36 15.12 7.02 9.88 13.13 14.22 16.09 6.90 9.15 11.02 12.17 3.96 7.37 12.31 12.49 4.96 8.31 12.29 3.94 6.53 10.83 9.22 5.71 8.06 11.58 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 70356 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 26785 26820 26841 26842 26843 26844 26850 26852 26860 26861 26862 26863 26910 26951 26952 26989 26990 26991 26992 27000 27001 27003 27005 27006 27025 27030 27033 27035 27036 27040 27041 27047 27048 27049 27050 27052 27054 27060 27062 27065 27066 27067 27070 27071 27075 27076 27077 27078 27079 27080 27086 27087 27090 27091 27093 27095 27096 27097 27098 27100 27105 27110 27111 27120 27122 27125 27130 27132 27134 27137 27138 27140 27146 27147 27151 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 4.20 8.25 7.12 8.23 7.60 8.72 6.96 8.45 4.68 1.74 7.36 3.89 7.59 4.58 6.30 0.00 7.47 6.67 13.00 5.61 6.93 7.33 9.65 9.67 11.14 12.99 13.37 16.66 12.86 2.87 9.88 7.44 6.24 13.64 4.35 6.22 8.53 5.42 5.36 5.89 10.31 13.81 10.70 11.44 34.95 22.09 39.94 13.42 13.73 6.38 1.87 8.53 11.13 22.11 1.30 1.50 1.40 8.79 8.82 11.06 11.75 13.24 12.13 17.98 14.96 14.67 20.09 23.27 28.48 21.14 22.14 12.22 17.40 20.55 22.48 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA 11.19 NA NA NA NA NA NA NA NA NA NA NA 5.25 NA 7.13 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 4.56 NA NA NA 4.47 5.74 4.36 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 4.54 13.29 13.27 13.41 12.39 13.40 12.24 12.93 11.22 0.93 12.38 2.12 11.25 10.18 11.69 0.00 7.23 5.45 10.41 5.30 6.11 6.50 7.84 8.00 8.57 9.67 9.95 11.26 10.03 2.02 6.66 4.78 4.81 8.42 4.43 5.90 7.36 4.38 5.21 5.46 8.46 10.69 9.16 10.15 19.26 14.55 22.73 9.97 9.57 4.84 1.83 6.68 8.81 14.03 0.48 0.52 0.33 6.43 7.04 8.69 9.19 9.14 9.16 11.87 11.07 10.65 13.34 15.68 17.84 13.97 14.43 9.44 12.17 13.29 7.97 Treat finger dislocation ....................................... Thumb fusion with graft ...................................... Fusion of thumb ................................................. Thumb fusion with graft ...................................... Fusion of hand joint ............................................ Fusion/graft of hand joint ................................... Fusion of knuckle ............................................... Fusion of knuckle with graft ............................... Fusion of finger joint ........................................... Fusion of finger jnt, add-on ................................ Fusion/graft of finger joint .................................. Fuse/graft added joint ........................................ Amputate metacarpal bone ................................ Amputation of finger/thumb ................................ Amputation of finger/thumb ................................ Hand/finger surgery ............................................ Drainage of pelvis lesion .................................... Drainage of pelvis bursa .................................... Drainage of bone lesion ..................................... Incision of hip tendon ......................................... Incision of hip tendon ......................................... Incision of hip tendon ......................................... Incision of hip tendon ......................................... Incision of hip tendons ....................................... Incision of hip/thigh fascia .................................. Drainage of hip joint ........................................... Exploration of hip joint ........................................ Denervation of hip joint ...................................... Excision of hip joint/muscle ................................ Biopsy of soft tissues ......................................... Biopsy of soft tissues ......................................... Remove hip/pelvis lesion ................................... Remove hip/pelvis lesion ................................... Remove tumor, hip/pelvis ................................... Biopsy of sacroiliac joint ..................................... Biopsy of hip joint ............................................... Removal of hip joint lining .................................. Removal of ischial bursa .................................... Remove femur lesion/bursa ............................... Removal of hip bone lesion ............................... Removal of hip bone lesion ............................... Remove/graft hip bone lesion ............................ Partial removal of hip bone ................................ Partial removal of hip bone ................................ Extensive hip surgery ......................................... Extensive hip surgery ......................................... Extensive hip surgery ......................................... Extensive hip surgery ......................................... Extensive hip surgery ......................................... Removal of tail bone .......................................... Remove hip foreign body ................................... Remove hip foreign body ................................... Removal of hip prosthesis .................................. Removal of hip prosthesis .................................. Injection for hip x-ray .......................................... Injection for hip x-ray .......................................... Inject sacroiliac joint ........................................... Revision of hip tendon ....................................... Transfer tendon to pelvis ................................... Transfer of abdominal muscle ............................ Transfer of spinal muscle ................................... Transfer of iliopsoas muscle .............................. Transfer of iliopsoas muscle .............................. 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 .......................................... Malpractice RVUs 0.68 1.30 1.18 1.32 1.15 1.33 1.06 1.22 0.73 0.27 1.10 0.56 1.16 0.71 0.95 0.00 1.22 1.11 2.16 0.98 1.24 1.12 1.72 1.69 1.84 2.26 2.32 2.15 2.26 0.27 1.35 1.03 0.92 2.06 0.60 1.08 1.47 0.80 0.93 1.01 1.79 1.84 1.74 1.92 5.64 3.70 6.12 2.22 1.94 0.93 0.25 1.35 1.94 3.84 0.13 0.14 0.08 1.57 0.95 1.85 1.72 2.18 1.94 3.08 2.61 2.54 3.50 4.04 4.94 3.67 3.84 2.11 2.96 3.57 3.91 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00242 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA 18.97 NA NA NA NA NA NA NA NA NA NA NA 8.39 NA 15.60 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 6.68 NA NA NA 5.90 7.38 5.84 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 9.42 22.84 21.57 22.96 21.14 23.45 20.26 22.60 16.63 2.94 20.84 6.57 20.00 15.47 18.94 0.00 15.92 13.23 25.57 11.89 14.28 14.95 19.21 19.36 21.55 24.92 25.64 30.07 25.15 5.16 17.89 13.25 11.97 24.12 9.38 13.20 17.36 10.60 11.50 12.36 20.56 26.34 21.60 23.51 59.85 40.34 68.79 25.61 25.24 12.15 3.95 16.56 21.88 39.98 1.91 2.16 1.81 16.79 16.81 21.60 22.66 24.56 23.23 32.93 28.64 27.86 36.93 42.99 51.26 38.78 40.41 23.77 32.53 37.41 34.36 Global 090 090 090 090 090 090 090 090 090 ZZZ 090 ZZZ 090 090 090 YYY 090 090 090 090 090 090 090 090 090 090 090 090 090 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 010 090 090 090 000 000 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70357 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 27156 27158 27161 27165 27170 27175 27176 27177 27178 27179 27181 27185 27187 27193 27194 27200 27202 27215 27216 27217 27218 27220 27222 27226 27227 27228 27230 27232 27235 27236 27238 27240 27244 27245 27246 27248 27250 27252 27253 27254 27256 27257 27258 27259 27265 27266 27275 27280 27282 27284 27286 27290 27295 27299 27301 27303 27305 27306 27307 27310 27315 27320 27323 27324 27327 27328 27329 27330 27331 27332 27333 27334 27335 27340 27345 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 24.59 19.71 16.68 17.88 16.05 8.45 12.03 15.06 11.97 12.96 14.66 9.17 13.52 5.55 9.64 1.84 7.03 10.03 15.17 14.09 20.12 6.17 12.68 14.89 23.41 27.12 5.49 10.66 12.14 15.58 5.51 12.48 15.92 20.28 4.70 10.43 6.94 10.37 12.90 18.23 4.11 5.21 15.41 21.52 5.04 7.48 2.27 13.37 11.32 23.41 23.41 23.25 18.62 0.00 6.48 8.27 5.91 4.61 5.79 9.26 6.96 6.29 2.28 4.89 4.46 5.56 14.12 4.96 5.87 8.26 7.29 8.69 9.99 4.17 5.91 NA NA NA NA NA NA NA NA NA NA NA NA NA 5.10 NA 2.23 NA NA NA NA NA 5.74 NA NA NA NA 5.53 NA NA NA NA NA NA NA 4.47 NA NA NA NA NA 3.53 NA NA NA NA NA NA NA NA NA NA NA NA 0.00 10.10 NA NA NA NA NA NA NA 3.52 NA 6.01 NA NA NA NA NA NA NA NA NA NA 16.11 11.00 12.14 12.95 11.33 6.69 9.04 10.92 8.44 10.02 10.23 7.54 10.35 5.10 7.67 2.16 16.91 7.10 9.62 10.17 11.43 5.65 10.00 7.83 15.44 17.67 5.11 7.19 9.48 11.08 5.15 9.50 11.33 13.78 4.43 8.23 4.63 7.45 9.81 12.05 2.09 2.82 10.90 14.16 4.80 6.36 2.11 10.29 8.02 14.80 15.84 14.10 11.34 0.00 5.15 7.00 5.20 4.73 5.40 7.60 4.96 5.25 1.89 4.19 3.73 4.38 9.05 4.58 5.54 7.14 6.69 7.43 8.24 4.57 5.64 Revision of hip bones ......................................... Revision of pelvis ............................................... Incision of neck of femur .................................... Incision/fixation of femur .................................... Repair/graft femur head/neck ............................. Treat slipped epiphysis ...................................... Treat slipped epiphysis ...................................... Treat slipped epiphysis ...................................... Treat slipped epiphysis ...................................... Revise head/neck of femur ................................ Treat slipped epiphysis ...................................... Revision of femur epiphysis ............................... Reinforce hip bones ........................................... Treat pelvic ring fracture .................................... Treat pelvic ring fracture .................................... Treat tail bone fracture ....................................... Treat tail bone fracture ....................................... Treat pelvic fracture(s) ....................................... Treat pelvic ring fracture .................................... Treat pelvic ring fracture .................................... Treat pelvic ring fracture .................................... Treat hip socket fracture .................................... Treat hip socket fracture .................................... Treat hip wall fracture ........................................ Treat hip fracture(s) ............................................ Treat hip fracture(s) ............................................ Treat thigh fracture ............................................. Treat thigh fracture ............................................. Treat thigh fracture ............................................. Treat thigh fracture ............................................. Treat thigh fracture ............................................. Treat thigh fracture ............................................. Treat thigh fracture ............................................. Treat thigh fracture ............................................. Treat thigh fracture ............................................. Treat thigh fracture ............................................. Treat hip dislocation ........................................... Treat hip dislocation ........................................... Treat hip dislocation ........................................... Treat hip dislocation ........................................... Treat hip dislocation ........................................... Treat hip dislocation ........................................... Treat hip dislocation ........................................... Treat hip dislocation ........................................... Treat hip dislocation ........................................... Treat hip dislocation ........................................... Manipulation of hip joint ..................................... Fusion of sacroiliac joint ..................................... Fusion of pubic bones ........................................ Fusion of hip joint ............................................... Fusion of hip joint ............................................... Amputation of leg at hip ..................................... Amputation of leg at hip ..................................... Pelvis/hip joint surgery ....................................... Drain thigh/knee lesion ....................................... Drainage of bone lesion ..................................... Incise thigh tendon & fascia ............................... Incision of thigh tendon ...................................... Incision of thigh tendons .................................... Exploration of knee joint ..................................... Partial removal, thigh nerve ............................... Partial removal, thigh nerve ............................... 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 ......................................... Malpractice RVUs 4.21 3.16 2.94 3.10 2.81 1.46 2.22 2.61 2.08 2.25 1.57 2.39 2.37 0.96 1.65 0.28 1.06 1.97 2.63 2.41 3.48 1.07 2.19 2.48 4.05 4.66 0.95 1.85 2.11 2.71 0.89 2.16 2.77 3.52 0.81 1.81 0.62 1.66 2.24 3.17 0.46 0.69 2.64 3.74 0.63 1.29 0.39 2.53 1.86 3.92 3.12 3.43 2.95 0.00 1.04 1.43 1.01 0.85 1.04 1.61 1.09 1.06 0.24 0.75 0.64 0.84 2.14 0.86 1.02 1.43 1.26 1.51 1.74 0.72 1.00 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00243 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA 11.61 NA 4.35 NA NA NA NA NA 12.98 NA NA NA NA 11.97 NA NA NA NA NA NA NA 9.98 NA NA NA NA NA 8.10 NA NA NA NA NA NA NA NA NA NA NA NA 0.00 17.62 NA NA NA NA NA NA NA 6.04 NA 11.11 NA NA NA NA NA NA NA NA NA NA Facility Total 44.91 33.87 31.76 33.93 30.19 16.60 23.29 28.59 22.49 25.23 26.46 19.10 26.24 11.61 18.96 4.28 25.00 19.10 27.42 26.67 35.03 12.89 24.87 25.20 42.90 49.45 11.55 19.70 23.73 29.37 11.55 24.14 30.02 37.58 9.94 20.47 12.19 19.48 24.95 33.45 6.66 8.72 28.95 39.42 10.47 15.13 4.77 26.19 21.20 42.13 42.37 40.78 32.91 0.00 12.67 16.70 12.12 10.19 12.23 18.47 13.01 12.60 4.41 9.83 8.83 10.78 25.31 10.40 12.43 16.83 15.24 17.63 19.97 9.46 12.55 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 010 010 090 090 090 090 010 090 090 090 090 090 090 YYY 090 090 090 090 090 090 090 090 010 090 090 090 090 090 090 090 090 090 090 090 090 70358 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 27347 27350 27355 27356 27357 27358 27360 27365 27370 27372 27380 27381 27385 27386 27390 27391 27392 27393 27394 27395 27396 27397 27400 27403 27405 27407 27409 27412 27415 27418 27420 27422 27424 27425 27427 27428 27429 27430 27435 27437 27438 27440 27441 27442 27443 27445 27446 27447 27448 27450 27454 27455 27457 27465 27466 27468 27470 27472 27475 27477 27479 27485 27486 27487 27488 27495 27496 27497 27498 27499 27500 27501 27502 27503 27506 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 5.77 8.16 7.64 9.47 10.51 4.73 10.48 16.25 0.96 5.06 7.15 10.32 7.75 10.54 5.32 7.19 9.19 6.38 8.49 11.71 7.85 11.26 9.01 8.32 8.64 10.26 12.88 23.23 18.49 10.83 9.82 9.77 9.80 5.21 9.35 13.98 15.50 9.66 9.48 8.45 11.21 10.41 10.80 11.87 10.91 17.65 15.82 21.45 11.04 13.96 17.53 12.80 13.43 13.85 16.31 18.94 16.05 17.69 8.63 9.84 12.78 8.83 19.24 25.23 15.72 15.53 6.10 7.16 7.98 8.99 5.91 5.91 10.56 10.56 17.42 NA NA NA NA NA NA NA NA 3.73 10.08 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 6.14 5.81 NA NA NA 5.44 7.26 6.79 7.87 8.73 2.53 9.58 11.71 0.32 4.70 7.30 9.12 7.65 9.54 5.12 6.58 7.61 5.85 7.24 9.35 7.02 9.07 7.27 7.20 7.51 8.34 9.98 14.84 12.59 8.93 8.13 8.14 8.11 5.54 7.82 11.27 12.45 8.02 8.50 7.26 8.56 6.01 6.73 8.94 8.75 12.39 11.30 14.64 8.62 10.61 12.54 9.91 9.95 10.25 11.86 12.39 11.82 12.72 7.23 7.75 9.67 7.42 13.53 16.60 11.73 11.44 5.62 5.45 5.97 6.84 5.00 5.40 8.13 8.31 12.82 Remove knee cyst .............................................. Removal of kneecap .......................................... Remove femur lesion ......................................... Remove femur lesion/graft ................................. Remove femur lesion/graft ................................. Remove femur lesion/fixation ............................. Partial removal, leg bone(s) ............................... Extensive leg surgery ......................................... Injection for knee x-ray ....................................... Removal of foreign body .................................... Repair of kneecap tendon .................................. Repair/graft kneecap tendon .............................. Repair of thigh muscle ....................................... Repair/graft of thigh muscle ............................... Incision of thigh tendon ...................................... Incision of thigh tendons .................................... Incision of thigh tendons .................................... Lengthening of thigh tendon .............................. Lengthening of thigh tendons ............................. Lengthening of thigh tendons ............................. Transplant of thigh tendon ................................. Transplants of thigh tendons .............................. Revise thigh muscles/tendons ........................... Repair of knee cartilage ..................................... Repair of knee ligament ..................................... Repair of knee ligament ..................................... Repair of knee ligaments ................................... Autochondrocyte implant knee ........................... Osteochondral knee allograft ............................. Repair degenerated kneecap ............................. Revision of unstable kneecap ............................ Revision of unstable kneecap ............................ Revision/removal of kneecap ............................. Lat retinacular release open .............................. Reconstruction, knee .......................................... Reconstruction, knee .......................................... Reconstruction, knee .......................................... Revision of thigh muscles .................................. Incision of knee joint .......................................... Revise kneecap .................................................. Revise kneecap with implant ............................. Revision of knee joint ......................................... Revision of knee joint ......................................... Revision of knee joint ......................................... Revision of knee joint ......................................... Revision of knee joint ......................................... Revision of knee joint ......................................... Total knee arthroplasty ....................................... Incision of thigh .................................................. Incision of thigh .................................................. Realignment of thigh bone ................................. Realignment of knee .......................................... Realignment of knee .......................................... Shortening of thigh bone .................................... Lengthening of thigh bone ................................. Shorten/lengthen thighs ..................................... Repair of thigh .................................................... Repair/graft of thigh ............................................ Surgery to stop leg growth ................................. Surgery to stop leg growth ................................. Surgery to stop leg growth ................................. 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 ................................. Malpractice RVUs 0.98 1.41 1.32 1.65 1.95 0.82 1.83 2.79 0.08 0.84 1.24 1.79 1.36 1.85 0.92 1.23 1.57 1.10 1.47 2.04 1.34 1.82 1.31 1.44 1.51 1.78 2.24 4.35 4.35 1.88 1.71 1.70 1.70 0.90 1.63 2.42 2.70 1.69 1.69 1.49 1.95 1.81 1.88 2.09 1.90 3.08 2.80 3.79 1.94 2.42 3.12 2.24 2.34 2.47 2.77 3.30 2.79 3.07 1.36 1.73 2.78 1.53 3.36 4.39 2.74 2.71 0.99 1.15 1.24 1.47 1.02 1.03 1.78 1.84 3.03 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00244 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA 4.77 15.98 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 13.07 12.75 NA NA NA Facility Total 12.19 16.83 15.75 18.99 21.19 8.08 21.89 30.75 1.36 10.60 15.69 21.23 16.76 21.93 11.36 15.00 18.37 13.33 17.20 23.10 16.21 22.15 17.59 16.96 17.66 20.38 25.10 42.42 35.43 21.64 19.66 19.61 19.61 11.65 18.80 27.67 30.65 19.37 19.67 17.20 21.72 18.23 19.41 22.90 21.56 33.12 29.92 39.88 21.60 26.99 33.19 24.95 25.72 26.57 30.94 34.63 30.66 33.48 17.22 19.32 25.23 17.78 36.13 46.22 30.19 29.68 12.71 13.76 15.19 17.30 11.93 12.34 20.47 20.71 33.27 Global 090 090 090 090 090 ZZZ 090 090 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70359 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 27507 27508 27509 27510 27511 27513 27514 27516 27517 27519 27520 27524 27530 27532 27535 27536 27538 27540 27550 27552 27556 27557 27558 27560 27562 27566 27570 27580 27590 27591 27592 27594 27596 27598 27599 27600 27601 27602 27603 27604 27605 27606 27607 27610 27612 27613 27614 27615 27618 27619 27620 27625 27626 27630 27635 27637 27638 27640 27641 27645 27646 27647 27648 27650 27652 27654 27656 27658 27659 27664 27665 27675 27676 27680 27681 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 13.97 5.82 7.70 9.12 13.62 17.89 17.27 5.36 8.77 15.00 2.86 9.99 3.77 7.29 11.48 15.63 4.86 13.08 5.75 7.89 14.39 16.74 17.69 3.81 5.78 12.21 1.74 19.34 12.01 12.66 10.00 6.91 10.58 10.51 0.00 5.64 5.63 7.34 4.93 4.46 2.87 4.13 7.96 8.33 7.32 2.17 5.65 12.54 5.08 8.39 5.97 8.29 8.90 4.79 7.77 9.84 10.55 11.35 9.23 14.15 12.64 12.22 0.96 9.68 10.31 10.00 4.56 4.97 6.80 4.58 5.39 7.17 8.41 5.73 6.81 NA 6.48 NA NA NA NA NA 6.37 NA NA 4.55 NA 5.33 7.38 NA NA 6.15 NA 6.03 NA NA NA NA 4.85 NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA 7.51 6.10 7.70 NA NA NA NA 3.24 7.15 NA 6.03 9.54 NA NA NA 7.58 NA NA NA NA NA NA NA NA 3.53 NA NA NA 8.55 NA NA NA NA NA NA NA NA 9.87 5.50 7.98 7.35 11.23 13.92 13.39 5.53 7.47 11.62 3.45 8.25 4.43 6.47 10.14 11.64 5.21 9.54 4.94 6.97 11.68 13.16 13.08 3.19 4.78 9.35 1.78 14.84 6.69 8.67 6.19 5.18 6.83 7.04 0.00 4.54 4.86 5.14 4.17 3.97 2.33 3.37 6.19 7.02 6.11 1.81 4.45 9.42 4.00 5.97 5.48 6.48 6.94 4.39 6.76 8.31 8.31 10.34 8.36 12.08 11.06 7.63 0.33 7.53 8.05 7.16 3.78 4.57 5.66 4.56 4.98 5.75 6.77 5.12 5.93 Treatment of thigh fracture ................................. Treatment of thigh fracture ................................. Treatment of thigh fracture ................................. Treatment of thigh fracture ................................. Treatment of thigh fracture ................................. Treatment of thigh fracture ................................. Treatment of thigh fracture ................................. Treat thigh fx growth plate ................................. Treat thigh fx growth plate ................................. Treat thigh fx growth plate ................................. Treat kneecap fracture ....................................... Treat kneecap fracture ....................................... Treat knee fracture ............................................. Treat knee fracture ............................................. Treat knee fracture ............................................. Treat knee fracture ............................................. Treat knee fracture(s) ......................................... Treat knee fracture ............................................. Treat knee dislocation ........................................ Treat knee dislocation ........................................ Treat knee dislocation ........................................ Treat knee dislocation ........................................ Treat knee dislocation ........................................ Treat kneecap dislocation .................................. Treat kneecap dislocation .................................. Treat kneecap dislocation .................................. Fixation of knee joint .......................................... Fusion of knee .................................................... Amputate leg at thigh ......................................... Amputate leg at thigh ......................................... Amputate leg at thigh ......................................... Amputation follow-up surgery ............................. Amputation follow-up surgery ............................. Amputate lower leg at knee ............................... Leg surgery procedure ....................................... Decompression of lower leg ............................... Decompression of lower leg ............................... Decompression of lower leg ............................... Drain lower leg lesion ......................................... Drain lower leg bursa ......................................... Incision of achilles tendon .................................. Incision of achilles tendon .................................. Treat lower leg bone lesion ................................ Explore/treat ankle joint ...................................... Exploration of ankle joint .................................... Biopsy lower leg soft tissue ............................... Biopsy lower leg soft tissue ............................... Remove tumor, lower leg ................................... Remove lower leg lesion .................................... Remove lower leg lesion .................................... Explore/treat ankle joint ...................................... Remove ankle joint lining ................................... Remove ankle joint lining ................................... Removal of tendon lesion .................................. Remove lower leg bone lesion ........................... Remove/graft leg bone lesion ............................ Remove/graft leg bone lesion ............................ Partial removal of tibia ....................................... Partial removal of fibula ..................................... Extensive lower leg surgery ............................... 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 ............................ Malpractice RVUs 2.42 0.97 1.34 1.53 2.37 3.12 3.00 0.81 1.22 2.55 0.47 1.74 0.65 1.26 2.00 2.73 0.84 2.27 0.76 1.36 2.50 2.97 3.08 0.40 0.94 2.12 0.30 3.37 1.74 2.02 1.45 1.02 1.57 1.65 0.00 0.86 0.80 1.10 0.74 0.69 0.41 0.69 1.31 1.40 1.13 0.20 0.78 1.83 0.72 1.25 0.97 1.28 1.48 0.74 1.31 1.66 1.84 1.88 1.46 2.41 2.05 1.75 0.08 1.59 1.71 1.58 0.69 0.79 1.09 0.76 0.89 1.11 1.37 0.93 1.15 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00245 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA 13.27 NA NA NA NA NA 12.54 NA NA 7.88 NA 9.75 15.93 NA NA 11.85 NA 12.54 NA NA NA NA 9.06 NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA 13.18 11.25 10.98 NA NA NA NA 5.61 13.58 NA 11.83 19.18 NA NA NA 13.11 NA NA NA NA NA NA NA NA 4.57 NA NA NA 13.80 NA NA NA NA NA NA NA NA Facility Total 26.26 12.29 17.02 18.00 27.22 34.93 33.66 11.70 17.46 29.17 6.78 19.98 8.85 15.02 23.62 30.00 10.91 24.89 11.45 16.22 28.57 32.87 33.85 7.40 11.50 23.68 3.82 37.55 20.44 23.35 17.64 13.11 18.98 19.20 0.00 11.04 11.29 13.58 9.84 9.12 5.61 8.19 15.46 16.75 14.56 4.18 10.88 23.79 9.80 15.61 12.42 16.05 17.32 9.92 15.84 19.81 20.70 23.57 19.05 28.64 25.75 21.60 1.37 18.80 20.07 18.74 9.03 10.33 13.55 9.90 11.26 14.03 16.55 11.78 13.89 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 010 090 090 090 090 090 090 090 YYY 090 090 090 090 090 010 010 090 090 090 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 090 090 090 090 090 090 090 090 090 090 090 090 70360 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 27685 27686 27687 27690 27691 27692 27695 27696 27698 27700 27702 27703 27704 27705 27707 27709 27712 27715 27720 27722 27724 27725 27727 27730 27732 27734 27740 27742 27745 27750 27752 27756 27758 27759 27760 27762 27766 27780 27781 27784 27786 27788 27792 27808 27810 27814 27816 27818 27822 27823 27824 27825 27826 27827 27828 27829 27830 27831 27832 27840 27842 27846 27848 27860 27870 27871 27880 27881 27882 27884 27886 27888 27889 27892 27893 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 6.49 7.45 6.23 8.70 9.95 1.87 6.50 8.26 9.35 9.28 13.65 15.85 7.61 10.36 4.36 9.94 14.23 14.37 11.77 11.80 18.17 15.57 13.99 7.40 5.31 8.47 9.29 10.28 10.05 3.19 5.83 6.77 11.65 13.74 3.01 5.24 8.35 2.65 4.39 7.10 2.84 4.44 7.65 2.83 5.12 10.66 2.89 5.49 10.98 12.98 2.89 6.18 8.53 14.04 16.21 5.48 3.78 4.55 6.48 4.57 6.20 9.78 11.18 2.34 13.89 9.16 11.83 12.32 8.93 8.20 9.31 9.66 9.97 7.38 7.34 7.31 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 5.58 NA 4.77 6.67 NA NA NA 4.69 6.35 NA 4.19 5.51 NA 4.47 5.66 NA 4.81 6.26 NA 4.39 6.39 NA NA 4.07 6.62 NA NA NA NA 4.40 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 5.48 6.51 5.33 6.37 7.78 0.93 5.89 6.45 6.96 5.70 10.49 11.26 5.61 8.19 4.95 8.15 10.77 10.80 9.43 9.16 12.40 11.94 10.37 6.44 4.94 6.30 8.01 5.58 8.19 3.86 5.69 6.48 9.21 10.34 3.60 5.29 7.24 3.22 4.65 6.49 3.34 4.66 6.98 3.71 5.16 8.58 3.42 5.18 10.68 11.50 3.57 5.40 8.85 12.80 13.97 6.80 3.86 4.47 6.19 3.77 5.13 7.95 9.74 1.99 10.55 7.60 7.15 8.87 6.50 5.77 6.53 7.52 6.49 5.61 5.48 Revision of lower leg tendon .............................. Revise lower leg tendons ................................... Revision of calf tendon ....................................... Revise lower leg tendon ..................................... Revise lower leg tendon ..................................... Revise additional leg tendon .............................. Repair of ankle ligament .................................... Repair of ankle ligaments .................................. Repair of ankle ligament .................................... Revision of ankle joint ........................................ Reconstruct ankle joint ....................................... Reconstruction, ankle joint ................................. Removal of ankle implant ................................... Incision of tibia ................................................... Incision of fibula ................................................. Incision of tibia & fibula ...................................... Realignment of lower leg ................................... Revision of lower leg .......................................... Repair of tibia ..................................................... Repair/graft of tibia ............................................. Repair/graft of tibia ............................................. Repair of lower leg ............................................. Repair of lower leg ............................................. Repair of tibia epiphysis ..................................... Repair of fibula epiphysis ................................... Repair lower leg epiphyses ................................ Repair of leg epiphyses ..................................... Repair of leg epiphyses ..................................... Reinforce tibia .................................................... Treatment of tibia fracture .................................. Treatment of tibia fracture .................................. Treatment of tibia fracture .................................. Treatment of tibia fracture .................................. Treatment of tibia fracture .................................. Treatment of ankle fracture ................................ Treatment of ankle fracture ................................ Treatment of ankle fracture ................................ Treatment of fibula fracture ................................ Treatment of fibula fracture ................................ Treatment of fibula fracture ................................ Treatment of ankle fracture ................................ Treatment of ankle fracture ................................ Treatment of ankle fracture ................................ Treatment of ankle fracture ................................ Treatment of ankle fracture ................................ Treatment of ankle fracture ................................ Treatment of ankle fracture ................................ Treatment of ankle fracture ................................ Treatment of ankle fracture ................................ Treatment of ankle fracture ................................ Treat lower leg fracture ...................................... Treat lower leg fracture ...................................... Treat lower leg fracture ...................................... Treat lower leg fracture ...................................... Treat lower leg fracture ...................................... Treat lower leg joint ............................................ Treat lower leg dislocation ................................. Treat lower leg dislocation ................................. Treat lower leg dislocation ................................. Treat ankle dislocation ....................................... Treat ankle dislocation ....................................... Treat ankle dislocation ....................................... Treat ankle dislocation ....................................... Fixation of ankle joint ......................................... Fusion of ankle joint, open ................................. Fusion of tibiofibular joint ................................... Amputation of lower leg ..................................... Amputation of lower leg ..................................... Amputation of lower leg ..................................... Amputation follow-up surgery ............................. Amputation follow-up surgery ............................. Amputation of foot at ankle ................................ Amputation of foot at ankle ................................ Decompression of leg ........................................ Decompression of leg ........................................ Malpractice RVUs 0.97 1.24 1.00 1.33 1.64 0.32 1.05 1.28 1.47 1.30 2.37 2.76 1.27 1.80 0.76 1.73 2.47 2.49 2.04 2.05 3.16 2.71 2.43 1.72 0.77 1.35 1.62 1.79 1.75 0.55 1.01 1.17 2.03 2.38 0.48 0.85 1.44 0.41 0.73 1.23 0.46 0.74 1.32 0.46 0.82 1.85 0.43 0.82 1.91 2.25 0.45 1.02 1.47 2.43 2.81 0.95 0.54 0.73 1.03 0.46 1.00 1.70 1.94 0.39 2.36 1.59 1.75 1.98 1.29 1.22 1.40 1.51 1.46 1.10 1.10 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00246 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 14.77 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 17.65 NA 8.51 13.51 NA NA NA 8.18 12.44 NA 7.25 10.63 NA 7.77 10.84 NA 8.10 12.20 NA 7.71 12.70 NA NA 7.41 13.82 NA NA NA NA 8.72 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 12.94 15.20 12.56 16.40 19.37 3.12 13.44 15.99 17.78 16.28 26.51 29.87 14.49 20.35 10.07 19.82 27.47 27.66 23.24 23.01 33.73 30.22 26.79 15.56 11.02 16.12 18.92 17.65 19.99 7.60 12.53 14.42 22.89 26.46 7.09 11.38 17.03 6.28 9.77 14.82 6.64 9.84 15.95 7.00 11.10 21.09 6.74 11.49 23.57 26.73 6.91 12.60 18.85 29.27 32.99 13.23 8.18 9.75 13.70 8.80 12.33 19.43 22.86 4.72 26.80 18.35 20.73 23.17 16.72 15.19 17.24 18.69 17.92 14.09 13.92 Global 090 090 090 090 090 ZZZ 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 010 090 090 090 090 090 090 090 090 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70361 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 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 28208 28210 28220 28222 28225 28226 28230 28232 28234 28238 28240 28250 28260 28261 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 10.47 0.00 2.73 4.61 8.40 8.67 4.44 2.84 4.13 5.00 4.66 4.37 6.14 5.08 3.53 4.71 10.16 4.24 3.93 3.44 5.22 6.51 5.09 4.57 3.57 4.77 3.85 4.40 3.63 5.65 7.72 6.49 5.11 7.15 5.55 4.15 4.07 5.00 4.48 4.78 9.78 7.74 5.95 5.38 5.39 7.28 4.80 3.51 8.10 6.90 4.08 3.65 3.73 9.59 8.79 6.04 1.96 4.63 5.72 4.59 6.83 4.36 6.34 4.52 5.61 3.65 4.52 4.23 3.38 3.36 7.72 4.35 5.91 7.95 11.71 NA 0.00 2.99 5.00 6.25 NA 4.56 2.38 NA 6.03 5.21 5.23 NA 5.87 3.82 5.39 8.79 4.90 4.92 4.73 5.49 6.53 5.23 5.54 5.12 8.00 5.77 5.15 5.23 7.98 NA NA 5.50 NA 6.54 4.60 5.23 6.29 5.82 6.07 11.65 6.81 6.26 5.44 7.30 6.85 5.00 4.22 NA 7.24 4.84 4.32 4.57 NA 7.61 5.72 3.40 5.49 5.62 5.10 7.23 4.82 6.23 4.68 5.25 4.29 4.80 4.68 4.53 4.68 7.26 4.64 5.64 6.34 8.63 7.79 0.00 1.96 3.78 5.24 6.06 3.21 2.38 3.31 4.14 3.86 3.93 3.66 4.10 3.18 3.61 6.49 3.60 3.44 3.24 3.88 4.02 3.82 4.31 3.69 4.69 3.90 3.46 3.53 4.70 5.96 4.62 3.93 4.44 4.21 3.26 3.23 3.66 3.58 4.32 8.39 5.18 4.35 3.73 4.42 5.28 3.66 3.00 6.73 4.77 3.29 2.69 3.34 5.44 5.21 3.71 1.48 3.65 3.93 3.56 4.50 3.31 4.03 3.43 4.13 2.91 3.75 3.68 3.32 3.36 4.94 3.49 4.14 5.00 7.32 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 ................................. 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 ...................................... Malpractice RVUs 1.65 0.00 0.33 0.61 1.12 1.16 0.57 0.36 0.59 0.72 0.62 0.58 0.74 0.70 0.46 0.63 1.36 0.60 0.53 0.46 0.70 0.83 0.73 0.68 0.47 0.76 0.61 0.59 0.49 0.82 1.14 0.91 0.70 0.97 0.74 0.53 0.54 0.67 0.61 0.63 1.42 1.03 0.84 0.70 0.77 0.98 0.60 0.45 1.26 0.92 0.53 0.47 0.49 1.33 1.12 0.73 0.22 0.61 0.73 0.61 0.91 0.58 0.81 0.57 0.69 0.46 0.58 0.55 0.44 0.44 1.06 0.58 0.82 1.14 1.57 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00247 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA 0.00 6.05 10.22 15.77 NA 9.57 5.58 NA 11.75 10.49 10.18 NA 11.65 7.81 10.73 20.31 9.74 9.38 8.63 11.41 13.87 11.05 10.79 9.16 13.53 10.23 10.14 9.35 14.45 NA NA 11.31 NA 12.83 9.28 9.84 11.96 10.91 11.48 22.85 15.58 13.05 11.52 13.46 15.11 10.40 8.18 NA 15.06 9.45 8.44 8.79 NA 17.52 12.49 5.58 10.73 12.07 10.30 14.97 9.76 13.38 9.77 11.55 8.40 9.90 9.46 8.35 8.48 16.04 9.57 12.37 15.43 21.91 Facility Total 19.91 0.00 5.02 9.00 14.76 15.89 8.22 5.58 8.03 9.86 9.14 8.88 10.54 9.88 7.17 8.95 18.01 8.44 7.90 7.14 9.80 11.36 9.64 9.56 7.73 10.22 8.36 8.45 7.65 11.17 14.82 12.02 9.74 12.56 10.50 7.94 7.84 9.33 8.67 9.73 19.59 13.95 11.14 9.81 10.58 13.54 9.06 6.96 16.09 12.59 7.90 6.81 7.56 16.36 15.12 10.48 3.66 8.89 10.38 8.76 12.24 8.25 11.18 8.52 10.43 7.02 8.85 8.46 7.14 7.16 13.72 8.42 10.87 14.09 20.60 Global 090 YYY 010 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 70362 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 28262 28264 28270 28272 28280 28285 28286 28288 28289 28290 28292 28293 28294 28296 28297 28298 28299 28300 28302 28304 28305 28306 28307 28308 28309 28310 28312 28313 28315 28320 28322 28340 28341 28344 28345 28360 28400 28405 28406 28415 28420 28430 28435 28436 28445 28450 28455 28456 28465 28470 28475 28476 28485 28490 28495 28496 28505 28510 28515 28525 28530 28531 28540 28545 28546 28555 28570 28575 28576 28585 28600 28605 28606 28615 28630 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 15.81 10.33 4.75 3.79 5.18 4.58 4.55 4.73 7.03 5.65 7.03 9.14 8.55 9.17 9.17 7.93 10.56 9.53 9.54 9.15 10.48 5.85 6.32 5.28 12.76 5.42 4.54 5.00 4.85 9.17 8.33 6.97 8.40 4.25 5.91 13.32 2.16 4.56 6.30 15.95 16.62 2.09 3.39 4.70 15.60 1.90 3.09 2.68 7.00 1.99 2.97 3.37 5.70 1.09 1.58 2.33 3.80 1.09 1.46 3.32 1.06 2.35 2.04 2.45 3.20 6.29 1.66 3.31 4.16 7.98 1.89 2.71 4.89 7.76 1.70 13.59 7.75 4.90 4.19 6.26 4.87 4.80 5.95 8.00 6.27 7.48 10.77 7.45 8.17 8.97 7.23 8.79 NA NA 7.96 NA 6.85 11.05 5.76 NA 5.76 5.45 5.29 4.90 NA 9.20 6.46 6.95 5.76 6.21 NA 3.64 4.84 NA NA NA 3.40 3.89 NA NA 3.12 3.43 NA NA 3.13 3.34 NA NA 2.02 2.18 8.27 8.12 1.53 1.90 7.53 1.44 7.28 2.41 2.35 6.93 9.93 2.43 3.73 NA 7.34 2.82 3.13 NA NA 1.57 10.94 7.30 3.74 2.86 4.49 3.43 3.26 4.89 5.78 4.73 5.55 6.12 4.72 5.43 6.27 5.01 6.08 7.05 6.90 5.75 6.74 4.18 5.30 3.69 7.97 3.56 3.64 4.84 3.34 6.73 6.35 4.25 4.82 3.64 4.69 10.52 3.06 4.63 6.81 13.32 12.95 2.57 3.75 5.93 11.06 2.48 3.43 4.16 6.33 2.45 3.22 4.99 5.46 1.64 2.07 3.20 3.91 1.53 1.90 3.44 1.44 2.07 2.41 2.35 4.39 5.69 2.34 3.73 4.18 5.85 2.69 3.13 4.70 8.06 1.00 Revision of foot and ankle ................................. Release of midfoot joint ..................................... Release of foot contracture ................................ Release of toe joint, each .................................. Fusion of toes ..................................................... Repair of hammertoe ......................................... Repair of hammertoe ......................................... Partial removal of foot bone ............................... Repair hallux rigidus ........................................... Correction of bunion ........................................... Correction of bunion ........................................... Correction of bunion ........................................... Correction of bunion ........................................... Correction of bunion ........................................... Correction of bunion ........................................... Correction of bunion ........................................... Correction of bunion ........................................... Incision of heel bone .......................................... Incision of ankle bone ........................................ Incision of midfoot bones ................................... Incise/graft midfoot bones .................................. Incision of metatarsal ......................................... Incision of metatarsal ......................................... Incision of metatarsal ......................................... Incision of metatarsals ....................................... Revision of big toe ............................................. Revision of toe ................................................... Repair deformity of toe ....................................... Removal of sesamoid bone ............................... Repair of foot bones ........................................... Repair of metatarsals ......................................... Resect enlarged toe tissue ................................ Resect enlarged toe ........................................... Repair extra toe(s) ............................................. Repair webbed toe(s) ......................................... Reconstruct cleft foot ......................................... Treatment of heel fracture .................................. Treatment of heel fracture .................................. Treatment of heel fracture .................................. Treat heel fracture .............................................. Treat/graft heel fracture ...................................... Treatment of ankle fracture ................................ Treatment of ankle fracture ................................ Treatment of ankle fracture ................................ Treat ankle fracture ............................................ Treat midfoot fracture, each ............................... Treat midfoot fracture, each ............................... Treat midfoot fracture ......................................... Treat midfoot fracture, each ............................... Treat metatarsal fracture .................................... Treat metatarsal fracture .................................... Treat metatarsal fracture .................................... Treat metatarsal fracture .................................... Treat big toe fracture .......................................... Treat big toe fracture .......................................... Treat big toe fracture .......................................... Treat big toe fracture .......................................... 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 ........................................... Malpractice RVUs 2.59 1.54 0.62 0.46 0.73 0.59 0.57 0.65 1.02 0.82 0.91 1.13 1.09 1.19 1.32 1.05 1.37 1.54 1.42 1.27 1.27 0.84 0.90 0.70 2.04 0.70 0.63 0.73 0.63 1.43 1.27 0.84 1.01 0.51 0.80 2.28 0.35 0.73 1.11 2.66 2.80 0.31 0.55 0.81 2.58 0.28 0.44 0.44 1.10 0.30 0.44 0.54 0.83 0.14 0.20 0.36 0.56 0.14 0.18 0.49 0.14 0.34 0.26 0.37 0.52 1.04 0.23 0.56 0.69 1.25 0.27 0.40 0.82 1.30 0.20 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00248 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 31.99 19.62 10.27 8.44 12.17 10.04 9.92 11.33 16.05 12.74 15.42 21.04 17.09 18.53 19.46 16.21 20.72 NA NA 18.38 NA 13.54 18.27 11.74 NA 11.88 10.62 11.02 10.38 NA 18.80 14.27 16.36 10.52 12.92 NA 6.15 10.13 NA NA NA 5.80 7.83 NA NA 5.30 6.96 NA NA 5.42 6.75 NA NA 3.25 3.96 10.96 12.48 2.76 3.54 11.34 2.64 9.97 4.71 5.17 10.65 17.26 4.32 7.60 NA 16.57 4.98 6.24 NA NA 3.47 Facility Total 29.34 19.17 9.11 7.11 10.40 8.60 8.38 10.27 13.83 11.20 13.49 16.39 14.36 15.79 16.76 13.99 18.01 18.12 17.86 16.17 18.49 10.87 12.52 9.67 22.77 9.68 8.81 10.57 8.82 17.33 15.95 12.06 14.23 8.40 11.40 26.12 5.57 9.92 14.22 31.93 32.37 4.97 7.69 11.44 29.24 4.66 6.96 7.28 14.43 4.74 6.63 8.90 11.99 2.87 3.85 5.89 8.27 2.76 3.54 7.25 2.64 4.76 4.71 5.17 8.11 13.02 4.23 7.60 9.03 15.08 4.85 6.24 10.41 17.12 2.90 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 010 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70363 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 28635 28636 28645 28660 28665 28666 28675 28705 28715 28725 28730 28735 28737 28740 28750 28755 28760 28800 28805 28810 28820 28825 28890 28899 29000 29010 29015 29020 29025 29035 29040 29044 29046 29049 29055 29058 29065 29075 29085 29086 29105 29125 29126 29130 29131 29200 29220 29240 29260 29280 29305 29325 29345 29355 29358 29365 29405 29425 29435 29440 29445 29450 29505 29515 29520 29530 29540 29550 29580 29590 29700 29705 29710 29715 29720 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 1.91 2.77 4.21 1.23 1.92 2.66 2.92 18.77 13.08 11.59 10.74 10.83 9.63 8.01 7.29 4.73 7.74 8.20 8.38 6.20 4.40 3.58 3.30 0.00 2.25 2.06 2.41 2.11 2.40 1.77 2.22 2.12 2.41 0.89 1.78 1.31 0.87 0.77 0.87 0.62 0.87 0.59 0.77 0.50 0.55 0.65 0.64 0.71 0.55 0.51 2.03 2.32 1.40 1.53 1.43 1.18 0.86 1.01 1.18 0.57 1.78 2.08 0.69 0.73 0.54 0.57 0.51 0.47 0.57 0.76 0.57 0.76 1.34 0.94 0.68 2.03 3.88 4.96 1.26 NA 5.90 7.16 NA NA NA NA NA NA 10.89 11.94 6.12 7.99 NA NA NA 7.57 7.01 5.73 0.00 2.97 3.29 2.98 3.19 3.15 3.62 2.47 3.98 3.24 1.30 2.99 1.56 1.33 1.26 1.28 0.96 1.23 1.02 1.21 0.47 0.74 0.72 0.72 0.85 0.74 0.80 3.35 3.54 1.77 1.71 2.07 1.66 1.22 1.23 1.56 0.69 1.81 1.47 1.18 0.87 0.85 0.79 0.42 0.42 0.65 0.51 0.89 0.82 1.53 1.17 1.16 1.53 2.63 3.28 0.79 1.43 2.59 3.36 12.47 9.78 8.26 8.50 7.84 6.82 6.48 6.68 3.76 5.53 5.81 5.66 4.48 3.79 3.49 2.09 0.00 1.74 1.78 1.60 1.41 1.86 1.58 1.51 1.91 2.10 0.53 1.47 0.72 0.75 0.68 0.63 0.49 0.51 0.39 0.46 0.17 0.24 0.34 0.39 0.36 0.32 0.32 1.77 1.96 1.06 1.12 1.09 0.95 0.71 0.74 0.93 0.27 0.96 1.09 0.45 0.46 0.47 0.33 0.31 0.28 0.35 0.29 0.28 0.38 0.70 0.40 0.39 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 .................................... High energy eswt, plantar f ................................ Foot/toes surgery procedure .............................. Application of body cast ..................................... Application of body cast ..................................... Application of body cast ..................................... Application of body cast ..................................... Application of body cast ..................................... Application of body cast ..................................... Application of body cast ..................................... Application of body cast ..................................... Application of body cast ..................................... Application of figure eight ................................... Application of shoulder cast ............................... Application of shoulder cast ............................... Application of long arm cast ............................... Application of forearm cast ................................ Apply hand/wrist cast ......................................... Apply finger cast ................................................. Apply long arm splint .......................................... Apply forearm splint ........................................... Apply forearm splint ........................................... Application of finger splint .................................. Application of finger splint .................................. Strapping of chest .............................................. Strapping of low back ......................................... Strapping of shoulder ......................................... Strapping of elbow or wrist ................................ Strapping of hand or finger ................................ Application of hip cast ........................................ Application of hip casts ...................................... Application of long leg cast ................................ Application of long leg cast ................................ Apply long leg cast brace ................................... Application of long leg cast ................................ Apply short leg cast ............................................ Apply short leg cast ............................................ Apply short leg cast ............................................ Addition of walker to cast ................................... Apply rigid leg cast ............................................. Application of leg cast ........................................ Application, long leg splint ................................. Application lower leg splint ................................. Strapping of hip .................................................. Strapping of knee ............................................... Strapping of ankle and/or ft ................................ Strapping of toes ................................................ Application of paste boot .................................... Application of foot splint ..................................... Removal/revision of cast .................................... Removal/revision of cast .................................... Removal/revision of cast .................................... Removal/revision of cast .................................... Repair of body cast ............................................ Malpractice RVUs 0.26 0.43 0.57 0.13 0.26 0.43 0.45 3.08 2.16 1.86 1.70 1.68 1.47 1.22 1.13 0.65 1.05 1.15 1.18 0.86 0.61 0.50 0.41 0.00 0.41 0.45 0.28 0.28 0.44 0.28 0.36 0.35 0.42 0.13 0.30 0.17 0.15 0.13 0.14 0.07 0.12 0.07 0.07 0.06 0.03 0.04 0.04 0.06 0.05 0.03 0.35 0.40 0.24 0.26 0.25 0.20 0.14 0.15 0.20 0.08 0.27 0.27 0.08 0.09 0.03 0.05 0.06 0.06 0.07 0.09 0.08 0.13 0.20 0.09 0.12 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00249 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 4.20 7.08 9.74 2.62 NA 8.99 10.53 NA NA NA NA NA NA 20.12 20.36 11.50 16.78 NA NA NA 12.58 11.09 9.44 0.00 5.63 5.80 5.67 5.58 5.99 5.67 5.05 6.45 6.07 2.32 5.07 3.04 2.35 2.16 2.29 1.65 2.22 1.68 2.05 1.03 1.32 1.41 1.40 1.62 1.34 1.34 5.73 6.26 3.41 3.50 3.75 3.04 2.22 2.39 2.94 1.34 3.86 3.82 1.95 1.69 1.42 1.41 0.99 0.95 1.29 1.36 1.54 1.71 3.07 2.20 1.96 Facility Total 3.70 5.83 8.06 2.15 3.61 5.68 6.73 34.32 25.02 21.71 20.94 20.35 17.92 15.71 15.10 9.14 14.32 15.16 15.22 11.54 8.80 7.57 5.80 0.00 4.40 4.29 4.29 3.80 4.70 3.63 4.09 4.38 4.93 1.55 3.55 2.20 1.77 1.58 1.64 1.18 1.50 1.05 1.30 0.73 0.82 1.03 1.07 1.13 0.92 0.86 4.15 4.68 2.70 2.91 2.77 2.33 1.71 1.90 2.31 0.92 3.01 3.44 1.22 1.28 1.04 0.95 0.88 0.81 0.99 1.14 0.93 1.27 2.24 1.43 1.19 Global 010 010 090 010 010 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 70364 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 29730 29740 29750 29799 29800 29804 29805 29806 29807 29819 29820 29821 29822 29823 29824 29825 29826 29827 29830 29834 29835 29836 29837 29838 29840 29843 29844 29845 29846 29847 29848 29850 29851 29855 29856 29860 29861 29862 29863 29866 29867 29868 29870 29871 29873 29874 29875 29876 29877 29879 29880 29881 29882 29883 29884 29885 29886 29887 29888 29889 29891 29892 29893 29894 29895 29897 29898 29899 29900 29901 29902 29999 30000 3000F 30020 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A I A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.75 1.12 1.26 0.00 6.42 8.13 5.88 14.35 13.88 7.61 7.06 7.71 7.42 8.16 8.24 7.61 8.98 15.34 5.75 6.27 6.47 7.54 6.86 7.70 5.53 6.00 6.36 7.51 6.74 7.07 5.43 8.18 13.08 10.60 14.12 8.04 9.14 9.89 9.89 13.88 17.00 23.59 5.06 6.54 5.99 7.04 6.30 7.91 7.34 8.03 8.49 7.75 8.64 11.03 7.32 9.08 7.53 9.03 13.88 15.98 8.39 8.99 5.21 7.20 6.98 7.17 8.31 13.89 5.41 6.12 6.69 0.00 1.43 0.00 1.43 0.81 1.15 1.06 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 6.30 NA NA NA NA NA NA NA NA 0.00 4.08 0.00 3.28 0.35 0.49 0.58 0.00 6.99 7.64 5.69 11.19 11.02 6.81 6.24 6.82 6.71 7.24 7.55 6.78 7.55 11.56 5.36 5.85 5.90 6.81 6.15 6.91 5.34 5.64 5.84 6.49 6.07 6.21 5.62 5.05 9.82 8.79 10.70 6.97 7.36 8.58 8.53 11.38 13.26 16.84 4.90 5.89 6.59 6.09 5.87 7.04 6.76 7.14 7.38 6.98 7.26 9.09 6.72 7.99 6.87 7.95 10.23 12.47 7.53 7.76 4.00 5.49 5.49 5.90 6.21 10.57 5.88 6.28 6.56 0.00 1.39 0.00 1.47 Windowing of cast .............................................. Wedging of cast ................................................. Wedging of clubfoot cast .................................... Casting/strapping procedure .............................. Jaw arthroscopy/surgery .................................... Jaw arthroscopy/surgery .................................... Shoulder arthroscopy, dx ................................... Shoulder arthroscopy/surgery ............................ Shoulder arthroscopy/surgery ............................ Shoulder arthroscopy/surgery ............................ Shoulder arthroscopy/surgery ............................ Shoulder arthroscopy/surgery ............................ Shoulder arthroscopy/surgery ............................ Shoulder arthroscopy/surgery ............................ Shoulder arthroscopy/surgery ............................ Shoulder arthroscopy/surgery ............................ Shoulder arthroscopy/surgery ............................ Arthroscop rotator cuff repr ................................ Elbow arthroscopy .............................................. Elbow arthroscopy/surgery ................................. Elbow arthroscopy/surgery ................................. Elbow arthroscopy/surgery ................................. Elbow arthroscopy/surgery ................................. Elbow arthroscopy/surgery ................................. Wrist arthroscopy ............................................... Wrist arthroscopy/surgery .................................. Wrist arthroscopy/surgery .................................. Wrist arthroscopy/surgery .................................. Wrist arthroscopy/surgery .................................. Wrist arthroscopy/surgery .................................. Wrist endoscopy/surgery .................................... Knee arthroscopy/surgery .................................. Knee arthroscopy/surgery .................................. Tibial arthroscopy/surgery .................................. Tibial arthroscopy/surgery .................................. Hip arthroscopy, dx ............................................ Hip arthroscopy/surgery ..................................... Hip arthroscopy/surgery ..................................... Hip arthroscopy/surgery ..................................... Autgrft implnt, knee w/scope .............................. Allgrft implnt, knee w/scope ............................... Meniscal trnspl, knee w/scpe ............................. Knee arthroscopy, dx ......................................... Knee arthroscopy/drainage ................................ Knee arthroscopy/surgery .................................. Knee arthroscopy/surgery .................................. Knee arthroscopy/surgery .................................. Knee arthroscopy/surgery .................................. Knee arthroscopy/surgery .................................. Knee arthroscopy/surgery .................................. Knee arthroscopy/surgery .................................. Knee arthroscopy/surgery .................................. Knee arthroscopy/surgery .................................. Knee arthroscopy/surgery .................................. Knee arthroscopy/surgery .................................. Knee arthroscopy/surgery .................................. 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 ..................................... Blood press </= 140/90 mmhg ........................... Drainage of nose lesion ..................................... Malpractice RVUs 0.12 0.18 0.21 0.00 0.99 1.38 1.02 2.49 2.41 1.32 1.22 1.33 1.28 1.41 1.42 1.32 1.55 2.66 0.99 1.08 1.13 1.22 1.19 1.30 0.84 0.92 1.04 0.99 1.07 1.08 0.86 1.25 2.34 1.84 2.39 1.36 1.59 1.62 1.42 2.39 2.78 4.35 0.85 1.14 1.04 1.11 1.09 1.37 1.28 1.39 1.47 1.34 1.50 1.92 1.27 1.58 1.30 1.57 2.41 2.78 1.39 1.41 0.63 1.15 1.11 1.17 1.28 2.40 0.94 1.06 1.12 0.00 0.12 0.00 0.12 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00250 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 1.68 2.45 2.53 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 12.14 NA NA NA NA NA NA NA NA 0.00 5.63 0.00 4.83 Facility Total 1.22 1.79 2.05 0.00 14.40 17.15 12.59 28.03 27.31 15.74 14.52 15.86 15.41 16.81 17.21 15.71 18.08 29.56 12.10 13.20 13.50 15.57 14.20 15.91 11.71 12.56 13.24 14.99 13.88 14.36 11.91 14.48 25.24 21.23 27.21 16.37 18.09 20.09 19.84 27.65 33.04 44.78 10.81 13.57 13.62 14.24 13.26 16.32 15.38 16.56 17.34 16.07 17.40 22.04 15.31 18.65 15.70 18.55 26.52 31.23 17.31 18.16 9.84 13.84 13.58 14.24 15.80 26.86 12.23 13.46 14.37 0.00 2.94 0.00 3.02 Global 000 000 000 YYY 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY 010 XXX 010 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70365 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 3002F 30100 30110 30115 30117 30118 30120 30124 30125 30130 30140 30150 30160 30200 30210 30220 30300 30310 30320 30400 30410 30420 30430 30435 30450 30460 30462 30465 30520 30540 30545 30560 30580 30600 30620 30630 30801 30802 30901 30903 30905 30906 30915 30920 30930 30999 31000 31002 31020 31030 31032 31040 31050 31051 31070 31075 31080 31081 31084 31085 31086 31087 31090 31200 31201 31205 31225 31230 31231 31233 31235 31237 31238 31239 31240 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... I A A A A A A A A A A A A A A A A A A R R R R R R A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.94 1.63 4.34 3.16 9.68 5.26 3.10 7.15 3.37 3.42 9.13 9.57 0.78 1.08 1.54 1.04 1.96 4.51 9.82 12.96 15.86 7.20 11.69 18.62 9.95 19.54 11.62 5.69 7.74 11.36 1.26 6.68 6.01 5.96 7.11 1.09 2.03 1.21 1.54 1.97 2.45 7.19 9.82 1.26 0.00 1.15 1.91 2.94 5.91 6.56 9.41 5.27 7.10 4.27 9.15 11.40 12.73 13.49 14.18 12.84 13.08 9.52 4.96 8.36 10.22 19.20 21.91 1.10 2.18 2.64 2.98 3.26 8.69 2.61 0.00 1.98 3.25 NA 13.18 NA 6.51 NA NA NA NA NA NA 1.62 2.11 4.24 4.64 NA NA NA NA NA NA NA NA NA NA NA NA NA NA 4.78 7.79 7.54 NA NA 4.14 4.62 1.36 2.72 3.52 3.90 NA NA NA 0.00 2.85 NA 8.55 11.53 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 3.39 4.31 4.92 5.21 5.25 NA NA 0.00 0.82 1.57 5.78 4.64 9.22 6.02 3.62 8.34 5.61 6.21 11.04 10.24 0.74 1.31 1.53 1.92 3.11 7.06 15.53 18.42 17.96 16.06 19.41 21.95 9.97 20.30 12.00 6.68 9.30 11.93 2.14 5.81 5.03 8.86 7.97 1.93 2.37 0.32 0.50 0.76 1.20 6.71 9.00 1.62 0.00 1.40 3.25 5.20 6.68 7.25 9.85 6.37 8.26 5.95 9.76 13.57 14.04 13.54 14.00 13.32 12.57 12.59 9.24 9.20 11.91 17.87 19.42 0.88 1.48 1.72 1.89 2.10 8.02 1.74 Blood pressure > 140/90 mmhg ......................... 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 ...................................... Excise inferior turbinate ...................................... Resect inferior turbinate ..................................... Partial removal of nose ...................................... Removal of nose ................................................ Injection treatment of nose ................................. Nasal sinus therapy ............................................ Insert nasal septal button ................................... Remove nasal foreign body ............................... Remove nasal foreign body ............................... Remove nasal foreign body ............................... Reconstruction of nose ...................................... Reconstruction of nose ...................................... Reconstruction of nose ...................................... Revision of nose ................................................. Revision of nose ................................................. Revision of nose ................................................. Revision of nose ................................................. Revision of nose ................................................. Repair nasal stenosis ......................................... Repair of nasal septum ...................................... Repair nasal defect ............................................ Repair nasal defect ............................................ Release of nasal adhesions ............................... Repair upper jaw fistula ..................................... Repair mouth/nose fistula .................................. Intranasal reconstruction .................................... Repair nasal septum defect ............................... Ablate inf turbinate, superf ................................. Cauterization, inner nose ................................... Control of nosebleed .......................................... Control of nosebleed .......................................... Control of nosebleed .......................................... Repeat control of nosebleed .............................. Ligation, nasal sinus artery ................................ Ligation, upper jaw artery ................................... Ther fx, nasal inf turbinate ................................. 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 ............................. Malpractice RVUs 0.00 0.07 0.14 0.41 0.26 0.78 0.52 0.25 0.63 0.31 0.35 0.93 0.88 0.06 0.09 0.12 0.08 0.16 0.39 1.04 1.42 1.46 0.77 1.22 1.96 1.03 2.53 1.06 0.46 0.67 1.70 0.10 0.89 0.70 0.57 0.61 0.09 0.16 0.11 0.13 0.17 0.20 0.58 0.80 0.12 0.00 0.09 0.15 0.29 0.60 0.59 0.87 0.49 0.62 0.38 0.75 1.23 2.46 1.19 1.72 1.07 1.44 0.94 0.29 0.82 0.67 1.59 1.77 0.09 0.20 0.26 0.28 0.27 0.62 0.24 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00251 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.00 2.99 5.02 NA 16.60 NA 12.29 NA NA NA NA NA NA 2.46 3.28 5.90 5.76 NA NA NA NA NA NA NA NA NA NA NA NA NA NA 6.14 15.36 14.25 NA NA 5.32 6.81 2.68 4.39 5.66 6.55 NA NA NA 0.00 4.09 NA 11.78 18.04 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 4.58 6.69 7.82 8.47 8.78 NA NA Facility Total 0.00 1.83 3.34 10.53 8.06 19.68 11.80 6.97 16.12 9.29 9.98 21.10 20.69 1.58 2.48 3.19 3.04 5.23 11.96 26.39 32.80 35.28 24.03 32.32 42.53 20.95 42.37 24.68 12.83 17.71 24.99 3.50 13.38 11.74 15.39 15.69 3.11 4.56 1.64 2.17 2.90 3.85 14.48 19.62 3.00 0.00 2.64 5.31 8.43 13.19 14.40 20.13 12.13 15.98 10.60 19.66 26.20 29.23 28.22 29.90 27.23 27.09 23.05 14.49 18.38 22.80 38.66 43.10 2.07 3.86 4.62 5.15 5.63 17.33 4.59 Global XXX 000 010 090 090 090 090 090 090 090 090 090 090 000 010 010 010 010 090 090 090 090 090 090 090 090 090 090 090 090 090 010 090 090 090 090 010 010 000 000 000 000 090 090 010 YYY 010 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 000 000 000 000 010 000 70366 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 31254 31255 31256 31267 31276 31287 31288 31290 31291 31292 31293 31294 31299 31300 31320 31360 31365 31367 31368 31370 31375 31380 31382 31390 31395 31400 31420 31500 31502 31505 31510 31511 31512 31513 31515 31520 31525 31526 31527 31528 31529 31530 31531 31535 31536 31540 31541 31545 31546 31560 31561 31570 31571 31575 31576 31577 31578 31579 31580 31582 31584 31587 31588 31590 31595 31599 31600 31601 31603 31605 31610 31611 31612 31613 31614 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 4.64 6.95 3.29 5.45 8.84 3.91 4.57 17.21 18.16 14.74 16.19 19.03 0.00 14.27 5.25 17.05 24.12 21.83 27.05 21.35 20.18 20.18 20.49 27.49 31.04 10.29 10.20 2.33 0.65 0.61 1.92 2.16 2.07 2.10 1.80 2.56 2.63 2.57 3.27 2.37 2.68 3.38 3.58 3.16 3.55 4.12 4.52 6.30 9.73 5.45 5.99 3.86 4.26 1.10 1.97 2.47 2.84 2.26 12.36 21.59 19.61 11.97 13.09 6.96 8.33 0.00 7.17 4.44 4.14 3.57 8.75 5.63 0.91 4.58 7.11 NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.31 1.45 3.31 3.13 3.21 NA 3.55 NA 3.65 NA NA NA NA NA NA NA NA NA NA NA NA NA NA 5.69 NA 1.91 3.67 3.77 4.29 3.79 NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA 1.10 NA NA 2.86 4.12 2.12 3.30 5.13 2.46 2.82 12.08 12.51 10.64 11.41 12.91 0.00 15.02 10.33 16.77 20.42 21.95 25.56 22.32 20.44 20.66 21.67 24.45 28.38 13.81 9.57 0.55 0.28 0.61 1.25 1.06 1.36 1.46 1.06 1.56 1.66 1.72 1.88 1.46 1.71 1.96 2.28 2.00 2.26 2.55 2.79 3.48 4.98 3.16 3.38 2.39 2.61 0.89 1.29 1.53 1.52 1.48 15.96 25.87 18.20 9.29 13.65 15.58 10.58 0.00 3.20 2.41 1.71 1.19 8.28 7.08 0.35 6.01 8.74 Revision of ethmoid sinus .................................. Removal of ethmoid sinus .................................. Exploration maxillary sinus ................................. Endoscopy, maxillary sinus ................................ Sinus endoscopy, surgical ................................. Nasal/sinus endoscopy, surg ............................. Nasal/sinus endoscopy, surg ............................. Nasal/sinus endoscopy, surg ............................. Nasal/sinus endoscopy, surg ............................. Nasal/sinus endoscopy, surg ............................. Nasal/sinus endoscopy, surg ............................. Nasal/sinus endoscopy, surg ............................. Sinus surgery procedure .................................... Removal of larynx lesion .................................... Diagnostic incision, larynx .................................. Removal of larynx .............................................. Removal of larynx .............................................. Partial removal of larynx .................................... Partial removal of larynx .................................... Partial removal of larynx .................................... Partial removal of larynx .................................... Partial removal of larynx .................................... Partial removal of larynx .................................... Removal of larynx & pharynx ............................. Reconstruct larynx & pharynx ............................ Revision of larynx ............................................... Removal of epiglottis .......................................... Insert emergency airway .................................... Change of windpipe airway ................................ Diagnostic laryngoscopy .................................... Laryngoscopy with biopsy .................................. Remove foreign body, larynx ............................. Removal of larynx lesion .................................... Injection into vocal cord ..................................... Laryngoscopy for aspiration ............................... Dx laryngoscopy, newborn ................................. Dx laryngoscopy excl nb .................................... Dx laryngoscopy w/oper scope .......................... Laryngoscopy for treatment ............................... Laryngoscopy and dilation ................................. Laryngoscopy and dilation ................................. Laryngoscopy w/fb removal ............................... Laryngoscopy w/fb & op scope .......................... Laryngoscopy w/biopsy ...................................... Laryngoscopy w/bx & op scope ......................... Laryngoscopy w/exc of tumor ............................ Larynscop w/tumr exc + scope .......................... Remove vc lesion w/scope ................................ Remove vc lesion scope/graft ............................ Laryngoscop w/arytenoidectom .......................... Larynscop, remve cart + scop ............................ Laryngoscope w/vc inj ........................................ Laryngoscop w/vc inj + scope ............................ Diagnostic laryngoscopy .................................... Laryngoscopy with biopsy .................................. Remove foreign body, larynx ............................. Removal of larynx lesion .................................... Diagnostic laryngoscopy .................................... Revision of larynx ............................................... Revision of larynx ............................................... 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 .................................... Malpractice RVUs 0.45 0.73 0.33 0.55 0.92 0.39 0.46 1.40 1.68 1.21 1.28 1.53 0.00 1.17 0.46 1.38 1.97 1.78 2.20 1.74 1.63 1.70 1.67 2.23 2.48 0.83 0.83 0.17 0.05 0.05 0.16 0.19 0.18 0.17 0.14 0.20 0.21 0.21 0.26 0.19 0.22 0.29 0.29 0.26 0.29 0.33 0.37 0.37 0.78 0.43 0.49 0.31 0.35 0.09 0.14 0.21 0.23 0.18 1.00 1.75 1.71 0.97 1.06 0.84 0.68 0.00 0.80 0.40 0.44 0.40 0.79 0.46 0.08 0.42 0.58 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00252 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 1.01 2.11 5.39 5.48 5.46 NA 5.49 NA 6.49 NA NA NA NA NA NA NA NA NA NA NA NA NA NA 9.86 NA 3.10 5.78 6.45 7.36 6.23 NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA 2.09 NA NA Facility Total 7.95 11.80 5.74 9.30 14.89 6.76 7.85 30.69 32.35 26.59 28.88 33.47 0.00 30.46 16.04 35.20 46.51 45.56 54.81 45.41 42.25 42.54 43.83 54.17 61.90 24.93 20.60 3.05 0.98 1.27 3.33 3.41 3.61 3.73 3.00 4.32 4.50 4.50 5.41 4.02 4.61 5.63 6.15 5.42 6.10 7.00 7.68 10.15 15.49 9.04 9.86 6.56 7.22 2.08 3.40 4.21 4.59 3.92 29.32 49.21 39.52 22.23 27.80 23.38 19.59 0.00 11.17 7.25 6.29 5.16 17.82 13.17 1.34 11.01 16.43 Global 000 000 000 000 000 000 000 010 010 010 010 010 YYY 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 090 090 090 090 090 090 090 YYY 000 000 000 000 090 090 000 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70367 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 31615 31620 31622 31623 31624 31625 31628 31629 31630 31631 31632 31633 31635 31636 31637 31638 31640 31641 31643 31645 31646 31656 31700 31708 31710 31715 31717 31720 31725 31730 31750 31755 31760 31766 31770 31775 31780 31781 31785 31786 31800 31805 31820 31825 31830 31899 32000 32002 32005 32019 32020 32035 32036 32095 32100 32110 32120 32124 32140 32141 32150 32151 32160 32200 32201 32215 32220 32225 32310 32320 32400 32402 32405 32420 32440 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 2.09 1.40 2.78 2.88 2.88 3.36 3.80 4.09 3.81 4.36 1.03 1.32 3.67 4.30 1.58 4.88 4.93 5.02 3.49 3.16 2.72 2.17 1.34 1.41 1.30 1.11 2.12 1.06 1.96 2.85 13.00 15.91 22.32 30.38 22.48 23.50 17.69 23.49 17.20 23.94 7.42 13.11 4.48 6.80 4.49 0.00 1.54 2.19 2.19 4.17 3.97 8.66 9.67 8.35 15.22 22.97 11.52 12.70 13.91 13.98 14.13 14.19 9.29 15.27 3.99 11.31 23.96 13.94 13.42 23.96 1.76 7.55 1.93 2.18 24.96 2.60 5.66 5.67 6.44 5.79 5.83 7.04 14.29 NA NA 0.81 0.92 6.13 NA NA NA NA NA NA 5.15 4.87 7.31 2.16 2.04 NA NA 8.27 0.33 0.65 2.20 NA NA NA NA NA NA NA NA NA NA NA NA 5.68 7.68 5.78 0.00 3.06 3.22 6.47 20.02 NA NA NA NA NA NA NA NA NA NA NA NA NA NA 20.76 NA NA NA NA NA 2.13 NA 0.67 NA NA 1.20 0.55 1.06 1.05 1.05 1.21 1.30 1.40 1.72 1.77 0.31 0.40 1.43 1.77 0.56 1.98 2.08 1.89 1.23 1.12 1.00 0.83 0.68 0.46 0.41 0.34 0.79 0.33 0.58 1.00 17.60 24.59 10.74 13.69 10.27 11.82 11.08 12.16 10.21 13.13 9.27 7.23 3.66 5.39 3.99 0.00 0.48 1.06 0.70 1.65 1.35 5.87 6.45 5.38 7.84 10.76 7.09 7.23 7.70 7.57 7.62 8.02 5.28 8.63 1.30 6.92 12.99 7.67 7.41 12.19 0.55 5.12 0.63 0.68 12.93 Visualization of windpipe .................................... Endobronchial us add-on ................................... Dx bronchoscope/wash ...................................... Dx bronchoscope/brush ..................................... Dx bronchoscope/lavage .................................... Bronchoscopy w/biopsy(s) ................................. Bronchoscopy/lung bx, each .............................. Bronchoscopy/needle bx, each .......................... Bronchoscopy dilate/fx repr ................................ Bronchoscopy, dilate w/stent ............................. Bronchoscopy/lung bx, add’l .............................. Bronchoscopy/needle bx add’l ........................... Bronchoscopy w/fb removal ............................... Bronchoscopy, bronch stents ............................. Bronchoscopy, stent add-on .............................. Bronchoscopy, revise stent ................................ Bronchoscopy w/tumor excise ........................... Bronchoscopy, treat blockage ............................ Diag bronchoscope/catheter .............................. Bronchoscopy, clear airways ............................. Bronchoscopy, reclear airway ............................ Bronchoscopy, inj for x-ray ................................ Insertion of airway catheter ................................ Instill airway contrast dye ................................... Insertion of airway catheter ................................ Injection for bronchus x-ray ................................ Bronchial brush biopsy ....................................... Clearance of airways .......................................... Clearance of airways .......................................... Intro, windpipe wire/tube .................................... Repair of windpipe ............................................. Repair of windpipe ............................................. Repair of windpipe ............................................. Reconstruction of windpipe ................................ Repair/graft of bronchus ..................................... Reconstruct bronchus ........................................ Reconstruct windpipe ......................................... Reconstruct windpipe ......................................... Remove windpipe lesion .................................... Remove windpipe lesion .................................... Repair of windpipe injury .................................... Repair of windpipe injury .................................... Closure of windpipe lesion ................................. Repair of windpipe defect .................................. Revise windpipe scar ......................................... Airways surgical procedure ................................ Drainage of chest ............................................... Treatment of collapsed lung ............................... Treat lung lining chemically ................................ Insert pleural catheter ........................................ Insertion of chest tube ........................................ Exploration of chest ............................................ Exploration of chest ............................................ Biopsy through chest wall .................................. Exploration/biopsy of chest ................................ Explore/repair chest ........................................... Re-exploration of chest ...................................... Explore chest free adhesions ............................. Removal of lung lesion(s) .................................. Remove/treat lung lesions .................................. Removal of lung lesion(s) .................................. Remove lung foreign body ................................. Open chest heart massage ................................ Drain, open, lung lesion ..................................... Drain, percut, lung lesion ................................... Treat chest lining ................................................ Release of lung .................................................. Partial release of lung ........................................ Removal of chest lining ...................................... Free/remove chest lining .................................... Needle biopsy chest lining ................................. Open biopsy chest lining .................................... Biopsy, lung or mediastinum .............................. Puncture/clear lung ............................................ Removal of lung ................................................. Malpractice RVUs 0.16 0.11 0.18 0.13 0.13 0.18 0.18 0.16 0.32 0.34 0.18 0.16 0.24 0.31 0.13 0.22 0.46 0.35 0.20 0.16 0.14 0.15 0.08 0.07 0.12 0.07 0.14 0.07 0.14 0.21 1.05 1.29 2.94 4.52 2.83 3.01 1.65 2.24 1.59 3.29 0.79 1.82 0.38 0.53 0.44 0.00 0.08 0.12 0.23 0.42 0.43 1.26 1.43 1.22 2.23 3.21 1.63 1.89 1.96 2.00 2.00 2.03 1.31 2.13 0.24 1.68 3.56 2.06 1.99 3.51 0.10 1.07 0.11 0.12 3.68 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00253 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 4.85 7.17 8.63 9.45 8.80 9.37 11.02 18.54 NA NA 2.02 2.40 10.04 NA NA NA NA NA NA 8.47 7.73 9.63 3.58 3.52 NA NA 10.53 1.46 2.75 5.26 NA NA NA NA NA NA NA NA NA NA NA NA 10.54 15.01 10.71 0.00 4.68 5.53 8.89 24.61 NA NA NA NA NA NA NA NA NA NA NA NA NA NA 24.99 NA NA NA NA NA 3.99 NA 2.71 NA NA Facility Total 3.45 2.06 4.02 4.06 4.06 4.75 5.28 5.65 5.85 6.47 1.52 1.88 5.34 6.38 2.27 7.08 7.47 7.26 4.92 4.44 3.86 3.15 2.10 1.94 1.83 1.52 3.05 1.46 2.68 4.06 31.65 41.79 36.00 48.59 35.58 38.33 30.42 37.89 29.00 40.36 17.48 22.16 8.52 12.72 8.92 0.00 2.10 3.37 3.12 6.24 5.75 15.79 17.55 14.95 25.29 36.94 20.24 21.82 23.57 23.55 23.75 24.24 15.88 26.03 5.53 19.91 40.51 23.67 22.82 39.66 2.41 13.74 2.67 2.98 41.57 Global 000 ZZZ 000 000 000 000 000 000 000 000 ZZZ ZZZ 000 000 ZZZ 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY 000 000 000 000 000 090 090 090 090 090 090 090 090 090 090 090 090 090 000 090 090 090 090 090 000 090 000 000 090 70368 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 32442 32445 32480 32482 32484 32486 32488 32491 32500 32501 32503 32504 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 33141 33200 33201 33206 33207 33208 33210 33211 33212 33213 33214 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A R A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A X A A A A C C A A A A A A C A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 26.20 25.05 23.71 24.96 20.66 23.88 25.67 21.22 21.97 4.68 30.00 34.80 14.62 5.45 5.95 7.80 8.77 6.92 8.39 10.73 12.89 18.63 12.85 12.42 13.08 12.89 13.63 11.61 11.57 17.40 13.23 16.42 18.44 14.18 15.52 13.67 13.03 23.12 21.45 0.00 38.57 41.74 47.74 50.90 0.00 0.00 20.24 20.72 26.73 19.40 1.84 5.99 0.00 2.24 2.24 6.79 12.59 12.07 18.68 21.76 14.34 24.52 21.36 19.97 4.83 12.46 10.16 6.66 8.03 8.12 3.30 3.39 5.51 6.36 7.74 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA 0.00 0.00 NA NA NA NA 1.74 NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 14.80 14.10 12.09 12.95 11.41 13.28 13.82 12.66 12.39 1.54 15.11 16.72 9.66 2.36 2.53 3.04 3.46 2.91 3.34 6.78 7.25 10.17 6.99 7.55 7.26 7.96 7.70 7.37 7.47 9.51 7.81 8.85 10.79 7.65 8.15 7.43 7.54 11.00 12.20 0.00 27.74 33.26 31.84 34.83 0.00 0.00 9.91 10.16 12.09 9.50 0.56 1.92 0.00 0.78 0.81 4.96 6.80 6.37 9.55 10.06 7.86 11.61 10.14 10.91 1.58 6.86 6.60 4.47 4.67 4.78 1.25 1.31 3.37 3.73 4.90 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 ..................................... Resect apical lung tumor ................................... Resect apical lung tum/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) .................................... 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 .......................... Malpractice RVUs 3.84 3.71 3.49 3.66 3.03 3.51 3.80 2.98 3.25 0.65 4.37 5.07 2.07 0.80 0.87 1.14 1.25 1.00 1.22 1.58 1.86 2.72 1.88 1.63 1.89 1.89 1.99 1.69 1.62 2.08 1.92 2.17 2.72 2.32 2.15 1.98 1.93 3.27 2.52 0.00 5.56 6.00 7.05 7.20 0.00 0.00 2.93 3.15 3.97 2.88 0.16 0.55 0.00 0.14 0.15 0.65 1.79 1.80 2.83 3.13 2.14 3.69 3.00 2.85 0.69 1.70 1.36 0.52 0.59 0.56 0.18 0.21 0.43 0.45 0.58 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00254 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA 0.00 0.00 NA NA NA NA 3.74 NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 44.84 42.86 39.29 41.57 35.10 40.67 43.29 36.86 37.61 6.87 49.48 56.59 26.35 8.61 9.35 11.98 13.48 10.83 12.95 19.09 22.00 31.52 21.72 21.60 22.23 22.74 23.32 20.67 20.66 28.99 22.96 27.44 31.95 24.15 25.82 23.08 22.50 37.39 36.17 0.00 71.87 81.00 86.63 92.93 0.00 0.00 33.08 34.03 42.79 31.78 2.56 8.46 0.00 3.16 3.20 12.40 21.18 20.24 31.06 34.95 24.34 39.82 34.50 33.73 7.10 21.02 18.12 11.65 13.29 13.46 4.73 4.91 9.31 10.54 13.22 Global 090 090 090 090 090 090 090 090 090 ZZZ 090 090 090 000 000 000 000 000 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 XXX 090 090 090 090 XXX XXX 090 090 090 090 000 000 YYY 000 000 090 090 090 090 090 090 090 090 090 ZZZ 090 090 090 090 090 000 000 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70369 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 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 33425 33426 33427 33430 33460 33463 33464 33465 33468 33470 33471 33472 33474 33475 33476 33478 33496 33500 33501 33502 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 4.75 5.77 5.74 5.43 5.51 4.95 6.45 9.04 8.33 8.68 3.29 7.81 9.39 12.58 13.69 15.20 7.59 3.24 22.61 13.74 14.28 20.68 14.21 21.82 24.84 31.01 24.84 4.16 2.50 17.89 21.41 18.48 22.34 16.76 20.17 20.59 21.40 23.92 29.96 28.46 23.87 24.85 28.50 34.95 37.44 32.41 36.20 41.94 43.43 30.30 27.11 30.30 28.49 22.67 25.90 26.96 32.95 39.94 33.45 23.56 25.58 27.29 28.75 30.07 20.78 22.22 22.22 23.01 32.95 25.73 26.70 27.21 25.51 17.75 21.01 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 3.19 4.21 4.24 4.31 4.28 4.30 4.60 4.01 3.26 3.83 3.28 4.92 6.83 7.45 7.80 8.22 4.59 2.97 11.49 8.92 7.92 10.31 8.38 11.05 11.69 13.86 11.80 4.03 3.54 9.26 10.64 9.61 10.91 8.24 9.81 10.39 10.29 10.54 13.37 15.71 13.54 14.34 14.58 18.34 19.18 16.63 18.79 20.46 20.87 14.17 12.05 13.54 13.65 9.59 13.69 13.09 17.18 19.42 17.34 11.33 12.95 13.56 13.00 13.69 10.72 9.78 11.89 10.91 15.41 11.99 13.09 12.78 11.49 8.30 11.10 Reposition pacing-defib lead .............................. Insert lead pace-defib, one ................................ Insert lead pace-defib, dual ................................ Repair lead pace-defib, one ............................... Repair lead pace-defib, dual .............................. Revise pocket, pacemaker ................................. Revise pocket, pacing-defib ............................... Insert pacing lead & connect ............................. L ventric pacing lead add-on .............................. Reposition l ventric lead ..................................... Removal of pacemaker system .......................... Removal of pacemaker system .......................... Removal pacemaker electrode .......................... Remove electrode/thoracotomy ......................... Remove electrode/thoracotomy ......................... Remove electrode/thoracotomy ......................... Insert pulse generator ........................................ Remove pulse generator .................................... Remove eltrd/thoracotomy ................................. Remove eltrd, transven ...................................... Insert epic eltrd pace-defib ................................. Insert epic eltrd/generator .................................. Eltrd/insert pace-defib ........................................ Ablate heart dysrhythm focus ............................ Ablate heart dysrhythm focus ............................ Reconstruct atria ................................................ Ablate heart dysrhythm focus ............................ Implant pat-active ht record ............................... Remove pat-active ht record .............................. Repair of heart wound ........................................ Repair of heart wound ........................................ Exploratory heart surgery ................................... Exploratory heart surgery ................................... Repair major blood vessel(s) ............................. Repair major vessel ........................................... Repair major blood vessel(s) ............................. Insert major vessel graft ..................................... Insert major vessel graft ..................................... Insert major vessel graft ..................................... Repair of aortic valve ......................................... Valvuloplasty, open ............................................ Valvuloplasty, w/cp bypass ................................ Prepare heart-aorta conduit ............................... Replacement of aortic valve ............................... Replacement of aortic valve ............................... Replacement of aortic valve ............................... Replacement of aortic valve ............................... Replacement of aortic valve ............................... Replacement of aortic valve ............................... Repair of aortic valve ......................................... Revision, subvalvular tissue ............................... Revise ventricle muscle ..................................... Repair of aortic valve ......................................... Revision of mitral valve ...................................... Revision of mitral valve ...................................... Repair of mitral valve ......................................... Repair of mitral valve ......................................... Repair of mitral valve ......................................... Replacement of mitral valve ............................... Revision of tricuspid valve ................................. Valvuloplasty, tricuspid ....................................... Valvuloplasty, tricuspid ....................................... Replace tricuspid valve ...................................... Revision of tricuspid valve ................................. Revision of pulmonary valve .............................. Valvotomy, pulmonary valve .............................. Revision of pulmonary valve .............................. Revision of pulmonary valve .............................. Replacement, pulmonary valve .......................... Revision of heart chamber ................................. Revision of heart chamber ................................. Repair, prosth valve clot .................................... Repair heart vessel fistula .................................. Repair heart vessel fistula .................................. Coronary artery correction ................................. Malpractice RVUs 0.37 0.36 0.39 0.37 0.37 0.42 0.45 0.54 0.45 0.59 0.22 0.56 0.73 1.68 1.59 2.02 0.41 0.18 2.09 0.99 2.01 2.63 0.77 3.18 3.59 4.52 3.45 0.23 0.14 2.65 3.12 2.58 3.27 2.07 2.90 2.85 2.81 3.02 4.27 4.10 3.56 3.54 4.32 5.31 5.43 4.68 5.46 6.37 6.51 4.56 4.13 4.56 4.09 1.81 3.93 4.06 5.01 6.07 5.08 3.44 3.86 4.14 4.38 4.06 1.03 3.38 3.54 3.21 4.92 2.41 3.88 4.12 3.86 1.90 2.99 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00255 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 8.31 10.34 10.37 10.11 10.16 9.67 11.50 13.59 12.04 13.10 6.79 13.29 16.95 21.71 23.08 25.44 12.59 6.39 36.19 23.65 24.21 33.62 23.36 36.05 40.12 49.39 40.09 8.42 6.18 29.80 35.17 30.67 36.52 27.07 32.88 33.83 34.50 37.48 47.60 48.27 40.97 42.73 47.40 58.60 62.05 53.72 60.45 68.77 70.81 49.03 43.29 48.40 46.23 34.07 43.52 44.11 55.14 65.43 55.87 38.33 42.39 44.99 46.13 47.82 32.53 35.38 37.65 37.13 53.28 40.13 43.67 44.11 40.86 27.95 35.10 Global 090 090 090 090 090 090 090 000 ZZZ 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 70370 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 33503 33504 33505 33506 33507 33508 33510 33511 33512 33513 33514 33516 33517 33518 33519 33521 33522 33523 33530 33533 33534 33535 33536 33542 33545 33548 33572 33600 33602 33606 33608 33610 33611 33612 33615 33617 33619 33641 33645 33647 33660 33665 33670 33681 33684 33688 33690 33692 33694 33697 33702 33710 33720 33722 33730 33732 33735 33736 33737 33750 33755 33762 33764 33766 33767 33768 33770 33771 33774 33775 33776 33777 33778 33779 33780 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 21.75 24.62 26.80 35.45 30.00 0.31 28.96 29.96 31.75 31.95 32.70 34.95 2.57 4.84 7.11 9.39 11.65 13.93 5.85 29.96 32.15 34.45 37.44 28.81 36.72 37.97 4.44 29.47 28.50 30.69 31.04 30.56 33.95 34.95 33.95 36.94 44.93 21.36 24.78 28.69 29.96 28.56 34.95 30.56 29.61 30.57 19.52 30.70 33.95 35.95 26.50 29.67 26.52 28.37 34.20 28.12 21.36 23.48 21.73 21.38 21.76 21.76 21.76 22.73 24.46 8.00 36.94 34.60 30.93 32.15 33.99 33.41 39.94 36.16 41.69 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 9.76 11.84 12.94 14.60 13.68 0.10 16.38 17.12 17.65 17.83 18.10 18.85 0.84 1.58 2.33 3.08 3.82 4.54 1.92 16.51 17.76 18.18 18.34 13.03 15.67 19.35 1.45 12.55 12.48 13.71 14.14 13.64 14.17 15.19 13.18 16.04 20.86 9.60 11.80 13.81 13.52 13.87 13.21 14.72 13.66 10.50 10.19 13.96 14.26 14.91 12.60 14.00 12.32 13.89 14.16 13.42 8.98 11.88 10.96 10.24 8.83 10.18 10.25 11.70 11.75 2.67 14.72 12.42 14.70 15.03 15.85 15.66 16.94 15.41 19.14 Coronary artery graft .......................................... Coronary artery graft .......................................... Repair artery w/tunnel ........................................ Repair artery, translocation ................................ Repair art, intramural ......................................... 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 ..................................... Restore/remodel, ventricle ................................. Open coronary endarterectomy ......................... Closure of valve ................................................. Closure of valve ................................................. Anastomosis/artery-aorta ................................... Repair anomaly w/conduit .................................. Repair by enlargement ....................................... Repair double ventricle ...................................... Repair double ventricle ...................................... Repair, modified fontan ...................................... Repair single ventricle ........................................ Repair single ventricle ........................................ Repair heart septum defect ................................ Revision of heart veins ....................................... Repair heart septum defects .............................. Repair of heart defects ....................................... Repair of heart defects ....................................... Repair of heart chambers .................................. Repair heart septum defect ................................ Repair heart septum defect ................................ Repair heart septum defect ................................ Reinforce pulmonary artery ................................ Repair of heart defects ....................................... Repair of heart defects ....................................... Repair of heart defects ....................................... Repair of heart defects ....................................... Repair of heart defects ....................................... 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 ............................................. Cavopulmonary shunting .................................... 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 ............................... Malpractice RVUs 1.77 3.35 2.18 4.65 4.05 0.04 4.40 4.55 4.66 4.87 4.76 5.11 0.39 0.73 1.04 1.37 1.77 2.12 0.88 4.55 4.69 5.01 5.42 4.37 5.19 5.51 0.65 4.41 3.81 4.40 4.73 4.55 4.36 5.28 4.31 5.64 6.44 3.22 3.78 3.31 4.48 3.99 4.64 4.44 3.38 4.72 1.96 4.57 5.26 4.08 3.67 4.42 3.83 1.30 5.01 3.67 1.91 3.08 3.24 1.16 3.25 3.13 3.00 3.69 3.81 1.19 5.72 5.66 4.80 4.98 5.07 5.47 6.18 2.91 3.67 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00256 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 33.28 39.81 41.92 54.70 47.73 0.45 49.74 51.63 54.06 54.65 55.56 58.91 3.80 7.15 10.48 13.84 17.24 20.59 8.65 51.02 54.60 57.64 61.20 46.21 57.58 62.83 6.54 46.43 44.79 48.80 49.91 48.75 52.48 55.42 51.44 58.62 72.23 34.18 40.36 45.81 47.96 46.42 52.80 49.72 46.65 45.79 31.67 49.23 53.47 54.94 42.77 48.09 42.67 43.56 53.37 45.21 32.25 38.44 35.93 32.78 33.84 35.07 35.01 38.12 40.02 11.86 57.38 52.68 50.43 52.16 54.91 54.54 63.06 54.48 64.50 Global 090 090 090 090 090 ZZZ 090 090 090 090 090 090 ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ 090 090 090 090 090 090 090 ZZZ 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 ZZZ 090 090 090 090 090 090 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70371 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 33781 33786 33788 33800 33802 33803 33813 33814 33820 33822 33824 33840 33845 33851 33852 33853 33860 33861 33863 33870 33875 33877 33880 33881 33883 33884 33886 33889 33891 33910 33915 33916 33917 33920 33922 33924 33925 33926 33930 33933 33935 33940 33944 33945 33960 33961 33967 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 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A 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 C R X C R A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 36.40 38.94 26.58 16.22 17.63 19.57 20.62 25.73 16.27 17.29 19.49 20.60 22.09 21.24 23.67 31.67 37.94 41.94 44.93 43.93 33.01 42.54 33.00 28.00 20.00 8.20 17.00 15.92 20.00 24.55 20.99 25.79 24.46 31.90 23.48 5.49 29.50 42.00 0.00 0.00 60.87 0.00 0.00 42.04 19.33 10.91 4.84 0.64 6.74 9.68 9.75 14.39 20.97 22.97 19.26 21.70 45.93 56.17 0.00 12.89 15.19 9.99 9.99 24.96 10.01 16.48 24.96 11.98 26.96 10.16 9.85 15.98 26.91 18.92 17.92 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 0.00 NA 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 13.37 16.76 11.98 8.13 9.25 9.79 10.94 12.68 8.38 8.98 10.01 10.32 11.38 10.71 11.39 14.86 16.50 17.76 18.74 18.43 14.13 16.36 13.51 11.99 9.21 2.58 8.25 5.19 6.98 11.46 9.66 11.37 12.22 13.86 10.93 1.85 14.70 17.73 0.00 0.00 28.85 0.00 0.00 21.45 4.92 3.62 1.85 0.23 2.29 6.02 3.32 7.90 6.30 7.57 11.10 11.78 14.96 25.31 0.00 6.73 7.80 5.37 5.37 10.43 5.43 8.08 10.69 6.31 11.47 5.32 5.44 8.51 12.33 9.44 8.47 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 ..................................... Endovasc taa repr incl subcl .............................. Endovasc taa repr w/o subcl .............................. Insert endovasc prosth, taa ................................ Endovasc prosth, taa, add-on ............................ Endovasc prosth, delayed .................................. Artery transpose/endovas taa ............................ Car-car bp grft/endovas taa ............................... Remove lung artery emboli ................................ Remove lung artery emboli ................................ Surgery of great vessel ...................................... Repair pulmonary artery ..................................... Repair pulmonary atresia ................................... Transect pulmonary artery ................................. Remove pulmonary shunt .................................. Rpr pul art unifocal w/o cpb ............................... Repr pul art, unifocal w/cpb ............................... 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 ........................................ 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 .......................................... Malpractice RVUs 5.95 5.69 4.02 2.45 2.26 3.19 3.12 3.84 2.34 2.67 2.88 2.15 3.21 3.17 2.15 4.47 5.74 6.35 6.57 6.60 4.88 5.92 2.74 2.32 2.10 0.86 1.79 2.17 2.72 3.69 1.44 3.66 3.69 4.37 3.09 0.82 4.60 6.20 0.00 0.00 9.03 0.00 0.00 6.24 2.66 0.88 0.35 0.07 0.82 1.25 1.26 1.73 3.06 3.25 2.80 3.30 6.95 8.56 0.00 1.84 2.20 1.41 1.40 3.55 1.45 2.35 3.09 1.55 3.83 1.18 1.41 2.34 3.62 2.32 2.28 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00257 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 0.00 NA 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 55.72 61.39 42.58 26.80 29.14 32.55 34.68 42.25 26.99 28.94 32.38 33.07 36.68 35.12 37.21 51.00 60.18 66.05 70.24 68.96 52.02 64.82 49.25 42.31 31.31 11.64 27.04 23.28 29.70 39.70 32.09 40.82 40.37 50.13 37.50 8.16 48.80 65.93 0.00 0.00 98.75 0.00 0.00 69.73 26.91 15.41 7.04 0.94 9.85 16.95 14.33 24.02 30.33 33.79 33.16 36.78 67.84 90.04 0.00 21.46 25.19 16.77 16.76 38.94 16.89 26.91 38.74 19.84 42.26 16.66 16.70 26.83 42.86 30.68 28.67 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 ZZZ 090 000 000 090 090 090 090 090 090 ZZZ 090 090 XXX XXX 090 XXX XXX 090 000 ZZZ 000 000 000 090 000 090 XXX XXX 090 090 XXX 090 YYY 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 70372 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 34530 34800 34802 34803 34804 34805 34808 34812 34813 34820 34825 34826 34830 34831 34832 34833 34834 34900 35001 35002 35005 35011 35013 35021 35022 35045 35081 35082 35091 35092 35102 35103 35111 35112 35121 35122 35131 35132 35141 35142 35151 35152 35180 35182 35184 35188 35189 35190 35201 35206 35207 35211 35216 35221 35226 35231 35236 35241 35246 35251 35256 35261 35266 35271 35276 35281 35286 35301 35311 35321 35331 35341 35351 35355 35361 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 16.62 20.72 22.97 24.00 22.97 21.85 4.12 6.74 4.79 9.74 11.98 4.12 32.54 35.29 35.29 11.98 5.34 16.36 19.61 20.97 18.09 17.97 21.97 19.62 23.15 17.54 27.97 38.44 35.35 44.93 30.71 40.44 24.96 29.96 29.96 34.95 24.96 29.96 19.97 23.27 22.61 25.58 13.60 29.96 17.97 14.26 27.96 12.73 16.12 13.23 10.13 22.09 18.72 24.35 14.48 19.97 17.08 23.09 26.41 30.15 18.33 17.77 14.89 22.09 24.21 27.96 16.14 18.67 26.96 15.98 26.16 25.07 22.97 18.47 28.16 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 8.63 9.19 9.81 10.24 9.83 9.67 1.37 2.24 1.57 3.24 6.16 1.37 13.73 11.76 14.66 4.44 2.20 7.60 9.58 9.72 8.87 8.00 9.70 9.44 9.88 7.52 11.49 15.33 13.60 17.68 12.39 15.89 10.49 11.99 12.40 13.84 10.77 12.41 8.94 10.39 10.01 11.40 6.96 12.83 8.31 7.65 11.98 6.49 8.01 6.57 7.37 10.64 9.00 9.96 7.45 9.79 7.90 11.15 11.45 11.82 8.37 8.03 7.02 10.54 11.23 11.73 8.07 8.45 11.77 7.40 11.26 10.89 9.62 8.10 11.73 Leg vein fusion ................................................... Endovas aaa repr w/sm tube ............................. Endovas aaa repr w/2-p part ............................. Endovas aaa repr w/3-p part ............................. Endovas aaa repr w/1-p part ............................. Endovas aaa repr w/long tube ........................... Endovas iliac a device addon ............................ Xpose for endoprosth, femorl ............................. Femoral endovas graft add-on ........................... Xpose for endoprosth, iliac ................................ Endovasc extend prosth, init .............................. Endovasc exten prosth, add’l ............................. Open aortic tube prosth repr .............................. Open aortoiliac prosth repr ................................ Open aortofemor prosth repr ............................. Xpose for endoprosth, iliac ................................ Xpose, endoprosth, brachial .............................. Endovasc iliac repr w/graft ................................. Repair defect of artery ....................................... Repair artery rupture, neck ................................ Repair defect of artery ....................................... Repair defect of artery ....................................... Repair artery rupture, arm .................................. Repair defect of artery ....................................... Repair artery rupture, chest ............................... Repair defect of arm artery ................................ Repair defect of artery ....................................... Repair artery rupture, aorta ................................ Repair defect of artery ....................................... Repair artery rupture, aorta ................................ Repair defect of artery ....................................... Repair artery rupture, groin ................................ Repair defect of artery ....................................... Repair artery rupture,spleen .............................. Repair defect of artery ....................................... Repair artery rupture, belly ................................ Repair defect of artery ....................................... Repair artery rupture, groin ................................ Repair defect of artery ....................................... Repair artery rupture, thigh ................................ Repair defect of artery ....................................... Repair artery rupture, knee ................................ Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. Repair blood vessel lesion ................................. 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 ....................................... Malpractice RVUs 1.73 2.45 2.32 2.00 2.29 2.00 0.59 1.18 0.67 1.50 1.28 0.44 4.54 4.88 4.84 1.69 0.76 1.99 2.80 2.99 1.76 2.54 3.09 2.86 3.16 2.44 4.00 5.42 5.12 6.38 4.47 5.74 3.46 4.07 4.29 4.74 3.79 4.29 2.89 3.35 3.23 3.60 1.00 4.35 2.52 2.15 4.00 1.79 2.33 1.86 1.48 3.19 2.64 3.36 2.01 2.88 2.42 3.52 3.85 4.12 2.62 2.60 2.09 3.15 3.48 3.96 2.34 2.67 3.41 2.24 3.82 3.77 3.34 2.66 4.14 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00258 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 26.98 32.36 35.10 36.24 35.09 33.52 6.08 10.16 7.03 14.48 19.42 5.93 50.81 51.93 54.79 18.11 8.30 25.95 31.99 33.68 28.72 28.51 34.76 31.92 36.19 27.50 43.46 59.19 54.07 68.99 47.57 62.07 38.91 46.02 46.65 53.53 39.52 46.66 31.80 37.01 35.85 40.58 21.56 47.14 28.80 24.06 43.94 21.01 26.46 21.66 18.98 35.92 30.36 37.67 23.94 32.64 27.40 37.76 41.71 46.09 29.32 28.40 24.00 35.78 38.92 43.65 26.55 29.79 42.14 25.62 41.24 39.73 35.93 29.23 44.03 Global 090 090 090 090 090 090 ZZZ 000 ZZZ 000 090 ZZZ 090 090 090 000 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70373 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 35363 35371 35372 35381 35390 35400 35450 35452 35454 35456 35458 35459 35460 35470 35471 35472 35473 35474 35475 35476 35480 35481 35482 35483 35484 35485 35490 35491 35492 35493 35494 35495 35500 35501 35506 35507 35508 35509 35510 35511 35512 35515 35516 35518 35521 35522 35525 35526 35531 35533 35536 35541 35546 35548 35549 35551 35556 35558 35560 35563 35565 35566 35571 35572 35583 35585 35587 35600 35601 35606 35612 35616 35621 35623 35626 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A R A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 30.15 14.70 17.97 15.79 3.19 3.00 10.05 6.90 6.03 7.34 9.48 8.62 6.03 8.62 10.05 6.90 6.03 7.35 9.48 6.03 11.06 7.60 6.64 8.09 10.42 9.48 11.06 7.60 6.64 8.09 10.42 9.48 6.44 19.16 19.64 19.64 18.62 18.04 22.97 21.17 22.47 18.62 16.30 21.17 22.17 21.73 20.60 29.91 36.15 27.96 31.65 25.76 25.50 21.54 23.31 26.63 21.73 21.17 31.95 24.16 23.17 26.88 24.02 6.81 22.34 28.35 24.71 4.94 17.47 18.68 15.74 15.68 19.97 23.96 27.71 NA NA NA NA NA NA NA NA NA NA NA NA NA 89.12 100.55 64.54 60.01 87.98 56.26 44.86 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 12.62 6.97 8.06 7.83 1.06 1.11 3.57 2.61 2.32 2.77 3.48 3.18 2.28 3.36 3.96 2.75 2.43 2.90 3.57 2.36 4.05 2.88 2.57 3.03 3.78 3.54 4.71 3.30 3.20 3.81 4.47 4.40 2.03 8.48 9.49 9.45 9.47 8.79 10.20 9.38 10.03 9.31 6.82 9.00 9.86 9.78 9.40 12.54 14.51 11.75 12.98 11.23 10.89 9.45 10.40 11.52 9.75 9.57 13.35 10.55 10.16 11.41 10.87 2.25 10.18 12.25 11.48 1.62 8.64 9.04 7.90 8.12 8.70 10.52 12.00 Rechanneling of artery ....................................... Rechanneling of artery ....................................... Rechanneling of artery ....................................... Rechanneling of artery ....................................... Reoperation, carotid add-on ............................... Angioscopy ......................................................... Repair arterial blockage ..................................... Repair arterial blockage ..................................... Repair arterial blockage ..................................... Repair arterial blockage ..................................... Repair arterial blockage ..................................... Repair arterial blockage ..................................... Repair venous blockage ..................................... Repair arterial blockage ..................................... Repair arterial blockage ..................................... Repair arterial blockage ..................................... Repair arterial blockage ..................................... Repair arterial blockage ..................................... Repair arterial blockage ..................................... Repair venous blockage ..................................... Atherectomy, open ............................................. Atherectomy, open ............................................. Atherectomy, open ............................................. Atherectomy, open ............................................. Atherectomy, open ............................................. Atherectomy, open ............................................. Atherectomy, percutaneous ............................... Atherectomy, percutaneous ............................... Atherectomy, percutaneous ............................... Atherectomy, percutaneous ............................... Atherectomy, percutaneous ............................... Atherectomy, percutaneous ............................... Harvest vein for bypass ..................................... Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. 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 ............................................. Malpractice RVUs 4.32 2.13 2.62 2.25 0.46 0.43 1.25 0.94 0.87 1.04 1.26 1.21 0.83 0.69 0.67 0.58 0.51 0.57 0.62 0.34 1.28 1.13 0.89 1.15 1.27 1.35 0.71 0.74 0.43 0.56 0.59 0.69 0.93 2.80 2.86 2.84 2.77 2.61 2.11 2.90 2.11 2.77 2.33 3.02 3.12 2.11 2.11 3.62 5.16 3.84 4.61 3.70 3.69 2.97 3.29 3.74 3.09 2.99 4.74 3.51 3.29 3.82 3.42 0.99 3.16 4.01 3.51 0.73 2.49 2.69 2.08 2.19 2.91 3.45 4.07 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00259 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA 98.43 111.27 72.02 66.55 95.90 66.36 51.23 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 47.09 23.80 28.65 25.87 4.71 4.54 14.87 10.45 9.22 11.15 14.22 13.01 9.14 12.67 14.68 10.23 8.97 10.82 13.67 8.73 16.39 11.61 10.10 12.27 15.47 14.37 16.48 11.64 10.27 12.46 15.48 14.57 9.40 30.44 31.99 31.93 30.86 29.44 35.28 33.45 34.61 30.70 25.45 33.19 35.15 33.62 32.11 46.07 55.82 43.55 49.24 40.69 40.08 33.96 37.00 41.89 34.57 33.73 50.04 38.22 36.62 42.11 38.31 10.05 35.68 44.61 39.70 7.29 28.60 30.41 25.72 25.99 31.58 37.93 43.78 Global 090 090 090 090 ZZZ ZZZ 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 ZZZ 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 ZZZ 090 090 090 ZZZ 090 090 090 090 090 090 090 70374 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 35631 35636 35641 35642 35645 35646 35647 35650 35651 35654 35656 35661 35663 35665 35666 35671 35681 35682 35683 35685 35686 35691 35693 35694 35695 35697 35700 35701 35721 35741 35761 35800 35820 35840 35860 35870 35875 35876 35879 35881 35901 35903 35905 35907 36000 36002 36005 36010 36011 36012 36013 36014 36015 36100 36120 36140 36145 36160 36200 36215 36216 36217 36218 36245 36246 36247 36248 36260 36261 36262 36299 36400 36405 36406 36410 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 33.95 29.46 24.53 17.95 17.44 30.95 27.96 18.97 25.00 24.96 19.50 18.97 21.97 20.97 22.16 19.30 1.60 7.19 8.49 4.04 3.34 18.02 15.34 19.13 19.13 3.00 3.08 8.49 7.17 7.99 5.36 7.01 12.86 9.76 5.54 22.14 10.11 16.97 15.98 17.97 8.18 9.38 31.20 34.95 0.18 1.96 0.95 2.43 3.14 3.51 2.52 3.02 3.51 3.02 2.01 2.01 2.01 2.52 3.02 4.67 5.27 6.29 1.01 4.67 5.27 6.29 1.01 9.70 5.44 4.01 0.00 0.38 0.31 0.18 0.18 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.57 2.87 7.67 19.36 27.90 19.00 21.42 20.18 23.73 12.11 10.73 12.81 12.59 13.52 16.56 27.11 29.16 55.60 5.10 32.18 30.05 49.65 4.05 NA NA NA 0.00 0.28 0.26 0.28 0.29 13.87 12.33 11.09 8.71 8.29 13.14 11.80 8.38 10.75 10.68 8.62 8.95 10.00 9.47 10.67 9.39 0.53 2.39 2.83 1.35 1.13 8.42 7.74 8.62 8.57 1.02 1.02 5.16 4.44 4.67 4.02 4.66 7.22 5.30 4.04 9.79 5.20 7.53 7.71 8.69 5.32 6.17 13.22 14.20 0.05 0.97 0.31 0.79 1.06 1.19 0.69 1.03 1.19 1.11 0.65 0.64 0.66 0.84 1.01 1.61 1.80 2.18 0.34 1.68 1.83 2.15 0.34 4.89 3.67 2.76 0.00 0.09 0.08 0.05 0.05 Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Artery bypass graft ............................................. Composite bypass graft ..................................... Composite bypass graft ..................................... Composite bypass graft ..................................... Bypass graft patency/patch ................................ Bypass graft/av fist patency ............................... Arterial transposition ........................................... Arterial transposition ........................................... Arterial transposition ........................................... Arterial transposition ........................................... Reimplant artery each ........................................ Reoperation, bypass graft .................................. Exploration, carotid artery .................................. Exploration, femoral artery ................................. Exploration popliteal artery ................................. Exploration of artery/vein ................................... Explore neck vessels ......................................... Explore chest vessels ........................................ Explore abdominal vessels ................................ Explore limb vessels .......................................... Repair vessel graft defect .................................. Removal of clot in graft ...................................... Removal of clot in graft ...................................... Revise graft w/vein ............................................. Revise graft w/vein ............................................. Excision, graft, neck ........................................... Excision, graft, extremity .................................... Excision, graft, thorax ......................................... Excision, graft, abdomen .................................... Place needle in vein ........................................... Pseudoaneurysm injection trt ............................. Injection ext venography .................................... Place catheter in vein ......................................... Place catheter in vein ......................................... Place catheter in vein ......................................... Place catheter in artery ...................................... Place catheter in artery ...................................... Place catheter in artery ...................................... Establish access to artery .................................. Establish access to artery .................................. Establish access to artery .................................. Artery to vein shunt ............................................ Establish access to aorta ................................... 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 ............................... Malpractice RVUs 4.95 4.09 3.53 2.27 2.49 4.43 3.98 2.71 3.35 3.52 2.79 2.71 3.10 3.00 3.15 2.77 0.23 1.03 1.20 0.58 0.47 2.58 2.21 2.69 2.73 0.41 0.44 1.12 1.03 1.12 0.75 0.95 1.94 1.34 0.78 3.00 1.41 2.39 2.27 2.55 1.15 1.30 4.43 4.91 0.01 0.17 0.05 0.20 0.27 0.23 0.25 0.19 0.21 0.26 0.14 0.16 0.11 0.26 0.24 0.27 0.31 0.44 0.07 0.31 0.38 0.47 0.07 1.29 0.70 0.54 0.00 0.03 0.03 0.01 0.01 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00260 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.76 5.00 8.67 21.99 31.31 22.74 24.19 23.39 27.45 15.39 12.88 14.98 14.71 16.30 19.82 32.05 34.74 62.33 6.18 37.16 35.70 56.41 5.13 NA NA NA 0.00 0.69 0.60 0.47 0.48 Facility Total 52.77 45.88 39.15 28.93 28.22 48.52 43.74 30.06 39.10 39.16 30.91 30.63 35.07 33.44 35.98 31.46 2.36 10.61 12.52 5.97 4.94 29.02 25.29 30.44 30.43 4.43 4.54 14.77 12.64 13.78 10.13 12.62 22.02 16.40 10.36 34.93 16.72 26.89 25.96 29.21 14.65 16.85 48.85 54.06 0.24 3.10 1.31 3.42 4.47 4.93 3.46 4.24 4.91 4.39 2.80 2.81 2.78 3.62 4.27 6.55 7.38 8.91 1.42 6.66 7.48 8.91 1.42 15.88 9.81 7.31 0.00 0.50 0.42 0.24 0.24 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 ZZZ ZZZ ZZZ ZZZ ZZZ 090 090 090 090 ZZZ ZZZ 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 XXX 000 000 XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ XXX XXX XXX ZZZ 090 090 090 YYY XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70375 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 36415 36416 36420 36425 36430 36440 36450 36455 36460 36468 36469 36470 36471 36475 36476 36478 36479 36481 36500 36510 36511 36512 36513 36514 36515 36516 36522 36540 36550 36555 36556 36557 36558 36560 36561 36563 36565 36566 36568 36569 36570 36571 36575 36576 36578 36580 36581 36582 36583 36584 36585 36589 36590 36595 36596 36597 36598 36600 36620 36625 36640 36660 36680 36800 36810 36815 36818 36819 36820 36821 36822 36823 36825 36830 36831 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... X B A A A A A A A R R A A A A A A A A A A A A A A A A B A A A A A A A A A A A A A A A A A A A A A A A A A A A A T A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.00 1.01 0.76 0.00 1.03 2.23 2.43 6.58 0.00 0.00 1.09 1.57 6.72 3.38 6.72 3.38 6.98 3.51 1.09 1.74 1.74 1.74 1.74 1.74 1.22 1.67 0.00 0.00 2.68 2.50 5.09 4.79 6.24 5.99 6.19 5.99 6.49 1.92 1.82 5.31 5.29 0.67 3.19 3.49 1.31 3.43 5.19 5.24 1.20 4.79 2.27 3.30 3.59 0.75 1.21 0.74 0.32 1.15 2.11 2.10 1.40 1.20 2.43 3.96 2.62 11.52 13.98 13.98 8.92 5.41 20.97 9.83 11.98 7.99 0.00 0.00 0.34 NA 1.01 NA NA NA NA 0.00 0.00 2.69 3.08 51.54 7.90 46.91 8.01 5.75 NA 3.90 NA NA NA 17.02 66.49 84.29 32.46 0.00 0.39 5.77 5.64 21.20 21.10 29.76 29.67 26.82 24.77 25.57 7.55 7.36 33.27 33.34 4.06 6.96 11.16 6.96 19.55 26.09 26.11 6.99 27.90 2.25 3.38 17.30 3.70 2.41 2.65 0.49 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 0.00 0.27 0.22 NA 0.29 0.71 1.01 2.25 0.00 0.00 0.73 0.96 2.54 1.14 2.54 1.14 2.60 1.37 0.61 0.73 0.74 0.73 0.71 0.66 0.48 0.96 0.00 NA 0.80 0.74 2.66 2.56 3.04 2.96 2.99 2.96 3.12 0.58 0.57 2.73 2.72 0.26 1.85 2.31 0.41 1.93 2.87 2.89 0.55 2.74 1.39 1.72 1.45 0.50 0.44 2.65 0.09 0.23 0.53 1.04 0.44 0.49 1.81 1.68 1.17 6.05 6.39 6.40 4.66 4.39 9.40 5.06 5.25 3.95 Routine venipuncture ......................................... Capillary blood draw ........................................... Vein access cutdown < 1 yr ............................... Vein access cutdown > 1 yr ............................... Blood transfusion service ................................... Bl push transfuse, 2 yr or < ............................... Bl exchange/transfuse, nb .................................. Bl exchange/transfuse non-nb ........................... Transfusion service, fetal ................................... Injection(s), spider veins .................................... Injection(s), spider veins .................................... Injection therapy of vein ..................................... Injection therapy of veins ................................... Endovenous rf, 1st vein ..................................... Endovenous rf, vein add-on ............................... Endovenous laser, 1st vein ................................ Endovenous laser vein 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 picc cath ................................................... Insert picc cath ................................................... Insert picvad cath ............................................... Insert picvad cath ............................................... Repair tunneled cv cath ..................................... Repair tunneled cv cath ..................................... Replace tunneled cv cath ................................... Replace cvad cath .............................................. Replace tunneled cv cath ................................... Replace tunneled cv cath ................................... Replace tunneled cv cath ................................... Replace picc cath ............................................... Replace picvad cath ........................................... Removal tunneled cv cath .................................. Removal tunneled cv cath .................................. Mech remov tunneled cv cath ............................ Mech remov tunneled cv cath ............................ Reposition venous catheter ................................ Inj w/fluor, eval cv device ................................... 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 fuse, uppr arm, basilic .................................. Av fusion/forearm vein ....................................... Av fusion direct any site ..................................... Insertion of cannula(s) ........................................ Insertion of cannula(s) ........................................ Artery-vein autograft ........................................... Artery-vein nonautograft ..................................... Open thrombect av fistula .................................. Malpractice RVUs 0.00 0.00 0.07 0.06 0.06 0.10 0.21 0.15 0.79 0.00 0.00 0.12 0.19 0.37 0.18 0.37 0.18 0.55 0.20 0.10 0.08 0.08 0.17 0.08 0.08 0.08 0.13 0.00 0.37 0.11 0.19 0.57 0.57 0.57 0.57 0.84 0.57 0.57 0.11 0.19 0.57 0.57 0.20 0.19 0.19 0.19 0.19 0.19 0.19 0.19 0.19 0.24 0.44 0.21 0.05 0.07 0.05 0.02 0.07 0.26 0.21 0.14 0.11 0.25 0.45 0.35 1.89 1.95 1.94 1.23 0.79 2.88 1.35 1.66 1.09 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00261 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.00 0.00 1.42 NA 1.07 NA NA NA NA 0.00 0.00 3.90 4.84 58.63 11.46 54.00 11.57 13.28 NA 5.09 NA NA NA 18.84 68.31 85.59 34.26 0.00 0.76 8.56 8.33 26.86 26.46 36.57 36.23 33.85 31.33 32.63 9.58 9.37 39.15 39.20 4.93 10.34 14.84 8.46 23.17 31.47 31.54 8.38 32.88 4.76 7.12 21.10 4.50 3.69 3.44 0.83 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 0.00 0.00 1.35 1.04 NA 1.42 3.15 3.59 9.62 0.00 0.00 1.94 2.72 9.63 4.70 9.63 4.70 10.13 5.08 1.80 2.55 2.56 2.64 2.53 2.48 1.78 2.76 0.00 NA 3.59 3.43 8.32 7.92 9.85 9.52 10.02 9.52 10.18 2.61 2.58 8.61 8.58 1.13 5.23 5.99 1.91 5.55 8.25 8.32 1.94 7.72 3.90 5.46 5.25 1.30 1.72 3.44 0.43 1.45 2.90 3.35 1.98 1.80 4.49 6.09 4.14 19.46 22.32 22.32 14.81 10.59 33.25 16.24 18.89 13.03 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX 000 000 010 010 000 ZZZ 000 ZZZ 000 000 000 000 000 000 000 000 000 000 XXX XXX 000 000 010 010 010 010 010 010 010 000 000 010 010 000 010 010 000 010 010 010 000 010 010 010 000 000 000 000 XXX 000 000 000 000 000 000 000 000 090 090 090 090 090 090 090 090 090 70376 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 36832 36833 36834 36835 36838 36860 36861 36870 37140 37145 37160 37180 37181 37182 37183 37184 37185 37186 37187 37188 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 37718 37722 37735 37760 37765 37766 37780 37785 37788 37790 37799 38100 38101 38102 38115 38120 38129 38200 38204 38205 38206 38207 38208 38209 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A R R A A A C A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A C A B R R I I I .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 10.48 11.93 9.92 7.14 20.60 2.01 2.52 5.15 23.56 24.57 21.57 24.57 26.64 16.97 7.99 8.66 3.28 4.92 8.03 5.71 0.00 4.55 4.99 5.67 5.02 18.11 8.27 4.12 8.27 4.12 2.27 18.71 17.98 2.10 1.60 10.98 0.00 10.86 11.23 13.09 6.27 6.15 3.00 5.72 16.47 22.03 4.83 10.54 7.79 20.97 3.72 6.76 7.79 10.51 10.45 7.34 9.29 3.83 3.83 21.98 8.33 0.00 14.48 15.29 4.79 15.80 16.97 0.00 2.64 0.00 1.50 1.50 0.00 0.00 0.00 NA NA NA NA NA 1.78 NA 53.18 NA NA NA NA NA NA NA 71.90 22.95 49.53 70.38 62.15 0.00 NA NA NA 32.97 NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA 4.51 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 5.21 NA NA 0.00 NA NA NA NA NA 0.00 NA 0.00 NA NA 0.00 0.00 0.00 4.73 5.22 4.80 4.33 9.41 0.68 1.49 3.16 10.51 10.89 9.28 10.32 11.03 6.08 3.02 3.36 1.11 1.66 3.15 2.37 0.00 1.50 2.55 3.04 2.04 5.92 3.76 1.43 3.17 1.38 0.74 9.12 8.84 0.75 0.55 6.87 0.00 5.64 6.65 6.92 4.57 3.57 1.97 4.12 8.10 9.20 3.62 5.73 4.69 9.08 2.80 4.07 4.42 5.52 5.36 4.63 5.34 2.86 2.73 9.11 4.38 0.00 6.19 6.54 1.64 6.66 7.40 0.00 0.89 0.00 0.67 0.67 0.00 0.00 0.00 Av fistula revision, open ..................................... Av fistula revision ............................................... Repair A-V aneurysm ......................................... Artery to vein shunt ............................................ Dist revas ligation, hemo .................................... External cannula declotting ................................ Cannula declotting .............................................. Percut thrombect av fistula ................................ Revision of circulation ........................................ Revision of circulation ........................................ Revision of circulation ........................................ Revision of circulation ........................................ Splice spleen/kidney veins ................................. Insert hepatic shunt (tips) ................................... Remove hepatic shunt (tips) .............................. Prim art mech thrombectomy ............................. Prim art m-thrombect add-on ............................. Sec art m-thrombect add-on .............................. Venous mech thrombectomy ............................. Venous m-thrombectomy add-on ....................... Thrombolytic therapy, stroke .............................. Transcatheter biopsy .......................................... Transcatheter therapy infuse ............................. Transcatheter therapy infuse ............................. Transcatheter retrieval ....................................... Transcatheter occlusion ..................................... Transcath iv stent, percut ................................... Transcath iv stent/perc addl ............................... Transcath iv stent, open ..................................... Transcath iv stent/open addl .............................. Change iv cath at thromb tx ............................... 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 ................................................... Ligate/strip short leg vein ................................... Ligate/strip long leg vein .................................... Removal of leg veins/lesion ............................... Ligation, leg veins, open .................................... Phleb veins - extrem - to 20 .............................. Phleb veins - extrem 20+ ................................... Revision of leg vein ............................................ Ligate/divide/excise vein .................................... Revascularization, penis .................................... Penile venous occlusion ..................................... Vascular surgery procedure ............................... Removal of spleen, total .................................... Removal of spleen, partial ................................. Removal of spleen, total .................................... Repair of ruptured spleen .................................. Laparoscopy, splenectomy ................................. Laparoscope proc, spleen .................................. Injection for spleen x-ray .................................... Bl donor search management ............................ Harvest allogenic stem cells .............................. Harvest auto stem cells ...................................... Cryopreserve stem cells ..................................... Thaw preserved stem cells ................................ Wash harvest stem cells .................................... Malpractice RVUs 1.44 1.65 1.37 0.98 3.01 0.11 0.27 0.29 2.01 3.25 2.81 3.34 3.40 1.00 0.47 0.55 0.21 0.32 0.51 0.37 0.00 0.27 0.33 0.43 0.29 1.48 0.60 0.31 1.17 0.59 0.15 1.09 1.04 0.21 0.19 1.54 0.00 1.33 1.41 1.98 1.23 0.85 0.36 0.68 2.32 2.97 0.67 0.91 1.01 2.48 0.53 0.14 0.86 1.48 1.44 0.48 0.48 0.53 0.54 2.25 0.59 0.00 1.91 2.04 0.63 2.08 2.24 0.00 0.14 0.00 0.07 0.07 0.00 0.00 0.00 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00262 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA 3.90 NA 58.62 NA NA NA NA NA NA NA 81.11 26.44 54.77 78.92 68.23 0.00 NA NA NA 38.28 NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA 7.87 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 9.58 NA NA 0.00 NA NA NA NA NA 0.00 NA 0.00 NA NA 0.00 0.00 0.00 Facility Total 16.65 18.80 16.09 12.45 33.02 2.80 4.28 8.60 36.08 38.71 33.66 38.23 41.07 24.05 11.48 12.57 4.60 6.90 11.69 8.45 0.00 6.32 7.87 9.14 7.35 25.51 12.63 5.86 12.61 6.09 3.16 28.92 27.86 3.06 2.34 19.39 0.00 17.83 19.29 21.99 12.07 10.57 5.33 10.52 26.89 34.20 9.12 17.18 13.49 32.53 7.05 10.97 13.07 17.51 17.25 12.45 15.11 7.22 7.10 33.34 13.30 0.00 22.58 23.87 7.06 24.54 26.61 0.00 3.67 0.00 2.24 2.24 0.00 0.00 0.00 Global 090 090 090 090 090 000 000 090 090 090 090 090 090 000 000 000 ZZZ ZZZ 000 000 XXX 000 000 000 000 000 000 ZZZ 000 ZZZ 000 090 090 ZZZ ZZZ 090 YYY 090 090 090 090 090 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY 090 090 ZZZ 090 090 YYY 000 XXX 000 000 XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70377 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 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 39599 4000F 4001F 4002F 4003F 4006F 4009F 4011F 4012F 4014F .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... I I I I I I A A R R R A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A C A A A A A C A A A A A A A A A A A C I I I I I I I I I .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.00 0.00 0.00 0.00 0.00 1.08 1.37 4.53 2.24 2.24 1.71 1.99 5.99 6.44 7.45 12.86 10.06 3.74 1.14 6.42 6.66 6.06 7.97 5.90 6.91 14.12 10.47 10.81 9.24 14.66 16.57 0.00 8.23 13.59 14.52 10.01 13.08 4.88 4.88 12.93 19.95 13.21 16.57 1.29 0.52 4.44 0.00 6.09 11.77 13.60 17.39 5.60 0.00 13.17 16.31 94.86 16.08 15.39 16.40 13.30 14.39 13.35 11.98 17.47 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.73 3.94 NA NA NA NA 4.31 NA NA NA NA NA 3.70 2.06 5.56 NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA 7.37 NA NA 0.00 NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.52 0.65 3.23 1.03 1.04 0.78 2.06 4.45 3.75 5.70 6.90 5.77 2.09 0.78 3.49 4.06 3.30 4.40 4.49 3.92 8.55 5.79 5.26 3.98 5.66 7.09 0.00 6.25 9.38 9.86 4.95 6.09 1.61 1.67 6.14 8.83 5.76 8.22 0.76 0.44 3.46 0.00 4.66 7.56 7.55 9.39 4.86 0.00 6.47 7.16 33.47 8.06 7.15 7.40 6.24 6.60 7.56 6.30 9.36 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 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 ............................... Diaphragm surgery procedure ........................... Tobacco use txmnt counseling .......................... Tobacco use txmnt, pharmacol .......................... Statin therapy, rx ................................................ Pt ed write/oral, pts w/ hf ................................... Beta-blocker therapy rx ...................................... Ace inhibitor therapy rx ...................................... Oral antiplatelet therapy rx ................................. Warfarin therapy rx ............................................. Written discharge instr prvd ............................... Malpractice RVUs 0.00 0.00 0.00 0.00 0.00 0.00 0.05 0.07 0.48 0.11 0.11 0.08 0.25 0.88 0.85 0.74 1.84 1.37 0.49 0.09 0.72 0.84 0.80 1.12 0.60 0.88 1.75 1.20 1.32 1.13 1.15 1.90 0.00 0.72 1.20 1.28 1.32 1.73 0.72 0.64 1.71 2.47 1.40 1.88 0.13 0.06 0.32 0.00 0.89 1.75 2.02 2.45 0.82 0.00 1.77 2.16 10.95 2.23 2.10 2.21 1.79 1.92 1.83 1.59 2.44 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00263 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.00 0.00 0.00 0.00 0.00 0.00 4.86 5.38 NA NA NA NA 6.55 NA NA NA NA NA 7.93 3.29 12.70 NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA 8.79 NA NA 0.00 NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Facility Total 0.00 0.00 0.00 0.00 0.00 0.00 1.65 2.09 8.24 3.38 3.39 2.57 4.30 11.32 11.04 13.89 21.60 17.20 6.32 2.01 10.63 11.56 10.16 13.49 10.99 11.71 24.42 17.46 17.39 14.35 21.47 25.56 0.00 15.20 24.17 25.66 16.28 20.90 7.21 7.19 20.78 31.25 20.37 26.67 2.18 1.02 8.22 0.00 11.64 21.08 23.17 29.23 11.28 0.00 21.41 25.63 139.28 26.37 24.64 26.01 21.33 22.91 22.74 19.87 29.27 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Global XXX XXX XXX XXX XXX XXX XXX XXX 010 XXX XXX 000 010 090 090 090 090 090 010 000 010 090 090 090 090 090 090 090 090 010 010 010 YYY 090 090 090 090 090 ZZZ ZZZ 090 090 090 090 000 000 090 YYY 090 090 090 090 010 YYY 090 090 090 090 090 090 090 090 090 090 090 YYY XXX XXX XXX XXX XXX XXX XXX XXX XXX 70378 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 4015F 4016F 4017F 4018F 40490 40500 40510 40520 40525 40527 40530 40650 40652 40654 40700 40701 40702 40720 40761 40799 40800 40801 40804 40805 40806 40808 40810 40812 40814 40816 40818 40819 40820 40830 40831 40840 40842 40843 40844 40845 40899 41000 41005 41006 41007 41008 41009 41010 41015 41016 41017 41018 41100 41105 41108 41110 41112 41113 41114 41115 41116 41120 41130 41135 41140 41145 41150 41153 41155 41250 41251 41252 41500 41510 41520 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... I I I I A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A R R R R R C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.00 0.00 0.00 1.22 4.27 4.69 4.66 7.54 9.12 5.39 3.63 4.25 5.30 12.77 15.83 13.02 13.53 14.70 0.00 1.17 2.53 1.24 2.69 0.31 0.96 1.31 2.31 3.41 3.66 2.41 2.41 1.28 1.76 2.46 8.72 8.72 12.08 15.99 18.55 0.00 1.30 1.26 3.24 3.10 3.36 3.58 1.06 3.95 4.06 4.06 5.09 1.63 1.42 1.05 1.51 2.73 3.19 8.46 1.74 2.44 9.76 11.13 23.06 25.46 30.01 23.01 23.73 27.68 1.91 2.27 2.97 3.70 3.41 2.73 0.00 0.00 0.00 0.00 1.63 6.91 6.63 7.56 NA NA 7.83 6.81 7.76 8.62 NA NA NA NA NA 0.00 2.97 4.03 3.40 4.49 1.84 2.66 2.89 3.73 4.95 5.18 5.18 4.09 3.94 3.73 4.67 9.81 10.09 11.98 15.81 17.11 0.00 2.32 3.34 4.80 5.15 4.69 4.98 3.43 5.42 5.63 5.65 6.15 2.43 2.31 2.08 2.99 4.48 4.75 NA 3.30 4.36 NA NA NA NA NA NA NA NA 2.75 3.28 3.90 NA NA 4.63 0.00 0.00 0.00 0.00 0.61 4.34 4.02 4.12 6.32 7.37 4.59 3.30 4.27 4.94 9.10 11.36 8.27 9.92 10.30 0.00 1.78 2.75 1.86 2.82 0.50 1.48 1.66 2.41 3.90 4.01 3.98 3.10 2.45 2.10 3.06 6.99 6.80 7.83 11.59 13.25 0.00 1.41 1.72 3.18 3.03 3.21 3.58 1.60 4.15 4.23 4.31 4.58 1.42 1.32 1.13 1.64 3.23 3.48 7.21 1.86 2.81 15.35 16.24 23.29 26.75 30.63 24.78 25.09 26.88 1.18 1.55 2.26 7.47 7.95 3.63 Persist asthma medicine ctrl .............................. Anti-inflm/anlgsc agent rx ................................... Gi prophylaxis for nsaid rx ................................. Therapy exercise joint rx .................................... Biopsy of lip ........................................................ Partial excision of lip .......................................... Partial excision of lip .......................................... Partial excision of lip .......................................... Reconstruct lip with flap ..................................... Reconstruct lip with flap ..................................... Partial removal of lip .......................................... Repair lip ............................................................ Repair lip ............................................................ Repair lip ............................................................ Repair cleft lip/nasal ........................................... Repair cleft lip/nasal ........................................... Repair cleft lip/nasal ........................................... Repair cleft lip/nasal ........................................... Repair cleft lip/nasal ........................................... Lip surgery procedure ........................................ Drainage of mouth lesion ................................... Drainage of mouth lesion ................................... Removal, foreign body, mouth ........................... Removal, foreign body, mouth ........................... Incision of lip fold ............................................... Biopsy of mouth lesion ....................................... Excision of mouth lesion .................................... Excise/repair mouth lesion ................................. Excise/repair mouth lesion ................................. Excision of mouth lesion .................................... Excise oral mucosa for graft .............................. Excise lip or cheek fold ...................................... Treatment of mouth lesion ................................. Repair mouth laceration ..................................... Repair mouth laceration ..................................... Reconstruction of mouth .................................... Reconstruction of mouth .................................... Reconstruction of mouth .................................... Reconstruction of mouth .................................... Reconstruction of mouth .................................... Mouth surgery procedure ................................... Drainage of mouth lesion ................................... Drainage of mouth lesion ................................... Drainage of mouth lesion ................................... Drainage of mouth lesion ................................... Drainage of mouth lesion ................................... Drainage of mouth lesion ................................... Incision of tongue fold ........................................ Drainage of mouth lesion ................................... Drainage of mouth lesion ................................... Drainage of mouth lesion ................................... Drainage of mouth lesion ................................... Biopsy of tongue ................................................ Biopsy of tongue ................................................ Biopsy of floor of mouth ..................................... Excision of tongue lesion ................................... Excision of tongue lesion ................................... Excision of tongue lesion ................................... Excision of tongue lesion ................................... Excision of tongue fold ....................................... Excision of mouth lesion .................................... Partial removal of tongue ................................... Partial removal of tongue ................................... Tongue and neck surgery .................................. Removal of tongue ............................................. Tongue removal, neck surgery .......................... Tongue, mouth, jaw surgery .............................. Tongue, mouth, neck surgery ............................ Tongue, jaw, & neck surgery ............................. Repair tongue laceration .................................... Repair tongue laceration .................................... Repair tongue laceration .................................... Fixation of tongue ............................................... Tongue to lip surgery ......................................... Reconstruction, tongue fold ............................... Malpractice RVUs 0.00 0.00 0.00 0.00 0.05 0.38 0.49 0.52 0.85 0.97 0.55 0.38 0.52 0.60 0.95 1.65 1.23 1.79 1.93 0.00 0.13 0.31 0.11 0.32 0.04 0.10 0.13 0.28 0.41 0.40 0.21 0.29 0.11 0.19 0.30 1.08 1.08 1.39 1.99 2.00 0.00 0.12 0.12 0.35 0.31 0.42 0.47 0.07 0.46 0.53 0.53 0.68 0.15 0.13 0.10 0.13 0.28 0.34 0.83 0.18 0.23 0.79 0.93 1.88 2.26 2.54 1.94 2.00 2.33 0.18 0.22 0.29 0.30 0.20 0.27 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00264 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.00 0.00 0.00 0.00 2.90 11.56 11.81 12.74 NA NA 13.77 10.82 12.53 14.52 NA NA NA NA NA 0.00 4.27 6.87 4.75 7.50 2.19 3.72 4.33 6.32 8.77 9.24 7.80 6.79 5.33 5.68 7.43 19.61 19.89 25.45 33.79 37.66 0.00 3.74 4.72 8.39 8.56 8.47 9.03 4.56 9.83 10.22 10.24 11.92 4.21 3.86 3.23 4.63 7.49 8.28 NA 5.22 7.03 NA NA NA NA NA NA NA NA 4.84 5.77 7.16 NA NA 7.63 Facility Total 0.00 0.00 0.00 0.00 1.88 8.99 9.20 9.30 14.71 17.46 10.53 7.31 9.04 10.84 22.82 28.84 22.52 25.24 26.93 0.00 3.08 5.59 3.21 5.83 0.85 2.54 3.10 5.00 7.72 8.07 6.60 5.80 3.84 4.05 5.82 16.79 16.60 21.30 29.57 33.80 0.00 2.83 3.10 6.77 6.44 6.99 7.63 2.73 8.56 8.82 8.90 10.35 3.20 2.87 2.28 3.28 6.24 7.01 16.50 3.78 5.48 25.90 28.30 48.23 54.47 63.18 49.73 50.82 56.89 3.27 4.04 5.52 11.47 11.56 6.63 Global XXX XXX XXX XXX 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY 010 010 010 010 000 010 010 010 090 090 090 090 010 010 010 090 090 090 090 090 YYY 010 010 090 090 090 090 010 090 090 090 090 010 010 010 010 090 090 090 010 090 090 090 090 090 090 090 090 090 010 010 010 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70379 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 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 42330 42335 42340 42400 42405 42408 42409 42410 42415 42420 42425 42426 42440 42450 42500 42505 42507 42508 42509 42510 42550 42600 42650 42660 42665 42699 42700 42720 42725 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... C A A A R R R R A A A R R R R R R C A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 1.17 1.24 2.69 0.00 0.00 2.31 3.30 1.31 2.31 3.41 3.09 3.34 0.00 0.00 2.59 3.09 0.00 1.23 1.31 1.64 2.10 4.43 6.16 1.62 8.04 1.80 2.50 3.82 11.98 13.27 14.48 8.81 7.01 9.53 9.99 9.51 7.86 9.79 1.54 1.93 0.00 1.93 6.06 1.56 2.35 2.21 3.31 4.59 0.78 3.29 4.53 2.81 9.33 16.86 19.56 13.00 21.23 6.96 4.61 4.29 6.17 6.10 9.09 11.52 8.14 1.25 4.81 0.77 1.13 2.53 0.00 1.62 5.41 10.70 0.00 2.60 2.68 3.59 0.00 0.00 3.90 5.58 3.07 2.44 5.53 3.81 4.97 0.00 0.00 5.03 4.85 0.00 2.57 2.09 2.55 3.23 5.73 NA 3.73 NA 4.26 3.08 3.88 NA NA NA NA NA NA NA NA NA 10.22 1.97 2.64 0.00 2.83 NA 2.27 3.28 3.15 4.91 6.06 1.65 4.01 5.93 4.53 NA NA NA NA NA NA 5.92 5.70 7.14 NA NA NA NA 3.22 6.60 1.10 1.35 4.18 0.00 2.66 4.84 NA 0.00 1.28 2.22 3.04 0.00 0.00 1.88 4.02 2.25 2.11 3.67 2.97 3.63 0.00 0.00 3.47 3.18 0.00 1.25 1.36 1.55 2.45 3.96 11.80 2.10 7.51 2.30 2.11 3.04 10.24 10.10 11.49 9.10 6.80 17.11 14.74 15.59 11.89 7.08 1.14 1.88 0.00 1.82 4.73 1.54 2.10 1.85 3.15 3.94 0.72 2.46 3.62 2.77 6.24 10.89 12.41 8.63 13.05 4.80 4.26 4.19 5.38 6.55 8.36 10.22 7.81 0.41 4.13 0.71 0.85 2.60 0.00 1.70 3.80 8.24 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 ................................. Removal of salivary stone .................................. Removal of salivary stone .................................. Removal of salivary stone .................................. Biopsy of salivary gland ..................................... Biopsy of salivary gland ..................................... Excision of salivary cyst ..................................... Drainage of salivary cyst .................................... Excise parotid gland/lesion ................................ Excise parotid gland/lesion ................................ Excise parotid gland/lesion ................................ Excise parotid gland/lesion ................................ Excise parotid gland/lesion ................................ Excise submaxillary gland .................................. Excise sublingual gland ...................................... Repair salivary duct ............................................ Repair salivary duct ............................................ Parotid duct diversion ......................................... Parotid duct diversion ......................................... Parotid duct diversion ......................................... 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 ................................ Malpractice RVUs 0.00 0.12 0.13 0.37 0.00 0.00 0.31 0.47 0.15 0.30 0.35 0.44 0.44 0.00 0.00 0.30 0.45 0.00 0.12 0.13 0.16 0.25 0.44 0.52 0.13 0.65 0.17 0.21 0.40 1.27 1.58 2.16 1.31 0.73 0.86 1.01 0.98 0.72 1.26 0.19 0.17 0.00 0.16 0.51 0.13 0.21 0.19 0.29 0.42 0.06 0.28 0.45 0.27 0.91 1.43 1.65 1.05 1.80 0.59 0.42 0.41 0.55 0.49 1.04 0.93 0.66 0.07 0.43 0.07 0.09 0.23 0.00 0.13 0.44 0.91 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00265 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.00 3.89 4.05 6.65 0.00 0.00 6.52 9.35 4.53 5.05 9.29 7.34 8.75 0.00 0.00 7.92 8.39 0.00 3.92 3.53 4.35 5.58 10.60 NA 5.48 NA 6.23 5.79 8.10 NA NA NA NA NA NA NA NA NA 21.27 3.70 4.74 0.00 4.92 NA 3.96 5.84 5.55 8.51 11.07 2.49 7.58 10.91 7.61 NA NA NA NA NA NA 10.95 10.40 13.86 NA NA NA NA 4.54 11.84 1.94 2.57 6.94 0.00 4.41 10.69 NA Facility Total 0.00 2.57 3.59 6.10 0.00 0.00 4.50 7.79 3.71 4.72 7.43 6.50 7.41 0.00 0.00 6.36 6.72 0.00 2.60 2.80 3.35 4.80 8.83 18.48 3.85 16.20 4.27 4.82 7.26 23.49 24.95 28.13 19.22 14.54 27.50 25.74 26.08 20.47 18.13 2.87 3.98 0.00 3.91 11.30 3.23 4.66 4.25 6.75 8.95 1.56 6.03 8.60 5.85 16.48 29.18 33.62 22.68 36.08 12.35 9.29 8.89 12.10 13.14 18.49 22.67 16.61 1.73 9.37 1.55 2.07 5.36 0.00 3.45 9.65 19.85 Global YYY 010 010 010 000 000 010 090 010 010 090 010 010 000 000 090 090 YYY 010 010 010 010 090 090 090 090 010 010 010 090 090 090 090 090 090 090 090 090 090 010 010 YYY 010 090 010 010 010 090 090 000 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 090 000 000 090 YYY 010 010 090 70380 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 42800 42802 42804 42806 42808 42809 42810 42815 42820 42821 42825 42826 42830 42831 42835 42836 42842 42844 42845 42860 42870 42890 42892 42894 42900 42950 42953 42955 42960 42961 42962 42970 42971 42972 42999 43020 43030 43045 43100 43101 43107 43108 43112 43113 43116 43117 43118 43121 43122 43123 43124 43130 43135 43200 43201 43202 43204 43205 43215 43216 43217 43219 43220 43226 43227 43228 43231 43232 43234 43235 43236 43237 43238 43239 43240 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 1.39 1.54 1.24 1.58 2.30 1.81 3.25 7.06 3.90 4.28 3.41 3.37 2.57 2.71 2.30 3.18 8.75 14.29 24.25 2.22 5.39 12.92 15.81 22.85 5.24 8.09 8.95 7.38 2.33 5.58 7.13 5.42 6.20 7.19 0.00 8.08 7.68 20.09 9.18 16.22 39.94 34.14 43.43 35.22 31.17 39.94 33.15 29.15 39.94 33.15 27.28 11.73 16.08 1.59 2.09 1.89 3.76 3.78 2.60 2.40 2.90 2.80 2.10 2.34 3.59 3.76 3.19 4.47 2.01 2.39 2.92 3.98 5.02 2.87 6.85 2.19 4.77 3.75 4.08 3.10 2.34 5.73 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 4.14 4.64 5.56 NA NA NA NA 6.97 NA NA NA NA NA NA NA 5.34 5.18 6.42 NA NA 5.73 NA 1.40 2.07 1.74 1.94 1.94 1.33 3.55 6.43 3.30 3.51 3.18 3.04 2.57 2.85 2.47 2.97 11.02 16.28 23.25 2.41 8.59 14.19 17.22 22.08 3.67 11.90 17.38 10.70 1.97 4.97 5.93 4.19 5.13 5.72 0.00 5.43 5.51 10.73 6.24 7.90 18.31 14.25 19.42 15.15 16.74 17.32 13.82 13.71 17.44 14.14 13.12 7.58 8.11 1.07 1.10 0.94 1.52 1.52 1.20 1.06 1.19 1.35 0.97 1.03 1.45 1.55 1.31 1.82 0.87 1.02 1.22 1.59 1.97 1.19 2.61 Biopsy of throat .................................................. Biopsy of throat .................................................. Biopsy of upper nose/throat ............................... Biopsy of upper nose/throat ............................... Excise pharynx lesion ........................................ Remove pharynx foreign body ........................... Excision of neck cyst .......................................... Excision of neck cyst .......................................... Remove tonsils and adenoids ............................ Remove tonsils and adenoids ............................ Removal of tonsils .............................................. Removal of tonsils .............................................. Removal of adenoids ......................................... Removal of adenoids ......................................... Removal of adenoids ......................................... Removal of adenoids ......................................... Extensive surgery of throat ................................ Extensive surgery of throat ................................ Extensive surgery of throat ................................ Excision of tonsil tags ........................................ Excision of lingual tonsil ..................................... Partial removal of pharynx ................................. Revision of pharyngeal walls ............................. Revision of pharyngeal walls ............................. Repair throat wound ........................................... Reconstruction of throat ..................................... Repair throat, esophagus ................................... Surgical opening of throat .................................. Control throat bleeding ....................................... Control throat bleeding ....................................... Control throat bleeding ....................................... Control nose/throat bleeding .............................. Control nose/throat bleeding .............................. Control nose/throat bleeding .............................. Throat surgery procedure ................................... Incision of esophagus ........................................ Throat muscle surgery ....................................... Incision of esophagus ........................................ Excision of esophagus lesion ............................. Excision of esophagus lesion ............................. Removal of esophagus ...................................... Removal of esophagus ...................................... Removal of esophagus ...................................... Removal of esophagus ...................................... Partial removal of esophagus ............................ Partial removal of esophagus ............................ Partial removal of esophagus ............................ Partial removal of esophagus ............................ Partial removal of esophagus ............................ Partial removal of esophagus ............................ Removal of esophagus ...................................... Removal of esophagus pouch ........................... Removal of esophagus pouch ........................... Esophagus endoscopy ....................................... Esoph scope w/submucous inj ........................... Esophagus endoscopy, biopsy .......................... Esoph scope w/sclerosis inj ............................... Esophagus endoscopy/ligation ........................... Esophagus endoscopy ....................................... Esophagus endoscopy/lesion ............................. Esophagus endoscopy ....................................... Esophagus endoscopy ....................................... Esoph endoscopy, dilation ................................. Esoph endoscopy, dilation ................................. 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 .......................... Malpractice RVUs 0.11 0.12 0.10 0.13 0.19 0.16 0.29 0.61 0.31 0.35 0.25 0.27 0.20 0.22 0.21 0.26 0.71 1.16 1.98 0.18 0.44 1.05 1.28 1.86 0.50 0.72 0.88 0.80 0.19 0.45 0.58 0.39 0.51 0.62 0.00 0.87 0.70 2.58 0.93 2.31 5.22 4.07 5.79 4.42 3.05 5.17 4.10 3.90 5.40 4.15 3.73 1.16 2.33 0.13 0.15 0.15 0.30 0.28 0.22 0.20 0.26 0.24 0.17 0.19 0.28 0.34 0.23 0.34 0.17 0.19 0.21 0.43 0.43 0.22 0.56 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00266 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 3.69 6.43 5.09 5.79 5.59 4.31 9.27 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 5.86 6.88 7.60 NA NA NA NA 10.13 NA NA NA NA NA NA NA 7.52 7.76 9.55 NA NA 8.82 NA Facility Total 2.90 3.73 3.08 3.65 4.43 3.30 7.09 14.10 7.51 8.14 6.84 6.68 5.34 5.78 4.98 6.41 20.48 31.73 49.48 4.81 14.42 28.16 34.31 46.79 9.41 20.71 27.21 18.88 4.49 11.00 13.64 10.00 11.84 13.53 0.00 14.38 13.89 33.40 16.35 26.43 63.47 52.46 68.64 54.79 50.96 62.43 51.07 46.76 62.78 51.44 44.13 20.47 26.52 2.79 3.34 2.98 5.58 5.58 4.02 3.66 4.35 4.39 3.24 3.56 5.32 5.65 4.73 6.63 3.05 3.60 4.35 6.00 7.42 4.28 10.02 Global 010 010 010 010 010 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 010 090 090 090 010 090 090 090 090 090 YYY 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70381 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 43241 43242 43243 43244 43245 43246 43247 43248 43249 43250 43251 43255 43256 43257 43258 43259 43260 43261 43262 43263 43264 43265 43267 43268 43269 43271 43272 43280 43289 43300 43305 43310 43312 43313 43314 43320 43324 43325 43326 43330 43331 43340 43341 43350 43351 43352 43360 43361 43400 43401 43405 43410 43415 43420 43425 43450 43453 43456 43458 43460 43496 43499 43500 43501 43502 43510 43520 43600 43605 43610 43611 43620 43621 43622 43631 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 2.59 7.30 4.56 5.04 3.18 4.32 3.38 3.15 2.90 3.20 3.69 4.81 4.34 5.50 4.54 5.19 5.95 6.26 7.38 7.28 8.89 10.00 7.38 7.38 8.20 7.38 7.38 17.22 0.00 9.13 17.36 25.35 28.38 45.21 50.19 19.90 20.54 20.03 19.71 19.74 20.10 19.58 20.82 15.76 18.32 15.24 35.65 40.44 21.17 22.06 19.98 13.45 24.96 14.33 21.00 1.38 1.51 2.57 3.06 3.79 0.00 0.00 11.03 20.01 23.10 13.06 9.98 1.91 11.96 14.58 17.81 29.99 30.68 32.48 22.56 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 2.64 6.08 13.78 6.67 NA 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA 1.10 2.74 1.80 1.97 1.30 1.69 1.37 1.31 1.21 1.31 1.48 1.89 1.71 2.21 1.79 2.00 2.29 2.40 2.79 2.77 3.32 3.70 2.79 2.89 3.08 2.79 2.79 7.29 0.00 6.39 10.72 11.09 11.92 18.86 19.24 9.23 8.79 8.81 9.32 8.55 9.81 8.99 10.04 8.46 9.82 8.40 15.11 16.93 9.46 9.51 9.61 7.65 11.77 7.42 10.00 0.69 0.73 1.10 1.28 1.49 0.00 0.00 4.98 8.32 9.48 6.60 5.27 0.66 5.30 6.16 7.58 11.82 12.00 12.62 9.18 Upper GI endoscopy with tube .......................... Uppr gi endoscopy w/us fn bx ........................... Upper gi endoscopy & inject .............................. Upper GI endoscopy/ligation .............................. Uppr gi scope dilate strictr ................................. Place gastrostomy tube ...................................... Operative upper GI endoscopy .......................... Uppr gi endoscopy/guide wire ............................ Esoph endoscopy, dilation ................................. Upper GI endoscopy/tumor ................................ Operative upper GI endoscopy .......................... Operative upper GI endoscopy .......................... Uppr gi endoscopy w/stent ................................. Uppr gi scope w/thrml txmnt .............................. Operative upper GI endoscopy .......................... Endoscopic ultrasound exam ............................. Endo cholangiopancreatograph ......................... Endo cholangiopancreatograph ......................... Endo cholangiopancreatograph ......................... Endo cholangiopancreatograph ......................... Endo cholangiopancreatograph ......................... Endo cholangiopancreatograph ......................... Endo cholangiopancreatograph ......................... Endo cholangiopancreatograph ......................... Endo cholangiopancreatograph ......................... Endo cholangiopancreatograph ......................... Endo cholangiopancreatograph ......................... Laparoscopy, fundoplasty .................................. Laparoscope proc, esoph ................................... Repair of esophagus .......................................... Repair esophagus and fistula ............................ Repair of esophagus .......................................... Repair esophagus and fistula ............................ Esophagoplasty congenital ................................ Tracheo-esophagoplasty cong ........................... Fuse esophagus & stomach .............................. Revise esophagus & stomach ........................... Revise esophagus & stomach ........................... Revise esophagus & stomach ........................... Repair of esophagus .......................................... Repair of esophagus .......................................... Fuse esophagus & intestine ............................... Fuse esophagus & intestine ............................... Surgical opening, esophagus ............................. Surgical opening, esophagus ............................. Surgical opening, esophagus ............................. Gastrointestinal repair ........................................ Gastrointestinal repair ........................................ Ligate esophagus veins ..................................... Esophagus surgery for veins ............................. Ligate/staple esophagus .................................... Repair esophagus wound .................................. Repair esophagus wound .................................. Repair esophagus opening ................................ Repair esophagus opening ................................ Dilate esophagus ................................................ Dilate esophagus ................................................ Dilate esophagus ................................................ Dilate esophagus ................................................ Pressure treatment esophagus .......................... Free jejunum flap, microvasc ............................. Esophagus surgery procedure ........................... Surgical opening of stomach .............................. 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 .............................. Malpractice RVUs 0.21 0.53 0.33 0.37 0.26 0.34 0.27 0.23 0.22 0.26 0.29 0.35 0.32 0.36 0.33 0.35 0.43 0.46 0.54 0.54 0.65 0.73 0.54 0.54 0.60 0.54 0.54 2.27 0.00 1.12 1.54 3.60 4.00 5.45 6.63 2.73 2.75 2.59 2.84 2.62 2.93 2.45 2.91 1.42 2.46 2.05 4.96 4.49 1.95 3.04 2.83 1.71 3.52 1.43 3.02 0.11 0.11 0.20 0.24 0.31 0.00 0.00 1.45 2.64 3.09 1.48 1.36 0.14 1.58 1.93 2.35 3.95 4.03 4.29 2.98 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00267 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 4.13 7.70 16.55 9.97 NA 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 3.90 10.57 6.69 7.38 4.74 6.35 5.02 4.69 4.33 4.77 5.46 7.05 6.37 8.07 6.66 7.54 8.67 9.12 10.71 10.59 12.86 14.43 10.71 10.81 11.88 10.71 10.71 26.78 0.00 16.64 29.62 40.04 44.30 69.52 76.06 31.86 32.08 31.43 31.87 30.91 32.84 31.02 33.77 25.64 30.60 25.69 55.72 61.86 32.58 34.61 32.42 22.81 40.25 23.18 34.02 2.18 2.35 3.87 4.58 5.59 0.00 0.00 17.46 30.97 35.67 21.14 16.61 2.71 18.84 22.67 27.74 45.76 46.71 49.39 34.72 Global 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 090 YYY 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 000 000 000 000 090 YYY 090 090 090 090 090 000 090 090 090 090 090 090 090 70382 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 43632 43633 43634 43635 43640 43641 43644 43645 43651 43652 43653 43659 43750 43752 43760 43761 43770 43771 43772 43773 43774 43800 43810 43820 43825 43830 43831 43832 43840 43842 43843 43845 43846 43847 43848 43850 43855 43860 43865 43870 43880 43886 43887 43888 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 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A R R R R C A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 22.56 23.07 25.08 2.06 16.99 17.24 27.83 29.96 10.13 12.13 7.72 0.00 4.48 0.81 1.10 2.01 16.71 19.50 15.00 19.50 15.00 13.67 14.63 15.35 19.19 9.52 7.83 15.58 15.54 18.44 18.62 31.00 24.01 26.88 29.35 24.68 26.12 24.96 26.48 9.68 24.61 4.00 3.95 5.80 0.00 16.21 12.50 2.62 13.97 14.06 14.26 14.01 21.97 2.01 11.79 14.27 16.97 4.44 17.51 35.45 40.94 4.44 14.47 0.00 0.00 0.00 0.00 0.00 2.23 20.97 19.48 22.96 21.50 26.38 27.50 NA NA NA NA NA NA NA NA NA NA NA 0.00 NA 0.28 2.09 1.17 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 10.80 NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 0.00 0.00 0.00 0.00 NA NA NA NA NA NA NA 9.18 9.35 10.11 0.70 7.27 7.38 11.24 12.04 4.77 5.77 4.19 0.00 2.20 0.26 0.45 0.66 7.73 8.61 6.44 8.61 6.58 5.91 6.19 6.42 8.03 4.85 4.52 6.86 6.78 7.81 7.78 10.80 10.05 10.92 11.84 9.84 10.35 9.99 10.53 4.52 9.92 3.14 2.78 3.77 0.00 6.73 5.46 0.88 5.95 5.98 6.04 5.97 8.75 0.71 5.24 6.12 7.09 1.52 7.27 14.15 15.76 1.53 6.23 0.00 0.00 0.00 0.00 0.00 0.76 8.67 10.07 10.71 9.64 10.83 12.89 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 .............................. Lap, place gastr adjust band .............................. Lap, revise adjust gast band .............................. Lap, remove adjust gast band ........................... Lap, change adjust gast band ............................ Lap remov adj gast band/port ............................ Reconstruction of pylorus ................................... Fusion of stomach and bowel ............................ Fusion of stomach and bowel ............................ Fusion of stomach and bowel ............................ Place gastrostomy tube ...................................... Place gastrostomy tube ...................................... Place gastrostomy tube ...................................... Repair of stomach lesion ................................... V-band gastroplasty ........................................... Gastroplasty w/o v-band .................................... Gastroplasty duodenal switch ............................ Gastric bypass for obesity .................................. Gastric bypass incl small i ................................. Revision gastroplasty ......................................... Revise stomach-bowel fusion ............................ Revise stomach-bowel fusion ............................ Revise stomach-bowel fusion ............................ Revise stomach-bowel fusion ............................ Repair stomach opening .................................... Repair stomach-bowel fistula ............................. Revise gastric port, open ................................... Remove gastric port, open ................................. Change gastric port, open .................................. 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 ..................................... Malpractice RVUs 2.98 3.05 3.32 0.27 2.25 2.24 3.15 3.53 1.33 1.55 1.01 0.00 0.43 0.02 0.09 0.13 2.18 2.54 1.92 2.55 1.84 1.81 1.93 2.03 2.53 1.25 1.03 1.97 2.05 2.44 2.45 4.05 3.18 3.55 3.87 3.27 3.46 3.30 3.50 1.27 3.26 0.25 0.51 0.70 0.00 2.14 1.64 0.35 1.85 1.86 1.89 1.85 2.90 0.17 1.55 1.86 2.24 0.58 2.26 4.68 5.75 0.61 1.87 0.00 0.00 0.00 0.00 0.00 0.28 2.70 2.52 3.04 2.85 3.28 3.40 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00268 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA 0.00 NA 1.11 3.28 3.31 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 45.85 NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 0.00 0.00 0.00 0.00 NA NA NA NA NA NA NA Facility Total 34.72 35.47 38.51 3.03 26.51 26.86 42.22 45.53 16.23 19.45 12.92 0.00 7.11 1.09 1.64 2.80 26.62 30.65 23.36 30.66 23.42 21.39 22.75 23.80 29.75 15.62 13.38 24.41 24.37 28.69 28.85 45.85 37.24 41.35 45.06 37.79 39.93 38.25 40.51 15.47 37.79 7.39 7.24 10.27 0.00 25.08 19.60 3.85 21.77 21.90 22.19 21.83 33.62 2.89 18.58 22.25 26.30 6.54 27.04 54.28 62.45 6.58 22.57 0.00 0.00 0.00 0.00 0.00 3.27 32.34 32.07 36.71 33.99 40.49 43.79 Global 090 090 090 ZZZ 090 090 090 090 090 090 090 YYY 010 000 000 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY 090 090 ZZZ 090 090 090 090 090 000 090 090 090 ZZZ 090 090 090 ZZZ 090 XXX XXX XXX XXX XXX ZZZ 090 090 090 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70383 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 44147 44150 44151 44152 44153 44155 44156 44160 44180 44186 44187 44188 44202 44203 44204 44205 44206 44207 44208 44210 44211 44212 44213 44227 44238 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 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 20.68 23.91 26.84 27.79 30.54 27.82 30.74 18.59 14.42 9.77 15.93 17.61 22.01 4.44 25.04 22.20 26.96 29.96 31.95 27.96 34.95 32.45 3.50 26.50 0.00 12.09 15.93 8.01 15.03 21.06 17.61 11.96 7.71 15.41 16.96 2.59 2.87 3.49 3.73 3.31 4.40 4.51 4.79 4.40 3.49 5.25 5.52 7.12 7.46 1.05 1.27 2.94 1.82 2.12 2.82 3.13 3.82 4.31 3.81 4.83 4.42 4.70 0.49 16.01 18.63 16.01 19.50 15.91 12.18 15.03 25.32 21.62 22.54 21.33 24.77 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 3.36 6.66 5.09 6.64 7.13 8.75 6.60 6.92 7.83 NA NA NA NA NA NA NA NA NA NA NA NA NA NA 8.71 12.05 13.43 11.62 14.41 13.34 15.07 7.76 6.25 4.80 8.29 8.87 8.95 1.50 9.98 8.87 11.28 11.51 13.17 11.90 14.71 13.72 1.22 10.65 0.00 5.50 6.71 4.00 6.57 8.56 7.67 8.59 4.27 6.90 7.40 1.10 1.20 1.38 1.49 1.36 1.74 1.74 1.98 1.74 1.42 2.03 2.14 2.70 2.92 0.55 0.63 1.27 0.75 0.88 1.15 1.27 1.49 1.69 1.49 1.87 1.72 1.80 0.16 6.41 7.29 6.47 8.41 6.69 5.34 6.32 9.84 8.59 8.91 8.36 9.58 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 ............................................... Lap, enterolysis .................................................. Lap, jejunostomy ................................................ Lap, ileo/jejuno-stomy ........................................ Lap, colostomy ................................................... Lap, enterectomy ................................................ 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 ............................. Lap, mobil splenic fl add-on ............................... Lap, close enterostomy ...................................... Laparoscope proc, intestine ............................... 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 ............................... Malpractice RVUs 2.55 3.03 3.48 3.51 3.54 3.27 3.94 2.36 1.85 1.27 1.95 2.23 2.84 0.57 3.10 2.74 3.45 3.66 3.87 3.41 4.16 3.77 0.44 3.37 0.00 1.60 1.98 0.92 1.74 2.37 2.25 1.54 0.99 1.96 2.12 0.19 0.21 0.27 0.27 0.24 0.32 0.33 0.37 0.35 0.27 0.42 0.40 0.52 0.62 0.08 0.12 0.21 0.15 0.20 0.26 0.27 0.32 0.34 0.34 0.42 0.38 0.39 0.03 2.11 2.41 2.11 2.51 2.06 1.51 1.85 3.26 2.77 2.92 2.13 2.80 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00269 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 5.33 8.98 8.17 10.04 11.27 13.40 10.75 12.17 12.63 NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 31.94 38.99 43.75 42.92 48.49 44.43 49.75 28.71 22.52 15.84 26.17 28.71 33.80 6.51 38.12 33.81 41.69 45.13 48.99 43.27 53.82 49.94 5.16 40.52 0.00 19.19 24.62 12.93 23.34 31.99 27.53 22.09 12.97 24.27 26.48 3.88 4.28 5.14 5.49 4.91 6.46 6.58 7.14 6.49 5.18 7.70 8.06 10.34 11.00 1.68 2.02 4.42 2.72 3.20 4.23 4.67 5.63 6.34 5.64 7.12 6.52 6.89 0.68 24.53 28.33 24.59 30.42 24.66 19.03 23.20 38.42 32.98 34.37 31.82 37.15 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 ZZZ 090 090 090 090 090 090 090 090 ZZZ 090 YYY 090 090 090 090 090 090 090 090 090 090 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 090 090 090 090 090 090 090 090 090 090 090 090 70384 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 44680 44700 44701 44715 44720 44721 44799 44800 44820 44850 44899 44900 44901 44950 44955 44960 44970 44979 45000 45005 45020 45100 45108 45110 45111 45112 45113 45114 45116 45119 45120 45121 45123 45126 45130 45135 45136 45150 45160 45170 45190 45300 45303 45305 45307 45308 45309 45315 45317 45320 45321 45327 45330 45331 45332 45333 45334 45335 45337 45338 45339 45340 45341 45342 45345 45355 45378 45378 45379 45380 45381 45382 45383 45384 45385 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 53 ..... .......... .......... .......... .......... .......... .......... .......... .......... Status A A A C A A C A A A C A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 15.38 16.09 3.10 0.00 5.00 7.00 0.00 11.21 12.07 10.72 0.00 10.12 3.37 9.99 1.53 12.32 8.69 0.00 4.51 1.99 4.71 3.67 4.75 27.96 16.46 30.49 30.53 27.28 24.54 30.79 24.56 27.00 16.68 45.09 16.42 19.25 27.26 5.66 15.30 11.47 9.73 0.38 0.44 1.01 0.94 0.83 2.01 1.40 1.50 1.58 1.17 1.65 0.96 1.15 1.79 1.79 2.73 1.46 2.36 2.34 3.14 1.89 2.60 4.05 2.92 3.51 0.96 3.69 4.68 4.43 4.19 5.68 5.86 4.69 5.30 NA NA NA 0.00 NA NA 0.00 NA NA NA 0.00 NA 27.97 NA NA NA NA 0.00 NA 4.06 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 1.53 18.73 2.64 3.04 2.00 2.82 2.87 2.44 2.92 NA NA 2.28 3.08 5.01 4.88 NA 3.22 NA 5.23 3.47 6.19 NA NA NA NA 2.28 6.16 7.68 7.21 7.13 9.97 7.94 6.82 7.82 6.46 6.68 1.06 0.00 1.71 2.40 0.00 5.40 5.50 5.01 0.00 4.70 1.11 4.32 0.54 5.35 4.09 0.00 2.97 1.58 3.28 2.37 2.78 12.43 7.18 11.79 12.63 10.90 10.05 12.49 10.15 11.13 6.87 19.26 6.78 8.43 12.55 2.97 6.66 5.25 4.63 0.28 0.33 0.50 0.48 0.44 0.84 0.63 0.66 0.71 0.56 0.69 0.50 0.59 0.80 0.80 1.14 0.69 1.00 1.00 1.28 0.83 1.07 1.54 1.16 1.38 0.50 1.47 1.82 1.74 1.65 2.19 2.23 1.83 2.04 Surgical revision, intestine ................................. Suspend bowel w/prosthesis .............................. Intraop colon lavage add-on .............................. Prepare donor intestine ...................................... Prep donor intestine/venous .............................. Prep donor intestine/artery ................................. Unlisted procedure intestine ............................... Excision of bowel pouch .................................... Excision of mesentery lesion ............................. Repair of mesentery ........................................... Bowel surgery procedure ................................... Drain app abscess, open ................................... Drain app abscess, percut ................................. Appendectomy .................................................... Appendectomy add-on ....................................... Appendectomy .................................................... Laparoscopy, appendectomy ............................. Laparoscope proc, app ...................................... Drainage of pelvic abscess ................................ Drainage of rectal abscess ................................ Drainage of rectal abscess ................................ Biopsy of rectum ................................................ Removal of anorectal lesion ............................... Removal of rectum ............................................. Partial removal of rectum ................................... Removal of rectum ............................................. Partial proctectomy ............................................. Partial removal of rectum ................................... Partial removal of rectum ................................... Remove rectum w/reservoir ............................... Removal of rectum ............................................. Removal of rectum and colon ............................ Partial proctectomy ............................................. Pelvic exenteration ............................................. Excision of rectal prolapse ................................. Excision of rectal prolapse ................................. Excise ileoanal reservior .................................... Excision of rectal stricture .................................. Excision of rectal lesion ..................................... Excision of rectal lesion ..................................... Destruction, rectal tumor .................................... Proctosigmoidoscopy dx .................................... Proctosigmoidoscopy dilate ................................ Proctosigmoidoscopy w/bx ................................. Proctosigmoidoscopy fb ..................................... Proctosigmoidoscopy removal ........................... Proctosigmoidoscopy removal ........................... Proctosigmoidoscopy removal ........................... Proctosigmoidoscopy bleed ............................... Proctosigmoidoscopy ablate .............................. Proctosigmoidoscopy volvul ............................... Proctosigmoidoscopy w/stent ............................. Diagnostic sigmoidoscopy .................................. Sigmoidoscopy and biopsy ................................ Sigmoidoscopy w/fb removal ............................. Sigmoidoscopy & polypectomy .......................... Sigmoidoscopy for bleeding ............................... Sigmoidoscopy w/submuc inj ............................. Sigmoidoscopy & decompress ........................... Sigmoidoscopy w/tumr remove .......................... Sigmoidoscopy w/ablate tumr ............................ Sig w/balloon dilation ......................................... Sigmoidoscopy w/ultrasound .............................. Sigmoidoscopy w/us guide bx ............................ Sigmoidoscopy w/stent ....................................... Surgical colonoscopy ......................................... Diagnostic colonoscopy ...................................... Diagnostic colonoscopy ...................................... Colonoscopy w/fb removal ................................. Colonoscopy and biopsy .................................... Colonoscopy, submucous inj ............................. Colonoscopy/control bleeding ............................ Lesion removal colonoscopy .............................. Lesion remove colonoscopy ............................... Lesion removal colonoscopy .............................. Malpractice RVUs 1.99 1.83 0.37 0.00 0.37 0.97 0.00 1.47 1.59 1.39 0.00 1.33 0.22 1.31 0.20 1.63 1.14 0.00 0.52 0.25 0.55 0.44 0.59 3.35 2.06 3.42 3.48 3.35 2.87 3.35 2.89 3.24 1.85 4.32 1.79 2.35 2.81 0.61 1.67 1.35 1.13 0.04 0.05 0.11 0.11 0.09 0.22 0.15 0.15 0.16 0.13 0.16 0.08 0.09 0.16 0.15 0.20 0.11 0.21 0.19 0.26 0.15 0.19 0.30 0.23 0.36 0.08 0.30 0.39 0.35 0.30 0.41 0.48 0.38 0.42 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00270 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA 0.00 NA NA 0.00 NA NA NA 0.00 NA 31.56 NA NA NA NA 0.00 NA 6.30 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 1.95 19.22 3.76 4.09 2.92 5.05 4.42 4.09 4.66 NA NA 3.32 4.32 6.96 6.82 NA 4.79 NA 7.76 6.87 8.23 NA NA NA NA 3.32 10.15 12.75 11.99 11.62 16.06 14.28 11.89 13.54 Facility Total 23.83 24.60 4.53 0.00 7.08 10.37 0.00 18.08 19.16 17.12 0.00 16.15 4.70 15.62 2.27 19.30 13.92 0.00 8.00 3.82 8.54 6.48 8.12 43.74 25.70 45.70 46.64 41.53 37.46 46.63 37.60 41.37 25.40 68.67 24.99 30.03 42.62 9.24 23.63 18.07 15.49 0.70 0.82 1.62 1.53 1.36 3.07 2.18 2.31 2.45 1.86 2.50 1.54 1.83 2.75 2.74 4.07 2.26 3.57 3.53 4.68 2.87 3.86 5.89 4.31 5.25 1.54 5.46 6.89 6.52 6.14 8.28 8.57 6.90 7.76 Global 090 090 ZZZ XXX XXX XXX YYY 090 090 090 YYY 090 000 090 ZZZ 090 090 YYY 090 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70385 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 45386 45387 45391 45392 45395 45397 45400 45402 45499 45500 45505 45520 45540 45541 45550 45560 45562 45563 45800 45805 45820 45825 45900 45905 45910 45915 45990 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 46505 46600 46604 46606 46608 46610 46611 46612 46614 46615 46700 46705 46706 46710 46712 46715 46716 46730 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A C A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 4.57 5.90 5.09 6.54 30.50 34.00 18.06 25.04 0.00 7.28 7.57 0.55 16.25 13.38 22.97 10.56 15.36 23.43 17.74 20.75 18.45 21.22 2.61 2.30 2.80 3.14 1.80 0.00 2.90 1.23 4.95 4.31 1.19 5.68 2.71 2.49 1.40 3.41 2.67 4.24 1.56 2.04 2.57 3.88 4.59 5.39 5.72 6.36 7.07 7.49 3.71 4.55 5.97 4.08 7.12 1.61 1.61 2.86 0.50 1.31 0.81 1.51 1.32 1.81 2.34 2.01 2.68 9.12 6.89 2.39 16.00 34.00 7.19 15.05 26.71 12.44 NA NA NA NA NA NA NA 0.00 NA NA 1.64 NA NA NA NA NA NA NA NA NA NA NA NA NA 4.33 NA 0.00 2.34 1.35 5.51 NA 2.55 NA NA 2.37 2.53 3.86 5.12 5.42 2.30 2.65 3.08 5.32 5.85 NA NA NA NA NA 5.00 4.64 NA 3.77 NA 2.13 2.12 3.05 1.56 9.15 3.79 4.41 4.04 3.34 5.20 2.33 2.49 NA NA NA NA NA NA NA NA 1.79 2.34 1.98 2.49 13.71 14.30 7.85 10.01 0.00 3.54 3.86 0.37 6.81 5.96 9.24 5.06 7.00 10.54 7.44 9.53 7.64 9.84 1.50 1.43 1.66 2.10 0.79 0.00 1.86 0.71 3.59 2.90 0.84 3.25 1.84 1.13 0.92 2.87 2.63 3.51 0.95 1.75 1.29 2.62 2.84 2.88 3.28 3.19 3.61 3.74 2.84 2.98 3.26 2.75 3.68 0.85 1.15 1.97 0.34 0.62 0.43 0.65 0.61 0.78 0.98 0.84 1.07 4.21 3.69 1.25 7.77 15.08 3.58 7.99 12.05 Colonoscopy dilate stricture ............................... Colonoscopy w/stent .......................................... Colonoscopy w/endoscope us ........................... Colonoscopy w/endoscopic fnb .......................... Lap, removal of rectum ...................................... Lap, remove rectum w/pouch ............................. Laparoscopic proctopexy ................................... Lap proctopexy w/sig resect .............................. Laparoscope proc, rectum ................................. Repair of rectum ................................................. Repair of rectum ................................................. Treatment of rectal prolapse .............................. Correct rectal prolapse ....................................... Correct rectal prolapse ....................................... Repair rectum/remove sigmoid .......................... Repair of rectocele ............................................. Exploration/repair of rectum ............................... Exploration/repair of rectum ............................... Repair rect/bladder fistula .................................. Repair fistula w/colostomy ................................. Repair rectourethral fistula ................................. Repair fistula w/colostomy ................................. Reduction of rectal prolapse .............................. Dilation of anal sphincter .................................... Dilation of rectal narrowing ................................ Remove rectal obstruction ................................. Surg dx exam, anorectal .................................... 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) ................................ Chemodenervation anal musc ........................... 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 ................................. Repr per/vag pouch sngl proc ............................ Repr per/vag pouch dbl proc ............................. Rep perf anoper fistu ......................................... Rep perf anoper/vestib fistu ............................... Construction of absent anus .............................. Malpractice RVUs 0.39 0.48 0.42 0.42 3.62 3.66 2.02 2.81 0.00 0.75 0.86 0.05 1.84 1.55 2.61 1.13 1.83 3.10 1.85 2.02 1.58 2.31 0.30 0.27 0.30 0.30 0.17 0.00 0.31 0.14 0.62 0.54 0.14 0.67 0.36 0.30 0.15 0.39 0.31 0.48 0.17 0.23 0.30 0.48 0.58 0.64 0.68 0.76 0.79 0.83 0.46 0.52 0.66 0.44 0.79 0.18 0.16 0.14 0.05 0.12 0.09 0.16 0.15 0.19 0.28 0.20 0.33 0.94 0.91 0.28 1.38 3.66 0.92 1.58 2.46 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00271 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 17.40 NA NA NA NA NA NA NA 0.00 NA NA 2.24 NA NA NA NA NA NA NA NA NA NA NA NA NA 7.77 NA 0.00 5.55 2.72 11.08 NA 3.88 NA NA 5.16 4.08 7.66 8.10 10.14 4.03 4.92 5.95 9.68 11.02 NA NA NA NA NA 9.17 9.71 NA 8.29 NA 3.92 3.89 6.05 2.11 10.58 4.69 6.08 5.51 5.34 7.82 4.54 5.50 NA NA NA NA NA NA NA NA Facility Total 6.75 8.72 7.49 9.45 47.83 51.96 27.93 37.86 0.00 11.57 12.29 0.97 24.90 20.89 34.82 16.75 24.19 37.07 27.03 32.30 27.67 33.37 4.41 4.00 4.76 5.54 2.76 0.00 5.07 2.08 9.16 7.75 2.17 9.60 4.91 3.92 2.47 6.67 5.61 8.23 2.68 4.02 4.16 6.98 8.01 8.91 9.68 10.31 11.47 12.06 7.01 8.05 9.89 7.27 11.59 2.64 2.92 4.97 0.89 2.05 1.33 2.32 2.08 2.78 3.60 3.05 4.08 14.27 11.49 3.92 25.15 52.74 11.69 24.62 41.22 Global 000 000 000 000 090 090 090 090 YYY 090 090 000 090 090 090 090 090 090 090 090 090 090 010 010 010 010 000 YYY 010 010 090 090 010 090 090 010 010 090 090 090 010 010 010 090 090 090 090 090 090 090 090 090 090 090 090 010 010 010 000 000 000 000 000 000 000 000 000 090 090 010 090 090 090 090 090 70386 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 46735 46740 46742 46744 46746 46748 46750 46751 46753 46754 46760 46761 46762 46900 46910 46916 46917 46922 46924 46934 46935 46936 46937 46938 46940 46942 46945 46946 46947 46999 47000 47001 47010 47011 47015 47100 47120 47122 47125 47130 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 47530 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A X R R A A A C C C A A A A A A A A A C A A A C A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 32.12 29.96 35.75 52.55 58.13 64.11 10.23 8.76 8.28 2.20 14.41 13.82 12.69 1.91 1.86 1.86 1.86 1.86 2.76 3.50 2.43 3.68 2.69 4.65 2.32 2.04 1.84 2.58 5.20 0.00 1.90 1.90 15.99 3.69 15.09 11.65 35.45 55.05 49.12 53.27 0.00 81.40 68.50 54.92 67.40 74.89 0.00 0.00 0.00 6.00 7.00 15.06 19.53 26.88 47.05 18.48 19.66 19.66 0.00 22.97 23.24 15.17 0.00 32.44 19.85 19.80 18.01 10.80 7.22 1.96 0.76 7.82 10.48 5.54 5.84 NA NA NA NA NA NA NA NA NA 3.60 NA NA NA 2.59 2.91 3.16 9.15 3.28 8.71 5.08 3.47 4.88 2.78 4.00 2.00 1.84 3.27 3.73 NA 0.00 3.08 NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA 0.00 0.00 0.00 NA NA NA NA NA NA NA NA NA 0.00 NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA 15.13 33.88 13.58 13.26 17.43 21.17 25.21 23.70 5.06 5.43 3.85 1.67 7.10 6.02 5.53 1.27 1.06 1.39 1.12 1.07 1.35 2.96 1.21 2.50 1.22 3.06 1.09 1.02 2.48 2.40 2.72 0.00 0.63 0.65 8.41 1.21 7.50 6.05 15.18 21.50 19.56 21.02 0.00 31.59 27.09 22.33 26.98 29.55 0.00 0.00 0.00 2.06 2.40 7.24 8.89 11.60 18.56 8.74 8.15 8.16 0.00 9.38 9.61 6.09 0.00 13.47 8.78 8.83 8.38 5.92 5.58 0.64 0.25 5.02 5.09 2.81 3.72 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 ..................................... 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 .................................. Revise/reinsert bile tube ..................................... Malpractice RVUs 3.20 2.41 3.19 6.38 7.68 3.36 1.10 0.94 0.94 0.19 1.59 1.43 1.24 0.17 0.19 0.11 0.21 0.22 0.26 0.32 0.23 0.34 0.14 0.58 0.23 0.19 0.19 0.27 0.75 0.00 0.12 0.25 1.80 0.22 1.83 1.53 4.65 7.19 6.45 6.94 0.00 9.93 8.41 5.17 5.17 5.17 0.00 0.00 0.00 0.83 0.97 1.98 2.58 3.37 5.85 2.50 2.55 2.60 0.00 2.86 2.84 0.96 0.00 3.07 2.62 2.61 2.20 1.42 0.43 0.12 0.04 0.46 0.62 0.33 0.37 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00272 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA 5.99 NA NA NA 4.67 4.96 5.13 11.22 5.36 11.73 8.90 6.13 8.90 5.61 9.23 4.55 4.07 5.30 6.58 NA 0.00 5.10 NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA 0.00 0.00 0.00 NA NA NA NA NA NA NA NA NA 0.00 NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA 21.00 40.09 Facility Total 48.90 45.63 56.37 80.10 91.02 91.17 16.39 15.13 13.07 4.06 23.10 21.27 19.46 3.35 3.11 3.36 3.19 3.15 4.37 6.78 3.87 6.52 4.05 8.29 3.64 3.25 4.51 5.25 8.67 0.00 2.65 2.80 26.20 5.12 24.42 19.23 55.28 83.74 75.13 81.23 0.00 122.92 104.00 82.42 99.55 109.61 0.00 0.00 0.00 8.89 10.37 24.28 31.00 41.85 71.46 29.72 30.36 30.42 0.00 35.21 35.69 22.22 0.00 48.98 31.25 31.24 28.59 18.14 13.23 2.72 1.05 13.30 16.19 8.68 9.93 Global 090 090 090 090 090 090 090 090 090 010 090 090 090 010 010 010 010 010 010 090 010 090 010 090 010 010 090 090 090 YYY 000 ZZZ 090 000 090 090 090 090 090 090 XXX 090 090 090 090 090 XXX 090 090 XXX XXX 090 090 090 090 090 090 090 YYY 090 090 010 YYY 090 090 090 090 090 090 000 000 090 090 010 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70387 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 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 48551 48552 48554 48556 48999 49000 49002 49010 49020 49021 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A N A A A A A A A A A X C A R A C A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 3.02 6.03 6.34 9.05 7.55 8.55 4.88 5.17 11.07 11.92 14.21 12.56 0.00 13.56 14.67 18.79 18.75 20.61 9.10 15.60 27.77 23.00 30.19 18.77 16.42 15.89 19.09 18.45 21.31 25.81 24.84 26.46 31.13 23.27 15.15 21.52 19.87 0.00 28.03 35.40 42.11 15.68 12.21 4.67 15.83 22.91 23.98 26.36 17.31 47.93 43.68 47.82 44.03 24.60 0.00 24.68 1.95 15.26 14.29 3.99 15.57 19.69 18.15 25.79 0.00 0.00 4.30 34.12 15.69 0.00 11.66 10.47 12.26 22.81 3.37 NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA 7.97 NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA 20.95 NA NA NA NA 0.00 0.00 NA NA NA 0.00 NA NA NA NA 21.11 1.02 2.38 2.07 3.36 2.47 2.79 1.67 1.92 4.99 5.31 5.96 5.38 0.00 6.14 6.51 7.94 7.89 8.53 4.89 7.42 11.50 9.94 12.44 8.44 7.83 7.48 8.57 8.38 9.30 10.86 10.81 11.22 12.93 10.07 8.16 9.68 8.88 0.00 11.52 13.90 16.59 7.31 5.60 1.95 6.86 9.55 9.84 12.00 7.61 19.54 18.23 19.58 18.26 11.68 0.00 10.17 0.64 7.34 7.45 1.31 6.71 8.12 7.99 10.50 0.00 0.00 1.46 18.30 8.08 0.00 5.39 5.02 5.91 10.21 1.11 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 ....................................... 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 ................................... Malpractice RVUs 0.40 0.42 0.37 0.96 0.45 0.50 0.65 0.66 1.46 1.58 1.88 1.65 0.00 1.79 1.94 2.48 2.47 2.73 0.65 2.06 3.67 3.04 3.92 2.48 2.14 2.10 2.52 2.41 2.82 3.41 3.29 3.49 4.09 3.07 1.16 2.85 2.64 0.00 3.47 4.68 5.54 2.12 1.62 0.28 2.09 3.02 3.17 3.49 2.29 6.30 5.78 6.29 5.82 3.26 0.00 3.27 0.15 2.02 1.82 0.24 2.05 2.60 2.37 3.41 0.00 0.00 0.31 4.18 2.07 0.00 1.52 1.37 1.51 2.84 0.20 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00273 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA 12.92 NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA 25.18 NA NA NA NA 0.00 0.00 NA NA NA 0.00 NA NA NA NA 24.68 Facility Total 4.44 8.83 8.78 13.37 10.47 11.84 7.20 7.75 17.52 18.81 22.05 19.59 0.00 21.49 23.12 29.21 29.11 31.87 14.64 25.08 42.94 35.98 46.55 29.69 26.39 25.47 30.18 29.24 33.43 40.08 38.94 41.17 48.15 36.41 24.47 34.05 31.39 0.00 43.02 53.98 64.24 25.11 19.43 6.90 24.78 35.48 36.99 41.85 27.21 73.77 67.69 73.69 68.11 39.54 0.00 38.12 2.74 24.62 23.56 5.54 24.33 30.41 28.51 39.70 0.00 0.00 6.07 56.60 25.84 0.00 18.57 16.86 19.68 35.86 4.68 Global ZZZ 000 000 000 000 000 000 000 090 090 090 090 YYY 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY 090 090 090 090 090 010 090 090 090 090 090 090 090 090 090 090 XXX 090 ZZZ 090 090 000 090 090 090 090 XXX XXX XXX 090 090 YYY 090 090 090 090 000 70388 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 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 49582 49585 49587 49590 49600 49605 49606 49610 49611 49650 49651 49659 49900 49904 49905 49906 49999 50010 50020 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A C C A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 13.50 3.99 15.84 3.69 11.34 1.35 1.26 12.12 1.73 10.23 14.82 33.45 14.86 8.34 11.12 5.09 5.39 5.69 9.47 0.00 1.88 6.64 2.22 5.53 6.24 1.46 0.76 11.35 9.62 0.89 6.05 7.39 11.11 14.01 5.88 8.78 5.47 8.87 7.59 9.56 9.62 11.95 8.56 10.37 8.62 9.43 9.02 11.13 11.55 14.23 11.55 14.38 4.88 5.68 6.72 4.10 6.64 6.22 7.55 8.53 10.94 75.89 18.57 10.48 8.91 6.26 8.23 0.00 12.26 19.97 6.54 0.00 0.00 10.96 14.64 NA 19.57 NA 19.68 NA 3.99 2.59 NA 3.11 NA NA NA NA NA NA NA NA NA NA 0.00 3.08 NA NA NA NA 14.11 3.72 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA 0.00 0.00 NA NA 6.43 1.31 7.44 1.21 5.44 0.46 0.43 5.51 0.57 5.03 7.04 14.08 6.64 4.27 5.62 2.64 2.65 3.00 4.50 0.00 0.62 3.57 1.09 3.16 2.90 0.52 0.29 5.61 4.77 0.30 3.93 3.43 5.06 6.12 2.96 4.28 3.12 4.21 3.75 4.46 4.44 5.25 4.08 4.75 4.13 4.42 4.27 4.99 5.15 6.07 5.23 6.14 1.67 3.17 3.47 2.60 3.47 3.30 3.74 4.09 5.34 28.58 7.70 5.21 6.99 3.20 4.05 0.00 6.24 15.25 2.30 0.00 0.00 5.23 7.76 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 .............................. Rpr umbil hern, block < 5 yr .............................. Rpr umbil hern, reduc > 5 yr .............................. Rpr umbil hern, block > 5 yr .............................. Repair spigelian hernia ...................................... Repair umbilical lesion ....................................... Repair umbilical lesion ....................................... Repair umbilical lesion ....................................... Repair umbilical lesion ....................................... Repair umbilical lesion ....................................... Laparo hernia repair initial ................................. Laparo hernia repair recur ................................. Laparo proc, hernia repair .................................. Repair of abdominal wall .................................... Omental flap, extra-abdom ................................. Omental flap, intra-abdom .................................. Free omental flap, microvasc ............................. Abdomen surgery procedure .............................. Exploration of kidney .......................................... Renal abscess, open drain ................................ Malpractice RVUs 1.69 0.24 1.74 0.22 1.39 0.08 0.09 1.62 0.10 1.24 1.87 4.37 1.88 1.08 1.43 0.65 0.70 0.71 1.20 0.00 0.15 0.81 0.21 0.74 0.83 0.09 0.04 1.54 1.28 0.07 0.80 1.02 1.40 1.80 0.74 1.07 0.71 1.12 1.03 1.27 1.28 1.59 1.13 1.37 1.14 1.24 1.20 1.47 1.52 1.88 1.52 1.90 0.64 0.75 0.88 0.54 0.88 0.82 0.99 1.13 1.32 9.36 2.45 1.07 0.78 0.93 1.14 0.00 1.62 2.69 0.75 0.00 0.00 0.93 1.34 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00274 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA 23.80 NA 23.59 NA 5.42 3.94 NA 4.94 NA NA NA NA NA NA NA NA NA NA 0.00 5.11 NA NA NA NA 15.66 4.52 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA 0.00 0.00 NA NA Facility Total 21.62 5.54 25.02 5.12 18.17 1.89 1.78 19.25 2.40 16.50 23.73 51.90 23.38 13.69 18.17 8.38 8.74 9.40 15.17 0.00 2.65 11.02 3.52 9.43 9.97 2.07 1.09 18.50 15.67 1.26 10.78 11.84 17.57 21.93 9.58 14.13 9.30 14.20 12.37 15.29 15.34 18.79 13.77 16.49 13.89 15.09 14.49 17.59 18.22 22.18 18.30 22.42 7.19 9.60 11.07 7.24 10.99 10.34 12.28 13.75 17.60 113.83 28.72 16.76 16.68 10.39 13.42 0.00 20.12 37.91 9.59 0.00 0.00 17.12 23.74 Global 090 000 090 000 090 000 000 090 000 090 090 090 090 090 090 010 010 010 090 YYY 000 090 000 090 010 000 000 090 090 000 010 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 ZZZ 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY 090 090 ZZZ 090 YYY 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70389 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 50021 50040 50045 50060 50065 50070 50075 50080 50081 50100 50120 50125 50130 50135 50200 50205 50220 50225 50230 50234 50236 50240 50250 50280 50290 50300 50320 50323 50325 50327 50328 50329 50340 50360 50365 50370 50380 50382 50384 50387 50389 50390 50391 50392 50393 50394 50395 50396 50398 50400 50405 50500 50520 50525 50526 50540 50541 50542 50543 50544 50545 50546 50547 50548 50549 50551 50553 50555 50557 50561 50562 50570 50572 50574 50575 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A 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 A C C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 3.37 14.92 15.44 19.27 20.76 20.29 25.30 14.69 21.77 16.07 15.89 16.50 17.26 19.15 2.63 11.29 17.12 20.20 22.04 22.37 24.82 21.97 19.97 15.65 14.71 0.00 22.18 0.00 0.00 4.00 3.50 3.34 12.13 31.48 36.75 13.70 20.73 5.50 5.00 2.00 1.10 1.96 1.96 3.37 4.15 0.76 3.37 2.09 1.46 19.47 23.89 19.54 17.20 22.24 23.98 19.90 15.98 19.97 25.46 22.37 23.96 20.45 25.46 24.36 0.00 5.59 5.98 6.52 6.61 7.58 10.90 9.53 10.33 11.00 13.96 21.71 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA 0.00 0.00 NA NA NA NA NA NA NA NA 36.22 35.32 18.26 12.78 NA 1.58 NA NA 2.69 NA NA 16.36 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 4.15 4.37 4.82 4.59 5.09 NA NA NA NA NA 1.10 6.82 6.61 7.84 6.09 8.23 9.92 6.29 8.78 7.80 6.78 6.98 7.18 7.79 1.29 5.02 7.25 8.16 8.59 8.85 10.27 9.03 9.18 6.70 6.47 0.00 10.68 0.00 0.00 1.35 1.18 1.13 6.51 15.51 18.24 7.16 12.05 1.87 1.71 0.67 0.37 0.64 0.63 1.52 1.79 0.66 1.50 1.08 0.52 7.89 9.05 8.40 7.44 9.02 9.88 8.34 6.50 8.15 10.22 8.54 9.21 8.38 11.13 9.20 0.00 1.98 2.18 2.34 2.30 2.65 4.32 3.22 3.51 3.75 4.64 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 .................................... Cryoablate renal mass open .............................. Removal of kidney lesion ................................... Removal of kidney lesion ................................... Remove cadaver donor kidney .......................... Remove kidney, living donor .............................. Prep cadaver renal allograft ............................... Prep donor renal graft ........................................ Prep renal graft/venous ...................................... Prep renal graft/arterial ...................................... Prep renal graft/ureteral ..................................... Removal of kidney .............................................. Transplantation of kidney ................................... Transplantation of kidney ................................... Remove transplanted kidney .............................. Reimplantation of kidney .................................... Change ureter stent, percut ............................... Remove ureter stent, percut .............................. Change ext/int ureter stent ................................. Remove renal tube w/fluoro ............................... Drainage of kidney lesion ................................... Instll rx agnt into rnal tub ................................... Insert kidney drain .............................................. Insert ureteral tube ............................................. Injection for kidney x-ray .................................... Create passage to kidney .................................. Measure kidney pressure ................................... Change kidney tube ........................................... Revision of kidney/ureter .................................... Revision of kidney/ureter .................................... Repair of kidney wound ..................................... Close kidney-skin fistula ..................................... Repair renal-abdomen fistula ............................. Repair renal-abdomen fistula ............................. Revision of horseshoe kidney ............................ Laparo ablate renal cyst ..................................... Laparo ablate renal mass .................................. Laparo partial nephrectomy ............................... Laparoscopy, pyeloplasty ................................... Laparo radical nephrectomy ............................... Laparoscopic nephrectomy ................................ Laparo removal donor kidney ............................ Laparo remove w/ureter ..................................... Laparoscope proc, renal .................................... Kidney endoscopy .............................................. Kidney endoscopy .............................................. Kidney endoscopy & biopsy ............................... Kidney endoscopy & treatment .......................... Kidney endoscopy & treatment .......................... Renal scope w/tumor resect .............................. Kidney endoscopy .............................................. Kidney endoscopy .............................................. Kidney endoscopy & biopsy ............................... Kidney endoscopy .............................................. Malpractice RVUs 0.20 1.03 1.24 1.36 1.59 1.44 1.80 1.04 1.54 2.06 1.21 1.43 1.22 1.33 0.16 1.30 1.35 1.50 1.55 1.59 1.76 1.55 1.39 1.19 1.41 0.00 2.35 0.00 0.00 0.29 0.26 0.25 1.65 3.81 4.42 1.67 2.50 0.34 0.31 0.12 0.07 0.12 0.14 0.20 0.25 0.05 0.21 0.13 0.09 1.38 1.78 2.01 1.49 1.83 1.96 1.36 1.13 1.39 1.80 1.58 1.70 1.57 2.76 1.72 0.00 0.40 0.39 0.45 0.47 0.54 0.73 0.68 0.85 0.77 0.99 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00275 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 25.28 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA 0.00 0.00 NA NA NA NA NA NA NA NA 42.06 40.63 20.38 13.95 NA 3.68 NA NA 3.50 NA NA 17.91 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 10.14 10.74 11.79 11.67 13.21 NA NA NA NA NA Facility Total 4.67 22.77 23.29 28.47 28.44 29.96 37.02 22.02 32.09 25.93 23.88 24.91 25.66 28.27 4.08 17.61 25.72 29.86 32.18 32.81 36.85 32.55 30.54 23.54 22.59 0.00 35.21 0.00 0.00 5.64 4.94 4.72 20.29 50.80 59.41 22.53 35.28 7.71 7.02 2.79 1.54 2.72 2.73 5.09 6.19 1.47 5.08 3.30 2.07 28.74 34.72 29.95 26.13 33.09 35.82 29.60 23.61 29.51 37.48 32.49 34.87 30.40 39.35 35.28 0.00 7.97 8.55 9.31 9.38 10.77 15.95 13.43 14.69 15.52 19.59 Global 000 090 090 090 090 090 090 090 090 090 090 090 090 090 000 090 090 090 090 090 090 090 090 090 090 XXX 090 XXX XXX XXX XXX XXX 090 090 090 090 090 000 000 000 000 000 000 000 000 000 000 000 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY 000 000 000 000 000 090 000 000 000 000 70390 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 50576 50580 50590 50592 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 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 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 10.97 11.84 9.08 6.75 15.82 15.44 15.90 15.14 14.92 17.38 19.52 0.76 1.51 1.17 1.16 15.19 18.87 16.33 18.46 8.17 12.00 18.39 19.48 18.39 19.48 18.33 19.51 20.52 20.49 14.50 20.02 19.90 21.86 28.14 31.23 19.97 20.86 15.34 13.60 14.31 18.69 14.49 16.97 24.46 22.47 0.00 5.83 6.23 6.74 6.78 6.04 7.13 6.88 9.16 9.03 6.84 0.78 1.02 3.52 6.70 6.76 4.39 6.76 6.91 8.84 8.84 5.95 10.12 9.28 13.95 12.36 12.55 15.64 21.20 21.59 NA NA 12.43 149.45 NA NA NA NA NA NA NA 4.98 3.45 NA 1.83 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 4.30 4.41 6.43 4.57 4.37 NA NA NA NA NA 1.95 4.71 5.62 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 3.67 3.97 4.12 2.99 6.68 6.75 6.98 6.35 6.29 7.24 7.97 0.47 0.82 1.06 0.72 7.13 8.76 7.82 8.06 4.28 5.57 7.75 8.00 7.69 7.99 7.60 8.79 8.23 8.31 6.48 9.11 8.46 8.66 11.15 12.20 8.44 8.92 6.63 6.15 6.58 7.98 6.41 7.05 9.71 8.71 0.00 2.06 2.37 2.69 2.38 2.19 2.47 2.47 3.11 3.07 2.38 0.24 0.34 1.88 3.86 3.98 2.77 3.93 3.65 4.51 4.36 3.55 5.01 4.68 6.14 5.76 6.12 6.74 8.68 8.98 Kidney endoscopy & treatment .......................... Kidney endoscopy & treatment .......................... Fragmenting of kidney stone .............................. Perc rf ablate renal tumor .................................. 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/stent ............................... Injection for ureter x-ray ..................................... Revision of ureter ............................................... Release of ureter ................................................ Release of ureter ................................................ Release/revise ureter ......................................... Revise ureter ...................................................... Revise ureter ...................................................... Fusion of ureter & kidney ................................... Fusion of ureter & kidney ................................... Fusion of ureters ................................................ Splicing of ureters .............................................. Reimplant ureter in bladder ................................ Reimplant ureter in bladder ................................ Reimplant ureter in bladder ................................ Reimplant ureter in bladder ................................ Implant ureter in bowel ....................................... Fusion of ureter & bowel .................................... Urine shunt to intestine ...................................... Construct bowel bladder .................................... Construct bowel bladder .................................... Revise urine flow ................................................ Replace ureter by bowel .................................... Appendico-vesicostomy ...................................... Transplant ureter to skin .................................... Repair of ureter .................................................. Closure ureter/skin fistula ................................... Closure ureter/bowel fistula ................................ Release of ureter ................................................ Laparoscopy ureterolithotomy ............................ Laparo new ureter/bladder ................................. Laparo new ureter/bladder ................................. Laparoscope proc, ureter ................................... Endoscopy of ureter ........................................... Endoscopy of ureter ........................................... Ureter endoscopy & biopsy ................................ Ureter endoscopy & treatment ........................... Ureter endoscopy & treatment ........................... Ureter endoscopy ............................................... Ureter endoscopy & catheter ............................. Ureter endoscopy & biopsy ................................ Ureter endoscopy & treatment ........................... Ureter endoscopy & treatment ........................... Drainage of bladder ............................................ Drainage of bladder ............................................ Drainage of bladder ............................................ Incise & treat bladder ......................................... Incise & treat bladder ......................................... Incise & drain bladder ........................................ Incise bladder/drain ureter ................................. Removal of bladder stone .................................. Removal of ureter stone ..................................... Remove ureter calculus ..................................... Drainage of bladder abscess ............................. Removal of bladder cyst .................................... Removal of bladder lesion ................................. Removal of bladder lesion ................................. Removal of bladder lesion ................................. Repair of ureter lesion ........................................ Partial removal of bladder .................................. Partial removal of bladder .................................. Revise bladder & ureter(s) ................................. Malpractice RVUs 0.78 0.83 0.65 0.43 1.13 1.45 1.43 1.07 1.09 1.23 1.38 0.05 0.11 0.07 0.07 1.27 2.13 1.90 1.52 0.61 1.00 1.96 1.38 1.55 1.45 1.51 1.61 1.98 1.45 1.19 2.31 1.54 1.89 2.07 2.37 1.47 1.57 1.29 1.14 1.01 1.28 1.26 1.36 2.16 1.70 0.00 0.41 0.43 0.48 0.48 0.41 0.52 0.49 0.64 0.66 0.48 0.05 0.10 0.28 0.47 0.58 0.31 0.52 0.49 0.62 0.63 0.43 1.03 0.69 0.99 1.05 1.23 1.31 1.69 1.63 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00276 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA 22.16 156.63 NA NA NA NA NA NA NA 5.79 5.07 NA 3.06 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 10.54 11.07 13.65 11.83 10.82 NA NA NA NA NA 2.78 5.83 9.42 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 15.42 16.64 13.85 10.17 23.63 23.64 24.31 22.56 22.30 25.85 28.87 1.28 2.44 2.30 1.95 23.59 29.76 26.05 28.04 13.06 18.57 28.10 28.86 27.63 28.92 27.44 29.91 30.73 30.25 22.17 31.44 29.90 32.41 41.36 45.80 29.88 31.35 23.26 20.89 21.90 27.95 22.16 25.38 36.33 32.88 0.00 8.30 9.03 9.91 9.64 8.64 10.12 9.84 12.91 12.76 9.70 1.07 1.46 5.68 11.03 11.32 7.47 11.21 11.05 13.97 13.83 9.93 16.16 14.65 21.08 19.17 19.90 23.69 31.57 32.20 Global 000 000 090 010 090 090 090 090 090 090 090 000 000 010 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY 000 000 000 000 000 000 000 000 000 000 000 000 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70391 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 51570 51575 51580 51585 51590 51595 51596 51597 51600 51605 51610 51700 51701 51702 51703 51705 51710 51715 51720 51725 51725 51725 51726 51726 51726 51736 51736 51736 51741 51741 51741 51772 51772 51772 51784 51784 51784 51785 51785 51785 51792 51792 51792 51795 51795 51795 51797 51797 51797 51798 51800 51820 51840 51841 51845 51860 51865 51880 51900 51920 51925 51940 51960 51980 51990 51992 51999 52000 52001 52005 52007 52010 52204 52214 52224 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 24.20 30.40 31.03 35.18 32.61 37.08 39.46 38.29 0.88 0.64 1.05 0.88 0.50 0.50 1.47 1.02 1.49 3.73 1.96 1.51 0.00 1.51 1.71 0.00 1.71 0.61 0.00 0.61 1.14 0.00 1.14 1.61 0.00 1.61 1.53 0.00 1.53 1.53 0.00 1.53 1.10 0.00 1.10 1.53 0.00 1.53 1.60 0.00 1.60 0.00 17.39 17.86 10.69 13.01 9.72 12.00 15.02 7.65 12.95 11.79 15.56 28.39 22.98 11.34 12.48 13.99 0.00 2.01 5.44 2.37 3.02 3.02 2.37 3.70 3.14 NA NA NA NA NA NA NA NA 5.06 6.07 2.29 1.60 1.58 2.09 2.74 2.28 3.34 3.91 1.75 0.49 5.11 5.60 0.56 6.96 7.52 0.20 0.38 0.58 0.37 0.42 0.79 0.55 5.04 5.59 0.50 3.49 3.99 0.50 3.95 4.45 0.41 5.60 6.01 0.50 6.81 7.31 0.53 5.27 5.80 0.34 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 3.31 5.08 5.58 16.49 10.78 14.55 38.21 36.56 9.76 12.05 12.52 13.73 12.64 14.16 15.26 14.86 0.29 0.35 0.60 0.28 0.19 0.24 0.56 0.61 0.77 1.35 0.69 0.49 NA NA 0.56 NA NA 0.20 NA NA 0.37 NA NA 0.55 NA NA 0.50 NA NA 0.50 NA NA 0.41 NA NA 0.50 NA NA 0.53 NA NA NA 7.58 8.30 5.58 6.39 4.75 5.77 6.69 3.96 6.08 5.65 8.63 12.11 9.66 5.39 6.16 6.22 0.00 0.76 1.87 0.89 1.15 1.15 0.90 1.33 1.15 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 ...................................... Simple cystometrogram ...................................... Simple cystometrogram ...................................... Complex cystometrogram .................................. Complex cystometrogram .................................. Complex cystometrogram .................................. Urine flow measurement .................................... Urine flow measurement .................................... Urine flow measurement .................................... Electro-uroflowmetry, first ................................... Electro-uroflowmetry, first ................................... Electro-uroflowmetry, first ................................... Urethra pressure profile ..................................... Urethra pressure profile ..................................... Urethra pressure profile ..................................... Anal/urinary muscle study .................................. Anal/urinary muscle study .................................. Anal/urinary muscle study .................................. Anal/urinary muscle study .................................. Anal/urinary muscle study .................................. Anal/urinary muscle study .................................. Urinary reflex study ............................................ Urinary reflex study ............................................ Urinary reflex study ............................................ Urine voiding pressure study ............................. Urine voiding pressure study ............................. Urine voiding pressure study ............................. Intraabdominal pressure test .............................. Intraabdominal pressure test .............................. Intraabdominal pressure test .............................. Us urine capacity measure ................................ Revision of bladder/urethra ................................ Revision of urinary tract ..................................... Attach bladder/urethra ........................................ Attach bladder/urethra ........................................ Repair bladder neck ........................................... Repair of bladder wound .................................... Repair of bladder wound .................................... Repair of bladder opening .................................. Repair bladder/vagina lesion .............................. Close bladder-uterus fistula ............................... Hysterectomy/bladder repair .............................. Correction of bladder defect ............................... Revision of bladder & bowel .............................. Construct bladder opening ................................. Laparo urethral suspension ................................ Laparo sling operation ........................................ Laparoscope proc, bladder ................................ Cystoscopy ......................................................... Cystoscopy, removal of clots ............................. Cystoscopy & ureter catheter ............................. Cystoscopy and biopsy ...................................... Cystoscopy & duct catheter ............................... Cystoscopy ......................................................... Cystoscopy and treatment ................................. Cystoscopy and treatment ................................. Malpractice RVUs 1.71 2.16 2.24 2.48 2.27 2.59 2.77 2.81 0.06 0.04 0.07 0.06 0.04 0.04 0.10 0.07 0.11 0.29 0.14 0.12 0.04 0.16 0.13 0.05 0.18 0.05 0.01 0.06 0.09 0.02 0.11 0.15 0.05 0.20 0.12 0.04 0.16 0.11 0.04 0.15 0.07 0.13 0.20 0.12 0.10 0.22 0.12 0.05 0.17 0.08 1.32 1.74 1.06 1.24 0.79 1.16 1.23 0.72 1.21 1.18 2.03 2.14 1.63 0.86 1.39 1.41 0.00 0.14 0.39 0.17 0.22 0.21 0.17 0.26 0.22 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00277 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA 6.00 6.75 3.41 2.54 2.12 2.63 4.31 3.37 4.94 7.93 3.85 2.12 5.15 7.27 2.40 7.01 9.41 0.86 0.39 1.25 1.60 0.44 2.04 2.31 5.09 7.40 2.15 3.53 5.68 2.14 3.99 6.13 1.58 5.73 7.31 2.15 6.91 9.06 2.25 5.32 7.57 0.42 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 5.46 10.91 8.12 19.73 14.01 17.09 42.17 39.92 Facility Total 35.67 44.61 45.79 51.39 47.52 53.83 57.49 55.96 1.23 1.03 1.72 1.22 0.73 0.78 2.13 1.70 2.37 5.37 2.79 2.12 NA NA 2.40 NA NA 0.86 NA NA 1.60 NA NA 2.31 NA NA 2.15 NA NA 2.14 NA NA 1.58 NA NA 2.15 NA NA 2.25 NA NA NA 26.29 27.90 17.33 20.64 15.26 18.93 22.94 12.33 20.24 18.62 26.22 42.64 34.27 17.59 20.03 21.62 0.00 2.91 7.70 3.43 4.39 4.38 3.44 5.29 4.51 Global 090 090 090 090 090 090 090 090 000 000 000 000 000 000 000 010 010 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 XXX 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 YYY 000 000 000 000 000 000 000 000 70392 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 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 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 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 4.62 5.44 9.71 4.49 3.91 2.94 3.36 4.69 4.99 6.16 2.80 6.39 3.73 3.60 4.58 5.30 5.50 5.30 2.81 5.20 6.71 9.18 4.69 6.15 5.18 5.03 2.83 4.82 5.99 6.49 7.19 7.69 8.19 9.22 5.85 6.87 7.96 7.33 8.81 9.67 5.27 7.63 8.46 6.71 12.35 8.12 7.97 6.83 6.60 7.25 6.61 10.34 11.19 6.79 2.28 3.63 1.77 1.13 6.39 2.63 6.28 10.25 2.59 12.55 15.56 6.99 9.57 10.12 6.44 5.88 2.98 3.12 3.09 4.52 12.75 NA NA NA NA NA 13.38 11.06 15.60 NA NA 7.11 NA 3.95 4.02 NA NA NA NA 4.70 8.69 29.02 NA NA NA 31.90 38.93 5.76 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 74.15 NA NA NA NA 3.01 3.74 NA 2.09 NA NA 1.32 NA NA NA NA NA NA NA 2.25 2.72 2.21 NA NA 1.66 1.94 3.31 1.65 1.42 1.11 1.24 1.66 1.79 2.23 1.08 2.24 1.38 1.33 1.65 1.91 1.99 1.86 1.03 1.84 2.29 3.10 1.63 2.12 1.82 1.76 1.05 1.74 2.22 2.35 2.59 2.80 2.96 3.29 2.15 2.51 2.86 2.68 3.15 3.74 1.70 3.68 3.93 3.12 5.11 3.56 3.74 3.35 2.99 3.20 2.97 4.54 4.80 3.19 1.54 2.92 0.67 0.51 3.44 1.37 5.97 7.42 0.98 5.85 6.64 3.72 4.72 4.91 3.53 3.30 1.42 1.42 1.54 2.26 6.04 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, stricture tx ................................... Cysto/uretero w/up stricture ............................... Cystouretero w/renal strict ................................. Cystouretero & or pyeloscope ............................ Cystouretero w/stone remove ............................ Cystouretero w/lithotripsy ................................... Cystouretero w/biopsy ........................................ Cystouretero w/excise tumor .............................. Cystouretero w/congen repr ............................... Cystourethro cut ejacul duct .............................. Incision of prostate ............................................. Revision of bladder neck .................................... Dilation prostatic urethra .................................... Prostatectomy (TURP) ....................................... Control postop bleeding ..................................... Prostatectomy, first stage ................................... Prostatectomy, second stage ............................. Remove residual prostate .................................. Remove prostate regrowth ................................. Relieve bladder contracture ............................... Laser surgery of prostate ................................... Laser surgery of prostate ................................... Drainage of prostate abscess ............................ Incision of urethra ............................................... Incision of urethra ............................................... Incision of urethra ............................................... Incision of urethra ............................................... Drainage of urethra abscess .............................. Drainage of urethra abscess .............................. Drainage of urinary leakage ............................... Drainage of urinary leakage ............................... Biopsy of urethra ................................................ Removal of urethra ............................................. Removal of urethra ............................................. Treatment of urethra lesion ................................ Removal of urethra lesion .................................. Removal of urethra lesion .................................. Surgery for urethra pouch .................................. Removal of urethra gland ................................... Treatment of urethra lesion ................................ Treatment of urethra lesion ................................ Removal of urethra gland ................................... Repair of urethra defect ..................................... Revise urethra, stage 1 ...................................... Malpractice RVUs 0.33 0.39 0.69 0.32 0.28 0.22 0.24 0.33 0.35 0.44 0.20 0.45 0.26 0.26 0.32 0.38 0.46 0.38 0.20 0.37 0.48 0.65 0.33 0.44 0.37 0.36 0.21 0.35 0.43 0.46 0.51 0.55 0.58 0.65 0.41 0.49 0.57 0.52 0.63 0.68 0.40 0.54 0.60 0.48 0.87 0.57 0.56 0.48 0.47 0.51 0.47 0.73 0.79 0.48 0.16 0.24 0.13 0.08 0.45 0.28 0.52 0.92 0.20 0.89 1.10 0.49 0.73 0.72 0.52 0.49 0.25 0.24 0.30 0.32 0.98 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00278 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA 16.54 14.66 20.62 NA NA 10.11 NA 7.94 7.88 NA NA NA NA 7.71 14.26 36.21 NA NA NA 37.45 44.32 8.80 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 85.22 NA NA NA NA 4.91 4.95 NA 5.00 NA NA 4.11 NA NA NA NA NA NA NA 5.48 6.08 5.60 NA NA Facility Total 6.61 7.77 13.71 6.46 5.61 4.27 4.84 6.68 7.13 8.83 4.08 9.08 5.37 5.19 6.55 7.59 7.95 7.54 4.04 7.41 9.48 12.93 6.65 8.71 7.37 7.15 4.09 6.91 8.64 9.30 10.29 11.04 11.73 13.16 8.41 9.87 11.39 10.53 12.59 14.09 7.37 11.85 12.99 10.31 18.33 12.25 12.27 10.66 10.06 10.96 10.05 15.61 16.78 10.46 3.98 6.79 2.57 1.72 10.28 4.28 12.77 18.59 3.77 19.29 23.30 11.20 15.02 15.75 10.49 9.67 4.65 4.78 4.93 7.10 19.77 Global 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 090 000 090 090 090 090 090 090 090 090 090 090 090 090 090 010 090 000 000 090 010 090 090 000 090 090 090 090 090 090 090 010 010 010 010 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70393 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 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 54050 54055 54056 54057 54060 54065 54100 54105 54110 54111 54112 54115 54120 54125 54130 54135 54150 54152 54160 54161 54162 54163 54164 54200 54205 54220 54230 54231 54235 54240 54240 54240 54250 54250 54250 54300 54304 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 14.46 16.42 19.38 14.06 15.96 16.32 19.86 13.60 11.55 13.38 14.04 10.21 13.47 21.12 9.69 6.13 7.11 12.19 7.62 7.62 10.09 13.29 8.67 1.21 0.98 1.28 1.62 1.35 0.71 0.72 0.76 9.44 9.87 5.23 0.00 1.54 2.19 5.31 1.24 1.22 1.24 1.24 1.93 2.42 1.90 3.49 10.11 13.55 15.84 6.14 9.96 13.51 20.11 26.32 1.81 2.31 2.48 3.27 3.00 3.00 2.50 1.06 7.92 2.42 1.34 2.04 1.19 1.31 0.00 1.31 2.22 0.00 2.22 10.39 12.47 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 1.14 1.27 NA 2.00 2.08 1.31 1.30 NA 94.33 89.03 55.50 0.00 2.92 3.19 NA 1.66 1.57 1.69 2.22 3.11 2.64 2.81 4.29 NA NA NA 4.38 NA NA NA NA 4.36 NA 4.15 NA 4.66 NA NA 1.80 NA 3.85 1.08 1.37 0.96 0.43 0.60 1.03 0.71 0.20 0.91 NA NA 6.33 7.07 7.35 6.30 6.90 7.01 8.07 5.99 5.45 5.89 7.10 5.23 6.44 9.07 4.73 3.30 3.70 6.22 3.99 3.87 5.17 5.94 4.48 0.43 0.37 0.41 0.59 0.49 0.31 0.29 0.25 3.95 4.38 2.86 0.00 0.93 1.11 2.56 1.03 0.80 1.13 0.83 1.06 1.23 0.82 1.94 4.76 5.78 6.81 3.46 4.68 5.84 8.19 10.19 0.70 1.20 1.09 1.56 1.44 2.01 1.84 0.97 4.69 0.95 0.63 0.87 0.58 0.43 NA NA 0.71 NA NA 5.58 6.34 Revise urethra, stage 2 ...................................... Reconstruction of urethra ................................... Reconstruction of urethra ................................... Reconstruct urethra, stage 1 .............................. Reconstruct urethra, stage 2 .............................. Reconstruction of urethra ................................... Reconstruct urethra/bladder ............................... Male sling procedure .......................................... Remove/revise male sling .................................. Insert tandem cuff .............................................. Insert uro/ves nck sphincter ............................... Remove uro sphincter ........................................ Remove/replace ur sphincter ............................. Remov/replc ur sphinctr comp ........................... Repair uro sphincter ........................................... Revision of urethra ............................................. Revision of urethra ............................................. Urethrlys, transvag w/ scope .............................. Repair of urethra injury ...................................... Repair of urethra injury ...................................... Repair of urethra injury ...................................... Repair of urethra injury ...................................... Repair of urethra defect ..................................... Dilate urethra stricture ........................................ Dilate urethra stricture ........................................ Dilate urethra stricture ........................................ Dilate urethra stricture ........................................ Dilate urethra stricture ........................................ Dilation of urethra ............................................... Dilation of urethra ............................................... Dilation of urethra ............................................... Prostatic microwave thermotx ............................ Prostatic rf thermotx ........................................... Prostatic water thermother ................................. Urology surgery procedure ................................. Slitting of prepuce .............................................. Slitting of prepuce .............................................. Drain penis lesion ............................................... Destruction, penis lesion(s) ................................ Destruction, penis lesion(s) ................................ Cryosurgery, penis lesion(s) .............................. Laser surg, penis lesion(s) ................................. Excision of penis lesion(s) ................................. Destruction, penis lesion(s) ................................ Biopsy of penis ................................................... Biopsy of penis ................................................... Treatment of penis lesion ................................... Treat penis lesion, graft ..................................... Treat penis lesion, graft ..................................... Treatment of penis lesion ................................... Partial removal of penis ..................................... Removal of penis ............................................... Remove penis & nodes ...................................... Remove penis & nodes ...................................... Circumcision ....................................................... Circumcision ....................................................... Circumcision ....................................................... Circumcision ....................................................... Lysis penil circumic lesion .................................. Repair of circumcision ........................................ Frenulotomy of penis .......................................... Treatment of penis lesion ................................... Treatment of penis lesion ................................... Treatment of penis lesion ................................... Prepare penis study ........................................... Dynamic cavernosometry ................................... Penile injection ................................................... Penis study ......................................................... Penis study ......................................................... Penis study ......................................................... Penis study ......................................................... Penis study ......................................................... Penis study ......................................................... Revision of penis ................................................ Revision of penis ................................................ Malpractice RVUs 1.10 1.16 1.37 0.96 1.13 1.15 1.41 0.96 0.82 0.94 0.99 0.72 0.95 1.50 0.68 0.43 0.50 0.90 0.62 0.54 0.74 1.05 0.61 0.09 0.07 0.09 0.11 0.10 0.05 0.05 0.06 0.67 0.70 0.37 0.00 0.11 0.15 0.38 0.08 0.08 0.06 0.09 0.13 0.13 0.10 0.25 0.72 0.96 1.11 0.43 0.68 0.95 1.52 1.87 0.16 0.19 0.19 0.23 0.21 0.21 0.18 0.08 0.56 0.17 0.09 0.16 0.08 0.11 0.06 0.17 0.16 0.02 0.18 0.76 0.88 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00279 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 2.44 2.32 NA 3.73 3.53 2.07 2.07 NA 104.44 99.60 61.10 0.00 4.57 5.53 NA 2.98 2.87 2.99 3.55 5.17 5.19 4.81 8.03 NA NA NA 10.95 NA NA NA NA 6.33 NA 6.82 NA 7.87 NA NA 2.94 NA 6.44 2.51 3.57 2.23 1.85 0.66 2.51 3.09 0.22 3.31 NA NA Facility Total 21.89 24.65 28.10 21.32 23.99 24.48 29.34 20.55 17.82 20.21 22.13 16.16 20.86 31.69 15.10 9.86 11.31 19.31 12.23 12.03 16.00 20.28 13.76 1.73 1.42 1.78 2.32 1.94 1.07 1.06 1.07 14.06 14.95 8.46 0.00 2.58 3.45 8.25 2.35 2.10 2.43 2.16 3.12 3.78 2.82 5.68 15.59 20.29 23.76 10.03 15.32 20.30 29.82 38.38 2.67 3.70 3.76 5.06 4.65 5.22 4.52 2.11 13.17 3.54 2.06 3.07 1.85 1.85 NA NA 3.09 NA NA 16.73 19.69 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 000 000 000 000 000 000 000 090 090 090 YYY 010 010 010 010 010 010 010 010 010 000 010 090 090 090 090 090 090 090 090 000 010 010 010 010 010 010 010 090 000 000 000 000 000 000 000 000 000 000 090 090 70394 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 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 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 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 11.81 13.55 16.79 11.23 12.99 16.29 15.70 15.63 17.05 20.01 8.90 15.92 17.12 24.70 11.91 13.16 15.37 21.58 8.98 10.26 13.41 12.08 12.73 15.48 15.98 8.19 10.85 14.17 11.40 10.13 6.11 0.00 1.12 1.31 3.45 8.57 5.22 9.49 8.57 12.14 7.77 11.11 7.00 4.89 6.89 11.43 5.10 6.40 12.63 10.94 12.86 0.00 3.42 2.33 5.13 5.37 5.19 6.31 8.89 13.18 17.91 1.43 5.35 7.73 5.51 2.13 5.69 5.08 7.21 5.23 10.70 4.23 3.29 3.50 8.48 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 0.95 0.61 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA 0.94 NA NA NA NA NA NA NA 2.07 NA NA NA 3.68 NA NA NA NA NA 12.35 11.50 NA NA 5.97 7.00 7.96 5.80 6.47 7.97 7.79 7.26 7.74 10.31 5.04 7.76 8.36 11.20 6.04 6.62 8.27 9.43 4.35 5.74 5.93 5.43 5.74 6.63 7.05 4.20 5.38 6.18 5.58 5.11 3.62 0.00 0.44 0.56 1.92 4.13 2.79 4.87 4.24 5.55 3.81 5.16 3.55 2.44 3.74 5.41 3.00 3.54 6.16 4.94 5.44 0.00 1.94 0.90 2.94 3.02 2.78 3.31 4.31 5.80 7.53 0.65 2.90 3.97 3.08 1.56 3.13 2.95 3.84 3.01 5.37 2.38 2.22 1.31 4.06 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 ............................................. 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 .......................................... Malpractice RVUs 0.84 1.24 1.21 1.39 0.92 1.14 1.11 0.98 1.21 2.20 0.63 1.54 1.23 2.24 0.84 0.93 0.86 1.54 0.64 0.73 0.95 0.86 0.90 1.10 1.13 0.58 0.77 1.00 0.81 0.72 0.43 0.00 0.08 0.10 0.27 0.67 0.50 0.89 0.66 0.95 0.59 0.90 0.51 0.37 0.62 1.16 0.44 0.47 1.16 1.02 1.30 0.00 0.28 0.23 0.40 0.41 0.37 0.45 0.63 0.93 1.82 0.11 0.43 0.60 0.46 0.17 0.43 0.39 0.56 0.37 0.90 0.33 0.25 0.25 0.64 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00280 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 2.15 2.02 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA 3.50 NA NA NA NA NA NA NA 3.61 NA NA NA 5.98 NA NA NA NA NA 16.91 15.04 NA NA Facility Total 18.62 1.79 25.96 18.42 20.38 25.40 24.60 23.87 26.00 32.52 14.57 25.22 26.71 38.14 18.79 20.71 24.50 32.55 13.97 16.73 20.29 18.37 19.37 23.21 24.16 12.97 17.00 21.35 17.79 15.96 10.16 0.00 1.64 1.97 5.64 13.37 8.51 15.25 13.47 18.64 12.17 17.17 11.06 7.70 11.25 18.00 8.54 10.41 19.95 16.90 19.60 0.00 5.64 3.46 8.47 8.80 8.34 10.07 13.83 19.91 27.26 2.19 8.68 12.30 9.05 3.86 9.25 8.42 11.61 8.61 16.97 6.94 5.76 5.06 13.18 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 000 010 090 090 090 090 090 090 090 090 010 090 090 090 090 090 090 090 YYY 010 000 090 090 090 090 090 090 090 000 090 090 090 010 090 090 090 090 090 090 090 000 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70395 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 55450 55500 55520 55530 55535 55540 55550 55559 55600 55605 55650 55680 55700 55705 55720 55725 55801 55810 55812 55815 55821 55831 55840 55842 55845 55859 55860 55862 55865 55866 55870 55873 55899 55970 55980 56405 56420 56440 56441 56501 56515 56605 56606 56620 56625 56630 56631 56632 56633 56634 56637 56640 56700 56720 56740 56800 56805 56810 56820 56821 57000 57010 57020 57022 57023 57061 57065 57100 57105 57106 57107 57109 57110 57111 57112 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A C 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 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 4.11 5.58 6.02 5.65 6.55 7.66 6.56 0.00 6.37 7.95 11.78 5.18 1.57 4.56 7.63 8.67 17.77 22.55 27.47 30.41 14.23 15.60 22.66 24.34 28.51 12.50 14.43 18.36 22.84 30.69 2.58 19.44 0.00 0.00 0.00 1.44 1.39 2.84 1.97 1.53 2.76 1.10 0.55 7.46 8.39 12.34 16.18 20.26 16.45 17.85 21.94 22.14 2.52 0.68 4.56 3.88 18.83 4.12 1.50 2.05 2.97 6.02 1.50 2.56 4.74 1.25 2.61 1.20 1.69 6.35 22.97 26.96 14.27 26.96 28.96 7.01 NA NA NA NA NA NA 0.00 NA NA NA NA 4.20 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 1.53 NA 0.00 0.00 0.00 1.33 2.28 NA 1.82 1.79 2.55 1.07 0.49 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 1.31 1.76 NA NA 0.94 NA NA 1.65 2.30 1.08 1.80 NA NA NA NA NA NA 1.87 3.09 3.25 3.01 3.40 3.80 3.30 0.00 3.33 4.29 5.28 2.97 0.64 2.30 3.82 4.49 7.62 8.95 10.99 11.90 6.21 6.66 9.29 9.85 10.94 5.85 6.41 7.85 9.27 11.73 1.08 8.96 0.00 0.00 0.00 1.14 1.04 1.71 1.41 1.24 1.82 0.46 0.22 4.80 5.33 6.85 8.83 9.54 8.61 9.45 11.09 10.64 1.84 0.51 2.57 2.20 9.44 2.30 0.65 0.91 1.72 3.81 0.59 1.49 2.58 1.12 1.67 0.48 1.42 4.19 10.49 11.27 7.29 12.65 12.13 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 ................................. 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 ............................ Malpractice RVUs 0.29 0.55 0.75 0.45 0.47 0.94 0.57 0.00 0.62 0.64 0.92 0.47 0.11 0.32 0.95 0.70 1.34 1.60 2.04 2.16 1.01 1.10 1.61 1.72 2.02 0.89 1.02 1.49 1.63 2.16 0.16 1.38 0.00 0.00 0.00 0.17 0.16 0.34 0.20 0.18 0.33 0.13 0.07 0.90 1.02 1.49 1.95 2.38 1.97 2.16 2.60 2.88 0.30 0.08 0.56 0.44 2.14 0.49 0.18 0.25 0.31 0.71 0.18 0.26 0.58 0.15 0.31 0.14 0.20 0.73 2.71 3.21 1.73 3.17 3.07 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00281 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 11.41 NA NA NA NA NA NA 0.00 NA NA NA NA 5.88 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 4.27 NA 0.00 0.00 0.00 2.94 3.83 NA 3.99 3.50 5.64 2.30 1.11 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 2.99 4.06 NA NA 2.62 NA NA 3.05 5.22 2.42 3.69 NA NA NA NA NA NA Facility Total 6.27 9.22 10.02 9.11 10.42 12.40 10.43 0.00 10.32 12.88 17.98 8.62 2.32 7.18 12.40 13.86 26.73 33.10 40.50 44.47 21.45 23.36 33.56 35.91 41.47 19.24 21.86 27.70 33.74 44.58 3.82 29.78 0.00 0.00 0.00 2.75 2.59 4.89 3.58 2.95 4.91 1.69 0.84 13.16 14.74 20.68 26.96 32.18 27.03 29.46 35.63 35.66 4.66 1.27 7.69 6.52 30.41 6.91 2.33 3.21 5.00 10.54 2.27 4.31 7.90 2.52 4.59 1.82 3.31 11.27 36.17 41.44 23.29 42.78 44.16 Global 010 090 090 090 090 090 090 YYY 090 090 090 090 000 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 090 YYY XXX XXX 010 010 010 010 010 010 000 ZZZ 090 090 090 090 090 090 090 090 090 010 000 010 010 090 010 000 000 010 090 000 010 010 010 010 000 010 090 090 090 090 090 090 70396 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 57120 57130 57135 57150 57155 57160 57170 57180 57200 57210 57220 57230 57240 57250 57260 57265 57267 57268 57270 57280 57282 57283 57284 57287 57288 57289 57291 57292 57295 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 58110 58120 58140 58145 58146 58150 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 7.40 2.43 2.67 0.55 6.26 0.89 0.91 1.58 3.93 5.16 4.30 5.63 6.06 5.52 8.26 11.32 4.88 6.75 12.09 15.02 6.86 10.84 12.68 10.69 13.00 11.56 7.94 13.07 7.45 7.60 13.75 15.91 9.93 6.77 7.97 8.00 12.33 18.70 2.27 1.75 2.17 1.60 2.20 15.73 1.50 2.33 1.99 1.85 2.83 3.43 0.97 1.14 1.90 1.90 1.90 4.03 3.35 4.78 27.96 12.20 13.01 5.52 8.94 8.36 3.54 4.12 0.77 1.67 1.53 0.77 3.27 14.58 8.03 18.97 15.22 NA 2.16 2.27 1.10 NA 1.01 1.48 2.17 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 2.02 NA 1.35 1.85 NA 1.28 1.64 1.72 1.65 5.86 6.12 2.55 1.46 1.56 1.83 1.72 3.94 3.16 NA NA NA NA NA NA NA NA NA 0.76 1.47 1.32 0.55 2.31 NA NA NA NA 4.61 1.54 1.65 0.21 4.57 0.34 0.33 1.26 2.90 3.44 3.11 3.41 3.82 3.58 4.84 6.05 1.98 4.20 6.26 7.38 4.51 5.93 7.16 5.49 5.92 6.05 4.93 6.95 4.44 4.29 6.28 7.01 5.10 3.84 4.12 4.37 5.72 9.05 1.11 0.89 1.42 0.67 0.96 6.65 0.76 1.15 0.87 0.82 1.38 1.47 0.63 1.10 1.04 1.37 1.40 2.88 2.46 3.39 13.20 6.25 6.69 3.83 5.09 4.86 3.11 3.11 0.47 1.14 0.72 0.31 1.88 7.12 4.80 9.03 7.50 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 ................................................. Extensive repair of vagina .................................. Insert mesh/pelvic flr addon ............................... Repair of bowel bulge ........................................ Repair of bowel pouch ....................................... Suspension of vagina ......................................... Colpopexy, extraperitoneal ................................. Colpopexy, intraperitoneal .................................. Repair paravaginal defect .................................. Revise/remove sling repair ................................. Repair bladder defect ......................................... Repair bladder & vagina .................................... Construction of vagina ....................................... Construct vagina with graft ................................ Change vaginal graft .......................................... Repair rectum-vagina fistula .............................. Repair rectum-vagina fistula .............................. Fistula repair & colostomy .................................. Fistula repair, transperine .................................. Repair urethrovaginal lesion .............................. Repair urethrovaginal lesion .............................. Repair bladder-vagina lesion ............................. Repair bladder-vagina lesion ............................. Repair vagina ..................................................... Dilation of vagina ................................................ Pelvic examination ............................................. Remove vaginal foreign body ............................ Exam of vagina w/scope .................................... Exam/biopsy of vag w/scope ............................. Laparoscopy, surg, colpopexy ........................... Exam of cervix w/scope ..................................... Bx/curett of cervix w/scope ................................ Biopsy of cervix w/scope .................................... Endocerv curettage w/scope .............................. Bx of cervix w/scope, leep ................................. Conz of cervix w/scope, leep ............................. Biopsy of cervix .................................................. Endocervical curettage ....................................... Cauterization of cervix ........................................ Cryocautery of cervix ......................................... Laser surgery of cervix ....................................... Conization of cervix ............................................ Conization of cervix ............................................ Removal of cervix ............................................... Removal of cervix, radical .................................. Removal of residual cervix ................................. Remove cervix/repair pelvis ............................... Removal of residual cervix ................................. Remove cervix/repair vagina .............................. Remove cervix, repair bowel .............................. Revision of cervix ............................................... Revision of cervix ............................................... Dilation of cervical canal .................................... D & c of residual cervix ...................................... Biopsy of uterus lining ........................................ Bx done w/colposcopy add-on ........................... Dilation and curettage ........................................ Myomectomy abdom method ............................. Myomectomy vag method .................................. Myomectomy abdom complex ........................... Total hysterectomy ............................................. Malpractice RVUs 0.89 0.29 0.31 0.07 0.43 0.10 0.11 0.19 0.46 0.62 0.51 0.54 0.62 0.65 0.97 1.32 0.64 0.79 1.42 1.67 1.02 1.02 1.41 0.90 1.12 1.21 0.93 1.58 0.91 0.87 1.72 2.01 1.14 0.54 0.65 0.69 1.06 1.91 0.26 0.18 0.24 0.19 0.27 1.75 0.18 0.28 0.24 0.22 0.34 0.41 0.12 0.14 0.23 0.23 0.23 0.49 0.41 0.58 3.34 1.49 1.52 0.67 1.09 0.92 0.41 0.49 0.09 0.20 0.18 0.09 0.39 1.81 0.97 2.32 1.84 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00282 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA 4.88 5.25 1.72 NA 2.00 2.50 3.94 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 3.95 NA 3.14 4.32 NA 2.96 4.25 3.95 3.72 9.03 9.96 3.64 2.74 3.69 3.96 3.85 8.46 6.92 NA NA NA NA NA NA NA NA NA 1.62 3.34 3.03 1.41 5.97 NA NA NA NA Facility Total 12.90 4.26 4.63 0.83 11.26 1.33 1.35 3.03 7.29 9.22 7.92 9.58 10.50 9.75 14.07 18.69 7.50 11.74 19.77 24.07 12.39 17.79 21.25 17.08 20.04 18.82 13.80 21.60 12.80 12.76 21.75 24.93 16.17 11.15 12.74 13.06 19.11 29.66 3.64 2.82 3.83 2.46 3.43 24.13 2.44 3.76 3.10 2.89 4.55 5.31 1.72 2.38 3.17 3.50 3.53 7.40 6.22 8.75 44.50 19.94 21.22 10.02 15.12 14.14 7.06 7.72 1.33 3.01 2.43 1.17 5.54 23.51 13.80 30.32 24.56 Global 090 010 010 000 090 000 000 010 090 090 090 090 090 090 090 090 ZZZ 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 000 010 000 000 090 000 000 000 000 000 000 000 010 010 010 010 090 090 090 090 090 090 090 090 090 090 090 000 010 000 ZZZ 010 090 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70397 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 58152 58180 58200 58210 58240 58260 58262 58263 58267 58270 58275 58280 58285 58290 58291 58292 58293 58294 58300 58301 58321 58322 58323 58340 58345 58346 58350 58353 58356 58400 58410 58520 58540 58545 58546 58550 58552 58553 58554 58555 58558 58559 58560 58561 58562 58563 58565 58578 58579 58600 58605 58611 58615 58660 58661 58662 58670 58671 58672 58673 58679 58700 58720 58740 58750 58752 58760 58770 58800 58805 58820 58822 58823 58825 58900 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A N A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C A A A A A A A A A A A C A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 20.57 15.27 21.56 28.81 38.33 12.96 14.75 16.04 17.01 14.24 15.74 16.98 22.23 18.97 20.76 22.05 23.03 20.25 +1.01 1.27 0.92 1.10 0.23 0.88 4.65 6.74 1.01 3.55 6.36 6.35 12.71 11.90 14.62 14.58 18.97 14.17 15.98 18.97 21.97 3.33 4.74 6.16 6.99 9.99 5.20 6.16 7.02 0.00 0.00 5.59 4.99 1.45 3.89 11.27 11.03 11.77 5.59 5.59 12.86 13.72 0.00 12.03 11.34 13.98 14.82 14.82 13.11 13.95 4.13 5.87 4.21 10.11 3.37 10.96 5.98 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 1.42 1.32 1.15 1.20 0.53 3.17 NA NA 1.49 35.76 61.61 NA NA NA NA NA NA NA NA NA NA 2.20 NA NA NA NA NA 56.35 49.70 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA 3.65 NA NA NA 21.38 NA NA 9.88 7.47 10.02 13.23 17.66 6.71 7.40 7.90 8.39 7.08 7.79 8.27 9.97 9.15 9.90 10.39 10.68 9.58 0.38 0.48 0.37 0.42 0.09 0.65 2.44 3.93 0.92 2.06 2.70 3.94 6.45 6.05 6.97 7.20 8.94 7.31 8.03 8.94 10.42 1.55 2.18 2.74 3.09 4.29 2.36 2.76 3.91 0.00 0.00 3.34 3.12 0.57 2.71 5.27 5.13 5.80 3.28 3.28 6.20 6.59 0.00 6.00 5.79 7.15 7.38 6.96 6.73 6.92 2.91 3.51 3.30 5.23 1.12 5.81 3.58 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 ................................ Vag hyst w/urinary repair ................................... Vag hyst w/enterocele repair ............................. Hysterectomy/revise vagina ............................... Hysterectomy/revise vagina ............................... Extensive hysterectomy ..................................... Vag hyst complex ............................................... Vag hyst incl t/o, complex .................................. Vag hyst t/o & repair, compl .............................. Vag hyst w/uro repair, compl ............................. Vag hyst w/enterocele, compl ............................ Insert intrauterine device .................................... Remove intrauterine device ............................... Artificial insemination .......................................... Artificial insemination .......................................... Sperm washing ................................................... Catheter for hysterography ................................ Reopen fallopian tube ........................................ Insert heyman uteri capsule ............................... Reopen fallopian tube ........................................ Endometr ablate, thermal ................................... Endometrial cryoablation .................................... Suspension of uterus ......................................... Suspension of uterus ......................................... Repair of ruptured uterus ................................... Revision of uterus .............................................. Laparoscopic myomectomy ................................ Laparo-myomectomy, complex .......................... Laparo-asst vag hysterectomy ........................... Laparo-vag hyst incl t/o ...................................... Laparo-vag hyst, complex .................................. Laparo-vag hyst w/t/o, compl ............................. Hysteroscopy, dx, sep proc ................................ Hysteroscopy, biopsy ......................................... Hysteroscopy, lysis ............................................. Hysteroscopy, resect septum ............................. Hysteroscopy, remove myoma ........................... Hysteroscopy, remove fb ................................... Hysteroscopy, ablation ....................................... Hysteroscopy, sterilization .................................. Laparo proc, uterus ............................................ Hysteroscope procedure .................................... Division of fallopian tube .................................... Division of fallopian tube .................................... Ligate oviduct(s) add-on ..................................... Occlude fallopian tube(s) ................................... Laparoscopy, lysis .............................................. Laparoscopy, remove adnexa ............................ Laparoscopy, excise lesions .............................. Laparoscopy, tubal cautery ................................ Laparoscopy, tubal block ................................... Laparoscopy, fimbrioplasty ................................. Laparoscopy, salpingostomy .............................. Laparo proc, oviduct-ovary ................................. Removal of fallopian tube .................................. Removal of ovary/tube(s) ................................... Revise fallopian tube(s) ...................................... Repair oviduct .................................................... Revise ovarian tube(s) ....................................... Remove tubal obstruction .................................. Create new tubal opening .................................. Drainage of ovarian cyst(s) ................................ Drainage of ovarian cyst(s) ................................ Drain ovary abscess, open ................................ Drain ovary abscess, percut .............................. Drain pelvic abscess, percut .............................. Transposition, ovary(s) ....................................... Biopsy of ovary(s) .............................................. Malpractice RVUs 2.47 1.64 2.54 3.37 4.22 1.57 1.79 1.94 2.06 1.73 1.91 2.06 2.70 2.29 2.52 2.67 2.78 2.39 0.12 0.15 0.10 0.13 0.03 0.09 0.41 0.56 0.12 0.43 0.82 0.75 1.45 1.47 1.78 1.77 2.30 1.72 1.72 2.30 2.27 0.40 0.57 0.74 0.84 1.21 0.63 0.74 1.19 0.00 0.00 0.66 0.59 0.18 0.47 1.40 1.34 1.43 0.67 0.68 1.60 1.69 0.00 1.51 1.39 1.71 1.84 1.80 1.79 1.73 0.43 0.69 0.52 1.16 0.24 1.32 0.69 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00283 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 2.55 2.74 2.17 2.43 0.79 4.14 NA NA 2.62 39.74 68.79 NA NA NA NA NA NA NA NA NA NA 5.93 NA NA NA NA NA 63.25 57.91 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA 8.21 NA NA NA 24.99 NA NA Facility Total 32.92 24.38 34.12 45.41 60.21 21.24 23.94 25.88 27.46 23.05 25.44 27.31 34.90 30.41 33.18 35.11 36.49 32.22 1.51 1.90 1.39 1.65 0.35 1.62 7.50 11.23 2.05 6.04 9.88 11.04 20.61 19.42 23.37 23.55 30.21 23.20 25.73 30.21 34.66 5.28 7.49 9.64 10.92 15.49 8.19 9.66 12.12 0.00 0.00 9.59 8.70 2.20 7.07 17.94 17.50 19.00 9.54 9.55 20.66 22.00 0.00 19.54 18.52 22.84 24.04 23.58 21.63 22.60 7.47 10.07 8.03 16.50 4.73 18.09 10.25 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 XXX 000 000 000 000 000 010 090 010 010 010 090 090 090 090 090 090 090 090 090 090 000 000 000 000 000 000 000 090 YYY YYY 090 090 ZZZ 010 090 010 090 090 090 090 090 YYY 090 090 090 090 090 090 090 090 090 090 090 000 090 090 70398 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 58920 58925 58940 58943 58950 58951 58952 58953 58954 58956 58960 58970 58974 58976 58999 59000 59001 59012 59015 59020 59020 59020 59025 59025 59025 59030 59050 59051 59070 59072 59074 59076 59100 59120 59121 59130 59135 59136 59140 59150 59151 59160 59200 59300 59320 59325 59350 59400 59409 59410 59412 59414 59425 59426 59430 59510 59514 59515 59525 59610 59612 59614 59618 59620 59622 59812 59820 59821 59830 59840 59841 59850 59851 59852 59855 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... Status A A A A A A A A A A A A C A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A R R R R R R Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 11.34 11.34 7.28 18.40 16.90 22.35 24.97 31.95 34.95 20.78 14.63 3.52 0.00 3.82 0.00 1.30 3.00 3.44 2.20 0.66 0.00 0.66 0.53 0.00 0.53 1.99 0.89 0.74 5.24 8.99 5.24 8.99 12.33 11.47 11.65 14.20 13.86 13.16 5.45 11.65 11.47 2.71 0.79 2.41 2.48 4.06 4.94 23.03 13.48 14.76 1.71 1.61 4.80 8.27 2.13 26.18 15.95 17.34 8.53 24.58 15.04 16.32 27.74 17.50 18.90 4.00 4.00 4.46 6.10 3.01 5.23 5.90 5.92 8.23 6.11 NA NA NA NA NA NA NA NA NA NA NA 2.32 0.00 2.69 0.00 2.08 NA NA 1.55 0.26 0.52 0.78 0.21 0.23 0.44 NA NA NA 5.16 NA 4.58 NA NA NA NA NA NA NA 2.22 NA NA 3.30 1.19 2.18 NA NA NA NA NA NA NA NA 4.21 7.56 1.23 NA NA NA NA NA NA NA NA NA NA NA 4.43 4.28 NA NA 3.50 NA NA NA NA 5.59 5.70 4.11 8.67 8.42 10.47 11.78 14.58 15.75 10.34 7.37 1.49 0.00 1.83 0.00 0.67 1.41 1.54 1.04 0.26 NA NA 0.21 NA NA 0.77 0.35 0.29 2.32 3.13 2.32 3.13 6.47 6.26 6.34 4.80 7.24 6.62 2.22 6.01 6.07 2.14 0.30 0.96 1.24 1.90 1.88 15.36 5.32 6.32 0.81 0.64 1.86 3.23 0.94 17.31 6.23 7.85 3.31 15.91 6.07 6.95 18.28 6.78 8.66 2.55 3.57 3.41 3.99 2.13 2.98 3.26 3.75 5.05 3.55 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 contract stress test .................................... Fetal contract stress test .................................... Fetal non-stress test ........................................... Fetal non-stress test ........................................... Fetal non-stress test ........................................... Fetal scalp blood sample ................................... Fetal monitor w/report ........................................ Fetal monitor/interpret only ................................ Transabdom amnioinfus w/us ............................ Umbilical cord occlud w/us ................................. Fetal fluid drainage w/us .................................... Fetal shunt placement, w/us .............................. Remove uterus lesion ........................................ Treat ectopic pregnancy ..................................... Treat ectopic pregnancy ..................................... Treat ectopic pregnancy ..................................... Treat ectopic pregnancy ..................................... Treat ectopic pregnancy ..................................... Treat ectopic pregnancy ..................................... Treat ectopic pregnancy ..................................... Treat ectopic pregnancy ..................................... D & c after delivery ............................................ Insert cervical dilator .......................................... Episiotomy or vaginal repair ............................... Revision of cervix ............................................... Revision of cervix ............................................... Repair of uterus .................................................. Obstetrical care .................................................. Obstetrical care .................................................. Obstetrical care .................................................. Antepartum manipulation ................................... Deliver placenta .................................................. Antepartum care only ......................................... Antepartum care only ......................................... Care after delivery .............................................. Cesarean delivery .............................................. Cesarean delivery only ....................................... Cesarean delivery .............................................. Remove uterus after cesarean ........................... Vbac delivery ...................................................... Vbac delivery only .............................................. Vbac care after delivery ..................................... Attempted vbac delivery ..................................... Attempted vbac delivery only ............................. Attempted vbac after care .................................. Treatment of miscarriage ................................... Care of miscarriage ............................................ Treatment of miscarriage ................................... Treat uterus infection ......................................... Abortion .............................................................. Abortion .............................................................. Abortion .............................................................. Abortion .............................................................. Abortion .............................................................. Abortion .............................................................. Malpractice RVUs 1.43 1.41 0.91 2.22 2.04 2.63 3.02 3.83 4.17 4.00 1.79 0.43 0.00 0.47 0.00 0.31 0.71 0.82 0.52 0.16 0.10 0.26 0.13 0.02 0.15 0.47 0.21 0.17 0.28 0.16 0.28 0.16 2.94 2.72 2.78 3.38 3.30 3.13 1.29 2.78 2.73 0.64 0.19 0.57 0.59 0.88 1.17 5.48 3.21 3.51 0.40 0.38 1.14 1.97 0.50 6.23 3.79 4.12 1.94 5.85 3.58 3.88 6.59 4.16 4.49 0.95 0.95 1.06 1.44 0.71 1.24 1.28 1.28 1.80 1.45 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00284 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA 6.27 0.00 6.98 0.00 3.69 NA NA 4.27 1.08 0.62 1.70 0.87 0.25 1.12 NA NA NA 10.68 NA 10.10 NA NA NA NA NA NA NA 8.96 NA NA 6.65 2.17 5.16 NA NA NA NA NA NA NA NA 10.15 17.80 3.86 NA NA NA NA NA NA NA NA NA NA NA 9.38 9.80 NA NA 9.97 NA NA NA NA Facility Total 18.36 18.45 12.30 29.29 27.36 35.45 39.77 50.36 54.87 35.12 23.79 5.44 0.00 6.12 0.00 2.28 5.12 5.80 3.76 1.08 NA NA 0.87 NA NA 3.23 1.45 1.20 7.84 12.28 7.84 12.28 21.74 20.45 20.77 22.38 24.40 22.91 8.96 20.44 20.27 5.49 1.28 3.94 4.31 6.84 7.99 43.87 22.01 24.59 2.92 2.63 7.80 13.47 3.57 49.72 25.97 29.31 13.78 46.34 24.69 27.15 52.61 28.44 32.05 7.50 8.52 8.93 11.53 5.85 9.45 10.44 10.95 15.08 11.11 Global 090 090 090 090 090 090 090 090 090 090 090 000 000 000 YYY 000 000 000 000 000 000 000 000 000 000 000 XXX XXX 000 000 000 000 090 090 090 090 090 090 090 090 090 010 000 000 000 000 000 MMM MMM MMM MMM MMM MMM MMM MMM MMM MMM MMM ZZZ MMM MMM MMM MMM MMM MMM 090 090 090 090 010 010 090 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70399 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 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 61312 61313 61314 61315 61316 61320 61321 61322 61323 61330 61332 61333 61334 61340 61343 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... R R R A A C C C A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 7.47 9.28 3.99 6.00 2.13 0.00 0.00 0.00 1.76 0.97 1.56 9.54 10.86 16.01 11.88 14.17 16.04 20.54 26.95 17.44 20.24 16.80 5.86 8.52 16.21 20.32 21.46 4.44 16.78 18.84 23.06 17.00 19.85 17.90 20.21 19.97 0.00 0.00 1.58 1.49 1.51 1.69 1.51 2.10 0.89 5.13 4.99 10.17 8.75 15.88 17.54 12.40 14.97 16.30 5.83 4.88 10.40 12.34 21.93 26.57 24.53 24.89 24.19 27.64 1.39 25.58 28.46 29.46 30.95 23.29 27.24 27.91 18.24 18.63 29.73 NA NA NA NA 1.75 0.00 0.00 0.00 1.93 1.41 1.40 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 4.07 4.72 1.90 4.49 1.13 0.00 0.00 0.00 1.71 0.33 0.53 6.00 5.65 7.69 6.16 7.42 7.60 10.12 14.18 8.67 10.48 8.60 4.67 5.85 7.42 9.38 10.95 1.62 8.31 9.57 11.29 7.60 8.55 10.99 12.29 8.00 0.00 0.00 0.95 1.06 1.34 1.39 1.27 1.42 1.01 3.94 2.54 7.16 6.01 9.91 10.40 7.83 9.51 9.86 2.92 4.01 6.87 7.74 12.87 15.35 15.08 14.84 13.07 16.06 0.60 14.79 16.17 15.71 16.13 13.76 15.64 15.62 10.66 11.15 16.85 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 .................................. Open skull for drainage ...................................... Open skull for drainage ...................................... Open skull for drainage ...................................... Open skull for drainage ...................................... Implt cran bone flap to abdo .............................. Open skull for drainage ...................................... Open skull for drainage ...................................... Decompressive craniotomy ................................ Decompressive lobectomy ................................. Decompress eye socket ..................................... Explore/biopsy eye socket ................................. Explore orbit/remove lesion ................................ Explore orbit/remove object ............................... Subtemporal decompression .............................. Incise skull (press relief) .................................... Malpractice RVUs 1.78 2.01 0.87 1.42 0.50 0.00 0.00 0.00 0.15 0.07 0.10 1.01 1.23 1.94 1.32 1.64 1.85 2.29 2.60 1.93 2.32 1.74 0.54 0.73 2.00 2.53 2.64 0.53 2.19 2.81 3.26 1.74 2.07 2.19 2.49 2.28 0.00 0.00 0.13 0.16 0.34 0.33 0.11 0.17 0.17 1.32 1.29 2.63 2.09 4.11 4.31 3.00 4.20 4.22 1.50 1.26 2.76 2.61 5.61 6.07 6.34 6.43 6.26 7.14 0.35 6.60 7.12 7.61 8.01 2.31 4.82 3.91 1.74 4.83 7.62 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00285 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA 4.38 0.00 0.00 0.00 3.84 2.45 3.06 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 13.32 16.01 6.76 11.91 3.76 0.00 0.00 0.00 3.62 1.37 2.19 16.55 17.74 25.64 19.36 23.23 25.49 32.95 43.73 28.04 33.04 27.14 11.07 15.10 25.63 32.23 35.05 6.59 27.28 31.22 37.61 26.34 30.47 31.08 34.99 30.25 0.00 0.00 2.66 2.71 3.19 3.41 2.89 3.69 2.07 10.39 8.82 19.96 16.85 29.90 32.25 23.23 28.68 30.38 10.25 10.15 20.03 22.69 40.41 47.99 45.95 46.16 43.52 50.84 2.34 46.97 51.75 52.78 55.09 39.36 47.70 47.44 30.64 34.61 54.20 Global 090 090 000 090 000 YYY YYY YYY 010 000 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 ZZZ 090 090 090 090 090 090 090 090 YYY YYY 000 000 000 000 000 000 000 090 000 090 090 090 090 090 090 090 000 090 090 090 090 090 090 090 090 090 ZZZ 090 090 090 090 090 090 090 090 090 090 70400 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 61345 61440 61450 61458 61460 61470 61480 61490 61500 61501 61510 61512 61514 61516 61517 61518 61519 61520 61521 61522 61524 61526 61530 61531 61533 61534 61535 61536 61537 61538 61539 61540 61541 61542 61543 61544 61545 61546 61548 61550 61552 61556 61557 61558 61559 61563 61564 61566 61567 61570 61571 61575 61576 61580 61581 61582 61583 61584 61585 61586 61590 61591 61592 61595 61596 61597 61598 61600 61601 61605 61606 61607 61608 61609 61610 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 27.16 26.59 25.91 27.25 28.35 26.02 26.45 25.62 17.89 14.82 28.41 35.04 25.22 24.57 1.38 37.26 41.33 54.76 44.41 29.41 27.82 52.09 43.79 14.61 19.68 20.94 11.61 35.47 24.96 26.77 32.03 29.96 28.81 30.97 29.18 25.46 43.73 31.25 21.50 14.63 19.53 22.23 22.35 25.54 32.74 26.79 33.78 30.95 35.45 24.56 26.35 34.31 52.35 30.30 34.55 31.61 36.16 34.60 38.55 25.06 41.72 43.61 39.58 29.53 35.58 37.90 33.36 25.81 27.85 29.29 38.77 36.22 42.04 9.88 29.63 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 15.43 14.24 14.32 15.55 16.46 13.89 15.31 14.36 10.83 9.23 16.74 19.73 14.47 14.30 0.64 21.15 22.71 30.41 24.28 16.46 15.71 29.57 25.12 9.15 11.56 12.12 7.44 19.84 14.78 15.35 17.81 17.29 16.25 17.87 16.43 13.86 24.28 17.54 12.82 6.95 9.14 11.39 13.66 14.23 19.37 15.28 18.33 17.82 20.73 13.95 15.18 19.69 34.83 25.65 23.51 27.38 25.18 24.59 26.57 22.65 28.70 29.61 26.58 22.41 24.51 23.06 23.30 19.83 20.55 22.02 25.22 23.85 26.66 4.86 13.18 Relieve cranial pressure ..................................... Incise skull for surgery ....................................... Incise skull for surgery ....................................... Incise skull for brain wound ............................... Incise skull for surgery ....................................... Incise skull for surgery ....................................... Incise skull for surgery ....................................... Incise skull for surgery ....................................... Removal of skull lesion ...................................... Remove infected skull bone ............................... Removal of brain lesion ..................................... Remove brain lining lesion ................................. Removal of brain abscess .................................. Removal of brain lesion ..................................... Implt brain chemotx add-on ............................... Removal of brain lesion ..................................... Remove brain lining lesion ................................. Removal of brain lesion ..................................... Removal of brain lesion ..................................... Removal of brain abscess .................................. Removal of brain lesion ..................................... Removal of brain lesion ..................................... Removal of brain lesion ..................................... Implant brain electrodes ..................................... Implant brain electrodes ..................................... Removal of brain lesion ..................................... Remove brain electrodes ................................... Removal of brain lesion ..................................... Removal of brain tissue ..................................... Removal of brain tissue ..................................... Removal of brain tissue ..................................... Removal of brain tissue ..................................... Incision of brain tissue ....................................... Removal of brain tissue ..................................... Removal of brain tissue ..................................... Remove & treat brain lesion .............................. Excision of brain tumor ...................................... Removal of pituitary gland ................................. Removal of pituitary gland ................................. Release of skull seams ...................................... Release of skull seams ...................................... Incise skull/sutures ............................................. Incise skull/sutures ............................................. Excision of skull/sutures ..................................... Excision of skull/sutures ..................................... Excision of skull tumor ....................................... Excision of skull tumor ....................................... Removal of brain tissue ..................................... Incision of brain tissue ....................................... Remove foreign body, brain ............................... Incise skull for brain wound ............................... Skull base/brainstem surgery ............................. Skull base/brainstem surgery ............................. Craniofacial approach, skull ............................... Craniofacial approach, skull ............................... Craniofacial approach, skull ............................... Craniofacial approach, skull ............................... Orbitocranial approach/skull ............................... Orbitocranial approach/skull ............................... Resect nasopharynx, skull ................................. Infratemporal approach/skull .............................. Infratemporal approach/skull .............................. Orbitocranial approach/skull ............................... Transtemporal approach/skull ............................ Transcochlear approach/skull ............................ Transcondylar approach/skull ............................ Transpetrosal approach/skull ............................. Resect/excise cranial lesion ............................... Resect/excise cranial lesion ............................... Resect/excise cranial lesion ............................... Resect/excise cranial lesion ............................... Resect/excise cranial lesion ............................... Resect/excise cranial lesion ............................... Transect artery, sinus ......................................... Transect artery, sinus ......................................... Malpractice RVUs 7.02 6.88 5.77 7.01 6.02 5.88 6.71 6.90 4.10 3.21 7.33 9.05 6.52 6.33 0.35 9.62 10.60 11.18 11.36 7.60 7.14 7.05 6.13 3.78 5.10 5.42 3.01 9.18 6.92 6.92 8.30 8.30 6.58 8.01 7.54 5.95 10.60 7.65 3.42 0.98 1.06 4.64 5.78 1.36 8.48 5.15 8.75 6.92 6.52 5.86 6.77 5.32 5.56 3.36 3.91 7.19 9.18 8.16 7.01 4.36 5.29 5.64 10.04 3.97 3.39 8.81 5.68 3.78 6.61 2.85 8.94 6.88 10.72 2.55 7.66 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00286 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 49.61 47.71 46.00 49.81 50.83 45.79 48.47 46.88 32.82 27.26 52.48 63.82 46.21 45.20 2.37 68.03 74.64 96.35 80.05 53.47 50.67 88.71 75.04 27.54 36.34 38.48 22.06 64.49 46.66 49.04 58.14 55.55 51.64 56.85 53.15 45.27 78.61 56.44 37.74 22.56 29.73 38.26 41.79 41.13 60.59 47.22 60.86 55.69 62.70 44.37 48.30 59.32 92.74 59.31 61.97 66.18 70.52 67.35 72.13 52.07 75.71 78.86 76.20 55.91 63.48 69.77 62.34 49.42 55.01 54.16 72.93 66.95 79.42 17.29 50.47 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 ZZZ 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 ZZZ ZZZ Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70401 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 61611 61612 61613 61615 61616 61618 61619 61623 61624 61626 61630 61635 61640 61641 61642 61680 61682 61684 61686 61690 61692 61697 61698 61700 61702 61703 61705 61708 61710 61711 61720 61735 61750 61751 61760 61770 61790 61791 61793 61795 61850 61860 61863 61864 61867 61868 61870 61875 61880 61885 61886 61888 62000 62005 62010 62100 62115 62116 62117 62120 62121 62140 62141 62142 62143 62145 62146 62147 62148 62160 62161 62162 62163 62164 62165 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A N N N N N A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 7.41 27.84 40.80 32.02 43.27 16.96 20.68 9.95 20.12 16.60 0.00 0.00 0.00 0.00 0.00 30.66 61.48 39.75 64.39 29.27 51.79 50.44 48.34 50.44 48.34 17.44 36.15 35.25 29.63 36.28 16.74 20.40 18.17 17.59 22.24 21.41 10.84 14.59 17.21 4.03 12.37 20.84 18.97 4.49 31.29 7.91 14.92 15.04 6.28 5.84 7.99 5.06 12.51 16.15 19.78 22.00 21.63 23.55 26.56 23.31 21.55 13.49 14.89 10.77 13.03 18.79 16.10 19.31 2.00 3.00 19.97 25.21 15.48 27.46 21.97 NA NA NA NA NA NA NA NA NA NA 0.00 0.00 0.00 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 3.83 13.35 26.34 22.79 28.73 10.47 12.28 4.09 6.91 5.53 0.00 0.00 0.00 0.00 0.00 17.48 32.30 22.06 34.82 16.77 27.55 28.09 26.77 27.88 26.11 10.49 19.31 15.19 13.68 19.86 10.00 12.20 10.64 10.85 8.74 12.29 5.93 8.94 10.15 2.04 7.69 12.09 11.80 2.29 18.07 4.02 9.73 8.59 4.58 5.32 6.37 3.68 5.53 8.82 11.74 12.82 11.67 13.40 15.41 18.53 15.49 8.34 9.07 7.01 8.06 10.92 9.66 11.33 0.86 1.53 12.13 14.89 9.95 14.99 13.42 Transect artery, sinus ......................................... Transect artery, sinus ......................................... Remove aneurysm, sinus ................................... Resect/excise lesion, skull ................................. Resect/excise lesion, skull ................................. Repair dura ......................................................... Repair dura ......................................................... Endovasc tempory vessel occl ........................... Transcath occlusion, cns .................................... Transcath occlusion, non-cns ............................ Intracranial angioplasty ...................................... Intracran angioplsty w/stent ............................... Dilate ic vasospasm, init .................................... Dilate ic vasospasm add-on ............................... Dilate ic vasospasm add-on ............................... 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, addl ................................ Implant neuroelectrode ....................................... Implant neuroelectrde, add’l ............................... Implant neuroelectrodes ..................................... Implant neuroelectrodes ..................................... Revise/remove neuroelectrode .......................... Insrt/redo neurostim 1 array ............................... Implant neurostim arrays .................................... Revise/remove neuroreceiver ............................ Treat skull fracture ............................................. Treat skull fracture ............................................. Treatment of head injury .................................... Repair brain fluid leakage .................................. Reduction of skull defect .................................... Reduction of skull defect .................................... Reduction of skull defect .................................... Repair skull cavity lesion .................................... Incise skull repair ............................................... Repair of skull defect ......................................... Repair of skull defect ......................................... Remove skull plate/flap ...................................... Replace skull plate/flap ...................................... Repair of skull & brain ........................................ Repair of skull with graft .................................... Repair of skull with graft .................................... Retr bone flap to fix skull ................................... Neuroendoscopy add-on .................................... Dissect brain w/scope ........................................ Remove colloid cyst w/scope ............................. Neuroendoscopy w/fb removal ........................... Remove brain tumor w/scope ............................ Remove pituit tumor w/scope ............................. Malpractice RVUs 1.88 4.30 8.42 4.72 8.24 3.71 3.94 1.05 1.95 1.24 0.00 0.00 0.00 0.00 0.00 7.93 15.85 10.28 16.66 6.92 13.39 12.81 12.50 12.98 10.76 4.05 8.84 2.50 4.51 9.39 2.78 2.72 4.71 4.55 5.40 3.54 2.81 3.39 4.45 0.79 3.21 4.94 5.41 5.41 5.41 5.41 3.86 2.94 1.66 1.59 1.96 1.33 1.06 3.86 5.12 4.83 5.49 6.09 4.52 2.99 4.16 3.46 3.75 2.72 3.36 4.49 3.61 4.31 0.48 0.77 5.17 5.89 4.00 5.36 3.00 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00287 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA 0.00 0.00 0.00 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 13.12 45.49 75.56 59.53 80.24 31.14 36.90 15.09 28.98 23.37 0.00 0.00 0.00 0.00 0.00 56.07 109.63 72.09 115.87 52.96 92.73 91.34 87.61 91.30 85.21 31.98 64.30 52.94 47.82 65.53 29.52 35.32 33.52 32.99 36.38 37.24 19.58 26.92 31.81 6.86 23.27 37.87 36.18 12.19 54.77 17.34 28.51 26.57 12.52 12.75 16.32 10.07 19.10 28.83 36.64 39.65 38.79 43.04 46.49 44.83 41.20 25.29 27.71 20.50 24.45 34.20 29.37 34.95 3.34 5.30 37.27 45.99 29.43 47.81 38.39 Global ZZZ ZZZ 090 090 090 090 090 000 000 000 090 090 000 ZZZ ZZZ 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 ZZZ 090 090 090 ZZZ 090 ZZZ 090 090 090 090 090 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 ZZZ ZZZ 090 090 090 090 090 70402 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 62180 62190 62192 62194 62200 62201 62220 62223 62225 62230 62252 62252 62252 62256 62258 62263 62264 62268 62269 62270 62272 62273 62280 62281 62282 62284 62287 62290 62291 62292 62294 62310 62311 62318 62319 62350 62351 62355 62360 62361 62362 62365 62367 62368 63001 63003 63005 63011 63012 63015 63016 63017 63020 63030 63035 63040 63042 63043 63044 63045 63046 63047 63048 63050 63051 63055 63056 63057 63064 63066 63075 63076 63077 63078 63081 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 21.03 11.05 12.23 5.02 18.29 14.84 12.98 12.85 5.40 10.52 0.74 0.00 0.74 6.59 14.52 6.13 4.42 4.73 5.01 1.13 1.35 2.15 2.63 2.66 2.33 1.54 8.07 3.00 2.91 7.85 11.81 1.91 1.54 2.04 1.87 6.86 9.99 5.44 2.62 5.41 7.03 5.41 0.48 0.75 15.80 15.93 14.90 14.50 15.38 19.32 19.17 15.92 14.79 11.98 3.15 18.78 17.44 0.00 0.00 16.48 15.78 14.59 3.26 20.75 24.25 21.96 20.33 5.25 24.57 3.26 19.38 4.04 21.41 3.28 23.69 NA NA NA NA NA NA NA NA NA NA 0.37 1.10 1.47 NA NA 12.73 7.75 11.56 14.72 3.00 3.62 2.72 6.95 5.67 8.38 4.97 NA 7.15 5.95 NA NA 4.82 4.93 5.74 4.99 NA NA NA NA NA NA NA 0.61 0.69 NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 12.32 7.10 7.64 2.44 10.87 9.47 8.00 8.26 4.10 6.50 0.37 NA NA 4.70 8.74 3.20 1.42 2.15 1.98 0.56 0.71 0.71 1.01 0.89 0.92 0.68 5.57 1.38 1.23 4.48 5.60 0.65 0.59 0.65 0.61 3.95 7.14 3.17 2.69 3.93 4.37 3.59 0.10 0.17 9.54 9.89 10.00 8.29 10.15 11.90 11.81 10.42 9.70 8.44 1.59 11.53 11.37 0.00 0.00 10.38 10.21 9.92 1.66 11.87 13.51 13.17 12.60 2.64 14.46 1.66 12.12 2.06 12.83 1.64 14.36 Establish brain cavity shunt ............................... Establish brain cavity shunt ............................... Establish brain cavity shunt ............................... Replace/irrigate catheter .................................... Establish brain cavity shunt ............................... Brain cavity shunt w/scope ................................ Establish brain cavity shunt ............................... Establish brain cavity shunt ............................... Replace/irrigate catheter .................................... Replace/revise brain shunt ................................. Csf shunt reprogram .......................................... Csf shunt reprogram .......................................... Csf shunt reprogram .......................................... Remove brain cavity shunt ................................. Replace brain cavity shunt ................................. Epidural lysis mult sessions ............................... Epidural lysis on single day ............................... Drain spinal cord cyst ......................................... Needle biopsy, spinal cord ................................. Spinal fluid tap, diagnostic ................................. Drain cerebro spinal fluid ................................... Inject epidural patch ........................................... Treat spinal cord lesion ...................................... Treat spinal cord lesion ...................................... Treat spinal canal lesion .................................... Injection for myelogram ...................................... Percutaneous diskectomy .................................. Inject for spine disk x-ray ................................... Inject for spine disk x-ray ................................... Injection into disk lesion ..................................... Injection into spinal artery .................................. Inject spine c/t .................................................... Inject spine l/s (cd) ............................................. Inject spine w/cath, c/t ........................................ Inject spine w/cath l/s (cd) ................................. Implant spinal canal cath ................................... Implant spinal canal cath ................................... Remove spinal canal catheter ............................ Insert spine infusion device ................................ Implant spine infusion pump .............................. Implant spine infusion pump .............................. Remove spine infusion device ........................... Analyze spine infusion pump ............................. Analyze spine infusion pump ............................. Removal of spinal lamina ................................... Removal of spinal lamina ................................... Removal of spinal lamina ................................... Removal of spinal lamina ................................... Removal of spinal lamina ................................... Removal of spinal lamina ................................... Removal of spinal lamina ................................... Removal of spinal lamina ................................... Neck spine disk surgery ..................................... Low back disk surgery ....................................... Spinal disk surgery add-on ................................ Laminotomy, single cervical ............................... Laminotomy, single lumbar ................................ Laminotomy, add’l cervical ................................. Laminotomy, add’l lumbar .................................. Removal of spinal lamina ................................... Removal of spinal lamina ................................... Removal of spinal lamina ................................... Remove spinal lamina add-on ........................... Cervical laminoplasty ......................................... C-laminoplasty w/graft/plate ............................... Decompress spinal cord ..................................... Decompress spinal cord ..................................... Decompress spine cord add-on ......................... Decompress spinal cord ..................................... Decompress spine cord add-on ......................... Neck spine disk surgery ..................................... Neck spine disk surgery ..................................... Spine disk surgery, thorax ................................. Spine disk surgery, thorax ................................. Removal of vertebral body ................................. Malpractice RVUs 4.97 2.79 3.01 0.92 4.64 3.67 3.34 3.13 1.39 2.70 0.19 0.02 0.21 1.71 3.73 0.41 0.27 0.43 0.37 0.08 0.18 0.13 0.30 0.19 0.17 0.13 0.58 0.23 0.26 0.82 1.24 0.12 0.09 0.12 0.11 1.02 2.24 0.71 0.34 0.80 1.18 0.86 0.03 0.06 3.76 3.72 3.34 3.37 3.48 4.75 4.58 3.63 3.71 3.00 0.79 4.67 4.25 0.00 0.00 3.98 3.55 3.23 0.72 4.66 4.66 5.27 4.75 1.22 5.69 0.69 4.62 0.96 3.98 0.66 5.54 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00288 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA 1.30 1.12 2.42 NA NA 19.27 12.44 16.72 20.10 4.21 5.15 5.00 9.88 8.52 10.88 6.64 NA 10.38 9.12 NA NA 6.85 6.56 7.90 6.97 NA NA NA NA NA NA NA 1.12 1.50 NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 38.32 20.94 22.88 8.38 33.80 27.98 24.32 24.24 10.89 19.72 1.30 NA NA 13.00 26.99 9.74 6.11 7.31 7.36 1.77 2.24 2.99 3.94 3.74 3.42 2.35 14.22 4.61 4.40 13.15 18.65 2.68 2.22 2.81 2.59 11.83 19.37 9.32 5.65 10.14 12.58 9.86 0.61 0.98 29.10 29.54 28.24 26.16 29.01 35.97 35.56 29.97 28.20 23.42 5.53 34.98 33.06 0.00 0.00 30.84 29.54 27.74 5.64 37.28 42.42 40.40 37.68 9.11 44.72 5.61 36.12 7.06 38.22 5.58 43.59 Global 090 090 090 010 090 090 090 090 090 090 XXX XXX XXX 090 090 010 010 000 000 000 000 000 010 010 010 000 090 000 000 090 090 000 000 000 000 090 090 090 090 090 090 090 XXX XXX 090 090 090 090 090 090 090 090 090 090 ZZZ 090 090 ZZZ ZZZ 090 090 090 ZZZ 090 090 090 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70403 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 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 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 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 4.36 26.88 3.19 35.52 4.32 28.12 3.03 31.95 31.95 4.82 19.80 17.63 21.96 18.24 20.47 15.02 17.42 17.51 19.16 18.81 22.27 21.08 25.34 26.85 19.15 40.70 41.14 41.13 21.53 22.27 17.92 18.49 26.76 26.88 25.28 24.25 23.64 23.41 20.80 20.53 28.31 28.01 26.35 24.96 35.95 35.58 36.64 37.32 5.25 24.39 27.56 27.77 30.45 30.28 31.98 32.17 31.58 5.24 14.00 8.72 16.26 6.73 10.27 6.15 7.03 5.38 16.51 18.45 21.15 24.07 11.24 14.30 14.05 11.34 8.24 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 59.85 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 2.23 15.51 1.59 19.51 2.18 16.08 1.46 19.33 19.33 2.51 11.89 10.67 12.84 11.01 10.98 8.11 10.16 10.50 11.74 11.07 13.42 12.24 8.45 15.07 11.32 19.98 22.65 22.29 12.80 13.21 11.10 10.39 15.50 15.61 14.72 14.37 13.80 13.71 12.55 12.42 16.35 16.21 15.36 14.69 19.99 19.95 20.47 20.64 2.15 14.33 15.59 15.89 16.95 17.31 18.09 17.84 16.85 2.61 5.41 2.26 9.29 3.18 6.91 3.62 4.15 3.56 10.33 11.06 12.95 13.61 7.72 9.42 9.06 7.36 4.76 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 ..................................... Excise intraspinal lesion ..................................... Excise intraspinal lesion ..................................... Excise intraspinal lesion ..................................... Excise intraspinal lesion ..................................... Excise intraspinal lesion ..................................... Biopsy/excise spinal tumor ................................. Biopsy/excise spinal tumor ................................. Biopsy/excise spinal tumor ................................. Biopsy/excise spinal tumor ................................. Biopsy/excise spinal tumor ................................. Biopsy/excise spinal tumor ................................. Biopsy/excise spinal tumor ................................. Biopsy/excise spinal tumor ................................. Biopsy/excise spinal tumor ................................. Biopsy/excise spinal tumor ................................. Biopsy/excise spinal tumor ................................. Biopsy/excise spinal tumor ................................. Repair of laminectomy defect ............................ Removal of vertebral body ................................. Removal of vertebral body ................................. Removal of vertebral body ................................. Removal of vertebral body ................................. Removal of vertebral body ................................. Removal of vertebral body ................................. Removal of vertebral body ................................. Removal of vertebral body ................................. Remove vertebral body add-on .......................... Remove spinal cord lesion ................................. Stimulation of spinal cord ................................... Remove lesion of spinal cord ............................. Implant neuroelectrodes ..................................... Implant neuroelectrodes ..................................... Revise/remove neuroelectrode .......................... Insrt/redo spine n generator ............................... Revise/remove neuroreceiver ............................ Repair of spinal herniation ................................. Repair of spinal herniation ................................. Repair of spinal herniation ................................. Repair of spinal herniation ................................. Repair spinal fluid leakage ................................. Repair spinal fluid leakage ................................. Graft repair of spine defect ................................ Install spinal shunt .............................................. Install spinal shunt .............................................. Malpractice RVUs 1.02 4.48 0.59 6.20 0.82 4.21 0.48 5.69 5.69 0.69 4.86 4.48 5.68 3.95 5.30 2.79 3.24 6.34 3.26 4.87 5.76 5.36 6.43 1.40 4.96 9.01 10.41 10.64 5.43 5.54 4.37 3.69 6.82 6.90 6.18 5.74 5.80 5.83 5.01 4.55 7.27 7.17 6.76 6.26 9.18 9.21 9.39 9.02 1.03 5.97 5.39 5.53 4.68 6.41 5.71 8.33 4.46 1.29 1.52 0.86 2.84 0.53 2.43 0.78 1.05 0.89 3.52 4.12 4.57 6.23 2.51 3.09 3.40 2.93 1.66 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00289 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 69.43 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 7.61 46.87 5.37 61.23 7.32 48.41 4.97 56.97 56.97 8.02 36.55 32.78 40.48 33.20 36.75 25.92 30.82 34.35 34.16 34.75 41.45 38.68 40.22 43.32 35.43 69.69 74.20 74.06 39.76 41.02 33.39 32.57 49.08 49.39 46.18 44.36 43.24 42.95 38.36 37.50 51.93 51.39 48.47 45.91 65.12 64.74 66.50 66.98 8.43 44.69 48.54 49.19 52.08 54.00 55.78 58.34 52.89 9.14 20.93 11.84 28.39 10.44 19.61 10.55 12.23 9.83 30.36 33.63 38.67 43.91 21.47 26.81 26.51 21.63 14.66 Global ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 090 ZZZ 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 ZZZ 090 090 090 090 090 090 090 090 ZZZ 090 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 70404 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 63744 63746 64400 64402 64405 64408 64410 64412 64413 64415 64416 64417 64418 64420 64421 64425 64430 64435 64445 64446 64447 64448 64449 64450 64470 64472 64475 64476 64479 64480 64483 64484 64505 64508 64510 64517 64520 64530 64550 64553 64555 64560 64561 64565 64573 64575 64577 64580 64581 64585 64590 64595 64600 64605 64610 64612 64613 64614 64620 64622 64623 64626 64627 64630 64640 64650 64653 64680 64681 64702 64704 64708 64712 64713 64714 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 8.09 6.42 1.11 1.25 1.32 1.41 1.43 1.18 1.40 1.48 3.49 1.44 1.32 1.18 1.68 1.75 1.46 1.45 1.48 3.25 1.50 3.00 3.00 1.27 1.85 1.29 1.41 0.98 2.20 1.54 1.90 1.33 1.36 1.12 1.22 2.20 1.35 1.58 0.18 2.31 2.27 2.36 6.73 1.76 7.49 4.34 4.61 4.11 13.48 2.06 2.40 1.73 3.44 5.60 7.15 1.96 1.96 2.20 2.84 3.00 0.99 3.28 1.16 3.00 2.76 0.70 0.88 2.62 3.54 4.22 4.56 6.11 7.74 10.98 10.31 NA NA 1.90 1.61 1.46 1.58 2.51 2.66 1.85 2.81 NA 3.04 2.63 3.89 6.10 1.65 2.52 2.53 2.68 NA NA NA NA 1.24 7.25 2.34 6.90 2.13 7.51 2.85 7.91 3.29 1.24 3.33 3.46 2.73 5.15 4.46 0.28 2.84 3.11 2.64 30.14 3.29 NA NA NA NA NA 11.31 7.16 10.42 9.38 9.58 8.89 2.49 2.94 3.23 5.07 7.78 2.97 7.80 4.54 2.74 4.19 0.87 0.92 6.73 9.32 NA NA NA NA NA NA 5.27 3.78 0.43 0.60 0.46 0.85 0.46 0.43 0.50 0.46 0.79 0.49 0.44 0.42 0.52 0.54 0.55 0.69 0.50 1.00 0.43 0.81 0.96 0.48 0.71 0.34 0.63 0.24 0.89 0.47 0.83 0.37 0.66 0.74 0.51 0.87 0.55 0.65 0.05 1.86 1.19 1.28 2.78 1.26 5.26 2.68 3.29 3.56 5.39 2.14 2.29 1.93 1.65 2.19 3.72 1.32 1.22 1.31 1.33 1.37 0.22 1.97 0.27 1.41 1.85 0.30 0.38 1.43 2.07 3.87 3.32 4.87 4.97 5.89 4.21 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 ................................. N block inj, brachial plexus ................................ N block cont infuse, b plex ................................. N block inj, axillary ............................................. N block inj, suprascapular .................................. N block inj, intercost, sng ................................... N block inj, intercost, mlt .................................... N block inj, ilio-ing/hypogi .................................. N block inj, pudendal .......................................... N block inj, paracervical ..................................... N block inj, sciatic, sng ...................................... N blk inj, sciatic, cont inf .................................... N block inj fem, single ........................................ N block inj fem, cont inf ..................................... N block inj, lumbar plexus .................................. N block, other peripheral .................................... Inj paravertebral c/t ............................................ Inj paravertebral c/t add-on ................................ Inj paravertebral l/s ............................................. Inj paravertebral l/s add-on ................................ Inj foramen epidural c/t ...................................... Inj foramen epidural add-on ............................... Inj foramen epidural l/s ....................................... Inj foramen epidural add-on ............................... N block, spenopalatine gangl ............................. N block, carotid sinus s/p ................................... N block, stellate ganglion ................................... N block inj, hypogas plxs ................................... N block, lumbar/thoracic ..................................... N block inj, celiac pelus ..................................... Apply neurostimulator ......................................... Implant neuroelectrodes ..................................... Implant neuroelectrodes ..................................... Implant neuroelectrodes ..................................... Implant neuroelectrodes ..................................... Implant neuroelectrodes ..................................... Implant neuroelectrodes ..................................... Implant neuroelectrodes ..................................... Implant neuroelectrodes ..................................... Implant neuroelectrodes ..................................... Implant neuroelectrodes ..................................... Revise/remove neuroelectrode .......................... Insrt/redo perph n generator .............................. Revise/remove neuroreceiver ............................ Injection treatment of nerve ............................... Injection treatment of nerve ............................... Injection treatment of nerve ............................... Destroy nerve, face muscle ............................... Destroy nerve, neck 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 ............................... Chemodenerv eccrine glands ............................ Chemodenerv eccrine glands ............................ 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) ................................... Malpractice RVUs 1.89 1.53 0.07 0.09 0.08 0.10 0.09 0.08 0.08 0.09 0.31 0.11 0.07 0.08 0.11 0.13 0.10 0.16 0.10 0.20 0.09 0.18 0.15 0.13 0.11 0.08 0.10 0.07 0.12 0.10 0.11 0.08 0.10 0.07 0.07 0.11 0.08 0.10 0.01 0.18 0.19 0.22 0.51 0.13 1.60 0.61 1.04 0.36 1.05 0.20 0.19 0.19 0.34 0.79 1.58 0.11 0.11 0.10 0.20 0.18 0.06 0.20 0.07 0.22 0.29 0.06 0.08 0.18 0.28 0.61 0.61 0.96 0.95 1.82 1.19 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00290 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA 3.08 2.95 2.86 3.09 4.03 3.92 3.33 4.38 NA 4.59 4.02 5.15 7.89 3.53 4.08 4.14 4.26 NA NA NA NA 2.64 9.21 3.71 8.41 3.18 9.83 4.49 9.92 4.70 2.70 4.52 4.75 5.04 6.58 6.14 0.47 5.33 5.57 5.22 37.38 5.18 NA NA NA NA NA 13.57 9.75 12.34 13.16 15.97 17.62 4.56 5.01 5.53 8.11 10.96 4.02 11.28 5.77 5.96 7.24 1.63 1.88 9.53 13.14 NA NA NA NA NA NA Facility Total 15.25 11.73 1.61 1.94 1.86 2.36 1.98 1.69 1.98 2.03 4.59 2.04 1.83 1.68 2.31 2.42 2.11 2.30 2.08 4.45 2.02 3.99 4.11 1.88 2.67 1.71 2.14 1.29 3.21 2.11 2.84 1.78 2.12 1.93 1.80 3.18 1.98 2.33 0.24 4.35 3.65 3.86 10.02 3.15 14.35 7.63 8.94 8.03 19.92 4.40 4.88 3.85 5.43 8.58 12.45 3.39 3.29 3.61 4.37 4.55 1.27 5.45 1.50 4.63 4.90 1.06 1.34 4.23 5.89 8.70 8.49 11.94 13.66 18.69 15.71 Global 090 090 000 000 000 000 000 000 000 000 010 000 000 000 000 000 000 000 000 010 000 010 010 000 000 ZZZ 000 ZZZ 000 ZZZ 000 ZZZ 000 000 000 000 000 000 000 010 010 010 010 010 090 090 090 090 090 010 010 010 010 010 010 010 010 010 010 010 ZZZ 010 ZZZ 010 010 000 000 010 010 090 090 090 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70405 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 64716 64718 64719 64721 64722 64726 64727 64732 64734 64736 64738 64740 64742 64744 64746 64752 64755 64760 64761 64763 64766 64771 64772 64774 64776 64778 64782 64783 64784 64786 64787 64788 64790 64792 64795 64802 64804 64809 64818 64820 64821 64822 64823 64831 64832 64834 64835 64836 64837 64840 64856 64857 64858 64859 64861 64862 64864 64865 64866 64868 64870 64872 64874 64876 64885 64886 64890 64891 64892 64893 64895 64896 64897 64898 64901 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 6.30 5.98 4.84 4.28 4.69 4.17 3.10 4.40 4.91 4.59 5.72 5.58 6.21 5.23 5.92 7.05 13.50 6.95 6.40 6.92 8.66 7.34 7.20 5.16 5.11 3.11 6.22 3.71 9.81 15.44 4.29 4.60 11.29 14.90 3.01 9.14 14.62 13.65 10.28 10.35 8.74 8.74 10.35 9.43 5.65 10.17 10.92 10.92 6.25 13.00 13.78 14.47 16.47 4.25 19.21 19.41 12.53 15.22 15.72 14.02 15.97 1.99 2.98 3.37 17.50 20.72 15.13 16.12 14.63 15.58 19.22 20.46 18.21 19.47 10.20 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 5.99 6.01 4.53 5.38 3.05 2.80 1.50 3.51 4.06 4.03 4.62 5.13 4.71 3.78 4.51 4.29 5.65 3.46 3.53 5.21 5.26 5.57 4.93 3.84 3.69 1.50 3.78 1.84 6.61 9.86 2.13 3.47 7.22 8.85 1.56 5.14 7.18 5.78 5.30 7.14 7.36 7.25 8.15 7.09 2.94 7.11 7.71 7.68 3.24 8.27 9.21 9.66 10.80 2.20 11.80 11.96 8.79 13.56 13.20 11.46 8.75 1.08 1.53 1.75 11.63 13.58 10.02 7.60 8.89 9.89 9.68 11.01 10.72 11.82 5.28 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 ...................................... 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 ............................................. Malpractice RVUs 0.63 1.05 0.77 0.73 0.48 0.54 0.48 0.98 0.89 0.52 1.08 0.69 0.73 1.16 0.82 0.93 1.83 0.81 0.53 0.94 1.06 1.23 1.40 0.74 0.76 0.46 0.86 0.51 1.38 2.60 0.58 0.73 2.10 2.48 0.52 1.29 2.14 1.50 1.33 1.49 1.24 1.30 1.57 1.41 0.85 1.54 1.73 1.67 0.97 1.37 2.12 2.21 3.33 0.67 4.08 4.31 1.26 1.50 2.04 1.43 1.30 0.29 0.42 0.47 1.63 2.08 2.29 1.63 2.47 2.61 2.57 3.16 2.54 2.77 1.37 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00291 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA Facility Total 12.92 13.04 10.14 10.39 8.22 7.51 5.08 8.89 9.86 9.14 11.42 11.40 11.65 10.17 11.25 12.27 20.98 11.22 10.46 13.07 14.98 14.14 13.53 9.74 9.56 5.07 10.86 6.06 17.80 27.90 7.00 8.80 20.61 26.23 5.09 15.57 23.94 20.93 16.91 18.98 17.34 17.29 20.07 17.93 9.44 18.82 20.36 20.27 10.46 22.64 25.11 26.34 30.60 7.12 35.09 35.68 22.58 30.28 30.96 26.91 26.02 3.36 4.93 5.59 30.76 36.38 27.44 25.35 25.99 28.08 31.47 34.63 31.47 34.06 16.85 Global 090 090 090 090 090 090 ZZZ 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 ZZZ 090 ZZZ 090 090 ZZZ 090 090 090 000 090 090 090 090 090 090 090 090 090 ZZZ 090 090 090 ZZZ 090 090 090 090 ZZZ 090 090 090 090 090 090 090 ZZZ ZZZ ZZZ 090 090 090 090 090 090 090 090 090 090 ZZZ 70406 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 64902 64905 64907 64999 65091 65093 65101 65103 65105 65110 65112 65114 65125 65130 65135 65140 65150 65155 65175 65205 65210 65220 65222 65235 65260 65265 65270 65272 65273 65275 65280 65285 65286 65290 65400 65410 65420 65426 65430 65435 65436 65450 65600 65710 65730 65750 65755 65760 65765 65767 65770 65771 65772 65775 65780 65781 65782 65800 65805 65810 65815 65820 65850 65855 65860 65865 65870 65875 65880 65900 65920 65930 66020 66030 66130 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A N N N A N A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 11.81 14.00 18.80 0.00 6.45 6.86 7.02 7.56 8.48 13.93 16.36 17.50 3.12 7.14 7.32 8.01 6.25 8.65 6.27 0.71 0.84 0.71 0.93 7.56 10.94 12.57 1.90 3.81 4.35 5.33 7.65 12.88 5.50 5.40 6.05 1.47 4.16 5.24 1.47 0.92 4.18 3.27 3.39 12.33 14.23 14.98 14.87 0.00 0.00 0.00 17.53 0.00 4.28 5.78 10.23 17.64 14.98 1.91 1.91 4.86 5.04 8.12 10.50 3.84 3.54 5.59 6.26 6.53 7.08 10.91 8.39 7.43 1.59 1.25 7.68 NA NA NA 0.00 NA NA NA NA NA NA NA NA 8.83 NA NA NA NA NA NA 0.64 0.81 0.64 0.89 NA NA NA 5.24 7.73 NA 6.33 NA NA 11.17 NA 8.35 2.12 8.88 10.20 1.29 1.00 4.10 4.08 5.02 NA NA NA NA 0.00 0.00 0.00 NA 0.00 5.55 NA NA NA NA 1.80 2.18 NA 10.03 NA NA 4.32 4.05 NA NA NA NA NA NA NA 3.13 2.97 9.65 5.98 8.51 12.56 0.00 8.37 8.74 9.55 9.76 10.49 13.71 16.18 16.39 3.61 9.19 9.34 9.90 7.99 10.51 8.50 0.29 0.38 0.28 0.38 6.76 9.68 10.65 1.39 3.30 3.59 3.95 6.25 9.24 4.63 4.75 6.14 0.97 4.45 4.93 0.98 0.71 3.68 3.95 3.36 11.23 12.05 12.00 11.92 0.00 0.00 0.00 13.24 0.00 4.14 5.97 10.32 13.71 12.02 1.18 1.19 4.71 4.82 9.08 8.46 3.11 2.51 5.64 6.43 6.81 7.05 10.28 8.19 6.85 1.44 1.28 5.63 Nerve graft add-on ............................................. Nerve pedicle transfer ........................................ Nerve pedicle transfer ........................................ Nervous system surgery .................................... Revise eye .......................................................... Revise eye with implant ..................................... Removal of eye .................................................. Remove eye/insert implant ................................. Remove eye/attach implant ................................ Removal of eye .................................................. Remove eye/revise socket ................................. Remove eye/revise socket ................................. Revise ocular implant ......................................... Insert ocular implant ........................................... Insert ocular implant ........................................... Attach ocular implant .......................................... Revise ocular implant ......................................... Reinsert ocular implant ...................................... Removal of ocular implant ................................. Remove foreign body from eye .......................... Remove foreign body from eye .......................... Remove foreign body from eye .......................... Remove foreign body from eye .......................... Remove foreign body from eye .......................... Remove foreign body from eye .......................... Remove foreign body from eye .......................... Repair of eye wound .......................................... Repair of eye wound .......................................... Repair of eye wound .......................................... Repair of eye wound .......................................... Repair of eye wound .......................................... Repair of eye wound .......................................... Repair of eye wound .......................................... Repair of eye socket wound .............................. Removal of eye lesion ........................................ Biopsy of cornea ................................................ Removal of eye lesion ........................................ Removal of eye lesion ........................................ Corneal smear .................................................... Curette/treat cornea ........................................... Curette/treat cornea ........................................... Treatment of corneal lesion ............................... Revision of cornea ............................................. Corneal transplant .............................................. Corneal transplant .............................................. Corneal transplant .............................................. Corneal transplant .............................................. Revision of cornea ............................................. Revision of cornea ............................................. Corneal tissue transplant ................................... Revise cornea with implant ................................ Radial keratotomy .............................................. Correction of astigmatism .................................. Correction of astigmatism .................................. Ocular reconst, transplant .................................. Ocular reconst, transplant .................................. Ocular reconst, transplant .................................. Drainage of eye .................................................. Drainage of eye .................................................. Drainage of eye .................................................. Drainage of eye .................................................. Relieve inner eye pressure ................................ Incision of eye .................................................... Laser surgery of eye .......................................... Incise inner eye adhesions ................................ Incise inner eye adhesions ................................ Incise inner eye adhesions ................................ Incise inner eye adhesions ................................ Incise inner eye adhesions ................................ Remove eye lesion ............................................. Remove implant of eye ...................................... Remove blood clot from eye .............................. Injection treatment of eye ................................... Injection treatment of eye ................................... Remove eye lesion ............................................. Malpractice RVUs 1.55 2.00 3.16 0.00 0.32 0.34 0.35 0.37 0.42 0.81 1.30 1.02 0.19 0.35 0.36 0.40 0.31 0.50 0.31 0.03 0.04 0.05 0.04 0.37 0.57 0.62 0.09 0.19 0.22 0.26 0.38 0.64 0.27 0.31 0.30 0.07 0.21 0.25 0.07 0.04 0.21 0.16 0.17 0.61 0.70 0.74 0.73 0.00 0.00 0.00 0.87 0.00 0.21 0.28 0.44 0.44 0.44 0.09 0.09 0.24 0.25 0.40 0.52 0.19 0.18 0.28 0.31 0.32 0.35 0.54 0.41 0.37 0.08 0.06 0.38 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00292 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA 0.00 NA NA NA NA NA NA NA NA 12.14 NA NA NA NA NA NA 1.38 1.69 1.40 1.86 NA NA NA 7.23 11.73 NA 11.92 NA NA 16.94 NA 14.70 3.66 13.25 15.69 2.83 1.96 8.49 7.51 8.58 NA NA NA NA 0.00 0.00 0.00 NA 0.00 10.04 NA NA NA NA 3.80 4.18 NA 15.32 NA NA 8.35 7.77 NA NA NA NA NA NA NA 4.80 4.28 17.71 Facility Total 19.34 24.51 34.52 0.00 15.14 15.94 16.92 17.69 19.39 28.45 33.84 34.91 6.92 16.68 17.02 18.31 14.55 19.66 15.08 1.03 1.26 1.04 1.35 14.69 21.19 23.84 3.38 7.30 8.16 9.54 14.28 22.76 10.40 10.46 12.49 2.51 8.82 10.42 2.52 1.67 8.07 7.38 6.92 24.17 26.98 27.72 27.52 0.00 0.00 0.00 31.64 0.00 8.63 12.03 20.99 31.79 27.44 3.18 3.19 9.81 10.11 17.60 19.48 7.14 6.23 11.51 13.00 13.66 14.48 21.73 16.99 14.65 3.11 2.59 13.69 Global ZZZ 090 090 YYY 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 000 000 000 090 090 090 010 090 090 090 090 090 090 090 090 000 090 090 000 000 090 090 090 090 090 090 090 XXX XXX XXX 090 XXX 090 090 090 090 090 000 000 090 090 090 090 010 090 090 090 090 090 090 090 090 010 010 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70407 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 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 67115 67120 67121 67141 67145 67208 67210 67218 67220 67221 67225 67227 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A R A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 8.29 8.28 10.15 8.00 12.14 15.02 14.53 8.13 7.76 11.03 5.97 3.70 4.07 8.67 12.77 5.12 6.15 6.24 5.43 6.20 4.77 4.77 6.60 4.77 4.77 4.06 4.57 5.17 3.88 2.35 8.22 8.19 7.90 9.10 9.96 8.85 10.16 8.92 13.48 8.98 10.21 8.38 12.26 1.51 0.00 5.69 6.86 6.91 6.83 10.83 2.52 4.83 3.66 11.87 21.21 14.50 17.20 7.52 7.40 14.82 20.79 8.80 16.83 4.98 5.97 10.65 5.19 5.36 6.69 8.81 18.50 13.11 4.00 0.47 6.57 NA NA NA NA NA NA NA NA NA NA 11.72 NA NA NA NA NA NA NA NA NA 5.26 5.18 NA 5.81 5.10 5.61 5.67 6.10 NA 4.10 NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA 9.25 NA 2.71 NA 4.61 NA NA NA NA 9.15 8.10 NA NA 10.26 NA NA 8.60 NA 5.87 5.74 6.14 6.59 NA 10.45 4.34 0.25 6.60 9.43 9.38 10.22 9.27 12.26 15.24 10.79 7.40 7.12 8.76 5.50 4.65 5.00 8.24 10.05 4.74 5.73 5.76 5.29 6.63 3.94 3.85 6.49 4.73 3.98 4.32 4.30 4.81 5.83 3.63 9.09 6.97 6.88 7.66 8.12 7.32 8.16 7.62 9.89 6.13 7.44 7.47 9.20 0.69 0.00 4.87 5.43 6.47 6.24 8.02 1.46 5.87 3.65 9.15 15.53 12.22 13.72 6.55 6.17 11.33 14.46 7.41 11.84 5.09 5.55 8.55 4.87 4.94 5.53 5.90 12.19 9.04 1.81 0.21 5.54 Glaucoma surgery .............................................. Glaucoma surgery .............................................. Glaucoma surgery .............................................. Glaucoma surgery .............................................. Glaucoma surgery .............................................. Incision of eye .................................................... Implant eye shunt ............................................... Revise eye shunt ................................................ Repair eye lesion ............................................... Repair/graft eye lesion ....................................... Follow-up surgery of eye .................................... Incision of iris ..................................................... Incision of iris ..................................................... Remove iris and lesion ....................................... Removal of iris ................................................... Removal of iris ................................................... Removal of iris ................................................... Removal of iris ................................................... Repair iris & ciliary body .................................... Repair iris & ciliary body .................................... Destruction, ciliary body ..................................... Ciliary transsleral therapy ................................... Ciliary endoscopic ablation ................................ Destruction, ciliary body ..................................... Destruction, ciliary body ..................................... Revision of iris .................................................... Revision of iris .................................................... Removal of inner eye lesion .............................. Incision, secondary cataract ............................... After cataract laser surgery ................................ Reposition intraocular lens ................................. Removal of lens lesion ....................................... Removal of lens material ................................... Removal of lens material ................................... Removal of lens material ................................... Extraction of lens ................................................ Extraction of lens ................................................ Extraction of lens ................................................ Cataract surgery, complex ................................. Cataract surg w/iol, 1 stage ............................... Cataract surg w/iol, 1 stage ............................... Insert lens prosthesis ......................................... Exchange lens prosthesis .................................. Ophthalmic endoscope add-on .......................... Eye surgery procedure ....................................... Partial removal of eye fluid ................................ Partial removal of eye fluid ................................ Release of eye fluid ........................................... Replace eye fluid ................................................ Implant eye drug system .................................... Injection eye drug ............................................... Incise inner eye strands ..................................... Laser surgery, eye strands ................................ Removal of inner eye fluid ................................. Strip retinal membrane ....................................... Laser treatment of retina .................................... Laser treatment of retina .................................... Repair detached retina ....................................... Repair detached retina ....................................... Repair detached retina ....................................... Repair detached retina ....................................... Repair detached retina ....................................... Rerepair detached retina .................................... Release encircling material ................................ Remove eye implant material ............................ Remove eye implant material ............................ Treatment of retina ............................................. Treatment of retina ............................................. Treatment of retinal lesion ................................. Treatment of retinal lesion ................................. Treatment of retinal lesion ................................. Treatment of choroid lesion ............................... Ocular photodynamic ther .................................. Eye photodynamic ther add-on .......................... Treatment of retinal lesion ................................. Malpractice RVUs 0.46 0.41 0.50 0.40 0.60 0.74 0.71 0.40 0.40 0.55 0.30 0.18 0.20 0.43 0.77 0.26 0.31 0.31 0.27 0.31 0.24 0.23 0.30 0.26 0.23 0.20 0.23 0.26 0.19 0.11 0.40 0.36 0.39 0.45 0.49 0.44 0.49 0.43 0.63 0.14 0.39 0.36 0.60 0.07 0.00 0.28 0.34 0.34 0.34 0.54 0.12 0.24 0.18 0.58 1.04 0.71 0.85 0.37 0.37 0.73 1.02 0.44 0.83 0.25 0.29 0.53 0.26 0.27 0.33 0.44 0.92 0.65 0.20 0.02 0.33 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00293 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA NA NA NA NA 17.99 NA NA NA NA NA NA NA NA NA 10.27 10.18 NA 10.84 10.10 9.87 10.47 11.53 NA 6.56 NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA 16.42 NA 5.35 NA 8.45 NA NA NA NA 17.04 15.87 NA NA 19.50 NA NA 14.86 NA 11.32 11.37 13.16 15.84 NA 24.21 8.54 0.74 13.50 Facility Total 18.18 18.07 20.87 17.67 25.00 31.00 26.03 15.93 15.28 20.34 11.77 8.53 9.27 17.34 23.59 10.12 12.19 12.31 10.99 13.14 8.95 8.85 13.39 9.76 8.98 8.58 9.10 10.24 9.90 6.09 17.71 15.52 15.17 17.21 18.57 16.61 18.81 16.97 24.00 15.25 18.04 16.21 22.06 2.27 0.00 10.84 12.63 13.72 13.41 19.39 4.10 10.94 7.49 21.60 37.78 27.43 31.77 14.44 13.94 26.88 36.27 16.65 29.50 10.32 11.81 19.73 10.32 10.57 12.55 15.15 31.61 22.80 6.01 0.70 12.44 Global 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 ZZZ YYY 090 090 090 090 090 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 ZZZ 090 70408 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 67228 67250 67255 67299 67311 67312 67314 67316 67318 67320 67331 67332 67334 67335 67340 67343 67345 67350 67399 67400 67405 67412 67413 67414 67415 67420 67430 67440 67445 67450 67500 67505 67515 67550 67560 67570 67599 67700 67710 67715 67800 67801 67805 67808 67810 67820 67825 67830 67835 67840 67850 67875 67880 67882 67900 67901 67902 67903 67904 67906 67908 67909 67911 67912 67914 67915 67916 67917 67921 67922 67923 67924 67930 67935 67938 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A C A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 12.72 8.65 8.89 0.00 6.64 8.53 7.51 9.65 7.84 4.32 4.05 4.48 3.97 2.49 4.92 7.34 2.96 2.87 0.00 9.75 7.92 9.49 9.99 11.11 1.76 20.03 13.37 13.07 14.40 13.49 0.79 0.82 0.61 10.17 10.58 13.56 0.00 1.35 1.02 1.22 1.38 1.88 2.22 3.79 1.48 0.89 1.38 1.70 5.55 2.04 1.69 1.35 3.79 5.06 6.13 7.39 9.35 6.36 6.25 6.78 5.12 5.39 5.26 5.67 3.67 3.18 5.30 6.01 3.39 3.06 5.87 5.78 3.60 6.21 1.33 11.51 NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA 2.59 NA 0.00 NA NA NA NA NA NA NA NA NA NA NA 0.67 0.69 0.59 NA NA NA 0.00 6.04 5.39 5.39 1.62 1.97 2.53 NA 3.34 0.60 1.74 5.55 NA 5.49 3.38 3.31 6.63 7.65 9.09 NA NA 9.59 9.66 5.39 6.65 8.05 NA 18.98 6.36 6.00 8.07 8.48 6.21 5.93 8.14 8.95 5.73 8.54 5.40 8.56 9.20 9.92 0.00 6.04 6.77 6.57 7.52 6.95 1.96 1.84 2.03 1.80 1.12 2.21 6.53 2.02 1.88 0.00 11.29 9.80 10.96 10.80 12.07 0.76 17.44 14.93 14.30 13.95 14.73 0.29 0.31 0.38 11.33 11.40 13.62 0.00 1.27 1.21 1.29 1.04 1.26 1.65 3.78 0.68 0.56 1.41 1.50 4.63 1.65 1.47 0.94 3.81 4.82 5.27 5.42 5.48 5.53 5.25 5.04 5.36 4.96 4.79 5.55 3.06 2.81 4.77 5.08 2.90 2.76 4.98 4.69 2.18 4.42 1.26 Treatment of retinal lesion ................................. Reinforce eye wall .............................................. Reinforce/graft eye wall ...................................... Eye surgery procedure ....................................... Revise eye muscle ............................................. Revise two eye muscles .................................... Revise eye muscle ............................................. Revise two eye muscles .................................... Revise eye muscle(s) ......................................... Revise eye muscle(s) add-on ............................ Eye surgery follow-up add-on ............................ Rerevise eye muscles add-on ............................ Revise eye muscle w/suture .............................. Eye suture during surgery .................................. Revise eye muscle add-on ................................. Release eye tissue ............................................. Destroy nerve of eye muscle ............................. Biopsy eye muscle ............................................. Eye muscle surgery procedure .......................... Explore/biopsy eye socket ................................. Explore/drain eye socket .................................... Explore/treat eye socket ..................................... Explore/treat eye socket ..................................... Explr/decompress eye socket ............................ Aspiration, orbital contents ................................. Explore/treat eye socket ..................................... Explore/treat eye socket ..................................... Explore/drain eye socket .................................... Explr/decompress eye socket ............................ Explore/biopsy eye socket ................................. Inject/treat eye socket ........................................ Inject/treat eye socket ........................................ Inject/treat eye socket ........................................ Insert eye socket implant ................................... Revise eye socket implant ................................. Decompress optic nerve .................................... Orbit surgery procedure ..................................... Drainage of eyelid abscess ................................ Incision of eyelid ................................................. Incision of eyelid fold .......................................... Remove eyelid lesion ......................................... Remove eyelid lesions ....................................... Remove eyelid lesions ....................................... Remove eyelid lesion(s) ..................................... Biopsy of eyelid .................................................. Revise eyelashes ............................................... Revise eyelashes ............................................... Revise eyelashes ............................................... Revise eyelashes ............................................... Remove eyelid lesion ......................................... Treat eyelid lesion .............................................. Closure of eyelid by suture ................................ Revision of eyelid ............................................... Revision of eyelid ............................................... Repair brow defect ............................................. Repair eyelid defect ........................................... Repair eyelid defect ........................................... Repair eyelid defect ........................................... Repair eyelid defect ........................................... Repair eyelid defect ........................................... Repair eyelid defect ........................................... Revise eyelid defect ........................................... Revise eyelid defect ........................................... Correction eyelid w/implant ................................ Repair eyelid defect ........................................... Repair eyelid defect ........................................... Repair eyelid defect ........................................... Repair eyelid defect ........................................... Repair eyelid defect ........................................... Repair eyelid defect ........................................... Repair eyelid defect ........................................... Repair eyelid defect ........................................... Repair eyelid wound ........................................... Repair eyelid wound ........................................... Remove eyelid foreign body .............................. Malpractice RVUs 0.63 0.47 0.44 0.00 0.37 0.43 0.39 0.49 0.41 0.22 0.21 0.23 0.20 0.13 0.25 0.37 0.17 0.15 0.00 0.56 0.44 0.48 0.50 0.65 0.09 1.15 0.86 0.70 0.90 0.68 0.05 0.05 0.03 0.72 0.60 0.68 0.00 0.07 0.05 0.06 0.07 0.09 0.11 0.19 0.06 0.04 0.07 0.08 0.28 0.10 0.07 0.07 0.19 0.25 0.38 0.54 0.60 0.47 0.41 0.46 0.28 0.31 0.31 0.28 0.19 0.16 0.28 0.36 0.17 0.15 0.30 0.30 0.19 0.39 0.06 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00294 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 24.86 NA NA 0.00 NA NA NA NA NA NA NA NA NA NA NA NA 5.72 NA 0.00 NA NA NA NA NA NA NA NA NA NA NA 1.51 1.56 1.23 NA NA NA 0.00 7.46 6.46 6.67 3.07 3.94 4.86 NA 4.88 1.53 3.19 7.33 NA 7.63 5.14 4.73 10.61 12.96 15.60 NA NA 16.42 16.32 12.63 12.05 13.75 NA 24.93 10.22 9.34 13.65 14.85 9.77 9.14 14.31 15.03 9.52 15.14 6.79 Facility Total 21.91 18.32 19.25 0.00 13.05 15.73 14.47 17.66 15.20 6.50 6.10 6.74 5.97 3.74 7.38 14.24 5.15 4.90 0.00 21.60 18.16 20.93 21.29 23.83 2.61 38.62 29.16 28.07 29.25 28.90 1.13 1.18 1.02 22.22 22.58 27.86 0.00 2.69 2.28 2.57 2.49 3.23 3.98 7.76 2.22 1.49 2.86 3.28 10.46 3.79 3.23 2.36 7.79 10.13 11.78 13.35 15.43 12.36 11.91 12.28 10.76 10.66 10.36 11.50 6.92 6.15 10.35 11.45 6.46 5.97 11.15 10.77 5.97 11.02 2.65 Global 090 090 090 YYY 090 090 090 090 090 ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ 090 010 000 YYY 090 090 090 090 090 000 090 090 090 090 090 000 000 000 090 090 090 YYY 010 010 010 010 010 010 090 000 000 010 010 090 010 010 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 010 090 010 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70409 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 67950 67961 67966 67971 67973 67974 67975 67999 68020 68040 68100 68110 68115 68130 68135 68200 68320 68325 68326 68328 68330 68335 68340 68360 68362 68371 68399 68400 68420 68440 68500 68505 68510 68520 68525 68530 68540 68550 68700 68705 68720 68745 68750 68760 68761 68770 68801 68810 68811 68815 68840 68850 68899 69000 69005 69020 69090 69100 69105 69110 69120 69140 69145 69150 69155 69200 69205 69210 69220 69222 69300 69310 69320 69399 69400 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A C A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A C A A A N A A A A A A A A A A A A A R A A C A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 5.81 5.68 6.56 9.78 12.85 12.82 9.12 0.00 1.37 0.85 1.35 1.77 2.36 4.92 1.84 0.49 5.36 7.35 7.14 8.17 4.82 7.18 4.16 4.36 7.33 4.89 0.00 1.69 2.30 0.94 11.00 10.92 4.60 7.50 4.42 3.65 10.58 13.24 6.59 2.06 8.95 8.62 8.65 1.73 1.36 7.01 0.94 1.90 2.35 3.20 1.25 0.80 0.00 1.45 2.11 1.48 0.00 0.81 0.85 3.43 4.04 7.96 2.62 13.41 20.77 0.77 1.20 0.61 0.83 1.40 6.35 10.77 16.93 0.00 0.83 8.66 8.71 9.16 NA NA NA NA 0.00 1.41 0.71 3.26 4.11 5.98 8.74 1.82 0.54 11.31 NA NA NA 9.44 NA 8.90 8.06 NA NA 0.00 5.92 6.21 2.09 NA NA 7.35 NA NA 8.19 NA NA NA 4.18 NA NA NA 3.55 2.28 3.19 1.95 3.67 NA 8.26 1.60 0.88 0.00 2.89 2.94 4.00 0.00 1.71 2.35 6.76 NA NA 5.80 NA NA 2.39 NA 0.63 2.37 3.86 NA NA NA 0.00 2.17 5.23 5.04 5.58 7.30 9.34 9.26 6.97 0.00 1.21 0.43 0.95 1.65 1.92 4.61 1.65 0.33 5.54 6.56 6.43 7.31 4.73 6.40 4.11 4.19 6.42 4.74 0.00 1.83 2.11 1.27 9.76 10.68 2.10 7.44 2.03 2.65 9.42 11.38 6.00 1.80 7.88 7.88 8.29 1.63 1.32 3.19 1.48 2.68 2.42 2.82 1.12 0.68 0.00 1.36 1.84 2.07 0.00 0.39 0.77 4.48 6.20 13.32 3.31 13.44 19.60 0.55 1.36 0.23 0.73 2.07 4.23 16.33 21.90 0.00 0.67 Revision of eyelid ............................................... Revision of eyelid ............................................... Revision of eyelid ............................................... Reconstruction of eyelid ..................................... Reconstruction of eyelid ..................................... Reconstruction of eyelid ..................................... Reconstruction of eyelid ..................................... Revision of eyelid ............................................... Incise/drain eyelid lining ..................................... Treatment of eyelid lesions ................................ Biopsy of eyelid lining ........................................ Remove eyelid lining lesion ............................... Remove eyelid lining lesion ............................... Remove eyelid lining lesion ............................... Remove eyelid lining lesion ............................... Treat eyelid by injection ..................................... Revise/graft eyelid lining .................................... Revise/graft eyelid lining .................................... Revise/graft eyelid lining .................................... Revise/graft eyelid lining .................................... Revise eyelid lining ............................................ Revise/graft eyelid lining .................................... Separate eyelid adhesions ................................. Revise eyelid lining ............................................ Revise eyelid lining ............................................ Harvest eye tissue, alograft ............................... Eyelid lining surgery ........................................... Incise/drain tear gland ........................................ Incise/drain tear sac ........................................... Incise tear duct opening ..................................... Removal of tear gland ........................................ Partial removal, tear gland ................................. Biopsy of tear gland ........................................... Removal of tear sac ........................................... Biopsy of tear sac .............................................. Clearance of tear duct ........................................ Remove tear gland lesion .................................. Remove tear gland lesion .................................. Repair tear ducts ................................................ Revise tear duct opening ................................... Create tear sac drain ......................................... Create tear duct drain ........................................ Create tear duct drain ........................................ Close tear duct opening ..................................... Close tear duct opening ..................................... Close tear system fistula .................................... Dilate tear duct opening ..................................... Probe nasolacrimal duct ..................................... Probe nasolacrimal duct ..................................... Probe nasolacrimal duct ..................................... Explore/irrigate tear ducts .................................. Injection for tear sac x-ray ................................. Tear duct system surgery .................................. Drain external ear lesion .................................... Drain external ear lesion .................................... Drain outer ear canal lesion ............................... Pierce earlobes .................................................. Biopsy of external ear ........................................ Biopsy of external ear canal .............................. Remove external ear, partial .............................. Removal of external ear ..................................... Remove ear canal lesion(s) ............................... Remove ear canal lesion(s) ............................... Extensive ear canal surgery ............................... Extensive ear/neck surgery ................................ Clear outer ear canal ......................................... Clear outer ear canal ......................................... Remove impacted ear wax ................................ Clean out mastoid cavity .................................... Clean out mastoid cavity .................................... Revise external ear ............................................ Rebuild outer ear canal ...................................... Rebuild outer ear canal ...................................... Outer ear surgery procedure .............................. Inflate middle ear canal ...................................... Malpractice RVUs 0.36 0.33 0.37 0.53 0.75 0.75 0.50 0.00 0.06 0.04 0.07 0.09 0.12 0.24 0.09 0.02 0.27 0.44 0.35 0.54 0.24 0.36 0.21 0.22 0.36 0.44 0.00 0.08 0.11 0.05 0.55 0.55 0.23 0.37 0.22 0.18 0.52 0.80 0.32 0.10 0.44 0.52 0.43 0.09 0.06 0.35 0.05 0.10 0.13 0.17 0.06 0.04 0.00 0.12 0.17 0.12 0.00 0.03 0.07 0.30 0.38 0.65 0.21 1.22 1.92 0.06 0.10 0.05 0.07 0.12 0.72 0.85 1.37 0.00 0.07 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00295 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 14.83 14.72 16.09 NA NA NA NA 0.00 2.84 1.60 4.68 5.97 8.46 13.90 3.75 1.05 16.94 NA NA NA 14.50 NA 13.27 12.64 NA NA 0.00 7.69 8.62 3.08 NA NA 12.18 NA NA 12.02 NA NA NA 6.34 NA NA NA 5.37 3.70 10.55 2.94 5.67 NA 11.63 2.91 1.72 0.00 4.46 5.22 5.60 0.00 2.55 3.27 10.49 NA NA 8.63 NA NA 3.22 NA 1.29 3.27 5.38 NA NA NA 0.00 3.07 Facility Total 11.40 11.05 12.51 17.61 22.94 22.83 16.59 0.00 2.64 1.32 2.37 3.51 4.40 9.77 3.58 0.84 11.17 14.35 13.92 16.02 9.79 13.94 8.48 8.77 14.11 10.07 0.00 3.60 4.52 2.26 21.31 22.15 6.93 15.31 6.67 6.48 20.52 25.42 12.91 3.96 17.27 17.02 17.37 3.45 2.74 10.55 2.47 4.68 4.90 6.19 2.43 1.52 0.00 2.93 4.12 3.67 0.00 1.23 1.69 8.21 10.62 21.93 6.14 28.07 42.29 1.38 2.66 0.89 1.63 3.59 11.30 27.95 40.20 0.00 1.57 Global 090 090 090 090 090 090 090 YYY 010 000 000 010 010 090 010 000 090 090 090 090 090 090 090 090 090 010 YYY 010 010 010 090 090 000 090 000 010 090 090 090 010 090 090 090 010 010 090 010 010 010 010 010 000 YYY 010 010 010 XXX 000 000 090 090 090 090 090 090 000 010 000 000 010 YYY 090 090 YYY 000 70410 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 69401 69405 69420 69421 69424 69433 69436 69440 69450 69501 69502 69505 69511 69530 69535 69540 69550 69552 69554 69601 69602 69603 69604 69605 69610 69620 69631 69632 69633 69635 69636 69637 69641 69642 69643 69644 69645 69646 69650 69660 69661 69662 69666 69667 69670 69676 69700 69710 69711 69714 69715 69717 69718 69720 69725 69740 69745 69799 69801 69802 69805 69806 69820 69840 69905 69910 69915 69930 69949 69950 69955 69960 69970 69979 69990 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A N A A A A A A A A A C A A A A A A A A A A C A A A A C R .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.63 2.63 1.33 1.73 0.85 1.52 1.96 7.56 5.56 9.06 12.36 12.97 13.50 19.16 36.09 1.20 10.97 19.43 33.11 13.22 13.56 14.00 14.00 18.46 4.42 5.88 9.85 12.73 12.08 13.31 15.20 15.09 12.69 16.81 15.30 16.94 16.36 17.96 9.65 11.88 15.72 15.42 9.74 9.75 11.49 9.51 8.22 0.00 10.42 13.98 18.22 14.96 18.47 14.36 25.34 15.94 16.66 0.00 8.55 13.08 13.80 12.33 10.32 10.24 11.08 13.61 21.20 16.78 0.00 25.60 27.00 27.00 29.99 0.00 3.46 1.24 3.51 3.16 NA 2.19 3.10 NA NA NA NA NA NA NA NA NA 3.75 NA NA NA NA NA NA NA NA 5.57 11.15 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA 0.00 NA 0.65 2.32 1.59 2.17 0.68 1.64 2.30 8.80 7.05 9.03 11.62 17.24 17.52 21.69 32.05 1.98 14.90 20.73 30.42 12.71 13.27 18.41 13.73 21.01 3.28 6.31 11.23 13.51 13.09 16.79 19.36 19.28 12.82 16.33 14.86 20.46 20.08 20.82 9.94 11.21 14.74 13.79 10.00 10.01 11.74 10.78 9.27 0.00 10.82 12.70 15.07 14.51 15.34 14.56 20.19 13.45 15.01 0.00 9.49 12.36 11.91 11.07 11.25 13.21 11.38 11.95 16.51 14.79 0.00 18.95 21.44 20.11 23.34 0.00 1.80 Inflate middle ear canal ...................................... Catheterize middle ear canal ............................. Incision of eardrum ............................................. Incision of eardrum ............................................. Remove ventilating tube ..................................... Create eardrum opening .................................... Create eardrum opening .................................... Exploration of middle ear ................................... Eardrum revision ................................................ Mastoidectomy ................................................... Mastoidectomy ................................................... Remove mastoid structures ............................... Extensive mastoid surgery ................................. Extensive mastoid surgery ................................. Remove part of temporal bone .......................... Remove ear lesion ............................................. Remove ear lesion ............................................. Remove ear lesion ............................................. Remove ear lesion ............................................. Mastoid surgery revision .................................... Mastoid surgery revision .................................... Mastoid surgery revision .................................... Mastoid surgery revision .................................... Mastoid surgery revision .................................... Repair of eardrum .............................................. Repair of eardrum .............................................. Repair eardrum structures ................................. Rebuild eardrum structures ................................ Rebuild eardrum structures ................................ Repair eardrum structures ................................. Rebuild eardrum structures ................................ Rebuild eardrum structures ................................ Revise middle ear & mastoid ............................. Revise middle ear & mastoid ............................. Revise middle ear & mastoid ............................. Revise middle ear & mastoid ............................. Revise middle ear & mastoid ............................. Revise middle ear & mastoid ............................. Release middle ear bone ................................... Revise middle ear bone ..................................... Revise middle ear bone ..................................... Revise middle ear bone ..................................... Repair middle ear structures .............................. Repair middle ear structures .............................. Remove mastoid air cells ................................... Remove middle ear nerve .................................. Close mastoid fistula .......................................... Implant/replace hearing aid ................................ Remove/repair hearing aid ................................. Implant temple bone w/stimul ............................ Temple bne implnt w/stimulat ............................ Temple bone implant revision ............................ Revise temple bone implant ............................... Release facial nerve ........................................... Release facial nerve ........................................... Repair facial nerve ............................................. Repair facial nerve ............................................. Middle ear surgery procedure ............................ Incise inner ear ................................................... Incise inner ear ................................................... Explore inner ear ................................................ Explore inner ear ................................................ Establish inner ear window ................................ Revise inner ear window .................................... Remove inner ear ............................................... Remove inner ear & mastoid ............................. Incise inner ear nerve ........................................ Implant cochlear device ..................................... Inner ear surgery procedure .............................. Incise inner ear nerve ........................................ Release facial nerve ........................................... Release inner ear canal ..................................... Remove inner ear lesion .................................... Temporal bone surgery ...................................... Microsurgery add-on .......................................... Malpractice RVUs 0.05 0.21 0.11 0.15 0.07 0.13 0.19 0.61 0.45 0.73 1.00 1.05 1.09 1.54 2.92 0.10 0.89 1.59 2.91 1.07 1.10 1.14 1.14 1.50 0.36 0.48 0.80 1.03 0.98 1.08 1.23 1.22 1.03 1.36 1.24 1.37 1.33 1.46 0.78 0.96 1.27 1.25 0.79 0.79 0.93 0.81 0.67 0.00 0.83 1.13 1.48 0.90 3.21 1.16 2.44 1.27 1.14 0.00 0.69 1.06 1.12 1.00 0.90 0.79 0.90 1.07 1.69 1.36 0.00 2.28 2.48 2.17 2.41 0.00 0.89 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00296 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 1.92 6.35 4.60 NA 3.11 4.75 NA NA NA NA NA NA NA NA NA 5.05 NA NA NA NA NA NA NA NA 10.35 17.51 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA 0.00 NA Facility Total 1.33 5.16 3.03 4.05 1.60 3.29 4.45 16.97 13.06 18.82 24.98 31.26 32.11 42.39 71.06 3.28 26.76 41.75 66.44 27.00 27.93 33.55 28.87 40.97 8.06 12.67 21.88 27.27 26.15 31.18 35.79 35.59 26.54 34.50 31.40 38.77 37.77 40.24 20.37 24.05 31.73 30.46 20.53 20.55 24.16 21.10 18.16 0.00 22.07 27.81 34.77 30.37 37.02 30.08 47.97 30.66 32.81 0.00 18.73 26.50 26.83 24.40 22.47 24.24 23.36 26.63 39.40 32.93 0.00 46.83 50.92 49.28 55.74 0.00 6.15 Global 000 010 010 010 000 010 010 090 090 090 090 090 090 090 090 010 090 090 090 090 090 090 090 090 010 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 XXX 090 090 090 090 090 090 090 090 090 YYY 090 090 090 090 090 090 090 090 090 090 YYY 090 090 090 090 YYY ZZZ Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70411 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 70010 70010 70010 70015 70015 70015 70030 70030 70030 70100 70100 70100 70110 70110 70110 70120 70120 70120 70130 70130 70130 70134 70134 70134 70140 70140 70140 70150 70150 70150 70160 70160 70160 70170 70170 70170 70190 70190 70190 70200 70200 70200 70210 70210 70210 70220 70220 70220 70240 70240 70240 70250 70250 70250 70260 70260 70260 70300 70300 70300 70310 70310 70310 70320 70320 70320 70328 70328 70328 70330 70330 70330 70332 70332 70332 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 1.19 0.00 1.19 1.19 0.00 1.19 0.17 0.00 0.17 0.18 0.00 0.18 0.25 0.00 0.25 0.18 0.00 0.18 0.34 0.00 0.34 0.34 0.00 0.34 0.19 0.00 0.19 0.26 0.00 0.26 0.17 0.00 0.17 0.30 0.00 0.30 0.21 0.00 0.21 0.28 0.00 0.28 0.17 0.00 0.17 0.25 0.00 0.25 0.19 0.00 0.19 0.24 0.00 0.24 0.34 0.00 0.34 0.10 0.00 0.10 0.16 0.00 0.16 0.22 0.00 0.22 0.18 0.00 0.18 0.24 0.00 0.24 0.54 0.00 0.54 0.39 4.34 4.73 0.39 1.35 1.74 0.06 0.42 0.48 0.06 0.52 0.58 0.08 0.62 0.70 0.06 0.62 0.68 0.11 0.78 0.89 0.11 0.73 0.84 0.06 0.62 0.68 0.08 0.78 0.86 0.06 0.52 0.58 0.10 0.95 1.05 0.07 0.62 0.69 0.09 0.78 0.87 0.06 0.62 0.68 0.08 0.78 0.86 0.06 0.42 0.48 0.08 0.62 0.70 0.11 0.89 1.00 0.05 0.26 0.31 0.08 0.42 0.50 0.08 0.78 0.86 0.06 0.49 0.55 0.08 0.84 0.92 0.20 2.11 2.31 0.39 NA NA 0.39 NA NA 0.06 NA NA 0.06 NA NA 0.08 NA NA 0.06 NA NA 0.11 NA NA 0.11 NA NA 0.06 NA NA 0.08 NA NA 0.06 NA NA 0.10 NA NA 0.07 NA NA 0.09 NA NA 0.06 NA NA 0.08 NA NA 0.06 NA NA 0.08 NA NA 0.11 NA NA 0.05 NA NA 0.08 NA NA 0.08 NA NA 0.06 NA NA 0.08 NA NA 0.20 NA NA Contrast x-ray of brain ....................................... Contrast x-ray of brain ....................................... Contrast x-ray of brain ....................................... Contrast x-ray of brain ....................................... Contrast x-ray of brain ....................................... Contrast x-ray of brain ....................................... X-ray eye for foreign body ................................. X-ray eye for foreign body ................................. X-ray eye for foreign body ................................. X-ray exam of jaw .............................................. X-ray exam of jaw .............................................. X-ray exam of jaw .............................................. X-ray exam of jaw .............................................. X-ray exam of jaw .............................................. X-ray exam of jaw .............................................. X-ray exam of mastoids ..................................... X-ray exam of mastoids ..................................... X-ray exam of mastoids ..................................... X-ray exam of mastoids ..................................... X-ray exam of mastoids ..................................... X-ray exam of mastoids ..................................... X-ray exam of middle ear ................................... X-ray exam of middle ear ................................... X-ray exam of middle ear ................................... X-ray exam of facial bones ................................ X-ray exam of facial bones ................................ X-ray exam of facial bones ................................ X-ray exam of facial bones ................................ X-ray exam of facial bones ................................ X-ray exam of facial bones ................................ X-ray exam of nasal bones ................................ X-ray exam of nasal bones ................................ X-ray exam of nasal bones ................................ X-ray exam of tear duct ..................................... X-ray exam of tear duct ..................................... X-ray exam of tear duct ..................................... X-ray exam of eye sockets ................................ X-ray exam of eye sockets ................................ X-ray exam of eye sockets ................................ X-ray exam of eye sockets ................................ X-ray exam of eye sockets ................................ X-ray exam of eye sockets ................................ X-ray exam of sinuses ....................................... X-ray exam of sinuses ....................................... X-ray exam of sinuses ....................................... X-ray exam of sinuses ....................................... X-ray exam of sinuses ....................................... X-ray exam of sinuses ....................................... X-ray exam, pituitary saddle .............................. X-ray exam, pituitary saddle .............................. X-ray exam, pituitary saddle .............................. X-ray exam of skull ............................................ X-ray exam of skull ............................................ X-ray exam of skull ............................................ X-ray exam of skull ............................................ X-ray exam of skull ............................................ X-ray exam of skull ............................................ X-ray exam of teeth ............................................ X-ray exam of teeth ............................................ X-ray exam of teeth ............................................ X-ray exam of teeth ............................................ X-ray exam of teeth ............................................ X-ray exam of teeth ............................................ Full mouth x-ray of teeth .................................... Full mouth x-ray of teeth .................................... Full mouth x-ray of teeth .................................... X-ray exam of jaw joint ...................................... X-ray exam of jaw joint ...................................... X-ray exam of jaw joint ...................................... X-ray exam of jaw joints ..................................... X-ray exam of jaw joints ..................................... X-ray exam of jaw joints ..................................... X-ray exam of jaw joint ...................................... X-ray exam of jaw joint ...................................... X-ray exam of jaw joint ...................................... Malpractice RVUs 0.05 0.22 0.27 0.08 0.08 0.16 0.01 0.02 0.03 0.01 0.02 0.03 0.01 0.04 0.05 0.01 0.04 0.05 0.02 0.05 0.07 0.02 0.05 0.07 0.01 0.04 0.05 0.01 0.05 0.06 0.01 0.02 0.03 0.01 0.06 0.07 0.01 0.04 0.05 0.01 0.05 0.06 0.01 0.04 0.05 0.01 0.05 0.06 0.01 0.02 0.03 0.01 0.04 0.05 0.02 0.06 0.08 0.01 0.02 0.03 0.01 0.02 0.03 0.01 0.05 0.06 0.01 0.02 0.03 0.01 0.05 0.06 0.02 0.12 0.14 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00297 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 1.63 4.56 6.19 1.66 1.43 3.09 0.24 0.44 0.68 0.25 0.54 0.79 0.34 0.66 1.00 0.25 0.66 0.91 0.47 0.83 1.30 0.47 0.78 1.25 0.26 0.66 0.92 0.35 0.83 1.18 0.24 0.54 0.78 0.41 1.01 1.42 0.29 0.66 0.95 0.38 0.83 1.21 0.24 0.66 0.90 0.34 0.83 1.17 0.26 0.44 0.70 0.33 0.66 0.99 0.47 0.95 1.42 0.16 0.28 0.44 0.25 0.44 0.69 0.31 0.83 1.14 0.25 0.51 0.76 0.33 0.89 1.22 0.76 2.23 2.99 Facility Total 1.63 NA NA 1.66 NA NA 0.24 NA NA 0.25 NA NA 0.34 NA NA 0.25 NA NA 0.47 NA NA 0.47 NA NA 0.26 NA NA 0.35 NA NA 0.24 NA NA 0.41 NA NA 0.29 NA NA 0.38 NA NA 0.24 NA NA 0.34 NA NA 0.26 NA NA 0.33 NA NA 0.47 NA NA 0.16 NA NA 0.25 NA NA 0.31 NA NA 0.25 NA NA 0.33 NA NA 0.76 NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70412 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 70336 70336 70336 70350 70350 70350 70355 70355 70355 70360 70360 70360 70370 70370 70370 70371 70371 70371 70373 70373 70373 70380 70380 70380 70390 70390 70390 70450 70450 70450 70460 70460 70460 70470 70470 70470 70480 70480 70480 70481 70481 70481 70482 70482 70482 70486 70486 70486 70487 70487 70487 70488 70488 70488 70490 70490 70490 70491 70491 70491 70492 70492 70492 70496 70496 70496 70498 70498 70498 70540 70540 70540 70542 70542 70542 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 1.48 0.00 1.48 0.17 0.00 0.17 0.20 0.00 0.20 0.17 0.00 0.17 0.32 0.00 0.32 0.84 0.00 0.84 0.44 0.00 0.44 0.17 0.00 0.17 0.38 0.00 0.38 0.85 0.00 0.85 1.13 0.00 1.13 1.27 0.00 1.27 1.28 0.00 1.28 1.38 0.00 1.38 1.45 0.00 1.45 1.14 0.00 1.14 1.30 0.00 1.30 1.42 0.00 1.42 1.28 0.00 1.28 1.38 0.00 1.38 1.45 0.00 1.45 1.75 0.00 1.75 1.75 0.00 1.75 1.35 0.00 1.35 1.62 0.00 1.62 0.49 11.23 11.72 0.07 0.38 0.45 0.07 0.57 0.64 0.06 0.42 0.48 0.10 1.31 1.41 0.28 2.11 2.39 0.14 1.79 1.93 0.06 0.67 0.73 0.12 1.79 1.91 0.28 4.73 5.01 0.37 5.68 6.05 0.42 7.09 7.51 0.42 4.73 5.15 0.45 5.68 6.13 0.48 7.09 7.57 0.37 4.73 5.10 0.43 5.68 6.11 0.46 7.09 7.55 0.42 4.73 5.15 0.45 5.68 6.13 0.47 7.09 7.56 0.57 10.63 11.20 0.57 10.63 11.20 0.44 11.23 11.67 0.53 13.48 14.01 0.49 NA NA 0.07 NA NA 0.07 NA NA 0.06 NA NA 0.10 NA NA 0.28 NA NA 0.14 NA NA 0.06 NA NA 0.12 NA NA 0.28 NA NA 0.37 NA NA 0.42 NA NA 0.42 NA NA 0.45 NA NA 0.48 NA NA 0.37 NA NA 0.43 NA NA 0.46 NA NA 0.42 NA NA 0.45 NA NA 0.47 NA NA 0.57 NA NA 0.57 NA NA 0.44 NA NA 0.53 NA NA Magnetic image, jaw joint ................................... Magnetic image, jaw joint ................................... Magnetic image, jaw joint ................................... X-ray head for orthodontia ................................. X-ray head for orthodontia ................................. X-ray head for orthodontia ................................. Panoramic x-ray of jaws ..................................... Panoramic x-ray of jaws ..................................... Panoramic x-ray of jaws ..................................... X-ray exam of neck ............................................ X-ray exam of neck ............................................ X-ray exam of neck ............................................ Throat x-ray & fluoroscopy ................................. Throat x-ray & fluoroscopy ................................. Throat x-ray & fluoroscopy ................................. Speech evaluation, complex .............................. Speech evaluation, complex .............................. Speech evaluation, complex .............................. Contrast x-ray of larynx ...................................... Contrast x-ray of larynx ...................................... Contrast x-ray of larynx ...................................... X-ray exam of salivary gland ............................. X-ray exam of salivary gland ............................. X-ray exam of salivary gland ............................. X-ray exam of salivary duct ............................... X-ray exam of salivary duct ............................... X-ray exam of salivary duct ............................... Ct head/brain w/o dye ........................................ Ct head/brain w/o dye ........................................ Ct head/brain w/o dye ........................................ Ct head/brain w/dye ........................................... Ct head/brain w/dye ........................................... Ct head/brain w/dye ........................................... Ct head/brain w/o & w/dye ................................. Ct head/brain w/o & w/dye ................................. Ct head/brain w/o & w/dye ................................. Ct orbit/ear/fossa w/o dye .................................. Ct orbit/ear/fossa w/o dye .................................. Ct orbit/ear/fossa w/o dye .................................. Ct orbit/ear/fossa w/dye ..................................... Ct orbit/ear/fossa w/dye ..................................... Ct orbit/ear/fossa w/dye ..................................... Ct orbit/ear/fossa w/o&w/dye ............................. Ct orbit/ear/fossa w/o&w/dye ............................. Ct orbit/ear/fossa w/o&w/dye ............................. Ct maxillofacial w/o dye ..................................... Ct maxillofacial w/o dye ..................................... Ct maxillofacial w/o dye ..................................... Ct maxillofacial w/dye ......................................... Ct maxillofacial w/dye ......................................... Ct maxillofacial w/dye ......................................... Ct maxillofacial w/o & w/dye .............................. Ct maxillofacial w/o & w/dye .............................. Ct maxillofacial w/o & w/dye .............................. Ct soft tissue neck w/o dye ................................ Ct soft tissue neck w/o dye ................................ Ct soft tissue neck w/o dye ................................ Ct soft tissue neck w/dye ................................... Ct soft tissue neck w/dye ................................... Ct soft tissue neck w/dye ................................... Ct sft tsue nck w/o & w/dye ............................... Ct sft tsue nck w/o & w/dye ............................... Ct sft tsue nck w/o & w/dye ............................... Ct angiography, head ......................................... Ct angiography, head ......................................... Ct angiography, head ......................................... Ct angiography, neck ......................................... Ct angiography, neck ......................................... Ct angiography, neck ......................................... Mri orbit/face/neck w/o dye ................................ Mri orbit/face/neck w/o dye ................................ Mri orbit/face/neck w/o dye ................................ Mri orbit/face/neck w/dye ................................... Mri orbit/face/neck w/dye ................................... Mri orbit/face/neck w/dye ................................... Malpractice RVUs 0.07 0.59 0.66 0.01 0.02 0.03 0.01 0.04 0.05 0.01 0.02 0.03 0.01 0.07 0.08 0.04 0.12 0.16 0.02 0.11 0.13 0.01 0.04 0.05 0.02 0.11 0.13 0.04 0.25 0.29 0.05 0.30 0.35 0.06 0.37 0.43 0.06 0.25 0.31 0.06 0.30 0.36 0.06 0.37 0.43 0.05 0.25 0.30 0.06 0.30 0.36 0.06 0.37 0.43 0.06 0.25 0.31 0.06 0.30 0.36 0.06 0.37 0.43 0.08 0.58 0.66 0.08 0.58 0.66 0.06 0.39 0.45 0.07 0.47 0.54 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00298 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 2.04 11.82 13.86 0.25 0.40 0.65 0.28 0.61 0.89 0.24 0.44 0.68 0.43 1.38 1.81 1.16 2.23 3.39 0.60 1.90 2.50 0.24 0.71 0.95 0.52 1.90 2.42 1.17 4.98 6.15 1.55 5.98 7.53 1.75 7.46 9.21 1.76 4.98 6.74 1.89 5.98 7.87 1.99 7.46 9.45 1.56 4.98 6.54 1.79 5.98 7.77 1.94 7.46 9.40 1.76 4.98 6.74 1.89 5.98 7.87 1.98 7.46 9.44 2.40 11.21 13.61 2.40 11.21 13.61 1.85 11.62 13.47 2.22 13.95 16.17 Facility Total 2.04 NA NA 0.25 NA NA 0.28 NA NA 0.24 NA NA 0.43 NA NA 1.16 NA NA 0.60 NA NA 0.24 NA NA 0.52 NA NA 1.17 NA NA 1.55 NA NA 1.75 NA NA 1.76 NA NA 1.89 NA NA 1.99 NA NA 1.56 NA NA 1.79 NA NA 1.94 NA NA 1.76 NA NA 1.89 NA NA 1.98 NA NA 2.40 NA NA 2.40 NA NA 1.85 NA NA 2.22 NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70413 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 70543 70543 70543 70544 70544 70544 70545 70545 70545 70546 70546 70546 70547 70547 70547 70548 70548 70548 70549 70549 70549 70551 70551 70551 70552 70552 70552 70553 70553 70553 70557 70557 70557 70558 70558 70558 70559 70559 70559 71010 71010 71010 71015 71015 71015 71020 71020 71020 71021 71021 71021 71022 71022 71022 71023 71023 71023 71030 71030 71030 71034 71034 71034 71035 71035 71035 71040 71040 71040 71060 71060 71060 71090 71090 71090 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C A C C A C C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 2.15 0.00 2.15 1.20 0.00 1.20 1.20 0.00 1.20 1.80 0.00 1.80 1.20 0.00 1.20 1.20 0.00 1.20 1.80 0.00 1.80 1.48 0.00 1.48 1.78 0.00 1.78 2.36 0.00 2.36 2.90 0.00 0.00 3.20 0.00 0.00 3.20 0.00 0.00 0.18 0.00 0.18 0.21 0.00 0.21 0.22 0.00 0.22 0.27 0.00 0.27 0.31 0.00 0.31 0.38 0.00 0.38 0.31 0.00 0.31 0.46 0.00 0.46 0.18 0.00 0.18 0.58 0.00 0.58 0.74 0.00 0.74 0.54 0.00 0.54 0.71 24.95 25.66 0.40 11.23 11.63 0.39 11.23 11.62 0.59 22.47 23.06 0.39 11.23 11.62 0.39 11.23 11.62 0.59 22.47 23.06 0.49 11.23 11.72 0.59 13.48 14.07 0.78 24.95 25.73 1.13 0.00 0.00 1.24 0.00 0.00 1.24 0.00 0.00 0.06 0.47 0.53 0.07 0.52 0.59 0.07 0.62 0.69 0.09 0.73 0.82 0.10 0.73 0.83 0.13 0.78 0.91 0.10 0.78 0.88 0.16 1.44 1.60 0.06 0.52 0.58 0.19 1.46 1.65 0.24 2.21 2.45 0.21 1.68 1.89 0.71 NA NA 0.40 NA NA 0.39 NA NA 0.59 NA NA 0.39 NA NA 0.39 NA NA 0.59 NA NA 0.49 NA NA 0.59 NA NA 0.78 NA NA 1.13 0.00 0.00 1.24 0.00 0.00 1.24 0.00 0.00 0.06 NA NA 0.07 NA NA 0.07 NA NA 0.09 NA NA 0.10 NA NA 0.13 NA NA 0.10 NA NA 0.16 NA NA 0.06 NA NA 0.19 NA NA 0.24 NA NA 0.21 NA NA Mri orbt/fac/nck w/o & w/dye .............................. Mri orbt/fac/nck w/o & w/dye .............................. Mri orbt/fac/nck w/o & w/dye .............................. Mr angiography head w/o dye ........................... Mr angiography head w/o dye ........................... Mr angiography head w/o dye ........................... Mr angiography head w/dye ............................... Mr angiography head w/dye ............................... Mr angiography head w/dye ............................... Mr angiograph head w/o&w/dye ........................ Mr angiograph head w/o&w/dye ........................ Mr angiograph head w/o&w/dye ........................ Mr angiography neck w/o dye ............................ Mr angiography neck w/o dye ............................ Mr angiography neck w/o dye ............................ Mr angiography neck w/dye ............................... Mr angiography neck w/dye ............................... Mr angiography neck w/dye ............................... Mr angiograph neck w/o&w/dye ......................... Mr angiograph neck w/o&w/dye ......................... Mr angiograph neck w/o&w/dye ......................... Mri brain w/o dye ................................................ Mri brain w/o dye ................................................ Mri brain w/o dye ................................................ Mri brain w/dye ................................................... Mri brain w/dye ................................................... Mri brain w/dye ................................................... Mri brain w/o & w/dye ........................................ Mri brain w/o & w/dye ........................................ Mri brain w/o & w/dye ........................................ Mri brain w/o dye ................................................ Mri brain w/o dye ................................................ Mri brain w/o dye ................................................ Mri brain w/dye ................................................... Mri brain w/dye ................................................... Mri brain w/dye ................................................... Mri brain w/o & w/dye ........................................ Mri brain w/o & w/dye ........................................ Mri brain w/o & w/dye ........................................ Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray and fluoroscopy .............................. Chest x-ray and fluoroscopy .............................. Chest x-ray and fluoroscopy .............................. Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray and fluoroscopy .............................. Chest x-ray and fluoroscopy .............................. Chest x-ray and fluoroscopy .............................. Chest x-ray ......................................................... Chest x-ray ......................................................... Chest x-ray ......................................................... Contrast x-ray of bronchi .................................... Contrast x-ray of bronchi .................................... Contrast x-ray of bronchi .................................... Contrast x-ray of bronchi .................................... Contrast x-ray of bronchi .................................... Contrast x-ray of bronchi .................................... X-ray & pacemaker insertion .............................. X-ray & pacemaker insertion .............................. X-ray & pacemaker insertion .............................. Malpractice RVUs 0.10 0.84 0.94 0.05 0.59 0.64 0.05 0.59 0.64 0.08 0.59 0.67 0.05 0.59 0.64 0.05 0.59 0.64 0.08 0.59 0.67 0.07 0.59 0.66 0.08 0.70 0.78 0.10 1.31 1.41 0.08 0.00 0.00 0.10 0.00 0.00 0.12 0.00 0.00 0.01 0.02 0.03 0.01 0.02 0.03 0.01 0.04 0.05 0.01 0.05 0.06 0.01 0.05 0.06 0.01 0.05 0.06 0.01 0.05 0.06 0.02 0.08 0.10 0.01 0.02 0.03 0.03 0.08 0.11 0.03 0.13 0.16 0.02 0.11 0.13 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00299 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 2.96 25.79 28.75 1.65 11.82 13.47 1.64 11.82 13.46 2.47 23.06 25.53 1.64 11.82 13.46 1.64 11.82 13.46 2.47 23.06 25.53 2.04 11.82 13.86 2.45 14.18 16.63 3.24 26.26 29.50 4.11 0.00 0.00 4.54 0.00 0.00 4.56 0.00 0.00 0.25 0.49 0.74 0.29 0.54 0.83 0.30 0.66 0.96 0.37 0.78 1.15 0.42 0.78 1.20 0.52 0.83 1.35 0.42 0.83 1.25 0.64 1.52 2.16 0.25 0.54 0.79 0.80 1.54 2.34 1.01 2.34 3.35 0.77 1.79 2.56 Facility Total 2.96 NA NA 1.65 NA NA 1.64 NA NA 2.47 NA NA 1.64 NA NA 1.64 NA NA 2.47 NA NA 2.04 NA NA 2.45 NA NA 3.24 NA NA 4.11 0.00 0.00 4.54 0.00 0.00 4.56 0.00 0.00 0.25 NA NA 0.29 NA NA 0.30 NA NA 0.37 NA NA 0.42 NA NA 0.52 NA NA 0.42 NA NA 0.64 NA NA 0.25 NA NA 0.80 NA NA 1.01 NA NA 0.77 NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70414 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 71100 71100 71100 71101 71101 71101 71110 71110 71110 71111 71111 71111 71120 71120 71120 71130 71130 71130 71250 71250 71250 71260 71260 71260 71270 71270 71270 71275 71275 71275 71550 71550 71550 71551 71551 71551 71552 71552 71552 71555 71555 71555 72010 72010 72010 72020 72020 72020 72040 72040 72040 72050 72050 72050 72052 72052 72052 72069 72069 72069 72070 72070 72070 72072 72072 72072 72074 72074 72074 72080 72080 72080 72090 72090 72090 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A R R R A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.22 0.00 0.22 0.27 0.00 0.27 0.27 0.00 0.27 0.32 0.00 0.32 0.20 0.00 0.20 0.22 0.00 0.22 1.16 0.00 1.16 1.24 0.00 1.24 1.38 0.00 1.38 1.92 0.00 1.92 1.46 0.00 1.46 1.73 0.00 1.73 2.26 0.00 2.26 1.81 0.00 1.81 0.45 0.00 0.45 0.15 0.00 0.15 0.22 0.00 0.22 0.31 0.00 0.31 0.36 0.00 0.36 0.22 0.00 0.22 0.22 0.00 0.22 0.22 0.00 0.22 0.22 0.00 0.22 0.22 0.00 0.22 0.28 0.00 0.28 0.07 0.57 0.64 0.09 0.67 0.76 0.09 0.78 0.87 0.10 0.89 0.99 0.07 0.65 0.72 0.07 0.71 0.78 0.38 5.93 6.31 0.41 7.09 7.50 0.45 8.88 9.33 0.63 12.42 13.05 0.48 11.23 11.71 0.57 13.48 14.05 0.74 24.95 25.69 0.60 11.23 11.83 0.15 1.02 1.17 0.05 0.42 0.47 0.07 0.60 0.67 0.10 0.89 0.99 0.12 1.13 1.25 0.08 0.49 0.57 0.07 0.65 0.72 0.07 0.73 0.80 0.07 0.91 0.98 0.07 0.67 0.74 0.09 0.67 0.76 0.07 NA NA 0.09 NA NA 0.09 NA NA 0.10 NA NA 0.07 NA NA 0.07 NA NA 0.38 NA NA 0.41 NA NA 0.45 NA NA 0.63 NA NA 0.48 NA NA 0.57 NA NA 0.74 NA NA 0.60 NA NA 0.15 NA NA 0.05 NA NA 0.07 NA NA 0.10 NA NA 0.12 NA NA 0.08 NA NA 0.07 NA NA 0.07 NA NA 0.07 NA NA 0.07 NA NA 0.09 NA NA X-ray exam of ribs .............................................. X-ray exam of ribs .............................................. X-ray exam of ribs .............................................. X-ray exam of ribs/chest .................................... X-ray exam of ribs/chest .................................... X-ray exam of ribs/chest .................................... X-ray exam of ribs .............................................. X-ray exam of ribs .............................................. X-ray exam of ribs .............................................. X-ray exam of ribs/chest .................................... X-ray exam of ribs/chest .................................... X-ray exam of ribs/chest .................................... X-ray exam of breastbone .................................. X-ray exam of breastbone .................................. X-ray exam of breastbone .................................. X-ray exam of breastbone .................................. X-ray exam of breastbone .................................. X-ray exam of breastbone .................................. Ct thorax w/o dye ............................................... Ct thorax w/o dye ............................................... Ct thorax w/o dye ............................................... Ct thorax w/dye .................................................. Ct thorax w/dye .................................................. Ct thorax w/dye .................................................. Ct thorax w/o & w/dye ........................................ Ct thorax w/o & w/dye ........................................ Ct thorax w/o & w/dye ........................................ Ct angiography, chest ........................................ Ct angiography, chest ........................................ Ct angiography, chest ........................................ Mri chest w/o dye ............................................... Mri chest w/o dye ............................................... Mri chest w/o dye ............................................... Mri chest w/dye .................................................. Mri chest w/dye .................................................. Mri chest w/dye .................................................. Mri chest w/o & w/dye ........................................ Mri chest w/o & w/dye ........................................ Mri chest w/o & w/dye ........................................ Mri angio chest w or w/o dye ............................. Mri angio chest w or w/o dye ............................. Mri angio chest w or w/o dye ............................. X-ray exam of spine ........................................... X-ray exam of spine ........................................... X-ray exam of spine ........................................... X-ray exam of spine ........................................... X-ray exam of spine ........................................... X-ray exam of spine ........................................... X-ray exam of neck spine .................................. X-ray exam of neck spine .................................. X-ray exam of neck spine .................................. X-ray exam of neck spine .................................. X-ray exam of neck spine .................................. X-ray exam of neck spine .................................. X-ray exam of neck spine .................................. X-ray exam of neck spine .................................. X-ray exam of neck spine .................................. X-ray exam of trunk spine .................................. X-ray exam of trunk spine .................................. X-ray exam of trunk spine .................................. X-ray exam of thoracic spine ............................. X-ray exam of thoracic spine ............................. X-ray exam of thoracic spine ............................. X-ray exam of thoracic spine ............................. X-ray exam of thoracic spine ............................. X-ray exam of thoracic spine ............................. X-ray exam of thoracic spine ............................. X-ray exam of thoracic spine ............................. X-ray exam of thoracic spine ............................. X-ray exam of trunk spine .................................. X-ray exam of trunk spine .................................. X-ray exam of trunk spine .................................. X-ray exam of trunk spine .................................. X-ray exam of trunk spine .................................. X-ray exam of trunk spine .................................. Malpractice RVUs 0.01 0.04 0.05 0.01 0.04 0.05 0.01 0.05 0.06 0.01 0.06 0.07 0.01 0.04 0.05 0.01 0.04 0.05 0.05 0.31 0.36 0.05 0.37 0.42 0.06 0.46 0.52 0.09 0.39 0.48 0.06 0.45 0.51 0.08 0.52 0.60 0.10 0.68 0.78 0.08 0.59 0.67 0.02 0.06 0.08 0.01 0.02 0.03 0.01 0.04 0.05 0.01 0.06 0.07 0.02 0.06 0.08 0.01 0.02 0.03 0.01 0.04 0.05 0.01 0.05 0.06 0.01 0.06 0.07 0.01 0.04 0.05 0.01 0.04 0.05 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00300 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.30 0.61 0.91 0.37 0.71 1.08 0.37 0.83 1.20 0.43 0.95 1.38 0.28 0.69 0.97 0.30 0.75 1.05 1.59 6.24 7.83 1.70 7.46 9.16 1.89 9.34 11.23 2.64 12.81 15.45 2.00 11.68 13.68 2.38 14.00 16.38 3.10 25.63 28.73 2.49 11.82 14.31 0.62 1.08 1.70 0.21 0.44 0.65 0.30 0.64 0.94 0.42 0.95 1.37 0.50 1.19 1.69 0.31 0.51 0.82 0.30 0.69 0.99 0.30 0.78 1.08 0.30 0.97 1.27 0.30 0.71 1.01 0.38 0.71 1.09 Facility Total 0.30 NA NA 0.37 NA NA 0.37 NA NA 0.43 NA NA 0.28 NA NA 0.30 NA NA 1.59 NA NA 1.70 NA NA 1.89 NA NA 2.64 NA NA 2.00 NA NA 2.38 NA NA 3.10 NA NA 2.49 NA NA 0.62 NA NA 0.21 NA NA 0.30 NA NA 0.42 NA NA 0.50 NA NA 0.31 NA NA 0.30 NA NA 0.30 NA NA 0.30 NA NA 0.30 NA NA 0.38 NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70415 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 72100 72100 72100 72110 72110 72110 72114 72114 72114 72120 72120 72120 72125 72125 72125 72126 72126 72126 72127 72127 72127 72128 72128 72128 72129 72129 72129 72130 72130 72130 72131 72131 72131 72132 72132 72132 72133 72133 72133 72141 72141 72141 72142 72142 72142 72146 72146 72146 72147 72147 72147 72148 72148 72148 72149 72149 72149 72156 72156 72156 72157 72157 72157 72158 72158 72158 72159 72159 72159 72170 72170 72170 72190 72190 72190 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A N N N A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.22 0.00 0.22 0.31 0.00 0.31 0.36 0.00 0.36 0.22 0.00 0.22 1.16 0.00 1.16 1.22 0.00 1.22 1.27 0.00 1.27 1.16 0.00 1.16 1.22 0.00 1.22 1.27 0.00 1.27 1.16 0.00 1.16 1.22 0.00 1.22 1.27 0.00 1.27 1.60 0.00 1.60 1.92 0.00 1.92 1.60 0.00 1.60 1.92 0.00 1.92 1.48 0.00 1.48 1.78 0.00 1.78 2.57 0.00 2.57 2.57 0.00 2.57 2.36 0.00 2.36 +1.80 +0.00 +1.80 0.17 0.00 0.17 0.21 0.00 0.21 0.07 0.67 0.74 0.10 0.91 1.01 0.12 1.19 1.31 0.07 0.89 0.96 0.38 5.93 6.31 0.40 7.09 7.49 0.42 8.88 9.30 0.38 5.93 6.31 0.40 7.09 7.49 0.42 8.88 9.30 0.38 5.93 6.31 0.40 7.09 7.49 0.42 8.88 9.30 0.53 11.23 11.76 0.64 13.48 14.12 0.53 12.48 13.01 0.63 13.48 14.11 0.49 12.48 12.97 0.60 13.48 14.08 0.85 24.95 25.80 0.84 24.95 25.79 0.78 24.95 25.73 0.69 12.27 12.96 0.06 0.52 0.58 0.07 0.67 0.74 0.07 NA NA 0.10 NA NA 0.12 NA NA 0.07 NA NA 0.38 NA NA 0.40 NA NA 0.42 NA NA 0.38 NA NA 0.40 NA NA 0.42 NA NA 0.38 NA NA 0.40 NA NA 0.42 NA NA 0.53 NA NA 0.64 NA NA 0.53 NA NA 0.63 NA NA 0.49 NA NA 0.60 NA NA 0.85 NA NA 0.84 NA NA 0.78 NA NA 0.69 12.27 12.96 0.06 NA NA 0.07 NA NA X-ray exam of lower spine ................................. X-ray exam of lower spine ................................. X-ray exam of lower spine ................................. X-ray exam of lower spine ................................. X-ray exam of lower spine ................................. X-ray exam of lower spine ................................. X-ray exam of lower spine ................................. X-ray exam of lower spine ................................. X-ray exam of lower spine ................................. X-ray exam of lower spine ................................. X-ray exam of lower spine ................................. X-ray exam of lower spine ................................. Ct neck spine w/o dye ........................................ Ct neck spine w/o dye ........................................ Ct neck spine w/o dye ........................................ Ct neck spine w/dye ........................................... Ct neck spine w/dye ........................................... Ct neck spine w/dye ........................................... Ct neck spine w/o & w/dye ................................ Ct neck spine w/o & w/dye ................................ Ct neck spine w/o & w/dye ................................ Ct chest spine w/o dye ....................................... Ct chest spine w/o dye ....................................... Ct chest spine w/o dye ....................................... Ct chest spine w/dye .......................................... Ct chest spine w/dye .......................................... Ct chest spine w/dye .......................................... Ct chest spine w/o & w/dye ............................... Ct chest spine w/o & w/dye ............................... Ct chest spine w/o & w/dye ............................... Ct lumbar spine w/o dye .................................... Ct lumbar spine w/o dye .................................... Ct lumbar spine w/o dye .................................... Ct lumbar spine w/dye ....................................... Ct lumbar spine w/dye ....................................... Ct lumbar spine w/dye ....................................... Ct lumbar spine w/o & w/dye ............................. Ct lumbar spine w/o & w/dye ............................. Ct lumbar spine w/o & w/dye ............................. Mri neck spine w/o dye ...................................... Mri neck spine w/o dye ...................................... Mri neck spine w/o dye ...................................... Mri neck spine w/dye ......................................... Mri neck spine w/dye ......................................... Mri neck spine w/dye ......................................... Mri chest spine w/o dye ..................................... Mri chest spine w/o dye ..................................... Mri chest spine w/o dye ..................................... Mri chest spine w/dye ........................................ Mri chest spine w/dye ........................................ Mri chest spine w/dye ........................................ Mri lumbar spine w/o dye ................................... Mri lumbar spine w/o dye ................................... Mri lumbar spine w/o dye ................................... Mri lumbar spine w/dye ...................................... Mri lumbar spine w/dye ...................................... Mri lumbar spine w/dye ...................................... Mri neck spine w/o & w/dye ............................... Mri neck spine w/o & w/dye ............................... Mri neck spine w/o & w/dye ............................... Mri chest spine w/o & w/dye .............................. Mri chest spine w/o & w/dye .............................. Mri chest spine w/o & w/dye .............................. Mri lumbar spine w/o & w/dye ............................ Mri lumbar spine w/o & w/dye ............................ Mri lumbar spine w/o & w/dye ............................ Mr angio spine w/o&w/dye ................................. Mr angio spine w/o&w/dye ................................. Mr angio spine w/o&w/dye ................................. X-ray exam of pelvis .......................................... X-ray exam of pelvis .......................................... X-ray exam of pelvis .......................................... X-ray exam of pelvis .......................................... X-ray exam of pelvis .......................................... X-ray exam of pelvis .......................................... Malpractice RVUs 0.01 0.04 0.05 0.01 0.06 0.07 0.02 0.06 0.08 0.01 0.06 0.07 0.05 0.31 0.36 0.05 0.37 0.42 0.06 0.46 0.52 0.05 0.31 0.36 0.05 0.37 0.42 0.06 0.46 0.52 0.05 0.31 0.36 0.05 0.37 0.42 0.06 0.46 0.52 0.07 0.59 0.66 0.09 0.70 0.79 0.07 0.64 0.71 0.09 0.70 0.79 0.07 0.64 0.71 0.08 0.70 0.78 0.11 1.31 1.42 0.11 1.31 1.42 0.10 1.31 1.41 0.10 0.64 0.74 0.01 0.02 0.03 0.01 0.04 0.05 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00301 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.30 0.71 1.01 0.42 0.97 1.39 0.50 1.25 1.75 0.30 0.95 1.25 1.59 6.24 7.83 1.67 7.46 9.13 1.75 9.34 11.09 1.59 6.24 7.83 1.67 7.46 9.13 1.75 9.34 11.09 1.59 6.24 7.83 1.67 7.46 9.13 1.75 9.34 11.09 2.20 11.82 14.02 2.65 14.18 16.83 2.20 13.12 15.32 2.64 14.18 16.82 2.04 13.12 15.16 2.46 14.18 16.64 3.53 26.26 29.79 3.52 26.26 29.78 3.24 26.26 29.50 2.59 12.91 15.50 0.24 0.54 0.78 0.29 0.71 1.00 Facility Total 0.30 NA NA 0.42 NA NA 0.50 NA NA 0.30 NA NA 1.59 NA NA 1.67 NA NA 1.75 NA NA 1.59 NA NA 1.67 NA NA 1.75 NA NA 1.59 NA NA 1.67 NA NA 1.75 NA NA 2.20 NA NA 2.65 NA NA 2.20 NA NA 2.64 NA NA 2.04 NA NA 2.46 NA NA 3.53 NA NA 3.52 NA NA 3.24 NA NA 2.59 12.91 15.50 0.24 NA NA 0.29 NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70416 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 72191 72191 72191 72192 72192 72192 72193 72193 72193 72194 72194 72194 72195 72195 72195 72196 72196 72196 72197 72197 72197 72198 72198 72198 72200 72200 72200 72202 72202 72202 72220 72220 72220 72240 72240 72240 72255 72255 72255 72265 72265 72265 72270 72270 72270 72275 72275 72275 72285 72285 72285 72295 72295 72295 73000 73000 73000 73010 73010 73010 73020 73020 73020 73030 73030 73030 73040 73040 73040 73050 73050 73050 73060 73060 73060 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... C ...... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 1.81 0.00 1.81 1.09 0.00 1.09 1.16 0.00 1.16 1.22 0.00 1.22 1.46 0.00 1.46 1.73 0.00 1.73 2.26 0.00 2.26 1.80 0.00 1.80 0.17 0.00 0.17 0.19 0.00 0.19 0.17 0.00 0.17 0.91 0.00 0.91 0.91 0.00 0.91 0.83 0.00 0.83 1.33 0.00 1.33 0.76 0.00 0.76 1.16 0.00 1.16 0.83 0.00 0.83 0.16 0.00 0.16 0.17 0.00 0.17 0.15 0.00 0.15 0.18 0.00 0.18 0.54 0.00 0.54 0.20 0.00 0.20 0.17 0.00 0.17 0.60 12.06 12.66 0.36 5.93 6.29 0.38 6.86 7.24 0.40 8.51 8.91 0.48 11.23 11.71 0.57 13.48 14.05 0.74 24.95 25.69 0.59 11.23 11.82 0.06 0.52 0.58 0.06 0.62 0.68 0.06 0.57 0.63 0.29 4.76 5.05 0.27 4.34 4.61 0.25 4.08 4.33 0.42 6.12 6.54 0.20 2.11 2.31 0.36 8.40 8.76 0.27 7.88 8.15 0.05 0.52 0.57 0.06 0.52 0.58 0.05 0.47 0.52 0.06 0.57 0.63 0.18 2.11 2.29 0.07 0.67 0.74 0.06 0.57 0.63 0.60 NA NA 0.36 NA NA 0.38 NA NA 0.40 NA NA 0.48 NA NA 0.57 NA NA 0.74 NA NA 0.59 NA NA 0.06 NA NA 0.06 NA NA 0.06 NA NA 0.29 NA NA 0.27 NA NA 0.25 NA NA 0.42 NA NA 0.20 NA NA 0.36 NA NA 0.27 NA NA 0.05 NA NA 0.06 NA NA 0.05 NA NA 0.06 NA NA 0.18 NA NA 0.07 NA NA 0.06 NA NA Ct angiograph pelv w/o&w/dye .......................... Ct angiograph pelv w/o&w/dye .......................... Ct angiograph pelv w/o&w/dye .......................... Ct pelvis w/o dye ................................................ Ct pelvis w/o dye ................................................ Ct pelvis w/o dye ................................................ Ct pelvis w/dye ................................................... Ct pelvis w/dye ................................................... Ct pelvis w/dye ................................................... Ct pelvis w/o & w/dye ......................................... Ct pelvis w/o & w/dye ......................................... Ct pelvis w/o & w/dye ......................................... Mri pelvis w/o dye .............................................. Mri pelvis w/o dye .............................................. Mri pelvis w/o dye .............................................. Mri pelvis w/dye .................................................. Mri pelvis w/dye .................................................. Mri pelvis w/dye .................................................. Mri pelvis w/o & w/dye ....................................... Mri pelvis w/o & w/dye ....................................... Mri pelvis w/o & w/dye ....................................... Mr angio pelvis w/o & w/dye .............................. Mr angio pelvis w/o & w/dye .............................. Mr angio pelvis w/o & w/dye .............................. X-ray exam sacroiliac joints ............................... X-ray exam sacroiliac joints ............................... X-ray exam sacroiliac joints ............................... X-ray exam sacroiliac joints ............................... X-ray exam sacroiliac joints ............................... X-ray exam sacroiliac joints ............................... X-ray exam of tailbone ....................................... X-ray exam of tailbone ....................................... X-ray exam of tailbone ....................................... Contrast x-ray of neck spine .............................. Contrast x-ray of neck spine .............................. Contrast x-ray of neck spine .............................. Contrast x-ray, thorax spine ............................... Contrast x-ray, thorax spine ............................... Contrast x-ray, thorax spine ............................... Contrast x-ray, lower spine ................................ Contrast x-ray, lower spine ................................ Contrast x-ray, lower spine ................................ Contrast x-ray, spine .......................................... Contrast x-ray, spine .......................................... Contrast x-ray, spine .......................................... Epidurography .................................................... Epidurography .................................................... Epidurography .................................................... X-ray c/t spine disk ............................................. X-ray c/t spine disk ............................................. X-ray c/t spine disk ............................................. X-ray of lower spine disk .................................... X-ray of lower spine disk .................................... X-ray of lower spine disk .................................... X-ray exam of collar bone .................................. X-ray exam of collar bone .................................. X-ray exam of collar bone .................................. X-ray exam of shoulder blade ............................ X-ray exam of shoulder blade ............................ X-ray exam of shoulder blade ............................ X-ray exam of shoulder ...................................... X-ray exam of shoulder ...................................... X-ray exam of shoulder ...................................... X-ray exam of shoulder ...................................... X-ray exam of shoulder ...................................... X-ray exam of shoulder ...................................... Contrast x-ray of shoulder .................................. Contrast x-ray of shoulder .................................. Contrast x-ray of shoulder .................................. X-ray exam of shoulders .................................... X-ray exam of shoulders .................................... X-ray exam of shoulders .................................... X-ray exam of humerus ...................................... X-ray exam of humerus ...................................... X-ray exam of humerus ...................................... Malpractice RVUs 0.08 0.39 0.47 0.05 0.31 0.36 0.05 0.36 0.41 0.05 0.43 0.48 0.06 0.45 0.51 0.08 0.52 0.60 0.10 0.92 1.02 0.08 0.59 0.67 0.01 0.02 0.03 0.01 0.04 0.05 0.01 0.04 0.05 0.04 0.25 0.29 0.04 0.22 0.26 0.04 0.22 0.26 0.06 0.33 0.39 0.04 0.22 0.26 0.07 0.43 0.50 0.06 0.40 0.46 0.01 0.02 0.03 0.01 0.02 0.03 0.01 0.02 0.03 0.01 0.04 0.05 0.02 0.12 0.14 0.01 0.04 0.05 0.01 0.04 0.05 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00302 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 2.49 12.45 14.94 1.50 6.24 7.74 1.59 7.22 8.81 1.67 8.94 10.61 2.00 11.68 13.68 2.38 14.00 16.38 3.10 25.87 28.97 2.47 11.82 14.29 0.24 0.54 0.78 0.26 0.66 0.92 0.24 0.61 0.85 1.24 5.01 6.25 1.22 4.56 5.78 1.12 4.30 5.42 1.81 6.45 8.26 1.00 2.33 3.33 1.59 8.83 10.42 1.16 8.28 9.44 0.22 0.54 0.76 0.24 0.54 0.78 0.21 0.49 0.70 0.25 0.61 0.86 0.74 2.23 2.97 0.28 0.71 0.99 0.24 0.61 0.85 Facility Total 2.49 NA NA 1.50 NA NA 1.59 NA NA 1.67 NA NA 2.00 NA NA 2.38 NA NA 3.10 NA NA 2.47 NA NA 0.24 NA NA 0.26 NA NA 0.24 NA NA 1.24 NA NA 1.22 NA NA 1.12 NA NA 1.81 NA NA 1.00 NA NA 1.59 NA NA 1.16 NA NA 0.22 NA NA 0.24 NA NA 0.21 NA NA 0.25 NA NA 0.74 NA NA 0.28 NA NA 0.24 NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70417 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 73070 73070 73070 73080 73080 73080 73085 73085 73085 73090 73090 73090 73092 73092 73092 73100 73100 73100 73110 73110 73110 73115 73115 73115 73120 73120 73120 73130 73130 73130 73140 73140 73140 73200 73200 73200 73201 73201 73201 73202 73202 73202 73206 73206 73206 73218 73218 73218 73219 73219 73219 73220 73220 73220 73221 73221 73221 73222 73222 73222 73223 73223 73223 73225 73225 73225 73500 73500 73500 73510 73510 73510 73520 73520 73520 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A N N N A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.15 0.00 0.15 0.17 0.00 0.17 0.54 0.00 0.54 0.16 0.00 0.16 0.16 0.00 0.16 0.16 0.00 0.16 0.17 0.00 0.17 0.54 0.00 0.54 0.16 0.00 0.16 0.17 0.00 0.17 0.13 0.00 0.13 1.09 0.00 1.09 1.16 0.00 1.16 1.22 0.00 1.22 1.81 0.00 1.81 1.35 0.00 1.35 1.62 0.00 1.62 2.15 0.00 2.15 1.35 0.00 1.35 1.62 0.00 1.62 2.15 0.00 2.15 +1.73 +0.00 +1.73 0.17 0.00 0.17 0.21 0.00 0.21 0.26 0.00 0.26 0.05 0.52 0.57 0.06 0.57 0.63 0.19 2.11 2.30 0.05 0.52 0.57 0.05 0.49 0.54 0.05 0.49 0.54 0.06 0.53 0.59 0.18 1.58 1.76 0.05 0.49 0.54 0.06 0.53 0.59 0.04 0.42 0.46 0.36 4.97 5.33 0.38 5.93 6.31 0.40 7.44 7.84 0.59 10.99 11.58 0.44 11.23 11.67 0.54 13.48 14.02 0.71 24.95 25.66 0.44 11.23 11.67 0.53 13.48 14.01 0.71 24.95 25.66 0.67 11.04 11.71 0.06 0.47 0.53 0.07 0.57 0.64 0.09 0.67 0.76 0.05 NA NA 0.06 NA NA 0.19 NA NA 0.05 NA NA 0.05 NA NA 0.05 NA NA 0.06 NA NA 0.18 NA NA 0.05 NA NA 0.06 NA NA 0.04 NA NA 0.36 NA NA 0.38 NA NA 0.40 NA NA 0.59 NA NA 0.44 NA NA 0.54 NA NA 0.71 NA NA 0.44 NA NA 0.53 NA NA 0.71 NA NA 0.67 11.04 11.71 0.06 NA NA 0.07 NA NA 0.09 NA NA X-ray exam of elbow .......................................... X-ray exam of elbow .......................................... X-ray exam of elbow .......................................... X-ray exam of elbow .......................................... X-ray exam of elbow .......................................... X-ray exam of elbow .......................................... Contrast x-ray of elbow ...................................... Contrast x-ray of elbow ...................................... Contrast x-ray of elbow ...................................... X-ray exam of forearm ....................................... X-ray exam of forearm ....................................... X-ray exam of forearm ....................................... X-ray exam of arm, infant .................................. X-ray exam of arm, infant .................................. X-ray exam of arm, infant .................................. X-ray exam of wrist ............................................ X-ray exam of wrist ............................................ X-ray exam of wrist ............................................ X-ray exam of wrist ............................................ X-ray exam of wrist ............................................ X-ray exam of wrist ............................................ Contrast x-ray of wrist ........................................ Contrast x-ray of wrist ........................................ Contrast x-ray of wrist ........................................ X-ray exam of hand ............................................ X-ray exam of hand ............................................ X-ray exam of hand ............................................ X-ray exam of hand ............................................ X-ray exam of hand ............................................ X-ray exam of hand ............................................ X-ray exam of finger(s) ...................................... X-ray exam of finger(s) ...................................... X-ray exam of finger(s) ...................................... Ct upper extremity w/o dye ................................ Ct upper extremity w/o dye ................................ Ct upper extremity w/o dye ................................ Ct upper extremity w/dye ................................... Ct upper extremity w/dye ................................... Ct upper extremity w/dye ................................... Ct uppr extremity w/o&w/dye ............................. Ct uppr extremity w/o&w/dye ............................. Ct uppr extremity w/o&w/dye ............................. Ct angio upr extrm w/o&w/dye ........................... Ct angio upr extrm w/o&w/dye ........................... Ct angio upr extrm w/o&w/dye ........................... Mri upper extremity w/o dye ............................... Mri upper extremity w/o dye ............................... Mri upper extremity w/o dye ............................... Mri upper extremity w/dye .................................. Mri upper extremity w/dye .................................. Mri upper extremity w/dye .................................. Mri uppr extremity w/o&w/dye ............................ Mri uppr extremity w/o&w/dye ............................ Mri uppr extremity w/o&w/dye ............................ Mri joint upr extrem w/o dye .............................. Mri joint upr extrem w/o dye .............................. Mri joint upr extrem w/o dye .............................. Mri joint upr extrem w/dye .................................. Mri joint upr extrem w/dye .................................. Mri joint upr extrem w/dye .................................. Mri joint upr extr w/o&w/dye ............................... Mri joint upr extr w/o&w/dye ............................... Mri joint upr extr w/o&w/dye ............................... Mr angio upr extr w/o&w/dye ............................. Mr angio upr extr w/o&w/dye ............................. Mr angio upr extr w/o&w/dye ............................. X-ray exam of hip ............................................... X-ray exam of hip ............................................... X-ray exam of hip ............................................... X-ray exam of hip ............................................... X-ray exam of hip ............................................... X-ray exam of hip ............................................... X-ray exam of hips ............................................. X-ray exam of hips ............................................. X-ray exam of hips ............................................. Malpractice RVUs 0.01 0.02 0.03 0.01 0.04 0.05 0.02 0.12 0.14 0.01 0.02 0.03 0.01 0.02 0.03 0.01 0.02 0.03 0.01 0.02 0.03 0.02 0.10 0.12 0.01 0.02 0.03 0.01 0.02 0.03 0.01 0.02 0.03 0.05 0.25 0.30 0.05 0.31 0.36 0.05 0.39 0.44 0.08 0.39 0.47 0.06 0.39 0.45 0.07 0.47 0.54 0.10 0.84 0.94 0.06 0.39 0.45 0.07 0.47 0.54 0.10 0.84 0.94 0.10 0.59 0.69 0.01 0.02 0.03 0.01 0.04 0.05 0.01 0.04 0.05 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00303 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.21 0.54 0.75 0.24 0.61 0.85 0.75 2.23 2.98 0.22 0.54 0.76 0.22 0.51 0.73 0.22 0.51 0.73 0.24 0.55 0.79 0.74 1.68 2.42 0.22 0.51 0.73 0.24 0.55 0.79 0.18 0.44 0.62 1.50 5.22 6.72 1.59 6.24 7.83 1.67 7.83 9.50 2.48 11.38 13.86 1.85 11.62 13.47 2.23 13.95 16.18 2.96 25.79 28.75 1.85 11.62 13.47 2.22 13.95 16.17 2.96 25.79 28.75 2.50 11.63 14.13 0.24 0.49 0.73 0.29 0.61 0.90 0.36 0.71 1.07 Facility Total 0.21 NA NA 0.24 NA NA 0.75 NA NA 0.22 NA NA 0.22 NA NA 0.22 NA NA 0.24 NA NA 0.74 NA NA 0.22 NA NA 0.24 NA NA 0.18 NA NA 1.50 NA NA 1.59 NA NA 1.67 NA NA 2.48 NA NA 1.85 NA NA 2.23 NA NA 2.96 NA NA 1.85 NA NA 2.22 NA NA 2.96 NA NA 2.50 11.63 14.13 0.24 NA NA 0.29 NA NA 0.36 NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70418 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 73525 73525 73525 73530 73530 73530 73540 73540 73540 73542 73542 73542 73550 73550 73550 73560 73560 73560 73562 73562 73562 73564 73564 73564 73565 73565 73565 73580 73580 73580 73590 73590 73590 73592 73592 73592 73600 73600 73600 73610 73610 73610 73615 73615 73615 73620 73620 73620 73630 73630 73630 73650 73650 73650 73660 73660 73660 73700 73700 73700 73701 73701 73701 73702 73702 73702 73706 73706 73706 73718 73718 73718 73719 73719 73719 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.54 0.00 0.54 0.29 0.00 0.29 0.20 0.00 0.20 0.59 0.00 0.59 0.17 0.00 0.17 0.17 0.00 0.17 0.18 0.00 0.18 0.22 0.00 0.22 0.17 0.00 0.17 0.54 0.00 0.54 0.17 0.00 0.17 0.16 0.00 0.16 0.16 0.00 0.16 0.17 0.00 0.17 0.54 0.00 0.54 0.16 0.00 0.16 0.17 0.00 0.17 0.16 0.00 0.16 0.13 0.00 0.13 1.09 0.00 1.09 1.16 0.00 1.16 1.22 0.00 1.22 1.90 0.00 1.90 1.35 0.00 1.35 1.62 0.00 1.62 0.18 2.11 2.29 0.10 0.52 0.62 0.07 0.57 0.64 0.16 2.11 2.27 0.06 0.57 0.63 0.06 0.52 0.58 0.06 0.57 0.63 0.07 0.62 0.69 0.06 0.49 0.55 0.17 2.63 2.80 0.06 0.52 0.58 0.05 0.49 0.54 0.05 0.49 0.54 0.06 0.53 0.59 0.18 2.11 2.29 0.05 0.49 0.54 0.06 0.53 0.59 0.05 0.47 0.52 0.04 0.42 0.46 0.36 4.97 5.33 0.38 5.93 6.31 0.40 7.44 7.84 0.62 10.99 11.61 0.44 11.23 11.67 0.53 13.48 14.01 0.18 NA NA 0.10 NA NA 0.07 NA NA 0.16 NA NA 0.06 NA NA 0.06 NA NA 0.06 NA NA 0.07 NA NA 0.06 NA NA 0.17 NA NA 0.06 NA NA 0.05 NA NA 0.05 NA NA 0.06 NA NA 0.18 NA NA 0.05 NA NA 0.06 NA NA 0.05 NA NA 0.04 NA NA 0.36 NA NA 0.38 NA NA 0.40 NA NA 0.62 NA NA 0.44 NA NA 0.53 NA NA Contrast x-ray of hip ........................................... Contrast x-ray of hip ........................................... Contrast x-ray of hip ........................................... X-ray exam of hip ............................................... X-ray exam of hip ............................................... X-ray exam of hip ............................................... X-ray exam of pelvis & hips ............................... X-ray exam of pelvis & hips ............................... X-ray exam of pelvis & hips ............................... X-ray exam, sacroiliac joint ................................ X-ray exam, sacroiliac joint ................................ X-ray exam, sacroiliac joint ................................ X-ray exam of thigh ............................................ X-ray exam of thigh ............................................ X-ray exam of thigh ............................................ X-ray exam of knee, 1 or 2 ................................ X-ray exam of knee, 1 or 2 ................................ X-ray exam of knee, 1 or 2 ................................ X-ray exam of knee, 3 ........................................ X-ray exam of knee, 3 ........................................ X-ray exam of knee, 3 ........................................ X-ray exam, knee, 4 or more ............................. X-ray exam, knee, 4 or more ............................. X-ray exam, knee, 4 or more ............................. X-ray exam of knees .......................................... X-ray exam of knees .......................................... X-ray exam of knees .......................................... Contrast x-ray of knee joint ................................ Contrast x-ray of knee joint ................................ Contrast x-ray of knee joint ................................ X-ray exam of lower leg ..................................... X-ray exam of lower leg ..................................... X-ray exam of lower leg ..................................... X-ray exam of leg, infant .................................... X-ray exam of leg, infant .................................... X-ray exam of leg, infant .................................... X-ray exam of ankle ........................................... X-ray exam of ankle ........................................... X-ray exam of ankle ........................................... X-ray exam of ankle ........................................... X-ray exam of ankle ........................................... X-ray exam of ankle ........................................... Contrast x-ray of ankle ....................................... Contrast x-ray of ankle ....................................... Contrast x-ray of ankle ....................................... X-ray exam of foot .............................................. X-ray exam of foot .............................................. X-ray exam of foot .............................................. X-ray exam of foot .............................................. X-ray exam of foot .............................................. X-ray exam of foot .............................................. X-ray exam of heel ............................................. X-ray exam of heel ............................................. X-ray exam of heel ............................................. X-ray exam of toe(s) .......................................... X-ray exam of toe(s) .......................................... X-ray exam of toe(s) .......................................... Ct lower extremity w/o dye ................................. Ct lower extremity w/o dye ................................. Ct lower extremity w/o dye ................................. Ct lower extremity w/dye .................................... Ct lower extremity w/dye .................................... Ct lower extremity w/dye .................................... Ct lwr extremity w/o&w/dye ................................ Ct lwr extremity w/o&w/dye ................................ Ct lwr extremity w/o&w/dye ................................ Ct angio lwr extr w/o&w/dye .............................. Ct angio lwr extr w/o&w/dye .............................. Ct angio lwr extr w/o&w/dye .............................. Mri lower extremity w/o dye ............................... Mri lower extremity w/o dye ............................... Mri lower extremity w/o dye ............................... Mri lower extremity w/dye .................................. Mri lower extremity w/dye .................................. Mri lower extremity w/dye .................................. Malpractice RVUs 0.03 0.12 0.15 0.01 0.02 0.03 0.01 0.04 0.05 0.03 0.12 0.15 0.01 0.04 0.05 0.01 0.02 0.03 0.01 0.04 0.05 0.01 0.04 0.05 0.01 0.02 0.03 0.03 0.14 0.17 0.01 0.02 0.03 0.01 0.02 0.03 0.01 0.02 0.03 0.01 0.02 0.03 0.03 0.12 0.15 0.01 0.02 0.03 0.01 0.02 0.03 0.01 0.02 0.03 0.01 0.02 0.03 0.05 0.25 0.30 0.05 0.31 0.36 0.05 0.39 0.44 0.08 0.39 0.47 0.06 0.39 0.45 0.07 0.47 0.54 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00304 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.75 2.23 2.98 0.40 0.54 0.94 0.28 0.61 0.89 0.78 2.23 3.01 0.24 0.61 0.85 0.24 0.54 0.78 0.25 0.61 0.86 0.30 0.66 0.96 0.24 0.51 0.75 0.74 2.77 3.51 0.24 0.54 0.78 0.22 0.51 0.73 0.22 0.51 0.73 0.24 0.55 0.79 0.75 2.23 2.98 0.22 0.51 0.73 0.24 0.55 0.79 0.22 0.49 0.71 0.18 0.44 0.62 1.50 5.22 6.72 1.59 6.24 7.83 1.67 7.83 9.50 2.60 11.38 13.98 1.85 11.62 13.47 2.22 13.95 16.17 Facility Total 0.75 NA NA 0.40 NA NA 0.28 NA NA 0.78 NA NA 0.24 NA NA 0.24 NA NA 0.25 NA NA 0.30 NA NA 0.24 NA NA 0.74 NA NA 0.24 NA NA 0.22 NA NA 0.22 NA NA 0.24 NA NA 0.75 NA NA 0.22 NA NA 0.24 NA NA 0.22 NA NA 0.18 NA NA 1.50 NA NA 1.59 NA NA 1.67 NA NA 2.60 NA NA 1.85 NA NA 2.22 NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70419 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 73720 73720 73720 73721 73721 73721 73722 73722 73722 73723 73723 73723 73725 73725 73725 74000 74000 74000 74010 74010 74010 74020 74020 74020 74022 74022 74022 74150 74150 74150 74160 74160 74160 74170 74170 74170 74175 74175 74175 74181 74181 74181 74182 74182 74182 74183 74183 74183 74185 74185 74185 74190 74190 74190 74210 74210 74210 74220 74220 74220 74230 74230 74230 74235 74235 74235 74240 74240 74240 74241 74241 74241 74245 74245 74245 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... Status A A A A A A A A A A A A R R R A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A R R R A A A A A A A A A A A A A C C A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 2.15 0.00 2.15 1.35 0.00 1.35 1.62 0.00 1.62 2.15 0.00 2.15 1.82 0.00 1.82 0.18 0.00 0.18 0.23 0.00 0.23 0.27 0.00 0.27 0.32 0.00 0.32 1.19 0.00 1.19 1.27 0.00 1.27 1.40 0.00 1.40 1.90 0.00 1.90 1.46 0.00 1.46 1.73 0.00 1.73 2.26 0.00 2.26 1.80 0.00 1.80 0.48 0.00 0.48 0.36 0.00 0.36 0.46 0.00 0.46 0.53 0.00 0.53 1.19 0.00 0.00 0.69 0.00 0.69 0.69 0.00 0.69 0.91 0.00 0.91 0.70 24.95 25.65 0.44 11.23 11.67 0.53 13.48 14.01 0.71 24.95 25.66 0.60 11.23 11.83 0.06 0.52 0.58 0.08 0.57 0.65 0.09 0.62 0.71 0.10 0.73 0.83 0.39 5.68 6.07 0.42 6.86 7.28 0.46 8.51 8.97 0.62 12.06 12.68 0.48 11.23 11.71 0.57 13.48 14.05 0.74 24.95 25.69 0.59 11.23 11.82 0.16 1.31 1.47 0.12 1.19 1.31 0.15 1.19 1.34 0.17 1.31 1.48 0.39 0.00 0.00 0.23 1.46 1.69 0.23 1.49 1.72 0.30 2.39 2.69 0.70 NA NA 0.44 NA NA 0.53 NA NA 0.71 NA NA 0.60 NA NA 0.06 NA NA 0.08 NA NA 0.09 NA NA 0.10 NA NA 0.39 NA NA 0.42 NA NA 0.46 NA NA 0.62 NA NA 0.48 NA NA 0.57 NA NA 0.74 NA NA 0.59 NA NA 0.16 NA NA 0.12 NA NA 0.15 NA NA 0.17 NA NA 0.39 0.00 0.00 0.23 NA NA 0.23 NA NA 0.30 NA NA Mri lwr extremity w/o&w/dye .............................. Mri lwr extremity w/o&w/dye .............................. Mri lwr extremity w/o&w/dye .............................. Mri jnt of lwr extre w/o dye ................................. Mri jnt of lwr extre w/o dye ................................. Mri jnt of lwr extre w/o dye ................................. Mri joint of lwr extr w/dye ................................... Mri joint of lwr extr w/dye ................................... Mri joint of lwr extr w/dye ................................... Mri joint lwr extr w/o&w/dye ............................... Mri joint lwr extr w/o&w/dye ............................... Mri joint lwr extr w/o&w/dye ............................... Mr ang lwr ext w or w/o dye .............................. Mr ang lwr ext w or w/o dye .............................. Mr ang lwr ext w or w/o dye .............................. X-ray exam of abdomen ..................................... X-ray exam of abdomen ..................................... X-ray exam of abdomen ..................................... X-ray exam of abdomen ..................................... X-ray exam of abdomen ..................................... X-ray exam of abdomen ..................................... X-ray exam of abdomen ..................................... X-ray exam of abdomen ..................................... X-ray exam of abdomen ..................................... X-ray exam series, abdomen ............................. X-ray exam series, abdomen ............................. X-ray exam series, abdomen ............................. Ct abdomen w/o dye .......................................... Ct abdomen w/o dye .......................................... Ct abdomen w/o dye .......................................... Ct abdomen w/dye ............................................. Ct abdomen w/dye ............................................. Ct abdomen w/dye ............................................. Ct abdomen w/o & w/dye ................................... Ct abdomen w/o & w/dye ................................... Ct abdomen w/o & w/dye ................................... Ct angio abdom w/o & w/dye ............................. Ct angio abdom w/o & w/dye ............................. Ct angio abdom w/o & w/dye ............................. Mri abdomen w/o dye ......................................... Mri abdomen w/o dye ......................................... Mri abdomen w/o dye ......................................... Mri abdomen w/dye ............................................ Mri abdomen w/dye ............................................ Mri abdomen w/dye ............................................ Mri abdomen w/o & w/dye ................................. Mri abdomen w/o & w/dye ................................. Mri abdomen w/o & w/dye ................................. Mri angio, abdom w orw/o dye ........................... Mri angio, abdom w orw/o dye ........................... Mri angio, abdom w orw/o dye ........................... X-ray exam of peritoneum .................................. X-ray exam of peritoneum .................................. X-ray exam of peritoneum .................................. Contrst x-ray exam of throat .............................. Contrst x-ray exam of throat .............................. Contrst x-ray exam of throat .............................. Contrast x-ray, esophagus ................................. Contrast x-ray, esophagus ................................. Contrast x-ray, esophagus ................................. Cine/vid x-ray, throat/esoph ............................... Cine/vid x-ray, throat/esoph ............................... Cine/vid x-ray, throat/esoph ............................... Remove esophagus obstruction ......................... Remove esophagus obstruction ......................... Remove esophagus obstruction ......................... X-ray exam, upper gi tract ................................. X-ray exam, upper gi tract ................................. X-ray exam, upper gi tract ................................. X-ray exam, upper gi tract ................................. X-ray exam, upper gi tract ................................. X-ray exam, upper gi tract ................................. X-ray exam, upper gi tract ................................. X-ray exam, upper gi tract ................................. X-ray exam, upper gi tract ................................. Malpractice RVUs 0.10 0.84 0.94 0.06 0.39 0.45 0.07 0.47 0.54 0.10 0.84 0.94 0.08 0.59 0.67 0.01 0.02 0.03 0.01 0.04 0.05 0.01 0.04 0.05 0.01 0.05 0.06 0.05 0.30 0.35 0.06 0.36 0.42 0.06 0.43 0.49 0.08 0.39 0.47 0.06 0.45 0.51 0.08 0.52 0.60 0.10 0.92 1.02 0.08 0.59 0.67 0.02 0.07 0.09 0.02 0.06 0.08 0.02 0.06 0.08 0.02 0.07 0.09 0.05 0.00 0.00 0.03 0.08 0.11 0.03 0.08 0.11 0.04 0.13 0.17 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00305 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 2.95 25.79 28.74 1.85 11.62 13.47 2.22 13.95 16.17 2.96 25.79 28.75 2.50 11.82 14.32 0.25 0.54 0.79 0.32 0.61 0.93 0.37 0.66 1.03 0.43 0.78 1.21 1.63 5.98 7.61 1.75 7.22 8.97 1.92 8.94 10.86 2.60 12.45 15.05 2.00 11.68 13.68 2.38 14.00 16.38 3.10 25.87 28.97 2.47 11.82 14.29 0.66 1.38 2.04 0.50 1.25 1.75 0.63 1.25 1.88 0.72 1.38 2.10 1.63 0.00 0.00 0.95 1.54 2.49 0.95 1.57 2.52 1.25 2.52 3.77 Facility Total 2.95 NA NA 1.85 NA NA 2.22 NA NA 2.96 NA NA 2.50 NA NA 0.25 NA NA 0.32 NA NA 0.37 NA NA 0.43 NA NA 1.63 NA NA 1.75 NA NA 1.92 NA NA 2.60 NA NA 2.00 NA NA 2.38 NA NA 3.10 NA NA 2.47 NA NA 0.66 NA NA 0.50 NA NA 0.63 NA NA 0.72 NA NA 1.63 0.00 0.00 0.95 NA NA 0.95 NA NA 1.25 NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70420 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 74246 74246 74246 74247 74247 74247 74249 74249 74249 74250 74250 74250 74251 74251 74251 74260 74260 74260 74270 74270 74270 74280 74280 74280 74283 74283 74283 74290 74290 74290 74291 74291 74291 74300 74300 74300 74301 74301 74301 74305 74305 74305 74320 74320 74320 74327 74327 74327 74328 74328 74328 74329 74329 74329 74330 74330 74330 74340 74340 74340 74350 74350 74350 74355 74355 74355 74360 74360 74360 74363 74363 74363 74400 74400 74400 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C A C C A A A A A A A A A A A A A C C A A A A A A A A A A A A A A A A C C A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.69 0.00 0.69 0.69 0.00 0.69 0.91 0.00 0.91 0.47 0.00 0.47 0.69 0.00 0.69 0.50 0.00 0.50 0.69 0.00 0.69 0.99 0.00 0.99 2.02 0.00 2.02 0.32 0.00 0.32 0.20 0.00 0.20 0.36 0.00 0.00 0.21 0.00 0.00 0.42 0.00 0.42 0.54 0.00 0.54 0.70 0.00 0.70 0.70 0.00 0.70 0.70 0.00 0.00 0.90 0.00 0.90 0.54 0.00 0.54 0.76 0.00 0.76 0.76 0.00 0.76 0.54 0.00 0.54 0.88 0.00 0.00 0.49 0.00 0.49 0.23 1.64 1.87 0.23 1.68 1.91 0.30 2.58 2.88 0.15 1.31 1.46 0.23 1.31 1.54 0.16 1.49 1.65 0.23 1.70 1.93 0.32 2.24 2.56 0.66 2.57 3.23 0.10 0.73 0.83 0.07 0.42 0.49 0.12 0.00 0.00 0.07 0.00 0.00 0.14 0.78 0.92 0.18 3.16 3.34 0.23 1.77 2.00 0.23 3.16 3.39 0.23 0.00 0.00 0.29 3.16 3.45 0.18 2.63 2.81 0.25 3.16 3.41 0.25 2.63 2.88 0.19 3.16 3.35 0.29 0.00 0.00 0.16 1.68 1.84 0.23 NA NA 0.23 NA NA 0.30 NA NA 0.15 NA NA 0.23 NA NA 0.16 NA NA 0.23 NA NA 0.32 NA NA 0.66 NA NA 0.10 NA NA 0.07 NA NA 0.12 0.00 0.00 0.07 0.00 0.00 0.14 NA NA 0.18 NA NA 0.23 NA NA 0.23 NA NA 0.23 0.00 0.00 0.29 NA NA 0.18 NA NA 0.25 NA NA 0.25 NA NA 0.19 NA NA 0.29 0.00 0.00 0.16 NA NA Contrst x-ray uppr gi tract .................................. Contrst x-ray uppr gi tract .................................. Contrst x-ray uppr gi tract .................................. Contrst x-ray uppr gi tract .................................. Contrst x-ray uppr gi tract .................................. Contrst x-ray uppr gi tract .................................. Contrst x-ray uppr gi tract .................................. Contrst x-ray uppr gi tract .................................. Contrst x-ray uppr gi tract .................................. X-ray exam of small bowel ................................. X-ray exam of small bowel ................................. X-ray exam of small bowel ................................. X-ray exam of small bowel ................................. X-ray exam of small bowel ................................. X-ray exam of small bowel ................................. X-ray exam of small bowel ................................. X-ray exam of small bowel ................................. X-ray exam of small bowel ................................. Contrast x-ray exam of colon ............................. Contrast x-ray exam of colon ............................. Contrast x-ray exam of colon ............................. Contrast x-ray exam of colon ............................. Contrast x-ray exam of colon ............................. Contrast x-ray exam of colon ............................. Contrast x-ray exam of colon ............................. Contrast x-ray exam of colon ............................. Contrast x-ray exam of colon ............................. Contrast x-ray, gallbladder ................................. Contrast x-ray, gallbladder ................................. Contrast x-ray, gallbladder ................................. Contrast x-rays, gallbladder ............................... Contrast x-rays, gallbladder ............................... Contrast x-rays, gallbladder ............................... X-ray bile ducts/pancreas ................................... X-ray bile ducts/pancreas ................................... X-ray bile ducts/pancreas ................................... X-rays at surgery add-on ................................... X-rays at surgery add-on ................................... X-rays at surgery add-on ................................... X-ray bile ducts/pancreas ................................... X-ray bile ducts/pancreas ................................... X-ray bile ducts/pancreas ................................... Contrast x-ray of bile ducts ................................ Contrast x-ray of bile ducts ................................ Contrast x-ray of bile ducts ................................ X-ray bile stone removal .................................... X-ray bile stone removal .................................... X-ray bile stone removal .................................... X-ray bile duct endoscopy .................................. X-ray bile duct endoscopy .................................. X-ray bile duct endoscopy .................................. X-ray for pancreas endoscopy ........................... X-ray for pancreas endoscopy ........................... X-ray for pancreas endoscopy ........................... X-ray bile/panc endoscopy ................................. X-ray bile/panc endoscopy ................................. X-ray bile/panc endoscopy ................................. X-ray guide for GI tube ...................................... X-ray guide for GI tube ...................................... X-ray guide for GI tube ...................................... X-ray guide, stomach tube ................................. X-ray guide, stomach tube ................................. X-ray guide, stomach tube ................................. X-ray guide, intestinal tube ................................ X-ray guide, intestinal tube ................................ X-ray guide, intestinal tube ................................ X-ray guide, GI dilation ...................................... X-ray guide, GI dilation ...................................... X-ray guide, GI dilation ...................................... X-ray, bile duct dilation ....................................... X-ray, bile duct dilation ....................................... X-ray, bile duct dilation ....................................... Contrst x-ray, urinary tract ................................. Contrst x-ray, urinary tract ................................. Contrst x-ray, urinary tract ................................. Malpractice RVUs 0.03 0.10 0.13 0.03 0.11 0.14 0.04 0.14 0.18 0.02 0.07 0.09 0.03 0.07 0.10 0.02 0.08 0.10 0.03 0.11 0.14 0.04 0.13 0.17 0.09 0.14 0.23 0.01 0.05 0.06 0.01 0.02 0.03 0.02 0.00 0.00 0.01 0.00 0.00 0.02 0.05 0.07 0.02 0.17 0.19 0.03 0.11 0.14 0.03 0.17 0.20 0.03 0.00 0.00 0.04 0.17 0.21 0.02 0.14 0.16 0.03 0.17 0.20 0.03 0.14 0.17 0.02 0.17 0.19 0.04 0.00 0.00 0.02 0.11 0.13 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00306 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.95 1.74 2.69 0.95 1.79 2.74 1.25 2.72 3.97 0.64 1.38 2.02 0.95 1.38 2.33 0.68 1.57 2.25 0.95 1.81 2.76 1.35 2.37 3.72 2.77 2.71 5.48 0.43 0.78 1.21 0.28 0.44 0.72 0.50 0.00 0.00 0.29 0.00 0.00 0.58 0.83 1.41 0.74 3.33 4.07 0.96 1.88 2.84 0.96 3.33 4.29 0.96 0.00 0.00 1.23 3.33 4.56 0.74 2.77 3.51 1.04 3.33 4.37 1.04 2.77 3.81 0.75 3.33 4.08 1.21 0.00 0.00 0.67 1.79 2.46 Facility Total 0.95 NA NA 0.95 NA NA 1.25 NA NA 0.64 NA NA 0.95 NA NA 0.68 NA NA 0.95 NA NA 1.35 NA NA 2.77 NA NA 0.43 NA NA 0.28 NA NA 0.50 0.00 0.00 0.29 0.00 0.00 0.58 NA NA 0.74 NA NA 0.96 NA NA 0.96 NA NA 0.96 0.00 0.00 1.23 NA NA 0.74 NA NA 1.04 NA NA 1.04 NA NA 0.75 NA NA 1.21 0.00 0.00 0.67 NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70421 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 74410 74410 74410 74415 74415 74415 74420 74420 74420 74425 74425 74425 74430 74430 74430 74440 74440 74440 74445 74445 74445 74450 74450 74450 74455 74455 74455 74470 74470 74470 74475 74475 74475 74480 74480 74480 74485 74485 74485 74710 74710 74710 74740 74740 74740 74742 74742 74742 74775 74775 74775 75552 75552 75552 75553 75553 75553 75554 75554 75554 75555 75555 75555 75556 75600 75600 75600 75605 75605 75605 75625 75625 75625 75630 75630 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C A A A A A A A A A A A A A A A N A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.49 0.00 0.49 0.49 0.00 0.49 0.36 0.00 0.36 0.36 0.00 0.36 0.32 0.00 0.32 0.38 0.00 0.38 1.14 0.00 1.14 0.33 0.00 0.33 0.33 0.00 0.33 0.54 0.00 0.54 0.54 0.00 0.54 0.54 0.00 0.54 0.54 0.00 0.54 0.34 0.00 0.34 0.38 0.00 0.38 0.61 0.00 0.00 0.62 0.00 0.62 1.60 0.00 1.60 2.00 0.00 2.00 1.83 0.00 1.83 1.74 0.00 1.74 0.00 0.49 0.00 0.49 1.14 0.00 1.14 1.14 0.00 1.14 1.79 0.00 0.16 1.96 2.12 0.16 2.13 2.29 0.12 2.63 2.75 0.12 1.31 1.43 0.10 1.05 1.15 0.12 1.13 1.25 0.37 1.13 1.50 0.11 1.46 1.57 0.11 1.58 1.69 0.18 1.25 1.43 0.18 4.08 4.26 0.18 4.08 4.26 0.17 3.16 3.33 0.11 1.05 1.16 0.13 1.31 1.44 0.20 0.00 0.00 0.21 1.46 1.67 0.53 11.23 11.76 0.65 11.23 11.88 0.64 11.23 11.87 0.64 11.23 11.87 0.00 0.19 12.64 12.83 0.40 12.64 13.04 0.38 12.64 13.02 0.61 13.17 0.16 NA NA 0.16 NA NA 0.12 NA NA 0.12 NA NA 0.10 NA NA 0.12 NA NA 0.37 NA NA 0.11 NA NA 0.11 NA NA 0.18 NA NA 0.18 NA NA 0.18 NA NA 0.17 NA NA 0.11 NA NA 0.13 NA NA 0.20 0.00 0.00 0.21 NA NA 0.53 NA NA 0.65 NA NA 0.64 NA NA 0.64 NA NA 0.00 0.19 NA NA 0.40 NA NA 0.38 NA NA 0.61 NA Contrst x-ray, urinary tract ................................. Contrst x-ray, urinary tract ................................. Contrst x-ray, urinary tract ................................. Contrst x-ray, urinary tract ................................. Contrst x-ray, urinary tract ................................. Contrst x-ray, urinary tract ................................. Contrst x-ray, urinary tract ................................. Contrst x-ray, urinary tract ................................. Contrst x-ray, urinary tract ................................. Contrst x-ray, urinary tract ................................. Contrst x-ray, urinary tract ................................. Contrst x-ray, urinary tract ................................. Contrast x-ray, bladder ....................................... Contrast x-ray, bladder ....................................... Contrast x-ray, bladder ....................................... X-ray, male genital tract ..................................... X-ray, male genital tract ..................................... X-ray, male genital tract ..................................... X-ray exam of penis ........................................... X-ray exam of penis ........................................... X-ray exam of penis ........................................... X-ray, urethra/bladder ........................................ X-ray, urethra/bladder ........................................ X-ray, urethra/bladder ........................................ X-ray, urethra/bladder ........................................ X-ray, urethra/bladder ........................................ X-ray, urethra/bladder ........................................ X-ray exam of kidney lesion ............................... X-ray exam of kidney lesion ............................... X-ray exam of kidney lesion ............................... X-ray control, cath insert .................................... X-ray control, cath insert .................................... X-ray control, cath insert .................................... X-ray control, cath insert .................................... X-ray control, cath insert .................................... X-ray control, cath insert .................................... X-ray guide, GU dilation ..................................... X-ray guide, GU dilation ..................................... X-ray guide, GU dilation ..................................... X-ray measurement of pelvis ............................. X-ray measurement of pelvis ............................. X-ray measurement of pelvis ............................. X-ray, female genital tract .................................. X-ray, female genital tract .................................. X-ray, female genital tract .................................. X-ray, fallopian tube ........................................... X-ray, fallopian tube ........................................... X-ray, fallopian tube ........................................... X-ray exam of perineum ..................................... X-ray exam of perineum ..................................... X-ray exam of perineum ..................................... Heart mri for morph w/o dye .............................. Heart mri for morph w/o dye .............................. Heart mri for morph w/o dye .............................. Heart mri for morph w/dye ................................. Heart mri for morph w/dye ................................. Heart mri for morph w/dye ................................. Cardiac MRI/function .......................................... Cardiac MRI/function .......................................... Cardiac MRI/function .......................................... Cardiac MRI/limited study .................................. Cardiac MRI/limited study .................................. Cardiac MRI/limited study .................................. Cardiac MRI/flow mapping ................................. Contrast x-ray exam of aorta ............................. Contrast x-ray exam of aorta ............................. Contrast x-ray exam of aorta ............................. Contrast x-ray exam of aorta ............................. Contrast x-ray exam of aorta ............................. Contrast x-ray exam of aorta ............................. Contrast x-ray exam of aorta ............................. Contrast x-ray exam of aorta ............................. Contrast x-ray exam of aorta ............................. X-ray aorta, leg arteries ..................................... X-ray aorta, leg arteries ..................................... Malpractice RVUs 0.02 0.11 0.13 0.02 0.12 0.14 0.02 0.14 0.16 0.02 0.07 0.09 0.02 0.06 0.08 0.02 0.06 0.08 0.07 0.06 0.13 0.02 0.08 0.10 0.02 0.10 0.12 0.02 0.07 0.09 0.02 0.22 0.24 0.02 0.22 0.24 0.03 0.17 0.20 0.02 0.06 0.08 0.02 0.07 0.09 0.03 0.00 0.00 0.03 0.08 0.11 0.07 0.59 0.66 0.07 0.59 0.66 0.07 0.59 0.66 0.07 0.59 0.66 0.00 0.02 0.65 0.67 0.05 0.65 0.70 0.06 0.65 0.71 0.11 0.69 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00307 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.67 2.07 2.74 0.67 2.25 2.92 0.50 2.77 3.27 0.50 1.38 1.88 0.44 1.11 1.55 0.52 1.19 1.71 1.58 1.19 2.77 0.46 1.54 2.00 0.46 1.68 2.14 0.74 1.32 2.06 0.74 4.30 5.04 0.74 4.30 5.04 0.74 3.33 4.07 0.47 1.11 1.58 0.53 1.38 1.91 0.84 0.00 0.00 0.86 1.54 2.40 2.20 11.82 14.02 2.72 11.82 14.54 2.54 11.82 14.36 2.45 11.82 14.27 0.00 0.70 13.29 13.99 1.59 13.29 14.88 1.58 13.29 14.87 2.51 13.86 Facility Total 0.67 NA NA 0.67 NA NA 0.50 NA NA 0.50 NA NA 0.44 NA NA 0.52 NA NA 1.58 NA NA 0.46 NA NA 0.46 NA NA 0.74 NA NA 0.74 NA NA 0.74 NA NA 0.74 NA NA 0.47 NA NA 0.53 NA NA 0.84 0.00 0.00 0.86 NA NA 2.20 NA NA 2.72 NA NA 2.54 NA NA 2.45 NA NA 0.00 0.70 NA NA 1.59 NA NA 1.58 NA NA 2.51 NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70422 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 75630 75635 75635 75635 75650 75650 75650 75658 75658 75658 75660 75660 75660 75662 75662 75662 75665 75665 75665 75671 75671 75671 75676 75676 75676 75680 75680 75680 75685 75685 75685 75705 75705 75705 75710 75710 75710 75716 75716 75716 75722 75722 75722 75724 75724 75724 75726 75726 75726 75731 75731 75731 75733 75733 75733 75736 75736 75736 75741 75741 75741 75743 75743 75743 75746 75746 75746 75756 75756 75756 75774 75774 75774 75790 75790 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 1.79 2.40 0.00 2.40 1.49 0.00 1.49 1.31 0.00 1.31 1.31 0.00 1.31 1.66 0.00 1.66 1.31 0.00 1.31 1.66 0.00 1.66 1.31 0.00 1.31 1.66 0.00 1.66 1.31 0.00 1.31 2.18 0.00 2.18 1.14 0.00 1.14 1.31 0.00 1.31 1.14 0.00 1.14 1.49 0.00 1.49 1.14 0.00 1.14 1.14 0.00 1.14 1.31 0.00 1.31 1.14 0.00 1.14 1.31 0.00 1.31 1.66 0.00 1.66 1.14 0.00 1.14 1.14 0.00 1.14 0.36 0.00 0.36 1.84 0.00 13.78 0.79 15.96 16.75 0.49 12.64 13.13 0.47 12.64 13.11 0.44 12.64 13.08 0.59 12.64 13.23 0.44 12.64 13.08 0.55 12.64 13.19 0.44 12.64 13.08 0.55 12.64 13.19 0.43 12.64 13.07 0.73 12.64 13.37 0.39 12.64 13.03 0.43 12.64 13.07 0.40 12.64 13.04 0.56 12.64 13.20 0.37 12.64 13.01 0.37 12.64 13.01 0.44 12.64 13.08 0.38 12.64 13.02 0.43 12.64 13.07 0.54 12.64 13.18 0.38 12.64 13.02 0.45 12.64 13.09 0.12 12.64 12.76 0.60 1.35 NA 0.79 NA NA 0.49 NA NA 0.47 NA NA 0.44 NA NA 0.59 NA NA 0.44 NA NA 0.55 NA NA 0.44 NA NA 0.55 NA NA 0.43 NA NA 0.73 NA NA 0.39 NA NA 0.43 NA NA 0.40 NA NA 0.56 NA NA 0.37 NA NA 0.37 NA NA 0.44 NA NA 0.38 NA NA 0.43 NA NA 0.54 NA NA 0.38 NA NA 0.45 NA NA 0.12 NA NA 0.60 NA X-ray aorta, leg arteries ..................................... Ct angio abdominal arteries ............................... Ct angio abdominal arteries ............................... Ct angio abdominal arteries ............................... Artery x-rays, head & neck ................................ Artery x-rays, head & neck ................................ Artery x-rays, head & neck ................................ Artery x-rays, arm ............................................... Artery x-rays, arm ............................................... Artery x-rays, arm ............................................... Artery x-rays, head & neck ................................ Artery x-rays, head & neck ................................ Artery x-rays, head & neck ................................ Artery x-rays, head & neck ................................ Artery x-rays, head & neck ................................ Artery x-rays, head & neck ................................ Artery x-rays, head & neck ................................ Artery x-rays, head & neck ................................ Artery x-rays, head & neck ................................ Artery x-rays, head & neck ................................ Artery x-rays, head & neck ................................ Artery x-rays, head & neck ................................ Artery x-rays, neck ............................................. Artery x-rays, neck ............................................. Artery x-rays, neck ............................................. Artery x-rays, neck ............................................. Artery x-rays, neck ............................................. Artery x-rays, neck ............................................. Artery x-rays, spine ............................................ Artery x-rays, spine ............................................ Artery x-rays, spine ............................................ Artery x-rays, spine ............................................ Artery x-rays, spine ............................................ Artery x-rays, spine ............................................ Artery x-rays, arm/leg ......................................... Artery x-rays, arm/leg ......................................... Artery x-rays, arm/leg ......................................... Artery x-rays, arms/legs ..................................... Artery x-rays, arms/legs ..................................... Artery x-rays, arms/legs ..................................... Artery x-rays, kidney .......................................... Artery x-rays, kidney .......................................... Artery x-rays, kidney .......................................... Artery x-rays, kidneys ......................................... Artery x-rays, kidneys ......................................... Artery x-rays, kidneys ......................................... Artery x-rays, abdomen ...................................... Artery x-rays, abdomen ...................................... Artery x-rays, abdomen ...................................... Artery x-rays, adrenal gland ............................... Artery x-rays, adrenal gland ............................... Artery x-rays, adrenal gland ............................... Artery x-rays, adrenals ....................................... Artery x-rays, adrenals ....................................... Artery x-rays, adrenals ....................................... Artery x-rays, pelvis ............................................ Artery x-rays, pelvis ............................................ Artery x-rays, pelvis ............................................ Artery x-rays, lung .............................................. Artery x-rays, lung .............................................. Artery x-rays, lung .............................................. Artery x-rays, lungs ............................................ Artery x-rays, lungs ............................................ Artery x-rays, lungs ............................................ Artery x-rays, lung .............................................. Artery x-rays, lung .............................................. Artery x-rays, lung .............................................. Artery x-rays, chest ............................................ Artery x-rays, chest ............................................ Artery x-rays, chest ............................................ Artery x-ray, each vessel ................................... Artery x-ray, each vessel ................................... Artery x-ray, each vessel ................................... Visualize A-V shunt ............................................ Visualize A-V shunt ............................................ Malpractice RVUs 0.80 0.11 0.39 0.50 0.07 0.65 0.72 0.07 0.65 0.72 0.06 0.65 0.71 0.06 0.65 0.71 0.09 0.65 0.74 0.07 0.65 0.72 0.07 0.65 0.72 0.07 0.65 0.72 0.06 0.65 0.71 0.13 0.65 0.78 0.07 0.65 0.72 0.07 0.65 0.72 0.05 0.65 0.70 0.05 0.65 0.70 0.05 0.65 0.70 0.06 0.65 0.71 0.06 0.65 0.71 0.06 0.65 0.71 0.06 0.65 0.71 0.07 0.65 0.72 0.05 0.65 0.70 0.04 0.65 0.69 0.02 0.65 0.67 0.09 0.08 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00308 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 16.37 3.30 16.35 19.65 2.05 13.29 15.34 1.85 13.29 15.14 1.81 13.29 15.10 2.31 13.29 15.60 1.84 13.29 15.13 2.28 13.29 15.57 1.82 13.29 15.11 2.28 13.29 15.57 1.80 13.29 15.09 3.04 13.29 16.33 1.60 13.29 14.89 1.81 13.29 15.10 1.59 13.29 14.88 2.10 13.29 15.39 1.56 13.29 14.85 1.57 13.29 14.86 1.81 13.29 15.10 1.58 13.29 14.87 1.80 13.29 15.09 2.27 13.29 15.56 1.57 13.29 14.86 1.63 13.29 14.92 0.50 13.29 13.79 2.53 1.43 Facility Total NA 3.30 NA NA 2.05 NA NA 1.85 NA NA 1.81 NA NA 2.31 NA NA 1.84 NA NA 2.28 NA NA 1.82 NA NA 2.28 NA NA 1.80 NA NA 3.04 NA NA 1.60 NA NA 1.81 NA NA 1.59 NA NA 2.10 NA NA 1.56 NA NA 1.57 NA NA 1.81 NA NA 1.58 NA NA 1.80 NA NA 2.27 NA NA 1.57 NA NA 1.63 NA NA 0.50 NA NA 2.53 NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70423 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 75790 75801 75801 75801 75803 75803 75803 75805 75805 75805 75807 75807 75807 75809 75809 75809 75810 75810 75810 75820 75820 75820 75822 75822 75822 75825 75825 75825 75827 75827 75827 75831 75831 75831 75833 75833 75833 75840 75840 75840 75842 75842 75842 75860 75860 75860 75870 75870 75870 75872 75872 75872 75880 75880 75880 75885 75885 75885 75887 75887 75887 75889 75889 75889 75891 75891 75891 75893 75893 75893 75894 75894 75894 75896 75896 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... Status A A A A A A A A A A A C C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 1.84 0.81 0.00 0.81 1.17 0.00 1.17 0.81 0.00 0.81 1.17 0.00 0.00 0.47 0.00 0.47 1.14 0.00 1.14 0.70 0.00 0.70 1.06 0.00 1.06 1.14 0.00 1.14 1.14 0.00 1.14 1.14 0.00 1.14 1.49 0.00 1.49 1.14 0.00 1.14 1.49 0.00 1.49 1.14 0.00 1.14 1.14 0.00 1.14 1.14 0.00 1.14 0.70 0.00 0.70 1.44 0.00 1.44 1.44 0.00 1.44 1.14 0.00 1.14 1.14 0.00 1.14 0.54 0.00 0.54 1.31 0.00 1.31 1.31 0.00 1.95 0.27 5.43 5.70 0.38 5.43 5.81 0.27 6.12 6.39 0.38 0.00 0.00 0.15 0.78 0.93 0.37 12.64 13.01 0.23 0.95 1.18 0.35 1.48 1.83 0.37 12.64 13.01 0.37 12.64 13.01 0.37 12.64 13.01 0.49 12.64 13.13 0.38 12.64 13.02 0.48 12.64 13.12 0.39 12.64 13.03 0.39 12.64 13.03 0.37 12.64 13.01 0.23 0.95 1.18 0.47 12.64 13.11 0.47 12.64 13.11 0.37 12.64 13.01 0.37 12.64 13.01 0.18 12.64 12.82 0.43 24.20 24.63 0.45 21.05 NA 0.27 NA NA 0.38 NA NA 0.27 NA NA 0.38 0.00 0.00 0.15 NA NA 0.37 NA NA 0.23 NA NA 0.35 NA NA 0.37 NA NA 0.37 NA NA 0.37 NA NA 0.49 NA NA 0.38 NA NA 0.48 NA NA 0.39 NA NA 0.39 NA NA 0.37 NA NA 0.23 NA NA 0.47 NA NA 0.47 NA NA 0.37 NA NA 0.37 NA NA 0.18 NA NA 0.43 NA NA 0.45 NA Visualize A-V shunt ............................................ Lymph vessel x-ray, arm/leg .............................. Lymph vessel x-ray, arm/leg .............................. Lymph vessel x-ray, arm/leg .............................. Lymph vessel x-ray,arms/legs ............................ Lymph vessel x-ray,arms/legs ............................ Lymph vessel x-ray,arms/legs ............................ Lymph vessel x-ray, trunk .................................. Lymph vessel x-ray, trunk .................................. Lymph vessel x-ray, trunk .................................. Lymph vessel x-ray, trunk .................................. Lymph vessel x-ray, trunk .................................. Lymph vessel x-ray, trunk .................................. Nonvascular shunt, x-ray ................................... Nonvascular shunt, x-ray ................................... Nonvascular shunt, x-ray ................................... Vein x-ray, spleen/liver ....................................... Vein x-ray, spleen/liver ....................................... Vein x-ray, spleen/liver ....................................... Vein x-ray, arm/leg ............................................. Vein x-ray, arm/leg ............................................. Vein x-ray, arm/leg ............................................. Vein x-ray, arms/legs ......................................... Vein x-ray, arms/legs ......................................... Vein x-ray, arms/legs ......................................... Vein x-ray, trunk ................................................. Vein x-ray, trunk ................................................. Vein x-ray, trunk ................................................. Vein x-ray, chest ................................................ Vein x-ray, chest ................................................ Vein x-ray, chest ................................................ Vein x-ray, kidney ............................................... Vein x-ray, kidney ............................................... Vein x-ray, kidney ............................................... Vein x-ray, kidneys ............................................. Vein x-ray, kidneys ............................................. Vein x-ray, kidneys ............................................. Vein x-ray, adrenal gland ................................... Vein x-ray, adrenal gland ................................... Vein x-ray, adrenal gland ................................... Vein x-ray, adrenal glands ................................. Vein x-ray, adrenal glands ................................. Vein x-ray, adrenal glands ................................. Vein x-ray, neck ................................................. Vein x-ray, neck ................................................. Vein x-ray, neck ................................................. Vein x-ray, skull .................................................. Vein x-ray, skull .................................................. Vein x-ray, skull .................................................. Vein x-ray, skull .................................................. Vein x-ray, skull .................................................. Vein x-ray, skull .................................................. Vein x-ray, eye socket ........................................ Vein x-ray, eye socket ........................................ Vein x-ray, eye socket ........................................ Vein x-ray, liver .................................................. Vein x-ray, liver .................................................. Vein x-ray, liver .................................................. Vein x-ray, liver .................................................. Vein x-ray, liver .................................................. Vein x-ray, liver .................................................. Vein x-ray, liver .................................................. Vein x-ray, liver .................................................. Vein x-ray, liver .................................................. Vein x-ray, liver .................................................. Vein x-ray, liver .................................................. Vein x-ray, liver .................................................. Venous sampling by catheter ............................. Venous sampling by catheter ............................. Venous sampling by catheter ............................. X-rays, transcath therapy ................................... X-rays, transcath therapy ................................... X-rays, transcath therapy ................................... X-rays, transcath therapy ................................... X-rays, transcath therapy ................................... Malpractice RVUs 0.17 0.08 0.29 0.37 0.05 0.29 0.34 0.05 0.33 0.38 0.05 0.00 0.00 0.02 0.05 0.07 0.05 0.65 0.70 0.03 0.06 0.09 0.05 0.08 0.13 0.07 0.65 0.72 0.05 0.65 0.70 0.06 0.65 0.71 0.09 0.65 0.74 0.07 0.65 0.72 0.07 0.65 0.72 0.04 0.65 0.69 0.05 0.65 0.70 0.14 0.65 0.79 0.03 0.06 0.09 0.06 0.65 0.71 0.06 0.65 0.71 0.05 0.65 0.70 0.05 0.65 0.70 0.02 0.65 0.67 0.08 1.27 1.35 0.05 1.10 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00309 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 3.96 1.16 5.72 6.88 1.60 5.72 7.32 1.13 6.45 7.58 1.60 0.00 0.00 0.64 0.83 1.47 1.56 13.29 14.85 0.96 1.01 1.97 1.46 1.56 3.02 1.58 13.29 14.87 1.56 13.29 14.85 1.57 13.29 14.86 2.07 13.29 15.36 1.59 13.29 14.88 2.04 13.29 15.33 1.57 13.29 14.86 1.58 13.29 14.87 1.65 13.29 14.94 0.96 1.01 1.97 1.97 13.29 15.26 1.97 13.29 15.26 1.56 13.29 14.85 1.56 13.29 14.85 0.74 13.29 14.03 1.82 25.47 27.29 1.81 22.15 Facility Total NA 1.16 NA NA 1.60 NA NA 1.13 NA NA 1.60 0.00 0.00 0.64 NA NA 1.56 NA NA 0.96 NA NA 1.46 NA NA 1.58 NA NA 1.56 NA NA 1.57 NA NA 2.07 NA NA 1.59 NA NA 2.04 NA NA 1.57 NA NA 1.58 NA NA 1.65 NA NA 0.96 NA NA 1.97 NA NA 1.97 NA NA 1.56 NA NA 1.56 NA NA 0.74 NA NA 1.82 NA NA 1.81 NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70424 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 75896 75898 75898 75898 75900 75900 75900 75901 75901 75901 75902 75902 75902 75940 75940 75940 75945 75945 75945 75946 75946 75946 75952 75952 75952 75953 75953 75953 75954 75954 75954 75956 75956 75956 75957 75957 75957 75958 75958 75958 75959 75959 75959 75960 75960 75960 75961 75961 75961 75962 75962 75962 75964 75964 75964 75966 75966 75966 75968 75968 75968 75970 75970 75970 75978 75978 75978 75980 75980 75980 75982 75982 75982 75984 75984 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... Status A A A A A C C A A A A A A A A A A A A A C C A C C A C C A C C A C C A C C A C C A C C A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 1.31 1.65 0.00 1.65 0.49 0.00 0.00 0.49 0.00 0.49 0.39 0.00 0.39 0.54 0.00 0.54 0.40 0.00 0.40 0.40 0.00 0.00 4.49 0.00 0.00 1.36 0.00 0.00 2.25 0.00 0.00 7.00 0.00 0.00 6.00 0.00 0.00 4.00 0.00 0.00 3.50 0.00 0.00 0.82 0.00 0.82 4.24 0.00 4.24 0.54 0.00 0.54 0.36 0.00 0.36 1.31 0.00 1.31 0.36 0.00 0.36 0.83 0.00 0.83 0.54 0.00 0.54 1.44 0.00 1.44 1.44 0.00 0.00 0.72 0.00 21.50 0.55 1.05 1.60 0.16 0.00 0.00 0.16 1.31 1.47 0.13 1.31 1.44 0.18 12.64 12.82 0.14 4.57 4.71 0.14 0.00 0.00 1.49 0.00 0.00 0.45 0.00 0.00 0.78 0.00 0.00 2.71 0.00 0.00 2.32 0.00 0.00 1.55 0.00 0.00 1.36 0.00 0.00 0.28 14.94 15.22 1.39 10.53 11.92 0.18 15.79 15.97 0.12 8.41 8.53 0.46 15.79 16.25 0.13 8.41 8.54 0.28 11.57 11.85 0.18 15.79 15.97 0.47 5.43 5.90 0.47 0.00 0.00 0.23 1.96 NA 0.55 NA NA 0.16 0.00 0.00 0.16 NA NA 0.13 NA NA 0.18 NA NA 0.14 NA NA 0.14 0.00 0.00 1.49 0.00 0.00 0.45 0.00 0.00 0.78 0.00 0.00 2.71 0.00 0.00 2.32 0.00 0.00 1.55 0.00 0.00 1.36 0.00 0.00 0.28 NA NA 1.39 NA NA 0.18 NA NA 0.12 NA NA 0.46 NA NA 0.13 NA NA 0.28 NA NA 0.18 NA NA 0.47 NA NA 0.47 0.00 0.00 0.23 NA X-rays, transcath therapy ................................... Follow-up angiography ....................................... Follow-up angiography ....................................... Follow-up angiography ....................................... Intravascular cath exchange .............................. Intravascular cath exchange .............................. Intravascular cath exchange .............................. Remove cva device obstruct .............................. Remove cva device obstruct .............................. Remove cva device obstruct .............................. Remove cva lumen obstruct .............................. Remove cva lumen obstruct .............................. Remove cva lumen obstruct .............................. X-ray placement, vein filter ................................ X-ray placement, vein filter ................................ X-ray placement, vein filter ................................ Intravascular us .................................................. Intravascular us .................................................. Intravascular us .................................................. Intravascular us add-on ...................................... Intravascular us add-on ...................................... Intravascular us add-on ...................................... Endovasc repair abdom aorta ............................ Endovasc repair abdom aorta ............................ Endovasc repair abdom aorta ............................ Abdom aneurysm endovas rpr ........................... Abdom aneurysm endovas rpr ........................... Abdom aneurysm endovas rpr ........................... Iliac aneurysm endovas rpr ................................ Iliac aneurysm endovas rpr ................................ Iliac aneurysm endovas rpr ................................ Xray, endovasc thor ao repr .............................. Xray, endovasc thor ao repr .............................. Xray, endovasc thor ao repr .............................. Xray, endovasc thor ao repr .............................. Xray, endovasc thor ao repr .............................. Xray, endovasc thor ao repr .............................. Xray, place prox ext thor ao ............................... Xray, place prox ext thor ao ............................... Xray, place prox ext thor ao ............................... Xray, place dist ext thor ao ................................ Xray, place dist ext thor ao ................................ Xray, place dist ext thor ao ................................ Transcath iv stent rs&i ....................................... Transcath iv stent rs&i ....................................... Transcath iv stent rs&i ....................................... Retrieval, broken catheter .................................. Retrieval, broken catheter .................................. Retrieval, broken catheter .................................. Repair arterial blockage ..................................... Repair arterial blockage ..................................... Repair arterial blockage ..................................... Repair artery blockage, each ............................. Repair artery blockage, each ............................. Repair artery blockage, each ............................. Repair arterial blockage ..................................... Repair arterial blockage ..................................... Repair arterial blockage ..................................... Repair artery blockage, each ............................. Repair artery blockage, each ............................. Repair artery blockage, each ............................. Vascular biopsy .................................................. Vascular biopsy .................................................. Vascular biopsy .................................................. Repair venous blockage ..................................... Repair venous blockage ..................................... Repair venous blockage ..................................... Contrast xray exam bile duct ............................. Contrast xray exam bile duct ............................. Contrast xray exam bile duct ............................. Contrast xray exam bile duct ............................. Contrast xray exam bile duct ............................. Contrast xray exam bile duct ............................. Xray control catheter change ............................. Xray control catheter change ............................. Malpractice RVUs 1.15 0.07 0.06 0.13 0.03 0.00 0.00 0.02 0.83 0.85 0.02 0.83 0.85 0.04 0.65 0.69 0.04 0.24 0.28 0.05 0.00 0.00 0.43 0.00 0.00 0.13 0.00 0.00 0.15 0.00 0.00 0.69 0.00 0.00 0.59 0.00 0.00 0.39 0.00 0.00 0.34 0.00 0.00 0.05 0.77 0.82 0.18 0.55 0.73 0.03 0.83 0.86 0.03 0.43 0.46 0.06 0.83 0.89 0.02 0.43 0.45 0.04 0.60 0.64 0.02 0.83 0.85 0.06 0.29 0.35 0.06 0.00 0.00 0.03 0.11 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00310 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 23.96 2.27 1.11 3.38 0.68 0.00 0.00 0.67 2.14 2.81 0.54 2.14 2.68 0.76 13.29 14.05 0.58 4.81 5.39 0.59 0.00 0.00 6.41 0.00 0.00 1.94 0.00 0.00 3.18 0.00 0.00 10.40 0.00 0.00 8.91 0.00 0.00 5.94 0.00 0.00 5.20 0.00 0.00 1.15 15.71 16.86 5.81 11.08 16.89 0.75 16.62 17.37 0.51 8.84 9.35 1.83 16.62 18.45 0.51 8.84 9.35 1.15 12.17 13.32 0.74 16.62 17.36 1.97 5.72 7.69 1.97 0.00 0.00 0.98 2.07 Facility Total NA 2.27 NA NA 0.68 0.00 0.00 0.67 NA NA 0.54 NA NA 0.76 NA NA 0.58 NA NA 0.59 0.00 0.00 6.41 0.00 0.00 1.94 0.00 0.00 3.18 0.00 0.00 10.40 0.00 0.00 8.91 0.00 0.00 5.94 0.00 0.00 5.20 0.00 0.00 1.15 NA NA 5.81 NA NA 0.75 NA NA 0.51 NA NA 1.83 NA NA 0.51 NA NA 1.15 NA NA 0.74 NA NA 1.97 NA NA 1.97 0.00 0.00 0.98 NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70425 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 75984 75989 75989 75989 75992 75992 75992 75993 75993 75993 75994 75994 75994 75995 75995 75995 75996 75996 75996 75998 75998 75998 76000 76000 76000 76001 76001 76001 76003 76003 76003 76005 76005 76005 76006 76010 76010 76010 76012 76012 76012 76013 76013 76013 76020 76020 76020 76040 76040 76040 76061 76061 76061 76062 76062 76062 76065 76065 76065 76066 76066 76066 76070 76070 76070 76071 76071 76071 76075 76075 76075 76076 76076 76076 76077 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... Status A A A A A A A A C C A C C A C C A C C A A A A A A A A A A A A A A A A A A A A C C A C C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.72 1.19 0.00 1.19 0.54 0.00 0.54 0.36 0.00 0.00 1.31 0.00 0.00 1.31 0.00 0.00 0.36 0.00 0.00 0.38 0.00 0.38 0.17 0.00 0.17 0.67 0.00 0.67 0.54 0.00 0.54 0.60 0.00 0.60 0.41 0.18 0.00 0.18 1.31 0.00 0.00 1.38 0.00 0.00 0.19 0.00 0.19 0.27 0.00 0.27 0.45 0.00 0.45 0.54 0.00 0.54 0.70 0.00 0.70 0.31 0.00 0.31 0.25 0.00 0.25 0.22 0.00 0.22 0.30 0.00 0.30 0.22 0.00 0.22 0.17 2.19 0.39 3.16 3.55 0.19 15.79 15.98 0.13 0.00 0.00 0.46 0.00 0.00 0.47 0.00 0.00 0.12 0.00 0.00 0.13 1.31 1.44 0.05 1.31 1.36 0.22 2.63 2.85 0.17 1.31 1.48 0.15 1.31 1.46 0.18 0.06 0.52 0.58 0.47 0.00 0.00 0.48 0.00 0.00 0.06 0.52 0.58 0.09 0.78 0.87 0.15 1.00 1.15 0.18 1.44 1.62 0.23 0.73 0.96 0.10 1.11 1.21 0.08 2.96 3.04 0.07 2.96 3.03 0.10 3.10 3.20 0.08 0.75 0.83 0.06 NA 0.39 NA NA 0.19 NA NA 0.13 0.00 0.00 0.46 0.00 0.00 0.47 0.00 0.00 0.12 0.00 0.00 0.13 NA NA 0.05 NA NA 0.22 NA NA 0.17 NA NA 0.15 NA NA 0.18 0.06 NA NA 0.47 0.00 0.00 0.48 0.00 0.00 0.06 NA NA 0.09 NA NA 0.15 NA NA 0.18 NA NA 0.23 NA NA 0.10 NA NA 0.08 NA NA 0.07 NA NA 0.10 NA NA 0.08 NA NA 0.06 Xray control catheter change ............................. Abscess drainage under x-ray ........................... Abscess drainage under x-ray ........................... Abscess drainage under x-ray ........................... Atherectomy, x-ray exam ................................... Atherectomy, x-ray exam ................................... Atherectomy, x-ray exam ................................... Atherectomy, x-ray exam ................................... Atherectomy, x-ray exam ................................... Atherectomy, x-ray exam ................................... Atherectomy, x-ray exam ................................... Atherectomy, x-ray exam ................................... Atherectomy, x-ray exam ................................... Atherectomy, x-ray exam ................................... Atherectomy, x-ray exam ................................... Atherectomy, x-ray exam ................................... Atherectomy, x-ray exam ................................... Atherectomy, x-ray exam ................................... Atherectomy, x-ray exam ................................... Fluoroguide for vein device ................................ Fluoroguide for vein device ................................ Fluoroguide for vein device ................................ Fluoroscope examination ................................... Fluoroscope examination ................................... Fluoroscope examination ................................... Fluoroscope exam, extensive ............................ Fluoroscope exam, extensive ............................ Fluoroscope exam, extensive ............................ Needle localization by x-ray ............................... Needle localization by x-ray ............................... Needle localization by x-ray ............................... Fluoroguide for spine inject ................................ Fluoroguide for spine inject ................................ Fluoroguide for spine inject ................................ X-ray stress view ................................................ X-ray, nose to rectum ......................................... X-ray, nose to rectum ......................................... X-ray, nose to rectum ......................................... Percut vertebroplasty fluor ................................. Percut vertebroplasty fluor ................................. Percut vertebroplasty fluor ................................. Percut vertebroplasty, ct .................................... Percut vertebroplasty, ct .................................... Percut vertebroplasty, ct .................................... X-rays for bone age ........................................... X-rays for bone age ........................................... X-rays for bone age ........................................... X-rays, bone evaluation ..................................... X-rays, bone evaluation ..................................... X-rays, bone evaluation ..................................... X-rays, bone survey ........................................... X-rays, bone survey ........................................... X-rays, bone survey ........................................... X-rays, bone survey ........................................... X-rays, bone survey ........................................... X-rays, bone survey ........................................... X-rays, bone evaluation ..................................... X-rays, bone evaluation ..................................... X-rays, bone evaluation ..................................... Joint survey, single view .................................... Joint survey, single view .................................... Joint survey, single view .................................... Ct bone density, axial ......................................... Ct bone density, axial ......................................... Ct bone density, axial ......................................... Ct bone density, peripheral ................................ Ct bone density, peripheral ................................ Ct bone density, peripheral ................................ Dxa bone density, axial ...................................... Dxa bone density, axial ...................................... Dxa bone density, axial ...................................... Dxa bone density/peripheral .............................. Dxa bone density/peripheral .............................. Dxa bone density/peripheral .............................. Dxa bone density/v-fracture ............................... Malpractice RVUs 0.14 0.05 0.17 0.22 0.03 0.83 0.86 0.02 0.00 0.00 0.07 0.00 0.00 0.05 0.00 0.00 0.02 0.00 0.00 0.01 0.10 0.11 0.01 0.07 0.08 0.05 0.14 0.19 0.02 0.07 0.09 0.03 0.07 0.10 0.06 0.01 0.02 0.03 0.10 0.00 0.00 0.07 0.00 0.00 0.01 0.02 0.03 0.01 0.05 0.06 0.02 0.06 0.08 0.02 0.08 0.10 0.03 0.05 0.08 0.02 0.06 0.08 0.01 0.16 0.17 0.01 0.05 0.06 0.01 0.17 0.18 0.01 0.05 0.06 0.01 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00311 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 3.05 1.63 3.33 4.96 0.76 16.62 17.38 0.51 0.00 0.00 1.84 0.00 0.00 1.83 0.00 0.00 0.50 0.00 0.00 0.52 1.41 1.93 0.23 1.38 1.61 0.94 2.77 3.71 0.73 1.38 2.11 0.78 1.38 2.16 0.65 0.25 0.54 0.79 1.88 0.00 0.00 1.93 0.00 0.00 0.26 0.54 0.80 0.37 0.83 1.20 0.62 1.06 1.68 0.74 1.52 2.26 0.96 0.78 1.74 0.43 1.17 1.60 0.34 3.12 3.46 0.30 3.01 3.31 0.41 3.27 3.68 0.31 0.80 1.11 0.24 Facility Total NA 1.63 NA NA 0.76 NA NA 0.51 0.00 0.00 1.84 0.00 0.00 1.83 0.00 0.00 0.50 0.00 0.00 0.52 NA NA 0.23 NA NA 0.94 NA NA 0.73 NA NA 0.78 NA NA 0.65 0.25 NA NA 1.88 0.00 0.00 1.93 0.00 0.00 0.26 NA NA 0.37 NA NA 0.62 NA NA 0.74 NA NA 0.96 NA NA 0.43 NA NA 0.34 NA NA 0.30 NA NA 0.41 NA NA 0.31 NA NA 0.24 Global XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70426 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 76077 76077 76078 76078 76078 76080 76080 76080 76082 76082 76082 76083 76083 76083 76086 76086 76086 76088 76088 76088 76090 76090 76090 76091 76091 76091 76092 76092 76092 76093 76093 76093 76094 76094 76094 76095 76095 76095 76096 76096 76096 76098 76098 76098 76100 76100 76100 76101 76101 76101 76102 76102 76102 76120 76120 76120 76125 76125 76125 76140 76150 76350 76355 76355 76355 76360 76360 76360 76362 76362 76362 76370 76370 76370 76376 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A I A C A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.17 0.20 0.00 0.20 0.54 0.00 0.54 0.06 0.00 0.06 0.06 0.00 0.06 0.36 0.00 0.36 0.45 0.00 0.45 0.70 0.00 0.70 0.87 0.00 0.87 0.70 0.00 0.70 1.63 0.00 1.63 1.63 0.00 1.63 1.59 0.00 1.59 0.56 0.00 0.56 0.16 0.00 0.16 0.58 0.00 0.58 0.58 0.00 0.58 0.58 0.00 0.58 0.38 0.00 0.38 0.27 0.00 0.27 0.00 0.00 0.00 1.21 0.00 1.21 1.16 0.00 1.16 3.99 0.00 3.99 0.85 0.00 0.85 0.20 0.75 0.81 0.07 0.75 0.82 0.18 1.05 1.23 0.02 0.42 0.44 0.02 0.42 0.44 0.12 2.63 2.75 0.15 3.67 3.82 0.23 1.05 1.28 0.28 1.31 1.59 0.23 1.23 1.46 0.53 17.67 18.20 0.53 23.98 24.51 0.52 7.18 7.70 0.18 1.31 1.49 0.05 0.42 0.47 0.19 1.25 1.44 0.19 1.42 1.61 0.19 1.74 1.93 0.13 1.05 1.18 0.09 0.78 0.87 0.00 0.42 0.00 0.40 8.28 8.68 0.38 8.28 8.66 1.30 8.28 9.58 0.28 2.96 3.24 0.07 NA NA 0.07 NA NA 0.18 NA NA 0.02 NA NA 0.02 NA NA 0.12 NA NA 0.15 NA NA 0.23 NA NA 0.28 NA NA 0.23 NA NA 0.53 NA NA 0.53 NA NA 0.52 NA NA 0.18 NA NA 0.05 NA NA 0.19 NA NA 0.19 NA NA 0.19 NA NA 0.13 NA NA 0.09 NA NA 0.00 NA 0.00 0.40 NA NA 0.38 NA NA 1.30 NA NA 0.28 NA NA 0.07 Dxa bone density/v-fracture ............................... Dxa bone density/v-fracture ............................... Radiographic absorptiometry ............................. Radiographic absorptiometry ............................. Radiographic absorptiometry ............................. X-ray exam of fistula .......................................... X-ray exam of fistula .......................................... X-ray exam of fistula .......................................... Computer mammogram add-on ......................... Computer mammogram add-on ......................... Computer mammogram add-on ......................... Computer mammogram add-on ......................... Computer mammogram add-on ......................... Computer mammogram add-on ......................... X-ray of mammary duct ...................................... X-ray of mammary duct ...................................... X-ray of mammary duct ...................................... X-ray of mammary ducts .................................... X-ray of mammary ducts .................................... X-ray of mammary ducts .................................... Mammogram, one breast ................................... Mammogram, one breast ................................... Mammogram, one breast ................................... Mammogram, both breasts ................................ Mammogram, both breasts ................................ Mammogram, both breasts ................................ Mammogram, screening ..................................... Mammogram, screening ..................................... Mammogram, screening ..................................... Magnetic image, breast ...................................... Magnetic image, breast ...................................... Magnetic image, breast ...................................... Magnetic image, both breasts ............................ Magnetic image, both breasts ............................ Magnetic image, both breasts ............................ Stereotactic breast biopsy .................................. Stereotactic breast biopsy .................................. Stereotactic breast biopsy .................................. X-ray of needle wire, breast ............................... X-ray of needle wire, breast ............................... X-ray of needle wire, breast ............................... X-ray exam, breast specimen ............................ X-ray exam, breast specimen ............................ X-ray exam, breast specimen ............................ X-ray exam of body section ............................... X-ray exam of body section ............................... X-ray exam of body section ............................... Complex body section x-ray ............................... Complex body section x-ray ............................... Complex body section x-ray ............................... Complex body section x-rays ............................. Complex body section x-rays ............................. Complex body section x-rays ............................. Cine/video x-rays ................................................ Cine/video x-rays ................................................ Cine/video x-rays ................................................ Cine/video x-rays add-on ................................... Cine/video x-rays add-on ................................... Cine/video x-rays add-on ................................... X-ray consultation ............................................... X-ray exam, dry process .................................... Special x-ray contrast study ............................... Ct scan for localization ....................................... Ct scan for localization ....................................... Ct scan for localization ....................................... Ct scan for needle biopsy .................................. Ct scan for needle biopsy .................................. Ct scan for needle biopsy .................................. Ct guide for tissue ablation ................................ Ct guide for tissue ablation ................................ Ct guide for tissue ablation ................................ Ct scan for therapy guide ................................... Ct scan for therapy guide ................................... Ct scan for therapy guide ................................... 3d render w/o postprocess ................................. Malpractice RVUs 0.05 0.06 0.01 0.05 0.06 0.02 0.06 0.08 0.01 0.01 0.02 0.01 0.01 0.02 0.02 0.14 0.16 0.02 0.19 0.21 0.03 0.06 0.09 0.04 0.07 0.11 0.03 0.07 0.10 0.07 0.92 0.99 0.07 1.24 1.31 0.09 0.37 0.46 0.02 0.07 0.09 0.01 0.02 0.03 0.03 0.07 0.10 0.03 0.08 0.11 0.03 0.11 0.14 0.02 0.06 0.08 0.01 0.05 0.06 0.00 0.02 0.00 0.05 0.42 0.47 0.05 0.42 0.47 0.18 1.46 1.64 0.04 0.16 0.20 0.02 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00312 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.80 1.04 0.28 0.80 1.08 0.74 1.11 1.85 0.09 0.43 0.52 0.09 0.43 0.52 0.50 2.77 3.27 0.62 3.86 4.48 0.96 1.11 2.07 1.19 1.38 2.57 0.96 1.30 2.26 2.23 18.59 20.82 2.23 25.22 27.45 2.20 7.55 9.75 0.76 1.38 2.14 0.22 0.44 0.66 0.80 1.32 2.12 0.80 1.50 2.30 0.80 1.85 2.65 0.53 1.11 1.64 0.37 0.83 1.20 0.00 0.44 0.00 1.66 8.70 10.36 1.59 8.70 10.29 5.47 9.74 15.21 1.17 3.12 4.29 0.29 Facility Total NA NA 0.28 NA NA 0.74 NA NA 0.09 NA NA 0.09 NA NA 0.50 NA NA 0.62 NA NA 0.96 NA NA 1.19 NA NA 0.96 NA NA 2.23 NA NA 2.23 NA NA 2.20 NA NA 0.76 NA NA 0.22 NA NA 0.80 NA NA 0.80 NA NA 0.80 NA NA 0.53 NA NA 0.37 NA NA 0.00 NA 0.00 1.66 NA NA 1.59 NA NA 5.47 NA NA 1.17 NA NA 0.29 Global XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70427 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 76376 76376 76377 76377 76377 76380 76380 76380 76390 76390 76390 76393 76393 76393 76394 76394 76394 76400 76400 76400 76496 76496 76496 76497 76497 76497 76498 76498 76498 76499 76499 76499 76506 76506 76506 76510 76510 76510 76511 76511 76511 76512 76512 76512 76513 76513 76513 76514 76514 76514 76516 76516 76516 76519 76519 76519 76529 76529 76529 76536 76536 76536 76604 76604 76604 76645 76645 76645 76700 76700 76700 76705 76705 76705 76770 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... Status A A A A A A A A N N N A A A A A A A A A C C C C C C C C C C C C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.20 0.79 0.00 0.79 0.98 0.00 0.98 +1.40 +0.00 +1.40 1.50 0.00 1.50 4.24 0.00 4.24 1.60 0.00 1.60 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.63 0.00 0.63 1.55 0.00 1.55 0.94 0.00 0.94 0.94 0.00 0.94 0.66 0.00 0.66 0.17 0.00 0.17 0.54 0.00 0.54 0.54 0.00 0.54 0.57 0.00 0.57 0.56 0.00 0.56 0.55 0.00 0.55 0.54 0.00 0.54 0.81 0.00 0.81 0.59 0.00 0.59 0.74 3.43 3.50 0.27 3.43 3.70 0.32 3.51 3.83 0.47 11.04 11.51 0.50 11.23 11.73 1.38 11.23 12.61 0.52 11.23 11.75 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.24 1.42 1.66 0.68 2.19 2.87 0.40 2.04 2.44 0.42 1.82 2.24 0.29 1.52 1.81 0.08 0.05 0.13 0.24 1.22 1.46 0.24 1.31 1.55 0.24 1.13 1.37 0.18 1.42 1.60 0.18 1.31 1.49 0.18 1.05 1.23 0.27 1.98 2.25 0.19 1.42 1.61 0.24 NA NA 0.27 NA NA 0.32 NA NA 0.47 11.04 11.51 0.50 NA NA 1.38 NA NA 0.52 NA NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.24 NA NA 0.68 NA NA 0.40 NA NA 0.42 NA NA 0.29 NA NA 0.08 NA NA 0.24 NA NA 0.24 NA NA 0.24 NA NA 0.18 NA NA 0.18 NA NA 0.18 NA NA 0.27 NA NA 0.19 NA NA 0.24 3d render w/o postprocess ................................. 3d render w/o postprocess ................................. 3d rendering w/postprocess ............................... 3d rendering w/postprocess ............................... 3d rendering w/postprocess ............................... CAT scan follow-up study .................................. CAT scan follow-up study .................................. CAT scan follow-up study .................................. Mr spectroscopy ................................................. Mr spectroscopy ................................................. Mr spectroscopy ................................................. Mr guidance for needle place ............................ Mr guidance for needle place ............................ Mr guidance for needle place ............................ Mri for tissue ablation ......................................... Mri for tissue ablation ......................................... Mri for tissue ablation ......................................... Magnetic image, bone marrow ........................... Magnetic image, bone marrow ........................... Magnetic image, bone marrow ........................... Fluoroscopic procedure ...................................... Fluoroscopic procedure ...................................... Fluoroscopic procedure ...................................... Ct procedure ....................................................... Ct procedure ....................................................... Ct procedure ....................................................... Mri procedure ..................................................... Mri procedure ..................................................... Mri procedure ..................................................... Radiographic procedure ..................................... Radiographic procedure ..................................... Radiographic procedure ..................................... Echo exam of head ............................................ Echo exam of head ............................................ Echo exam of head ............................................ Ophth us, b & quant a ........................................ Ophth us, b & quant a ........................................ Ophth us, b & quant a ........................................ Ophth us, quant a only ....................................... Ophth us, quant a only ....................................... Ophth us, quant a only ....................................... Ophth us, b w/non-quant a ................................ Ophth us, b w/non-quant a ................................ Ophth us, b w/non-quant a ................................ Echo exam of eye, water bath ........................... Echo exam of eye, water bath ........................... Echo exam of eye, water bath ........................... Echo exam of eye, thickness ............................. Echo exam of eye, thickness ............................. Echo exam of eye, thickness ............................. Echo exam of eye .............................................. Echo exam of eye .............................................. Echo exam of eye .............................................. Echo exam of eye .............................................. Echo exam of eye .............................................. Echo exam of eye .............................................. Echo exam of eye .............................................. Echo exam of eye .............................................. Echo exam of eye .............................................. Us exam of head and neck ................................ Us exam of head and neck ................................ Us exam of head and neck ................................ Us exam, chest, b-scan ..................................... Us exam, chest, b-scan ..................................... Us exam, chest, b-scan ..................................... Us exam, breast(s) ............................................. Us exam, breast(s) ............................................. Us exam, breast(s) ............................................. Us exam, abdom, complete ............................... Us exam, abdom, complete ............................... Us exam, abdom, complete ............................... Echo exam of abdomen ..................................... Echo exam of abdomen ..................................... Echo exam of abdomen ..................................... Us exam abdo back wall, comp ......................... Malpractice RVUs 0.08 0.10 0.08 0.31 0.39 0.04 0.18 0.22 0.07 0.59 0.66 0.09 0.55 0.64 0.24 1.57 1.81 0.07 0.59 0.66 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.06 0.08 0.14 0.03 0.07 0.10 0.03 0.07 0.10 0.02 0.10 0.12 0.02 0.10 0.12 0.01 0.01 0.02 0.01 0.07 0.08 0.01 0.07 0.08 0.02 0.08 0.10 0.02 0.08 0.10 0.02 0.07 0.09 0.02 0.06 0.08 0.04 0.11 0.15 0.03 0.08 0.11 0.03 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00313 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 3.51 3.80 1.14 3.74 4.88 1.34 3.69 5.03 1.94 11.63 13.57 2.09 11.78 13.87 5.86 12.80 18.66 2.19 11.82 14.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.93 1.50 2.43 2.26 2.26 4.52 1.37 2.11 3.48 1.38 1.92 3.30 0.97 1.62 2.59 0.26 0.06 0.32 0.79 1.29 2.08 0.79 1.38 2.17 0.83 1.21 2.04 0.76 1.50 2.26 0.75 1.38 2.13 0.74 1.11 1.85 1.12 2.09 3.21 0.81 1.50 2.31 1.01 Facility Total NA NA 1.14 NA NA 1.34 NA NA 1.94 11.63 13.57 2.09 NA NA 5.86 NA NA 2.19 NA NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.93 NA NA 2.26 NA NA 1.37 NA NA 1.38 NA NA 0.97 NA NA 0.26 NA NA 0.79 NA NA 0.79 NA NA 0.83 NA NA 0.76 NA NA 0.75 NA NA 0.74 NA NA 1.12 NA NA 0.81 NA NA 1.01 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70428 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 76770 76770 76775 76775 76775 76778 76778 76778 76800 76800 76800 76801 76801 76801 76802 76802 76802 76805 76805 76805 76810 76810 76810 76811 76811 76811 76812 76812 76812 76815 76815 76815 76816 76816 76816 76817 76817 76817 76818 76818 76818 76819 76819 76819 76820 76820 76820 76821 76821 76821 76825 76825 76825 76826 76826 76826 76827 76827 76827 76828 76828 76828 76830 76830 76830 76831 76831 76831 76856 76856 76856 76857 76857 76857 76870 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.74 0.58 0.00 0.58 0.74 0.00 0.74 1.13 0.00 1.13 0.99 0.00 0.99 0.83 0.00 0.83 0.99 0.00 0.99 0.98 0.00 0.98 1.90 0.00 1.90 1.78 0.00 1.78 0.65 0.00 0.65 0.85 0.00 0.85 0.75 0.00 0.75 1.05 0.00 1.05 0.77 0.00 0.77 0.50 0.00 0.50 0.70 0.00 0.70 1.67 0.00 1.67 0.83 0.00 0.83 0.58 0.00 0.58 0.56 0.00 0.56 0.69 0.00 0.69 0.72 0.00 0.72 0.69 0.00 0.69 0.38 0.00 0.38 0.64 1.98 2.22 0.19 1.42 1.61 0.24 1.98 2.22 0.34 1.42 1.76 0.34 2.11 2.45 0.29 1.05 1.34 0.34 2.11 2.45 0.34 1.05 1.39 0.71 3.54 4.25 0.66 1.05 1.71 0.23 1.42 1.65 0.32 1.11 1.43 0.26 1.52 1.78 0.39 1.61 2.00 0.28 1.61 1.89 0.19 1.61 1.80 0.27 1.61 1.88 0.60 1.98 2.58 0.29 0.71 1.00 0.21 1.72 1.93 0.22 1.11 1.33 0.23 1.52 1.75 0.25 1.52 1.77 0.23 1.52 1.75 0.12 1.71 1.83 0.21 NA NA 0.19 NA NA 0.24 NA NA 0.34 NA NA 0.34 NA NA 0.29 NA NA 0.34 NA NA 0.34 NA NA 0.71 NA NA 0.66 NA NA 0.23 NA NA 0.32 NA NA 0.26 NA NA 0.39 NA NA 0.28 NA NA 0.19 NA NA 0.27 NA NA 0.60 NA NA 0.29 NA NA 0.21 NA NA 0.22 NA NA 0.23 NA NA 0.25 NA NA 0.23 NA NA 0.12 NA NA 0.21 Us exam abdo back wall, comp ......................... Us exam abdo back wall, comp ......................... Us exam abdo back wall, lim ............................. Us exam abdo back wall, lim ............................. Us exam abdo back wall, lim ............................. Us exam kidney transplant ................................. Us exam kidney transplant ................................. Us exam kidney transplant ................................. Us exam, spinal canal ........................................ Us exam, spinal canal ........................................ Us exam, spinal canal ........................................ Ob us < 14 wks, single fetus ............................. Ob us < 14 wks, single fetus ............................. Ob us < 14 wks, single fetus ............................. Ob us < 14 wks, add’l fetus ............................... Ob us < 14 wks, add’l fetus ............................... Ob us < 14 wks, add’l fetus ............................... Ob us >/= 14 wks, sngl fetus ............................. Ob us >/= 14 wks, sngl fetus ............................. Ob us >/= 14 wks, sngl fetus ............................. Ob us >/= 14 wks, addl fetus ............................. Ob us >/= 14 wks, addl fetus ............................. Ob us >/= 14 wks, addl fetus ............................. Ob us, detailed, sngl fetus ................................. Ob us, detailed, sngl fetus ................................. Ob us, detailed, sngl fetus ................................. Ob us, detailed, addl fetus ................................. Ob us, detailed, addl fetus ................................. Ob us, detailed, addl fetus ................................. Ob us, limited, fetus(s) ....................................... Ob us, limited, fetus(s) ....................................... Ob us, limited, fetus(s) ....................................... Ob us, follow-up, per fetus ................................. Ob us, follow-up, per fetus ................................. Ob us, follow-up, per fetus ................................. Transvaginal us, obstetric .................................. Transvaginal us, obstetric .................................. Transvaginal us, obstetric .................................. Fetal biophys profile w/nst ................................. Fetal biophys profile w/nst ................................. Fetal biophys profile w/nst ................................. Fetal biophys profil w/o nst ................................ Fetal biophys profil w/o nst ................................ Fetal biophys profil w/o nst ................................ Umbilical artery echo .......................................... Umbilical artery echo .......................................... Umbilical artery echo .......................................... Middle cerebral artery echo ............................... Middle cerebral artery echo ............................... Middle cerebral artery echo ............................... Echo exam of fetal heart .................................... Echo exam of fetal heart .................................... Echo exam of fetal heart .................................... Echo exam of fetal heart .................................... Echo exam of fetal heart .................................... Echo exam of fetal heart .................................... Echo exam of fetal heart .................................... Echo exam of fetal heart .................................... Echo exam of fetal heart .................................... Echo exam of fetal heart .................................... Echo exam of fetal heart .................................... Echo exam of fetal heart .................................... Transvaginal us, non-ob ..................................... Transvaginal us, non-ob ..................................... Transvaginal us, non-ob ..................................... Echo exam, uterus ............................................. Echo exam, uterus ............................................. Echo exam, uterus ............................................. Us exam, pelvic, complete ................................. Us exam, pelvic, complete ................................. Us exam, pelvic, complete ................................. Us exam, pelvic, limited ..................................... Us exam, pelvic, limited ..................................... Us exam, pelvic, limited ..................................... Us exam, scrotum .............................................. Malpractice RVUs 0.11 0.14 0.03 0.08 0.11 0.03 0.11 0.14 0.05 0.08 0.13 0.04 0.12 0.16 0.04 0.12 0.16 0.04 0.12 0.16 0.04 0.22 0.26 0.09 0.43 0.52 0.08 0.41 0.49 0.03 0.08 0.11 0.04 0.06 0.10 0.03 0.06 0.09 0.05 0.10 0.15 0.03 0.10 0.13 0.03 0.12 0.15 0.03 0.12 0.15 0.07 0.11 0.18 0.03 0.05 0.08 0.02 0.12 0.14 0.03 0.08 0.11 0.03 0.10 0.13 0.03 0.10 0.13 0.03 0.10 0.13 0.02 0.06 0.08 0.03 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00314 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 2.09 3.10 0.80 1.50 2.30 1.01 2.09 3.10 1.52 1.50 3.02 1.37 2.23 3.60 1.16 1.17 2.33 1.37 2.23 3.60 1.36 1.27 2.63 2.70 3.97 6.67 2.52 1.46 3.98 0.91 1.50 2.41 1.21 1.17 2.38 1.04 1.58 2.62 1.49 1.71 3.20 1.08 1.71 2.79 0.72 1.73 2.45 1.00 1.73 2.73 2.34 2.09 4.43 1.15 0.76 1.91 0.81 1.84 2.65 0.81 1.19 2.00 0.95 1.62 2.57 1.00 1.62 2.62 0.95 1.62 2.57 0.52 1.77 2.29 0.88 Facility Total NA NA 0.80 NA NA 1.01 NA NA 1.52 NA NA 1.37 NA NA 1.16 NA NA 1.37 NA NA 1.36 NA NA 2.70 NA NA 2.52 NA NA 0.91 NA NA 1.21 NA NA 1.04 NA NA 1.49 NA NA 1.08 NA NA 0.72 NA NA 1.00 NA NA 2.34 NA NA 1.15 NA NA 0.81 NA NA 0.81 NA NA 0.95 NA NA 1.00 NA NA 0.95 NA NA 0.52 NA NA 0.88 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70429 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 76870 76870 76872 76872 76872 76873 76873 76873 76880 76880 76880 76885 76885 76885 76886 76886 76886 76930 76930 76930 76932 76932 76932 76936 76936 76936 76937 76937 76937 76940 76940 76940 76941 76941 76941 76942 76942 76942 76945 76945 76945 76946 76946 76946 76948 76948 76948 76950 76950 76950 76965 76965 76965 76970 76970 76970 76975 76975 76975 76977 76977 76977 76986 76986 76986 76999 76999 76999 77261 77262 77263 77280 77280 77280 77285 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C C A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.64 0.69 0.00 0.69 1.55 0.00 1.55 0.59 0.00 0.59 0.74 0.00 0.74 0.62 0.00 0.62 0.67 0.00 0.67 0.67 0.00 0.67 1.99 0.00 1.99 0.30 0.00 0.30 2.00 0.00 2.00 1.34 0.00 1.34 0.67 0.00 0.67 0.67 0.00 0.67 0.38 0.00 0.38 0.38 0.00 0.38 0.58 0.00 0.58 1.34 0.00 1.34 0.40 0.00 0.40 0.81 0.00 0.81 0.05 0.00 0.05 1.20 0.00 1.20 0.00 0.00 0.00 1.39 2.11 3.14 0.70 0.00 0.70 1.05 1.52 1.73 0.22 2.03 2.25 0.50 2.11 2.61 0.19 1.42 1.61 0.24 1.52 1.76 0.20 1.42 1.62 0.25 1.52 1.77 0.25 1.52 1.77 0.66 6.31 6.97 0.10 0.38 0.48 0.65 1.52 2.17 0.47 1.53 2.00 0.22 2.82 3.04 0.22 1.53 1.75 0.14 1.52 1.66 0.13 1.52 1.65 0.19 1.31 1.50 0.43 5.59 6.02 0.13 1.05 1.18 0.28 1.52 1.80 0.02 0.82 0.84 0.40 2.63 3.03 0.00 0.00 0.00 0.51 0.75 1.11 0.22 3.48 3.70 0.34 NA NA 0.22 NA NA 0.50 NA NA 0.19 NA NA 0.24 NA NA 0.20 NA NA 0.25 NA NA 0.25 NA NA 0.66 NA NA 0.10 NA NA 0.65 NA NA 0.47 NA NA 0.22 NA NA 0.22 NA NA 0.14 NA NA 0.13 NA NA 0.19 NA NA 0.43 NA NA 0.13 NA NA 0.28 NA NA 0.02 NA NA 0.40 NA NA 0.00 0.00 0.00 0.51 0.75 1.11 0.22 NA NA 0.34 Us exam, scrotum .............................................. Us exam, scrotum .............................................. Us, transrectal .................................................... Us, transrectal .................................................... Us, transrectal .................................................... Echograp trans r, pros study .............................. Echograp trans r, pros study .............................. Echograp trans r, pros study .............................. Us exam, extremity ............................................ Us exam, extremity ............................................ Us exam, extremity ............................................ Us exam infant hips, dynamic ............................ Us exam infant hips, dynamic ............................ Us exam infant hips, dynamic ............................ Us exam infant hips, static ................................. Us exam infant hips, static ................................. Us exam infant hips, static ................................. Echo guide, cardiocentesis ................................ Echo guide, cardiocentesis ................................ Echo guide, cardiocentesis ................................ Echo guide for heart biopsy ............................... Echo guide for heart biopsy ............................... Echo guide for heart biopsy ............................... Echo guide for artery repair ............................... Echo guide for artery repair ............................... Echo guide for artery repair ............................... Us guide, vascular access ................................. Us guide, vascular access ................................. Us guide, vascular access ................................. Us guide, tissue ablation .................................... Us guide, tissue ablation .................................... Us guide, tissue ablation .................................... Echo guide for transfusion ................................. Echo guide for transfusion ................................. Echo guide for transfusion ................................. Echo guide for biopsy ........................................ Echo guide for biopsy ........................................ Echo guide for biopsy ........................................ Echo guide, villus sampling ................................ Echo guide, villus sampling ................................ Echo guide, villus sampling ................................ Echo guide for amniocentesis ............................ Echo guide for amniocentesis ............................ Echo guide for amniocentesis ............................ Echo guide, ova aspiration ................................. Echo guide, ova aspiration ................................. Echo guide, ova aspiration ................................. Echo guidance radiotherapy .............................. Echo guidance radiotherapy .............................. Echo guidance radiotherapy .............................. Echo guidance radiotherapy .............................. Echo guidance radiotherapy .............................. Echo guidance radiotherapy .............................. Ultrasound exam follow-up ................................. Ultrasound exam follow-up ................................. Ultrasound exam follow-up ................................. GI endoscopic ultrasound .................................. GI endoscopic ultrasound .................................. GI endoscopic ultrasound .................................. Us bone density measure .................................. Us bone density measure .................................. Us bone density measure .................................. Ultrasound guide intraoper ................................. Ultrasound guide intraoper ................................. Ultrasound guide intraoper ................................. Echo examination procedure ............................. Echo examination procedure ............................. Echo examination procedure ............................. Radiation therapy planning ................................ Radiation therapy planning ................................ Radiation therapy planning ................................ Set radiation therapy field .................................. Set radiation therapy field .................................. Set radiation therapy field .................................. Set radiation therapy field .................................. Malpractice RVUs 0.10 0.13 0.04 0.10 0.14 0.09 0.16 0.25 0.03 0.08 0.11 0.03 0.10 0.13 0.03 0.08 0.11 0.02 0.10 0.12 0.02 0.10 0.12 0.13 0.34 0.47 0.03 0.10 0.13 0.31 0.29 0.60 0.07 0.08 0.15 0.03 0.10 0.13 0.03 0.08 0.11 0.02 0.10 0.12 0.02 0.10 0.12 0.03 0.07 0.10 0.08 0.29 0.37 0.02 0.06 0.08 0.04 0.10 0.14 0.01 0.05 0.06 0.13 0.14 0.27 0.00 0.00 0.00 0.07 0.11 0.16 0.04 0.18 0.22 0.05 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00315 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 1.62 2.50 0.95 2.13 3.08 2.14 2.27 4.41 0.81 1.50 2.31 1.01 1.62 2.63 0.85 1.50 2.35 0.94 1.62 2.56 0.94 1.62 2.56 2.78 6.65 9.43 0.43 0.48 0.91 2.96 1.81 4.77 1.88 1.61 3.49 0.92 2.92 3.84 0.92 1.61 2.53 0.54 1.62 2.16 0.53 1.62 2.15 0.80 1.38 2.18 1.85 5.88 7.73 0.55 1.11 1.66 1.13 1.62 2.75 0.08 0.87 0.95 1.73 2.77 4.50 0.00 0.00 0.00 1.97 2.97 4.41 0.96 3.66 4.62 1.44 Facility Total NA NA 0.95 NA NA 2.14 NA NA 0.81 NA NA 1.01 NA NA 0.85 NA NA 0.94 NA NA 0.94 NA NA 2.78 NA NA 0.43 NA NA 2.96 NA NA 1.88 NA NA 0.92 NA NA 0.92 NA NA 0.54 NA NA 0.53 NA NA 0.80 NA NA 1.85 NA NA 0.55 NA NA 1.13 NA NA 0.08 NA NA 1.73 NA NA 0.00 0.00 0.00 1.97 2.97 4.41 0.96 NA NA 1.44 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70430 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 77285 77285 77290 77290 77290 77295 77295 77295 77299 77299 77299 77300 77300 77300 77301 77301 77301 77305 77305 77305 77310 77310 77310 77315 77315 77315 77321 77321 77321 77326 77326 77326 77327 77327 77327 77328 77328 77328 77331 77331 77331 77332 77332 77332 77333 77333 77333 77334 77334 77334 77336 77370 77399 77399 77399 77401 77402 77403 77404 77406 77407 77408 77409 77411 77412 77413 77414 77416 77417 77418 77421 77421 77421 77422 77423 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... .......... .......... Status A A A A A A A A C C C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C C A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 1.05 1.56 0.00 1.56 4.56 0.00 4.56 0.00 0.00 0.00 0.62 0.00 0.62 7.99 0.00 7.99 0.70 0.00 0.70 1.05 0.00 1.05 1.56 0.00 1.56 0.95 0.00 0.95 0.93 0.00 0.93 1.39 0.00 1.39 2.09 0.00 2.09 0.87 0.00 0.87 0.54 0.00 0.54 0.84 0.00 0.84 1.24 0.00 1.24 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.39 0.00 0.39 0.00 0.00 5.59 5.93 0.50 6.53 7.03 1.46 28.01 29.47 0.00 0.00 0.00 0.20 1.34 1.54 2.57 28.01 30.58 0.23 1.87 2.10 0.34 2.34 2.68 0.50 2.67 3.17 0.30 4.05 4.35 0.30 2.37 2.67 0.44 3.48 3.92 0.67 4.97 5.64 0.28 0.50 0.78 0.17 1.34 1.51 0.27 1.90 2.17 0.40 3.26 3.66 2.99 3.50 0.00 0.00 0.00 1.78 1.78 1.78 1.78 1.78 2.10 2.10 2.10 2.10 2.34 2.34 2.34 2.34 0.59 18.07 0.13 3.36 3.49 1.71 2.26 NA NA 0.50 NA NA 1.46 NA NA 0.00 0.00 0.00 0.20 NA NA 2.57 NA NA 0.23 NA NA 0.34 NA NA 0.50 NA NA 0.30 NA NA 0.30 NA NA 0.44 NA NA 0.67 NA NA 0.28 NA NA 0.17 NA NA 0.27 NA NA 0.40 NA NA NA NA 0.00 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.13 NA NA NA NA Set radiation therapy field .................................. Set radiation therapy field .................................. Set radiation therapy field .................................. Set radiation therapy field .................................. Set radiation therapy field .................................. Set radiation therapy field .................................. Set radiation therapy field .................................. Set radiation therapy field .................................. Radiation therapy planning ................................ Radiation therapy planning ................................ Radiation therapy planning ................................ Radiation therapy dose plan .............................. Radiation therapy dose plan .............................. Radiation therapy dose plan .............................. Radiotherapy dose plan, imrt ............................. Radiotherapy dose plan, imrt ............................. Radiotherapy dose plan, imrt ............................. Teletx isodose plan simple ................................. Teletx isodose plan simple ................................. Teletx isodose plan simple ................................. Teletx isodose plan intermed ............................. Teletx isodose plan intermed ............................. Teletx isodose plan intermed ............................. Teletx isodose plan complex .............................. Teletx isodose plan complex .............................. Teletx isodose plan complex .............................. Special teletx port plan ....................................... Special teletx port plan ....................................... Special teletx port plan ....................................... Brachytx isodose calc simp ................................ Brachytx isodose calc simp ................................ Brachytx isodose calc simp ................................ Brachytx isodose calc interm ............................. Brachytx isodose calc interm ............................. Brachytx isodose calc interm ............................. Brachytx isodose plan compl ............................. Brachytx isodose plan compl ............................. Brachytx isodose plan compl ............................. Special radiation dosimetry ................................ Special radiation dosimetry ................................ Special radiation dosimetry ................................ Radiation treatment aid(s) .................................. Radiation treatment aid(s) .................................. Radiation treatment aid(s) .................................. Radiation treatment aid(s) .................................. Radiation treatment aid(s) .................................. Radiation treatment aid(s) .................................. Radiation treatment aid(s) .................................. Radiation treatment aid(s) .................................. Radiation treatment aid(s) .................................. Radiation physics consult ................................... Radiation physics consult ................................... External radiation dosimetry ............................... External radiation dosimetry ............................... External radiation dosimetry ............................... Radiation treatment delivery .............................. Radiation treatment delivery .............................. Radiation treatment delivery .............................. Radiation treatment delivery .............................. Radiation treatment delivery .............................. Radiation treatment delivery .............................. Radiation treatment delivery .............................. Radiation treatment delivery .............................. Radiation treatment delivery .............................. Radiation treatment delivery .............................. Radiation treatment delivery .............................. Radiation treatment delivery .............................. Radiation treatment delivery .............................. Radiology port film(s) ......................................... Radiation tx delivery, imrt ................................... Stereoscopic x-ray guidance .............................. Stereoscopic x-ray guidance .............................. Stereoscopic x-ray guidance .............................. Neutron beam tx, simple .................................... Neutron beam tx, complex ................................. Malpractice RVUs 0.30 0.35 0.08 0.35 0.43 0.23 1.48 1.71 0.00 0.00 0.00 0.03 0.07 0.10 0.40 1.48 1.88 0.04 0.11 0.15 0.05 0.13 0.18 0.08 0.14 0.22 0.05 0.21 0.26 0.05 0.13 0.18 0.07 0.18 0.25 0.11 0.25 0.36 0.04 0.02 0.06 0.03 0.07 0.10 0.04 0.11 0.15 0.06 0.17 0.23 0.16 0.18 0.00 0.00 0.00 0.11 0.11 0.11 0.11 0.11 0.12 0.12 0.12 0.12 0.13 0.13 0.13 0.13 0.04 0.13 0.02 0.10 0.12 0.13 0.13 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00316 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 5.89 7.33 2.14 6.88 9.02 6.25 29.49 35.74 0.00 0.00 0.00 0.85 1.41 2.26 10.96 29.49 40.45 0.97 1.98 2.95 1.44 2.47 3.91 2.14 2.81 4.95 1.30 4.26 5.56 1.28 2.50 3.78 1.90 3.66 5.56 2.87 5.22 8.09 1.19 0.52 1.71 0.74 1.41 2.15 1.15 2.01 3.16 1.70 3.43 5.13 3.15 3.68 0.00 0.00 0.00 1.89 1.89 1.89 1.89 1.89 2.22 2.22 2.22 2.22 2.47 2.47 2.47 2.47 0.63 18.20 0.54 3.46 4.00 1.84 2.39 Facility Total NA NA 2.14 NA NA 6.25 NA NA 0.00 0.00 0.00 0.85 NA NA 10.96 NA NA 0.97 NA NA 1.44 NA NA 2.14 NA NA 1.30 NA NA 1.28 NA NA 1.90 NA NA 2.87 NA NA 1.19 NA NA 0.74 NA NA 1.15 NA NA 1.70 NA NA NA NA 0.00 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.54 NA NA NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70431 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 77427 77431 77432 77470 77470 77470 77499 77499 77499 77520 77522 77523 77525 77600 77600 77600 77605 77605 77605 77610 77610 77610 77615 77615 77615 77620 77620 77620 77750 77750 77750 77761 77761 77761 77762 77762 77762 77763 77763 77763 77776 77776 77776 77777 77777 77777 77778 77778 77778 77781 77781 77781 77782 77782 77782 77783 77783 77783 77784 77784 77784 77789 77789 77789 77790 77790 77790 77799 77799 77799 78000 78000 78000 78001 78001 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... Status A A A A A A C C C C C C C R R R R R R R R R R R R R R R A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C C A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 3.31 1.81 7.92 2.09 0.00 2.09 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.56 0.00 1.56 2.09 0.00 2.09 1.56 0.00 1.56 2.09 0.00 2.09 1.56 0.00 1.56 4.90 0.00 4.90 3.80 0.00 3.80 5.71 0.00 5.71 8.56 0.00 8.56 4.65 0.00 4.65 7.47 0.00 7.47 11.17 0.00 11.17 1.66 0.00 1.66 2.49 0.00 2.49 3.72 0.00 3.72 5.60 0.00 5.60 1.12 0.00 1.12 1.05 0.00 1.05 0.00 0.00 0.00 0.19 0.00 0.19 0.26 0.00 1.06 0.68 2.91 0.67 11.18 11.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50 3.06 3.56 0.66 4.07 4.73 0.51 3.06 3.57 0.66 4.07 4.73 0.52 3.06 3.58 1.58 1.33 2.91 1.09 2.51 3.60 1.84 3.62 5.46 2.75 4.50 7.25 0.95 2.19 3.14 2.38 4.24 6.62 3.58 5.14 8.72 0.53 20.36 20.89 0.80 20.36 21.16 1.19 20.36 21.55 1.80 20.36 22.16 0.37 0.45 0.82 0.34 0.50 0.84 0.00 0.00 0.00 0.06 0.97 1.03 0.09 1.31 1.06 0.68 2.91 0.67 NA NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50 NA NA 0.66 NA NA 0.51 NA NA 0.66 NA NA 0.52 NA NA 1.58 NA NA 1.09 NA NA 1.84 NA NA 2.75 NA NA 0.95 NA NA 2.38 NA NA 3.58 NA NA 0.53 NA NA 0.80 NA NA 1.19 NA NA 1.80 NA NA 0.37 NA NA 0.34 NA NA 0.00 0.00 0.00 0.06 NA NA 0.09 NA Radiation tx management, x5 ............................ Radiation therapy management ......................... Stereotactic radiation trmt .................................. Special radiation treatment ................................ Special radiation treatment ................................ Special radiation treatment ................................ Radiation therapy management ......................... Radiation therapy management ......................... Radiation therapy management ......................... Proton trmt, simple w/o comp ............................ Proton trmt, simple w/comp ............................... Proton trmt, intermediate .................................... Proton treatment, complex ................................. Hyperthermia treatment ...................................... Hyperthermia treatment ...................................... Hyperthermia treatment ...................................... Hyperthermia treatment ...................................... Hyperthermia treatment ...................................... Hyperthermia treatment ...................................... Hyperthermia treatment ...................................... Hyperthermia treatment ...................................... Hyperthermia treatment ...................................... Hyperthermia treatment ...................................... Hyperthermia treatment ...................................... Hyperthermia treatment ...................................... Hyperthermia treatment ...................................... Hyperthermia treatment ...................................... Hyperthermia treatment ...................................... Infuse radioactive materials ............................... Infuse radioactive materials ............................... Infuse radioactive materials ............................... Apply intrcav radiat simple ................................. Apply intrcav radiat simple ................................. Apply intrcav radiat simple ................................. Apply intrcav radiat interm ................................. Apply intrcav radiat interm ................................. Apply intrcav radiat interm ................................. Apply intrcav radiat compl .................................. Apply intrcav radiat compl .................................. Apply intrcav radiat compl .................................. Apply interstit radiat simpl .................................. Apply interstit radiat simpl .................................. Apply interstit radiat simpl .................................. Apply interstit radiat inter ................................... Apply interstit radiat inter ................................... Apply interstit radiat inter ................................... Apply interstit radiat compl ................................. Apply interstit radiat compl ................................. Apply interstit radiat compl ................................. High intensity brachytherapy .............................. High intensity brachytherapy .............................. High intensity brachytherapy .............................. High intensity brachytherapy .............................. High intensity brachytherapy .............................. High intensity brachytherapy .............................. High intensity brachytherapy .............................. High intensity brachytherapy .............................. High intensity brachytherapy .............................. High intensity brachytherapy .............................. High intensity brachytherapy .............................. High intensity brachytherapy .............................. Apply surface radiation ....................................... Apply surface radiation ....................................... Apply surface radiation ....................................... Radiation handling .............................................. Radiation handling .............................................. Radiation handling .............................................. Radium/radioisotope therapy ............................. Radium/radioisotope therapy ............................. Radium/radioisotope therapy ............................. Thyroid, single uptake ........................................ Thyroid, single uptake ........................................ Thyroid, single uptake ........................................ Thyroid, multiple uptakes ................................... Thyroid, multiple uptakes ................................... Malpractice RVUs 0.17 0.09 0.41 0.11 0.59 0.70 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.08 0.16 0.24 0.16 0.22 0.38 0.08 0.16 0.24 0.11 0.22 0.33 0.20 0.16 0.36 0.25 0.07 0.32 0.19 0.14 0.33 0.29 0.19 0.48 0.43 0.23 0.66 0.44 0.13 0.57 0.39 0.22 0.61 0.57 0.27 0.84 0.08 1.06 1.14 0.13 1.06 1.19 0.19 1.06 1.25 0.29 1.06 1.35 0.06 0.02 0.08 0.05 0.02 0.07 0.00 0.00 0.00 0.01 0.06 0.07 0.01 0.07 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00317 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 4.54 2.58 11.24 2.87 11.77 14.64 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.14 3.22 5.36 2.91 4.29 7.20 2.15 3.22 5.37 2.86 4.29 7.15 2.28 3.22 5.50 6.73 1.40 8.13 5.08 2.65 7.73 7.84 3.81 11.65 11.74 4.73 16.47 6.04 2.32 8.36 10.24 4.46 14.70 15.32 5.41 20.73 2.27 21.42 23.69 3.42 21.42 24.84 5.10 21.42 26.52 7.69 21.42 29.11 1.55 0.47 2.02 1.44 0.52 1.96 0.00 0.00 0.00 0.26 1.03 1.29 0.36 1.38 Facility Total 4.54 2.58 11.24 2.87 NA NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.14 NA NA 2.91 NA NA 2.15 NA NA 2.86 NA NA 2.28 NA NA 6.73 NA NA 5.08 NA NA 7.84 NA NA 11.74 NA NA 6.04 NA NA 10.24 NA NA 15.32 NA NA 2.27 NA NA 3.42 NA NA 5.10 NA NA 7.69 NA NA 1.55 NA NA 1.44 NA NA 0.00 0.00 0.00 0.26 NA NA 0.36 NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 000 000 000 XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70432 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 78001 78003 78003 78003 78006 78006 78006 78007 78007 78007 78010 78010 78010 78011 78011 78011 78015 78015 78015 78016 78016 78016 78018 78018 78018 78020 78020 78020 78070 78070 78070 78075 78075 78075 78099 78099 78099 78102 78102 78102 78103 78103 78103 78104 78104 78104 78110 78110 78110 78111 78111 78111 78120 78120 78120 78121 78121 78121 78122 78122 78122 78130 78130 78130 78135 78135 78135 78140 78140 78140 78185 78185 78185 78190 78190 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.26 0.33 0.00 0.33 0.49 0.00 0.49 0.50 0.00 0.50 0.39 0.00 0.39 0.45 0.00 0.45 0.67 0.00 0.67 0.82 0.00 0.82 0.86 0.00 0.86 0.60 0.00 0.60 0.82 0.00 0.82 0.74 0.00 0.74 0.00 0.00 0.00 0.55 0.00 0.55 0.75 0.00 0.75 0.80 0.00 0.80 0.19 0.00 0.19 0.22 0.00 0.22 0.23 0.00 0.23 0.32 0.00 0.32 0.45 0.00 0.45 0.61 0.00 0.61 0.64 0.00 0.64 0.61 0.00 0.61 0.40 0.00 0.40 1.09 0.00 1.40 0.11 0.97 1.08 0.16 2.39 2.55 0.17 2.58 2.75 0.13 1.83 1.96 0.15 2.42 2.57 0.23 2.58 2.81 0.28 3.49 3.77 0.30 5.44 5.74 0.21 1.31 1.52 0.28 4.28 4.56 0.26 5.44 5.70 0.00 0.00 0.00 0.19 2.05 2.24 0.26 3.18 3.44 0.27 4.08 4.35 0.07 0.95 1.02 0.08 2.58 2.66 0.08 1.74 1.82 0.11 2.92 3.03 0.16 4.61 4.77 0.21 2.86 3.07 0.22 4.88 5.10 0.20 3.94 4.14 0.14 2.37 2.51 0.39 5.73 NA 0.11 NA NA 0.16 NA NA 0.17 NA NA 0.13 NA NA 0.15 NA NA 0.23 NA NA 0.28 NA NA 0.30 NA NA 0.21 NA NA 0.28 NA NA 0.26 NA NA 0.00 0.00 0.00 0.19 NA NA 0.26 NA NA 0.27 NA NA 0.07 NA NA 0.08 NA NA 0.08 NA NA 0.11 NA NA 0.16 NA NA 0.21 NA NA 0.22 NA NA 0.20 NA NA 0.14 NA NA 0.39 NA Thyroid, multiple uptakes ................................... Thyroid suppress/stimul ..................................... Thyroid suppress/stimul ..................................... Thyroid suppress/stimul ..................................... Thyroid imaging with uptake .............................. Thyroid imaging with uptake .............................. Thyroid imaging with uptake .............................. Thyroid image, mult uptakes .............................. Thyroid image, mult uptakes .............................. Thyroid image, mult uptakes .............................. Thyroid imaging .................................................. Thyroid imaging .................................................. Thyroid imaging .................................................. Thyroid imaging with flow ................................... Thyroid imaging with flow ................................... Thyroid imaging with flow ................................... Thyroid met imaging ........................................... Thyroid met imaging ........................................... Thyroid met imaging ........................................... Thyroid met imaging/studies .............................. Thyroid met imaging/studies .............................. Thyroid met imaging/studies .............................. Thyroid met imaging, body ................................. Thyroid met imaging, body ................................. Thyroid met imaging, body ................................. Thyroid met uptake ............................................ Thyroid met uptake ............................................ Thyroid met uptake ............................................ Parathyroid nuclear imaging .............................. Parathyroid nuclear imaging .............................. Parathyroid nuclear imaging .............................. Adrenal nuclear imaging .................................... Adrenal nuclear imaging .................................... Adrenal nuclear imaging .................................... Endocrine nuclear procedure ............................. Endocrine nuclear procedure ............................. Endocrine nuclear procedure ............................. Bone marrow imaging, ltd .................................. Bone marrow imaging, ltd .................................. Bone marrow imaging, ltd .................................. Bone marrow imaging, mult ............................... Bone marrow imaging, mult ............................... Bone marrow imaging, mult ............................... Bone marrow imaging, body .............................. Bone marrow imaging, body .............................. Bone marrow imaging, body .............................. Plasma volume, single ....................................... Plasma volume, single ....................................... Plasma volume, single ....................................... Plasma volume, multiple .................................... Plasma volume, multiple .................................... Plasma volume, multiple .................................... Red cell mass, single ......................................... Red cell mass, single ......................................... Red cell mass, single ......................................... Red cell mass, multiple ...................................... Red cell mass, multiple ...................................... Red cell mass, multiple ...................................... Blood volume ...................................................... Blood volume ...................................................... Blood volume ...................................................... Red cell survival study ....................................... Red cell survival study ....................................... Red cell survival study ....................................... Red cell survival kinetics .................................... Red cell survival kinetics .................................... Red cell survival kinetics .................................... Red cell sequestration ........................................ Red cell sequestration ........................................ Red cell sequestration ........................................ Spleen imaging ................................................... Spleen imaging ................................................... Spleen imaging ................................................... Platelet survival, kinetics .................................... Platelet survival, kinetics .................................... Malpractice RVUs 0.08 0.01 0.06 0.07 0.02 0.13 0.15 0.02 0.14 0.16 0.02 0.11 0.13 0.02 0.13 0.15 0.03 0.14 0.17 0.03 0.18 0.21 0.04 0.29 0.33 0.02 0.14 0.16 0.04 0.11 0.15 0.03 0.29 0.32 0.00 0.00 0.00 0.02 0.12 0.14 0.03 0.17 0.20 0.03 0.22 0.25 0.01 0.06 0.07 0.01 0.14 0.15 0.01 0.11 0.12 0.01 0.14 0.15 0.02 0.24 0.26 0.03 0.14 0.17 0.03 0.25 0.28 0.03 0.21 0.24 0.02 0.13 0.15 0.08 0.30 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00318 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 1.74 0.45 1.03 1.48 0.67 2.52 3.19 0.69 2.72 3.41 0.54 1.94 2.48 0.62 2.55 3.17 0.93 2.72 3.65 1.13 3.67 4.80 1.20 5.73 6.93 0.83 1.45 2.28 1.14 4.39 5.53 1.03 5.73 6.76 0.00 0.00 0.00 0.76 2.17 2.93 1.04 3.35 4.39 1.10 4.30 5.40 0.27 1.01 1.28 0.31 2.72 3.03 0.32 1.85 2.17 0.44 3.06 3.50 0.63 4.85 5.48 0.85 3.00 3.85 0.89 5.13 6.02 0.84 4.15 4.99 0.56 2.50 3.06 1.56 6.03 Facility Total NA 0.45 NA NA 0.67 NA NA 0.69 NA NA 0.54 NA NA 0.62 NA NA 0.93 NA NA 1.13 NA NA 1.20 NA NA 0.83 NA NA 1.14 NA NA 1.03 NA NA 0.00 0.00 0.00 0.76 NA NA 1.04 NA NA 1.10 NA NA 0.27 NA NA 0.31 NA NA 0.32 NA NA 0.44 NA NA 0.63 NA NA 0.85 NA NA 0.89 NA NA 0.84 NA NA 0.56 NA NA 1.56 NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70433 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 78190 78191 78191 78191 78195 78195 78195 78199 78199 78199 78201 78201 78201 78202 78202 78202 78205 78205 78205 78206 78206 78206 78215 78215 78215 78216 78216 78216 78220 78220 78220 78223 78223 78223 78230 78230 78230 78231 78231 78231 78232 78232 78232 78258 78258 78258 78261 78261 78261 78262 78262 78262 78264 78264 78264 78267 78268 78270 78270 78270 78271 78271 78271 78272 78272 78272 78278 78278 78278 78282 78282 78282 78290 78290 78290 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... Status A A A A A A A C C C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A X X A A A A A A A A A A A A A C C A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 1.09 0.61 0.00 0.61 1.20 0.00 1.20 0.00 0.00 0.00 0.44 0.00 0.44 0.51 0.00 0.51 0.71 0.00 0.71 0.96 0.00 0.96 0.49 0.00 0.49 0.57 0.00 0.57 0.49 0.00 0.49 0.84 0.00 0.84 0.45 0.00 0.45 0.52 0.00 0.52 0.47 0.00 0.47 0.74 0.00 0.74 0.69 0.00 0.69 0.68 0.00 0.68 0.78 0.00 0.78 0.00 0.00 0.20 0.00 0.20 0.20 0.00 0.20 0.27 0.00 0.27 0.99 0.00 0.99 0.38 0.00 0.00 0.68 0.00 0.68 6.12 0.20 7.36 7.56 0.41 4.08 4.49 0.00 0.00 0.00 0.15 2.37 2.52 0.17 2.89 3.06 0.24 5.93 6.17 0.33 5.93 6.26 0.16 2.95 3.11 0.19 3.49 3.68 0.16 3.73 3.89 0.28 3.67 3.95 0.15 2.19 2.34 0.18 3.18 3.36 0.16 3.55 3.71 0.25 2.89 3.14 0.24 4.11 4.35 0.23 4.26 4.49 0.26 4.14 4.40 0.00 0.00 0.07 1.55 1.62 0.07 1.64 1.71 0.09 2.33 2.42 0.33 4.88 5.21 0.13 0.00 0.00 0.23 3.06 3.29 NA 0.20 NA NA 0.41 NA NA 0.00 0.00 0.00 0.15 NA NA 0.17 NA NA 0.24 NA NA 0.33 NA NA 0.16 NA NA 0.19 NA NA 0.16 NA NA 0.28 NA NA 0.15 NA NA 0.18 NA NA 0.16 NA NA 0.25 NA NA 0.24 NA NA 0.23 NA NA 0.26 NA NA 0.00 0.00 0.07 NA NA 0.07 NA NA 0.09 NA NA 0.33 NA NA 0.13 0.00 0.00 0.23 NA NA Platelet survival, kinetics .................................... Platelet survival .................................................. Platelet survival .................................................. Platelet survival .................................................. Lymph system imaging ...................................... Lymph system imaging ...................................... Lymph system imaging ...................................... Blood/lymph nuclear exam ................................. Blood/lymph nuclear exam ................................. Blood/lymph nuclear exam ................................. Liver imaging ...................................................... Liver imaging ...................................................... Liver imaging ...................................................... Liver imaging with flow ....................................... Liver imaging with flow ....................................... Liver imaging with flow ....................................... Liver imaging (3D) .............................................. Liver imaging (3D) .............................................. Liver imaging (3D) .............................................. Liver image (3d) with flow .................................. Liver image (3d) with flow .................................. Liver image (3d) with flow .................................. Liver and spleen imaging ................................... Liver and spleen imaging ................................... Liver and spleen imaging ................................... Liver & spleen image/flow .................................. Liver & spleen image/flow .................................. Liver & spleen image/flow .................................. Liver function study ............................................ Liver function study ............................................ Liver function study ............................................ Hepatobiliary imaging ......................................... Hepatobiliary imaging ......................................... Hepatobiliary imaging ......................................... Salivary gland imaging ....................................... Salivary gland imaging ....................................... Salivary gland imaging ....................................... Serial salivary imaging ....................................... Serial salivary imaging ....................................... Serial salivary imaging ....................................... Salivary gland function exam ............................. Salivary gland function exam ............................. Salivary gland function exam ............................. Esophageal motility study .................................. Esophageal motility study .................................. Esophageal motility study .................................. Gastric mucosa imaging ..................................... Gastric mucosa imaging ..................................... Gastric mucosa imaging ..................................... Gastroesophageal reflux exam .......................... Gastroesophageal reflux exam .......................... Gastroesophageal reflux exam .......................... Gastric emptying study ....................................... Gastric emptying study ....................................... Gastric emptying study ....................................... Breath tst attain/anal c-14 .................................. Breath test analysis, c-14 ................................... Vit B-12 absorption exam ................................... Vit B-12 absorption exam ................................... Vit B-12 absorption exam ................................... Vit b-12 absrp exam, int fac ............................... Vit b-12 absrp exam, int fac ............................... Vit b-12 absrp exam, int fac ............................... Vit B-12 absorp, combined ................................. Vit B-12 absorp, combined ................................. Vit B-12 absorp, combined ................................. Acute GI blood loss imaging .............................. Acute GI blood loss imaging .............................. Acute GI blood loss imaging .............................. GI protein loss exam .......................................... GI protein loss exam .......................................... GI protein loss exam .......................................... Meckel’s divert exam .......................................... Meckel’s divert exam .......................................... Meckel’s divert exam .......................................... Malpractice RVUs 0.38 0.03 0.37 0.40 0.06 0.22 0.28 0.00 0.00 0.00 0.02 0.13 0.15 0.02 0.14 0.16 0.03 0.31 0.34 0.04 0.11 0.15 0.02 0.14 0.16 0.02 0.18 0.20 0.02 0.19 0.21 0.04 0.19 0.23 0.02 0.13 0.15 0.02 0.17 0.19 0.02 0.18 0.20 0.03 0.14 0.17 0.03 0.22 0.25 0.03 0.22 0.25 0.03 0.22 0.25 0.00 0.00 0.01 0.10 0.11 0.01 0.10 0.11 0.01 0.13 0.14 0.04 0.25 0.29 0.02 0.00 0.00 0.03 0.16 0.19 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00319 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 7.59 0.84 7.73 8.57 1.67 4.30 5.97 0.00 0.00 0.00 0.61 2.50 3.11 0.70 3.03 3.73 0.98 6.24 7.22 1.33 6.04 7.37 0.67 3.09 3.76 0.78 3.67 4.45 0.67 3.92 4.59 1.16 3.86 5.02 0.62 2.32 2.94 0.72 3.35 4.07 0.65 3.73 4.38 1.02 3.03 4.05 0.96 4.33 5.29 0.94 4.48 5.42 1.07 4.36 5.43 0.00 0.00 0.28 1.65 1.93 0.28 1.74 2.02 0.37 2.46 2.83 1.36 5.13 6.49 0.53 0.00 0.00 0.94 3.22 4.16 Facility Total NA 0.84 NA NA 1.67 NA NA 0.00 0.00 0.00 0.61 NA NA 0.70 NA NA 0.98 NA NA 1.33 NA NA 0.67 NA NA 0.78 NA NA 0.67 NA NA 1.16 NA NA 0.62 NA NA 0.72 NA NA 0.65 NA NA 1.02 NA NA 0.96 NA NA 0.94 NA NA 1.07 NA NA 0.00 0.00 0.28 NA NA 0.28 NA NA 0.37 NA NA 1.36 NA NA 0.53 0.00 0.00 0.94 NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70434 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 78291 78291 78291 78299 78299 78299 78300 78300 78300 78305 78305 78305 78306 78306 78306 78315 78315 78315 78320 78320 78320 78350 78350 78350 78351 78399 78399 78399 78414 78414 78414 78428 78428 78428 78445 78445 78445 78456 78456 78456 78457 78457 78457 78458 78458 78458 78459 78459 78459 78460 78460 78460 78461 78461 78461 78464 78464 78464 78465 78465 78465 78466 78466 78466 78468 78468 78468 78469 78469 78469 78472 78472 78472 78473 78473 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... Status A A A C C C A A A A A A A A A A A A A A A A A A N C C C A C C A A A A A A A A A A A A A A A A C C A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.88 0.00 0.88 0.00 0.00 0.00 0.62 0.00 0.62 0.83 0.00 0.83 0.86 0.00 0.86 1.02 0.00 1.02 1.04 0.00 1.04 0.22 0.00 0.22 +0.30 0.00 0.00 0.00 0.45 0.00 0.00 0.78 0.00 0.78 0.49 0.00 0.49 1.00 0.00 1.00 0.77 0.00 0.77 0.90 0.00 0.90 1.50 0.00 0.00 0.86 0.00 0.86 1.23 0.00 1.23 1.09 0.00 1.09 1.46 0.00 1.46 0.69 0.00 0.69 0.80 0.00 0.80 0.92 0.00 0.92 0.98 0.00 0.98 1.47 0.00 0.30 3.07 3.37 0.00 0.00 0.00 0.21 2.49 2.70 0.28 3.67 3.95 0.29 4.28 4.57 0.34 4.79 5.13 0.36 5.93 6.29 0.07 0.75 0.82 1.72 0.00 0.00 0.00 0.16 0.00 0.00 0.29 2.26 2.55 0.17 1.87 2.04 0.34 3.99 4.33 0.26 2.67 2.93 0.32 4.03 4.35 0.57 0.00 0.00 0.29 2.37 2.66 0.43 4.73 5.16 0.38 7.09 7.47 0.52 11.82 12.34 0.24 2.63 2.87 0.27 3.67 3.94 0.31 5.24 5.55 0.34 5.53 5.87 0.51 8.28 0.30 NA NA 0.00 0.00 0.00 0.21 NA NA 0.28 NA NA 0.29 NA NA 0.34 NA NA 0.36 NA NA 0.07 NA NA 0.12 0.00 0.00 0.00 0.16 0.00 0.00 0.29 NA NA 0.17 NA NA 0.34 NA NA 0.26 NA NA 0.32 NA NA 0.57 0.00 0.00 0.29 NA NA 0.43 NA NA 0.38 NA NA 0.52 NA NA 0.24 NA NA 0.27 NA NA 0.31 NA NA 0.34 NA NA 0.51 NA Leveen/shunt patency exam .............................. Leveen/shunt patency exam .............................. Leveen/shunt patency exam .............................. GI nuclear procedure ......................................... GI nuclear procedure ......................................... GI nuclear procedure ......................................... Bone imaging, limited area ................................ Bone imaging, limited area ................................ Bone imaging, limited area ................................ Bone imaging, multiple areas ............................. Bone imaging, multiple areas ............................. Bone imaging, multiple areas ............................. Bone imaging, whole body ................................. Bone imaging, whole body ................................. Bone imaging, whole body ................................. Bone imaging, 3 phase ...................................... Bone imaging, 3 phase ...................................... Bone imaging, 3 phase ...................................... Bone imaging (3D) ............................................. Bone imaging (3D) ............................................. Bone imaging (3D) ............................................. Bone mineral, single photon .............................. Bone mineral, single photon .............................. Bone mineral, single photon .............................. Bone mineral, dual photon ................................. Musculoskeletal nuclear exam ........................... Musculoskeletal nuclear exam ........................... Musculoskeletal nuclear exam ........................... Non-imaging heart function ................................ Non-imaging heart function ................................ Non-imaging heart function ................................ Cardiac shunt imaging ....................................... Cardiac shunt imaging ....................................... Cardiac shunt imaging ....................................... Vascular flow imaging ........................................ Vascular flow imaging ........................................ Vascular flow imaging ........................................ Acute venous thrombus image .......................... Acute venous thrombus image .......................... Acute venous thrombus image .......................... Venous thrombosis imaging ............................... Venous thrombosis imaging ............................... Venous thrombosis imaging ............................... Ven thrombosis images, bilat ............................. Ven thrombosis images, bilat ............................. Ven thrombosis images, bilat ............................. Heart muscle imaging (PET) .............................. Heart muscle imaging (PET) .............................. Heart muscle imaging (PET) .............................. Heart muscle blood, single ................................. Heart muscle blood, single ................................. Heart muscle blood, single ................................. Heart muscle blood, multiple .............................. Heart muscle blood, multiple .............................. Heart muscle blood, multiple .............................. Heart image (3d), single ..................................... Heart image (3d), single ..................................... Heart image (3d), single ..................................... Heart image (3d), multiple .................................. Heart image (3d), multiple .................................. Heart image (3d), multiple .................................. Heart infarct image ............................................. Heart infarct image ............................................. Heart infarct image ............................................. Heart infarct image (ef) ...................................... Heart infarct image (ef) ...................................... Heart infarct image (ef) ...................................... Heart infarct image (3D) ..................................... Heart infarct image (3D) ..................................... Heart infarct image (3D) ..................................... Gated heart, planar, single ................................. Gated heart, planar, single ................................. Gated heart, planar, single ................................. Gated heart, multiple .......................................... Gated heart, multiple .......................................... Malpractice RVUs 0.04 0.16 0.20 0.00 0.00 0.00 0.03 0.14 0.17 0.04 0.19 0.23 0.04 0.22 0.26 0.04 0.25 0.29 0.04 0.31 0.35 0.01 0.05 0.06 0.01 0.00 0.00 0.00 0.02 0.00 0.00 0.03 0.13 0.16 0.02 0.11 0.13 0.04 0.29 0.33 0.03 0.14 0.17 0.04 0.21 0.25 0.05 0.00 0.00 0.04 0.13 0.17 0.05 0.25 0.30 0.04 0.37 0.41 0.05 0.62 0.67 0.03 0.14 0.17 0.03 0.19 0.22 0.03 0.28 0.31 0.04 0.30 0.34 0.06 0.42 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00320 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 1.22 3.23 4.45 0.00 0.00 0.00 0.86 2.63 3.49 1.15 3.86 5.01 1.19 4.50 5.69 1.40 5.04 6.44 1.44 6.24 7.68 0.30 0.80 1.10 2.03 0.00 0.00 0.00 0.63 0.00 0.00 1.10 2.39 3.49 0.68 1.98 2.66 1.38 4.28 5.66 1.06 2.81 3.87 1.26 4.24 5.50 2.12 0.00 0.00 1.19 2.50 3.69 1.71 4.98 6.69 1.51 7.46 8.97 2.03 12.44 14.47 0.96 2.77 3.73 1.10 3.86 4.96 1.26 5.52 6.78 1.36 5.83 7.19 2.04 8.70 Facility Total 1.22 NA NA 0.00 0.00 0.00 0.86 NA NA 1.15 NA NA 1.19 NA NA 1.40 NA NA 1.44 NA NA 0.30 NA NA 0.43 0.00 0.00 0.00 0.63 0.00 0.00 1.10 NA NA 0.68 NA NA 1.38 NA NA 1.06 NA NA 1.26 NA NA 2.12 0.00 0.00 1.19 NA NA 1.71 NA NA 1.51 NA NA 2.03 NA NA 0.96 NA NA 1.10 NA NA 1.26 NA NA 1.36 NA NA 2.04 NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70435 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 78473 78478 78478 78478 78480 78480 78480 78481 78481 78481 78483 78483 78483 78491 78491 78491 78492 78492 78492 78494 78494 78494 78496 78496 78496 78499 78499 78499 78580 78580 78580 78584 78584 78584 78585 78585 78585 78586 78586 78586 78587 78587 78587 78588 78588 78588 78591 78591 78591 78593 78593 78593 78594 78594 78594 78596 78596 78596 78599 78599 78599 78600 78600 78600 78601 78601 78601 78605 78605 78605 78606 78606 78606 78607 78607 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... Status A A A A A A A A A A A A A A C C A C C A A A A A A C C C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C C A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 1.47 0.62 0.00 0.62 0.62 0.00 0.62 0.98 0.00 0.98 1.47 0.00 1.47 1.50 0.00 0.00 1.87 0.00 0.00 1.19 0.00 1.19 0.50 0.00 0.50 0.00 0.00 0.00 0.74 0.00 0.74 0.99 0.00 0.99 1.09 0.00 1.09 0.40 0.00 0.40 0.49 0.00 0.49 1.09 0.00 1.09 0.40 0.00 0.40 0.49 0.00 0.49 0.53 0.00 0.53 1.27 0.00 1.27 0.00 0.00 0.00 0.44 0.00 0.44 0.51 0.00 0.51 0.53 0.00 0.53 0.64 0.00 0.64 1.23 0.00 8.79 0.23 1.56 1.79 0.22 1.56 1.78 0.36 5.24 5.60 0.54 7.89 8.43 0.59 0.00 0.00 0.74 0.00 0.00 0.42 7.09 7.51 0.18 7.09 7.27 0.00 0.00 0.00 0.25 3.44 3.69 0.33 3.21 3.54 0.36 5.66 6.02 0.13 2.60 2.73 0.17 2.81 2.98 0.36 3.21 3.57 0.13 2.86 2.99 0.16 3.46 3.62 0.18 4.99 5.17 0.42 7.09 7.51 0.00 0.00 0.00 0.15 2.89 3.04 0.17 3.41 3.58 0.18 3.41 3.59 0.21 3.88 4.09 0.43 6.57 NA 0.23 NA NA 0.22 NA NA 0.36 NA NA 0.54 NA NA 0.59 0.00 0.00 0.74 0.00 0.00 0.42 NA NA 0.18 NA NA 0.00 0.00 0.00 0.25 NA NA 0.33 NA NA 0.36 NA NA 0.13 NA NA 0.17 NA NA 0.36 NA NA 0.13 NA NA 0.16 NA NA 0.18 NA NA 0.42 NA NA 0.00 0.00 0.00 0.15 NA NA 0.17 NA NA 0.18 NA NA 0.21 NA NA 0.43 NA Gated heart, multiple .......................................... Heart wall motion add-on ................................... Heart wall motion add-on ................................... Heart wall motion add-on ................................... Heart function add-on ......................................... Heart function add-on ......................................... Heart function add-on ......................................... Heart first pass, single ....................................... Heart first pass, single ....................................... Heart first pass, single ....................................... Heart first pass, multiple .................................... Heart first pass, multiple .................................... Heart first pass, multiple .................................... Heart image (pet), single .................................... Heart image (pet), single .................................... Heart image (pet), single .................................... Heart image (pet), multiple ................................. Heart image (pet), multiple ................................. Heart image (pet), multiple ................................. Heart image, spect ............................................. Heart image, spect ............................................. Heart image, spect ............................................. Heart first pass add-on ....................................... Heart first pass add-on ....................................... Heart first pass add-on ....................................... Cardiovascular nuclear exam ............................. Cardiovascular nuclear exam ............................. Cardiovascular nuclear exam ............................. Lung perfusion imaging ...................................... Lung perfusion imaging ...................................... Lung perfusion imaging ...................................... Lung V/Q image single breath ........................... Lung V/Q image single breath ........................... Lung V/Q image single breath ........................... Lung V/Q imaging .............................................. Lung V/Q imaging .............................................. Lung V/Q imaging .............................................. Aerosol lung image, single ................................. Aerosol lung image, single ................................. Aerosol lung image, single ................................. Aerosol lung image, multiple .............................. Aerosol lung image, multiple .............................. Aerosol lung image, multiple .............................. Perfusion lung image ......................................... Perfusion lung image ......................................... Perfusion lung image ......................................... Vent image, 1 breath, 1 proj .............................. Vent image, 1 breath, 1 proj .............................. Vent image, 1 breath, 1 proj .............................. Vent image, 1 proj, gas ...................................... Vent image, 1 proj, gas ...................................... Vent image, 1 proj, gas ...................................... Vent image, mult proj, gas ................................. Vent image, mult proj, gas ................................. Vent image, mult proj, gas ................................. Lung differential function .................................... Lung differential function .................................... Lung differential function .................................... Respiratory nuclear exam .................................. Respiratory nuclear exam .................................. Respiratory nuclear exam .................................. Brain imaging, ltd static ...................................... Brain imaging, ltd static ...................................... Brain imaging, ltd static ...................................... Brain imaging, ltd w/flow .................................... Brain imaging, ltd w/flow .................................... Brain imaging, ltd w/flow .................................... Brain imaging, complete ..................................... Brain imaging, complete ..................................... Brain imaging, complete ..................................... Brain imaging, compl w/flow .............................. Brain imaging, compl w/flow .............................. Brain imaging, compl w/flow .............................. Brain imaging (3D) ............................................. Brain imaging (3D) ............................................. Malpractice RVUs 0.48 0.02 0.10 0.12 0.02 0.10 0.12 0.03 0.28 0.31 0.05 0.41 0.46 0.06 0.00 0.00 0.07 0.00 0.00 0.05 0.30 0.35 0.02 0.30 0.32 0.00 0.00 0.00 0.03 0.18 0.21 0.04 0.17 0.21 0.05 0.30 0.35 0.02 0.14 0.16 0.02 0.14 0.16 0.05 0.18 0.23 0.02 0.14 0.16 0.02 0.18 0.20 0.02 0.25 0.27 0.05 0.37 0.42 0.00 0.00 0.00 0.02 0.14 0.16 0.02 0.18 0.20 0.02 0.18 0.20 0.03 0.21 0.24 0.05 0.35 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00321 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 10.74 0.87 1.66 2.53 0.86 1.66 2.52 1.37 5.52 6.89 2.06 8.30 10.36 2.15 0.00 0.00 2.68 0.00 0.00 1.66 7.39 9.05 0.70 7.39 8.09 0.00 0.00 0.00 1.02 3.62 4.64 1.36 3.38 4.74 1.50 5.96 7.46 0.55 2.74 3.29 0.68 2.95 3.63 1.50 3.39 4.89 0.55 3.00 3.55 0.67 3.64 4.31 0.73 5.24 5.97 1.74 7.46 9.20 0.00 0.00 0.00 0.61 3.03 3.64 0.70 3.59 4.29 0.73 3.59 4.32 0.88 4.09 4.97 1.71 6.92 Facility Total NA 0.87 NA NA 0.86 NA NA 1.37 NA NA 2.06 NA NA 2.15 0.00 0.00 2.68 0.00 0.00 1.66 NA NA 0.70 NA NA 0.00 0.00 0.00 1.02 NA NA 1.36 NA NA 1.50 NA NA 0.55 NA NA 0.68 NA NA 1.50 NA NA 0.55 NA NA 0.67 NA NA 0.73 NA NA 1.74 NA NA 0.00 0.00 0.00 0.61 NA NA 0.70 NA NA 0.73 NA NA 0.88 NA NA 1.71 NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70436 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 78607 78608 78608 78608 78609 78609 78609 78610 78610 78610 78615 78615 78615 78630 78630 78630 78635 78635 78635 78645 78645 78645 78647 78647 78647 78650 78650 78650 78660 78660 78660 78699 78699 78699 78700 78700 78700 78701 78701 78701 78704 78704 78704 78707 78707 78707 78708 78708 78708 78709 78709 78709 78710 78710 78710 78715 78715 78715 78725 78725 78725 78730 78730 78730 78740 78740 78740 78760 78760 78760 78761 78761 78761 78799 78799 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... Status A A C C A C C A A A A A A A A A A A A A A A A A A A A A A A A C C C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 1.23 1.50 0.00 0.00 1.50 0.00 0.00 0.30 0.00 0.30 0.42 0.00 0.42 0.68 0.00 0.68 0.61 0.00 0.61 0.57 0.00 0.57 0.90 0.00 0.90 0.61 0.00 0.61 0.53 0.00 0.53 0.00 0.00 0.00 0.45 0.00 0.45 0.49 0.00 0.49 0.74 0.00 0.74 0.96 0.00 0.96 1.21 0.00 1.21 1.41 0.00 1.41 0.66 0.00 0.66 0.30 0.00 0.30 0.38 0.00 0.38 0.36 0.00 0.36 0.57 0.00 0.57 0.66 0.00 0.66 0.71 0.00 0.71 0.00 0.00 7.00 0.51 0.00 0.00 0.51 0.00 0.00 0.11 1.58 1.69 0.15 3.86 4.01 0.23 5.05 5.28 0.23 2.55 2.78 0.19 3.44 3.63 0.31 5.93 6.24 0.21 4.65 4.86 0.18 2.13 2.31 0.00 0.00 0.00 0.15 3.06 3.21 0.16 3.57 3.73 0.25 3.96 4.21 0.32 4.48 4.80 0.41 4.48 4.89 0.47 4.48 4.95 0.22 5.93 6.15 0.11 1.58 1.69 0.13 1.79 1.92 0.12 1.46 1.58 0.19 2.13 2.32 0.22 2.69 2.91 0.24 3.21 3.45 0.00 0.00 NA 0.51 0.00 0.00 0.51 0.00 0.00 0.11 NA NA 0.15 NA NA 0.23 NA NA 0.23 NA NA 0.19 NA NA 0.31 NA NA 0.21 NA NA 0.18 NA NA 0.00 0.00 0.00 0.15 NA NA 0.16 NA NA 0.25 NA NA 0.32 NA NA 0.41 NA NA 0.47 NA NA 0.22 NA NA 0.11 NA NA 0.13 NA NA 0.12 NA NA 0.19 NA NA 0.22 NA NA 0.24 NA NA 0.00 0.00 Brain imaging (3D) ............................................. Brain imaging (PET) ........................................... Brain imaging (PET) ........................................... Brain imaging (PET) ........................................... Brain imaging (PET) ........................................... Brain imaging (PET) ........................................... Brain imaging (PET) ........................................... Brain flow imaging only ...................................... Brain flow imaging only ...................................... Brain flow imaging only ...................................... Cerebral vascular flow image ............................. Cerebral vascular flow image ............................. Cerebral vascular flow image ............................. Cerebrospinal fluid scan ..................................... Cerebrospinal fluid scan ..................................... Cerebrospinal fluid scan ..................................... CSF ventriculography ......................................... CSF ventriculography ......................................... CSF ventriculography ......................................... CSF shunt evaluation ......................................... CSF shunt evaluation ......................................... CSF shunt evaluation ......................................... Cerebrospinal fluid scan ..................................... Cerebrospinal fluid scan ..................................... Cerebrospinal fluid scan ..................................... CSF leakage imaging ......................................... CSF leakage imaging ......................................... CSF leakage imaging ......................................... Nuclear exam of tear flow .................................. Nuclear exam of tear flow .................................. Nuclear exam of tear flow .................................. Nervous system nuclear exam ........................... Nervous system nuclear exam ........................... Nervous system nuclear exam ........................... Kidney imaging, static ........................................ Kidney imaging, static ........................................ Kidney imaging, static ........................................ Kidney imaging with flow .................................... Kidney imaging with flow .................................... Kidney imaging with flow .................................... Imaging renogram .............................................. Imaging renogram .............................................. Imaging renogram .............................................. Kidney flow/function image ................................ Kidney flow/function image ................................ Kidney flow/function image ................................ Kidney flow/function image ................................ Kidney flow/function image ................................ Kidney flow/function image ................................ Kidney flow/function image ................................ Kidney flow/function image ................................ Kidney flow/function image ................................ Kidney imaging (3D) ........................................... Kidney imaging (3D) ........................................... Kidney imaging (3D) ........................................... Renal vascular flow exam .................................. Renal vascular flow exam .................................. Renal vascular flow exam .................................. Kidney function study ......................................... Kidney function study ......................................... Kidney function study ......................................... Urinary bladder retention .................................... Urinary bladder retention .................................... Urinary bladder retention .................................... Ureteral reflux study ........................................... Ureteral reflux study ........................................... Ureteral reflux study ........................................... Testicular imaging .............................................. Testicular imaging .............................................. Testicular imaging .............................................. Testicular imaging/flow ....................................... Testicular imaging/flow ....................................... Testicular imaging/flow ....................................... Genitourinary nuclear exam ............................... Genitourinary nuclear exam ............................... Malpractice RVUs 0.40 0.06 0.00 0.00 0.06 0.00 0.00 0.01 0.10 0.11 0.02 0.21 0.23 0.03 0.27 0.30 0.02 0.14 0.16 0.02 0.18 0.20 0.04 0.31 0.35 0.03 0.24 0.27 0.02 0.12 0.14 0.00 0.00 0.00 0.02 0.16 0.18 0.02 0.18 0.20 0.03 0.21 0.24 0.04 0.23 0.27 0.05 0.23 0.28 0.06 0.23 0.29 0.03 0.31 0.34 0.01 0.10 0.11 0.02 0.11 0.13 0.02 0.08 0.10 0.03 0.12 0.15 0.03 0.14 0.17 0.03 0.17 0.20 0.00 0.00 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00322 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 8.63 2.07 0.00 0.00 2.07 0.00 0.00 0.42 1.68 2.10 0.59 4.07 4.66 0.94 5.32 6.26 0.86 2.69 3.55 0.78 3.62 4.40 1.25 6.24 7.49 0.85 4.89 5.74 0.73 2.25 2.98 0.00 0.00 0.00 0.62 3.22 3.84 0.67 3.75 4.42 1.02 4.17 5.19 1.32 4.71 6.03 1.67 4.71 6.38 1.94 4.71 6.65 0.91 6.24 7.15 0.42 1.68 2.10 0.53 1.90 2.43 0.50 1.54 2.04 0.79 2.25 3.04 0.91 2.83 3.74 0.98 3.38 4.36 0.00 0.00 Facility Total NA 2.07 0.00 0.00 2.07 0.00 0.00 0.42 NA NA 0.59 NA NA 0.94 NA NA 0.86 NA NA 0.78 NA NA 1.25 NA NA 0.85 NA NA 0.73 NA NA 0.00 0.00 0.00 0.62 NA NA 0.67 NA NA 1.02 NA NA 1.32 NA NA 1.67 NA NA 1.94 NA NA 0.91 NA NA 0.42 NA NA 0.53 NA NA 0.50 NA NA 0.79 NA NA 0.91 NA NA 0.98 NA NA 0.00 0.00 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70437 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 78799 78800 78800 78800 78801 78801 78801 78802 78802 78802 78803 78803 78803 78804 78804 78804 78805 78805 78805 78806 78806 78806 78807 78807 78807 78811 78811 78811 78812 78812 78812 78813 78813 78813 78814 78814 78814 78815 78815 78815 78816 78816 78816 78890 78890 78890 78891 78891 78891 78999 78999 78999 79005 79005 79005 79101 79101 79101 79200 79200 79200 79300 79300 79300 79403 79403 79403 79440 79440 79440 79445 79445 79445 79999 79999 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... Status C A A A A A A A A A A A A A A A A A A A A A A A A A C C A C C A C C A C C A C C A C C B B B B B B C C C A A A A A A A A A A C C A A A A A A A C C C C Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.66 0.00 0.66 0.79 0.00 0.79 0.86 0.00 0.86 1.09 0.00 1.09 1.07 0.00 1.07 0.73 0.00 0.73 0.86 0.00 0.86 1.09 0.00 1.09 1.54 0.00 0.00 1.93 0.00 0.00 2.00 0.00 0.00 2.20 0.00 0.00 2.44 0.00 0.00 2.50 0.00 0.00 +0.05 +0.00 +0.05 +0.10 +0.00 +0.10 0.00 0.00 0.00 1.80 0.00 1.80 1.96 0.00 1.96 1.99 0.00 1.99 1.60 0.00 0.00 2.25 0.00 2.25 1.99 0.00 1.99 2.40 0.00 0.00 0.00 0.00 0.00 0.22 3.41 3.63 0.27 4.23 4.50 0.29 5.55 5.84 0.38 6.57 6.95 0.37 11.09 11.46 0.25 3.41 3.66 0.29 6.45 6.74 0.39 6.57 6.96 0.53 0.00 0.00 0.66 0.00 0.00 0.69 0.00 0.00 0.76 0.00 0.00 0.84 0.00 0.00 0.86 0.00 0.00 0.02 1.31 1.33 0.04 2.63 2.67 0.00 0.00 0.00 0.60 2.63 3.23 0.67 2.63 3.30 0.69 2.63 3.32 0.56 0.00 0.00 0.89 4.28 5.17 0.72 2.63 3.35 0.82 0.00 0.00 0.00 0.00 0.00 0.22 NA NA 0.27 NA NA 0.29 NA NA 0.38 NA NA 0.37 NA NA 0.25 NA NA 0.29 NA NA 0.39 NA NA 0.53 0.00 0.00 0.66 0.00 0.00 0.69 0.00 0.00 0.76 0.00 0.00 0.84 0.00 0.00 0.86 0.00 0.00 0.02 NA NA 0.04 NA NA 0.00 0.00 0.00 0.60 NA NA 0.67 NA NA 0.69 NA NA 0.56 0.00 0.00 0.89 NA NA 0.72 NA NA 0.82 0.00 0.00 0.00 0.00 Genitourinary nuclear exam ............................... Tumor imaging, limited area .............................. Tumor imaging, limited area .............................. Tumor imaging, limited area .............................. Tumor imaging, mult areas ................................ Tumor imaging, mult areas ................................ Tumor imaging, mult areas ................................ Tumor imaging, whole body ............................... Tumor imaging, whole body ............................... Tumor imaging, whole body ............................... Tumor imaging (3D) ........................................... Tumor imaging (3D) ........................................... Tumor imaging (3D) ........................................... Tumor imaging, whole body ............................... Tumor imaging, whole body ............................... Tumor imaging, whole body ............................... Abscess imaging, ltd area .................................. Abscess imaging, ltd area .................................. Abscess imaging, ltd area .................................. Abscess imaging, whole body ............................ Abscess imaging, whole body ............................ Abscess imaging, whole body ............................ Nuclear localization/abscess .............................. Nuclear localization/abscess .............................. Nuclear localization/abscess .............................. Tumor imaging (pet), limited .............................. Tumor imaging (pet), limited .............................. Tumor imaging (pet), limited .............................. Tumor image (pet)/skul-thigh ............................. Tumor image (pet)/skul-thigh ............................. Tumor image (pet)/skul-thigh ............................. Tumor image (pet) full body ............................... Tumor image (pet) full body ............................... Tumor image (pet) full body ............................... Tumor image pet/ct, limited ................................ Tumor image pet/ct, limited ................................ Tumor image pet/ct, limited ................................ Tumorimage pet/ct skul-thigh ............................. Tumorimage pet/ct skul-thigh ............................. Tumorimage pet/ct skul-thigh ............................. Tumor image pet/ct full body ............................. Tumor image pet/ct full body ............................. Tumor image pet/ct full body ............................. Nuclear medicine data proc ............................... Nuclear medicine data proc ............................... Nuclear medicine data proc ............................... Nuclear med data proc ....................................... Nuclear med data proc ....................................... Nuclear med data proc ....................................... Nuclear diagnostic exam .................................... Nuclear diagnostic exam .................................... Nuclear diagnostic exam .................................... Nuclear rx, oral admin ........................................ Nuclear rx, oral admin ........................................ Nuclear rx, oral admin ........................................ Nuclear rx, iv admin ........................................... Nuclear rx, iv admin ........................................... Nuclear rx, iv admin ........................................... Nuclear rx, intracav admin ................................. Nuclear rx, intracav admin ................................. Nuclear rx, intracav admin ................................. Nuclr rx, interstit colloid ...................................... Nuclr rx, interstit colloid ...................................... Nuclr rx, interstit colloid ...................................... Hematopoietic nuclear tx .................................... Hematopoietic nuclear tx .................................... Hematopoietic nuclear tx .................................... Nuclear rx, intra-articular .................................... Nuclear rx, intra-articular .................................... Nuclear rx, intra-articular .................................... Nuclear rx, intra-arterial ...................................... Nuclear rx, intra-arterial ...................................... Nuclear rx, intra-arterial ...................................... Nuclear medicine therapy .................................. Nuclear medicine therapy .................................. Malpractice RVUs 0.00 0.04 0.18 0.22 0.05 0.22 0.27 0.04 0.30 0.34 0.05 0.35 0.40 0.04 0.30 0.34 0.03 0.18 0.21 0.04 0.35 0.39 0.04 0.35 0.39 0.11 0.00 0.00 0.11 0.00 0.00 0.11 0.00 0.00 0.11 0.00 0.00 0.11 0.00 0.00 0.11 0.00 0.00 0.01 0.06 0.07 0.01 0.13 0.14 0.00 0.00 0.00 0.08 0.14 0.22 0.08 0.14 0.22 0.09 0.14 0.23 0.13 0.00 0.00 0.10 0.14 0.24 0.08 0.14 0.22 0.12 0.00 0.00 0.00 0.00 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00323 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.00 0.92 3.59 4.51 1.11 4.45 5.56 1.19 5.85 7.04 1.52 6.92 8.44 1.48 11.39 12.87 1.01 3.59 4.60 1.19 6.80 7.99 1.52 6.92 8.44 2.18 0.00 0.00 2.70 0.00 0.00 2.80 0.00 0.00 3.07 0.00 0.00 3.39 0.00 0.00 3.47 0.00 0.00 0.08 1.37 1.45 0.15 2.76 2.91 0.00 0.00 0.00 2.48 2.77 5.25 2.71 2.77 5.48 2.77 2.77 5.54 2.29 0.00 0.00 3.24 4.42 7.66 2.79 2.77 5.56 3.34 0.00 0.00 0.00 0.00 Facility Total 0.00 0.92 NA NA 1.11 NA NA 1.19 NA NA 1.52 NA NA 1.48 NA NA 1.01 NA NA 1.19 NA NA 1.52 NA NA 2.18 0.00 0.00 2.70 0.00 0.00 2.80 0.00 0.00 3.07 0.00 0.00 3.39 0.00 0.00 3.47 0.00 0.00 0.08 NA NA 0.15 NA NA 0.00 0.00 0.00 2.48 NA NA 2.71 NA NA 2.77 NA NA 2.29 0.00 0.00 3.24 NA NA 2.79 NA NA 3.34 0.00 0.00 0.00 0.00 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70438 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 79999 80500 80502 83020 83912 84165 84166 84181 84182 85060 85097 85390 85396 85576 86077 86078 86079 86255 86256 86320 86325 86327 86334 86335 86485 86490 86510 86580 87164 87207 88104 88104 88104 88106 88106 88106 88107 88107 88107 88108 88108 88108 88112 88112 88112 88125 88125 88125 88141 88160 88160 88160 88161 88161 88161 88162 88162 88162 88172 88172 88172 88173 88173 88173 88182 88182 88182 88184 88185 88187 88188 88189 88199 88199 88199 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... .......... .......... 26 ..... 26 ..... 26 ..... 26 ..... 26 ..... 26 ..... .......... .......... 26 ..... .......... 26 ..... .......... .......... .......... 26 ..... 26 ..... 26 ..... 26 ..... 26 ..... 26 ..... 26 ..... .......... .......... .......... .......... 26 ..... 26 ..... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... Status C A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C C Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.37 1.33 0.37 0.37 0.37 0.37 0.37 0.37 0.45 0.94 0.37 0.37 0.37 0.94 0.94 0.94 0.37 0.37 0.37 0.37 0.42 0.37 0.37 0.00 0.00 0.00 0.00 0.37 0.37 0.56 0.00 0.56 0.56 0.00 0.56 0.76 0.00 0.76 0.56 0.00 0.56 1.18 0.00 1.18 0.26 0.00 0.26 0.42 0.50 0.00 0.50 0.50 0.00 0.50 0.76 0.00 0.76 0.60 0.00 0.60 1.39 0.00 1.39 0.77 0.00 0.77 0.00 0.00 1.36 1.69 2.23 0.00 0.00 0.00 0.00 0.21 0.54 0.15 0.12 0.14 0.14 0.14 0.16 0.18 1.92 0.13 NA 0.16 0.39 0.46 0.45 0.15 0.15 0.15 0.13 0.18 0.15 0.14 0.00 0.29 0.32 0.25 0.12 0.16 0.24 0.61 0.85 0.24 1.11 1.35 0.33 1.21 1.54 0.24 0.97 1.21 0.51 1.46 1.97 0.11 0.16 0.27 0.15 0.21 0.62 0.83 0.21 0.73 0.94 0.33 0.69 1.02 0.26 0.47 0.73 0.59 1.55 2.14 0.33 1.65 1.98 1.32 0.64 0.45 0.57 0.75 0.00 0.00 0.00 0.00 0.16 0.54 0.15 0.12 0.14 0.14 0.14 0.16 0.18 0.41 0.13 0.16 0.16 0.39 0.40 0.41 0.15 0.15 0.15 0.13 0.18 0.15 0.14 0.00 NA NA NA 0.12 0.16 0.24 NA NA 0.24 NA NA 0.33 NA NA 0.24 NA NA 0.51 NA NA 0.11 NA NA 0.15 0.21 NA NA 0.21 NA NA 0.33 NA NA 0.26 NA NA 0.59 NA NA 0.33 NA NA NA NA 0.45 0.57 0.75 0.00 0.00 0.00 Nuclear medicine therapy .................................. Lab pathology consultation ................................ Lab pathology consultation ................................ Hemoglobin electrophoresis ............................... Genetic examination ........................................... Protein e-phoresis, serum .................................. Protein e-phoresis/urine/csf ................................ Western blot test ................................................ Protein, western blot test ................................... Blood smear interpretation ................................. Bone marrow interpretation ................................ Fibrinolysins screen ............................................ Clotting assay, whole blood ............................... Blood platelet aggregation ................................. Physician blood bank service ............................. Physician blood bank service ............................. Physician blood bank service ............................. Fluorescent antibody, screen ............................. Fluorescent antibody, titer .................................. Serum immunoelectrophoresis ........................... Other immunoelectrophoresis ............................ Immunoelectrophoresis assay ............................ Immunofix e-phoresis, serum ............................. Immunfix e-phorsis/urine/csf .............................. Skin test, candida ............................................... Coccidioidomycosis skin test ............................. Histoplasmosis skin test ..................................... TB intradermal test ............................................. Dark field examination ........................................ Smear, special stain ........................................... Cytopathology, fluids .......................................... Cytopathology, fluids .......................................... Cytopathology, fluids .......................................... Cytopathology, fluids .......................................... Cytopathology, fluids .......................................... Cytopathology, fluids .......................................... Cytopathology, fluids .......................................... Cytopathology, fluids .......................................... Cytopathology, fluids .......................................... Cytopath, concentrate tech ................................ Cytopath, concentrate tech ................................ Cytopath, concentrate tech ................................ Cytopath, cell enhance tech ............................... Cytopath, cell enhance tech ............................... Cytopath, cell enhance tech ............................... Forensic cytopathology ...................................... Forensic cytopathology ...................................... Forensic cytopathology ...................................... Cytopath, c/v, interpret ....................................... Cytopath smear, other source ............................ Cytopath smear, other source ............................ Cytopath smear, other source ............................ Cytopath smear, other source ............................ Cytopath smear, other source ............................ Cytopath smear, other source ............................ Cytopath smear, other source ............................ Cytopath smear, other source ............................ Cytopath smear, other source ............................ Cytopathology eval of fna .................................. Cytopathology eval of fna .................................. Cytopathology eval of fna .................................. Cytopath eval, fna, report ................................... Cytopath eval, fna, report ................................... Cytopath eval, fna, report ................................... Cell marker study ............................................... Cell marker study ............................................... Cell marker study ............................................... Flowcytometry/ tc, 1 marker ............................... Flowcytometry/tc, add-on ................................... Flowcytometry/read, 2-8 ..................................... Flowcytometry/read, 9-15 ................................... Flowcytometry/read, 16 & > ............................... Cytopathology procedure ................................... Cytopathology procedure ................................... Cytopathology procedure ................................... Malpractice RVUs 0.00 0.01 0.04 0.01 0.01 0.01 0.01 0.01 0.02 0.02 0.04 0.01 0.04 0.01 0.03 0.03 0.03 0.01 0.01 0.01 0.01 0.02 0.01 0.01 0.00 0.02 0.02 0.02 0.01 0.01 0.02 0.02 0.04 0.02 0.02 0.04 0.03 0.02 0.05 0.02 0.02 0.04 0.02 0.02 0.04 0.01 0.01 0.02 0.02 0.02 0.02 0.04 0.02 0.02 0.04 0.03 0.02 0.05 0.02 0.02 0.04 0.05 0.02 0.07 0.03 0.04 0.07 0.02 0.02 0.01 0.01 0.01 0.00 0.00 0.00 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00324 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.00 0.59 1.91 0.53 0.50 0.52 0.52 0.52 0.55 0.65 2.90 0.51 NA 0.54 1.36 1.43 1.42 0.53 0.53 0.53 0.51 0.62 0.53 0.52 0.00 0.31 0.34 0.27 0.50 0.54 0.82 0.63 1.45 0.82 1.13 1.95 1.12 1.23 2.35 0.82 0.99 1.81 1.71 1.48 3.19 0.38 0.17 0.55 0.59 0.73 0.64 1.37 0.73 0.75 1.48 1.12 0.71 1.83 0.88 0.49 1.37 2.03 1.57 3.60 1.13 1.69 2.82 1.34 0.66 1.82 2.27 2.99 0.00 0.00 0.00 Facility Total 0.00 0.54 1.91 0.53 0.50 0.52 0.52 0.52 0.55 0.65 1.39 0.51 0.57 0.54 1.36 1.37 1.38 0.53 0.53 0.53 0.51 0.62 0.53 0.52 0.00 NA NA NA 0.50 0.54 0.82 NA NA 0.82 NA NA 1.12 NA NA 0.82 NA NA 1.71 NA NA 0.38 NA NA 0.59 0.73 NA NA 0.73 NA NA 1.12 NA NA 0.88 NA NA 2.03 NA NA 1.13 NA NA NA NA 1.82 2.27 2.99 0.00 0.00 0.00 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70439 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 88291 88299 88300 88300 88300 88302 88302 88302 88304 88304 88304 88305 88305 88305 88307 88307 88307 88309 88309 88309 88311 88311 88311 88312 88312 88312 88313 88313 88313 88314 88314 88314 88318 88318 88318 88319 88319 88319 88321 88323 88323 88323 88325 88329 88331 88331 88331 88332 88332 88332 88333 88333 88333 88334 88334 88334 88342 88342 88342 88346 88346 88346 88347 88347 88347 88348 88348 88348 88349 88349 88349 88355 88355 88355 88356 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... 26 ..... TC .... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... Status A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.52 0.00 0.08 0.00 0.08 0.13 0.00 0.13 0.22 0.00 0.22 0.75 0.00 0.75 1.59 0.00 1.59 2.28 0.00 2.28 0.24 0.00 0.24 0.54 0.00 0.54 0.24 0.00 0.24 0.45 0.00 0.45 0.42 0.00 0.42 0.53 0.00 0.53 1.30 1.35 0.00 1.35 2.22 0.67 1.19 0.00 1.19 0.59 0.00 0.59 1.20 0.00 1.20 0.59 0.00 0.59 0.85 0.00 0.85 0.86 0.00 0.86 0.86 0.00 0.86 1.51 0.00 1.51 0.76 0.00 0.76 1.85 0.00 1.85 3.02 0.17 0.00 0.03 0.42 0.45 0.06 0.97 1.03 0.09 1.23 1.32 0.33 1.58 1.91 0.68 2.48 3.16 0.97 3.43 4.40 0.10 0.13 0.23 0.23 1.29 1.52 0.10 1.15 1.25 0.19 1.88 2.07 0.18 1.47 1.65 0.22 3.20 3.42 0.79 0.57 1.21 1.78 2.94 0.65 0.51 0.59 1.10 0.25 0.21 0.46 0.53 0.55 1.08 0.26 0.34 0.60 0.36 1.10 1.46 0.36 1.21 1.57 0.35 0.91 1.26 0.64 8.74 9.38 0.33 3.24 3.57 0.79 8.00 8.79 1.26 0.17 0.00 0.03 NA NA 0.06 NA NA 0.09 NA NA 0.33 NA NA 0.68 NA NA 0.97 NA NA 0.10 NA NA 0.23 NA NA 0.10 NA NA 0.19 NA NA 0.18 NA NA 0.22 NA NA 0.56 0.57 NA NA 0.95 0.29 0.51 NA NA 0.25 NA NA 0.53 NA NA 0.26 NA NA 0.36 NA NA 0.36 NA NA 0.35 NA NA 0.64 NA NA 0.33 NA NA 0.79 NA NA 1.26 Cyto/molecular report ......................................... Cytogenetic study ............................................... Surgical path, gross ........................................... Surgical path, gross ........................................... Surgical path, gross ........................................... Tissue exam by pathologist ............................... Tissue exam by pathologist ............................... Tissue exam by pathologist ............................... Tissue exam by pathologist ............................... Tissue exam by pathologist ............................... Tissue exam by pathologist ............................... Tissue exam by pathologist ............................... Tissue exam by pathologist ............................... Tissue exam by pathologist ............................... Tissue exam by pathologist ............................... Tissue exam by pathologist ............................... Tissue exam by pathologist ............................... Tissue exam by pathologist ............................... Tissue exam by pathologist ............................... Tissue exam by pathologist ............................... Decalcify tissue .................................................. Decalcify tissue .................................................. Decalcify tissue .................................................. Special stains ..................................................... Special stains ..................................................... Special stains ..................................................... Special stains ..................................................... Special stains ..................................................... Special stains ..................................................... Histochemical stain ............................................ Histochemical stain ............................................ Histochemical stain ............................................ Chemical histochemistry .................................... Chemical histochemistry .................................... Chemical histochemistry .................................... Enzyme histochemistry ...................................... Enzyme histochemistry ...................................... Enzyme histochemistry ...................................... Microslide consultation ....................................... Microslide consultation ....................................... Microslide consultation ....................................... Microslide consultation ....................................... Comprehensive review of data .......................... Path consult introp ............................................. Path consult intraop, 1 bloc ............................... Path consult intraop, 1 bloc ............................... Path consult intraop, 1 bloc ............................... Path consult intraop, add’l .................................. Path consult intraop, add’l .................................. Path consult intraop, add’l .................................. Intraop cyto path consult, 1 ................................ Intraop cyto path consult, 1 ................................ Intraop cyto path consult, 1 ................................ Intraop cyto path consult, 2 ................................ Intraop cyto path consult, 2 ................................ Intraop cyto path consult, 2 ................................ Immunohistochemistry ........................................ Immunohistochemistry ........................................ Immunohistochemistry ........................................ Immunofluorescent study ................................... Immunofluorescent study ................................... Immunofluorescent study ................................... Immunofluorescent study ................................... Immunofluorescent study ................................... Immunofluorescent study ................................... Electron microscopy ........................................... Electron microscopy ........................................... Electron microscopy ........................................... Scanning electron microscopy ........................... Scanning electron microscopy ........................... Scanning electron microscopy ........................... Analysis, skeletal muscle ................................... Analysis, skeletal muscle ................................... Analysis, skeletal muscle ................................... Analysis, nerve ................................................... Malpractice RVUs 0.02 0.00 0.01 0.01 0.02 0.01 0.02 0.03 0.01 0.02 0.03 0.03 0.04 0.07 0.06 0.06 0.12 0.08 0.06 0.14 0.01 0.01 0.02 0.02 0.01 0.03 0.01 0.01 0.02 0.02 0.02 0.04 0.02 0.01 0.03 0.02 0.02 0.04 0.05 0.05 0.02 0.07 0.07 0.02 0.04 0.04 0.08 0.02 0.02 0.04 0.04 0.04 0.08 0.02 0.02 0.04 0.03 0.02 0.05 0.03 0.02 0.05 0.03 0.02 0.05 0.06 0.07 0.13 0.03 0.06 0.09 0.07 0.06 0.13 0.12 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00325 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.71 0.00 0.12 0.43 0.55 0.20 0.99 1.19 0.32 1.25 1.57 1.11 1.62 2.73 2.33 2.54 4.87 3.33 3.49 6.82 0.35 0.14 0.49 0.79 1.30 2.09 0.35 1.16 1.51 0.66 1.90 2.56 0.62 1.48 2.10 0.77 3.22 3.99 2.14 1.97 1.23 3.20 5.23 1.34 1.74 0.63 2.37 0.86 0.23 1.09 1.77 0.59 2.36 0.87 0.36 1.23 1.24 1.12 2.36 1.25 1.23 2.48 1.24 0.93 2.17 2.21 8.81 11.02 1.12 3.30 4.42 2.71 8.06 10.77 4.40 Facility Total 0.71 0.00 0.12 NA NA 0.20 NA NA 0.32 NA NA 1.11 NA NA 2.33 NA NA 3.33 NA NA 0.35 NA NA 0.79 NA NA 0.35 NA NA 0.66 NA NA 0.62 NA NA 0.77 NA NA 1.91 1.97 NA NA 3.24 0.98 1.74 NA NA 0.86 NA NA 1.77 NA NA 0.87 NA NA 1.24 NA NA 1.25 NA NA 1.24 NA NA 2.21 NA NA 1.12 NA NA 2.71 NA NA 4.40 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70440 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 88356 88356 88358 88358 88358 88360 88360 88360 88361 88361 88361 88362 88362 88362 88365 88365 88365 88367 88367 88367 88368 88368 88368 88371 88372 88380 88380 88380 88384 88384 88384 88385 88385 88385 88386 88386 88386 88399 88399 88399 89049 89060 89100 89105 89130 89132 89135 89136 89140 89141 89220 89230 89240 90281 90283 90287 90288 90291 90296 90371 90375 90376 90378 90379 90384 90385 90386 90389 90393 90396 90399 90465 90466 90467 90468 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... 26 ..... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... 26 ..... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... Status A A A A A A A A A A A A A A A A A A A A A A A A A C C C C C C A C C A C C C C C A A A A A A A A A A A A C I I I I I E E E E X I I E I I E E I A A R R Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 3.02 0.95 0.00 0.95 1.10 0.00 1.10 1.18 0.00 1.18 2.17 0.00 2.17 1.20 0.00 1.20 1.30 0.00 1.30 1.40 0.00 1.40 0.37 0.37 0.00 0.00 0.00 0.00 0.00 0.00 1.50 0.00 0.00 1.88 0.00 0.00 0.00 0.00 0.00 1.40 0.37 0.60 0.50 0.45 0.19 0.79 0.21 0.94 0.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.17 0.15 0.17 0.15 2.93 4.19 0.40 0.44 0.84 0.47 1.26 1.73 0.49 2.54 3.03 0.92 3.78 4.70 0.51 1.62 2.13 0.54 3.50 4.04 0.60 1.80 2.40 0.13 0.16 0.00 0.00 0.00 0.00 0.00 0.00 0.65 0.00 0.00 0.82 0.00 0.00 0.00 0.00 0.00 3.56 0.16 1.84 2.23 1.75 1.55 1.90 1.74 2.09 2.80 0.43 0.11 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.31 0.13 0.17 0.11 NA NA 0.40 NA NA 0.47 NA NA 0.49 NA NA 0.92 NA NA 0.51 NA NA 0.54 NA NA 0.60 NA NA 0.13 0.16 0.00 0.00 0.00 0.00 0.00 0.00 0.65 0.00 0.00 0.82 0.00 0.00 0.00 0.00 0.00 0.27 0.16 0.21 0.17 0.13 0.06 0.25 0.09 0.27 0.33 NA NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NA NA 0.09 0.06 Analysis, nerve ................................................... Analysis, nerve ................................................... Analysis, tumor ................................................... Analysis, tumor ................................................... Analysis, tumor ................................................... Tumor immunohistochem/manual ...................... Tumor immunohistochem/manual ...................... Tumor immunohistochem/manual ...................... Tumor immunohistochem/comput ...................... Tumor immunohistochem/comput ...................... Tumor immunohistochem/comput ...................... Nerve teasing preparations ................................ Nerve teasing preparations ................................ Nerve teasing preparations ................................ Insitu hybridization (fish) .................................... Insitu hybridization (fish) .................................... Insitu hybridization (fish) .................................... Insitu hybridization, auto .................................... Insitu hybridization, auto .................................... Insitu hybridization, auto .................................... Insitu hybridization, manual ................................ Insitu hybridization, manual ................................ Insitu hybridization, manual ................................ Protein, western blot tissue ................................ Protein analysis w/probe .................................... Microdissection ................................................... Microdissection ................................................... Microdissection ................................................... Eval molecular probes, 11-50 ............................ Eval molecular probes, 11-50 ............................ Eval molecular probes, 11-50 ............................ Eval molecul probes, 51-250 ............................. Eval molecul probes, 51-250 ............................. Eval molecul probes, 51-250 ............................. Eval molecul probes, 251-500 ........................... Eval molecul probes, 251-500 ........................... Eval molecul probes, 251-500 ........................... Surgical pathology procedure ............................ Surgical pathology procedure ............................ Surgical pathology procedure ............................ Chct for mal hyperthermia .................................. Exam,synovial fluid crystals ............................... Sample intestinal contents ................................. Sample intestinal contents ................................. Sample stomach contents .................................. Sample stomach contents .................................. Sample stomach contents .................................. Sample stomach contents .................................. Sample stomach contents .................................. Sample stomach contents .................................. Sputum specimen collection .............................. Collect sweat for test .......................................... Pathology lab procedure .................................... Human ig, im ...................................................... Human ig, iv ....................................................... Botulinum antitoxin ............................................. Botulism ig, iv ..................................................... Cmv ig, iv ........................................................... Diphtheria antitoxin ............................................. Hep b ig, im ........................................................ Rabies ig, im/sc .................................................. 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 ........................... Malpractice RVUs 0.07 0.19 0.10 0.07 0.17 0.06 0.02 0.08 0.10 0.07 0.17 0.09 0.06 0.15 0.03 0.02 0.05 0.06 0.06 0.12 0.06 0.06 0.12 0.01 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.06 0.00 0.00 0.08 0.00 0.00 0.00 0.00 0.00 0.06 0.01 0.03 0.02 0.02 0.01 0.04 0.01 0.04 0.03 0.02 0.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.01 0.01 0.01 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00326 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 3.00 7.40 1.45 0.51 1.96 1.63 1.28 2.91 1.77 2.61 4.38 3.18 3.84 7.02 1.74 1.64 3.38 1.90 3.56 5.46 2.06 1.86 3.92 0.51 0.54 0.00 0.00 0.00 0.00 0.00 0.00 2.21 0.00 0.00 2.78 0.00 0.00 0.00 0.00 0.00 5.02 0.54 2.47 2.75 2.22 1.75 2.73 1.96 3.07 3.68 0.45 0.13 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.49 0.29 0.35 0.27 Facility Total NA NA 1.45 NA NA 1.63 NA NA 1.77 NA NA 3.18 NA NA 1.74 NA NA 1.90 NA NA 2.06 NA NA 0.51 0.54 0.00 0.00 0.00 0.00 0.00 0.00 2.21 0.00 0.00 2.78 0.00 0.00 0.00 0.00 0.00 1.73 0.54 0.84 0.69 0.60 0.26 1.08 0.31 1.25 1.21 NA NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NA NA 0.27 0.22 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ XXX ZZZ Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70441 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 90471 90472 90473 90474 90476 90477 90581 90585 90586 90632 90633 90634 90636 90645 90646 90647 90648 90649 90655 90656 90657 90658 90660 90665 90669 90675 90676 90680 90690 90691 90692 90693 90698 90700 90701 90702 90703 90704 90705 90706 90707 90708 90710 90712 90713 90714 90715 90716 90717 90718 90719 90720 90721 90723 90725 90727 90732 90733 90734 90735 90736 90740 90743 90744 90746 90747 90748 90749 90760 90761 90765 90766 90767 90768 90772 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A R R E E E E E E E E E E E E E E X X X X X E N E E E E E E E E E E E E E E E E E E E E E E E E E E E E I E E X E E E E X X X X X I E A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.17 0.15 0.17 0.15 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.17 0.09 0.21 0.18 0.19 0.17 0.17 0.31 0.13 0.19 0.10 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.43 0.40 1.76 0.46 0.89 0.44 0.31 NA NA 0.07 0.06 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.43 0.40 1.76 0.46 0.89 0.44 0.31 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 ......................................... H papilloma vacc 3 dose im ............................... Flu vaccine no preserv 6-35m ........................... Flu vaccine no preserv 3 & > ............................. Flu vaccine, 6-35 mo, im .................................... Flu vaccine age 3 & over, im ............................. Flu vaccine, nasal .............................................. Lyme disease vaccine, im .................................. Pneumococcal vacc, ped <5 .............................. Rabies vaccine, im ............................................. Rabies vaccine, id .............................................. Rotovirus vacc 3 dose, oral ............................... Typhoid vaccine, oral ......................................... Typhoid vaccine, im ........................................... Typhoid vaccine, h-p, sc/id ................................ Typhoid vaccine, akd, sc .................................... Dtap-hib-ip vaccine, im ....................................... Dtap vaccine, < 7 yrs, im ................................... Dtp vaccine, im ................................................... Dt vaccine < 7, im .............................................. Tetanus vaccine, im ........................................... Mumps vaccine, sc ............................................. Measles vaccine, sc ........................................... Rubella vaccine, sc ............................................ Mmr vaccine, sc ................................................. Measles-rubella vaccine, sc ............................... Mmrv vaccine, sc ............................................... Oral poliovirus vaccine ....................................... Poliovirus, ipv, sc/im ........................................... Td vaccine no prsrv >/= 7 im ............................. 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 ..................................... Zoster vacc, 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 .................................................... Hydration iv infusion, init .................................... Hydrate iv infusion, add-on ................................ Ther/proph/diag iv inf, init ................................... Ther/proph/dg iv inf, add-on ............................... Tx/proph/dg addl seq iv inf ................................. Ther/diag concurrent inf ..................................... Ther/proph/diag inj, sc/im ................................... Malpractice RVUs 0.01 0.01 0.01 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.07 0.04 0.07 0.04 0.04 0.04 0.01 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00327 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.49 0.29 0.37 0.26 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.67 0.53 2.04 0.68 1.12 0.65 0.49 Facility Total NA NA 0.25 0.22 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.67 0.53 2.04 0.68 1.12 0.65 0.49 Global XXX ZZZ XXX ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ XXX ZZZ ZZZ ZZZ XXX 70442 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 90773 90774 90775 90779 90801 90802 90804 90805 90806 90807 90808 90809 90810 90811 90812 90813 90814 90815 90816 90817 90818 90819 90821 90822 90823 90824 90826 90827 90828 90829 90845 90846 90847 90849 90853 90857 90862 90865 90870 90875 90876 90880 90882 90885 90887 90889 90899 90901 90911 90918 90919 90920 90921 90922 90923 90924 90925 90935 90937 90940 90945 90947 90989 90993 90997 90999 91000 91000 91000 91010 91010 91010 91011 91011 91011 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... Status A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A R R R A A A A A N N A N B B B C A A I I I I I I I I A A X A A X X A C A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.17 0.18 0.10 0.00 2.80 3.01 1.21 1.37 1.86 2.02 2.79 2.95 1.32 1.48 1.97 2.13 2.90 3.06 1.25 1.41 1.89 2.05 2.83 2.99 1.36 1.52 2.01 2.16 2.94 3.10 1.79 1.83 2.21 0.59 0.59 0.63 0.95 2.84 1.88 +1.20 +1.90 2.19 0.00 +0.97 +1.48 0.00 0.00 0.41 0.89 +11.16 +8.53 +7.26 +4.46 +0.37 +0.28 +0.24 +0.15 1.22 2.11 0.00 1.28 2.16 0.00 0.00 1.84 0.00 0.73 0.00 0.73 1.25 0.00 1.25 1.50 0.00 1.50 0.32 1.30 0.57 0.00 1.17 1.20 0.49 0.50 0.70 0.70 1.03 1.00 0.51 0.57 0.79 0.77 1.10 1.05 NA NA NA NA NA NA NA NA NA NA NA NA 0.58 0.65 0.82 0.27 0.25 0.29 0.40 1.36 1.94 0.90 1.16 1.04 0.00 0.37 0.82 0.00 0.00 0.65 1.56 6.13 4.01 3.76 2.45 0.21 0.13 0.12 0.08 NA NA 0.00 NA NA 0.00 0.00 NA 0.00 0.25 0.08 0.33 0.44 3.98 4.42 0.53 4.71 5.24 0.32 1.30 0.57 0.00 0.93 0.98 0.38 0.42 0.60 0.63 0.90 0.92 0.42 0.46 0.64 0.67 0.98 0.95 0.46 0.46 0.69 0.65 1.01 0.95 0.48 0.49 0.72 0.68 1.06 0.98 0.55 0.65 0.76 0.24 0.23 0.25 0.32 0.91 0.59 0.46 0.73 0.69 0.00 0.37 0.56 0.00 0.00 0.14 0.31 6.13 4.01 3.76 2.45 0.21 0.13 0.12 0.08 0.67 0.97 0.00 0.69 0.99 0.00 0.00 0.66 0.00 0.25 NA NA 0.44 NA NA 0.53 NA NA Ther/proph/diag inj, ia ........................................ Ther/proph/diag inj, iv push ................................ Ther/proph/diag inj add-on ................................. Ther/prop/diag inj/inf proc .................................. Psy dx interview ................................................. Intac psy dx interview ......................................... Psytx, office, 20-30 min ...................................... Psytx, off, 20-30 min w/e&m .............................. Psytx, off, 45-50 min .......................................... Psytx, off, 45-50 min w/e&m .............................. Psytx, office, 75-80 min ...................................... Psytx, off, 75-80, w/e&m .................................... Intac psytx, off, 20-30 min .................................. Intac psytx, 20-30, w/e&m .................................. Intac psytx, off, 45-50 min .................................. Intac psytx, 45-50 min w/e&m ............................ Intac psytx, off, 75-80 min .................................. Intac psytx, 75-80 w/e&m ................................... Psytx, hosp, 20-30 min ...................................... Psytx, hosp, 20-30 min w/e&m .......................... Psytx, hosp, 45-50 min ...................................... Psytx, hosp, 45-50 min w/e&m .......................... Psytx, hosp, 75-80 min ...................................... Psytx, hosp, 75-80 min w/e&m .......................... Intac psytx, hosp, 20-30 min .............................. Intac psytx, hsp 20-30 w/e&m ............................ Intac psytx, hosp, 45-50 min .............................. Intac psytx, hsp 45-50 w/e&m ............................ Intac psytx, hosp, 75-80 min .............................. Intac psytx, hsp 75-80 w/e&m ............................ Psychoanalysis ................................................... Family psytx w/o patient ..................................... Family psytx w/patient ........................................ Multiple family group psytx ................................. Group psychotherapy ......................................... Intac group psytx ................................................ Medication management .................................... Narcosynthesis ................................................... Electroconvulsive therapy .................................. 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 access study ................................ Dialysis, one evaluation ..................................... Dialysis, repeated eval ....................................... Dialysis training, complete ................................. Dialysis training, incompl .................................... Hemoperfusion ................................................... Dialysis procedure .............................................. Esophageal intubation ........................................ Esophageal intubation ........................................ Esophageal intubation ........................................ Esophagus motility study ................................... Esophagus motility study ................................... Esophagus motility study ................................... Esophagus motility study ................................... Esophagus motility study ................................... Esophagus motility study ................................... Malpractice RVUs 0.02 0.04 0.04 0.00 0.06 0.07 0.03 0.03 0.04 0.05 0.06 0.07 0.04 0.04 0.04 0.05 0.06 0.07 0.03 0.03 0.04 0.05 0.06 0.08 0.03 0.04 0.05 0.05 0.06 0.07 0.04 0.04 0.05 0.02 0.01 0.01 0.02 0.12 0.04 0.04 0.05 0.05 0.00 0.02 0.04 0.00 0.00 0.02 0.06 0.36 0.29 0.23 0.14 0.01 0.01 0.01 0.01 0.04 0.07 0.00 0.04 0.07 0.00 0.00 0.06 0.00 0.03 0.01 0.04 0.06 0.06 0.12 0.07 0.06 0.13 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00328 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.51 1.52 0.71 0.00 4.03 4.28 1.73 1.90 2.60 2.77 3.88 4.02 1.87 2.09 2.80 2.95 4.06 4.18 NA NA NA NA NA NA NA NA NA NA NA NA 2.41 2.52 3.08 0.88 0.85 0.93 1.37 4.32 3.86 2.14 3.11 3.28 0.00 1.36 2.34 0.00 0.00 1.08 2.51 17.65 12.83 11.25 7.05 0.59 0.42 0.37 0.24 NA NA 0.00 NA NA 0.00 0.00 NA 0.00 1.01 0.09 1.10 1.75 4.04 5.79 2.10 4.77 6.87 Facility Total 0.51 1.52 0.71 0.00 3.79 4.06 1.62 1.82 2.50 2.70 3.75 3.94 1.78 1.98 2.65 2.85 3.94 4.08 1.74 1.90 2.62 2.75 3.90 4.02 1.87 2.05 2.78 2.89 4.06 4.15 2.38 2.52 3.02 0.85 0.83 0.89 1.29 3.87 2.51 1.70 2.68 2.93 0.00 1.36 2.08 0.00 0.00 0.57 1.26 17.65 12.83 11.25 7.05 0.59 0.42 0.37 0.24 1.93 3.15 0.00 2.01 3.22 0.00 0.00 2.56 0.00 1.01 NA NA 1.75 NA NA 2.10 NA NA Global XXX XXX ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 000 XXX XXX XXX XXX XXX XXX XXX XXX 000 000 XXX XXX XXX XXX XXX XXX XXX XXX 000 000 XXX 000 000 XXX XXX 000 XXX 000 000 000 000 000 000 000 000 000 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70443 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 91012 91012 91012 91020 91020 91020 91022 91022 91022 91030 91030 91030 91034 91034 91034 91035 91035 91035 91037 91037 91037 91038 91038 91038 91040 91040 91040 91052 91052 91052 91055 91055 91055 91060 91060 91060 91065 91065 91065 91100 91105 91110 91110 91110 91120 91120 91120 91122 91122 91122 91123 91132 91132 91132 91133 91133 91133 91299 91299 91299 92002 92004 92012 92014 92015 92018 92019 92020 92060 92060 92060 92065 92065 92065 92070 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A B A C C A C C C C C A A A A N A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 1.46 0.00 1.46 1.44 0.00 1.44 1.44 0.00 1.44 0.91 0.00 0.91 0.97 0.00 0.97 1.59 0.00 1.59 0.97 0.00 0.97 1.10 0.00 1.10 0.97 0.00 0.97 0.79 0.00 0.79 0.94 0.00 0.94 0.45 0.00 0.45 0.20 0.00 0.20 1.08 0.37 3.64 0.00 3.64 0.97 0.00 0.97 1.77 0.00 1.77 0.00 0.52 0.00 0.00 0.66 0.00 0.00 0.00 0.00 0.00 0.88 1.67 0.67 1.10 +0.38 2.50 1.31 0.37 0.69 0.00 0.69 0.37 0.00 0.37 0.70 0.51 5.26 5.77 0.49 4.04 4.53 0.51 3.90 4.41 0.32 2.12 2.44 0.34 4.91 5.25 0.56 10.27 10.83 0.34 2.60 2.94 0.39 1.84 2.23 0.34 10.82 11.16 0.28 2.18 2.46 0.27 2.68 2.95 0.14 1.83 1.97 0.07 1.39 1.46 2.80 2.11 1.28 20.96 22.24 0.34 10.67 11.01 0.60 4.51 5.11 0.00 0.18 0.00 0.00 0.23 0.00 0.00 0.00 0.00 0.00 0.97 1.70 1.03 1.41 1.49 NA NA 0.34 0.29 0.44 0.73 0.15 0.38 0.53 1.07 0.51 NA NA 0.49 NA NA 0.51 NA NA 0.32 NA NA 0.34 NA NA 0.56 NA NA 0.34 NA NA 0.39 NA NA 0.34 NA NA 0.28 NA NA 0.27 NA NA 0.14 NA NA 0.07 NA NA 0.28 0.09 1.28 NA NA 0.34 NA NA 0.60 NA NA 0.00 0.18 0.00 0.00 0.23 0.00 0.00 0.00 0.00 0.00 0.34 0.68 0.29 0.47 0.15 1.07 0.56 0.16 0.29 NA NA 0.15 NA NA 0.32 Esophagus motility study ................................... Esophagus motility study ................................... Esophagus motility study ................................... Gastric motility studies ....................................... Gastric motility studies ....................................... Gastric motility studies ....................................... Duodenal motility study ...................................... Duodenal motility study ...................................... Duodenal motility study ...................................... Acid perfusion of esophagus .............................. Acid perfusion of esophagus .............................. Acid perfusion of esophagus .............................. Gastroesophageal reflux test ............................. Gastroesophageal reflux test ............................. Gastroesophageal reflux test ............................. G-esoph reflx tst w/electrod ............................... G-esoph reflx tst w/electrod ............................... G-esoph reflx tst w/electrod ............................... Esoph imped function test .................................. Esoph imped function test .................................. Esoph imped function test .................................. Esoph imped funct test > 1h .............................. Esoph imped funct test > 1h .............................. Esoph imped funct test > 1h .............................. Esoph balloon distension tst .............................. Esoph balloon distension tst .............................. Esoph balloon distension tst .............................. Gastric analysis test ........................................... Gastric analysis test ........................................... Gastric analysis test ........................................... Gastric intubation for smear ............................... Gastric intubation for smear ............................... Gastric intubation for smear ............................... Gastric saline load test ....................................... Gastric saline load test ....................................... Gastric saline load test ....................................... Breath hydrogen test .......................................... Breath hydrogen test .......................................... Breath hydrogen test .......................................... Pass intestine bleeding tube .............................. Gastric intubation treatment ............................... Gi tract capsule endoscopy ................................ Gi tract capsule endoscopy ................................ Gi tract capsule endoscopy ................................ Rectal sensation test .......................................... Rectal sensation test .......................................... Rectal sensation test .......................................... Anal pressure record .......................................... Anal pressure record .......................................... Anal pressure record .......................................... Irrigate fecal impaction ....................................... Electrogastrography ........................................... Electrogastrography ........................................... Electrogastrography ........................................... Electrogastrography w/test ................................. Electrogastrography w/test ................................. Electrogastrography w/test ................................. Gastroenterology procedure ............................... Gastroenterology procedure ............................... Gastroenterology procedure ............................... Eye exam, new patient ....................................... Eye exam, new patient ....................................... Eye exam established pat .................................. Eye exam & treatment ....................................... Refraction ........................................................... New eye exam & treatment ............................... Eye exam & treatment ....................................... Special eye evaluation ....................................... Special eye evaluation ....................................... Special eye evaluation ....................................... Special eye evaluation ....................................... Orthoptic/pleoptic training ................................... Orthoptic/pleoptic training ................................... Orthoptic/pleoptic training ................................... Fitting of contact lens ......................................... Malpractice RVUs 0.06 0.07 0.13 0.07 0.06 0.13 0.07 0.06 0.13 0.04 0.02 0.06 0.06 0.06 0.12 0.06 0.06 0.12 0.06 0.06 0.12 0.06 0.06 0.12 0.06 0.06 0.12 0.03 0.02 0.05 0.05 0.02 0.07 0.03 0.02 0.05 0.01 0.02 0.03 0.07 0.03 0.09 0.07 0.16 0.07 0.04 0.11 0.13 0.08 0.21 0.00 0.02 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.02 0.04 0.02 0.03 0.01 0.07 0.03 0.01 0.02 0.01 0.03 0.01 0.01 0.02 0.02 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00329 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 2.03 5.33 7.36 2.00 4.10 6.10 2.02 3.96 5.98 1.27 2.14 3.41 1.37 4.97 6.34 2.21 10.33 12.54 1.37 2.66 4.03 1.55 1.90 3.45 1.37 10.88 12.25 1.10 2.20 3.30 1.26 2.70 3.96 0.62 1.85 2.47 0.28 1.41 1.69 3.95 2.51 5.01 21.03 26.04 1.38 10.71 12.09 2.50 4.59 7.09 0.00 0.72 0.00 0.00 0.92 0.00 0.00 0.00 0.00 0.00 1.87 3.41 1.72 2.54 1.88 NA NA 0.72 1.00 0.45 1.45 0.53 0.39 0.92 1.79 Facility Total 2.03 NA NA 2.00 NA NA 2.02 NA NA 1.27 NA NA 1.37 NA NA 2.21 NA NA 1.37 NA NA 1.55 NA NA 1.37 NA NA 1.10 NA NA 1.26 NA NA 0.62 NA NA 0.28 NA NA 1.43 0.49 5.01 NA NA 1.38 NA NA 2.50 NA NA 0.00 0.72 0.00 0.00 0.92 0.00 0.00 0.00 0.00 0.00 1.24 2.39 0.98 1.60 0.54 3.64 1.90 0.54 1.00 NA NA 0.53 NA NA 1.04 Global 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 XXX XXX XXX XXX XXX XXX 000 000 000 XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70444 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 92081 92081 92081 92082 92082 92082 92083 92083 92083 92100 92120 92130 92135 92135 92135 92136 92136 92136 92140 92225 92226 92230 92235 92235 92235 92240 92240 92240 92250 92250 92250 92260 92265 92265 92265 92270 92270 92270 92275 92275 92275 92283 92283 92283 92284 92284 92284 92285 92285 92285 92286 92286 92286 92287 92310 92311 92312 92313 92314 92315 92316 92317 92325 92326 92340 92341 92342 92352 92353 92354 92355 92358 92370 92371 92499 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... A ...... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A N A A A N A A A A A N N N B B B B B N B C Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.36 0.00 0.36 0.44 0.00 0.44 0.50 0.00 0.50 0.92 0.81 0.81 0.35 0.00 0.35 0.54 0.00 0.54 0.50 0.38 0.33 0.60 0.81 0.00 0.81 1.10 0.00 1.10 0.44 0.00 0.44 0.20 0.81 0.00 0.81 0.81 0.00 0.81 1.01 0.00 1.01 0.17 0.00 0.17 0.24 0.00 0.24 0.20 0.00 0.20 0.66 0.00 0.66 0.81 +1.17 1.08 1.26 0.92 +0.69 0.45 0.68 0.45 0.00 0.00 +0.37 +0.47 +0.53 +0.37 +0.50 +0.00 +0.00 +0.00 +0.32 +0.00 0.00 0.15 0.79 0.94 0.19 1.04 1.23 0.22 1.21 1.43 1.35 1.07 1.28 0.15 0.64 0.79 0.24 1.41 1.65 0.99 0.22 0.21 1.53 0.37 2.25 2.62 0.50 5.62 6.12 0.19 1.34 1.53 0.26 0.28 1.21 1.49 0.33 1.20 1.53 0.43 1.51 1.94 0.07 0.77 0.84 0.08 1.81 1.89 0.09 0.90 0.99 0.29 2.77 3.06 2.39 1.12 1.09 1.08 1.06 0.94 0.85 0.91 0.94 0.40 1.63 0.70 0.74 0.76 0.68 0.73 8.89 4.34 0.97 0.55 0.62 0.00 0.15 NA NA 0.19 NA NA 0.22 NA NA 0.36 0.32 0.37 0.15 NA NA 0.24 NA NA 0.21 0.16 0.14 0.20 0.37 NA NA 0.50 NA NA 0.19 NA NA 0.09 0.28 NA NA 0.33 NA NA 0.43 NA NA 0.07 NA NA 0.08 NA NA 0.09 NA NA 0.29 NA NA 0.31 0.45 0.35 0.50 0.29 0.27 0.16 0.29 0.15 NA NA 0.14 0.18 0.21 0.14 0.19 NA NA NA 0.13 NA 0.00 Visual field examination(s) ................................. Visual field examination(s) ................................. Visual field examination(s) ................................. Visual field examination(s) ................................. Visual field examination(s) ................................. Visual field examination(s) ................................. Visual field examination(s) ................................. Visual field examination(s) ................................. Visual field examination(s) ................................. Serial tonometry exam(s) ................................... Tonography & eye evaluation ............................ Water provocation tonography ........................... Opthalmic dx imaging ......................................... Opthalmic dx imaging ......................................... Opthalmic dx imaging ......................................... Ophthalmic biometry .......................................... Ophthalmic biometry .......................................... Ophthalmic biometry .......................................... Glaucoma provocative tests ............................... Special eye exam, initial .................................... Special eye exam, subsequent .......................... Eye exam with photos ........................................ Eye exam with photos ........................................ Eye exam with photos ........................................ Eye exam with photos ........................................ Icg angiography .................................................. Icg angiography .................................................. Icg angiography .................................................. Eye exam with photos ........................................ Eye exam with photos ........................................ Eye exam with photos ........................................ Ophthalmoscopy/dynamometry .......................... Eye muscle evaluation ....................................... Eye muscle evaluation ....................................... Eye muscle evaluation ....................................... Electro-oculography ............................................ Electro-oculography ............................................ Electro-oculography ............................................ Electroretinography ............................................ Electroretinography ............................................ Electroretinography ............................................ Color vision examination .................................... Color vision examination .................................... Color vision examination .................................... Dark adaptation eye exam ................................. Dark adaptation eye exam ................................. Dark adaptation eye exam ................................. Eye photography ................................................ Eye photography ................................................ Eye photography ................................................ Internal eye photography ................................... Internal eye photography ................................... Internal eye photography ................................... Internal eye photography ................................... Contact lens fitting .............................................. Contact lens fitting .............................................. Contact lens fitting .............................................. Contact lens fitting .............................................. Prescription of contact lens ................................ Prescription of contact lens ................................ Prescription of contact lens ................................ Prescription of contact lens ................................ Modification of contact lens ................................ Replacement of contact lens .............................. Fitting of 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 ................................ Eye service or procedure ................................... Malpractice RVUs 0.01 0.01 0.02 0.01 0.01 0.02 0.01 0.01 0.02 0.02 0.02 0.02 0.01 0.01 0.02 0.01 0.07 0.08 0.01 0.01 0.01 0.02 0.02 0.06 0.08 0.03 0.06 0.09 0.01 0.01 0.02 0.01 0.04 0.02 0.06 0.03 0.02 0.05 0.03 0.02 0.05 0.01 0.01 0.02 0.01 0.01 0.02 0.01 0.01 0.02 0.02 0.02 0.04 0.02 0.04 0.03 0.03 0.02 0.01 0.01 0.02 0.01 0.01 0.06 0.01 0.01 0.01 0.01 0.02 0.10 0.01 0.05 0.02 0.02 0.00 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00330 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.52 0.80 1.32 0.64 1.05 1.69 0.73 1.22 1.95 2.29 1.90 2.11 0.51 0.65 1.16 0.79 1.48 2.27 1.50 0.61 0.55 2.15 1.20 2.31 3.51 1.63 5.68 7.31 0.64 1.35 1.99 0.47 1.13 1.23 2.36 1.17 1.22 2.39 1.47 1.53 3.00 0.25 0.78 1.03 0.33 1.82 2.15 0.30 0.91 1.21 0.97 2.79 3.76 3.22 2.33 2.20 2.37 2.00 1.64 1.31 1.61 1.40 0.41 1.69 1.08 1.22 1.30 1.06 1.25 8.99 4.35 1.02 0.89 0.64 0.00 Facility Total 0.52 NA NA 0.64 NA NA 0.73 NA NA 1.30 1.15 1.20 0.51 NA NA 0.79 NA NA 0.72 0.55 0.48 0.82 1.20 NA NA 1.63 NA NA 0.64 NA NA 0.30 1.13 NA NA 1.17 NA NA 1.47 NA NA 0.25 NA NA 0.33 NA NA 0.30 NA NA 0.97 NA NA 1.14 1.66 1.46 1.79 1.23 0.97 0.62 0.99 0.61 NA NA 0.52 0.66 0.75 0.52 0.71 NA NA NA 0.47 NA 0.00 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70445 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 92499 92499 92502 92504 92506 92507 92508 92511 92512 92516 92520 92526 92531 92532 92533 92534 92541 92541 92541 92542 92542 92542 92543 92543 92543 92544 92544 92544 92545 92545 92545 92546 92546 92546 92547 92548 92548 92548 92551 92552 92553 92555 92556 92557 92559 92560 92561 92562 92563 92564 92565 92567 92568 92569 92571 92572 92573 92575 92576 92577 92579 92582 92583 92584 92585 92585 92585 92586 92587 92587 92587 92588 92588 92588 92590 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... Status C C A A A A A A A A A A B B B B A A A A A A A A A A A A A A A A A A A A A A N A A A A A N N A A A A A A A A A A A A A A A A A A A A A A A A A A A A N Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.00 1.51 0.18 0.86 0.52 0.26 0.84 0.55 0.43 0.75 0.55 0.00 0.00 0.00 0.00 0.40 0.00 0.40 0.33 0.00 0.33 0.10 0.00 0.10 0.26 0.00 0.26 0.23 0.00 0.23 0.29 0.00 0.29 0.00 0.50 0.00 0.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50 0.00 0.50 0.00 0.13 0.00 0.13 0.36 0.00 0.36 0.00 0.00 0.00 NA 0.50 2.60 1.11 0.51 3.32 1.14 1.20 0.51 1.64 0.00 0.00 0.00 0.00 0.19 0.84 1.03 0.16 0.98 1.14 0.05 0.52 0.57 0.12 0.78 0.90 0.11 0.69 0.80 0.13 1.86 1.99 0.08 0.26 2.00 2.26 0.00 0.44 0.66 0.38 0.57 1.19 0.00 0.00 0.72 0.41 0.38 0.47 0.40 0.52 0.38 0.41 0.39 0.09 0.35 0.30 0.44 0.72 0.73 0.73 0.89 2.48 0.21 1.86 2.07 1.86 0.06 1.31 1.37 0.16 1.47 1.63 0.00 0.00 0.00 1.11 0.09 0.40 0.23 0.12 0.78 0.18 0.22 0.39 0.20 0.00 0.00 0.00 0.00 0.19 NA NA 0.16 NA NA 0.05 NA NA 0.12 NA NA 0.11 NA NA 0.13 NA NA NA 0.26 NA NA 0.00 NA NA NA NA NA 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.21 NA NA NA 0.06 NA NA 0.16 NA NA 0.00 Eye service or procedure ................................... Eye service or procedure ................................... Ear and throat examination ................................ Ear microscopy examination .............................. Speech/hearing evaluation ................................. Speech/hearing therapy ..................................... Speech/hearing therapy ..................................... Nasopharyngoscopy ........................................... Nasal function studies ........................................ Facial nerve function test ................................... Laryngeal function studies ................................. Oral function therapy .......................................... Spontaneous nystagmus study .......................... Positional nystagmus test .................................. Caloric vestibular test ......................................... Optokinetic nystagmus test ................................ Spontaneous nystagmus test ............................. Spontaneous nystagmus test ............................. Spontaneous nystagmus test ............................. Positional nystagmus test .................................. Positional nystagmus test .................................. Positional nystagmus test .................................. Caloric vestibular test ......................................... Caloric vestibular test ......................................... Caloric vestibular test ......................................... Optokinetic nystagmus test ................................ Optokinetic nystagmus test ................................ Optokinetic nystagmus test ................................ Oscillating tracking test ...................................... Oscillating tracking test ...................................... Oscillating tracking test ...................................... Sinusoidal rotational test .................................... Sinusoidal rotational test .................................... Sinusoidal rotational test .................................... Supplemental electrical test ............................... Posturography .................................................... Posturography .................................................... Posturography .................................................... Pure tone hearing test, air ................................. Pure tone audiometry, air ................................... Audiometry, air & bone ...................................... Speech threshold audiometry ............................ Speech audiometry, complete ............................ Comprehensive hearing test .............................. Group audiometric testing .................................. Bekesy audiometry, screen ................................ Bekesy audiometry, diagnosis ........................... Loudness balance test ....................................... Tone decay hearing test .................................... Sisi hearing test .................................................. Stenger test, pure tone ...................................... Tympanometry .................................................... Acoustic refl threshold tst ................................... Acoustic reflex decay test .................................. Filtered speech hearing test ............................... Staggered spondaic word test ........................... Lombard test ...................................................... Sensorineural acuity test .................................... Synthetic sentence test ...................................... Stenger test, speech .......................................... Visual audiometry (vra) ...................................... Conditioning play audiometry ............................. Select picture audiometry ................................... Electrocochleography ......................................... Auditor evoke potent, compre ............................ Auditor evoke potent, compre ............................ Auditor evoke potent, compre ............................ Auditor evoke potent, limit .................................. Evoked auditory test ........................................... Evoked auditory test ........................................... Evoked auditory test ........................................... Evoked auditory test ........................................... Evoked auditory test ........................................... Evoked auditory test ........................................... Hearing aid exam, one ear ................................ Malpractice RVUs 0.00 0.00 0.05 0.01 0.03 0.02 0.01 0.03 0.02 0.01 0.03 0.02 0.00 0.00 0.00 0.00 0.02 0.02 0.04 0.01 0.02 0.03 0.01 0.01 0.02 0.01 0.02 0.03 0.01 0.02 0.03 0.01 0.02 0.03 0.06 0.02 0.13 0.15 0.00 0.04 0.06 0.04 0.06 0.12 0.00 0.00 0.06 0.04 0.04 0.05 0.04 0.06 0.04 0.04 0.04 0.01 0.04 0.02 0.05 0.07 0.06 0.06 0.08 0.21 0.03 0.14 0.17 0.14 0.01 0.11 0.12 0.01 0.13 0.14 0.00 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00331 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.00 0.00 NA 0.69 3.49 1.65 0.78 4.19 1.71 1.64 1.29 2.21 0.00 0.00 0.00 0.00 0.61 0.86 1.47 0.50 1.00 1.50 0.16 0.53 0.69 0.39 0.80 1.19 0.35 0.71 1.06 0.43 1.88 2.31 0.14 0.78 2.13 2.91 0.00 0.48 0.72 0.42 0.63 1.31 0.00 0.00 0.78 0.45 0.42 0.52 0.44 0.58 0.42 0.45 0.43 0.10 0.39 0.32 0.49 0.79 0.79 0.79 0.97 2.69 0.74 2.00 2.74 2.00 0.20 1.42 1.62 0.53 1.60 2.13 0.00 Facility Total 0.00 0.00 2.67 0.28 1.29 0.77 0.39 1.65 0.75 0.66 1.17 0.77 0.00 0.00 0.00 0.00 0.61 NA NA 0.50 NA NA 0.16 NA NA 0.39 NA NA 0.35 NA NA 0.43 NA NA NA 0.78 NA NA 0.00 NA NA NA NA NA 0.00 0.00 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.74 NA NA NA 0.20 NA NA 0.53 NA NA 0.00 Global XXX XXX 000 XXX XXX XXX XXX 000 XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70446 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 92591 92592 92593 92594 92595 92596 92597 92601 92602 92603 92604 92605 92606 92607 92608 92609 92610 92611 92612 92613 92614 92615 92616 92617 92620 92621 92625 92626 92627 92630 92633 92700 92950 92953 92960 92961 92970 92971 92973 92974 92975 92977 92978 92978 92978 92979 92979 92979 92980 92981 92982 92984 92986 92987 92990 92992 92993 92995 92996 92997 92998 93000 93005 93010 93012 93014 93015 93016 93017 93018 93024 93024 93024 93025 93025 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... Status N N N N N A A A A A A B B A A A A A A A A A A A A A A A A I I C A A A A A A A A A A A A A A A A A A A A A A A C C A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.00 0.00 0.00 0.00 0.00 0.86 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.27 0.71 1.27 0.63 1.88 0.79 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.79 0.23 2.25 4.59 3.51 1.77 3.28 3.00 7.24 0.00 1.80 0.00 1.80 1.44 0.00 1.44 14.82 4.16 10.96 2.97 21.77 22.67 17.31 0.00 0.00 12.07 3.26 11.98 5.99 0.17 0.00 0.17 0.00 0.52 0.75 0.45 0.00 0.30 1.17 0.00 1.17 0.75 0.00 0.00 0.00 0.00 0.00 0.00 0.59 1.69 3.51 2.39 2.15 1.35 0.00 0.00 3.09 0.55 1.59 3.44 3.44 2.75 0.40 2.51 0.35 3.40 0.44 1.14 0.25 1.12 0.55 0.55 0.00 0.00 0.00 4.21 NA 6.33 NA NA NA NA NA NA 8.07 0.71 4.57 5.28 0.56 2.30 2.86 NA NA NA NA NA NA NA 0.00 0.00 NA NA NA NA 0.51 0.45 0.06 6.03 0.19 1.96 0.17 1.68 0.11 0.45 1.12 1.57 0.29 7.32 0.00 0.00 0.00 0.00 0.00 NA 0.45 NA NA NA NA 0.00 0.00 NA NA NA NA NA 0.66 0.39 0.66 0.35 0.99 0.44 NA NA NA NA NA 0.00 0.00 0.00 0.97 0.07 1.17 2.09 1.06 0.85 1.29 1.18 2.82 NA 0.71 NA NA 0.56 NA NA 6.07 1.63 4.54 1.16 11.86 12.25 9.82 0.00 0.00 4.97 1.27 4.83 2.21 NA NA 0.06 NA 0.19 NA 0.17 NA 0.11 0.45 NA NA 0.29 NA Hearing aid exam, both ears .............................. Hearing aid check, one ear ................................ Hearing aid check, both ears ............................. Electro hearng aid test, one ............................... Electro hearng aid tst, both ................................ Ear protector evaluation ..................................... Oral speech device eval ..................................... Cochlear implt f/up exam < 7 ............................. Reprogram cochlear implt < 7 ............................ Cochlear implt f/up exam 7 > ............................. Reprogram cochlear implt 7 > ............................ Eval for nonspeech device rx ............................. Non-speech device service ................................ Ex for speech device rx, 1hr .............................. Ex for speech device rx addl ............................. Use of speech device service ............................ Evaluate swallowing function ............................. Motion fluoroscopy/swallow ................................ Endoscopy swallow tst (fees) ............................. Endoscopy swallow tst (fees) ............................. Laryngoscopic sensory test ................................ Eval laryngoscopy sense tst .............................. Fees w/laryngeal sense test .............................. Interprt fees/laryngeal test .................................. Auditory function, 60 min ................................... Auditory function, + 15 min ................................ Tinnitus assessment ........................................... Eval aud rehab status ........................................ Eval aud status rehab add-on ............................ Aud rehab pre-ling hear loss .............................. Aud rehab postling hear loss ............................. Ent procedure/service ........................................ Heart/lung resuscitation cpr ............................... Temporary external pacing ................................ Cardioversion electric, ext .................................. Cardioversion, electric, int .................................. Cardioassist, internal .......................................... Cardioassist, external ......................................... Percut coronary thrombectomy .......................... Cath place, cardio brachytx ............................... Dissolve clot, heart vessel ................................. Dissolve clot, heart vessel ................................. Intravasc us, heart add-on ................................. Intravasc us, heart add-on ................................. Intravasc us, heart add-on ................................. Intravasc us, heart add-on ................................. Intravasc us, heart add-on ................................. Intravasc us, heart add-on ................................. Insert intracoronary stent ................................... Insert intracoronary stent ................................... Coronary artery dilation ...................................... Coronary artery dilation ...................................... Revision of aortic valve ...................................... Revision of mitral valve ...................................... Revision of pulmonary valve .............................. Revision of heart chamber ................................. Revision of heart chamber ................................. Coronary atherectomy ........................................ Coronary atherectomy add-on ........................... Pul art balloon repr, percut ................................ Pul art balloon repr, percut ................................ Electrocardiogram, complete .............................. Electrocardiogram, tracing ................................. Electrocardiogram report .................................... Transmission of ecg ........................................... Report on transmitted ecg .................................. Cardiovascular stress test .................................. Cardiovascular stress test .................................. Cardiovascular stress test .................................. Cardiovascular stress test .................................. Cardiac drug stress test ..................................... Cardiac drug stress test ..................................... Cardiac drug stress test ..................................... Microvolt t-wave assess ..................................... Microvolt t-wave assess ..................................... Malpractice RVUs 0.00 0.00 0.00 0.00 0.00 0.06 0.03 0.07 0.07 0.07 0.07 0.00 0.00 0.05 0.05 0.04 0.08 0.08 0.04 0.05 0.04 0.05 0.06 0.05 0.06 0.06 0.06 0.06 0.06 0.00 0.00 0.00 0.28 0.02 0.07 0.29 0.16 0.06 0.23 0.21 0.50 0.46 0.06 0.24 0.30 0.06 0.13 0.19 1.03 0.29 0.76 0.21 1.51 1.59 1.20 0.00 0.00 0.84 0.10 0.40 0.28 0.03 0.02 0.01 0.18 0.02 0.14 0.02 0.11 0.01 0.04 0.08 0.12 0.03 0.11 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00332 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.00 0.00 0.00 0.00 0.00 0.65 2.58 3.58 2.46 2.22 1.42 0.00 0.00 3.14 0.60 1.63 3.52 3.52 4.06 1.16 3.82 1.03 5.34 1.28 1.20 0.31 1.18 0.61 0.61 0.00 0.00 0.00 8.28 NA 8.65 NA NA NA NA NA NA 8.53 2.57 4.81 7.38 2.06 2.43 4.49 NA NA NA NA NA NA NA 0.00 0.00 NA NA NA NA 0.71 0.47 0.24 6.21 0.73 2.85 0.64 1.79 0.42 1.66 1.20 2.86 1.07 7.43 Facility Total 0.00 0.00 0.00 0.00 0.00 NA 1.34 NA NA NA NA 0.00 0.00 NA NA NA NA NA 1.97 1.15 1.97 1.03 2.93 1.28 NA NA NA NA NA 0.00 0.00 0.00 5.04 0.32 3.49 6.97 4.73 2.68 4.80 4.39 10.56 NA 2.57 NA NA 2.06 NA NA 21.92 6.08 16.26 4.34 35.14 36.51 28.33 0.00 0.00 17.88 4.63 17.21 8.48 NA NA 0.24 NA 0.73 NA 0.64 NA 0.42 1.66 NA NA 1.07 NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ XXX XXX XXX XXX XXX XXX 000 000 000 000 000 000 ZZZ ZZZ 000 XXX ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ 000 ZZZ 000 ZZZ 090 090 090 090 090 000 ZZZ 000 ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70447 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 93025 93040 93041 93042 93224 93225 93226 93227 93230 93231 93232 93233 93235 93236 93237 93268 93270 93271 93272 93278 93278 93278 93303 93303 93303 93304 93304 93304 93307 93307 93307 93308 93308 93308 93312 93312 93312 93313 93314 93314 93314 93315 93315 93315 93316 93317 93317 93317 93318 93318 93318 93320 93320 93320 93321 93321 93321 93325 93325 93325 93350 93350 93350 93501 93501 93501 93503 93505 93505 93505 93508 93508 93508 93510 93510 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C A A C C A C C A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.75 0.16 0.00 0.16 0.52 0.00 0.00 0.52 0.52 0.00 0.00 0.52 0.45 0.00 0.45 0.52 0.00 0.00 0.52 0.25 0.00 0.25 1.30 0.00 1.30 0.75 0.00 0.75 0.92 0.00 0.92 0.53 0.00 0.53 2.20 0.00 2.20 0.95 1.25 0.00 1.25 2.78 0.00 0.00 0.95 1.83 0.00 0.00 2.20 0.00 0.00 0.38 0.00 0.38 0.15 0.00 0.15 0.07 0.00 0.07 1.48 0.00 1.48 3.02 0.00 3.02 2.91 4.37 0.00 4.37 4.09 0.00 4.09 4.32 0.00 7.61 0.20 0.15 0.05 3.62 1.24 2.19 0.19 3.90 1.52 2.19 0.19 2.79 2.63 0.16 7.46 1.24 6.03 0.19 0.10 1.15 1.25 0.48 3.87 4.35 0.28 1.95 2.23 0.35 3.87 4.22 0.20 1.95 2.15 0.79 3.79 4.58 NA 0.47 3.79 4.26 1.01 0.00 0.00 NA 0.67 0.00 0.00 0.48 0.00 0.00 0.15 1.71 1.86 0.06 1.11 1.17 0.03 2.91 2.94 0.57 1.77 2.34 1.15 16.95 18.10 NA 1.68 1.99 3.67 2.09 12.64 14.73 2.18 37.06 NA NA NA 0.05 NA NA NA 0.19 NA NA NA 0.19 NA NA 0.16 NA NA NA 0.19 0.10 NA NA 0.48 NA NA 0.28 NA NA 0.35 NA NA 0.20 NA NA 0.79 NA NA 0.21 0.47 NA NA 1.01 0.00 0.00 0.24 0.67 0.00 0.00 0.48 0.00 0.00 0.15 NA NA 0.06 NA NA 0.03 NA NA 0.57 NA NA 1.15 NA NA 0.68 1.68 NA NA 2.09 NA NA 2.18 NA Microvolt t-wave assess ..................................... Rhythm ECG with report .................................... Rhythm ECG, tracing ......................................... Rhythm ECG, report ........................................... ECG monitor/report, 24 hrs ................................ ECG monitor/record, 24 hrs ............................... ECG monitor/report, 24 hrs ................................ ECG monitor/review, 24 hrs ............................... ECG monitor/report, 24 hrs ................................ Ecg monitor/record, 24 hrs ................................. ECG monitor/report, 24 hrs ................................ ECG monitor/review, 24 hrs ............................... ECG monitor/report, 24 hrs ................................ ECG monitor/report, 24 hrs ................................ ECG monitor/review, 24 hrs ............................... ECG record/review ............................................. ECG recording .................................................... Ecg/monitoring and analysis .............................. Ecg/review, interpret only ................................... ECG/signal-averaged ......................................... ECG/signal-averaged ......................................... ECG/signal-averaged ......................................... Echo transthoracic .............................................. Echo transthoracic .............................................. Echo transthoracic .............................................. Echo transthoracic .............................................. Echo transthoracic .............................................. Echo transthoracic .............................................. Echo exam of heart ............................................ Echo exam of heart ............................................ Echo exam of heart ............................................ Echo exam of heart ............................................ Echo exam of heart ............................................ Echo exam of heart ............................................ Echo transesophageal ........................................ Echo transesophageal ........................................ Echo transesophageal ........................................ Echo transesophageal ........................................ Echo transesophageal ........................................ Echo transesophageal ........................................ Echo transesophageal ........................................ Echo transesophageal ........................................ Echo transesophageal ........................................ Echo transesophageal ........................................ Echo transesophageal ........................................ Echo transesophageal ........................................ Echo transesophageal ........................................ Echo transesophageal ........................................ Echo transesophageal intraop ........................... Echo transesophageal intraop ........................... Echo transesophageal intraop ........................... Doppler echo exam, heart .................................. Doppler echo exam, heart .................................. Doppler echo exam, heart .................................. Doppler echo exam, heart .................................. Doppler echo exam, heart .................................. Doppler echo exam, heart .................................. Doppler color flow add-on .................................. Doppler color flow add-on .................................. Doppler color flow add-on .................................. Echo transthoracic .............................................. Echo transthoracic .............................................. Echo transthoracic .............................................. Right heart catheterization ................................. Right heart catheterization ................................. Right heart catheterization ................................. Insert/place heart catheter ................................. Biopsy of heart lining .......................................... Biopsy of heart lining .......................................... Biopsy of heart lining .......................................... Cath placement, angiography ............................ Cath placement, angiography ............................ Cath placement, angiography ............................ Left heart catheterization .................................... Left heart catheterization .................................... Malpractice RVUs 0.14 0.02 0.01 0.01 0.24 0.08 0.14 0.02 0.26 0.11 0.13 0.02 0.16 0.14 0.02 0.28 0.08 0.18 0.02 0.01 0.11 0.12 0.04 0.23 0.27 0.02 0.13 0.15 0.03 0.23 0.26 0.02 0.13 0.15 0.08 0.29 0.37 0.06 0.04 0.29 0.33 0.09 0.00 0.00 0.05 0.08 0.00 0.00 0.14 0.00 0.00 0.01 0.12 0.13 0.01 0.08 0.09 0.01 0.21 0.22 0.05 0.13 0.18 0.21 1.05 1.26 0.20 0.30 0.16 0.46 0.28 0.65 0.93 0.30 2.31 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00333 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 8.50 0.38 0.16 0.22 4.38 1.32 2.33 0.73 4.68 1.63 2.32 0.73 3.40 2.77 0.63 8.26 1.32 6.21 0.73 0.36 1.26 1.62 1.82 4.10 5.92 1.05 2.08 3.13 1.30 4.10 5.40 0.75 2.08 2.83 3.07 4.08 7.15 NA 1.76 4.08 5.84 3.88 0.00 0.00 NA 2.58 0.00 0.00 2.82 0.00 0.00 0.54 1.83 2.37 0.22 1.19 1.41 0.11 3.12 3.23 2.10 1.90 4.00 4.38 18.00 22.38 NA 6.35 2.15 8.50 6.46 13.29 19.75 6.80 39.37 Facility Total NA NA NA 0.22 NA NA NA 0.73 NA NA NA 0.73 NA NA 0.63 NA NA NA 0.73 0.36 NA NA 1.82 NA NA 1.05 NA NA 1.30 NA NA 0.75 NA NA 3.07 NA NA 1.22 1.76 NA NA 3.88 0.00 0.00 1.24 2.58 0.00 0.00 2.82 0.00 0.00 0.54 NA NA 0.22 NA NA 0.11 NA NA 2.10 NA NA 4.38 NA NA 3.79 6.35 NA NA 6.46 NA NA 6.80 NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ XXX XXX XXX 000 000 000 000 000 000 000 000 000 000 000 000 70448 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 93510 93511 93511 93511 93514 93514 93514 93524 93524 93524 93526 93526 93526 93527 93527 93527 93528 93528 93528 93529 93529 93529 93530 93530 93530 93531 93531 93531 93532 93532 93532 93533 93533 93533 93539 93540 93541 93542 93543 93544 93545 93555 93555 93555 93556 93556 93556 93561 93561 93561 93562 93562 93562 93571 93571 93571 93572 93572 93572 93580 93581 93600 93600 93600 93602 93602 93602 93603 93603 93603 93609 93609 93609 93610 93610 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... Status A A A A A C R A A A A A A A A A A A A A A A A A A A A A A C C A C C A A A A A A A A A A A A A A A A A A A A A A A C C A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 4.32 5.02 0.00 5.02 7.04 0.00 7.04 6.94 0.00 6.94 5.98 0.00 5.98 7.27 0.00 7.27 8.99 0.00 8.99 4.79 0.00 4.79 4.22 0.00 4.22 8.34 0.00 8.34 9.99 0.00 0.00 6.69 0.00 0.00 0.40 0.43 0.29 0.29 0.29 0.25 0.40 0.81 0.00 0.81 0.83 0.00 0.83 0.50 0.00 0.50 0.16 0.00 0.16 1.80 0.00 1.80 1.44 0.00 0.00 17.97 24.39 2.12 0.00 2.12 2.12 0.00 2.12 2.12 0.00 2.12 4.99 0.00 4.99 3.02 0.00 39.24 2.45 36.07 38.52 3.13 0.00 39.09 3.18 47.14 50.32 2.82 48.43 51.25 3.32 47.14 50.46 4.04 47.14 51.18 2.28 47.14 49.42 1.94 16.95 18.89 3.59 48.43 52.02 4.26 0.00 0.00 2.80 0.00 0.00 NA NA NA NA NA NA NA 0.32 6.29 6.61 0.32 9.92 10.24 0.16 0.52 0.68 0.05 0.32 0.37 0.68 4.57 5.25 0.50 0.00 0.00 NA NA 0.83 1.96 2.79 0.82 1.11 1.93 0.81 1.68 2.49 1.96 2.73 4.69 1.16 1.35 NA 2.45 NA NA 3.13 0.00 39.09 3.18 NA NA 2.82 NA NA 3.32 NA NA 4.04 NA NA 2.28 NA NA 1.94 NA NA 3.59 NA NA 4.26 0.00 0.00 2.80 0.00 0.00 0.16 0.17 0.11 0.11 0.11 0.10 0.16 0.32 NA NA 0.32 NA NA 0.16 NA NA 0.05 NA NA 0.68 NA NA 0.50 0.00 0.00 7.40 9.42 0.83 NA NA 0.82 NA NA 0.81 NA NA 1.96 NA NA 1.16 NA Left heart catheterization .................................... Left heart catheterization .................................... Left heart catheterization .................................... Left heart catheterization .................................... Left heart catheterization .................................... Left heart catheterization .................................... Left heart catheterization .................................... Left heart catheterization .................................... Left heart catheterization .................................... Left heart catheterization .................................... Rt & Lt heart catheters ....................................... Rt & Lt heart catheters ....................................... Rt & Lt heart catheters ....................................... Rt & Lt heart catheters ....................................... Rt & Lt heart catheters ....................................... Rt & Lt heart catheters ....................................... Rt & Lt heart catheters ....................................... Rt & Lt heart catheters ....................................... Rt & Lt heart catheters ....................................... Rt, lt heart catheterization .................................. Rt, lt heart catheterization .................................. Rt, lt heart catheterization .................................. Rt heart cath, congenital .................................... Rt heart cath, congenital .................................... Rt heart cath, congenital .................................... R & l heart cath, congenital ............................... R & l heart cath, congenital ............................... R & l heart cath, congenital ............................... R & l heart cath, congenital ............................... R & l heart cath, congenital ............................... R & l heart cath, congenital ............................... R & l heart cath, congenital ............................... R & l heart cath, congenital ............................... R & l heart cath, congenital ............................... Injection, cardiac cath ........................................ Injection, cardiac cath ........................................ Injection for lung angiogram ............................... Injection for heart x-rays .................................... Injection for heart x-rays .................................... Injection for aortography .................................... Inject for coronary x-rays ................................... Imaging, cardiac cath ......................................... Imaging, cardiac cath ......................................... Imaging, cardiac cath ......................................... Imaging, cardiac cath ......................................... Imaging, cardiac cath ......................................... Imaging, cardiac cath ......................................... Cardiac output measurement ............................. Cardiac output measurement ............................. Cardiac output measurement ............................. Cardiac output measurement ............................. Cardiac output measurement ............................. Cardiac output measurement ............................. Heart flow reserve measure ............................... Heart flow reserve measure ............................... Heart flow reserve measure ............................... Heart flow reserve measure ............................... Heart flow reserve measure ............................... Heart flow reserve measure ............................... Transcath closure of asd .................................... Transcath closure of vsd .................................... Bundle of His recording ...................................... Bundle of His recording ...................................... Bundle of His recording ...................................... Intra-atrial recording ........................................... Intra-atrial recording ........................................... Intra-atrial recording ........................................... Right ventricular recording ................................. Right ventricular recording ................................. Right ventricular recording ................................. Map tachycardia, add-on .................................... Map tachycardia, add-on .................................... Map tachycardia, add-on .................................... Intra-atrial pacing ................................................ Intra-atrial pacing ................................................ Malpractice RVUs 2.61 0.35 2.24 2.59 0.49 0.00 2.74 0.48 2.95 3.43 0.42 3.04 3.46 0.51 2.95 3.46 0.62 2.95 3.57 0.33 2.95 3.28 0.29 1.05 1.34 0.58 3.04 3.62 0.69 0.00 0.00 0.47 0.00 0.00 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.03 0.34 0.37 0.03 0.51 0.54 0.02 0.06 0.08 0.01 0.04 0.05 0.06 0.24 0.30 0.04 0.00 0.00 1.25 1.71 0.16 0.13 0.29 0.17 0.07 0.24 0.18 0.11 0.29 0.35 0.17 0.52 0.24 0.10 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00334 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 46.17 7.82 38.31 46.13 10.66 0.00 48.87 10.60 50.09 60.69 9.22 51.47 60.69 11.10 50.09 61.19 13.65 50.09 63.74 7.40 50.09 57.49 6.45 18.00 24.45 12.51 51.47 63.98 14.94 0.00 0.00 9.96 0.00 0.00 NA NA NA NA NA NA NA 1.16 6.63 7.79 1.18 10.43 11.61 0.68 0.58 1.26 0.22 0.36 0.58 2.54 4.81 7.35 1.98 0.00 0.00 NA NA 3.11 2.09 5.20 3.11 1.18 4.29 3.11 1.79 4.90 7.30 2.90 10.20 4.42 1.45 Facility Total NA 7.82 NA NA 10.66 0.00 48.87 10.60 NA NA 9.22 NA NA 11.10 NA NA 13.65 NA NA 7.40 NA NA 6.45 NA NA 12.51 NA NA 14.94 0.00 0.00 9.96 0.00 0.00 0.57 0.61 0.41 0.41 0.41 0.36 0.57 1.16 NA NA 1.18 NA NA 0.68 NA NA 0.22 NA NA 2.54 NA NA 1.98 0.00 0.00 26.62 35.52 3.11 NA NA 3.11 NA NA 3.11 NA NA 7.30 NA NA 4.42 NA Global 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 XXX XXX XXX XXX XXX XXX 000 000 000 000 000 000 ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ 000 000 000 000 000 000 000 000 000 000 000 ZZZ ZZZ ZZZ 000 000 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70449 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 93610 93612 93612 93612 93613 93615 93615 93615 93616 93616 93616 93618 93618 93618 93619 93619 93619 93620 93620 93620 93621 93621 93621 93622 93622 93622 93623 93623 93623 93624 93624 93624 93631 93631 93631 93640 93640 93640 93641 93641 93641 93642 93642 93642 93650 93651 93652 93660 93660 93660 93662 93662 93662 93668 93701 93701 93701 93720 93721 93722 93724 93724 93724 93727 93731 93731 93731 93732 93732 93732 93733 93733 93733 93734 93734 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... 26 ..... TC .... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... 26 ..... TC .... .......... .......... .......... .......... 26 ..... TC .... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... Status A A A A A A A A A C C A A A A A A A C C A C C A C C A C C A A A A C C A A A A A A A A A A A A A A A A C C N A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 3.02 3.02 0.00 3.02 6.99 0.99 0.00 0.99 1.49 0.00 0.00 4.25 0.00 4.25 7.31 0.00 7.31 11.57 0.00 0.00 2.10 0.00 0.00 3.10 0.00 0.00 2.85 0.00 0.00 4.80 0.00 4.80 7.59 0.00 0.00 3.51 0.00 3.51 5.92 0.00 5.92 4.88 0.00 4.88 10.49 16.23 17.65 1.89 0.00 1.89 2.80 0.00 0.00 0.00 0.17 0.00 0.17 0.17 0.00 0.17 4.88 0.00 4.88 0.52 0.45 0.00 0.45 0.92 0.00 0.92 0.17 0.00 0.17 0.38 0.00 2.51 1.16 1.61 2.77 NA 0.27 0.32 0.59 0.43 0.00 0.00 1.67 3.97 5.64 3.19 7.72 10.91 4.85 0.00 0.00 0.82 0.00 0.00 1.21 0.00 0.00 1.11 0.00 0.00 2.20 1.99 4.19 2.78 0.00 0.00 1.36 7.19 8.55 2.32 7.19 9.51 2.22 7.19 9.41 NA NA NA 0.74 1.68 2.42 1.11 0.00 0.00 0.00 0.07 0.91 0.98 0.76 0.71 0.05 1.92 3.97 5.89 0.20 0.17 0.49 0.66 0.35 0.51 0.86 0.07 0.73 0.80 0.15 0.35 NA 1.16 NA NA 2.77 0.27 NA NA 0.43 0.00 0.00 1.67 NA NA 3.19 NA NA 4.85 0.00 0.00 0.82 0.00 0.00 1.21 0.00 0.00 1.11 0.00 0.00 2.20 NA NA 2.78 0.00 0.00 1.36 NA NA 2.32 NA NA 2.22 NA NA 4.44 6.34 6.90 0.74 NA NA 1.11 0.00 0.00 0.00 0.07 NA NA NA NA 0.05 1.92 NA NA 0.20 0.17 NA NA 0.35 NA NA 0.07 NA NA 0.15 NA Intra-atrial pacing ................................................ Intraventricular pacing ........................................ Intraventricular pacing ........................................ Intraventricular pacing ........................................ Electrophys map 3d, add-on .............................. Esophageal recording ........................................ Esophageal recording ........................................ Esophageal recording ........................................ Esophageal recording ........................................ Esophageal recording ........................................ Esophageal recording ........................................ Heart rhythm pacing ........................................... Heart rhythm pacing ........................................... Heart rhythm pacing ........................................... Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Stimulation, pacing heart .................................... Stimulation, pacing heart .................................... Stimulation, pacing heart .................................... Electrophysiologic study ..................................... Electrophysiologic study ..................................... Electrophysiologic study ..................................... Heart pacing, mapping ....................................... Heart pacing, mapping ....................................... Heart pacing, mapping ....................................... Evaluation heart device ...................................... Evaluation heart device ...................................... Evaluation heart device ...................................... Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Electrophysiology evaluation .............................. Ablate heart dysrhythm focus ............................ Ablate heart dysrhythm focus ............................ Ablate heart dysrhythm focus ............................ Tilt table evaluation ............................................ Tilt table evaluation ............................................ Tilt table evaluation ............................................ Intracardiac ecg (ice) .......................................... Intracardiac ecg (ice) .......................................... Intracardiac ecg (ice) .......................................... Peripheral vascular rehab .................................. Bioimpedance, thoracic ...................................... Bioimpedance, thoracic ...................................... Bioimpedance, thoracic ...................................... Total body plethysmography .............................. Plethysmography tracing .................................... Plethysmography report ..................................... Analyze pacemaker system ............................... Analyze pacemaker system ............................... Analyze pacemaker system ............................... Analyze ilr system .............................................. Analyze pacemaker system ............................... Analyze pacemaker system ............................... Analyze pacemaker system ............................... Analyze pacemaker system ............................... Analyze pacemaker system ............................... Analyze pacemaker system ............................... Telephone analy, pacemaker ............................. Telephone analy, pacemaker ............................. Telephone analy, pacemaker ............................. Analyze pacemaker system ............................... Analyze pacemaker system ............................... Malpractice RVUs 0.34 0.25 0.11 0.36 0.49 0.03 0.02 0.05 0.09 0.00 0.00 0.30 0.24 0.54 0.51 0.47 0.98 0.80 0.00 0.00 0.15 0.00 0.00 0.22 0.00 0.00 0.20 0.00 0.00 0.33 0.13 0.46 0.97 0.00 0.00 0.24 0.42 0.66 0.41 0.42 0.83 0.15 0.42 0.57 0.73 1.13 1.23 0.06 0.02 0.08 0.09 0.00 0.00 0.00 0.01 0.01 0.02 0.07 0.06 0.01 0.15 0.24 0.39 0.02 0.01 0.04 0.05 0.03 0.04 0.07 0.01 0.06 0.07 0.01 0.02 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00335 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 5.87 4.43 1.72 6.15 NA 1.29 0.34 1.63 2.01 0.00 0.00 6.22 4.21 10.43 11.01 8.19 19.20 17.22 0.00 0.00 3.07 0.00 0.00 4.53 0.00 0.00 4.16 0.00 0.00 7.33 2.12 9.45 11.34 0.00 0.00 5.11 7.61 12.72 8.65 7.61 16.26 7.25 7.61 14.86 NA NA NA 2.69 1.70 4.39 4.00 0.00 0.00 0.00 0.25 0.92 1.17 1.00 0.77 0.23 6.95 4.21 11.16 0.74 0.63 0.53 1.16 1.30 0.55 1.85 0.25 0.79 1.04 0.54 0.37 Facility Total NA 4.43 NA NA 10.25 1.29 NA NA 2.01 0.00 0.00 6.22 NA NA 11.01 NA NA 17.22 0.00 0.00 3.07 0.00 0.00 4.53 0.00 0.00 4.16 0.00 0.00 7.33 NA NA 11.34 0.00 0.00 5.11 NA NA 8.65 NA NA 7.25 NA NA 15.66 23.70 25.78 2.69 NA NA 4.00 0.00 0.00 0.00 0.25 NA NA NA NA 0.23 6.95 NA NA 0.74 0.63 NA NA 1.30 NA NA 0.25 NA NA 0.54 NA Global 000 000 000 000 ZZZ 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX 000 000 000 XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70450 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 93734 93735 93735 93735 93736 93736 93736 93740 93740 93740 93741 93741 93741 93742 93742 93742 93743 93743 93743 93744 93744 93744 93745 93745 93745 93760 93762 93770 93770 93770 93784 93786 93788 93790 93797 93798 93799 93799 93799 93875 93875 93875 93880 93880 93880 93882 93882 93882 93886 93886 93886 93888 93888 93888 93890 93890 93890 93892 93892 93892 93893 93893 93893 93922 93922 93922 93923 93923 93923 93924 93924 93924 93925 93925 93925 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... Status A A A A A A A B B B A A A A A A A A A A A A C C C N N B B B A A A A A A C C C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.38 0.74 0.00 0.74 0.15 0.00 0.15 +0.16 +0.00 +0.16 0.80 0.00 0.80 0.91 0.00 0.91 1.03 0.00 1.03 1.18 0.00 1.18 0.00 0.00 0.00 0.00 0.00 +0.16 +0.00 +0.16 0.38 0.00 0.00 0.38 0.18 0.28 0.00 0.00 0.00 0.22 0.00 0.22 0.60 0.00 0.60 0.40 0.00 0.40 0.94 0.00 0.94 0.62 0.00 0.62 1.00 0.00 1.00 1.15 0.00 1.15 1.15 0.00 1.15 0.25 0.00 0.25 0.45 0.00 0.45 0.50 0.00 0.50 0.58 0.00 0.58 0.50 0.28 0.44 0.72 0.06 0.63 0.69 0.04 0.15 0.19 0.31 0.67 0.98 0.36 0.67 1.03 0.40 0.73 1.13 0.46 0.67 1.13 0.00 0.00 0.00 0.00 0.00 0.05 0.03 0.08 1.55 0.91 0.51 0.13 0.30 0.46 0.00 0.00 0.00 0.08 2.26 2.34 0.20 5.37 5.57 0.14 3.37 3.51 0.37 6.39 6.76 0.23 4.02 4.25 0.40 4.51 4.91 0.46 4.71 5.17 0.46 4.58 5.04 0.08 2.61 2.69 0.15 3.89 4.04 0.17 4.63 4.80 0.20 6.60 6.80 NA 0.28 NA NA 0.06 NA NA 0.04 NA NA 0.31 NA NA 0.36 NA NA 0.40 NA NA 0.46 NA NA 0.00 0.00 0.00 0.00 0.00 0.05 NA NA NA NA NA 0.13 0.07 0.11 0.00 0.00 0.00 0.08 NA NA 0.20 NA NA 0.14 NA NA 0.37 NA NA 0.23 NA NA 0.40 NA NA 0.46 NA NA 0.46 NA NA 0.08 NA NA 0.15 NA NA 0.17 NA NA 0.20 NA NA Analyze pacemaker system ............................... Analyze pacemaker system ............................... Analyze pacemaker system ............................... Analyze pacemaker system ............................... Telephonic analy, pacemaker ............................ Telephonic analy, pacemaker ............................ Telephonic analy, pacemaker ............................ Temperature gradient studies ............................ Temperature gradient studies ............................ Temperature gradient studies ............................ Analyze ht pace device sngl .............................. Analyze ht pace device sngl .............................. Analyze ht pace device sngl .............................. Analyze ht pace device sngl .............................. Analyze ht pace device sngl .............................. Analyze ht pace device sngl .............................. Analyze ht pace device dual .............................. Analyze ht pace device dual .............................. Analyze ht pace device dual .............................. Analyze ht pace device dual .............................. Analyze ht pace device dual .............................. Analyze ht pace device dual .............................. Set-up cardiovert-defibrill ................................... Set-up cardiovert-defibrill ................................... Set-up cardiovert-defibrill ................................... Cephalic thermogram ......................................... Peripheral thermogram ....................................... Measure venous pressure .................................. Measure venous pressure .................................. Measure venous pressure .................................. Ambulatory BP monitoring ................................. Ambulatory BP recording ................................... Ambulatory BP analysis ..................................... Review/report BP recording ............................... Cardiac rehab ..................................................... Cardiac rehab/monitor ........................................ Cardiovascular procedure .................................. Cardiovascular procedure .................................. Cardiovascular procedure .................................. Extracranial study ............................................... Extracranial study ............................................... Extracranial study ............................................... Extracranial study ............................................... Extracranial study ............................................... Extracranial study ............................................... Extracranial study ............................................... Extracranial study ............................................... Extracranial study ............................................... Intracranial study ................................................ Intracranial study ................................................ Intracranial study ................................................ Intracranial study ................................................ Intracranial study ................................................ Intracranial study ................................................ Tcd, vasoreactivity study .................................... Tcd, vasoreactivity study .................................... Tcd, vasoreactivity study .................................... Tcd, emboli detect w/o inj .................................. Tcd, emboli detect w/o inj .................................. Tcd, emboli detect w/o inj .................................. Tcd, emboli detect w/inj ..................................... Tcd, emboli detect w/inj ..................................... Tcd, emboli detect w/inj ..................................... Extremity study ................................................... Extremity study ................................................... Extremity study ................................................... Extremity study ................................................... Extremity study ................................................... Extremity study ................................................... Extremity study ................................................... Extremity study ................................................... Extremity study ................................................... Lower extremity study ........................................ Lower extremity study ........................................ Lower extremity study ........................................ Malpractice RVUs 0.03 0.02 0.04 0.06 0.01 0.06 0.07 0.01 0.01 0.02 0.03 0.04 0.07 0.03 0.04 0.07 0.03 0.04 0.07 0.04 0.04 0.08 0.00 0.00 0.00 0.00 0.00 0.01 0.01 0.02 0.03 0.01 0.01 0.01 0.01 0.01 0.00 0.00 0.00 0.01 0.11 0.12 0.04 0.35 0.39 0.04 0.22 0.26 0.06 0.39 0.45 0.05 0.27 0.32 0.06 0.39 0.45 0.06 0.39 0.45 0.06 0.39 0.45 0.02 0.13 0.15 0.04 0.22 0.26 0.05 0.25 0.30 0.04 0.35 0.39 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00336 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.91 1.04 0.48 1.52 0.22 0.69 0.91 0.21 0.16 0.37 1.14 0.71 1.85 1.30 0.71 2.01 1.46 0.77 2.23 1.68 0.71 2.39 0.00 0.00 0.00 0.00 0.00 0.22 0.04 0.26 1.96 0.92 0.52 0.52 0.49 0.75 0.00 0.00 0.00 0.31 2.37 2.68 0.84 5.72 6.56 0.58 3.59 4.17 1.37 6.78 8.15 0.90 4.29 5.19 1.46 4.90 6.36 1.67 5.10 6.77 1.67 4.97 6.64 0.35 2.74 3.09 0.64 4.11 4.75 0.72 4.88 5.60 0.82 6.95 7.77 Facility Total NA 1.04 NA NA 0.22 NA NA 0.21 NA NA 1.14 NA NA 1.30 NA NA 1.46 NA NA 1.68 NA NA 0.00 0.00 0.00 0.00 0.00 0.22 NA NA NA NA NA 0.52 0.26 0.40 0.00 0.00 0.00 0.31 NA NA 0.84 NA NA 0.58 NA NA 1.37 NA NA 0.90 NA NA 1.46 NA NA 1.67 NA NA 1.67 NA NA 0.35 NA NA 0.64 NA NA 0.72 NA NA 0.82 NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 000 000 XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70451 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 93926 93926 93926 93930 93930 93930 93931 93931 93931 93965 93965 93965 93970 93970 93970 93971 93971 93971 93975 93975 93975 93976 93976 93976 93978 93978 93978 93979 93979 93979 93980 93980 93980 93981 93981 93981 93990 93990 93990 94010 94010 94010 94014 94015 94016 94060 94060 94060 94070 94070 94070 94150 94150 94150 94200 94200 94200 94240 94240 94240 94250 94250 94250 94260 94260 94260 94350 94350 94350 94360 94360 94360 94370 94370 94370 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A B B B A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.39 0.00 0.39 0.46 0.00 0.46 0.31 0.00 0.31 0.35 0.00 0.35 0.68 0.00 0.68 0.45 0.00 0.45 1.80 0.00 1.80 1.21 0.00 1.21 0.65 0.00 0.65 0.44 0.00 0.44 1.25 0.00 1.25 0.44 0.00 0.44 0.25 0.00 0.25 0.17 0.00 0.17 0.52 0.00 0.52 0.31 0.00 0.31 0.60 0.00 0.60 +0.07 +0.00 +0.07 0.11 0.00 0.11 0.26 0.00 0.26 0.11 0.00 0.11 0.13 0.00 0.13 0.26 0.00 0.26 0.26 0.00 0.26 0.26 0.00 0.26 0.13 3.93 4.06 0.16 5.21 5.37 0.10 3.39 3.49 0.12 2.68 2.80 0.23 5.03 5.26 0.15 3.45 3.60 0.60 7.05 7.65 0.40 3.94 4.34 0.22 4.30 4.52 0.15 3.07 3.22 0.41 2.45 2.86 0.14 2.74 2.88 0.09 3.91 4.00 0.05 0.62 0.67 0.76 0.59 0.17 0.09 0.98 1.07 0.18 0.64 0.82 0.03 0.44 0.47 0.03 0.41 0.44 0.08 0.58 0.66 0.03 0.61 0.64 0.04 0.54 0.58 0.08 0.68 0.76 0.08 0.62 0.70 0.08 0.64 0.72 0.13 NA NA 0.16 NA NA 0.10 NA NA 0.12 NA NA 0.23 NA NA 0.15 NA NA 0.60 NA NA 0.40 NA NA 0.22 NA NA 0.15 NA NA 0.41 NA NA 0.14 NA NA 0.09 NA NA 0.05 NA NA NA NA 0.17 0.09 NA NA 0.18 NA NA 0.03 NA NA 0.03 NA NA 0.08 NA NA 0.03 NA NA 0.04 NA NA 0.08 NA NA 0.08 NA NA 0.08 NA NA Lower extremity study ........................................ Lower extremity study ........................................ Lower extremity study ........................................ Upper extremity study ........................................ Upper extremity study ........................................ Upper extremity study ........................................ Upper extremity study ........................................ Upper extremity study ........................................ Upper extremity study ........................................ Extremity study ................................................... Extremity study ................................................... Extremity study ................................................... Extremity study ................................................... Extremity study ................................................... Extremity study ................................................... Extremity study ................................................... Extremity study ................................................... Extremity study ................................................... Vascular study .................................................... Vascular study .................................................... Vascular study .................................................... Vascular study .................................................... Vascular study .................................................... Vascular study .................................................... Vascular study .................................................... Vascular study .................................................... Vascular study .................................................... Vascular study .................................................... Vascular study .................................................... Vascular study .................................................... Penile vascular study ......................................... Penile vascular study ......................................... Penile vascular study ......................................... Penile vascular study ......................................... Penile vascular study ......................................... Penile vascular study ......................................... Doppler flow testing ............................................ Doppler flow testing ............................................ Doppler flow testing ............................................ Breathing capacity test ....................................... Breathing capacity test ....................................... Breathing capacity test ....................................... Patient recorded spirometry ............................... Patient recorded spirometry ............................... Review patient spirometry .................................. Evaluation of wheezing ...................................... Evaluation of wheezing ...................................... Evaluation of wheezing ...................................... Evaluation of wheezing ...................................... Evaluation of wheezing ...................................... Evaluation of wheezing ...................................... Vital capacity test ............................................... Vital capacity test ............................................... Vital capacity test ............................................... Lung function test (MBC/MVV) .......................... Lung function test (MBC/MVV) .......................... Lung function test (MBC/MVV) .......................... Residual lung capacity ....................................... Residual lung capacity ....................................... Residual lung capacity ....................................... Expired gas collection ........................................ Expired gas collection ........................................ Expired gas collection ........................................ Thoracic gas volume .......................................... Thoracic gas volume .......................................... Thoracic gas volume .......................................... Lung nitrogen washout curve ............................. Lung nitrogen washout curve ............................. Lung nitrogen washout curve ............................. Measure airflow resistance ................................ Measure airflow resistance ................................ Measure airflow resistance ................................ Breath airway closing volume ............................ Breath airway closing volume ............................ Breath airway closing volume ............................ Malpractice RVUs 0.04 0.23 0.27 0.04 0.37 0.41 0.03 0.24 0.27 0.02 0.12 0.14 0.06 0.40 0.46 0.03 0.27 0.30 0.13 0.43 0.56 0.05 0.30 0.35 0.06 0.37 0.43 0.03 0.24 0.27 0.08 0.34 0.42 0.02 0.31 0.33 0.03 0.23 0.26 0.01 0.02 0.03 0.03 0.01 0.02 0.01 0.06 0.07 0.03 0.10 0.13 0.01 0.01 0.02 0.01 0.02 0.03 0.01 0.05 0.06 0.01 0.01 0.02 0.01 0.04 0.05 0.01 0.04 0.05 0.01 0.06 0.07 0.01 0.02 0.03 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00337 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.56 4.16 4.72 0.66 5.58 6.24 0.44 3.63 4.07 0.49 2.80 3.29 0.97 5.43 6.40 0.63 3.72 4.35 2.53 7.48 10.01 1.66 4.24 5.90 0.93 4.67 5.60 0.62 3.31 3.93 1.74 2.79 4.53 0.60 3.05 3.65 0.37 4.14 4.51 0.23 0.64 0.87 1.31 0.60 0.71 0.41 1.04 1.45 0.81 0.74 1.55 0.11 0.45 0.56 0.15 0.43 0.58 0.35 0.63 0.98 0.15 0.62 0.77 0.18 0.58 0.76 0.35 0.72 1.07 0.35 0.68 1.03 0.35 0.66 1.01 Facility Total 0.56 NA NA 0.66 NA NA 0.44 NA NA 0.49 NA NA 0.97 NA NA 0.63 NA NA 2.53 NA NA 1.66 NA NA 0.93 NA NA 0.62 NA NA 1.74 NA NA 0.60 NA NA 0.37 NA NA 0.23 NA NA NA NA 0.71 0.41 NA NA 0.81 NA NA 0.11 NA NA 0.15 NA NA 0.35 NA NA 0.15 NA NA 0.18 NA NA 0.35 NA NA 0.35 NA NA 0.35 NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70452 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 94375 94375 94375 94400 94400 94400 94450 94450 94450 94452 94452 94452 94453 94453 94453 94620 94620 94620 94621 94621 94621 94640 94642 94656 94657 94660 94662 94664 94667 94668 94680 94680 94680 94681 94681 94681 94690 94690 94690 94720 94720 94720 94725 94725 94725 94750 94750 94750 94760 94761 94762 94770 94770 94770 94772 94772 94772 94799 94799 94799 95004 95010 95015 95024 95027 95028 95044 95052 95056 95060 95065 95070 95071 95075 95078 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... Status A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A T T A A A A C C C C C C A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.31 0.00 0.31 0.40 0.00 0.40 0.40 0.00 0.40 0.31 0.00 0.31 0.40 0.00 0.40 0.64 0.00 0.64 1.42 0.00 1.42 0.00 0.00 1.22 0.83 0.76 0.76 0.00 0.00 0.00 0.26 0.00 0.26 0.20 0.00 0.20 0.07 0.00 0.07 0.26 0.00 0.26 0.26 0.00 0.26 0.23 0.00 0.23 0.00 0.00 0.00 0.15 0.00 0.15 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.15 0.15 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.95 0.00 0.09 0.51 0.60 0.12 0.72 0.84 0.12 0.73 0.85 0.09 0.93 1.02 0.12 1.39 1.51 0.20 2.30 2.50 0.44 1.77 2.21 0.30 0.00 1.16 0.98 0.65 NA 0.31 0.52 0.45 0.08 1.79 1.87 0.06 2.47 2.53 0.02 1.98 2.00 0.08 0.92 1.00 0.08 2.84 2.92 0.07 1.27 1.34 0.04 0.07 0.47 0.04 0.71 0.75 0.00 0.00 0.00 0.00 0.00 0.00 0.10 0.32 0.14 0.15 0.15 0.23 0.20 0.25 0.17 0.35 0.20 2.29 2.93 0.82 0.25 0.09 NA NA 0.12 NA NA 0.12 NA NA 0.09 NA NA 0.12 NA NA 0.20 NA NA 0.44 NA NA NA 0.00 0.32 0.25 0.23 0.23 NA NA NA 0.08 NA NA 0.06 NA NA 0.02 NA NA 0.08 NA NA 0.08 NA NA 0.07 NA NA NA NA NA 0.04 NA NA 0.00 0.00 0.00 0.00 0.00 0.00 NA 0.06 0.06 NA NA NA NA NA NA NA NA NA NA 0.38 NA Respiratory flow volume loop ............................. Respiratory flow volume loop ............................. Respiratory flow volume loop ............................. CO2 breathing response curve .......................... CO2 breathing response curve .......................... CO2 breathing response curve .......................... Hypoxia response curve ..................................... Hypoxia response curve ..................................... Hypoxia response curve ..................................... Hast w/report ...................................................... Hast w/report ...................................................... Hast w/report ...................................................... Hast w/oxygen titrate .......................................... Hast w/oxygen titrate .......................................... Hast w/oxygen titrate .......................................... Pulmonary stress test/simple ............................. Pulmonary stress test/simple ............................. Pulmonary stress test/simple ............................. Pulm stress test/complex ................................... Pulm stress test/complex ................................... Pulm stress test/complex ................................... Airway inhalation treatment ................................ Aerosol inhalation treatment .............................. Initial ventilator mgmt ......................................... Continued ventilator mgmt ................................. Pos airway pressure, CPAP ............................... Neg press ventilation, cnp .................................. Evaluate pt use of inhaler .................................. Chest wall manipulation ..................................... Chest wall manipulation ..................................... Exhaled air analysis, o2 ..................................... Exhaled air analysis, o2 ..................................... Exhaled air analysis, o2 ..................................... Exhaled air analysis, o2/co2 .............................. Exhaled air analysis, o2/co2 .............................. Exhaled air analysis, o2/co2 .............................. Exhaled air analysis ........................................... Exhaled air analysis ........................................... Exhaled air analysis ........................................... Monoxide diffusing capacity ............................... Monoxide diffusing capacity ............................... Monoxide diffusing capacity ............................... Membrane diffusion capacity ............................. Membrane diffusion capacity ............................. Membrane diffusion capacity ............................. Pulmonary compliance study ............................. Pulmonary compliance study ............................. Pulmonary compliance study ............................. Measure blood oxygen level .............................. Measure blood oxygen level .............................. Measure blood oxygen level .............................. Exhaled carbon dioxide test ............................... Exhaled carbon dioxide test ............................... Exhaled carbon dioxide test ............................... Breath recording, infant ...................................... Breath recording, infant ...................................... Breath recording, infant ...................................... Pulmonary service/procedure ............................. Pulmonary service/procedure ............................. Pulmonary service/procedure ............................. Percut allergy skin tests ..................................... Percut allergy titrate test .................................... Id allergy titrate-drug/bug ................................... Id allergy test, drug/bug ..................................... Id allergy titrate-airborne .................................... Id allergy test-delayed type ................................ Allergy patch tests .............................................. Photo patch test ................................................. Photosensitivity tests .......................................... Eye allergy tests ................................................. Nose allergy test ................................................ Bronchial allergy tests ........................................ Bronchial allergy tests ........................................ Ingestion challenge test ..................................... Provocative testing ............................................. Malpractice RVUs 0.01 0.02 0.03 0.03 0.06 0.09 0.02 0.02 0.04 0.02 0.02 0.04 0.02 0.02 0.04 0.03 0.10 0.13 0.06 0.10 0.16 0.02 0.00 0.06 0.04 0.04 0.03 0.04 0.05 0.02 0.01 0.06 0.07 0.01 0.12 0.13 0.01 0.04 0.05 0.01 0.06 0.07 0.01 0.12 0.13 0.01 0.04 0.05 0.02 0.06 0.10 0.01 0.07 0.08 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.02 0.01 0.02 0.02 0.03 0.02 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00338 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.41 0.53 0.94 0.55 0.78 1.33 0.54 0.75 1.29 0.42 0.95 1.37 0.54 1.41 1.95 0.87 2.40 3.27 1.92 1.87 3.79 0.32 0.00 2.44 1.85 1.45 NA 0.35 0.57 0.47 0.35 1.85 2.20 0.27 2.59 2.86 0.10 2.02 2.12 0.35 0.98 1.33 0.35 2.96 3.31 0.31 1.31 1.62 0.06 0.13 0.57 0.20 0.78 0.98 0.00 0.00 0.00 0.00 0.00 0.00 0.11 0.48 0.30 0.16 0.16 0.24 0.21 0.26 0.18 0.37 0.21 2.31 2.95 1.80 0.27 Facility Total 0.41 NA NA 0.55 NA NA 0.54 NA NA 0.42 NA NA 0.54 NA NA 0.87 NA NA 1.92 NA NA NA 0.00 1.60 1.12 1.03 1.02 NA NA NA 0.35 NA NA 0.27 NA NA 0.10 NA NA 0.35 NA NA 0.35 NA NA 0.31 NA NA NA NA NA 0.20 NA NA 0.00 0.00 0.00 0.00 0.00 0.00 NA 0.22 0.22 NA NA NA NA NA NA NA NA NA NA 1.36 NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70453 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 95115 95117 95120 95125 95130 95131 95132 95133 95134 95144 95145 95146 95147 95148 95149 95165 95170 95180 95199 95250 95251 95805 95805 95805 95806 95806 95806 95807 95807 95807 95808 95808 95808 95810 95810 95810 95811 95811 95811 95812 95812 95812 95813 95813 95813 95816 95816 95816 95819 95819 95819 95822 95822 95822 95824 95824 95824 95827 95827 95827 95829 95829 95829 95830 95831 95832 95833 95834 95851 95852 95857 95860 95860 95860 95861 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... Status A A I I I I I I I A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C C A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.06 0.06 0.06 0.06 0.06 0.06 0.06 0.06 2.01 0.00 0.00 0.52 1.88 0.00 1.88 1.66 0.00 1.66 1.66 0.00 1.66 2.65 0.00 2.65 3.52 0.00 3.52 3.79 0.00 3.79 1.08 0.00 1.08 1.73 0.00 1.73 1.08 0.00 1.08 1.08 0.00 1.08 1.08 0.00 1.08 0.74 0.00 0.00 1.08 0.00 1.08 6.20 0.00 6.20 1.70 0.28 0.29 0.47 0.60 0.16 0.11 0.53 0.96 0.00 0.96 1.54 0.39 0.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.19 0.32 0.44 0.42 0.58 0.80 0.19 0.13 2.04 0.00 4.11 0.19 0.66 16.65 17.31 0.54 2.80 3.34 0.53 11.35 11.88 0.92 12.31 13.23 1.18 16.36 17.54 1.27 17.97 19.24 0.45 3.59 4.04 0.70 4.33 5.03 0.46 3.26 3.72 0.46 2.53 2.99 0.46 4.15 4.61 0.31 0.00 0.00 0.41 2.30 2.71 2.32 28.77 31.09 3.30 0.46 0.33 0.58 0.63 0.36 0.26 0.60 0.42 1.00 1.42 0.68 NA NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.02 0.02 0.03 0.02 0.03 0.03 0.02 0.03 0.93 0.00 NA 0.19 0.66 NA NA 0.54 NA NA 0.53 NA NA 0.92 NA NA 1.18 NA NA 1.27 NA NA 0.45 NA NA 0.70 NA NA 0.46 NA NA 0.46 NA NA 0.46 NA NA 0.31 0.00 0.00 0.41 NA NA 2.32 NA NA 0.73 0.13 0.12 0.23 0.28 0.08 0.05 0.23 0.42 NA NA 0.68 Immunotherapy, one injection ............................ Immunotherapy injections .................................. Immunotherapy, one injection ............................ Immunotherapy, many antigens ......................... Immunotherapy, insect venom ........................... Immunotherapy, insect venoms ......................... Immunotherapy, insect venoms ......................... Immunotherapy, insect venoms ......................... Immunotherapy, insect venoms ......................... Antigen therapy services .................................... Antigen therapy services .................................... Antigen therapy services .................................... Antigen therapy services .................................... Antigen therapy services .................................... Antigen therapy services .................................... Antigen therapy services .................................... Antigen therapy services .................................... Rapid desensitization ......................................... Allergy immunology services .............................. Glucose monitoring, cont ................................... Gluc monitor, cont, phys i&r ............................... Multiple sleep latency test .................................. Multiple sleep latency test .................................. Multiple sleep latency test .................................. Sleep study, unattended .................................... Sleep study, unattended .................................... Sleep study, unattended .................................... Sleep study, attended ........................................ Sleep study, attended ........................................ Sleep study, attended ........................................ Polysomnography, 1-3 ....................................... Polysomnography, 1-3 ....................................... Polysomnography, 1-3 ....................................... Polysomnography, 4 or more ............................. Polysomnography, 4 or more ............................. Polysomnography, 4 or more ............................. Polysomnography w/cpap .................................. Polysomnography w/cpap .................................. Polysomnography w/cpap .................................. Eeg, 41-60 minutes ............................................ Eeg, 41-60 minutes ............................................ Eeg, 41-60 minutes ............................................ Eeg, over 1 hour ................................................ Eeg, over 1 hour ................................................ Eeg, over 1 hour ................................................ Eeg, awake and drowsy ..................................... Eeg, awake and drowsy ..................................... Eeg, awake and drowsy ..................................... Eeg, awake and asleep ...................................... Eeg, awake and asleep ...................................... Eeg, awake and asleep ...................................... Eeg, coma or sleep only .................................... Eeg, coma or sleep only .................................... Eeg, coma or sleep only .................................... Eeg, cerebral death only .................................... Eeg, cerebral death only .................................... Eeg, cerebral death only .................................... Eeg, all night recording ...................................... Eeg, all night recording ...................................... Eeg, all night recording ...................................... Surgery electrocorticogram ................................ Surgery electrocorticogram ................................ Surgery electrocorticogram ................................ Insert electrodes for EEG ................................... Limb muscle testing, manual ............................. Hand muscle testing, manual ............................. Body muscle testing, manual ............................. Body muscle testing, manual ............................. Range of motion measurements ........................ Range of motion measurements ........................ Tensilon test ....................................................... Muscle test, one limb ......................................... Muscle test, one limb ......................................... Muscle test, one limb ......................................... Muscle test, 2 limbs ........................................... Malpractice RVUs 0.02 0.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.04 0.00 0.01 0.02 0.09 0.34 0.43 0.08 0.31 0.39 0.08 0.42 0.50 0.13 0.42 0.55 0.17 0.42 0.59 0.18 0.43 0.61 0.06 0.11 0.17 0.09 0.11 0.20 0.06 0.10 0.16 0.06 0.10 0.16 0.06 0.13 0.19 0.04 0.00 0.00 0.05 0.14 0.19 0.48 0.02 0.50 0.11 0.01 0.02 0.02 0.03 0.01 0.01 0.02 0.05 0.02 0.07 0.07 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00339 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.41 0.52 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.26 0.39 0.51 0.49 0.65 0.87 0.26 0.20 4.09 0.00 4.12 0.73 2.63 16.99 19.62 2.28 3.11 5.39 2.27 11.77 14.04 3.70 12.73 16.43 4.87 16.78 21.65 5.24 18.40 23.64 1.59 3.70 5.29 2.52 4.44 6.96 1.60 3.36 4.96 1.60 2.63 4.23 1.60 4.28 5.88 1.09 0.00 0.00 1.54 2.44 3.98 9.00 28.79 37.79 5.11 0.75 0.64 1.07 1.26 0.53 0.38 1.15 1.43 1.02 2.45 2.29 Facility Total NA NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.09 0.09 0.10 0.09 0.10 0.10 0.09 0.10 2.98 0.00 NA 0.73 2.63 NA NA 2.28 NA NA 2.27 NA NA 3.70 NA NA 4.87 NA NA 5.24 NA NA 1.59 NA NA 2.52 NA NA 1.60 NA NA 1.60 NA NA 1.60 NA NA 1.09 0.00 0.00 1.54 NA NA 9.00 NA NA 2.54 0.42 0.43 0.72 0.91 0.25 0.17 0.78 1.43 NA NA 2.29 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70454 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 95861 95861 95863 95863 95863 95864 95864 95864 95865 95865 95865 95866 95866 95866 95867 95867 95867 95868 95868 95868 95869 95869 95869 95870 95870 95870 95872 95872 95872 95873 95873 95873 95874 95874 95874 95875 95875 95875 95900 95900 95900 95903 95903 95903 95904 95904 95904 95920 95920 95920 95921 95921 95921 95922 95922 95922 95923 95923 95923 95925 95925 95925 95926 95926 95926 95927 95927 95927 95928 95928 95928 95929 95929 95929 95930 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... Status A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 1.54 1.87 0.00 1.87 1.99 0.00 1.99 1.57 0.00 1.57 1.25 0.00 1.25 0.79 0.00 0.79 1.18 0.00 1.18 0.37 0.00 0.37 0.37 0.00 0.37 1.50 0.00 1.50 0.37 0.00 0.37 0.37 0.00 0.37 1.10 0.00 1.10 0.42 0.00 0.42 0.60 0.00 0.60 0.34 0.00 0.34 2.11 0.00 2.11 0.90 0.00 0.90 0.96 0.00 0.96 0.90 0.00 0.90 0.54 0.00 0.54 0.54 0.00 0.54 0.54 0.00 0.54 1.50 0.00 1.50 1.50 0.00 1.50 0.35 0.73 1.41 0.80 0.94 1.74 0.87 1.79 2.66 0.77 0.68 1.45 0.56 0.20 0.76 0.35 0.58 0.93 0.51 0.70 1.21 0.16 0.21 0.37 0.16 0.21 0.37 0.63 0.60 1.23 0.16 0.20 0.36 0.17 0.20 0.37 0.47 0.98 1.45 0.18 1.08 1.26 0.26 0.93 1.19 0.15 0.94 1.09 0.93 1.31 2.24 0.33 0.38 0.71 0.40 0.38 0.78 0.38 1.56 1.94 0.22 0.91 1.13 0.23 0.91 1.14 0.25 0.91 1.16 0.65 2.38 3.03 0.65 2.57 3.22 0.15 NA NA 0.80 NA NA 0.87 NA NA 0.77 NA NA 0.56 NA NA 0.35 NA NA 0.51 NA NA 0.16 NA NA 0.16 NA NA 0.63 NA NA 0.16 NA NA 0.17 NA NA 0.47 NA NA 0.18 NA NA 0.26 NA NA 0.15 NA NA 0.93 NA NA 0.33 NA NA 0.40 NA NA 0.38 NA NA 0.22 NA NA 0.23 NA NA 0.25 NA NA 0.65 NA NA 0.65 NA NA 0.15 Muscle test, 2 limbs ........................................... Muscle test, 2 limbs ........................................... Muscle test, 3 limbs ........................................... Muscle test, 3 limbs ........................................... Muscle test, 3 limbs ........................................... Muscle test, 4 limbs ........................................... Muscle test, 4 limbs ........................................... Muscle test, 4 limbs ........................................... Muscle test, larynx ............................................. Muscle test, larynx ............................................. Muscle test, larynx ............................................. Muscle test, hemidiaphragm .............................. Muscle test, hemidiaphragm .............................. Muscle test, hemidiaphragm .............................. Muscle test cran nerv unilat ............................... Muscle test cran nerv unilat ............................... Muscle test cran nerv unilat ............................... Muscle test cran nerve bilat ............................... Muscle test cran nerve bilat ............................... Muscle test cran nerve bilat ............................... Muscle test, thor paraspinal ............................... Muscle test, thor paraspinal ............................... Muscle test, thor paraspinal ............................... Muscle test, nonparaspinal ................................ Muscle test, nonparaspinal ................................ Muscle test, nonparaspinal ................................ Muscle test, one fiber ......................................... Muscle test, one fiber ......................................... Muscle test, one fiber ......................................... Guide nerv destr, elec stim ................................ Guide nerv destr, elec stim ................................ Guide nerv destr, elec stim ................................ Guide nerv destr, needle emg ........................... Guide nerv destr, needle emg ........................... Guide nerv destr, needle emg ........................... Limb exercise test .............................................. Limb exercise test .............................................. Limb exercise test .............................................. Motor nerve conduction test ............................... Motor nerve conduction test ............................... Motor nerve conduction test ............................... Motor nerve conduction test ............................... Motor nerve conduction test ............................... Motor nerve conduction test ............................... Sense nerve conduction test .............................. Sense nerve conduction test .............................. Sense nerve conduction test .............................. Intraop nerve test add-on ................................... Intraop nerve test add-on ................................... Intraop nerve test add-on ................................... Autonomic nerv function test .............................. Autonomic nerv function test .............................. Autonomic nerv function test .............................. Autonomic nerv function test .............................. Autonomic nerv function test .............................. Autonomic nerv function test .............................. Autonomic nerv function test .............................. Autonomic nerv function test .............................. Autonomic nerv function test .............................. Somatosensory testing ....................................... Somatosensory testing ....................................... Somatosensory testing ....................................... Somatosensory testing ....................................... Somatosensory testing ....................................... Somatosensory testing ....................................... Somatosensory testing ....................................... Somatosensory testing ....................................... Somatosensory testing ....................................... C motor evoked, uppr limbs ............................... C motor evoked, uppr limbs ............................... C motor evoked, uppr limbs ............................... C motor evoked, lwr limbs ................................. C motor evoked, lwr limbs ................................. C motor evoked, lwr limbs ................................. Visual evoked potential test ............................... Malpractice RVUs 0.06 0.13 0.09 0.06 0.15 0.09 0.12 0.21 0.08 0.03 0.11 0.07 0.03 0.10 0.03 0.04 0.07 0.05 0.05 0.10 0.02 0.02 0.04 0.02 0.02 0.04 0.08 0.05 0.13 0.02 0.02 0.04 0.02 0.02 0.04 0.05 0.06 0.11 0.02 0.02 0.04 0.03 0.02 0.05 0.02 0.02 0.04 0.16 0.07 0.23 0.04 0.02 0.06 0.05 0.02 0.07 0.05 0.02 0.07 0.04 0.06 0.10 0.03 0.06 0.09 0.04 0.06 0.10 0.06 0.03 0.09 0.06 0.03 0.09 0.02 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00340 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.79 3.08 2.76 1.00 3.76 2.95 1.91 4.86 2.42 0.71 3.13 1.88 0.23 2.11 1.17 0.62 1.79 1.74 0.75 2.49 0.55 0.23 0.78 0.55 0.23 0.78 2.21 0.65 2.86 0.55 0.22 0.77 0.56 0.22 0.78 1.62 1.04 2.66 0.62 1.10 1.72 0.89 0.95 1.84 0.51 0.96 1.47 3.20 1.38 4.58 1.27 0.40 1.67 1.41 0.40 1.81 1.33 1.58 2.91 0.80 0.97 1.77 0.80 0.97 1.77 0.83 0.97 1.80 2.21 2.41 4.62 2.21 2.60 4.81 0.52 Facility Total NA NA 2.76 NA NA 2.95 NA NA 2.42 NA NA 1.88 NA NA 1.17 NA NA 1.74 NA NA 0.55 NA NA 0.55 NA NA 2.21 NA NA 0.55 NA NA 0.56 NA NA 1.62 NA NA 0.62 NA NA 0.89 NA NA 0.51 NA NA 3.20 NA NA 1.27 NA NA 1.41 NA NA 1.33 NA NA 0.80 NA NA 0.80 NA NA 0.83 NA NA 2.21 NA NA 2.21 NA NA 0.52 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70455 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 95930 95930 95933 95933 95933 95934 95934 95934 95936 95936 95936 95937 95937 95937 95950 95950 95950 95951 95951 95951 95953 95953 95953 95954 95954 95954 95955 95955 95955 95956 95956 95956 95957 95957 95957 95958 95958 95958 95961 95961 95961 95962 95962 95962 95965 95965 95965 95966 95966 95966 95967 95967 95967 95970 95971 95972 95973 95974 95975 95978 95979 95990 95991 95999 96000 96001 96002 96003 96004 96101 96102 96103 96105 96110 96111 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... Status A A A A A A A A A A A A A A A A A A C C A A A A A A A A A A A A A A A A A A A A A A A A A C C A C C A C C A A A A A A A A A A C A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.35 0.59 0.00 0.59 0.51 0.00 0.51 0.55 0.00 0.55 0.65 0.00 0.65 1.51 0.00 1.51 5.99 0.00 0.00 3.08 0.00 3.08 2.45 0.00 2.45 1.01 0.00 1.01 3.08 0.00 3.08 1.98 0.00 1.98 4.24 0.00 4.24 2.97 0.00 2.97 3.21 0.00 3.21 7.99 0.00 0.00 3.99 0.00 0.00 3.49 0.00 0.00 0.45 0.78 1.50 0.92 3.00 1.70 3.50 1.64 0.00 0.77 0.00 1.80 2.15 0.41 0.37 2.14 1.86 0.50 0.51 0.00 0.00 2.60 2.10 2.25 0.24 0.78 1.02 0.22 0.21 0.43 0.24 0.21 0.45 0.27 0.34 0.61 0.64 3.30 3.94 2.56 0.00 0.00 1.29 6.35 7.64 1.04 3.19 4.23 0.36 1.97 2.33 1.30 14.15 15.45 0.85 1.70 2.55 1.75 1.75 3.50 1.32 1.31 2.63 1.39 1.31 2.70 3.43 0.00 0.00 1.71 0.00 0.00 1.18 0.00 0.00 0.85 0.68 1.21 0.62 1.70 0.89 1.94 0.87 1.50 1.46 0.00 NA NA NA NA 0.94 0.65 0.66 0.21 1.77 0.18 1.05 NA NA 0.24 NA NA 0.22 NA NA 0.24 NA NA 0.27 NA NA 0.64 NA NA 2.56 0.00 0.00 1.29 NA NA 1.04 NA NA 0.36 NA NA 1.30 NA NA 0.85 NA NA 1.75 NA NA 1.32 NA NA 1.39 NA NA 3.43 0.00 0.00 1.71 0.00 0.00 1.18 0.00 0.00 0.14 0.22 0.49 0.34 1.30 0.73 1.30 0.69 NA 0.17 0.00 0.53 0.66 0.15 0.12 0.94 0.63 0.17 0.17 NA NA NA Visual evoked potential test ............................... Visual evoked potential test ............................... Blink reflex test ................................................... Blink reflex test ................................................... Blink reflex test ................................................... H-reflex test ........................................................ H-reflex test ........................................................ H-reflex test ........................................................ H-reflex test ........................................................ H-reflex test ........................................................ H-reflex test ........................................................ Neuromuscular junction test ............................... Neuromuscular junction test ............................... Neuromuscular junction test ............................... Ambulatory eeg monitoring ................................ Ambulatory eeg monitoring ................................ Ambulatory eeg monitoring ................................ EEG monitoring/videorecord .............................. EEG monitoring/videorecord .............................. EEG monitoring/videorecord .............................. EEG monitoring/computer .................................. EEG monitoring/computer .................................. EEG monitoring/computer .................................. EEG monitoring/giving drugs ............................. EEG monitoring/giving drugs ............................. EEG monitoring/giving drugs ............................. EEG during surgery ............................................ EEG during surgery ............................................ EEG during surgery ............................................ Eeg monitoring, cable/radio ............................... Eeg monitoring, cable/radio ............................... Eeg monitoring, cable/radio ............................... EEG digital analysis ........................................... EEG digital analysis ........................................... EEG digital analysis ........................................... EEG monitoring/function test ............................. EEG monitoring/function test ............................. EEG monitoring/function test ............................. Electrode stimulation, brain ................................ Electrode stimulation, brain ................................ Electrode stimulation, brain ................................ Electrode stim, brain add-on .............................. Electrode stim, brain add-on .............................. Electrode stim, brain add-on .............................. Meg, spontaneous .............................................. Meg, spontaneous .............................................. Meg, spontaneous .............................................. Meg, evoked, single ........................................... Meg, evoked, single ........................................... Meg, evoked, single ........................................... Meg, evoked, each add’l .................................... Meg, evoked, each add’l .................................... Meg, evoked, each add’l .................................... Analyze neurostim, no prog ............................... Analyze neurostim, simple ................................. Analyze neurostim, complex .............................. Analyze neurostim, complex .............................. Cranial neurostim, complex ................................ Cranial neurostim, complex ................................ Analyze neurostim brain/1h ................................ Analyz neurostim brain 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 ............................... Psycho testing by psych/phys ............................ Psycho testing by technician .............................. Psycho testing admin by comp .......................... Assessment of aphasia ...................................... Developmental test, lim ...................................... Developmental test, extend ................................ Malpractice RVUs 0.01 0.03 0.04 0.06 0.10 0.02 0.02 0.04 0.03 0.02 0.05 0.08 0.02 0.10 0.08 0.43 0.51 0.32 0.00 0.00 0.17 0.43 0.60 0.13 0.06 0.19 0.05 0.17 0.22 0.16 0.43 0.59 0.11 0.12 0.23 0.21 0.13 0.34 0.48 0.07 0.55 0.32 0.07 0.39 0.46 0.00 0.00 0.19 0.00 0.00 0.16 0.00 0.00 0.03 0.07 0.14 0.07 0.16 0.12 0.18 0.08 0.06 0.06 0.00 0.11 0.10 0.02 0.02 0.11 0.05 0.01 0.02 0.18 0.18 0.18 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00341 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 2.11 2.63 0.87 0.84 1.71 0.75 0.23 0.98 0.82 0.23 1.05 1.00 0.36 1.36 2.23 3.73 5.96 8.87 0.00 0.00 4.54 6.78 11.32 3.62 3.25 6.87 1.42 2.14 3.56 4.54 14.58 19.12 2.94 1.82 4.76 6.20 1.88 8.08 4.77 1.38 6.15 4.92 1.38 6.30 11.88 0.00 0.00 5.89 0.00 0.00 4.83 0.00 0.00 1.33 1.53 2.85 1.61 4.86 2.71 5.62 2.59 1.56 2.29 0.00 NA NA NA NA 3.19 2.56 1.17 0.74 1.95 0.36 3.83 Facility Total NA NA 0.87 NA NA 0.75 NA NA 0.82 NA NA 1.00 NA NA 2.23 NA NA 8.87 0.00 0.00 4.54 NA NA 3.62 NA NA 1.42 NA NA 4.54 NA NA 2.94 NA NA 6.20 NA NA 4.77 NA NA 4.92 NA NA 11.88 0.00 0.00 5.89 0.00 0.00 4.83 0.00 0.00 0.62 1.07 2.13 1.33 4.46 2.55 4.98 2.41 NA 1.00 0.00 2.44 2.91 0.58 0.51 3.19 2.54 0.68 0.70 NA NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ XXX XXX XXX ZZZ XXX ZZZ XXX ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70456 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 96116 96118 96119 96120 96150 96151 96152 96153 96154 96155 96401 96402 96405 96406 96409 96411 96413 96415 96416 96417 96420 96422 96423 96425 96440 96445 96450 96521 96522 96523 96542 96549 96567 96570 96571 96900 96902 96910 96912 96913 96920 96921 96922 96999 97001 97002 97003 97004 97005 97006 97010 97012 97014 97016 97018 97022 97024 97026 97028 97032 97033 97034 97035 97036 97039 97110 97112 97113 97116 97124 97139 97140 97150 97530 97532 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A N A A A A A A A A A A A A A A A A A A A T A C A A A A B A A A A A A C A A A A I I B A I A A A A A A A A A A A C A A A A A C A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 1.86 1.86 0.55 0.51 0.50 0.48 0.46 0.10 0.45 +0.44 0.21 0.19 0.52 0.80 0.24 0.20 0.28 0.19 0.21 0.21 0.17 0.17 0.17 0.17 2.37 2.20 1.53 0.21 0.21 0.04 0.75 0.00 0.00 1.10 0.55 0.00 +0.41 0.00 0.00 0.00 1.15 1.17 2.10 0.00 1.20 0.60 1.20 0.60 0.00 0.00 +0.06 0.25 +0.18 0.18 0.06 0.17 0.06 0.06 0.08 0.25 0.26 0.21 0.21 0.28 0.00 0.45 0.45 0.44 0.40 0.35 0.00 0.43 0.27 0.44 0.44 0.83 1.39 1.02 0.74 0.18 0.18 0.17 0.04 0.17 0.18 1.53 0.74 2.78 3.08 2.93 1.61 4.20 0.77 4.61 1.95 2.66 4.84 1.89 4.48 8.04 8.05 6.96 3.77 2.65 0.69 4.24 0.00 1.96 NA NA 0.44 0.18 0.99 1.26 1.68 2.54 2.61 3.49 0.00 0.75 0.44 0.88 0.67 0.00 0.00 0.05 0.13 0.19 0.18 0.10 0.21 0.07 0.06 0.07 0.16 0.27 0.15 0.10 0.32 0.00 0.27 0.31 0.39 0.24 0.23 0.00 0.25 0.18 0.32 0.20 0.64 0.63 0.19 0.17 0.18 0.17 0.16 0.03 0.16 0.17 1.53 0.74 0.24 0.29 2.93 1.61 4.20 0.77 4.61 1.95 NA NA NA NA 1.23 1.18 1.29 3.77 2.65 0.69 0.66 0.00 NA 0.37 0.19 NA 0.16 NA NA NA 0.56 0.57 0.62 0.00 0.45 0.23 0.40 0.19 0.00 0.00 NA NA 0.19 NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA 0.00 NA NA NA NA Neurobehavioral status exam ............................ Neuropsych tst by psych/phys ........................... Neuropsych testing by tech ................................ Neuropsych tst admin w/comp ........................... Assess hlth/behave, init ..................................... Assess hlth/behave, subseq .............................. Intervene hlth/behave, indiv ............................... Intervene hlth/behave, group ............................. Interv hlth/behav, fam w/pt ................................. Interv hlth/behav fam no pt ................................ Chemo, anti-neopl, sq/im ................................... Chemo hormon antineopl sq/im ......................... Chemo intralesional, up to 7 .............................. Chemo intralesional over 7 ................................ Chemo, iv push, sngl drug ................................. Chemo, iv push, addl drug ................................. Chemo, iv infusion, 1 hr ..................................... Chemo, iv infusion, addl hr ................................ Chemo prolong infuse w/pump .......................... Chemo iv infus each addl seq ........................... Chemo, ia, push tecnique .................................. Chemo ia infusion up to 1 hr ............................. Chemo ia infuse each addl hr ............................ Chemotherapy,infusion method ......................... Chemotherapy, intracavitary .............................. Chemotherapy, intracavitary .............................. Chemotherapy, into CNS ................................... Refill/maint, portable pump ................................ Refill/maint pump/resvr syst ............................... Irrig drug delivery device .................................... Chemotherapy injection ...................................... Chemotherapy, unspecified ................................ Photodynamic tx, skin ........................................ Photodynamic tx, 30 min .................................... Photodynamic tx, addl 15 min ............................ Ultraviolet light therapy ....................................... Trichogram ......................................................... Photochemotherapy with UV-B .......................... Photochemotherapy with UV-A .......................... Photochemotherapy, UV-A or B ......................... Laser tx, skin < 250 sq cm ................................. Laser tx, skin 250-500 sq cm ............................. Laser tx, skin > 500 sq cm ................................. Dermatological procedure .................................. Pt evaluation ....................................................... Pt re-evaluation .................................................. Ot evaluation ...................................................... Ot re-evaluation .................................................. Athletic train eval ................................................ Athletic train reeval ............................................. Hot or cold packs therapy .................................. Mechanical traction therapy ............................... Electric stimulation therapy ................................ Vasopneumatic device therapy .......................... Paraffin bath therapy .......................................... Whirlpool therapy ............................................... Diathermy eg, microwave ................................... 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 ........................... Therapeutic activities .......................................... Cognitive skills development .............................. Malpractice RVUs 0.18 0.18 0.18 0.02 0.01 0.01 0.01 0.01 0.01 0.02 0.01 0.01 0.03 0.03 0.06 0.06 0.08 0.07 0.08 0.07 0.08 0.08 0.02 0.08 0.17 0.14 0.09 0.06 0.06 0.01 0.07 0.00 0.04 0.11 0.03 0.02 0.01 0.04 0.05 0.10 0.02 0.03 0.04 0.00 0.05 0.02 0.06 0.02 0.00 0.00 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.00 0.02 0.01 0.01 0.01 0.01 0.00 0.01 0.01 0.01 0.01 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00342 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 2.87 3.43 1.75 1.27 0.69 0.67 0.64 0.15 0.63 0.64 1.75 0.94 3.33 3.91 3.23 1.87 4.56 1.03 4.90 2.23 2.91 5.09 2.08 4.73 10.58 10.39 8.58 4.04 2.92 0.74 5.06 0.00 2.00 NA NA 0.46 0.60 1.03 1.31 1.78 3.71 3.81 5.63 0.00 2.00 1.06 2.14 1.29 0.00 0.00 0.12 0.39 0.38 0.37 0.17 0.39 0.14 0.13 0.16 0.42 0.54 0.37 0.32 0.61 0.00 0.74 0.77 0.84 0.65 0.59 0.00 0.69 0.46 0.77 0.65 Facility Total 2.68 2.67 0.92 0.70 0.69 0.66 0.63 0.14 0.62 0.63 1.75 0.94 0.79 1.12 3.23 1.87 4.56 1.03 4.90 2.23 NA NA NA NA 3.77 3.52 2.91 4.04 2.92 0.74 1.48 0.00 NA 1.58 0.77 NA 0.58 NA NA NA 1.73 1.77 2.76 0.00 1.70 0.85 1.66 0.81 0.00 0.00 NA NA 0.38 NA NA NA NA NA NA NA NA NA NA NA 0.00 NA NA NA NA NA 0.00 NA NA NA NA Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 000 000 XXX ZZZ XXX ZZZ XXX ZZZ XXX XXX ZZZ XXX 000 000 000 XXX XXX XXX XXX XXX XXX ZZZ ZZZ XXX XXX XXX XXX XXX 000 000 000 XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70457 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 97533 97535 97537 97542 97545 97546 97597 97598 97602 97605 97606 97750 97755 97760 97761 97762 97799 97802 97803 97804 97810 97811 97813 97814 98925 98926 98927 98928 98929 98940 98941 98942 98943 98960 98961 98962 99000 99001 99002 99024 99026 99027 99050 99051 99053 99056 99058 99060 99070 99071 99075 99078 99080 99082 99090 99091 99100 99116 99135 99140 99143 99144 99145 99148 99149 99150 99170 99172 99173 99175 99183 99185 99186 99190 99191 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A R R A A B A A A A A A A C A A A N N N N A A A A A A A A N N N N B B B B N N B B B B B B B B N B B C B B B B B B C C C C C C A N N A A A A X X .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.44 0.45 0.45 0.45 0.00 0.00 0.58 0.80 0.00 0.55 0.60 0.45 0.62 0.45 0.45 0.25 0.00 0.00 0.00 0.00 +0.60 +0.50 +0.65 +0.55 0.45 0.65 0.87 1.03 1.19 0.45 0.65 0.87 +0.40 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.75 0.00 0.00 0.00 2.34 0.00 0.00 0.00 0.00 0.24 0.33 0.26 0.28 0.00 0.00 0.66 0.79 0.00 0.34 0.90 0.32 0.28 0.34 0.28 0.42 0.00 0.47 0.47 0.18 0.38 0.25 0.40 0.30 0.32 0.41 0.50 0.59 0.67 0.23 0.30 0.36 0.24 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.77 0.00 0.00 1.39 3.25 0.64 1.79 0.00 0.00 NA NA NA NA 0.00 0.00 NA NA 0.00 0.22 0.41 NA NA 0.20 0.19 0.19 0.00 NA NA NA 0.23 0.19 0.25 0.21 0.14 0.25 0.29 0.34 0.37 0.12 0.17 0.23 0.16 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.55 0.00 0.00 NA 0.72 NA NA 0.00 0.00 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 ............................ Physical performance test .................................. Assistive technology assess .............................. Orthotic mgmt and training ................................. Prosthetic training ............................................... C/o for orthotic/prosth use .................................. 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 ................................... Self-mgmt educ & train, 1 pt .............................. Self-mgmt educ/train, 2-4 pt ............................... Self-mgmt educ/train, 5-8 pt ............................... Specimen handling ............................................. Specimen handling ............................................. Device handling .................................................. Postop follow-up visit ......................................... In-hospital on call service ................................... Out-of-hosp on call service ................................ Medical services after hrs .................................. Med serv, eve/wkend/holiday ............................. Med serv 10pm-8am, 24 hr fac .......................... Med service out of office .................................... Office emergency care ....................................... Out of office emerg med serv ............................ 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 ....................................... Mod cs by same phys, < 5 yrs ........................... Mod cs by same phys, 5 yrs + ........................... Mod cs by same phys add-on ............................ Mod cs diff phys < 5 yrs ..................................... Mod cs diff phys 5 yrs + ..................................... Mod cs diff phys add-on ..................................... 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 ....................................... Malpractice RVUs 0.01 0.01 0.01 0.01 0.00 0.00 0.05 0.05 0.00 0.02 0.03 0.02 0.02 0.03 0.02 0.02 0.00 0.01 0.01 0.01 0.03 0.03 0.03 0.03 0.02 0.03 0.03 0.04 0.05 0.01 0.01 0.02 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.08 0.00 0.00 0.10 0.16 0.04 0.45 0.00 0.00 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00343 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.69 0.79 0.72 0.74 0.00 0.00 1.29 1.64 0.00 0.91 1.53 0.79 0.92 0.82 0.75 0.69 0.00 0.48 0.48 0.19 1.01 0.78 1.08 0.88 0.79 1.09 1.40 1.66 1.91 0.69 0.96 1.25 0.65 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.60 0.00 0.00 1.49 5.75 0.68 2.24 0.00 0.00 Facility Total NA NA NA NA 0.00 0.00 NA NA 0.00 0.79 1.04 NA NA 0.68 0.66 0.46 0.00 NA NA NA 0.86 0.72 0.93 0.79 0.61 0.93 1.19 1.41 1.61 0.58 0.83 1.12 0.57 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.38 0.00 0.00 NA 3.22 NA NA 0.00 0.00 Global XXX XXX XXX XXX XXX ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ XXX ZZZ 000 000 000 000 000 000 000 000 XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ ZZZ XXX XXX ZZZ XXX XXX ZZZ 000 XXX XXX XXX XXX XXX XXX XXX XXX 70458 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 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 99253 99254 99255 99281 99282 99283 99284 99285 99288 99289 99290 99291 99292 99293 99294 99295 99296 99298 99299 99300 99304 99305 99306 99307 99308 99309 99310 99315 99316 99318 99324 99325 99326 99327 99328 99334 99335 99336 99337 99339 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... X A C A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A B A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A B .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.00 0.00 0.45 0.88 1.34 2.00 2.67 0.17 0.45 0.67 1.10 1.77 1.28 1.28 2.14 2.99 1.28 2.14 2.99 0.64 1.06 1.51 2.56 3.41 4.26 1.28 1.75 0.64 1.29 1.72 2.58 3.42 0.66 1.32 1.82 2.64 3.64 0.33 0.55 1.24 1.95 3.06 0.00 4.79 2.40 3.99 2.00 15.98 7.99 18.46 7.99 2.75 2.50 2.40 1.20 1.61 2.01 0.60 1.00 1.42 1.77 1.13 1.50 1.20 1.01 1.52 2.27 3.03 3.78 0.76 1.26 2.02 3.03 0.00 0.00 0.44 0.00 0.49 0.79 1.13 1.50 1.78 0.39 0.54 0.69 1.03 1.32 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 0.64 1.04 1.39 1.83 2.28 NA NA NA NA NA NA NA NA NA NA 0.00 NA NA 2.58 0.90 NA NA NA NA NA NA NA 0.49 0.63 0.75 0.27 0.45 0.62 0.78 0.45 0.59 0.49 0.49 0.68 0.92 1.17 1.42 0.40 0.58 0.82 1.15 0.00 0.00 NA 0.00 0.15 0.31 0.48 0.71 0.95 0.06 0.16 0.24 0.41 0.65 0.53 0.44 0.72 1.03 0.45 0.74 1.03 0.23 0.37 0.52 0.89 1.15 1.44 0.54 0.73 0.22 0.46 0.63 0.92 1.24 0.24 0.50 0.68 0.98 1.35 0.09 0.14 0.31 0.47 0.72 0.00 1.45 0.81 1.28 0.64 4.76 2.41 5.39 2.55 0.93 0.86 0.84 0.49 0.63 0.75 0.27 0.45 0.62 0.78 0.45 0.59 0.49 0.38 0.55 0.78 1.05 1.31 0.26 0.43 0.66 0.98 0.00 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 ........................................ Initial inpatient consult ........................................ Initial inpatient consult ........................................ Initial inpatient consult ........................................ Emergency dept visit .......................................... Emergency dept visit .......................................... Emergency dept visit .......................................... Emergency dept visit .......................................... Emergency dept visit .......................................... Direct advanced life support .............................. Ped crit care transport ........................................ Ped crit care transport addl ................................ Critical care, first hour ........................................ Critical care, add’l 30 min .................................. Ped critical care, initial ....................................... Ped critical care, subseq .................................... Neonate crit care, initial ..................................... Neonate critical care subseq .............................. Ic for lbw infant < 1500 gm ................................ Ic, lbw infant 1500-2500 gm ............................... Ic, infant pbw 2501-5000 gm ............................. Nursing facility care, init ..................................... Nursing facility care, init ..................................... Nursing facility care, init ..................................... Nursing fac care, subseq ................................... Nursing fac care, subseq ................................... Nursing fac care, subseq ................................... Nursing fac care, subseq ................................... Nursing fac discharge day ................................. Nursing fac discharge day ................................. Annual nursing fac assessmnt ........................... Domicil/r-home visit new pat .............................. Domicil/r-home visit new pat .............................. Domicil/r-home visit new pat .............................. Domicil/r-home visit new pat .............................. Domicil/r-home visit new pat .............................. Domicil/r-home visit est pat ................................ Domicil/r-home visit est pat ................................ Domicil/r-home visit est pat ................................ Domicil/r-home visit est pat ................................ Domicil/r-home care supervis ............................. Malpractice RVUs 0.00 0.02 0.00 0.03 0.05 0.09 0.12 0.15 0.01 0.03 0.03 0.05 0.08 0.06 0.06 0.10 0.14 0.07 0.10 0.13 0.03 0.04 0.06 0.13 0.16 0.19 0.05 0.07 0.05 0.10 0.13 0.16 0.21 0.05 0.09 0.11 0.13 0.18 0.02 0.04 0.09 0.14 0.23 0.00 0.24 0.12 0.21 0.11 1.12 0.45 1.16 0.32 0.17 0.16 2.40 0.05 0.07 0.09 0.03 0.04 0.06 0.08 0.05 0.06 0.05 0.05 0.07 0.10 0.13 0.16 0.04 0.06 0.09 0.13 0.00 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00344 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.00 0.46 0.00 0.97 1.72 2.56 3.62 4.60 0.57 1.02 1.39 2.18 3.17 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 1.33 2.43 3.24 4.57 5.91 NA NA NA NA NA NA NA NA NA NA 0.00 NA NA 6.78 3.01 NA NA NA NA NA NA NA 1.74 2.31 2.85 0.90 1.49 2.10 2.63 1.63 2.15 1.74 1.55 2.27 3.29 4.33 5.36 1.20 1.90 2.93 4.31 0.00 Facility Total 0.00 NA 0.00 0.63 1.24 1.91 2.83 3.77 0.24 0.64 0.94 1.56 2.50 1.87 1.78 2.96 4.16 1.80 2.98 4.15 0.90 1.47 2.09 3.58 4.72 5.89 1.87 2.55 0.91 1.85 2.48 3.66 4.87 0.95 1.91 2.61 3.75 5.17 0.44 0.73 1.64 2.56 4.01 0.00 6.48 3.33 5.48 2.75 21.86 10.85 25.01 10.86 3.85 3.52 5.64 1.74 2.31 2.85 0.90 1.49 2.10 2.63 1.63 2.15 1.74 1.44 2.14 3.15 4.21 5.25 1.06 1.75 2.77 4.14 0.00 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ XXX ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70459 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status 99340 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 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 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... I A A A A A A A A A A A A A B B X B B B B B B I B I B B N N N N N N N N N N N N N N N N N N N N N N A A A A A A N R R C I I I I I I I I I I I I I I I .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 1.01 1.52 2.27 3.03 3.78 0.76 1.26 2.02 3.03 1.77 1.77 1.71 1.71 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 +1.10 +1.73 +1.10 +1.73 +1.10 +1.73 +1.19 +1.36 +1.36 +1.53 +1.53 +1.88 +2.06 +1.02 +1.19 +1.19 +1.36 +1.36 +1.53 +1.71 +0.48 +0.98 +1.46 +1.95 +0.15 +0.25 0.00 0.00 1.17 1.26 0.62 1.50 1.50 2.93 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.48 0.68 0.94 1.18 1.43 0.40 0.58 0.83 1.18 0.77 0.75 NA NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.70 1.55 0.70 1.95 0.70 0.99 1.50 1.54 1.48 1.55 1.55 1.75 1.88 1.02 1.09 1.06 1.13 1.16 1.25 1.36 0.62 0.87 1.09 1.32 0.18 0.25 0.00 0.00 NA 0.93 NA NA NA NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NA NA NA NA NA NA NA NA NA 0.66 0.62 0.62 0.63 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.42 1.55 0.42 1.95 0.42 0.66 0.45 0.52 0.52 0.59 0.59 0.72 0.79 0.39 0.45 0.45 0.52 0.52 0.59 0.66 0.19 0.37 0.56 0.75 0.06 0.10 0.00 0.00 0.38 0.40 0.20 0.59 0.47 0.93 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Domicil/r-home care supervis ............................. 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 ................................... 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 add’l hr ............................. Malpractice RVUs 0.00 0.05 0.07 0.10 0.13 0.16 0.04 0.06 0.09 0.13 0.08 0.07 0.07 0.08 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.05 0.07 0.05 0.07 0.04 0.06 0.05 0.05 0.05 0.06 0.06 0.07 0.07 0.04 0.05 0.05 0.05 0.05 0.06 0.06 0.01 0.02 0.04 0.05 0.01 0.01 0.00 0.00 0.05 0.07 0.02 0.06 0.06 0.12 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00345 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.00 1.54 2.27 3.31 4.34 5.37 1.20 1.90 2.94 4.34 2.62 2.59 NA NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.85 3.35 1.85 3.75 1.84 2.78 2.74 2.95 2.89 3.14 3.14 3.70 4.01 2.08 2.33 2.30 2.54 2.57 2.84 3.13 1.11 1.87 2.59 3.32 0.34 0.51 0.00 0.00 NA 2.26 NA NA NA NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Facility Total 0.00 NA NA NA NA NA NA NA NA NA 2.51 2.46 2.40 2.42 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.57 3.35 1.57 3.75 1.56 2.45 1.69 1.93 1.93 2.18 2.18 2.67 2.92 1.45 1.69 1.69 1.93 1.93 2.18 2.43 0.68 1.37 2.06 2.75 0.22 0.36 0.00 0.00 1.60 1.73 0.84 2.15 2.03 3.98 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ ZZZ ZZZ ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70460 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod Status A4890 D0150 D0240 D0250 D0260 D0270 D0272 D0274 D0277 D0416 D0421 D0431 D0460 D0472 D0473 D0474 D0475 D0476 D0477 D0478 D0479 D0480 D0481 D0482 D0483 D0484 D0485 D0502 D0999 D1510 D1515 D1520 D1525 D1550 D2999 D3460 D3999 D4260 D4263 D4264 D4268 D4270 D4271 D4273 D4355 D4381 D5911 D5912 D5951 D5983 D5984 D5985 D5987 D6920 D7111 D7140 D7210 D7220 D7230 D7240 D7241 D7250 D7260 D7261 D7283 D7288 D7291 D7321 D7511 D7521 D7940 D9110 D9230 D9248 D9630 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R R .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Repair/maint cont hemo equip ........................... Comprehensve oral evaluation .......................... Intraoral occlusal film ......................................... Extraoral first film ............................................... Extraoral ea additional film ................................. Dental bitewing single film ................................. Dental bitewings two films .................................. Dental bitewings four films ................................. Vert bitewings-sev to eight ................................. Viral culture ........................................................ Gen tst suscept oral disease ............................. Diag tst detect mucos abnorm ........................... Pulp vitality test .................................................. Gross exam, prep & report ................................ Micro exam, prep & report ................................. Micro w exam of surg margins ........................... Decalcification procedure ................................... Spec stains for microorganis .............................. Spec stains not for microorg .............................. Immunohistochemical stains .............................. Tissue in-situ hybridization ................................. Cytopath smear prep & report ........................... Electron microscopy diagnost ............................ Direct immunofluorescence ................................ Indirect immunofluorescence ............................. Consult slides prep elsewher ............................. Consult inc prep of slides ................................... Other oral pathology procedu ............................ Unspecified diagnostic proce ............................. Space maintainer fxd unilat ................................ Fixed bilat space maintainer .............................. Remove unilat space maintain ........................... Remove bilat space maintain ............................. Recement space maintainer .............................. Dental unspec restorative pr .............................. Endodontic endosseous implan ......................... Endodontic procedure ........................................ Osseous surgery per quadrant .......................... Bone replce graft first site .................................. Bone replce graft each add ................................ Surgical revision procedure ................................ Pedicle soft tissue graft pr ................................. Free soft tissue graft proc .................................. Subepithelial tissue graft .................................... Full mouth debridement ..................................... Localized delivery antimicro ............................... Facial moulage sectional .................................... Facial moulage complete ................................... Feeding aid ......................................................... Radiation applicator ............................................ Radiation shield .................................................. Radiation cone locator ....................................... Commissure splint .............................................. Dental connector bar .......................................... Extraction coronal remnants .............................. Extraction erupted tooth/exr ............................... Rem imp tooth w mucoper flp ............................ Impact tooth remov soft tiss ............................... Impact tooth remov part bony ............................ Impact tooth remov comp bony ......................... Impact tooth rem bony w/comp .......................... Tooth root removal ............................................. Oral antral fistula closure ................................... Primary closure sinus perf ................................. Place device impacted tooth .............................. Brush biopsy ....................................................... Transseptal fiberotomy ....................................... Alveoloplasty not w/extracts ............................... Incision/drain abscess intra ................................ Incision/drain abscess extra ............................... Reshaping bone orthognathic ............................ Tx dental pain minor proc .................................. Analgesia ............................................................ Sedation (non-iv) ................................................ Other drugs/medicaments .................................. Malpractice RVUs 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00346 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Facility Total 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Global XXX YYY YYY YYY YYY YYY YYY YYY XXX XXX XXX XXX YYY XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX YYY YYY YYY YYY YYY YYY YYY YYY YYY YYY YYY YYY YYY XXX YYY YYY YYY YYY YYY YYY YYY YYY YYY YYY YYY YYY YYY XXX XXX YYY YYY YYY YYY YYY YYY YYY XXX XXX XXX YYY XXX XXX XXX YYY YYY YYY XXX YYY Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70461 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod D9930 .... D9940 .... D9950 .... D9951 .... D9952 .... G0008 ... G0009 ... G0010 ... G0027 ... G0101 ... G0102 ... G0103 ... G0104 ... G0105 ... G0105 ... G0106 ... G0106 ... G0106 ... G0107 ... G0108 ... G0109 ... G0117 ... G0118 ... G0120 ... G0120 ... G0120 ... G0121 ... G0121 ... G0122 ... G0122 ... G0122 ... G0123 ... G0124 ... G0127 ... G0128 ... G0130 ... G0130 ... G0130 ... G0141 ... G0143 ... G0144 ... G0145 ... G0147 ... G0148 ... G0166 ... G0168 ... G0173 ... G0175 ... G0176 ... G0177 ... G0179 ... G0180 ... G0181 ... G0182 ... G0186 ... G0202 ... G0202 ... G0202 ... G0204 ... G0204 ... G0204 ... G0206 ... G0206 ... G0206 ... G0219 ... G0219 ... G0219 ... G0235 ... G0235 ... G0235 ... G0237 ... G0238 ... G0239 ... G0243 ... G0245 ... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 53 ..... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 53 ..... .......... 26 ..... TC .... .......... .......... .......... .......... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... Status R R R R R X X X X A A X A A A A A A X A A T T A A A A A N N N X A R R A A A A X X X X X A A X X X X A A A A C A A A A A A A A A N N N N N N A A A X R Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.45 0.17 0.00 0.96 0.96 3.69 0.99 0.00 0.99 0.00 0.00 0.00 0.45 0.17 0.99 0.00 0.99 0.96 3.69 +0.99 +0.00 +0.99 0.00 0.42 0.17 0.08 0.22 0.00 0.22 0.42 0.00 0.00 0.00 0.00 0.00 0.07 0.45 0.00 0.00 0.00 0.00 0.45 0.67 1.73 1.73 0.00 0.70 0.00 0.70 0.87 0.00 0.87 0.70 0.00 0.70 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.88 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.52 0.39 0.00 2.28 2.28 6.16 0.32 2.24 2.56 0.00 0.83 0.48 0.72 0.53 0.32 2.24 2.56 2.28 6.16 0.38 2.20 2.58 0.00 0.15 0.25 0.03 0.07 0.80 0.87 0.15 0.00 0.00 0.00 0.00 0.00 3.58 1.94 0.00 0.00 0.00 0.00 1.03 1.26 1.48 1.66 0.00 0.23 2.55 2.78 0.28 2.51 2.79 0.23 2.03 2.26 0.00 0.00 0.00 0.00 0.00 0.00 0.47 0.49 0.33 0.00 0.79 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.17 0.06 0.00 0.50 0.50 1.47 0.32 NA NA 0.00 NA NA 0.19 0.06 0.32 NA NA 0.50 1.47 0.38 2.20 2.58 0.00 0.15 0.07 0.03 0.07 NA NA 0.15 0.00 0.00 0.00 0.00 0.00 0.03 0.22 0.00 0.00 0.00 0.00 NA NA NA NA 0.00 0.23 NA NA 0.28 NA NA 0.23 NA NA 0.00 0.00 0.00 0.00 0.00 0.00 NA NA NA 0.00 0.31 Treatment of complications ................................ Dental occlusal guard ......................................... Occlusion analysis .............................................. Limited occlusal adjustment ............................... Complete occlusal adjustment ........................... Admin influenza virus vac .................................. Admin pneumococcal vaccine ............................ Admin hepatitis b vaccine .................................. Semen analysis .................................................. CA screen;pelvic/breast exam ........................... Prostate ca screening; dre ................................. Psa, total screening ............................................ CA screen;flexi sigmoidscope ............................ Colorectal scrn; hi risk ind .................................. Colorectal scrn; hi risk ind .................................. Colon CA screen;barium enema ........................ Colon CA screen;barium enema ........................ Colon CA screen;barium enema ........................ CA screen; fecal blood test ................................ Diab manage trn per indiv .................................. Diab manage trn ind/group ................................ Glaucoma scrn hgh risk direc ............................ Glaucoma scrn hgh risk direc ............................ Colon ca scrn; barium enema ............................ Colon ca scrn; barium enema ............................ Colon ca scrn; barium enema ............................ Colon ca scrn not hi rsk ind ............................... Colon ca scrn not hi rsk ind ............................... Colon ca scrn; barium enema ............................ Colon ca scrn; barium enema ............................ Colon ca scrn; barium enema ............................ Screen cerv/vag thin layer ................................. Screen c/v thin layer by MD ............................... Trim nail(s) ......................................................... CORF skilled nursing service ............................. Single energy x-ray study .................................. Single energy x-ray study .................................. Single energy x-ray study .................................. Scr c/v cyto,autosys and md .............................. 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 ................................ 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 .......................... Screeningmammographydigital .......................... Screeningmammographydigital .......................... Diagnosticmammographydigital ......................... Diagnosticmammographydigital ......................... Diagnosticmammographydigital ......................... Diagnosticmammographydigital ......................... Diagnosticmammographydigital ......................... Diagnosticmammographydigital ......................... PET img wholbod melano nonco ....................... PET img wholbod melano nonco ....................... PET img wholbod melano nonco ....................... PET not otherwise specified .............................. PET not otherwise specified .............................. PET not otherwise specified .............................. Therapeutic procd strg endur ............................. Oth resp proc, indiv ............................................ Oth resp proc, group .......................................... Multisour photon stero treat ............................... Initial foot exam pt lops ...................................... Malpractice RVUs 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.02 0.01 0.00 0.08 0.08 0.30 0.04 0.13 0.17 0.00 0.01 0.01 0.01 0.01 0.04 0.13 0.17 0.08 0.30 0.05 0.13 0.18 0.00 0.02 0.01 0.01 0.01 0.05 0.06 0.02 0.00 0.00 0.00 0.00 0.00 0.01 0.03 0.00 0.00 0.00 0.00 0.02 0.03 0.07 0.07 0.00 0.03 0.07 0.10 0.04 0.07 0.11 0.03 0.06 0.09 0.00 0.00 0.00 0.00 0.00 0.00 0.02 0.02 0.02 0.00 0.04 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00347 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.99 0.57 0.00 3.32 3.32 10.15 1.35 2.37 3.72 0.00 0.84 0.49 1.18 0.71 1.35 2.37 3.72 3.32 10.15 1.42 2.33 3.75 0.00 0.59 0.43 0.12 0.30 0.85 1.15 0.59 0.00 0.00 0.00 0.00 0.00 3.66 2.42 0.00 0.00 0.00 0.00 1.50 1.96 3.28 3.46 0.00 0.96 2.62 3.58 1.19 2.58 3.77 0.96 2.09 3.05 0.00 0.00 0.00 0.00 0.00 0.00 0.49 0.51 0.35 0.00 1.71 Facility Total 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.64 0.24 0.00 1.54 1.54 5.46 1.35 NA NA 0.00 NA NA 0.65 0.24 1.35 NA NA 1.54 5.46 1.42 2.33 3.75 0.00 0.59 0.25 0.12 0.30 NA NA 0.59 0.00 0.00 0.00 0.00 0.00 0.11 0.70 0.00 0.00 0.00 0.00 NA NA NA NA 0.00 0.96 NA NA 1.19 NA NA 0.96 NA NA 0.00 0.00 0.00 0.00 0.00 0.00 NA NA NA 0.00 1.23 Global YYY YYY YYY YYY YYY XXX XXX XXX XXX XXX XXX XXX 000 000 000 XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 000 000 XXX XXX XXX XXX XXX 000 XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 000 XXX XXX XXX XXX XXX XXX XXX XXX YYY XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 70462 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 G0246 G0247 G0248 G0249 G0250 G0251 G0255 G0255 G0255 G0257 G0259 G0260 G0265 G0266 G0267 G0268 G0269 G0270 G0271 G0275 G0278 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 G0364 G0365 G0365 G0365 G0366 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mod .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... .......... Status R R R R R E N N N E E E X X X A B A A A A A N A A A E E E E N X X X X 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 X A X C C A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.45 0.50 0.00 0.00 0.18 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.61 0.00 0.00 0.00 0.25 0.25 0.18 0.00 0.18 0.00 1.48 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.74 10.61 8.49 9.73 8.11 6.49 8.28 6.90 5.52 5.09 4.24 3.39 10.61 8.11 6.90 4.24 0.35 0.23 0.27 0.14 0.00 0.06 +1.34 0.00 0.00 6.98 11.92 19.85 1.34 0.16 0.25 0.00 0.25 0.17 0.54 0.52 6.63 3.97 0.06 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.63 0.00 0.47 0.18 NA NA 0.11 0.00 0.11 10.64 NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.56 7.12 5.70 4.73 3.93 3.15 4.43 3.68 2.95 2.87 2.39 1.91 7.12 3.93 3.68 2.39 0.24 0.12 0.13 0.08 0.00 0.14 0.51 0.00 0.00 5.75 NA NA 1.13 0.14 0.09 3.91 4.00 0.51 0.16 0.21 NA NA 0.06 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.24 0.00 NA NA 0.10 0.10 NA 0.00 NA NA 0.80 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.56 7.12 5.70 4.73 3.93 3.15 4.43 3.68 2.95 2.87 2.39 1.91 7.12 3.93 3.68 2.39 0.24 0.12 0.13 0.08 0.00 0.02 0.51 0.00 0.00 2.60 5.31 8.78 0.48 0.06 0.09 NA NA NA 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 ............................. Current percep threshold tst .............................. Current percep threshold tst .............................. Current percep threshold tst .............................. Unsched dialysis ESRD pt hos .......................... Inject for sacroiliac joint ...................................... Inj for sacroiliac jt anesth ................................... 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 ................................. Elec stim unattend for press .............................. Elect stim wound care not pd ............................ Elec stim other than wound ............................... Recon, CTA for surg plan .................................. Arthro, loose body + chondro ............................. 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 1 vst <2yrs ............................ ESRD related svs 4+mo 2-11yr ......................... ESRD relate svs 2-3 mo 2-11y .......................... ESRD related svs 1 mon 2-11y ......................... ESRD related svs 4+ mo 12-19 ......................... ESRD related svs 2-3mo/12-19 ......................... ESRD related svs 1vis/12-19y ........................... ESRD related svs 4+mo 20+yrs ........................ ESRD related svs 2-3 mo 20+y ......................... ESRD related svs 1visit 20+y ............................ ESD related svs home undr 2 ............................ ESRDrelatedsvs home mo 2-11y ....................... ESRD related svs hom mo12-19 ....................... ESRD related svs home mo 20+ ....................... ESRD relate svs home/dy <2yr .......................... ESRD relate home/day/ 2-11yr .......................... ESRD relate home/dy 12-19yr ........................... 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 transp ............................... Initial preventive exam ....................................... Bone marrow aspirate &biopsy .......................... Vessel mapping hemo access ........................... Vessel mapping hemo access ........................... Vessel mapping hemo access ........................... EKG for initial prevent exam .............................. Malpractice RVUs 0.02 0.02 0.01 0.01 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.02 0.00 0.01 0.01 0.01 0.01 0.01 0.00 0.01 0.18 0.26 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.42 0.36 0.28 0.34 0.29 0.22 0.27 0.23 0.17 0.17 0.14 0.11 0.36 0.29 0.23 0.14 0.01 0.01 0.01 0.01 0.00 0.01 0.09 0.00 0.00 0.48 1.46 2.06 0.10 0.04 0.02 0.23 0.25 0.03 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00348 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 1.01 1.04 6.64 3.98 0.25 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.26 0.00 0.48 0.19 NA NA 0.30 0.00 0.30 10.82 NA 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21.72 18.09 14.47 14.80 12.33 9.86 12.98 10.81 8.64 8.13 6.77 5.41 18.09 12.33 10.81 6.77 0.60 0.36 0.41 0.23 0.00 0.21 1.94 0.00 0.00 13.21 NA NA 2.57 0.34 0.36 4.14 4.50 0.71 Facility Total 0.63 0.73 NA NA 0.25 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.87 0.00 NA NA 0.36 0.36 NA 0.00 NA NA 2.54 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21.72 18.09 14.47 14.80 12.33 9.86 12.98 10.81 8.64 8.13 6.77 5.41 18.09 12.33 10.81 6.77 0.60 0.36 0.41 0.23 0.00 0.09 1.94 0.00 0.00 10.06 18.69 30.69 1.92 0.26 0.36 NA NA NA Global XXX ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 000 XXX XXX XXX ZZZ ZZZ XXX XXX XXX XXX ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX 000 090 090 XXX ZZZ XXX XXX XXX XXX Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70463 ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued CPT 1 HCPCS 2 Mod G0367 ... G0368 ... G0372 ... G0375 ... G0376 ... G0378 ... G0379 ... 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 ... G9043 ... G9044 ... M0064 ... P3001 .... Q0035 ... Q0035 ... Q0035 ... Q0091 ... Q0092 ... Q3001 ... Q3014 ... R0070 .... R0075 .... R0076 .... V5299 .... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... TC .... .......... .......... .......... .......... .......... .......... .......... .......... .......... 1 CPT Status A A A A A X X X X X X X X X 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 X X X X A A A A A A A C X C C B R Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.00 0.17 0.17 0.24 0.48 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.37 0.42 0.17 0.00 0.17 0.37 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.45 0.06 0.39 0.09 0.18 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.34 0.15 0.06 0.39 0.45 0.67 0.32 0.00 0.00 0.00 0.00 0.00 0.00 NA 0.06 0.06 0.09 0.17 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.12 0.15 0.06 NA NA 0.14 NA 0.00 0.00 0.00 0.00 0.00 0.00 EKG tracing for initial prev ................................. EKG interpret & report preve ............................. MD service required for PMD ............................ Smoke/tobacco counselng 3-10 ......................... Smoke/tobacco counseling >10 ......................... Hospital observation per hr ................................ Direct admit hospital observ ............................... 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 100mg oral ............................. Zanamivir,inhalation pwd 10m ........................... Oseltamivir phosphate 75mg ............................. Rimantadine HCL 100mg oral ............................ 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 rehab occupationa ............................ Low vision rehab orient/mobi ............................. Low vision lowvision therapi ............................... Low vision rehabilate teache .............................. Visit for drug monitoring ..................................... Screening pap smear by phys ........................... Cardiokymography ............................................. Cardiokymography ............................................. Cardiokymography ............................................. Obtaining screen pap smear .............................. Set up port xray equipment ................................ Brachytherapy Radioelements ........................... Telehealth facility fee ......................................... Transport portable x-ray ..................................... Transport port x-ray multipl ................................ Transport portable EKG ..................................... Hearing service .................................................. Malpractice RVUs 0.02 0.01 0.01 0.01 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.02 0.01 0.02 0.03 0.02 0.01 0.00 0.00 0.00 0.00 0.00 0.00 NonFacility Total 0.47 0.24 0.57 0.34 0.67 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.72 0.59 0.24 0.41 0.65 1.06 0.33 0.00 0.00 0.00 0.00 0.00 0.00 Facility Total NA 0.24 0.24 0.34 0.66 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50 0.59 0.24 NA NA 0.53 NA 0.00 0.00 0.00 0.00 0.00 0.00 Global XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates ADDENDUM C.—CODES WITH INTERIM RVUS CPT 1 HCPCS 2 Mod Status 15040 .... 15110 .... 15111 .... .......... .......... .......... A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 2.00 9.50 1.85 4.57 10.70 1.29 1.13 7.02 0.79 Harvest cultured skin graft ................................. Epidrm autogrft trnk/arm/leg ............................... Epidrm autogrft t/a/l add-on ............................... Malpractice RVUs 0.24 1.31 0.26 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00349 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 6.81 21.51 3.40 Facility Total 3.37 17.83 2.90 Global 000 090 ZZZ 70464 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM C.—CODES WITH INTERIM RVUS—Continued CPT 1 HCPCS 2 Mod Status 15115 15116 15130 15131 15135 15136 15150 15151 15152 15155 15156 15157 15170 15171 15175 15176 15300 15301 15320 15321 15330 15331 15335 15336 15340 15341 15360 15361 15365 15366 15420 15421 15430 15431 22010 22015 22523 22524 22525 28890 32503 32504 33507 33548 33768 33880 33881 33883 33884 33886 33889 33891 33925 33926 36598 37184 37185 37186 37187 37188 37718 37722 43770 43771 43772 43773 43774 43845 43886 43887 43888 44180 44186 44187 44188 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A C A A A A A A A A A A A A A A A A A A A A T A A A A A A A A A A A A A A A A A A A A .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 9.81 2.50 7.00 1.50 10.50 1.50 8.25 2.00 2.50 9.00 2.75 3.00 5.00 1.55 7.00 2.45 3.99 1.00 4.70 1.50 3.99 1.00 4.50 1.43 3.72 0.50 3.87 1.15 4.15 1.45 4.50 1.50 5.75 0.00 11.05 10.94 8.94 8.54 4.47 3.30 30.00 34.80 30.00 37.97 8.00 33.00 28.00 20.00 8.20 17.00 15.92 20.00 29.50 42.00 0.74 8.66 3.28 4.92 8.03 5.71 6.76 7.79 16.71 19.50 15.00 19.50 15.00 31.00 4.00 3.95 5.80 14.42 9.77 15.93 17.61 9.25 1.58 9.89 1.07 9.90 0.89 8.48 1.31 1.56 7.84 1.56 1.78 3.84 0.68 5.44 1.11 3.21 0.47 3.63 0.69 3.20 0.46 3.48 0.69 4.01 0.61 4.48 0.58 4.56 0.70 4.79 1.32 6.92 0.00 NA NA NA NA NA 5.73 NA NA NA NA NA NA NA NA NA NA NA NA NA NA 2.65 71.90 22.95 49.53 70.38 62.15 NA NA NA NA NA NA NA 10.80 NA NA NA NA NA NA NA 7.37 1.12 6.36 0.64 8.15 0.67 6.46 0.85 1.06 6.98 1.24 1.35 2.37 0.62 4.01 0.99 2.24 0.40 2.54 0.59 2.23 0.40 2.45 0.57 2.76 0.20 3.09 0.46 3.20 0.58 3.80 0.62 6.63 0.00 8.91 8.85 5.92 5.71 2.28 2.09 15.11 16.72 13.68 19.35 2.67 13.51 11.99 9.21 2.58 8.25 5.19 6.98 14.70 17.73 2.65 3.36 1.11 1.66 3.15 2.37 4.07 4.42 7.73 8.61 6.44 8.61 6.58 10.80 3.14 2.78 3.77 6.25 4.80 8.29 8.87 Epidrm a-grft face/nck/hf/g ................................. Epidrm a-grft f/n/hf/g addl .................................. Derm autograft, trnk/arm/leg .............................. Derm autograft t/a/l add-on ................................ Derm autograft face/nck/hf/g .............................. Derm autograft, f/n/hf/g add ............................... Cult epiderm grft t/arm/leg ................................. Cult epiderm grft t/a/l addl .................................. Cult epiderm graft t/a/l +% ................................. Cult epiderm graft, f/n/hf/g ................................. Cult epidrm grft f/n/hfg add ................................ Cult epiderm grft f/n/hfg +% ............................... Acell graft trunk/arms/legs .................................. Acell graft t/arm/leg add-on ................................ Acellular graft, f/n/hf/g ........................................ Acell graft, f/n/hf/g add-on .................................. Apply skinallogrft, t/arm/lg .................................. Apply sknallogrft t/a/l addl .................................. Apply skin allogrft f/n/hf/g ................................... Aply sknallogrft f/n/hfg add ................................. Aply acell alogrft t/arm/leg .................................. Aply acell grft t/a/l add-on .................................. Apply acell graft, f/n/hf/g .................................... Aply acell grft f/n/hf/g add .................................. Apply cult skin substitute .................................... Apply cult skin sub add-on ................................. Apply cult derm sub, t/a/l ................................... Aply cult derm sub t/a/l add ............................... Apply cult derm sub f/n/hf/g ............................... Apply cult derm f/hf/g add .................................. Apply skin xgraft, f/n/hf/g .................................... Apply skn xgrft f/n/hf/g add ................................ Apply acellular xenograft .................................... Apply acellular xgraft add ................................... I&d, p-spine, c/t/cerv-thor ................................... I&d, p-spine, l/s/ls ............................................... Percut kyphoplasty, thor ..................................... Percut kyphoplasty, lumbar ................................ Percut kyphoplasty, add-on ................................ High energy eswt, plantar f ................................ Resect apical lung tumor ................................... Resect apical lung tum/chest ............................. Repair art, intramural ......................................... Restore/remodel, ventricle ................................. Cavopulmonary shunting .................................... Endovasc taa repr incl subcl .............................. Endovasc taa repr w/o subcl .............................. Insert endovasc prosth, taa ................................ Endovasc prosth, taa, add-on ............................ Endovasc prosth, delayed .................................. Artery transpose/endovas taa ............................ Car-car bp grft/endovas taa ............................... Rpr pul art unifocal w/o cpb ............................... Repr pul art, unifocal w/cpb ............................... Inj w/fluor, eval cv device ................................... Prim art mech thrombectomy ............................. Prim art m-thrombect add-on ............................. Sec art m-thrombect add-on .............................. Venous mech thrombectomy ............................. Venous m-thrombectomy add-on ....................... Ligate/strip short leg vein ................................... Ligate/strip long leg vein .................................... Lap, place gastr adjust band .............................. Lap, revise adjust gast band .............................. Lap, remove adjust gast band ........................... Lap, change adjust gast band ............................ Lap remov adj gast band/port ............................ Gastroplasty duodenal switch ............................ Revise gastric port, open ................................... Remove gastric port, open ................................. Change gastric port, open .................................. Lap, enterolysis .................................................. Lap, jejunostomy ................................................ Lap, ileo/jejuno-stomy ........................................ Lap, colostomy ................................................... Malpractice RVUs 1.15 0.33 0.97 0.21 1.23 0.20 1.14 0.28 0.35 1.05 0.36 0.39 0.55 0.19 0.82 0.29 0.49 0.14 0.58 0.21 0.49 0.14 0.55 0.20 0.41 0.06 0.43 0.14 0.46 0.17 0.52 0.21 0.66 0.00 1.73 1.71 1.43 1.36 0.72 0.41 4.37 5.07 4.05 5.51 1.19 2.74 2.32 2.10 0.86 1.79 2.17 2.72 4.60 6.20 0.05 0.55 0.21 0.32 0.51 0.37 0.14 0.86 2.18 2.54 1.92 2.55 1.84 4.05 0.25 0.51 0.70 1.85 1.27 1.95 2.23 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00350 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total 20.21 4.41 17.86 2.78 21.63 2.59 17.87 3.59 4.41 17.89 4.67 5.17 9.39 2.42 13.26 3.85 7.69 1.61 8.91 2.40 7.68 1.60 8.53 2.32 8.14 1.17 8.78 1.87 9.17 2.32 9.81 3.03 13.33 0.00 NA NA NA NA NA 9.44 NA NA NA NA NA NA NA NA NA NA NA NA NA NA 3.44 81.11 26.44 54.77 78.92 68.23 NA NA NA NA NA NA NA 45.85 NA NA NA NA NA NA NA Facility Total 18.33 3.95 14.33 2.35 19.88 2.37 15.85 3.13 3.91 17.03 4.35 4.74 7.92 2.36 11.83 3.73 6.72 1.54 7.82 2.30 6.71 1.54 7.50 2.20 6.89 0.76 7.39 1.75 7.81 2.20 8.82 2.33 13.04 0.00 21.69 21.50 16.29 15.61 7.47 5.80 49.48 56.59 47.73 62.83 11.86 49.25 42.31 31.31 11.64 27.04 23.28 29.70 48.80 65.93 3.44 12.57 4.60 6.90 11.69 8.45 10.97 13.07 26.62 30.65 23.36 30.66 23.42 45.85 7.39 7.24 10.27 22.52 15.84 26.17 28.71 Global 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ ZZZ 090 ZZZ ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 010 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 ZZZ 090 090 010 010 ZZZ 090 090 090 090 090 ZZZ 090 090 090 ZZZ 090 000 000 090 090 000 000 ZZZ ZZZ 000 000 090 090 090 090 090 090 090 090 090 090 090 090 090 090 090 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70465 ADDENDUM C.—CODES WITH INTERIM RVUS—Continued CPT 1 HCPCS 2 44213 44227 45395 45397 45400 45402 45499 45990 46505 46710 46712 50250 50382 50384 50387 50389 50592 51999 57295 58110 61630 61635 61640 61641 61642 64650 64653 67901 67902 75956 75957 75958 75959 76376 76377 77421 77422 77423 88333 88334 88384 88385 88386 89049 90760 90761 90765 90766 90767 90768 90772 90773 90774 90775 90779 91022 92520 92626 92627 92630 92633 95251 95865 95866 95873 95874 96101 96102 96103 96116 96118 96119 96120 96401 96402 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Mod .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... 26 ..... 26 ..... 26 ..... 26 ..... 26 ..... 26 ..... .......... .......... 26 ..... 26 ..... 26 ..... 26 ..... 26 ..... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... 26 ..... .......... .......... .......... .......... .......... .......... 26 ..... 26 ..... 26 ..... 26 ..... .......... .......... .......... .......... .......... .......... .......... .......... .......... Status A A A A A A C A A A A A A A A A A C A A N N N N N A A A A A A A A A A A A A A A C A A A A A A A A A A A A A C A A A A I I A A A A A A A A A A A A A A Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 3.50 26.50 30.50 34.00 18.06 25.04 0.00 1.80 2.86 16.00 34.00 19.97 5.50 5.00 2.00 1.10 6.75 0.00 7.45 0.77 0.00 0.00 0.00 0.00 0.00 0.70 0.88 7.39 9.35 7.00 6.00 4.00 3.50 0.20 0.79 0.39 0.00 0.00 1.20 0.59 0.00 1.50 1.88 1.40 0.17 0.09 0.21 0.18 0.19 0.17 0.17 0.17 0.18 0.10 0.00 1.44 0.75 0.00 0.00 0.00 0.00 0.52 1.57 1.25 0.37 0.37 1.86 0.50 0.51 1.86 1.86 0.55 0.51 0.21 0.19 NA NA NA NA NA NA 0.00 NA 3.05 NA NA NA 36.22 35.32 18.26 12.78 149.45 0.00 NA 0.55 0.00 0.00 0.00 0.00 0.00 0.87 0.92 NA NA 2.71 2.32 1.55 1.36 0.07 0.27 0.13 1.71 2.26 0.53 0.26 0.00 0.65 0.82 3.56 1.43 0.40 1.76 0.46 0.89 0.44 0.31 0.32 1.30 0.57 0.00 0.51 0.51 0.55 0.55 0.00 0.00 0.19 0.77 0.56 0.16 0.17 0.65 0.66 0.21 0.83 1.39 1.02 0.74 1.53 0.74 1.22 10.65 13.71 14.30 7.85 10.01 0.00 0.79 1.97 7.77 15.08 9.18 1.87 1.71 0.67 0.37 2.99 0.00 4.44 0.31 0.00 0.00 0.00 0.00 0.00 0.30 0.38 5.42 5.48 2.71 2.32 1.55 1.36 0.07 0.27 0.13 NA NA 0.53 0.26 0.00 0.65 0.82 0.27 1.43 0.40 1.76 0.46 0.89 0.44 0.31 0.32 1.30 0.57 0.00 0.51 0.39 NA NA 0.00 0.00 0.19 0.77 0.56 0.16 0.17 0.63 0.17 0.17 0.64 0.63 0.19 0.17 1.53 0.74 Lap, mobil splenic fl add-on ............................... Lap, close enterostomy ...................................... Lap, removal of rectum ...................................... Lap, remove rectum w/pouch ............................. Laparoscopic proctopexy ................................... Lap proctopexy w/sig resect .............................. Laparoscope proc, rectum ................................. Surg dx exam, anorectal .................................... Chemodenervation anal musc ........................... Repr per/vag pouch sngl proc ............................ Repr per/vag pouch dbl proc ............................. Cryoablate renal mass open .............................. Change ureter stent, percut ............................... Remove ureter stent, percut .............................. Change ext/int ureter stent ................................. Remove renal tube w/fluoro ............................... Perc rf ablate renal tumor .................................. Laparoscope proc, bladder ................................ Change vaginal graft .......................................... Bx done w/colposcopy add-on ........................... Intracranial angioplasty ...................................... Intracran angioplsty w/stent ............................... Dilate ic vasospasm, init .................................... Dilate ic vasospasm add-on ............................... Dilate ic vasospasm add-on ............................... Chemodenerv eccrine glands ............................ Chemodenerv eccrine glands ............................ Repair eyelid defect ........................................... Repair eyelid defect ........................................... Xray, endovasc thor ao repr .............................. Xray, endovasc thor ao repr .............................. Xray, place prox ext thor ao ............................... Xray, place dist ext thor ao ................................ 3d render w/o postprocess ................................. 3d rendering w/postprocess ............................... Stereoscopic x-ray guidance .............................. Neutron beam tx, simple .................................... Neutron beam tx, complex ................................. Intraop cyto path consult, 1 ................................ Intraop cyto path consult, 2 ................................ Eval molecular probes, 11-50 ............................ Eval molecul probes, 51-250 ............................. Eval molecul probes, 251-500 ........................... Chct for mal hyperthermia .................................. Hydration iv infusion, init .................................... Hydrate iv infusion, add-on ................................ Ther/proph/diag iv inf, init ................................... Ther/proph/dg iv inf, add-on ............................... Tx/proph/dg addl seq iv inf ................................. Ther/diag concurrent inf ..................................... Ther/proph/diag inj, sc/im ................................... Ther/proph/diag inj, ia ........................................ Ther/proph/diag inj, iv push ................................ Ther/proph/diag inj add-on ................................. Ther/prop/diag inj/inf proc .................................. Duodenal motility study ...................................... Laryngeal function studies ................................. Eval aud rehab status ........................................ Eval aud status rehab add-on ............................ Aud rehab pre-ling hear loss .............................. Aud rehab postling hear loss ............................. Gluc monitor, cont, phys i&r ............................... Muscle test, larynx ............................................. Muscle test, hemidiaphragm .............................. Guide nerv destr, elec stim ................................ Guide nerv destr, needle emg ........................... Psycho testing by psych/phys ............................ Psycho testing by technician .............................. Psycho testing admin by comp .......................... Neurobehavioral status exam ............................ Neuropsych tst by psych/phys ........................... Neuropsych testing by tech ................................ Neuropsych tst admin w/comp ........................... Chemo, anti-neopl, sq/im ................................... Chemo hormon antineopl sq/im ......................... Malpractice RVUs 0.44 3.37 3.62 3.66 2.02 2.81 0.00 0.17 0.14 1.38 3.66 1.39 0.34 0.31 0.12 0.07 0.43 0.00 0.91 0.09 0.00 0.00 0.00 0.00 0.00 0.06 0.08 0.54 0.60 0.69 0.59 0.39 0.34 0.02 0.08 0.02 0.13 0.13 0.04 0.02 0.00 0.06 0.08 0.06 0.07 0.04 0.07 0.04 0.04 0.04 0.01 0.02 0.04 0.04 0.00 0.07 0.03 0.06 0.06 0.00 0.00 0.02 0.08 0.07 0.02 0.02 0.05 0.01 0.02 0.18 0.18 0.18 0.02 0.01 0.01 —————————— 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00351 Fmt 4742 Sfmt 4742 E:\FR\FM\21NOR2.SGM 21NOR2 NonFacility Total NA NA NA NA NA NA 0.00 NA 6.05 NA NA NA 42.06 40.63 20.38 13.95 156.63 0.00 NA 1.41 0.00 0.00 0.00 0.00 0.00 1.63 1.88 NA NA 10.40 8.91 5.94 5.20 0.29 1.14 0.54 1.84 2.39 1.77 0.87 0.00 2.21 2.78 5.02 1.67 0.53 2.04 0.68 1.12 0.65 0.49 0.51 1.52 0.71 0.00 2.02 1.29 0.61 0.61 0.00 0.00 0.73 2.42 1.88 0.55 0.56 2.56 1.17 0.74 2.87 3.43 1.75 1.27 1.75 0.94 Facility Total 5.16 40.52 47.83 51.96 27.93 37.86 0.00 2.76 4.97 25.15 52.74 30.54 7.71 7.02 2.79 1.54 10.17 0.00 12.80 1.17 0.00 0.00 0.00 0.00 0.00 1.06 1.34 13.35 15.43 10.40 8.91 5.94 5.20 0.29 1.14 0.54 NA NA 1.77 0.87 0.00 2.21 2.78 1.73 1.67 0.53 2.04 0.68 1.12 0.65 0.49 0.51 1.52 0.71 0.00 2.02 1.17 NA NA 0.00 0.00 0.73 2.42 1.88 0.55 0.56 2.54 0.68 0.70 2.68 2.67 0.92 0.70 1.75 0.94 Global ZZZ 090 090 090 090 090 YYY 000 010 090 090 090 000 000 000 000 010 YYY 090 ZZZ 090 090 000 ZZZ ZZZ 000 000 090 090 XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ XXX ZZZ ZZZ ZZZ XXX XXX XXX ZZZ XXX 000 XXX XXX XXX XXX XXX XXX XXX XXX ZZZ ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX 70466 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM C.—CODES WITH INTERIM RVUS—Continued CPT 1 HCPCS 2 Mod Status 96409 96411 96413 96415 96416 96417 96450 96521 96522 96523 96542 97760 97761 97762 98960 98961 98962 99143 99144 99145 99148 99149 99150 99300 99304 99305 99306 99307 99308 99309 99310 99318 99324 99325 99326 99327 99328 99334 99335 99336 99337 99339 99340 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... A A A A A A A A A T A A A A N N N C C C C C C A A A A A A A A A A A A A A A A A A B I .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 1 CPT Physician work RVUs 3 Description NonFacility PE RVUs Facility PE RVUs 0.24 0.20 0.28 0.19 0.21 0.21 1.53 0.21 0.21 0.04 0.75 0.45 0.45 0.25 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.40 1.20 1.61 2.01 0.60 1.00 1.42 1.77 1.20 1.01 1.52 2.27 3.03 3.78 0.76 1.26 2.02 3.03 0.00 0.00 2.93 1.61 4.20 0.77 4.61 1.95 6.96 3.77 2.65 0.69 4.24 0.34 0.28 0.42 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NA 0.49 0.63 0.75 0.27 0.45 0.62 0.78 0.49 0.49 0.68 0.92 1.17 1.42 0.40 0.58 0.82 1.15 0.00 0.00 2.93 1.61 4.20 0.77 4.61 1.95 1.29 3.77 2.65 0.69 0.66 0.20 0.19 0.19 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.84 0.49 0.63 0.75 0.27 0.45 0.62 0.78 0.49 0.38 0.55 0.78 1.05 1.31 0.26 0.43 0.66 0.98 0.00 0.00 Chemo, iv push, sngl drug ................................. Chemo, iv push, addl drug ................................. Chemo, iv infusion, 1 hr ..................................... Chemo, iv infusion, addl hr ................................ Chemo prolong infuse w/pump .......................... Chemo iv infus each addl seq ........................... Chemotherapy, into CNS ................................... Refill/maint, portable pump ................................ Refill/maint pump/resvr syst ............................... Irrig drug delivery device .................................... Chemotherapy injection ...................................... Orthotic mgmt and training ................................. Prosthetic training ............................................... C/o for orthotic/prosth use .................................. Self-mgmt educ & train, 1 pt .............................. Self-mgmt educ/train, 2-4 pt ............................... Self-mgmt educ/train, 5-8 pt ............................... Mod cs by same phys, < 5 yrs ........................... Mod cs by same phys, 5 yrs + ........................... Mod cs by same phys add-on ............................ Mod cs diff phys < 5 yrs ..................................... Mod cs diff phys 5 yrs + ..................................... Mod cs diff phys add-on ..................................... Ic, infant pbw 2501-5000 gm ............................. Nursing facility care, init ..................................... Nursing facility care, init ..................................... Nursing facility care, init ..................................... Nursing fac care, subseq ................................... Nursing fac care, subseq ................................... Nursing fac care, subseq ................................... Nursing fac care, subseq ................................... Annual nursing fac assessmnt ........................... Domicil/r-home visit new pat .............................. Domicil/r-home visit new pat .............................. Domicil/r-home visit new pat .............................. Domicil/r-home visit new pat .............................. Domicil/r-home visit new pat .............................. Domicil/r-home visit est pat ................................ Domicil/r-home visit est pat ................................ Domicil/r-home visit est pat ................................ Domicil/r-home visit est pat ................................ Domicil/r-home care supervis ............................. Domicil/r-home care supervis ............................. Malpractice RVUs 0.06 0.06 0.08 0.07 0.08 0.07 0.09 0.06 0.06 0.01 0.07 0.03 0.02 0.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.40 0.05 0.07 0.09 0.03 0.04 0.06 0.08 0.05 0.05 0.07 0.10 0.13 0.16 0.04 0.06 0.09 0.13 0.00 0.00 NonFacility Total 3.23 1.87 4.56 1.03 4.90 2.23 8.58 4.04 2.92 0.74 5.06 0.82 0.75 0.69 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NA 1.74 2.31 2.85 0.90 1.49 2.10 2.63 1.74 1.55 2.27 3.29 4.33 5.36 1.20 1.90 2.93 4.31 0.00 0.00 Facility Total 3.23 1.87 4.56 1.03 4.90 2.23 2.91 4.04 2.92 0.74 1.48 0.68 0.66 0.46 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5.64 1.74 2.31 2.85 0.90 1.49 2.10 2.63 1.74 1.44 2.14 3.15 4.21 5.25 1.06 1.75 2.77 4.14 0.00 0.00 Global XXX ZZZ XXX ZZZ XXX ZZZ 000 XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX ZZZ XXX XXX ZZZ XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2005 American Dental Association. All rights reserved. RVUs are not used for Medicare payment. 2 Copyright 3 +Indicates ADDENDUM D.—2006 GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY Carrier 00510 00831 00832 00520 31140 31140 31140 31140 31140 31146 31146 31146 31140 31146 00824 00591 00903 00902 00590 00590 00590 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 Locality 00 01 00 13 03 05 06 07 09 17 18 26 99 99 01 00 01 01 03 04 99 ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. Work GPCI Locality Name Alabama .............................................................................................................................. Alaska .................................................................................................................................. Arizona ................................................................................................................................ Arkansas .............................................................................................................................. Marin/Napa/Solano, CA ....................................................................................................... San Francisco, CA .............................................................................................................. San Mateo, CA .................................................................................................................... Oakland/Berkley, CA ........................................................................................................... Santa Clara, CA .................................................................................................................. Ventura, CA ......................................................................................................................... Los Angeles, CA ................................................................................................................. Anaheim/Santa Ana, CA ..................................................................................................... Rest of California* ............................................................................................................... Rest of California* ............................................................................................................... Colorado .............................................................................................................................. Connecticut .......................................................................................................................... DC + MD/VA Suburbs ......................................................................................................... Delaware ............................................................................................................................. Fort Lauderdale, FL ............................................................................................................. Miami, FL ............................................................................................................................. Rest of Florida ..................................................................................................................... 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00352 Fmt 4701 Sfmt 4701 E:\FR\FM\21NOR2.SGM 21NOR2 1.000 1.017 1.000 1.000 1.035 1.060 1.073 1.054 1.083 1.028 1.041 1.034 1.007 1.007 1.000 1.038 1.048 1.012 1.000 1.000 1.000 PE GPCI 0.846 1.103 0.992 0.831 1.340 1.543 1.536 1.371 1.540 1.179 1.156 1.236 1.053 1.053 1.014 1.170 1.250 1.018 0.988 1.046 0.934 MP GPCI 0.752 1.029 1.069 0.438 0.651 0.651 0.639 0.651 0.604 0.744 0.954 0.954 0.733 0.733 0.803 0.900 0.926 0.892 1.703 2.269 1.272 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70467 ADDENDUM D.—2006 GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY—Continued Carrier 00511 00511 00833 05130 00952 00952 00952 00952 00630 00826 00650 00660 00528 00528 31142 31142 00901 00901 31143 31143 00953 00953 00954 00512 00740 00523 00523 00740 00751 00655 00834 31144 00805 00805 00521 00801 00803 00803 00803 14330 05535 00820 00883 00522 00835 00835 00865 00865 00973 00524 00880 00820 05440 00900 00900 00900 00900 00900 00900 00900 00900 00823 31145 00973 00904 00836 00836 00884 00951 00825 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... Locality 01 99 01 00 12 15 16 99 00 00 00 00 01 99 03 99 01 99 01 99 01 99 00 00 02 01 99 99 01 00 00 40 01 99 05 99 01 02 03 04 00 01 00 00 01 99 01 99 20 01 01 02 35 09 11 15 18 20 28 31 99 09 50 50 00 02 99 16 00 21 ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. Work GPCI Locality Name Atlanta, GA .......................................................................................................................... Rest of Georgia ................................................................................................................... Hawaii/Guam ....................................................................................................................... Idaho .................................................................................................................................... East St. Louis, IL ................................................................................................................. Suburban Chicago, IL ......................................................................................................... Chicago, IL .......................................................................................................................... Rest of Illinois ...................................................................................................................... Indiana ................................................................................................................................. Iowa ..................................................................................................................................... Kansas* ............................................................................................................................... Kentucky .............................................................................................................................. New Orleans, LA ................................................................................................................. Rest of Louisiana ................................................................................................................ Southern Maine ................................................................................................................... Rest of Maine ...................................................................................................................... Baltimore/Surr. Cntys, MD .................................................................................................. Rest of Maryland ................................................................................................................. Metropolitan Boston ............................................................................................................ Rest of Massachusetts ........................................................................................................ Detroit, MI ............................................................................................................................ Rest of Michigan ................................................................................................................. Minnesota ............................................................................................................................ Mississippi ........................................................................................................................... Metropolitan Kansas City, MO ............................................................................................ Metropolitan St. Louis, MO ................................................................................................. Rest of Missouri* ................................................................................................................. Rest of Missouri* ................................................................................................................. Montana ............................................................................................................................... Nebraska ............................................................................................................................. Nevada ................................................................................................................................ New Hampshire ................................................................................................................... Northern NJ ......................................................................................................................... Rest of New Jersey ............................................................................................................. New Mexico ......................................................................................................................... Rest of New York ................................................................................................................ Manhattan, NY .................................................................................................................... NYC Suburbs/Long I., NY ................................................................................................... Poughkpsie/N NYC Suburbs, NY ........................................................................................ Queens, NY ......................................................................................................................... North Carolina ..................................................................................................................... North Dakota ....................................................................................................................... Ohio ..................................................................................................................................... Oklahoma ............................................................................................................................ Portland, OR ........................................................................................................................ Rest of Oregon .................................................................................................................... Metropolitan Philadelphia, PA ............................................................................................. Rest of Pennsylvania .......................................................................................................... Puerto Rico .......................................................................................................................... Rhode Island ....................................................................................................................... South Carolina ..................................................................................................................... South Dakota ....................................................................................................................... Tennessee ........................................................................................................................... Brazoria, TX ........................................................................................................................ Dallas, TX ............................................................................................................................ Galveston, TX ...................................................................................................................... Houston, TX ........................................................................................................................ Beaumont, TX ..................................................................................................................... Fort Worth, TX ..................................................................................................................... Austin, TX ............................................................................................................................ Rest of Texas ...................................................................................................................... Utah ..................................................................................................................................... Vermont ............................................................................................................................... Virgin Islands ....................................................................................................................... Virginia ................................................................................................................................. Seattle (King Cnty), WA ...................................................................................................... Rest of Washington ............................................................................................................. West Virginia ....................................................................................................................... Wisconsin ............................................................................................................................ Wyoming .............................................................................................................................. For 2005 & 2006, if the work GPCI falls below a 1.0 index, the work GPCI equals 1.0. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00353 Fmt 4701 Sfmt 4701 E:\FR\FM\21NOR2.SGM 21NOR2 1.010 1.000 1.005 1.000 1.000 1.018 1.025 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.012 1.000 1.030 1.007 1.037 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.003 1.000 1.058 1.043 1.000 1.000 1.065 1.052 1.014 1.032 1.000 1.000 1.000 1.000 1.002 1.000 1.016 1.000 1.000 1.045 1.000 1.000 1.000 1.020 1.009 1.000 1.016 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.014 1.000 1.000 1.000 1.000 PE GPCI 1.089 0.872 1.111 0.868 0.939 1.115 1.126 0.872 0.906 0.868 0.878 0.854 0.946 0.847 1.013 0.886 1.078 0.980 1.329 1.103 1.054 0.921 1.005 0.839 0.975 0.955 0.802 0.802 0.844 0.875 1.043 1.027 1.220 1.119 0.887 0.917 1.298 1.280 1.074 1.228 0.920 0.860 0.933 0.854 1.057 0.925 1.104 0.902 0.698 0.989 0.893 0.876 0.879 0.961 1.062 0.952 1.014 0.860 0.989 1.046 0.865 0.937 0.968 1.014 0.940 1.131 0.978 0.819 0.918 0.853 MP GPCI 0.966 0.966 0.800 0.459 1.750 1.652 1.867 1.193 0.436 0.589 0.721 0.873 1.197 1.058 0.637 0.637 0.947 0.760 0.823 0.823 2.744 1.518 0.410 0.722 0.946 0.941 0.892 0.892 0.904 0.454 1.068 0.942 0.973 0.973 0.895 0.677 1.504 1.785 1.167 1.710 0.640 0.602 0.976 0.382 0.441 0.441 1.386 0.806 0.261 0.909 0.394 0.365 0.631 1.298 1.061 1.298 1.297 1.298 1.061 0.986 1.138 0.662 0.514 1.003 0.579 0.819 0.819 1.547 0.790 0.935 70468 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations * States are served by more than one carrier. ADDENDUM E.—2006 GAFS Carrier 31140 31140 31140 00803 00803 31140 31140 31143 14330 00903 00805 31146 00953 00952 00591 31146 00952 31146 00805 00865 00590 00836 00831 00803 00833 00511 31143 00901 00900 00900 00834 00590 00900 31146 31140 31144 00902 00973 00900 00835 00952 00832 00824 00900 31142 00900 00740 00953 00836 00528 00901 00590 00954 00523 00883 31145 00823 00904 00951 00952 00801 05535 00900 00865 00900 00521 00835 00511 00740 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 Locality 09 06 05 01 02 07 03 01 04 01 01 26 01 16 00 18 15 17 99 01 04 02 01 03 01 01 99 01 11 18 00 03 31 99 99 40 01 50 09 01 12 00 01 28 03 15 02 99 99 01 99 99 00 01 00 50 09 00 00 99 99 00 20 99 99 05 99 99 99 ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. 2006 GAF Locality name Santa Clara, CA ................................................................................................................................................... San Mateo, CA .................................................................................................................................................... San Francisco, CA ............................................................................................................................................... Manhattan, NY ..................................................................................................................................................... NYC Suburbs/Long I., NY ................................................................................................................................... Oakland/Berkley, CA ........................................................................................................................................... Marin/Napa/Solano, CA ....................................................................................................................................... Metropolitan Boston ............................................................................................................................................. Queens, NY ......................................................................................................................................................... DC + MD/VA Suburbs ......................................................................................................................................... Northern NJ ......................................................................................................................................................... Anaheim/Santa Ana, CA ...................................................................................................................................... Detroit, MI ............................................................................................................................................................ Chicago, IL ........................................................................................................................................................... Connecticut .......................................................................................................................................................... Los Angeles, CA .................................................................................................................................................. Suburban Chicago, IL .......................................................................................................................................... Ventura, CA ......................................................................................................................................................... Rest of New Jersey ............................................................................................................................................. Metropolitan Philadelphia, PA ............................................................................................................................. Miami, FL ............................................................................................................................................................. Seattle (King Cnty), WA ...................................................................................................................................... Alaska .................................................................................................................................................................. Poughkpsie/N NYC Suburbs, NY ........................................................................................................................ Hawaii/Guam ....................................................................................................................................................... Atlanta, GA .......................................................................................................................................................... Rest of Massachusetts ........................................................................................................................................ Baltimore/Surr. Cntys, MD ................................................................................................................................... Dallas, TX ............................................................................................................................................................ Houston, TX ......................................................................................................................................................... Nevada ................................................................................................................................................................. Fort Lauderdale, FL ............................................................................................................................................. Austin, TX ............................................................................................................................................................ Rest of California* ................................................................................................................................................ Rest of California* ................................................................................................................................................ New Hampshire ................................................................................................................................................... Delaware .............................................................................................................................................................. Virgin Islands ....................................................................................................................................................... Brazoria, TX ......................................................................................................................................................... Portland, OR ........................................................................................................................................................ East St. Louis, IL ................................................................................................................................................. Arizona ................................................................................................................................................................. Colorado .............................................................................................................................................................. Fort Worth, TX ..................................................................................................................................................... Southern Maine ................................................................................................................................................... Galveston, TX ...................................................................................................................................................... Metropolitan Kansas City, MO ............................................................................................................................. Rest of Michigan .................................................................................................................................................. Rest of Washington ............................................................................................................................................. New Orleans, LA ................................................................................................................................................. Rest of Maryland ................................................................................................................................................. Rest of Florida ..................................................................................................................................................... Minnesota ............................................................................................................................................................ Metropolitan St. Louis, MO .................................................................................................................................. Ohio ..................................................................................................................................................................... Vermont ............................................................................................................................................................... Utah ..................................................................................................................................................................... Virginia ................................................................................................................................................................. Wisconsin ............................................................................................................................................................. Rest of Illinois ...................................................................................................................................................... Rest of New York ................................................................................................................................................ North Carolina ...................................................................................................................................................... Beaumont, TX ...................................................................................................................................................... Rest of Pennsylvania ........................................................................................................................................... Rest of Texas ...................................................................................................................................................... New Mexico ......................................................................................................................................................... Rest of Oregon .................................................................................................................................................... Rest of Georgia ................................................................................................................................................... Rest of Missouri* ................................................................................................................................................. 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00354 Fmt 4701 Sfmt 4701 E:\FR\FM\21NOR2.SGM 21NOR2 1.265 1.259 1.256 1.184 1.180 1.177 1.154 1.153 1.144 1.132 1.126 1.119 1.111 1.102 1.091 1.088 1.085 1.083 1.074 1.069 1.069 1.058 1.055 1.046 1.044 1.043 1.042 1.039 1.034 1.026 1.023 1.022 1.020 1.017 1.017 1.010 1.010 1.007 1.005 1.005 1.003 0.999 0.999 0.998 0.992 0.991 0.987 0.986 0.984 0.984 0.982 0.982 0.980 0.978 0.970 0.968 0.960 0.958 0.956 0.952 0.952 0.951 0.951 0.950 0.947 0.947 0.946 0.943 0.910 70469 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM E.—2006 GAFS—Continued Carrier 00884 00630 31142 00650 00528 00825 05440 00660 00880 00870 00751 00826 00655 00820 00510 05130 00820 00512 00522 00740 00523 00520 00973 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... Locality 16 00 99 00 99 21 35 00 01 01 01 00 00 01 00 00 02 00 00 99 99 13 20 ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. 2006 GAF Locality name West Virginia ........................................................................................................................................................ Indiana ................................................................................................................................................................. Rest of Maine ...................................................................................................................................................... Kansas* ................................................................................................................................................................ Rest of Louisiana ................................................................................................................................................. Wyoming .............................................................................................................................................................. Tennessee ........................................................................................................................................................... Kentucky .............................................................................................................................................................. South Carolina ..................................................................................................................................................... Rhode Island ........................................................................................................................................................ Montana ............................................................................................................................................................... Iowa ..................................................................................................................................................................... Nebraska .............................................................................................................................................................. North Dakota ........................................................................................................................................................ Alabama ............................................................................................................................................................... Idaho .................................................................................................................................................................... South Dakota ....................................................................................................................................................... Mississippi ............................................................................................................................................................ Oklahoma ............................................................................................................................................................. Rest of Missouri* ................................................................................................................................................. Rest of Missouri* ................................................................................................................................................. Arkansas .............................................................................................................................................................. Puerto Rico .......................................................................................................................................................... 0.942 0.937 0.936 0.936 0.936 0.934 0.933 0.932 0.930 0.930 0.928 0.927 0.925 0.924 0.923 0.922 0.922 0.919 0.913 0.910 0.910 0.905 0.840 * States are served by more than one carrier. ADDENDUM F.—REVISED SINGLE DRUG CATEGORY LIST HCPCS J0150 J0152 J0170 J0207 J0215 J0280 J0290 J0475 J0540 J0550 J0570 J0585 J0587 J0600 J0637 J0640 J0670 J0690 J0692 J0696 J0698 J0702 J0704 J0735 J0800 J0895 J1000 J1020 J1030 J1040 J1051 J1094 J1100 J1190 J1200 J1212 J1245 J1250 J1260 J1335 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 Recalculated weights Long description INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG ................................................................................. INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG .................................................................................. INJECTION, ADRENALIN, EPINEPHRINE, 1 ML AMPULE .................................................................................... INJECTION, AMIFOSTINE, 500 MG ........................................................................................................................ INJECTION, ALEFACEPT, 0.5 MG .......................................................................................................................... INJECTION, AMINOPHYLLIN, 250 MG ................................................................................................................... INJECTION, AMPICILLIN SODIUM, 500 MG .......................................................................................................... INJECTION, BACLOFEN, 10 MG ............................................................................................................................. INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, 1,200,000 UNITS .......................... INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, 2,400,000 UNITS .......................... INJECTION, PENICILLIN G BENZATHINE, 1,200,000 UNITS ............................................................................... BOTULINUM TOXIN TYPE A, PER UNIT ................................................................................................................ BOTULINUM TOXIN TYPE B, PER 100 UNITS ...................................................................................................... INJECTION, EDETATE CALCIUM DISODIUM, 1000 MG ....................................................................................... INJECTION, CASPOFUNGIN ACETATE, 5 MG ...................................................................................................... INJECTION, LEUCOVORIN CALCIUM, PER 50 MG .............................................................................................. INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML ............................................................................... INJECTION, CEFAZOLIN SODIUM, 500 MG .......................................................................................................... INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG ........................................................................................... INJECTION, CEFTRIAXONE SODIUM, PER 250 MG ............................................................................................ INJECTION, CEFOTAXIME SODIUM, PER GM ...................................................................................................... INJECTION, BETAMETHASONE ACETATE & BETAMETHASONE SODIUM PHOSPHATE, PER 3 MG ........... INJECTION, BETAMETHASONE SODIUM PHOSPHATE, PER 4 MG .................................................................. INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG .............................................................................................. INJECTION, CORTICOTROPIN, 40 UNITS ............................................................................................................. INJECTION, DEFEROXAMINE MESYLATE, 500 MG ............................................................................................. INJECTION, DEPO-ESTRADIOL CYPIONATE, 5 MG ............................................................................................ INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG ................................................................................... INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG ................................................................................... INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG ................................................................................... INJECTION, MEDROXYPROGESTERONE ACETATE, 50 MG .............................................................................. INJECTION, DEXAMETHASONE ACETATE, 1 MG ................................................................................................ INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG ............................................................................ INJECTION, DEXRAZOXANE HYDROCHLORIDE, PER 250 MG ......................................................................... INJECTION, DIPHENHYDRAMINE HCL, 50 MG .................................................................................................... INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML ................................................................................... INJECTION, DIPYRIDAMOLE, PER 10 MG ............................................................................................................ INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG ............................................................................. INJECTION, DOLASETRON MESYLATE, 10 MG ................................................................................................... INJECTION, ERTAPENEM SODIUM, 500 MG ........................................................................................................ 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00355 Fmt 4701 Sfmt 4701 E:\FR\FM\21NOR2.SGM 21NOR2 0.00069828 0.00458348 0.00007878 0.00016059 0.00083178 0.00081886 0.00012626 0.00024582 0.00007191 0.00001826 0.00004593 0.03734001 0.00150333 0.00004448 0.00008462 0.01061886 0.00038303 0.00042306 0.00024785 0.00667188 0.00014842 0.00287002 0.00056918 0.00034065 0.00363050 0.00024388 0.00020962 0.00127016 0.00591680 0.00526505 0.00006510 0.00350405 0.05478551 0.00002438 0.00215958 0.00008455 0.00382235 0.00053051 0.01732829 0.00013230 70470 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM F.—REVISED SINGLE DRUG CATEGORY LIST—Continued HCPCS J1440 J1441 J1450 J1580 J1600 J1626 J1631 J1642 J1644 J1645 J1650 J1655 J1720 J1745 J1750 J1756 J1885 J1940 J1956 J2001 J2010 J2150 J2260 J2300 J2325 J2353 J2354 J2405 J2430 J2505 J2550 J2680 J2765 J2780 J2820 J2912 J2916 J2920 J2930 J2997 J3260 J3301 J3302 J3303 J3315 J3370 J3396 J3410 J3420 J3475 J3480 J3487 J7030 J7040 J7042 J7050 J7060 J7070 J7120 J7318 J9000 J9001 J9031 J9040 J9045 J9050 J9060 J9062 J9065 J9070 J9080 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 Recalculated weights Long description INJECTION, FILGRASTIM (G-CSF), 300 MCG ....................................................................................................... INJECTION, FILGRASTIM (G-CSF), 480 MCG ....................................................................................................... INJECTION FLUCONAZOLE, 200 MG .................................................................................................................... INJECTION, GARAMYCIN, GENTAMICIN, 80 MG ................................................................................................. INJECTION, GOLD SODIUM THIOMALATE, 50 MG .............................................................................................. INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG ................................................................................ INJECTION, HALOPERIDOL DECANOATE, PER 50 MG ...................................................................................... INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS ...................................................... INJECTION, HEPARIN SODIUM, PER 1000 UNITS ............................................................................................... INJECTION, DALTEPARIN SODIUM, PER 2500 IU ............................................................................................... INJECTION, ENOXAPARIN SODIUM, 10 MG ......................................................................................................... INJECTION, TINZAPARIN SODIUM, 1000 IU ......................................................................................................... INJECTION, HYDROCORTISONE SODIUM SUCCINATE, 100 MG ...................................................................... INJECTION INFLIXIMAB, 10 MG ............................................................................................................................. INJECTION, IRON DEXTRAN, 50 MG ..................................................................................................................... INJECTION, IRON SUCROSE, 1 MG ...................................................................................................................... INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG ................................................................................... INJECTION, FUROSEMIDE, 20 MG ........................................................................................................................ INJECTION, LEVOFLOXACIN, 250 MG .................................................................................................................. INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG .............................................................. INJECTION, LINCOMYCIN HCL, 300 MG ............................................................................................................... INJECTION, MANNITOL, 25% IN 50 ML ................................................................................................................. INJECTION, MILRINONE LACTATE, 5 MG ............................................................................................................. INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG ................................................................................ INJECTION, NESIRITIDE, 0.1 MG ........................................................................................................................... INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG ................................... INJECTION, OCTREOTIDE, NON-DEPOT SUBCUTANEOUS OR INTRAVENOUS INJECTION, 25 MCG ......... INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG ............................................................................. INJECTION, PAMIDRONATE DISODIUM, PER 30 MG .......................................................................................... INJECTION, PEGFILGRASTIM, 6 MG ..................................................................................................................... INJECTION, PROMETHAZINE HCL, 50 MG ........................................................................................................... INJECTION, FLUPHENAZINE DECANOATE, 25 MG ............................................................................................. INJECTION, METOCLOPRAMIDE HCL, 10 MG ..................................................................................................... INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG ........................................................................................... INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG .............................................................................................. INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML .............................................................................................. INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 12.5 MG .......................... INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, 40 MG ............................................................... INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, 125 MG ............................................................. INJECTION, ALTEPLASE RECOMBINANT, 1 MG .................................................................................................. INJECTION, TOBRAMYCIN SULFATE, 80 MG ....................................................................................................... INJECTION, TRIAMCINOLONE ACETONIDE, PER 10MG .................................................................................... INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG ....................................................................................... INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG ............................................................................... INJECTION, TRIPTORELIN PAMOATE, 3.75 MG .................................................................................................. INJECTION, VANCOMYCIN HCL, 500 MG ............................................................................................................. INJECTION, VERTEPORFIN, 0.1 MG ..................................................................................................................... INJECTION, HYDROXYZINE HCL, 25 MG .............................................................................................................. INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG .................................................................. INJECTION, MAGNESIUM SULFATE, PER 500 MG .............................................................................................. INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ .............................................................................................. INJECTION, ZOLEDRONIC ACID, 1 MG ................................................................................................................. INFUSION, NORMAL SALINE SOLUTION , 1000 CC ............................................................................................ INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT) ............................................................... 5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT) .......................................................................................... INFUSION, NORMAL SALINE SOLUTION , 250 CC .............................................................................................. 5% DEXTROSE/WATER (500 ML = 1 UNIT) .......................................................................................................... INFUSION, D5W, 1000 CC ...................................................................................................................................... RINGERS LACTATE INFUSION, 1000 CC .............................................................................................................. HYALURONAN (SODIUM HYALURONATE) OR DERIVATIVE, INTRA-ARTICULAR INJECTION, 1 MG ............ DOXORUBICIN HCL, 10 MG ................................................................................................................................... DOXORUBICIN HYDROCHLORIDE, ALL LIPID FORMULATIONS, 10 MG .......................................................... BCG (INTRAVESICAL) PER INSTILLATION ........................................................................................................... BLEOMYCIN SULFATE, 15 UNITS .......................................................................................................................... CARBOPLATIN, 50 MG ............................................................................................................................................ CARMUSTINE, 100 MG ........................................................................................................................................... CISPLATIN, POWDER OR S0LUTION, PER 10 MG .............................................................................................. CISPLATIN, 50 MG ................................................................................................................................................... INJECTION, CLADRIBINE, PER 1 MG .................................................................................................................... CYCLOPHOSPHAMIDE, 100 MG ............................................................................................................................ CYCLOPHOSPHAMIDE, 200 MG ............................................................................................................................ 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00356 Fmt 4701 Sfmt 4701 E:\FR\FM\21NOR2.SGM 21NOR2 0.00193096 0.00406386 0.00001605 0.00039839 0.00005600 0.01480082 0.00020651 0.06406943 0.00353690 0.00011497 0.00135285 0.00047054 0.00013295 0.02755927 0.00245914 0.01024469 0.00329270 0.00065208 0.00008608 0.00077337 0.00062307 0.00029139 0.00004947 0.00026276 0.00027338 0.00194628 0.00008391 0.01369661 0.00156404 0.00064954 0.00068512 0.00015076 0.00011107 0.00088333 0.00217374 0.00678337 0.00060984 0.00031153 0.00077009 0.00012209 0.00018247 0.02161210 0.00172788 0.00094370 0.00000712 0.00083980 0.05425250 0.00040904 0.01200091 0.00108238 0.00215178 0.00335651 0.00102582 0.00242568 0.00049750 0.00990901 0.00102607 0.00015855 0.00016938 0.00340613 0.00235266 0.00032456 0.00049146 0.00003718 0.00568694 0.00000887 0.00095159 0.00025368 0.00008122 0.00062537 0.00004956 70471 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM F.—REVISED SINGLE DRUG CATEGORY LIST—Continued Recalculated weights HCPCS Long description J9090 ....... J9091 ....... J9092 ....... J9093 ....... J9094 ....... J9095 ....... J9096 ....... J9097 ....... J9098 ....... J9100 ....... J9110 ....... J9130 ....... J9140 ....... J9150 ....... J9170 ....... J9178 ....... J9181 ....... J9182 ....... J9185 ....... J9190 ....... J9200 ....... J9201 ....... J9202 ....... J9206 ....... J9208 ....... J9209 ....... J9211 ....... J9213 ....... J9214 ....... J9219 ....... J9245 ....... J9250 ....... J9260 ....... J9263 ....... J9265 ....... J9268 ....... J9280 ....... J9290 ....... J9291 ....... J9293 ....... J9310 ....... J9320 ....... J9340 ....... J9350 ....... J9355 ....... J9360 ....... J9370 ....... J9375 ....... J9390 ....... J9395 ....... J9600 ....... J0885 ....... J0881 ....... Q3025 ...... CYCLOPHOSPHAMIDE, 500 MG ............................................................................................................................ CYCLOPHOSPHAMIDE, 1.0 GRAM ........................................................................................................................ CYCLOPHOSPHAMIDE, 2.0 GRAM ........................................................................................................................ CYCLOPHOSPHAMIDE, LYOPHILIZED, 100 MG ................................................................................................... CYCLOPHOSPHAMIDE, LYOPHILIZED, 200 MG ................................................................................................... CYCLOPHOSPHAMIDE, LYOPHILIZED, 500 MG ................................................................................................... CYCLOPHOSPHAMIDE, LYOPHILIZED, 1.0 GRAM ............................................................................................... CYCLOPHOSPHAMIDE, LYOPHILIZED, 2.0 GRAM ............................................................................................... CYTARABINE LIPOSOME, 10 MG .......................................................................................................................... CYTARABINE, 100 MG ............................................................................................................................................ CYTARABINE, 500 MG ............................................................................................................................................ DACARBAZINE, 100 MG .......................................................................................................................................... DACARBAZINE, 200 MG .......................................................................................................................................... DAUNORUBICIN, 10 MG ......................................................................................................................................... DOCETAXEL, 20 MG ............................................................................................................................................... INJECTION, EPIRUBICIN HCL, 2 MG ..................................................................................................................... ETOPOSIDE, 10 MG ................................................................................................................................................ ETOPOSIDE, 100 MG .............................................................................................................................................. FLUDARABINE PHOSPHATE, 50 MG ..................................................................................................................... FLUOROURACIL, 500 MG ....................................................................................................................................... FLOXURIDINE, 500 MG ........................................................................................................................................... GEMCITABINE HCL, 200 MG .................................................................................................................................. GOSERELIN ACETATE IMPLANT, PER 3.6 MG .................................................................................................... IRINOTECAN, 20 MG ............................................................................................................................................... IFOSFAMIDE, 1 GM ................................................................................................................................................. MESNA, 200 MG ...................................................................................................................................................... IDARUBICIN HYDROCHLORIDE, 5 MG .................................................................................................................. INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS .............................................................................. INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS .............................................................................. LEUPROLIDE ACETATE IMPLANT, 65 MG ............................................................................................................ INJECTION, MELPHALAN HYDROCHLORIDE, 50 MG ......................................................................................... METHOTREXATE SODIUM, 5 MG .......................................................................................................................... METHOTREXATE SODIUM, 50 MG ........................................................................................................................ INJECTION, OXALIPLATIN, 0.5 MG ........................................................................................................................ PACLITAXEL, 30 MG ............................................................................................................................................... PENTOSTATIN, PER 10 MG ................................................................................................................................... MITOMYCIN, 5 MG ................................................................................................................................................... MITOMYCIN, 20 MG ................................................................................................................................................. MITOMYCIN, 40 MG ................................................................................................................................................. INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG ............................................................................ RITUXIMAB, 100 MG ................................................................................................................................................ STREPTOZOCIN, 1 GM ........................................................................................................................................... THIOTEPA, 15 MG ................................................................................................................................................... TOPOTECAN, 4 MG ................................................................................................................................................. TRASTUZUMAB, 10 MG .......................................................................................................................................... VINBLASTINE SULFATE, 1 MG .............................................................................................................................. VINCRISTINE SULFATE, 1 MG ............................................................................................................................... VINCRISTINE SULFATE, 2 MG ............................................................................................................................... VINORELBINE TARTRATE, PER 10 MG ................................................................................................................ INJECTION, FULVESTRANT, 25 MG ...................................................................................................................... PORFIMER SODIUM, 75 MG ................................................................................................................................... INJECTION, EPOETIN ALPHA, (FOR NON ESRD USE), PER 1000 UNITS ........................................................ INJECTION, DARBEPOETIN ALFA, 1 MCG (NON-ESRD USE) ............................................................................ INJECTION, INTERFERON BETA-1A, 11 MCG FOR INTRAMUSCULAR USE .................................................... ADDENDUM G.—REVISED NEW DRUGS FOR CAP BIDDING FOR 2006 0.00008105 0.00005036 0.00000528 0.00092452 0.00009167 0.00017653 0.00013943 0.00001356 0.00000815 0.00012978 0.00002071 0.00009406 0.00007007 0.00000488 0.00256588 0.00121617 0.00230896 0.00052981 0.00030572 0.00395219 0.00000408 0.00494962 0.00287887 0.00318310 0.00007873 0.00036778 0.00000318 0.00008062 0.00673538 0.00006510 0.00000158 0.00186241 0.00051323 0.07300568 0.00555323 0.00000643 0.00004067 0.00003473 0.00006128 0.00025058 0.00408558 0.00000671 0.00002446 0.00018223 0.00542012 0.00035725 0.00019702 0.00011487 0.00110762 0.00126358 0.00000030 0.25074794 0.15914222 0.00078070 HCPCS J0128 J0180 J0278 J0878 J1751 J1752 J1931 J2357 ..... ..... ..... ..... ..... ..... ..... ..... ADDENDUM G.—REVISED NEW DRUGS FOR CAP BIDDING FOR 2006—Continued [Effective January 1, 2006] [Effective January 1, 2006] ADDENDUM G.—REVISED NEW DRUGS FOR CAP BIDDING FOR 2006—Continued [Effective January 1, 2006] Long description Abarelix injection. Agalsidase beta injection. Amikacin. Daptomycin injection. Iron Dextran 165. Iron Dextran 267. Laronidase injection. Omalizumab injection. VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 HCPCS J2469 J2503 J2794 J9035 J9041 J9055 J9225 PO 00000 ..... ..... ..... ..... ..... ..... ..... Long description Palonosetron HCl. Pegaptanib. Risperidone, long acting. Bevacizumab injection. Bortezomib injection. Cetuximab injection. Histrelin implant. Frm 00357 Fmt 4701 Sfmt 4701 HCPCS Long description J9264 ..... J9305 ..... Paclitaxel protein bound particles. Pemetrexed injection. E:\FR\FM\21NOR2.SGM 21NOR2 70472 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM H.—LIST OF CPT 1/ HCPCS CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE CATEGORIES 2 UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT ADDENDUM H.—LIST OF CPT 1/ HCPCS CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE CATEGORIES 2 UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued ADDENDUM H.—LIST OF CPT 1/ HCPCS CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE CATEGORIES 2 UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued [Effective Date: All codes are effective January 1, 2006, except those followed by an asterisk. Codes followed by an asterisk will become effective on January 1, 2007.] [Effective Date: All codes are effective January 1, 2006, except those followed by an asterisk. Codes followed by an asterisk will become effective on January 1, 2007.] [Effective Date: All codes are effective January 1, 2006, except those followed by an asterisk. Codes followed by an asterisk will become effective on January 1, 2007.] CLINICAL LABORATORY SERVICES Include CPT codes for all clinical laboratory services in the 80000 series, except EXCLUDE CPT codes for the following blood component collection services: 86890 ................... Autologous blood process 86891 ................... Autologous blood, op salvage 86927 ................... Plasma, fresh frozen 86930 ................... Frozen blood prep 86931 ................... Frozen blood thaw 86932 ................... Frozen blood freeze/thaw 86945 ................... Blood product/irradiation 86950 ................... Leukacyte transfusion 86965 ................... Pooling blood platelets 86985 ................... Split blood or products Include the following CPT and HCPCS level 2 codes for other clinical laboratory services: 0026T ................... Measure remnant lipoproteins 0030T ................... Antiprothrombin antibody 0041T ................... Detect ur infect agnt w/cpas 0043T ................... Co expired gas analysis 0058T ................... Cryopreservation, ovary tiss 0059T ................... Cryopreservation, oocyte 0064T ................... Spectroscop eval expired gas 0085T ................... Breath test heart reject 0087T ................... Sperm eval hyaluronan 0103T ................... Holotranscobalamin 0104T ................... At rest cardio gas rebreathe 0111T ................... RBC membranes fatty acids 0140T ................... Exhaled breath condensate ph 36415 ................... Routine venipuncture 78267 ................... Breath test attain/anal c-14 78268 ................... Breath test analysis c-14 G0027 .................. Semen analysis G0103 .................. Psa, total screening G0107 .................. CA screen; fecal blood test G0123 .................. Screen cerv/vag thin layer G0124 .................. Screen c/v thin layer by MD G0141 .................. Scr c/v cyto,autosys and md G0143 .................. Scr c/v cyto,thinlayer,rescr G0144 .................. Scr c/v cyto,thinlayer,rescr G0145 .................. Scr c/v cyto,thinlayer,rescr G0147 .................. Scr c/v cyto, automated sys G0148 .................. Scr c/v cyto, autosys, rescr G0306 .................. CBC/diffwbc w/o platelet G0307 .................. CBC without platelet G0328 .................. Fecal blood scrn immunoassay P2028 ................... Cephalin floculation test P2029 ................... Congo red blood test P2033 ................... Blood thymol turbidity P2038 ................... Blood mucoprotein P3000 ................... Screen pap by tech w md supv P3001 ................... Screening pap smear by phys P9612 ................... Catheterize for urine spec P9615 ................... Urine specimen collect mult Q0111 .................. Wet mounts/ w preparations Q0112 .................. Potassium hydroxide preps Q0113 .................. Pinworm examinations Q0114 .................. Fern test Q0115 .................. Post-coital mucous exam PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH-LANGUAGE PATHOLOGY 92507 92508 92526 92597 92607 92608 92609 92610 92611 92612 92614 92616 93797 93798 94667 94668 95831 95832 95833 95834 95851 97760 ................... Orthotic mgmt and training 97761 ................... Prosthetic training 97762 ................... C/O for orthotic/prosth use 97799 ................... Physical medicine procedure G0281 .................. Elec stim unattend for press G0283 .................. Elec stim other than wound G0329 .................. Electromagntic tx for ulcers RADIOLOGY AND CERTAIN OTHER IMAGING SERVICES Include the following CPT and HCPCS codes for the physical therapy/occupational therapy/speechlanguage pathology services: 0019T ................... Extracorp shock wv tx,ms nos 0029T ................... Magnetic tx for incontinence 64550 ................... Apply neurostimulator 90901 ................... Biofeedback train, any meth 90911 ................... Biofeedback peri/uro/rectal 92506 ................... Speech/hearing evaluation VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 95852 ................... 96000 96001 96002 96003 96105 96110 96111 97001 97002 97003 97004 97010 97012 97016 97018 97022 97024 97026 97028 97032 97033 97034 97035 97036 97039 97110 97112 97113 97116 97124 97139 97140 97150 97530 97532 97533 97535 97537 97542 97545 97546 97597 97598 97602 97605 97606 97750 97755 PO 00000 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... Frm 00358 Speech/hearing therapy Speech/hearing therapy Oral function therapy Oral speech device eval 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) Laryngoscopic sensory test Fees w/laryngeal sense test Cardiac rehab Cardiac rehab/monitor Chest wall manipulation Chest wall manipulation Limb muscle testing, manual Hand muscle testing, manual Body muscle testing, manual Body muscle testing, manual Range of motion measurements Range of motion measurements Motion analysis, video/3d Motion test w/ft press meas Dynamic surface emg Dynamic fine wire emg Assessment of aphasia Developmental test, lim Developmental test, extend Pt evaluation Pt re-evaluation Ot evaluation Ot re-evaluation Hot or cold packs therapy Mechanical traction therapy Vasopneumatic device therapy Paraffin bath therapy Whirlpool therapy Diathermy eg, microwave 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 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/20cm or < Active wound care > 20cm Wound(s) care nonselective Neg press wound tx, < 50 cm Neg press wound tx, > 50 cm Physical performance test Assistive technology assess Fmt 4701 Sfmt 4701 Include the following 0028T ................... 0042T ................... 0067T ................... 51798 ................... 70100 ................... 70110 ................... 70120 ................... 70130 ................... 70134 ................... 70140 ................... 70150 ................... 70160 ................... 70190 ................... 70200 ................... 70210 ................... 70220 ................... 70240 ................... 70250 ................... 70260 ................... 70300 ................... 70310 ................... 70320 ................... 70328 ................... 70330 ................... 70336 ................... 70350 ................... 70355 ................... 70360 ................... 70370 ................... 70371 ................... 70380 ................... 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 ................... 71010 ................... 71015 ................... 71020 ................... 71021 ................... 71022 ................... E:\FR\FM\21NOR2.SGM 21NOR2 CPT and HCPCS codes: Dexa body composition study Ct perfusion w/contrast, cbf Ct colonography;dx Us urine capacity measure 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 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 Magnetic image, jaw joint X-ray head for orthodontia Panoramic x-ray of jaws X-ray exam of neck Throat x-ray & fluoroscopy Speech evaluation, complex X-ray exam of salivary gland 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 Chest x-ray Chest x-ray Chest x-ray Chest x-ray Chest x-ray Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70473 ADDENDUM H.—LIST OF CPT 1/ HCPCS CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE CATEGORIES 2 UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued ADDENDUM H.—LIST OF CPT 1/ HCPCS CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE CATEGORIES 2 UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued ADDENDUM H.—LIST OF CPT 1/ HCPCS CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE CATEGORIES 2 UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued [Effective Date: All codes are effective January 1, 2006, except those followed by an asterisk. Codes followed by an asterisk will become effective on January 1, 2007.] [Effective Date: All codes are effective January 1, 2006, except those followed by an asterisk. Codes followed by an asterisk will become effective on January 1, 2007.] [Effective Date: All codes are effective January 1, 2006, except those followed by an asterisk. Codes followed by an asterisk will become effective on January 1, 2007.] 71023 71030 71034 71035 71100 71101 71110 71111 71120 71130 71250 71260 71270 71275 71550 71551 71552 71555 72010 72020 72040 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 72170 72190 72191 72192 72193 72194 72195 72196 72197 72198 72200 72202 72220 73000 73010 73020 73030 73050 73060 73070 73080 73090 73092 73100 73110 73120 73130 73140 73200 73201 73202 73206 73218 73219 73220 73221 73222 73223 73500 73510 73520 73540 73550 73560 73562 73564 73565 73590 73592 73600 73610 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 74210 74220 74230 74240 74241 74245 74246 74247 74249 74250 74290 74291 74710 75552 75553 75554 75555 75635 76000 76006 76010 76020 76040 76061 76062 76065 76066 76070 76071 76075 76076 76077 76078 76082 76083 76090 76091 76092 76093 76094 76100 76101 76102 76120 76125 76150 76370 76376 76377 76380 76400 76499 76506 76510 76511 76512 76513 76514 76516 76519 76536 76604 76645 76700 76705 76770 76775 76778 76800 76801 76802 76805 76810 76811 76812 76815 76816 76818 76819 76820 76821 76825 76826 76827 76828 76856 76857 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... VerDate Aug<31>2005 Chest x-ray and fluoroscopy Chest x-ray Chest x-ray and fluoroscopy Chest x-ray 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 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 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 X-ray exam of collar bone X-ray exam of shoulder blade X-ray exam of shoulder X-ray exam of shoulder X-ray exam of shoulders X-ray exam of humerus X-ray exam of elbow X-ray exam of elbow 14:28 Nov 18, 2005 Jkt 208001 PO 00000 ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... Frm 00359 X-ray exam of forearm X-ray exam of arm, infant X-ray exam of wrist X-ray exam of wrist 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 X-ray exam of hip X-ray exam of hip X-ray exam of hips X-ray exam of pelvis & hips 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 X-ray exam of lower leg X-ray exam of leg, infant X-ray exam of ankle X-ray exam 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 Contrst x-ray exam of throat Contrast x-ray, esophagus Cine/vid x-ray, throat/esoph X-ray exam, upper gi tract X-ray exam, upper gi tract X-ray exam, upper gi tract Contrst x-ray uppr gi tract Contrst x-ray uppr gi tract Contrst x-ray uppr gi tract X-ray exam of small bowel Contrast x-ray, gallbladder Contrast x-rays, gallbladder X-ray measurement of pelvis Heart mri for morph w/o dye Heart mri for morph w/dye Fmt 4701 Sfmt 4701 E:\FR\FM\21NOR2.SGM ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... ................... 21NOR2 Cardiac MRI/function Cardiac MRI/limited study Ct angio abdominal arteries Fluoroscope examination X-ray stress view X-ray, nose to rectum 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 bone density, axial Ct bone density, peripheral Dxa bone density, axial Dxa bone density/peripheral Dxa bone density/v-fracture Radiographic absorptiometry Computer mammogram add-on Computer mammogram add-on Mammogram, one breast Mammogram, both breasts Mammogram, screening Magnetic image, breast Magnetic image, both breasts 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 exam, dry process Ct scan for therapy guide 3d render w/o postprocess 3d rendering w/postprocess CAT scan follow-up study Magnetic image, bone marrow Radiographic procedure Echo exam of head Ophth us, b & quant a Ophth us, quant a only Ophth us, b w/non-quant a Echo exam of eye, water bath Echo exam of eye, thickness 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 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 Ob us >/= 14 wks, sngl fetus Ob us >/= 14 wks, addl fetus Ob us, detailed, sngl fetus Ob us, detailed, addl fetus Ob us, limited, fetus(s) Ob us, follow-up, per fetus 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 Us exam, pelvic, complete Us exam, pelvic, limited 70474 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM H.—LIST OF CPT 1/ HCPCS CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE CATEGORIES 2 UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued ADDENDUM H.—LIST OF CPT 1/ HCPCS CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE CATEGORIES 2 UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued ADDENDUM H.—LIST OF CPT 1/ HCPCS CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE CATEGORIES 2 UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued [Effective Date: All codes are effective January 1, 2006, except those followed by an asterisk. Codes followed by an asterisk will become effective on January 1, 2007.] [Effective Date: All codes are effective January 1, 2006, except those followed by an asterisk. Codes followed by an asterisk will become effective on January 1, 2007.] [Effective Date: All codes are effective January 1, 2006, except those followed by an asterisk. Codes followed by an asterisk will become effective on January 1, 2007.] 76870 ................... 76880 ................... 76885 ................... 76886 ................... 76970 ................... 76977 ................... 76999 ................... 78000* .................. 78001* .................. 78003* .................. 78006* .................. 78007* .................. 78010* .................. 78011* .................. 78015* .................. 78016* .................. 78018* .................. 78020* .................. 78070* .................. 78075* .................. 78099* .................. 78102* .................. 78103* .................. 78104* .................. 78110* .................. 78111* .................. 78120* .................. 78121* .................. 78122* .................. 78130* .................. 78135* .................. 78140* .................. 78185* .................. 78190* .................. 78191* .................. 78195* .................. 78199* .................. 78201* .................. 78202* .................. 78205* .................. 78206* .................. 78215* .................. 78216* .................. 78220* .................. 78223* .................. 78230* .................. 78231* .................. 78232* .................. 78258* .................. 78261* .................. 78262* .................. 78264* .................. 78270* .................. 78271* .................. 78272* .................. 78278* .................. 78282* .................. 78290* .................. 78291* .................. 78299* .................. 78300* .................. 78305* .................. 78306* .................. 78315* .................. 78320* .................. 78350 ................... 78399* .................. 78414* .................. 78428* .................. 78445* .................. 78456* .................. 78457* .................. 78458* 78459* 78460* 78461* 78464* 78465* 78466* 78468* 78469* 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* .................. 78890* .................. 78891* .................. 78999* .................. 91110 ................... 93303 ................... 93304 ................... 93307 ................... 93308 ................... 93320 ................... VerDate Aug<31>2005 Us exam, scrotum Us exam, extremity Us exam infant hips, dynamic Us exam infant hips, static Ultrasound exam follow-up Us bone density measure Echo examination procedure 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 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 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 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 Musculoskeletal nuclear exam Non-imaging heart function Cardiac shunt imaging Vascular flow imaging Acute venous thrombus image Venous thrombosis imaging 14:28 Nov 18, 2005 Jkt 208001 PO 00000 .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. Frm 00360 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) 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 Fmt 4701 Sfmt 4701 93321 ................... 93325 ................... 93875 ................... 93880 ................... 93882 ................... 93886 ................... 93888 ................... 93890 ................... 93892 ................... 93922 ................... 93923 ................... 93924 ................... 93925 ................... 93926 ................... 93930 ................... 93931 ................... 93965 ................... 93970 ................... 93971 ................... 93975 ................... 93976 ................... 93978 ................... 93979 ................... 93980 ................... 93981 ................... 93990 ................... A4641* ................. A4642* ................. A9500* A9502* A9503* A9504* A9505* A9507* A9508* A9510* A9511* A9512* A9513* A9514* ................. ................. ................. ................. ................. ................. ................. ................. ................. ................. ................. ................. A9515* ................. A9516* ................. A9519* ................. A9520* A9521* A9522* A9524* A9526* A9528* A9529* A9531* E:\FR\FM\21NOR2.SGM ................. ................. ................. ................. ................. ................. ................. ................. 21NOR2 Tumor image pet/ct, limited Tumor image pet/ct skul-thigh Tumor image pet/ct full body Nuclear medicine data proc Nuclear med data proc Nuclear diagnostic exam Gi tract capsule endoscopy Echo transthoracic Echo transthoracic Echo exam of heart Echo exam of heart Doppler echo exam, heart [if used in conjunction with 9330393308] Doppler echo exam, heart [if used in conjunction with 9330393308] Doppler color flow add-on [if used in conjunction with 9330393308] Extracranial study Extracranial study Extracranial study Intracranial study Intracranial study Tcd, vasoreactivity study Tcd, emboli detect w/o 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 Diagnostic imaging agent Satumomab pendetide per dose Technetium TC 99m sestamibi Technetium TC99M tetrofosmin Technetium TC 99m medronate Technetium tc 99m apcitide Thallous chloride TL 201/mci Indium/111 capromab pendetid Iobenguane sulfate I-131 Technetium TC99m Disofenin Technetium TC 99m depreotide Technetiumtc99mpertechnetate Technetium tc-99m mebrofenin Technetiumtc99m pyrophosphate Technetium tc-99m pentetate I-123 sodium iodide capsule Technetiumtc-99mmacroag albu Technetiumtc-99m sulfur clld Technetiumtc-99m exametazine Indium111ibritumomabtiuxetan Iodinated I-131 serumalbumin Ammonia N-13, per dose Dx I131 so iodide cap millic Dx I131 so iodide sol millic Dx I131 so iodide microcurie Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations 70475 ADDENDUM H.—LIST OF CPT 1/ HCPCS CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE CATEGORIES 2 UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued ADDENDUM H.—LIST OF CPT 1/ HCPCS CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE CATEGORIES 2 UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued ADDENDUM H.—LIST OF CPT 1/ HCPCS CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE CATEGORIES 2 UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued [Effective Date: All codes are effective January 1, 2006, except those followed by an asterisk. Codes followed by an asterisk will become effective on January 1, 2007.] [Effective Date: All codes are effective January 1, 2006, except those followed by an asterisk. Codes followed by an asterisk will become effective on January 1, 2007.] [Effective Date: All codes are effective January 1, 2006, except those followed by an asterisk. Codes followed by an asterisk will become effective on January 1, 2007.] A9533* ................. A9700* ................. G0130 .................. G0202 .................. G0204 .................. G0206 .................. G0288 .................. Q0092 .................. Q3000* ................. Q3002* ................. Q3003* ................. Q3004* ................. Q3005* ................. Q3006* ................. Q3007* ................. Q3008* ................. Q3009* ................. Q3010* ................. Q3011* ................. Q3012* ................. Q9945* ................. Q9946* ................. 77331 ................... 77332 ................... 77333 ................... 77334 ................... 77336 ................... 77370 ................... 77399 ................... 77401 ................... 77402 ................... 77403 ................... 77404 ................... 77406 ................... 77407 ................... 77408 ................... 77409 ................... 77411 ................... 77412 ................... 77413 ................... 77414 ................... 77416 ................... 77417 ................... 77418 ................... 77421 ................... 77422 ................... 77423 ................... 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 ................... 79005* .................. 79101* .................. 79200* .................. 79300* .................. 79403* .................. 79440* .................. 79445* .................. 79999* .................. 92974 ................... A9517* ................. A9523* ................. A9530* ................. A9532* ................. A9534* ................. A9600* ................. A9605* ................. A9699* ................. G0173 .................. G0243 .................. G0251 .................. Linear acc based stero radio G0339 .................. Robot lin-radsurg com, first G0340 .................. Robt lin-radsurg fractx 2-5 Q3001* ................. Brachytherapy radioelements Q3007* ................. Sodium phosphate p32 Q3011* ................. Chromic phosphate p32 EPO AND OTHER DIALYSIS-RELATED DRUGS The physician self-referral prohibition does not apply to the following codes for EPO and other dialysis-related drugs furnished in or by an ESRD facility if the conditions in § 411.355(g) are satisfied: J0630 ................... Calcitonin salmon injection J0636 ................... Inj calcitriol per 0.1 mcg J0882 ................... Darbepoetin alfa, esrd use J0886 ................... Epoetin alfa, esrd J0895 ................... Deferoxamine mesylate inj J1270 ................... Injection, doxercalciferol J1751 ................... Iron dextran 165 injection J1752 ................... Iron dextran 267 injection J1756 ................... Iron sucrose injection J1955 ................... Inj levocarnitine per 1 gm J2501 ................... Paricalcitol J2916 ................... Na ferric gluconate complex J2993 ................... Reteplase injection J2995 ................... Inj streptokinase /250000 IU J2997 ................... Alteplase recombinant J3364 ................... Urokinase 5000 IU injection P9041 ................... Albumin (human),5%, 50ml P9045 ................... Albumin (human), 5%, 250ml P9046 ................... Albumin (human), 25%, 20ml P9047 ................... Albumin (human), 25%, 50ml PREVENTIVE SCREENING TESTS, IMMUNIZATIONS AND VACCINES The physician self-referral prohibition does not apply to the following tests if they are performed for screening purposes and satisfy the conditions in § 411.355(h): 76083 ................... Computer mammogram add-on 76092 ................... Mammogram, screening 80061 ................... Lipid panel [only when billed with one of the following ICD-9CM codes: V81.0, V81.1, or V.81.2] 82465 ................... Assay, bld/serum cholesterol [only when billed with one of the following ICD-9-CM codes: V81.0, V81.1, or V.81.2] 82947 ................... Assay, glucose, blood quant [only when billed with ICD-9CM code V77.1] 82950 ................... Glucose test [only when billed with ICD-9-CM code V77.1] 82951 ................... Glucose tolerance test (GTT) [only when billed with ICD-9CM code V77.1] 83718 ................... Assay of lipoprotein [only when billed with one of the following ICD-9-CM codes: V81.0, V81.1, or V.81.2] 84478 ................... Assay of triglycerides [only when billed with one of the following ICD-9-CM codes: V81.0, V81.1, or V.81.2] G0103 .................. Psa, total screening G0107 .................. CA screen; fecal blood test G0123 .................. Screen cerv/vag thin layer G0124 .................. Screen c/v thin layer by MD G0141 .................. Scr c/v cyto,autosys and md G0143 .................. Scr c/v cyto,thinlayer,rescr G0144 .................. Scr c/v cyto,thinlayer,rescr G0145 .................. Scr c/v cyto,thinlayer,rescr I-131 tositumomab diagnostic Echocardiography contrast Single energy x-ray study Screeningmammographydigital Diagnosticmammographydigital Diagnosticmammographydigital Recon, CTA for surg plan Set up port xray equipment Rubidium RB-82 Gallium ga 67 Technetium tc99m bicisate Xenon xe 133 Technetium tc99m mertiatide Technetium tc99m glucepatate Sodium phosphate p32 Indium 111-in pentetreotide Technetium tc99m oxidronate Technetium tc99mlabeledrbcs Chromic phosphate p32 Cyanocobalamin cobalt co57 LOCM<=149mg/ml iodine, 1 ml LOCM 150-199mg/ml iodine,1ml Q9947* ................. LOCM 200-249mg/ml iodine,1ml Q9948* ................. LOCM 250-299mg/ml/iodine,1ml Q9949* ................. LOCM 300-349mg/ml iodine,1ml Q9950* ................. LOCM 350-399mg/ml iodine,1ml Q9951* ................. LOCM>=400 mg/ml iodine,1ml Q9952* ................. Inj Gad-base MR contrast, ml Q9953* ................. Inj Fe-base MR contrast, ml Q9954* ................. Oral MR contrast, 100ml Q9955* ................. Inj perflexane lip micros, ml Q9956* ................. Inj octafluoropropane mic,ml Q9957* ................. Inj perflutren lip micros, ml R0070 ................... Transport portable x-ray R0075 ................... Transport port x-ray multipl RADIATION THERAPY SERVICES AND SUPPLIES Include the following 0073T ................... 0082T ................... 0083T ................... 19296 ................... 19297 ................... 19298 ................... 31643 ................... 55859 ................... 57155 ................... 58346 ................... 61770 ................... 61793 ................... 77261 ................... 77262 ................... 77263 ................... 77280 ................... 77285 ................... 77290 ................... 77295 ................... 77299 ................... 77300 ................... 77301 ................... 77305 ................... 77310 ................... 77315 ................... 77321 ................... 77326 ................... 77327 ................... 77328 ................... VerDate Aug<31>2005 CPT and HCPCS codes: Delivery, comp imrt Stereotactic rad delivery Stereotactic rad tx mngmt Place po breast cath for rad Place breast cath for rad Place breast rad tube/caths Diag bronchoscope/catheter Percut/needle insert, pros Insert uteri tandems/ovoids Insert heyman uteri capsule Incise skull for treatment Focus radiation beam 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 Brachytx isodose calc simp Brachytx isodose calc interm Brachytx isodose plan compl 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00361 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 Stereoscopic x-ray guidance Neutron beam tx, single Neutron beam tx, complex 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 Nuclear rx, oral admin Nuclear rx, iv admin Nuclear rx, intracav admin Nuclr rx, interstit colloid Hematopoietic nuclear tx Nuclear rx, intra-articular Nuclear rx, intra-arterial Nuclear medicine therapy Cath place, cardio brachytx Th I131 so iodide cap millic Yttrium90ibritumomabtiuxetan Th I131 so iodide sol millic I-125 serum albumin micro I-131 tositumomab therapeut Strontium-89 chloride Samarium sm153 lexidronamm Noc therapeutic radiopharm Stereo radiosurgery,complete Multisour photon stero treat Fmt 4701 Sfmt 4701 E:\FR\FM\21NOR2.SGM 21NOR2 70476 Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 / Rules and Regulations ADDENDUM H.—LIST OF CPT 1/ HCPCS CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE CATEGORIES 2 UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued [Effective Date: All codes are effective January 1, 2006, except those followed by an asterisk. Codes followed by an asterisk will become effective on January 1, 2007.] G0147 .................. Scr c/v cyto, automated sys G0148 .................. Scr c/v cyto, autosys, rescr G0202 .................. Screening mammographydigital G0328 .................. Fecal blood scrn immunoassay P3000 ................... Screen pap by tech w md supv P3001 ................... Screening pap smear by phys The physician self-referral prohibition does not apply to the following immunization and vaccine codes if they satisfy the conditions in § 411.355(h): 90655 ................... Flu vaccine no preserv 6-35m 90656 ................... Flu vaccine no preserv 3 & > 90657 ................... Flu vaccine, 6-35 mo, im 90658 ................... Flu vaccine age 3 & over, im 90732 ................... Pneumococcal vaccine 90740 ................... Hepb vacc, ill pat 3 dose im 90743 ................... Hep b vacc, adol, 2 dose, im 90744 ................... Hepb vacc ped/adol 3 dose im 90746 ................... Hep b vaccine, adult, im 90747 ................... Hepb vacc, ill pat 4 dose im 1 CPT codes and descriptions only are copyright 2005 American Medical Association. All rights are reserved and applicable FARS/ DFARS clauses apply. 2 This list does not include codes for the following designated health service (DHS) categories: durable medical equipment and supplies; parenteral and enteral nutrients, equipment and supplies; prosthetics, orthotics, and prosthetic devices and supplies; home health services; outpatient prescription drugs; and inpatient and outpatient hospital services. For the definitions of these DHS categories, refer to 42 CFR 411.351. For more information, refer to https://cms.hhs.gov/medlearn/refphys.asp. * Nuclear medicine services and supplies assigned an asterisk will be subject to the physician self-referral prohibition effective January 1, 2007. [FR Doc. 05–22160 Filed 11–2–05; 5:07 pm] BILLING CODE 4120–01–P VerDate Aug<31>2005 14:28 Nov 18, 2005 Jkt 208001 PO 00000 Frm 00362 Fmt 4701 Sfmt 4701 E:\FR\FM\21NOR2.SGM 21NOR2

Agencies

[Federal Register Volume 70, Number 223 (Monday, November 21, 2005)]
[Rules and Regulations]
[Pages 70116-70476]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-22160]

[[Page 70115]]

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Part II

Department of Health and Human Services

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Centers for Medicare & Medicaid Services

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42 CFR Part 405, et al.

Medicare Program; Revisions to Payment Policies Under the Physician Fee
Schedule for Calendar Year 2006 and Certain Provisions Related to the
Competitive Acquisition Program of Outpatient Drugs and Biologicals
Under Part B; Final Rule

Federal Register / Vol. 70, No. 223 / Monday, November 21, 2005 /
Rules and Regulations

[[Page 70116]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 405, 410, 411, 413, 414, 424, and 426

[CMS-1502-FC and CMS-1325-F]
RINs 0938-AN84 and 0938-AN58

Medicare Program; Revisions to Payment Policies Under the
Physician Fee Schedule for Calendar Year 2006 and Certain Provisions
Related to the Competitive Acquisition Program of Outpatient Drugs and
Biologicals Under Part B

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

ACTION: Final rule with comment.

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SUMMARY: This rule addresses Medicare Part B payment policy, including
the physician fee schedule that are applicable for calendar year (CY)
2006; and finalizes certain provisions of the interim final rule to
implement the Competitive Acquisition Program (CAP) for Part B Drugs.
It also revises Medicare Part B payment and related policies regarding:
Physician work; practice expense (PE) and malpractice relative value
units (RVUs); Medicare telehealth services; multiple diagnostic imaging
procedures; covered outpatient drugs and biologicals; supplemental
payments to Federally Qualified Health Centers (FQHCs); renal dialysis
services; coverage for glaucoma screening services; National Coverage
Decision (NCD) timeframes; and physician referrals for nuclear medicine
services and supplies to health care entities with which they have
financial relationships. In addition, the rule finalizes the interim
RVUs for CY 2005 and issues interim RVUs for new and revised procedure
codes for CY 2006. This rule also updates the codes subject to the
physician self-referral prohibition and discusses payment policies
relating to teaching anesthesia services, therapy caps, private
contracts and opt-out, and chiropractic and oncology demonstrations.
As required by the statute, it also announces that the physician
fee schedule update for CY 2006 is -4.4 percent, the initial estimate
for the sustainable growth rate for CY 2006 is 1.7 percent and the
conversion factor for CY 2006 is $36.1770.

DATES: Effective Date: These regulations are effective on January 1,
2006.
Comment Date: To be assured consideration, comments must be
received at one of the addresses provided below, no later than 5 p.m.
on January 3, 2006.

ADDRESSES: In commenting, please refer to file code CMS-1502-FC.
Because of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
You may submit comments in one of four ways (no duplicates,
please):
1. Electronically. You may submit electronic comments on specific
issues in this regulation to https://www.cms.hhs.gov/regulations/
ecomments. (Attachments should be in Microsoft Word, WordPerfect, or
Excel; however, we prefer Microsoft Word.)
2. By regular mail. You may mail written comments (one original and
two copies) to the following address ONLY:
Centers for Medicare & Medicaid Services, Department of Health and
Human Services, Attention: CMS-1502-FC, P.O. Box 8017, Baltimore, MD
21244-8017.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments (one
original and two copies) to the following address ONLY:
Centers for Medicare & Medicaid Services, Department of Health and
Human Services, Attention: CMS-1502-FC, Mail Stop C4-26-05, 7500
Security Boulevard, Baltimore, MD 21244-1850.
4. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments (one original and two copies) before the
close of the comment period to one of the following addresses. If you
intend to deliver your comments to the Baltimore address, please call
telephone number (410) 786-7197 in advance to schedule your arrival
with one of our staff members. Room 445-G, Hubert H. Humphrey Building,
200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security
Boulevard, Baltimore, MD 21244-1850.
(Because access to the interior of the HHH Building is not readily
available to persons without Federal Government identification,
commenters are encouraged to leave their comments in the CMS drop slots
located in the main lobby of the building. A stamp-in clock is
available for persons wishing to retain a proof of filing by stamping
in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
Submission of comments on paperwork requirements. You may submit
comments on this document's paperwork requirements by mailing your
comments to the addresses provided at the end of the ``Collection of
Information Requirements'' section in this document.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Pam West (410) 786-2302 (for issues
related to practice expense).

Rick Ensor (410) 786-5617 (for issues related to the nonphysician
workpool and supplemental survey data).
Stephanie Monroe (410) 786-6864 (for issues related to the geographic
practice cost index and malpractice RVUs).
Craig Dobyski (410) 786-4584 (for issues related to list of telehealth
services).
Ken Marsalek (410) 786-4502 (for issues related to multiple procedure
reduction for diagnostic imaging services and payment for teaching
anesthesiologists).
Henry Richter (410) 786-4562 (for issues related to payments for end
stage renal disease facilities).
Angela Mason (410) 786-7452 or Catherine Jansto (410) 786-7762 (for
issues related to payment for covered outpatient drugs and
biologicals).
Fred Grabau (410) 786-0206 (for issues related to private contracts and
opt out provision).
David Worgo (410) 786-5919 (for issues related to Federally Qualified
Health Centers).
Dorothy Shannon (410) 786-3396 (for issues related to the outpatient
therapy cap).
Vadim Lubarsky (410) 786-0840 (for issues related to National Coverage
Decision timeframes).
Bill Larson (410) 786-7176 (for issues related to coverage of screening
for glaucoma).
Lia Prela (410) 786-0548 (for issues related to the competitive
acquisition program (CAP) for part B drugs).
Diane Milstead (410) 786-3355 or Gaysha Brooks (410) 786-9649 (for all
other issues).

SUPPLEMENTARY INFORMATION:
Submitting Comments: We welcome comments from the public on the
following issues: interim RVUs for selected procedure codes identified
in Addendum C; and the physician self referral designated health
services listed in tables 32 and 33. You can assist us by referencing
the file code CMS-1502-FC and the specific ``issue identifier'' that
precedes the section on which you choose to comment.
Inspection of Public Comments: All comments received before the
close of

[[Page 70117]]

the comment period are available for viewing by the public, including
any personally identifiable or confidential business information that
is included in a comment. CMS posts all comments received before the
close of the comment period on its public web site as soon as possible
after they are received. Hard copy comments received timely will be
available for public inspection as they are received, generally
beginning approximately 3 weeks after publication of a document, at the
headquarters of the Centers for Medicare & Medicaid Services, 7500
Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of
each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view
public comments, phone 1-800-743-3951.
This Federal Register document is also available from the Federal
Register online database through GPO Access a service of the U.S.
Government Printing Office. The web site address is: https://
www.access.gpo.gov/nara/.
Information on the physician fee schedule can be found on the CMS
homepage. You can access this data by using the following directions:
1. Go to the CMS homepage (https://www.cms.hhs.gov).
2. Place your cursor over the word ``Professionals'' in the blue
areas near the top of the page. Select ``physicians'' from the drop-
down menu.
3. Under ``Billing/Payment'' select ``Physician Fee Schedule''.
To assist readers in referencing sections contained in this
preamble, we are providing the following table of contents. Some of the
issues discussed in this preamble affect the payment policies, but do
not require changes to the regulations in the Code of Federal
Regulations. Information on the regulation's impact appears throughout
the preamble and is not exclusively in section VI.

Table of Contents

I. Background
A. Introduction
B. Development of the Relative Value System
C. Components of the Fee Schedule Payment Amounts
D. Most Recent Changes the Fee Schedule
II. Provisions of the Final Rule
A. Resource-Based Practice Expense Relative Value Units (PE
RVUs)
1. Current Methodology
2. PE Proposals for CY 2006
3. PE Recommendations on CPEP Inputs for CY 2006
4. Payment for Splint and Cast Supplies
5. Miscellaneous PE Issues
B. Geographic Practice Cost Indices (GPCIs)
C. Malpractice RVUs
1. Five Percent Specialty Threshold
2. Specialty Crosswalk Issues
3. Cardiac Catheterization and Angioplasty Exception
4. Dominant Specialty for Low-Volume Codes
5. Collection of Premium Data
D. Medicare Telehealth Services
1. Requests for Adding Services to the List of Medicare
Telehealth Services
2. Definition of an Originating Site
3. Other Issues
E. Contractor Pricing of Unlisted Therapy Modalities and
Procedures
F. Payment for Teaching Anesthesiologists
G. End Stage Renal Disease (ESRD) Related Provisions
1. Revised Pricing Methodology for Separately Billable Drugs and
Biologicals Furnished by ESRD Facilities.
2. Adjustment to Account for Changes in the Pricing of
Separately Billable Drugs and Biologicals, and the Estimated
Increase in Expenditures for Drugs and Biologicals
3. Revisions to Geographic Designations and Wage Indexes Applied
to the ESRD Composite Payment Rate
4. Miscellaneous Comments on ESRD Issues
5. Revisions to the Composite Payment Rate Exceptions Process
H. Payment for Covered Outpatient Drugs and Biologicals
1. ASP issues
2. Payment for Drugs Furnished During CY 2006 in Connection With
the Furnishing of Renal Dialysis Services if Separately Billed by
Renal Dialysis Facilities
3. Clotting Factor Furnishing Fee
4. Payment for Inhalation Drugs and Dispensing Fee
5. Supplying Fee
6. Competitive Acquisition of Outpatient Drugs And Biologicals
Under Part B
I. Private Contracts and Opt-out Provision
J. Multiple Procedure Payment Reduction for Diagnostic Imaging
K. Therapy Cap
L. Chiropractic Demonstration Discussion
M. Supplemental Payments to FQHCs Subcontracting with Medicare
Advantage Plans
N. National Coverage Decisions Timeframes
O. Coverage of Screening for Glaucoma
P. Additional Issues
1. Corrections to Conditions for Medicare Payment (Sec. 424.22)
2. Chemotherapy Demonstration Project
III. Refinement of RVUs for CY 2006 and Response to Public Comments
on Interim RVUs for 2005
A. Summary of Issues Discussed Related to the Adjustment of RVUs
B. Process for Establishing Work RVUs for the 2005 PFS
C. Work RVU Refinements of Interim RVUs
1. Methodology (Includes Table titled ``Work Relative Value Unit
Refinements of the 2004 Interim and Related Relative Value Units'')
2. Interim 2005 Codes
D. Establishment of Interim Work RVUs for New and Revised
Physician's Current Procedural Terminology (CPT) Codes and New
Healthcare Common Procedure Coding System Codes (HCPCS) for 2006
(Includes Table titled ``American Medical Association Specialty
Relative Value Update Committee and Health Care Professionals
Advisory Committee Recommendations and CMS's Decisions for New and
Revised 2006 CPT Codes'')
E. Discussion of Codes for Which There Were No RUC
Recommendations or for Which the RUC Recommendations Were Not
Accepted
F. Establishment of Interim PE RVUs for New and Revised
Physician's Current Procedural Terminology (CPT) Codes and New
Healthcare Common Procedure Coding System (HCPCS) Codes for 2006
IV. Five-Year Refinement of RVUs -Status update
V. Physician Self-Referral Prohibition: Nuclear Medicine and Annual
Update to the List of CPT/HCPCS Codes
A. General
B. Nuclear Medicine
1. Response to Comments
2. Revisions to the List of Codes Identifying Nuclear Medicine
Services
C. Annual Update to the Code List
1. Response to Comments
2. Revisions Effective for 2006
VI. Physician Fee Schedule Update for CY 2006
A. Physician Fee Schedule Update
B. The Percentage Change in the Medicare Economic Index (MEI)
C. The Update Adjustment Factor
VII. Allowed Expenditures for Physicians' Services and the
Sustainable Growth Rate
A. Medicare Sustainable Growth Rate
B. Physicians' Services
C. Preliminary Estimate of the SGR for 2006
D. Revised Sustainable Growth Rate for 2005
E. Final Sustainable Growth Rate for 2004
F. Calculation of 2006, 2005, and 2004 Sustainable Growth Rates
VIII. Anesthesia and Physician Fee Schedule Conversion Factors for
CY 2006
A. Physician Fee Schedule Conversion Factor
B. Anesthesia Fee Schedule Conversion Factor
IX. Telehealth Originating Site Facility Fee Payment Amount Update
X. Provisions of the Final Rule
XI. Waiver of Proposed Rulemaking
XII. Collection of Information Requirements
XIII. Response to Comments
XIV. Regulatory Impact Analysis
Addendum A--Explanation and Use of Addendum B.
Addendum B--Relative Value Units and Related Information
Addendum C--Codes with Interim RVUs
Addendum D--2006 Geographic Practice Cost Indices by Medicare
Carrier and Locality
Addendum E-2006 GAFs
Addendum F--CAP: Revised Single Drug Category List
Addendum G--CAP: Revised New Drugs for CAP Bidding for 2006
Addendum H--List of CPT/HCPCS Codes Used to Describe Certain
Designated Health Services Under Section 1877 of the Social Security
Act

[[Page 70118]]

In addition, because of the many organizations and terms to which
we refer by acronym in this proposed final rule with comment, we are
listing these acronyms and their corresponding terms in alphabetical
order below:
AADA American Academy of Dermatology Association
AAH American Association for Homecare
ABN Advanced Beneficiary Notice
ACC American College of Cardiology
ACG American College of Gastroenterology
ACR American College of Radiology
AFROC Association of Freestanding Radiation Oncology Centers
AGA American Gastroenterological Association
AMA American Medical Association
AMP Average manufacturer price
AOAO American Osteopathic Academy of Orthopedics
ASA American Society of Anesthesiologists
ASGE American Society of Gastrointestinal Endoscopy
ASP Average sales price
ASTRO American Society for Therapeutic Radiation Oncology
AUA American Urological Association
AWP Average wholesale price
BBA Balanced Budget Act of 1997
BBRA Balanced Budget Refinement Act of 1999
BIPA Benefits Improvement and Protection Act of 2000
BLS Bureau of Labor Statistics
BMI Body mass index
BNF Budget neutrality factor
BSA Body surface area
CAP Competitive Acquisition Program
CBSA Core-Based Statistical Area
CF Conversion factor
CFR Code of Federal Regulations
CMA California Medical Association
CMS Centers for Medicare & Medicaid Services
CNS Clinical nurse specialist
COBC Coordination of Benefits Contractor
CPEP Clinical Practice Expert Panel
CPI Consumer Price Index
CPO Care Plan Oversight
CPT (Physicians') Current Procedural Terminology (4th Edition, 2002,
copyrighted by the American Medical Association)
CRNA Certified Registered Nurse Anesthetist
CT Computed tomography
CTA Computed tomographic angiography
CY Calendar year
DAW Dispense as written
DHS Designated health services
DME Durable medical equipment
DMERC Durable Medical Equipment Regional Carrier
DSMT Diabetes outpatient self-management training services
EAC Estimated acquisition cost
ECP External counterpulsation
E/M Evaluation and management
EPO Erythopoeitin
ESRD End stage renal disease
FAX Facsimile
FDA Food and Drug Administration
FI Fiscal intermediary
FQHC Federally qualified health center
FR Federal Register
GAF Geographic adjustment factor
GAO Government Accountability Office
GPCI Geographic practice cost index
GPOs Group Purchasing Organizations
HCPAC Health Care Professional Advisory Committee
HCPCS Healthcare Common Procedure Coding System
HHA Home health agency
HHS (Department of) Health and Human Services
HIC Health Insurance Number
HIPAA Health Insurance Portability and Accountability Act of 1996,
Public Law 104-191
HOCM High Osmolar Contrast Media
HPSA Health professional shortage area
HRSA Health Resources and Services Administration (HHS)
IDTFs Independent diagnostic testing facilities
IPF Inpatient psychiatric facility
IPPS Inpatient prospective payment system
IRF Inpatient rehabilitation facility
ISO Insurance Services Office
IVIG Intravenous immune globulin
JCAAI Joint Council of Allergy, Asthma, and Immunology
JUA Joint underwriting association
LCD Local coverage determination
LTCH Long-term care hospital
LOCM Low Osmolar Contrast Media
MA Medicare Advantage
MCAC Medicare Coverage Advisory Committee
MCG Medical College of Georgia
MedPAC Medicare Payment Advisory Commission
MEI Medicare Economic Index
MMA Medicare Prescription Drug, Improvement, and Modernization Act of
2003
MNT Medical nutrition therapy
MRA Magnetic resonance angiography
MRI Magnetic resonance imaging
MSA Metropolitan statistical area
MSN Medicare summary notice
NCD National coverage determination
NCQDIS National Coalition of Quality Diagnostic Imaging Services
NDC National drug code
NECMA New England County Metropolitan Area
NECTA New England City and Town Area
NP Nurse practitioner
NPP Nonphysician practitioners
NPWP Nonphysician work pool
OBRA Omnibus Budget Reconciliation Act
OIG Office of Inspector General
OMB Office of Management and Budget
OPPS Outpatient prospective payment system
OT Occupational therapy
PA Physician assistant
PC Professional component
PE Practice Expense
PEAC Practice Expense Advisory Committee
PERC Practice Expense Review Committee
PET Positron emission tomography
PFS Physician Fee Schedule
PLI Professional liability insurance
PPAC Practicing Physicians Advisory Council
PIN Provider identification number
PPI Producer price index
PPO Preferred provider organization
PPS Prospective payment system
PRA Paperwork Reduction Act
PT Physical therapy
RFA Regulatory Flexibility Act
RIA Regulatory impact analysis
RN Registered nurse
RUC (AMA's Specialty Society) Relative (Value) Update Committee
RVU Relative value unit
SGR Sustainable growth rate
SMS (AMA's) Socioeconomic Monitoring System
SNF Skilled nursing facility
SNM Society for Nuclear Medicine
TA Technology assessment
TC Technical component
TEB Thoracic electrical bioimpedance
tPA Tissue-type plasminogen activator
UAF Update adjustment factor
UPIN Unique provider identification number
WAC Wholesale acquisition cost
WAMP Widely available market price

I. Background

A. Introduction

Since January 1, 1992, Medicare has paid for physicians' services
under section 1848 of the Social Security Act (the Act), ``Payment for
Physicians` Services.'' The Act requires that payments under the
physician fee schedule (PFS) be based on national uniform relative
value units (RVUs) based on the resources used in furnishing a service.
Section 1848(c) of the Act requires that national RVUs be established
for physician work, practice expense (PE), and malpractice expense.
Prior to the establishment of the

[[Page 70119]]

resource-based relative value system, Medicare payment for physicians'
services was based on reasonable charges.
Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments
in RVUs may not cause total physician fee schedule payments to differ
by more than $20 million from what they would have been had the
adjustments not been made. If adjustments to RVUs cause expenditures to
change by more than $20 million, we must make adjustments to ensure
that they do not increase or decrease by more than $20 million.

B. Development of the Relative Value System

1. Work RVUs
The concepts and methodology underlying the PFS were enacted as
part of the Omnibus Budget Reconciliation Act (OBRA) of 1989, Public
Law 101-239, and OBRA 1990, (Public Law 101-508). The final rule
published November 25, 1991 (56 FR 59502) set forth the fee schedule
for payment for physicians' services beginning January 1, 1992.
Initially, only the physician work RVUs were resource-based, and the PE
and malpractice RVUs were based on average allowable charges.
The physician work RVUs established for the implementation of the
fee schedule in January 1992 were developed with extensive input from
the physician community. A research team at the Harvard School of
Public Health developed the original physician work RVUs for most codes
in a cooperative agreement with the Department of Health and Human
Services (HHS). In constructing the code-specific vignettes for the
original physician work RVUs, Harvard worked with panels of experts,
both inside and outside the government, and obtained input from
numerous physician specialty groups.
Section 1848(b)(2)(A) of the Act specifies that the RVUs for
radiology services are based on a relative value scale we adopted under
section 1834(b)(1)(A) of the Act, (the American College of Radiology
(ACR) relative value scale), which we integrated into the overall PFS.
Section 1848(b)(2)(B) of the Act specifies that the RVUs for anesthesia
services are based on RVUs from a uniform relative value guide. We
established a separate conversion factor (CF) for anesthesia services,
and we continue to utilize time units as a basis for determining
payment for these services. As a result, there is a separate payment
methodology for anesthesia services.
We establish physician work RVUs for new and revised codes based on
recommendations received from the American Medical Association's (AMA)
Specialty Society Relative Value Update Committee (RUC).
2. Practice Expense Relative Value Units (PE RVUs)
Section 121 of the Social Security Act Amendments of 1994 (Pub. L.
103-432), enacted on October 31, 1994, amended section
1848(c)(2)(C)(ii) of the Act and required us to develop resource-based
PE RVUs for each physician's service beginning in 1998. We were to
consider the staff, equipment, and supplies used in the provision of
various medical and surgical services. The legislation specifically
required that, in implementing the new system of PE RVUs, we apply the
same budget-neutrality provisions that are applicable to other
adjustments under the physician fee schedule.
Section 4505(a) of the Balanced Budget Act of 1997 (BBA) (Pub. L.
105-33), amended section 1848(c)(2)(C)(ii) of the Act to delay
implementation of the resource-based PE RVU system until January 1,
1999. In addition, section 4505(b) of the BBA provided for a 4-year
transition period from charge-based PE RVUs to resource-based RVUs.
We established the resource-based PE RVUs for each physician's
service in a final rule, published November 2, 1998 (63 FR 58814),
effective for services furnished in 1999. Based on the requirement to
transition to a resource-based system for PE over a 4-year period,
resource-based PE RVUs did not become fully effective until 2002.
This resource-based system was based on two significant sources of
actual PE data: The Clinical Practice Expert Panel (CPEP) data and the
AMA's Socioeconomic Monitoring System (SMS) data. The CPEP data were
collected from panels of physicians, practice administrators, and
nonphysicians (for example, registered nurses) nominated by physician
specialty societies and other groups. The CPEP panels identified the
direct inputs required for each physician's service in both the office
setting and out-of-office setting. The AMA's SMS data provided
aggregate specialty-specific information on hours worked and PEs.
Separate PE RVUs are established for procedures that can be
performed in both a nonfacility setting, such as a physician's office,
and a facility setting, such as a hospital outpatient department. The
difference between the facility and nonfacility RVUs reflects the fact
that a facility receives separate payment from Medicare for its costs
of providing the service, apart from payment under the PFS. The
nonfacility RVUs reflect all of the direct and indirect PEs of
providing a particular service outside a facility setting.
Section 212 of the Medicare, Medicaid and State Child Health
Insurance Program Balanced Budget Refinement Act of 1999 (BBRA) (Pub.
L. 106-113) directed the Secretary to establish a process under which
we accept and use, to the maximum extent practicable and consistent
with sound data practices, data collected or developed by entities and
organizations to supplement the data we normally collect in determining
the PE component. On May 3, 2000, we published the interim final rule
(65 FR 25664) that set forth the criteria for the submission of these
supplemental PE survey data. The criteria were modified in response to
comments received, and published in the Federal Register (65 FR 65376)
as part of the November 1, 2000 final rule. The PFS final rules
published in 2001 and 2003, respectively, (66 FR 55246 and 68 FR 63196)
extended the period during which we would accept these supplemental
data.
As discussed in the January 7, 2004 physician fee schedule final
rule (69 FR 1092), section 303(a)(1)(B) of MMA amended section
1848(c)(2) of the Act by adding new subparagraph (H), ``Adjustments in
Practice Expense Relative Value Units for Certain Drug Administration
Services beginning in 2004''. Subparagraph (H)(i) requires the
Secretary to determine the practice expense RVUs for 2004 using
practice expense surveys submitted to the Secretary as of January 1,
2003 by a physician specialty organization in accordance with section
212 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act
(BBRA) of 1999 if the survey: (1) Covers practice expenses for oncology
drug administration services; and (2) meets criteria established by the
Secretary for acceptance of such surveys. Consistent with section
1848(c)(2)(H)(i) of the Act, in January 7, 2005 final rule, we
announced we would use the ASCO survey to determine the practice
expense RVUs for physician fee schedule services furnished on or after
January 1, 2004 because it: (1) Was submitted prior to January 1, 2003;
(2) includes expenses for drug administration services; and (3) meets
criteria we have established for use of surveys.

[[Page 70120]]

3. Resource-Based Malpractice RVUs
Section 4505(f) of the BBA amended section 1848(c) of the Act to
require us to implement resource-based malpractice RVUs for services
furnished on or after 2000. The resource-based malpractice RVUs were
implemented in the PFS final rule published November 2, 1999 (64 FR
59380). The malpractice RVUs are based on malpractice insurance premium
data collected from commercial and physician-owned insurers from all
the States, the District of Columbia, and Puerto Rico.
4. Refinements to the RVUs
Section 1848(c)(2)(B)(i) of the Act requires that we review all
RVUs no less often than every five years. The first 5-year review of
the physician work RVUs went into effect in 1997, published on November
22, 1996 (61 FR 59489). The second 5-year review went into effect in
2002, published on November 1, 2001 (66 FR 55246). The next 5-year
review is scheduled to go into effect in 2007.
In 1999, the AMA's RUC established the Practice Expense Advisory
Committee (PEAC) for the purpose of refining the direct PE inputs.
Through March of 2004, the PEAC provided recommendations to CMS for
over 7,600 codes (all but a few hundred of the codes currently listed
in the AMA's Current Procedural Terminology (CPT) codes).
In the November 15, 2004, PFS final rule (69 FR 66236), hereinafter
referred to as the CY 2005 final rule, we implemented the first 5-year
review of the malpractice RVUs (69 FR 66263).
5. Adjustments to RVUS Are Budget Neutral
Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments
in RVUs for a year may not cause total PFS payments to differ by more
than $20 million from what they would have been if the adjustments were
not made. In accordance with section 1848(c)(2)(B)(ii)(II) of the Act,
if adjustments to RVUs cause expenditures to change by more than $20
million, we make adjustments to ensure that expenditures do not
increase or decrease by more than $20 million.

C. Components of the Fee Schedule Payment Amounts

Under the formula set forth in section 1848(b)(1) of the Act, the
payment amount for each service paid under the physician fee schedule
is the product of three factors: (1) A nationally uniform relative
value unit (RVU) for the service; (2) a geographic adjustment factor
(GAF) for each physician fee schedule area; and (3) a nationally
uniform conversion factor (CF) for the service. The CF converts the
relative values into payment amounts.
For each physician fee schedule service, there are 3 relative
values: (1) An RVU for physician work; (2) an RVU for practice expense;
and (3) an RVU for malpractice expense. For each of these components of
the fee schedule, there is a geographic practice cost index (GPCI) for
each fee schedule area.
To calculate the payment for every physician service, the
components of the fee schedule (physician work, PE, and malpractice
RVUs) are adjusted by a geographic practice cost index (GPCI). The
GPCIs reflect the relative costs of physician work, PEs, and
malpractice insurance in an area compared to the national average costs
for each component.
Payments are converted to dollar amounts through the application of
a CF, which is calculated by the Office of the Actuary and is updated
annually for inflation.
The general formula for calculating the Medicare fee schedule
amount for a given service and fee schedule area can be expressed as:

Payment = [(RVU work x GPCI work) + (RVU PE x GPCI PE) + (RVU
malpractice x GPCI malpractice)] x CF.

The CF for calendar year (CY) 2005 appears in section VI, Physician
Fee Schedule Update for CY 2006. The RVUs for CY 2006 are in Addendum
B. The GPCIs for CY 2006 can be found in Addendum D.
Section 1848(e) of the Act requires us to develop GAFs for all
physician fee schedule areas. The total GAF for a fee schedule area is
equal to a weighted average of the individual GPCIs for each of the
three components of the service. However, in accordance with the
statute, the GAF for the physician's work reflects one-quarter of the
relative cost of physician's work compared to the national average.

D. Most Recent Changes to the Fee Schedule

In the CY 2005 final rule (69 FR 66236), we refined the resource-
based PE RVUs and made other changes and clarifications to Medicare
Part B payment policy. These included:
Supplemental survey data for PE;
Updated GPCIs for physician work and PE;
Updated malpractice RVUs;
Revised requirements for supervision of therapy
assistants;
Revised payment rules for low osmolar contrast media
(LOCM);
Payment policies for physicians and practitioners managing
dialysis patients;
Clarification of care plan oversight (CPO) requirements;
Requirements for supervision of diagnostic psychological
testing services;
Clarifications to the policies affecting therapy services
provided incident to a physician's service;
Requirements for assignment of Medicare claims;
Additions to the list of telehealth services;
Changes to payments for drug administration services; and
Several coding issues.
The CY 2005 final rule (69 FR 66236) also addressed the following
provisions of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA) (Pub. L. 108-173):
Coverage of an initial preventive physical examination.
Coverage of cardiovascular screening blood tests.
Coverage of diabetes screening tests.
Incentive payment improvements for physicians in physician
shortage areas.
Changes to payment for covered outpatient drugs and
biologicals and drug administration services.
Changes to payment for renal dialysis services.
Coverage of routine costs associated with certain clinical
trials of category A devices as defined by the Food and Drug
Administration.
Coverage of hospice consultation service.
Indexing the Part B deductible to inflation.
Extension of coverage of intravenous immune globulin
(IVIG) for the treatment in the home of primary immune deficiency
diseases.
Revisions to reassignment provisions.
Payment for diagnostic mammograms.
Coverage of religious nonmedical health care institution
items and services to the beneficiary's home.
In addition, the CY 2005 PFS final rule finalized the calendar year
(CY) 2004 interim RVUs for new and revised codes in effect during CY
2004 and issued interim RVUs for new and revised procedure codes for CY
2005; updated the codes subject to the physician self-referral
prohibition; discussed payment for set up of portable x-ray equipment;
discussed the third 5-year refinement of work RVUs; and solicited
comments on potentially misvalued work RVUs.
In accordance with section 1848(d)(1)(E) of the Act, we also
announced that the PFS update for CY 2005 would be 1.5 percent; the
initial

[[Page 70121]]

estimate for the sustainable growth rate for CY 2005 was 4.3; and the
CF for CY 2005 would be $37.8975.

II. Provisions of the Final Rule

In response to the August 8, 2005 proposed rule (70 FR 45764), we
received approximately 15,000 comments. We received comments from
individual physicians, health care workers, professional associations
and societies, and beneficiaries. The majority of the comments
addressed the proposals related to PE and the negative update to the
PFS, GPCIs, and Teaching Anesthesiology.
The proposed rule discussed policies that affected the RVUs on
which payment for certain services would be based and other changes to
Medicare Part B payment policy. We also discussed changes related to
payment for covered outpatient drugs and biologicals; supplemental
payments to federally qualified health centers (FQHCs); payment for
renal dialysis services; the national coverage decision (NCD) process;
coverage of screening for glaucoma; private contracts; and physician
referrals for nuclear medicine services and supplies to health care
entities with which they have financial relationships. RVU changes
implemented through this final rule with comment are subject to the $20
million limitation on annual adjustments contained in section
1848(c)(2)(B)(ii)(II) of the Act.
After reviewing the comments and determining the policies we would
implement, we have estimated the costs and savings of these policies
and discuss in detail the effects of these changes in the Regulatory
Impact Analysis in section XIV.
For the convenience of the reader, the headings for the policy
issues correspond to the headings used in the August 8, 2005 proposed
rule. More detailed background information for each issue can be found
in the August 8, 2005 proposed rule.

A. Resource Based Practice Expense (PE) RVUs

Based on section 1848(c)(1)(B) of the Act, PEs are the portion of
the resources used in furnishing the service that reflects the general
categories of physician and practitioner expenses (such as office rent
and wages of personnel, but excluding malpractice expenses).
Section 121 of the Social Security Amendments of 1994 (Pub. L. 103-
432), enacted on October 31, 1994, required us to develop a methodology
for a resource-based system for determining PE RVUs for each
physician's service. Up until that point, physicians' PEs were based on
historical allowed charges. This legislation stated that the revised PE
methodology must consider the staff, equipment, and supplies used in
the provision of various medical and surgical services in various
settings beginning in 1998. The Secretary has interpreted this to mean
that Medicare payments for each service would be based on the relative
PE resources typically involved with performing the service.
The initial implementation of resource-based PE RVUs was delayed
until January 1, 1999, by section 4505(a) of the BBA. In addition,
section 4505(b) of the BBA required the new payment methodology be
phased-in over 4 years, effective for services furnished in CY 1999,
and fully effective in CY 2002. The first step toward implementation
called for by the statute was to adjust the PE values for certain
services for CY 1998. Section 4505(d) of BBA required that, in
developing the resource-based PE RVUs, the Secretary must:
Use, to the maximum extent possible, generally accepted
cost accounting principles that recognize all staff, equipment,
supplies, and expenses, not solely those that can be linked to specific
procedures.
Develop a refinement method to be used during the
transition.
Consider, in the course of notice and comment rulemaking,
impact projections that compare new proposed payment amounts to data on
actual physician PEs.
Beginning in CY 1999, Medicare began the 4 year transition to
resource-based PE RVUs. In CY 2002, the resource-based PE RVUs were
fully transitioned.
1. Current Methodology
The following sections discuss the current PE methodology.
a. Data Sources
There are two primary data sources used to calculate PEs. The AMA's
SMS survey data are used to develop the PEs per hour for each
specialty. The second source of data used to calculate PEs was
originally developed by the CPEP. The CPEP data include the supplies,
equipment, and staff times specific to each procedure.
The AMA developed the SMS survey in 1981 and discontinued it in
1999. Beginning in 2002, we incorporated the 1999 SMS survey data into
our calculation of the PE RVUs, using a 5-year average of SMS survey
data. (See Revisions to Payment Policies and Five-Year Review of and
Adjustments to the Relative Value Units Under the Physician Fee
Schedule for CY 2002 final rule, published November 1, 2001 (66 FR
55246).) The SMS PE survey data are adjusted to a common year, 1995.
The SMS data provide the following six categories of PE costs:
Clinical payroll expenses, which are payroll expenses
(including fringe benefits) for clinical nonphysician personnel.
Administrative payroll expenses, which are payroll
expenses (including fringe benefits) for nonphysician personnel
involved in administrative, secretarial or clerical activities.
Office expenses, which include expenses for rent, mortgage
interest, depreciation on medical buildings, utilities and telephones.
Medical material and supply expenses, which include
expenses for drugs, x-ray films, and disposable medical products.
Medical equipment expenses, which include depreciation
expenses, leases, and rent of medical equipment used in the diagnosis
or treatment of patients.
All other expenses, including expenses for legal services,
accounting, office management, professional association memberships,
and any professional expenses not mentioned above.
In accordance with section 212 of the BBRA, we established a
process to supplement the SMS data for a specialty with data collected
by entities and organizations other than the AMA (that is, the
specialty itself). (See the Criteria for Submitting Supplemental
Practice Expense Survey Data interim final rule with comment period,
published on May 3, 2000 (65 FR 25664).) Originally, the deadline to
submit supplementary survey data was through August 1, 2001. This
deadline was extended in the November 1, 2001 final rule through August
1, 2003. (See the Revisions to Payment Policies and Five-Year Review of
and Adjustments to the Relative Value Units Under the Physician Fee
Schedule for CY 2002 final rule, published on November 1, 2001 (66 FR
55246).) Then, to ensure maximum opportunity for specialties to submit
supplementary survey data, we extended the deadline to submit surveys
until March 1, 2005. (See the Revisions to Payment Policies Under the
Physician Fee Schedule for CY 2002 final rule, published on November 7,
2003 (68 FR 63196).)
The CPEPs consisted of panels of physicians, practice
administrators, and nonphysicians (registered nurses, for example) who
were nominated by physician specialty societies and other groups. There
were 15 CPEPs consisting

[[Page 70122]]

of 180 members from more than 61 specialties and subspecialties.
Approximately 50 percent of the panelists were physicians.
The CPEPs identified specific inputs involved in each physician
service provided in an office or facility setting. The inputs
identified were the quantity and type of nonphysician labor, medical
supplies, and medical equipment.
In 1999, the AMA's Multi-specialty Relative Value Update Committee
(RUC) established the PEAC. Since 1999, and until March 2004, the PEAC,
a multi-specialty committee, reviewed the original CPEP inputs and
provided us with recommendations for refining these direct PE inputs
for existing CPT codes. Through its last meeting in March 2004, the
PEAC provided recommendations which we have reviewed and accepted for
over 7,600 codes. As a result of this scrutiny by the PEAC, the current
CPEP/RUC inputs differ markedly from those originally recommended by
the CPEPs. The PEAC has now been replaced by the Practice Expense
Review Committee (PERC), which acts to assist the RUC in recommending
PE inputs.
b. Allocation of Practice Expenses to Services
In order to establish PE RVUs for specific services, it is
necessary to establish the direct and indirect PE associated with each
service. Our current approach is to allocate aggregate specialty
practice costs to specific procedures and, thus, it is often referred
to as a ``top-down'' approach. The specialty PEs are derived from the
AMA's SMS survey and supplementary survey data. The PEs for a given
specialty are allocated to the services performed by that specialty on
the basis of the CPEP/RUC data and work RVUs assigned to each CPT code.
The specific process is detailed as follows:

Step 1--Calculation of the SMS Cost Pool for Each Specialty

The six SMS cost categories can be described as either direct or
indirect expenses. The three direct expense categories include clinical
labor, medical supplies and medical equipment. Indirect expenses
include administrative labor, office expense, and all other expenses.
We combine these indirect expenses into a single category. The SMS cost
pool for each specialty is calculated as follows:
The specialty PE per hour (PE/HR) for each of the three
direct and one indirect cost categories from the SMS is calculated by
dividing the aggregate PE per specialty by the specialty's total hours
spent in patient care activities (also determined by the SMS survey).
The PE/HR is divided by 60 to obtain the PE per minute (PE/MIN).
Each specialty's PE pools (for each of the three direct
and one indirect cost categories) are created by multiplying the PE/MIN
for the specialty by the total time the specialty spent treating
Medicare patients for all procedures (determined using Medicare
utilization data). Physician time on a procedure-specific level is
available through RUC surveys of new or revised codes and through
surveys conducted as part of the 5-year review process. For codes that
the RUC has not yet reviewed, the original data from the Harvard
resource-based RVU system survey is used. Physician time includes time
spent on the case before, during, and after the procedure. The
physician procedure time is multiplied by the frequency that each
procedure is performed on Medicare patients by the specialty.
The total specialty-specific SMS PE for each cost category
is the sum, for each direct and indirect cost category, of all of the
procedure-specific total PEs.
Table 1 illustrates an example of the calculation of the total SMS
cost pools for the three direct and one indirect cost categories
discussed in step 1. For this specialty, PE/HR for clinical payroll
expenses is $9.30 per hour. The hourly rate is divided by 60 minutes to
obtain the clinical payroll per minute for the specialty.
The total clinical payroll for providing hypothetical procedure
00001 for this specialty of $3,633,465 is the result of taking the
clinical payroll per minute of $0.16; multiplying this by the physician
time for procedure 00001 (56 minutes); and multiplying the result by
the number of times this procedure was provided to Medicare patients by
this specialty (418,602). The total amount spent on clinical payroll in
this specialty is $667,457,018. This amount is calculated by summing
the clinical payroll expenses of procedure 00001 and all of the other
services provided by this specialty.
[GRAPHIC] [TIFF OMITTED] TR21NO05.002

Step 2--Calculation of CPEP Cost Pool

CPEP data provide expenditure amounts for the direct expense
categories (clinical labor, supplies, and equipment cost) at the
procedure level. Multiplying the CPEP procedure-level PEs for each of
these three categories by the number of times the specialty provided
the procedure, produces a total category cost, per procedure, for that
specialty. The sum of the total expenses from each procedure results in
the total CPEP category cost for the specialty.

[[Page 70123]]

For example, in Table 2, using CPEP data, the clinical labor cost
of procedure 00001 is $65.23. Under the methodology described above in
this step, this is multiplied by the number of services for the
specialty (418,602), to yield the total CPEP data clinical labor cost
of the procedure: $27,305,408. In this example, the clinical labor cost
for all other services performed by this specialty is $831,618,600.
Therefore, the entire clinical labor CPEP expense pool for the
specialty is $858,924,008. Step 2 is repeated to calculate the CPEP
supply and equipment costs.
[GRAPHIC] [TIFF OMITTED] TR21NO05.003

Step 3--Calculation and Application of Scaling Factors

This step ensures that the total of the CPEP costs across all
procedures performed by the specialty equates with the total direct
costs for the specialty as reflected by the SMS data. To accomplish
this, the CPEP data are scaled to SMS data by means of a scaling factor
so that the total CPEP costs for each specialty equals the total SMS
cost for the specialty. (The scaling factor is calculated by dividing
the specialty's SMS pool by the specialty's CPEP pool.)
The unscaled CPEP cost per procedure value, at the direct cost
level, is then multiplied by the respective specialty scalar to yield
the scaled CPEP procedure value. The sum of the scaled CPEP direct cost
pool expenditures equals the total scaled direct expense for the
specific procedure at the specialty level.
In the Step 3 example shown in Table 3, the SMS total clinical
labor costs for the specialty is $667,457,018. This amount divided by
the CPEP total clinical labor amount of $858,924,008 yields a scaling
factor of 0.78. The CPEP clinical labor cost for hypothetical procedure
00001 is $65.23. Multiplying the 0.78 scaling factor for clinical labor
costs by $65.23 yields the scaled clinical labor cost amount of $50.69.
Individual scaling factors must also be calculated for supply and
equipment expenses. The sum of the scaled direct cost values, $50.69,
$43.90, and $139.45, respectively, equals the total scaled direct
expense of $234.04.

Table 3.--Calculation and Application of Scaling Factors
----------------------------------------------------------------------------------------------------------------
Total Scaled
direct expense
Standard methodology Clinical/Labor Supplies Equipment (Sum of A, B, and
C)
(A) (B) (C) (D)
----------------------------------
(a) Total--SMS Pool.............. $667,457,018 $344,493,945 $531,094,831
(b) Total--CPEP Pool............. 858,924,008 411,894,617 5,929,275,023
(c) Scaling Factor............... 0.78 52.49 1,556.86
Unscaled Value
(e) CPT 00001--Scaled Value...... 50.69 43.90 139.45 $234.04
(c) = (a)/(b)
(e) = (c)*(d)
----------------------------------------------------------------------------------------------------------------

Step 4--Calculation of Indirect Expenses

Indirect PEs cannot be directly attributed to a specific service
because they are incurred by the practice as a whole. Indirect costs
include rent, utilities, office equipment and supplies, and accounting
and legal fees. There is not a single, universally accepted approach
for allocating indirect practice costs to individual procedure codes.
Rather allocation involves judgment in identifying the base or bases
that are the best measures of a practice's indirect costs.
To allocate the indirect PEs to a specific service, we use the
following methodology:
The total scaled direct expenses and the converted work
RVU (the work RVU for the service is multiplied by $34.5030, the 1995
CF) are added together, and then multiplied by the number of services
provided by the specialty to Medicare patients.
The total indirect PEs per specialty are calculated by
summing the indirect expenses for all other procedures provided by that
specialty.
For example, in Table 4, the physician work RVU for procedure 00001
is 2.36. Multiplying the work RVU by the 1995 CF of $34.5030 equals
$81.43. The physician work value is added to the scaled total direct
expense from Step 3

[[Page 70124]]

($234.04). The total of $314.47 is a proxy for the indirect PE for the
specialty attributed to this procedure. The total indirect expenses are
then multiplied by the number of times procedure 00001 is provided by
the specialty (418,602), to calculate total indirect expenses for this
procedure of $132,055,728. The process is repeated across all
procedures performed by the specialty, and the indirect expenses for
each service are summed to arrive at the total specialty indirect PE
pool of $6,745,545,434.

Table 4.--Calculation of Indirect Expense
----------------------------------------------------------------------------------------------------------------
Total direct
Standard Methodology Physician Work* expense Total
(A) (B) (C)
-------------------------------------------------------
(a) CPT 00001......................................... $81.43 $234.04 $315.47
(b) Allowed Services.................................. ................. ................. 418,602
--------------------
(c) Subtotal.......................................... ................. ................. 132,055,728
(d) All Other Services................................ ................. ................. 6,613,489,706
====================
(e) Total Indirect Expense............................ ................. ................. 6,745,545,434
----------------------------------------------------------------------------------------------------------------
* Calculated by multiplying work RVU of 2.36 by 1995 CF of $34.5030.

Step 5--Calculation and Application of Indirect Scaling Factors

Similar to the direct costs, the indirect costs are scaled to
ensure that the total across all procedures performed by the specialty
equates with the total indirect costs for the specialty as reflected by
the SMS data. To accomplish this, the indirect costs calculated in Step
4 (Table 4) are scaled to SMS data. The calculation of the indirect
scaling factors is as follows:
The specialty's total SMS indirect expense pool is divided
by the specialty's total indirect expense pool calculated in Step 4
(Table 4), to yield the indirect expense scaling factor.
The unscaled indirect expense amount, at the procedure
level, is multiplied by the specialty's scaling factor to calculate the
procedure's scaled indirect expenses.
The sum of the scaled indirect expense amount and the
procedure's direct expenses yields the total PEs for the specialty for
this procedure.
In table 5, to calculate the indirect scaling factor for
hypothetical procedure 00001, divide the total SMS indirect pool,
$3,337,285,089 (calculated in Step 1-Table 1)), by the total indirect
expense for the specialty across all procedures of $6,745,545,434. This
results in a scaling factor of 0.49. Next, the unscaled indirect cost
of $315.47 is multiplied by the 0.49 scaling factor, resulting in
scaled indirect cost of $156.07. To calculate the total PEs for the
specialty for procedure 00001, the scaled direct and indirect expenses
are added, totaling $390.12.

Table 5.--Calculation of Indirect Scaling Factors and Total Practice Expenses
----------------------------------------------------------------------------------------------------------------
Specialty
specific practice
Standard methodology Indirect costs Direct cost expenses (Sum of
A, B)
(A) (B) (C)
-------------------------------------------------------
(a) Total--SMS Indirect Expense....................... $3,337,285,089
(b) Total Indirect Expense for all Procedures (from 6,745,545,434
Step 4)..............................................
(c) Scaling Factor.................................... 0.49
(d) CPT 00001--Unscaled Value......................... 315.47
(e) CPT 00001--Scaled Value........................... 156.07 $234.04 $390.12
----------------------------------------------------------------------------------------------------------------

Step 6--Weighted Average of RVUs for Procedures Performed by More Than
One Specialty

For codes that are performed by more than one specialty, a
weighted-average PE is calculated based on Medicare frequency data of
all specialties performing the procedure as shown in Table 6.

Table 6.--Weight Averaging for All Specialties
------------------------------------------------------------------------
Practice expense Percent of total
Standard methodology value allowed services
(A) (B)
-----------------------------------
(a) Specialty Total Practice $390.12 83
Expense..........................
(b) Weighted Avg.--All Other 929.87 17
Specialties......................
(c) Weighted Avg.--All Specialties 481.70 100
------------------------------------------------------------------------

[[Page 70125]]

Step 7--Budget Neutrality and Final RVU Calculation

The total scaled direct and indirect inputs are then adjusted by a
budget neutrality factor (BNF) to calculate RVUs. Section
1848(c)(2)(B)(ii)(II) of the Act provides that adjustments in RVUs may
not cause total PFS payments to differ by more than $20 million from
what they would have been if the adjustments were not made. Budget
neutrality for the upcoming year is determined relative to the sum of
PE RVUs for the current year. Although the PE RVUs for any particular
code may vary from year-to-year, the sum of PE RVUs across all codes is
set equal to the current year. The BNF is equal to the sum of the
current year's PE RVUs, divided by the sum of the direct and indirect
inputs across all codes for the upcoming year. The BNF is applied to
(multiplied by) the scaled direct and indirect expenses for each code
to set the PE RVU for the upcoming year.
In Table 7, the sum of the scaled direct and indirect expenses for
hypothetical code 00001 ($481.70) is multiplied by the BNF (0.02 in
this example) to yield a PE RVU of 10.60.

Table 7.--Calculate PE RVU
----------------------------------------------------------------------------------------------------------------
Total scaled
direct and Budget neutrality Final PE RVU
indirect inputs factor
(A) (B) (C)
--------------------------------------------------------
(a) Code 00001......................................... $481.70 0.02 10.60
----------------------------------------------------------------------------------------------------------------

c. Other Methodological Issues: Nonphysician Work Pool (NPWP)
As an interim measure, until we could further analyze the effect of
the top-down methodology on the Medicare payment for services with no
physician work (including the technical components (TCs) of radiation
oncology, radiology and other diagnostic tests), we created a separate
PE pool for these services. However, any specialty society could
request that its services be removed from the nonphysician work pool
(NPWP). We have removed some services from the NPWP if we find that the
requesting specialty provides the service the majority of the time.

NPWP Step 1--Calculation of the SMS Cost Pool for Each Code

This step parallels the calculations described above for the
standard ``top-down'' PE allocation methodology. For codes in the NPWP,
the direct and indirect SMS costs are set equal to the weighted average
of the PE/HR for the specialties that provide the services in the pool.
Clinical staff time is substituted for physician time in the
calculation. The clinical staff time for the code is from CPEP data.
Otherwise, the calculation is similar to the method described
previously for codes with physician time.
The following example in Table 8 illustrates this calculation for
hypothetical code 00002. In this example, the average clinical payroll
PE/HR for all specialties in the NPWP is $12.30 and the clinical staff
time for code 00002 is 116 minutes.
[GRAPHIC] [TIFF OMITTED] TR21NO05.004

NPWP Step 2--Calculation of Charge-Based PE RVU Cost Pool

The NPWP calculation uses the 1998 (charge-based) PE RVU value for
the code, multiplied by the 1995 CF (25.74 x $34.503 = $888.11). The
percentage of clinical labor, supplies and equipment are the percentage
that each PE category represents for all physicians relative to the
total PE for all physicians (calculated from the SMS data) as shown in
Table 9.

[[Page 70126]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.005

NPWP Step 3--Calculation and Application of Scaling Factors

After the total cost pools for each code in the NPWP are
calculated, the steps to ensure the total charge-based PEs for the
procedure do not exceed the total SMS PEs for the procedure (scaling)
are the same as those described previously for codes with physician
work.
In Table 10, the SMS total clinical labor costs are $2,499,159.
This amount divided by the charge-based total clinical labor amount of
$16,613,742 yields a scaling factor of 0.15. The charge-based clinical
labor cost for hypothetical procedure 00002 is $158.08 (from NPWP Step
2--Table 9). Multiplying the 0.15 scaling factor for clinical labor
costs by $158.08 yields the scaled clinical labor cost amount of
$23.78. Individual scaling factors must be calculated for both supply
and equipment expenses. The sum of the scaled direct cost values,
$23.78, $32.57 and $2.72, respectively, equals the total scaled direct
expense of $59.07.

Table 10.--Calculation and Application of Direct Cost Scaling Factors
----------------------------------------------------------------------------------------------------------------
Total scaled
direct expense
NPWP methodology Clinical Supplies Equipment (Sum of A, B,
and C)
(A) (B) (C) (D)
--------------------------------------
(a) Total--NPWP Specialty Pool....... $2,499,159 $1,503,559 $650,188
(b) Total NPWP Charge-based Pool..... 16,613,742 4,386,775 9,986,912
(c) Scaling Factor................... 0.15 0.34 0.06
(d) CPT 00002--Unscaled Value........ 158.08 95.03 41.74
(e) CPT 00002--Scaled Value.......... 23.78 32.57 2.72 $59.07
----------------------------------------------------------------------------------------------------------------

NPWP Step 4--Calculation of Indirect Expenses

Because codes in the NPWP do not have work RVUs, indirect expenses
are set equal to direct expenses (for codes with physician work,
indirect expenses equal the sum of the scaled direct expenses and the
converted work RVU). This amount is then multiplied by the number of
times the procedure is performed.
In Table 11, the scaled total direct expense from NPWP Step 3
(Table 10) ($59.07) is also the proxy for the total indirect expense
attributed to the procedure. The total indirect expense is multiplied
by the number of services (105,095), to calculate total indirect cost

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