Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011; Corrections, 1670-1859 [2010-33264]
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Federal Register / Vol. 76, No. 7 / Tuesday, January 11, 2011 / Rules and Regulations
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Parts 405, 409, 410, 411, 413,
414, 415, and 424
[CMS–1503–CN2]
RIN 0938–AP79
Medicare Program; Payment Policies
Under the Physician Fee Schedule and
Other Revisions to Part B for CY 2011;
Corrections
physician fee schedule (PFS) for CY
2011.
As this correction notice corrects the
CY 2011 physician fee schedule final
rule with comment period that was
released prior to enactment of the
statutory changes contained in the two
laws noted above, the statutory changes
to PFS payments for CY 2011 are not
reflected in this correction notice.
Payment files reflecting current law as
of January 1, 2011 will be made
available through usual CMS notices
and data files.
II. Summary of Errors
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Correction of final rule with
comment period.
A. Errors in the Preamble
This document corrects
several technical and typographical
errors in the final rule with comment
period that appeared in the November
29, 2010 Federal Register entitled
‘‘Medicare Program; Payment Policies
Under the Physician Fee Schedule and
Other Revisions to Part B for CY 2011;
Final Rule’’ (75 FR 73170).
DATES: Effective Date: This correction is
effective January 1, 2011.
FOR FURTHER INFORMATION CONTACT:
Rebecca Cole or Erin Smith, (410) 786–
4497.
SUPPLEMENTARY INFORMATION:
On page 73276, we are correcting the
adjustments to the PE and malpractice
RVUs to match the proportions of the
RVU shares to the rebased and revised
Medicare Economic Index (MEI),
resulting from the corrections of work,
PE, and malpractice RVUs discussed in
this section. We are making the
corresponding changes to Table 45—
Calculation of the CY 2011 PFS CF.
On pages 73283 and 73284, we are
correcting the figures for the CY 2011
budget neutrality factors, conversion
factor (CF), and anesthesia CF to reflect
the updated values resulting from the
corrections to the work, PE, and
malpractice RVUs discussed in this
section.
On page 73388, we are correcting
Table 60—CY 2011 RVUs for CPT code
77080 to reflect the corrected CF.
AGENCY:
1. Errors in the Budget Neutrality,
Conversion, Anesthesia, and Other
Factors
SUMMARY:
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I. Background
In FR Doc. 2010–27969 of November
29, 2010 (75 FR 73170) (hereinafter
referred to as the Calendar Year (CY)
2011 Physician Fee Schedule (PFS) final
rule with comment period), there were
a number of technical and typographical
errors that are identified and corrected
in the Correction of Errors section of
this notice. The provisions of this notice
are effective as if they had been
included in the CY 2011 PFS final rule
with comment period. Accordingly, the
corrections are effective January 1, 2011.
On November 30, 2010, the Physician
Payment and Therapy Relief Act of 2010
(Pub. L. 111–286) was signed into law.
Section 3 of Public Law 111–286
changed the policy finalized in the CY
2011 PFS final rule with comment
period regarding payment reductions
applied to multiple therapy services
provided to the same patient on the
same day and paid for under the PFS
effective January 1, 2011.
Further, on December 15, 2010, the
Medicare and Medicaid Extenders Act
of 2010 (Pub. L. 111–309) was signed
into law. Section 101 of Public Law
111–309 provides for a 1-year zeropercent update to the Medicare
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2. Errors in Work RVUs
On page 73328, we are correcting the
count of AMA RUC work RVU
recommendations with which we agreed
or disagreed. Due to a typographical
error, the published count was
incorrect.
On page 73340, we are correcting the
CY 2011 Interim Final Work RVU value
for CPT code 52332 that was listed
incorrectly due to a typographical error.
On page 73341, we are correcting the
CY 2011 Interim Final Work RVU value
for CPT code 77427 that was incorrect
due to a technical error.
On pages 73342 through 73349, we
are correcting Table 53: AMA RUC
Recommendations and Interim Final
Work RVUs for CY 2011 New, Revised,
and Potentially Misvalued Codes to
reflect the corrections previously listed
for CPT codes 52332 and 77427, and to
make these additional corrections:
• The AMA RUC–Recommended
Work RVU value for CPT code 77427
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was incorrect due to a typographical
error.
• The CMS Decision and CY 2011
Interim Final Work RVU fields for CPT
code 64483 were incorrect due to
typographical errors.
3. Errors in the PE RVUs
On pages 73352 and 73353, in Table
54—CPT Codes With Accepted AMA
RUC Direct PE Recommendations for CY
2011 Codes, we listed codes for which
we accepted on an interim final basis
the AMA RUC direct PE
recommendations. However, due to
technical errors, we did not apply the
correct inputs when calculating the PE
values for the following CPT codes:
31296, 31297, 37223, 90945, 95800, and
95801. Similar technical errors in the
creation of the direct practice expense
database resulted in incorrect direct PE
inputs for five other CPT codes: 77750,
92506, 93224, 93225, and 93226. The
corrections to these direct PE inputs are
included in the corrected final CY 2011
direct PE database available under
downloads for the CY 2011 PFS final
rule with comment period on the CMS
Web site at: https://www.cms.gov/
PhysicianFeeSched/PFSFRN/
list.asp#TopOfPage.
Changes to the PE RVUs resulting
from the corrections to the direct PE
inputs and the work RVU corrections
previously noted are reflected in
changes to Addendum B and
Addendum C. We also note that because
work RVUs factor into the calculation
for both the malpractice (MP) and
practice expense (PE) RVUs, those
values for these CPT codes may have
also changed, and these subsequent
changes are reflected in Addenda B and
C. In addition, on page 73188, we are
correcting errors in Table 2—
Calculation of PE RVUs Under
Methodology for Selected Codes (we are
correcting the table in its entirety) as a
result of changed values for PE RVUs
that indirectly resulted from the changes
to work RVUs.
Finally, we note that changes in the
RVUs for these codes affect additional
codes due to various factors related to
the relativity of the system including
budget neutrality and adjustments to
maintain PE RVU shares.
4. Errors in the Malpractice RVUs
In section II.B.2 of the preamble to the
CY 2011 PFS final rule with comment
period, we discussed malpractice RVUs
for new and revised services. These
codes are listed on pages 73209 through
73213 in Table 8: Source Codes for CY
2011 New/Revised Codes Used to Set
the Malpractice RVUs, and their MP
RVU values are listed in Addendum B
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and Addendum C. Due to a technical
error in the application of the
methodology used to calculate the MP
RVUs as described in the CY 2011 PFS
final rule with comment period, the MP
RVU values listed for the following CPT
codes were incorrect: 92606, 92607,
92608, 92609, 93452, 93452TC, 93453,
93453TC, 93454, 93454TC, 93457,
93457TC, 93458, 93458TC, 93459,
93459TC, 93460, 93460TC, 93461,
93461TC.
Additionally, changes to the MP
RVUs resulting from the correction to
the work RVUs for CPT codes 77427 and
52332 as previously described are also
reflected in Addendum B and
Addendum C. Finally, we note that
changes in RVUs previously described
affect MP RVUs for additional codes due
to various factors related to the relativity
of the system.
Due to the changes previously noted,
we are correcting errors on pages 73595
through 73596 in Table 101: CY 2011
PFS Final Rule Total Allowed Charge
Estimated Impact for RVU, MPPR, and
MEI Rebasing Changes and on pages
73598 through 73600 in Table 102:
Impact of Final Rule with Comment
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Period and Estimated Physician Update
on CY 2011 Payment for Selected
Procedures by replacing the tables in
their entirety.
B. Errors in the Addenda
On pages 73630 through 73809 and
73810 through 73815, in Addendum B:
CY 2011—Relative Value Units and
Related Information Used in
Determining Medicare Payments and
Addendum C: Codes with Interim
RVUs, respectively, we need to correct
errors in the work, PE, or MP RVUs (or
combinations of these RVUs) for certain
existing new and revised CY 2011 CPT
codes. These errors are a result of the
technical and typographical errors
identified and summarized in section
II.A. of this correction notice. We note
that we are providing these addenda in
their entirety.
On page 73831 in Addendum J: List
of CPT 1/HCPCS Codes Used to Define
Certain Designated Health Service
Categories 2 under Section 1877 of the
Social Security Act Effective January 1,
2011 we are correcting a technical error
in the short descriptor for HCPCS code
G0431.
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On pages 73841 through 73859, in
Addendum K: CY 2011 ESRD Wage
Index for Urban Areas Based on CBSA
Labor Market Areas, we made technical
and typographical errors in the
composite rate wage index for CBSA
codes 11540, 12060, 19060, 27740, and
35380, and in the ESRD PPS wage index
for CBSA codes 40980 and 43780. On
page 73848, we also made a
typographical error in the CBSA code
for Houston-Sugar Land-Baytown, TX.
On page 73859, in Addendum L: CY
2011 ESRD Wage Index for Rural Areas
Based on CBSA Labor Market Areas, we
made a technical error in the composite
wage index for the nonurban area of
Alaska.
III. Correction of Errors
In FR Doc. 2010–27969 of November
29, 2010 make the following corrections:
A. Corrections to the Preamble
1. On page 73188, in Table 2—
Calculation of PE RVUs Under
Methodology for Selected Codes, the
table is corrected to read as follows:
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AMA ........................
AMA ........................
AMA ........................
Source
=Lab * Dir Adj .........
= Sup * Dir Adj .......
= Eqp * Dir Adj .......
.................................
PFS ........................
Step 1 .............
Steps 2–4 .......
=(Sup * Dir Adj)/CF
Step 5 .............
PFS ........................
Surveys ..................
Surveys ..................
See Step 8 .............
.................................
See Step 8 .............
.................................
.................................
See footnote** ........
=Ind Alloc * Ind Adj
Step 5 .............
Setup File .......
Steps 6, 7 .......
Steps 6, 7 .......
Step 8 .............
Step 8 .............
Step 8 .............
Step 8 .............
Step 8 .............
Steps 9–11 .....
Steps 9–11 .....
See Steps 12–16 ...
.................................
Step 5 .............
Step 18 ...........
Step 18 ...........
PFS ........................
=(Adj Dir + Adj Ind)
* budn * MEI Adj
* MPPR Adj.
Step 17 ...........
Step 18 ...........
= Adj.Ind Alloc *
PCI.
PFS ........................
Steps 12–16 ...
=(Eqp * Dir Adj)/CF
Step 5 .............
=(Lab * Dir Adj)/CF
Steps 2–4 .......
Steps 2–4 .......
Steps 2–4 .......
Steps 2–4 .......
Step 5 .............
.................................
See footnote* .........
Step 1 .............
Step 1 .............
Step 1 .............
Step
................................
=((14)+(26)) * budn
* (27) * (28)
................................
=(24) * (25)
................................
................................
................................
=(19)+(21)
See (20)
See (18)
................................
................................
................................
................................
................................
=(11)+(12)+(13)
=(8)/(10)
=(7)/(10)
=(6)/(10)
=(1)*(5)
=(2)*(5)
=(3)*(5)
=(6)+(7)+(8)
................................
=(1)+(2)+(3)
................................
................................
................................
................................
Formula
1.01
1.06
1.18
0.67
1.11
0.60
0.37
1.62
0.97
0.97
0.26
0.74
((14)/(16)) *
(17)
0.65
(15)
0.22
0.00
0.04
0.18
6.65
1.49
0.10
8.23
36.87
16.50
0.50
13.32
2.98
0.19
99213
Office visit,
est
nonfacility
1.01
15.69
1.18
12.05
0.83
14.46
0.37
39.02
33.75
33.75
0.18
0.82
((14)/(16)) *
(17)
5.27
(15)
1.16
0.01
0.10
1.05
38.68
3.66
0.33
42.67
36.87
85.51
0.50
77.52
7.34
0.65
33533
CABG,
arterial,
single
facility
1.01
0.62
1.18
0.29
0.89
0.32
0.37
0.88
0.30
0.22
0.29
0.71
((14)/(16)) *
(17)
0.58
(15)+(11)
0.23
0.11
0.05
0.08
2.86
1.69
4.08
8.64
36.87
17.31
0.50
5.74
3.39
8.17
71020
Chest x-ray
nonfacility
1.01
0.53
1.18
0.22
0.89
0.24
0.37
0.66
0.08
0.00
0.29
0.71
((14)/(16)) *
(17)
0.58
(11)
0.23
0.11
0.05
0.08
2.86
1.69
4.08
8.64
36.87
17.31
0.50
5.74
3.39
8.17
71020–TC
1.01
0.09
1.18
0.07
0.89
0.08
0.37
0.22
0.22
0.22
0.29
0.71
((14)/(16)) *
(17)
0.00
(15)
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
36.87
0.00
0.50
0.00
0.00
0.00
71020–26
Chest xray
nonfacility
TABLE 2—CALCULATION OF PE RVUS UNDER METHODOLOGY FOR SELECTED CODES
Note: PE RVUs in table 2, row 29, may not match Addendum B due to rounding.
* The direct adj = [current pe rvus * CF * avg dir pct]/[sum direct inputs] = [Step 2]/[Step 3].
** The indirect adj = [current pe rvus * avg ind pct]/[sum of ind allocators] = [Step 9]/[Step 10].
(27) MEI Rebasing Adjustment.
(28) MPPR Adjustment
(29) PE RVU .................
(1) Labor cost (Lab) ......
(2) Supply cost (Sup) ....
(3) Equipment cost
(Eqp.).
(4) Direct cost (Dir) ........
(5) Direct adjustment
(Dir. Adj).
(6) Adjusted Labor .........
(7) Adjusted Supplies ....
(8) Adjusted Equipment
(9) Adjusted direct .........
(10) Conversion Factor
(CF).
(11) Adj. labor cost converted.
(12) Adj. supply cost
converted.
(13) Adj. equipment cost
converted.
(14) Adj. direct cost converted.
(15) Work RVU ..............
(16) Dir_pct ....................
(17) Ind_pct ...................
(18) Ind. Alloc. Formula
(1st part).
(19) Ind. Alloc. (1st part)
(20) Ind. Alloc. Formulas
(2nd part).
(21) Ind. Alloc. (2nd
part).
(22) Indirect Allocator
(1st + 2nd).
(23) Indirect Adjustment
(Ind. Adj.).
(24) Adjusted indirect allocator.
(25) Ind. Practice Cost
Index (IPCI).
(26) Adjusted Indirect ....
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1.01
0.32
1.18
0.17
0.92
0.19
0.37
0.50
0.25
0.17
0.29
0.71
((14)/(16)) *
(17)
0.25
(15)+(11)
0.10
0.00
0.02
0.08
3.05
0.60
0.06
3.71
36.87
7.43
0.50
6.12
1.19
0.12
93000
ECG,
complete
nonfacility
1.01
0.25
1.18
0.11
0.92
0.12
0.37
0.33
0.08
0.00
0.29
0.71
((14)/(16)) *
(17)
0.25
(11)
0.10
0.00
0.02
0.08
3.05
0.60
0.06
3.71
36.87
7.43
0.50
6.12
1.19
0.12
93005
ECG, tracing
nonfacility
1.01
0.07
1.18
0.06
0.92
0.06
0.37
0.17
0.17
0.17
0.29
0.71
((14)/(16)) *
(17)
0.00
(15)
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
36.87
0.00
0.50
0.00
0.00
0.00
93010
ECG, report
nonfacility
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(3) Line 12, the figure ‘‘1.358’’ is
corrected to read ‘‘1.361.’’
3. On page 73283,
a. Top half of the page,
(1) First column, first full paragraph,
(a) Line 1, the figure ‘‘$25.5217’’ is
corrected to read ‘‘$25.4999.’’
(b) Line 3, the figure ‘‘$15.8085’’ is
corrected to read ‘‘$15.7999.’’
(2) Second column, second partial
paragraph, last line, the figure ‘‘1.0045’’
is corrected to read ‘‘1.0043.’’
2. On page 73276, third column,
a. Second full paragraph,
(1) Line 23, the figure ‘‘1.181’’ is
corrected to read ‘‘1.182.’’
(2) Line 24, the figure ‘‘1.358’’ is
corrected to read ‘‘1.361.’’
(3) Line 28, the figure ‘‘1.358’’ is
corrected to read ‘‘1.361.’’
b. Last partial paragraph,
(1) Line 10, the figure ‘‘0.9181’’ is
corrected to read ‘‘0.9175.’’
(2) Line 11, the figure ‘‘1.181’’ is
corrected to read ‘‘1.182.’’
CY 2011 RVU Budget Neutrality Adjustment ..............................................................
CY 2011 Rescaling to Match MEI Weights Budget Neutrality Adjustment .................
CY 2011 Conversion Factor .........................................................................................
4. On pages 73283 and 73284, top of
the page, in Table 46—Calculation of
the CY 2011 Anesthesia Conversion
(3) Third column, first partial
paragraph,
(a) Line 6, the figure ‘‘0.9181’’ is
corrected to read ‘‘0.9175.’’
(b) Line 15, the figure ‘‘$25.5217’’ is
corrected to read ‘‘$25.4999’’
b. Bottom half of the page, in Table
45—Calculation of the CY 2011 PFS CF,
the listed entries are corrected to read as
follows:
0.4 percent (1.0043).
¥8.3 percent (0.9175).
...................................................................
¥2.4 percent (0.9760).
...................................................................
a. Line 9, the number ‘‘1.47’’ is
corrected to read ‘‘2.60.’’
b. Line 10, the phrase ‘‘25th
percentile’’ is corrected to read ‘‘low
value.’’
c. Line 14, the number ‘‘1.47’’ is
corrected to read ‘‘2.60.’’
CPT code
Short descriptor
Valued in relation
to a potentially
misvalued code
screen
52332 .....
64483 .....
77427 .....
Cystoscopy and treatment ..........................................................
Inj foramen epidural l/s ................................................................
Radiation tx management x5 ......................................................
AMA RUCrecommended
work RVUs
2.83
1.90
3.45
a. First column, first paragraph, last
line, the figure ‘‘$25.5217’’ is corrected
to read ‘‘$25.4999.’’
$15.7999
7. On page 73341, third column, last
paragraph, line 12, the figure ‘‘2.92’’ is
corrected to read ‘‘3.37.’’
8. On pages 73342 through 73349, in
Table 53—AMA RUC Recommendations
and Interim Final Work RVUs for CY
2011 New, Revised, and Potentially
Misvalued Codes the listed entries are
corrected to read as follows:
x
x
x
9. On page 73388, lower third of the
page,
$25.4999
Factor, the listed entries are corrected to
read as follows:
CY 2011 Anesthesia Adjustment .................................................................................
CY 2011 Anesthesia Conversion Factor ......................................................................
5. On page 73328, first column, last
paragraph,
a. Line 4, the figure ‘‘207’’ is corrected
to read ‘‘206.’’
b. Line 7, the figure ‘‘84’’ is corrected
to read ‘‘85.’’
6. On page 73340, first column, first
full paragraph,
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CMS
decision
Disagree ..
Disagree ..
Disagree ..
CY 2011
interim final
work RVUs
2.60
1.75
3.37
b. Table 60—CY 2011 RVUs for CPT
Code 77080, the table is corrected to
read as follows:
TABLE 60—CY 2011 RVUS FOR CPT CODE 77080
[Note: Calculated using the current law CY 2011 CF of $25.4999]
CY 2011 physician work RVUs
Mod
77080 .........................................................................
77080 .........................................................................
77080 .........................................................................
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CY 2011 CPT code
CY 2011 nonfacility PE RVUs
0.31
0.00
0.31
0.10
3.23
3.33
26 .............
TC ............
..................
10. On pages 73595 and 73596, in
Table 101—CY 2011 PFS Final Rule
Total Allowed Charge Estimate Impact
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PE RVUs
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0.01
0.18
0.19
Changes, the table is corrected to read
as follows:
BILLING CODE 4120–01–P
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0.10
NA
NA
CY 2011 malpractice RVUs
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Comment Period and Estimated
Physician Update on CY 2011 Payment
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for Selected Procedures, the table is
corrected to read as follows:
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11. On pages 73598 through 73600, in
Table 102—Impact of Final Rule with
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1. On pages 73630 through 73809, in
Addendum B: CY 2011–Relative Value
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Units and Related Information Used in
Determining Medicare Payments, the
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addendum is corrected to read as
follows:
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B. Corrections to the Addenda
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January 1, 2011, the listed entry is
corrected to read as follows:
Labor Market Areas, the listed entries
are corrected to read as follows:
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Service Categories 2 under Section 1877
of the Social Security Act Effective
4. On pages 73841 through 73859, in
Addendum K: CY 2011 ESRD Wage
Index for Urban Areas Based on CBSA
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4. On page 73859, in Addendum L:
CY 2011 ESRD Wage Index for Rural
Areas Based on CBSA Labor Market
Areas, the listed entry is corrected to
read as follows:
III. Waiver of Proposed Rulemaking
and Delay in Effective Date
the findings and its reasons in the rule
issued.
This document merely corrects
typographical and technical errors made
in the CY 2011 PFS final rule with
comment period, which appeared in the
November 29, 2010 Federal Register
(75 FR 73170), and is (with limited
exceptions not relevant to these
corrections, but noted in the rule),
effective January 1, 2011. The
provisions of the final rule with
comment period have been subjected
previously to notice and comment
procedures. The corrections contained
in this document are consistent with,
and do not make substantive changes to,
the payment methodologies and policies
adopted in the CY 2011 PFS final rule
with comment period. As such, these
corrections are being made to ensure the
CY 2011 PFS final rule with comment
period accurately reflects the policies
adopted in that rule. Therefore, we find
for good cause that it is unnecessary and
would be contrary to the public interest
to undertake further notice and
comment procedures to incorporate
these corrections into the CY 2011 PFS
final rule with comment period.
For the same reasons, we are also
waiving the 30-day delay in effective
date for these corrections. We believe
that it is in the public interest to ensure
that the CY 2011 PFS final rule with
comment period accurately states our
policies as of the date they take effect.
Therefore, we find that delaying the
effective date of these corrections
beyond the effective date of the final
rule with comment period would be
contrary to the public interest. In so
doing, we find good cause to waive the
30-day delay in the effective date.
Authority: (Catalog of Federal Domestic
Assistance Program No. 93.774, Medicare—
Supplementary Medical Insurance Program)
Dated: December 29, 2010.
Dawn L. Smalls,
Executive Secretary to the Department.
[FR Doc. 2010–33264 Filed 12–30–10; 4:15 pm]
BILLING CODE 4120–01–C
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We ordinarily publish a notice of
proposed rulemaking in the Federal
Register to provide a period for public
comment before the provisions of a rule
take effect in accordance with section
553(b) of the Administrative Procedure
Act (APA) (5 U.S.C. 553(b)). However,
we can waive the notice and comment
procedure if the Secretary finds, for
good cause, that the notice and
comment process is impracticable,
unnecessary, or contrary to the public
interest, and incorporates a statement of
the finding and the reasons for it in the
rule.
Section 553(d) of the APA ordinarily
requires a 30-day delay in the effective
date of final rules after the date of their
publication. This 30-day delay in
effective date can be waived, however,
if an agency finds for good cause that
the delay is impracticable, unnecessary,
or contrary to the public interest, and
the agency incorporates a statement of
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]]>Agencies
[Federal Register Volume 76, Number 7 (Tuesday, January 11, 2011)]
[Rules and Regulations]
[Pages 1670-1859]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-33264]
[[Page 1669]]
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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 Parts 405, 409, 410, et al.
Medicare Program; Payment Policies Under the Physician Fee Schedule and
Other Revisions to Part B for CY 2011; Corrections; Final Rule
Federal Register / Vol. 76 , No. 7 / Tuesday, January 11, 2011 /
Rules and Regulations
[[Page 1670]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 405, 409, 410, 411, 413, 414, 415, and 424
[CMS-1503-CN2]
RIN 0938-AP79
Medicare Program; Payment Policies Under the Physician Fee
Schedule and Other Revisions to Part B for CY 2011; Corrections
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Correction of final rule with comment period.
-----------------------------------------------------------------------
SUMMARY: This document corrects several technical and typographical
errors in the final rule with comment period that appeared in the
November 29, 2010 Federal Register entitled ``Medicare Program; Payment
Policies Under the Physician Fee Schedule and Other Revisions to Part B
for CY 2011; Final Rule'' (75 FR 73170).
DATES: Effective Date: This correction is effective January 1, 2011.
FOR FURTHER INFORMATION CONTACT: Rebecca Cole or Erin Smith, (410) 786-
4497.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2010-27969 of November 29, 2010 (75 FR 73170)
(hereinafter referred to as the Calendar Year (CY) 2011 Physician Fee
Schedule (PFS) final rule with comment period), there were a number of
technical and typographical errors that are identified and corrected in
the Correction of Errors section of this notice. The provisions of this
notice are effective as if they had been included in the CY 2011 PFS
final rule with comment period. Accordingly, the corrections are
effective January 1, 2011.
On November 30, 2010, the Physician Payment and Therapy Relief Act
of 2010 (Pub. L. 111-286) was signed into law. Section 3 of Public Law
111-286 changed the policy finalized in the CY 2011 PFS final rule with
comment period regarding payment reductions applied to multiple therapy
services provided to the same patient on the same day and paid for
under the PFS effective January 1, 2011.
Further, on December 15, 2010, the Medicare and Medicaid Extenders
Act of 2010 (Pub. L. 111-309) was signed into law. Section 101 of
Public Law 111-309 provides for a 1-year zero-percent update to the
Medicare physician fee schedule (PFS) for CY 2011.
As this correction notice corrects the CY 2011 physician fee
schedule final rule with comment period that was released prior to
enactment of the statutory changes contained in the two laws noted
above, the statutory changes to PFS payments for CY 2011 are not
reflected in this correction notice. Payment files reflecting current
law as of January 1, 2011 will be made available through usual CMS
notices and data files.
II. Summary of Errors
A. Errors in the Preamble
1. Errors in the Budget Neutrality, Conversion, Anesthesia, and Other
Factors
On page 73276, we are correcting the adjustments to the PE and
malpractice RVUs to match the proportions of the RVU shares to the
rebased and revised Medicare Economic Index (MEI), resulting from the
corrections of work, PE, and malpractice RVUs discussed in this
section. We are making the corresponding changes to Table 45--
Calculation of the CY 2011 PFS CF.
On pages 73283 and 73284, we are correcting the figures for the CY
2011 budget neutrality factors, conversion factor (CF), and anesthesia
CF to reflect the updated values resulting from the corrections to the
work, PE, and malpractice RVUs discussed in this section.
On page 73388, we are correcting Table 60--CY 2011 RVUs for CPT
code 77080 to reflect the corrected CF.
2. Errors in Work RVUs
On page 73328, we are correcting the count of AMA RUC work RVU
recommendations with which we agreed or disagreed. Due to a
typographical error, the published count was incorrect.
On page 73340, we are correcting the CY 2011 Interim Final Work RVU
value for CPT code 52332 that was listed incorrectly due to a
typographical error.
On page 73341, we are correcting the CY 2011 Interim Final Work RVU
value for CPT code 77427 that was incorrect due to a technical error.
On pages 73342 through 73349, we are correcting Table 53: AMA RUC
Recommendations and Interim Final Work RVUs for CY 2011 New, Revised,
and Potentially Misvalued Codes to reflect the corrections previously
listed for CPT codes 52332 and 77427, and to make these additional
corrections:
The AMA RUC-Recommended Work RVU value for CPT code 77427
was incorrect due to a typographical error.
The CMS Decision and CY 2011 Interim Final Work RVU fields
for CPT code 64483 were incorrect due to typographical errors.
3. Errors in the PE RVUs
On pages 73352 and 73353, in Table 54--CPT Codes With Accepted AMA
RUC Direct PE Recommendations for CY 2011 Codes, we listed codes for
which we accepted on an interim final basis the AMA RUC direct PE
recommendations. However, due to technical errors, we did not apply the
correct inputs when calculating the PE values for the following CPT
codes: 31296, 31297, 37223, 90945, 95800, and 95801. Similar technical
errors in the creation of the direct practice expense database resulted
in incorrect direct PE inputs for five other CPT codes: 77750, 92506,
93224, 93225, and 93226. The corrections to these direct PE inputs are
included in the corrected final CY 2011 direct PE database available
under downloads for the CY 2011 PFS final rule with comment period on
the CMS Web site at: https://www.cms.gov/PhysicianFeeSched/PFSFRN/list.asp#TopOfPage.
Changes to the PE RVUs resulting from the corrections to the direct
PE inputs and the work RVU corrections previously noted are reflected
in changes to Addendum B and Addendum C. We also note that because work
RVUs factor into the calculation for both the malpractice (MP) and
practice expense (PE) RVUs, those values for these CPT codes may have
also changed, and these subsequent changes are reflected in Addenda B
and C. In addition, on page 73188, we are correcting errors in Table
2--Calculation of PE RVUs Under Methodology for Selected Codes (we are
correcting the table in its entirety) as a result of changed values for
PE RVUs that indirectly resulted from the changes to work RVUs.
Finally, we note that changes in the RVUs for these codes affect
additional codes due to various factors related to the relativity of
the system including budget neutrality and adjustments to maintain PE
RVU shares.
4. Errors in the Malpractice RVUs
In section II.B.2 of the preamble to the CY 2011 PFS final rule
with comment period, we discussed malpractice RVUs for new and revised
services. These codes are listed on pages 73209 through 73213 in Table
8: Source Codes for CY 2011 New/Revised Codes Used to Set the
Malpractice RVUs, and their MP RVU values are listed in Addendum B
[[Page 1671]]
and Addendum C. Due to a technical error in the application of the
methodology used to calculate the MP RVUs as described in the CY 2011
PFS final rule with comment period, the MP RVU values listed for the
following CPT codes were incorrect: 92606, 92607, 92608, 92609, 93452,
93452TC, 93453, 93453TC, 93454, 93454TC, 93457, 93457TC, 93458,
93458TC, 93459, 93459TC, 93460, 93460TC, 93461, 93461TC.
Additionally, changes to the MP RVUs resulting from the correction
to the work RVUs for CPT codes 77427 and 52332 as previously described
are also reflected in Addendum B and Addendum C. Finally, we note that
changes in RVUs previously described affect MP RVUs for additional
codes due to various factors related to the relativity of the system.
Due to the changes previously noted, we are correcting errors on
pages 73595 through 73596 in Table 101: CY 2011 PFS Final Rule Total
Allowed Charge Estimated Impact for RVU, MPPR, and MEI Rebasing Changes
and on pages 73598 through 73600 in Table 102: Impact of Final Rule
with Comment Period and Estimated Physician Update on CY 2011 Payment
for Selected Procedures by replacing the tables in their entirety.
B. Errors in the Addenda
On pages 73630 through 73809 and 73810 through 73815, in Addendum
B: CY 2011--Relative Value Units and Related Information Used in
Determining Medicare Payments and Addendum C: Codes with Interim RVUs,
respectively, we need to correct errors in the work, PE, or MP RVUs (or
combinations of these RVUs) for certain existing new and revised CY
2011 CPT codes. These errors are a result of the technical and
typographical errors identified and summarized in section II.A. of this
correction notice. We note that we are providing these addenda in their
entirety.
On page 73831 in Addendum J: List of CPT \1\/HCPCS Codes Used to
Define Certain Designated Health Service Categories \2\ under Section
1877 of the Social Security Act Effective January 1, 2011 we are
correcting a technical error in the short descriptor for HCPCS code
G0431.
On pages 73841 through 73859, in Addendum K: CY 2011 ESRD Wage
Index for Urban Areas Based on CBSA Labor Market Areas, we made
technical and typographical errors in the composite rate wage index for
CBSA codes 11540, 12060, 19060, 27740, and 35380, and in the ESRD PPS
wage index for CBSA codes 40980 and 43780. On page 73848, we also made
a typographical error in the CBSA code for Houston-Sugar Land-Baytown,
TX.
On page 73859, in Addendum L: CY 2011 ESRD Wage Index for Rural
Areas Based on CBSA Labor Market Areas, we made a technical error in
the composite wage index for the nonurban area of Alaska.
III. Correction of Errors
In FR Doc. 2010-27969 of November 29, 2010 make the following
corrections:
A. Corrections to the Preamble
1. On page 73188, in Table 2--Calculation of PE RVUs Under
Methodology for Selected Codes, the table is corrected to read as
follows:
[[Page 1672]]
Table 2--Calculation of PE RVUS Under Methodology for Selected Codes
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
33533 CABG,
99213 Office arterial, 71020 Chest 71020-26 93000 ECG, 93005 ECG, 93010 ECG,
Step Source Formula visit, est single x-ray 71020-TC Chest xray complete tracing report
nonfacility facility nonfacility nonfacility nonfacility nonfacility nonfacility
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
(1) Labor cost (Lab)..................... Step 1...................... AMA........................ .................. 13.32 77.52 5.74 5.74 0.00 6.12 6.12 0.00
(2) Supply cost (Sup).................... Step 1...................... AMA........................ .................. 2.98 7.34 3.39 3.39 0.00 1.19 1.19 0.00
(3) Equipment cost (Eqp.)................ Step 1...................... AMA........................ .................. 0.19 0.65 8.17 8.17 0.00 0.12 0.12 0.00
(4) Direct cost (Dir).................... Step 1...................... ........................... =(1)+(2)+(3) 16.50 85.51 17.31 17.31 0.00 7.43 7.43 0.00
(5) Direct adjustment (Dir. Adj)......... Steps 2-4................... See footnote*.............. .................. 0.50 0.50 0.50 0.50 0.50 0.50 0.50 0.50
(6) Adjusted Labor....................... Steps 2-4................... =Lab * Dir Adj............. =(1)*(5) 6.65 38.68 2.86 2.86 0.00 3.05 3.05 0.00
(7) Adjusted Supplies.................... Steps 2-4................... = Sup * Dir Adj............ =(2)*(5) 1.49 3.66 1.69 1.69 0.00 0.60 0.60 0.00
(8) Adjusted Equipment................... Steps 2-4................... = Eqp * Dir Adj............ =(3)*(5) 0.10 0.33 4.08 4.08 0.00 0.06 0.06 0.00
(9) Adjusted direct...................... Steps 2-4................... ........................... =(6)+(7)+(8) 8.23 42.67 8.64 8.64 0.00 3.71 3.71 0.00
(10) Conversion Factor (CF).............. Step 5...................... PFS........................ .................. 36.87 36.87 36.87 36.87 36.87 36.87 36.87 36.87
(11) Adj. labor cost converted........... Step 5...................... =(Lab * Dir Adj)/CF........ =(6)/(10) 0.18 1.05 0.08 0.08 0.00 0.08 0.08 0.00
(12) Adj. supply cost converted.......... Step 5...................... =(Sup * Dir Adj)/CF........ =(7)/(10) 0.04 0.10 0.05 0.05 0.00 0.02 0.02 0.00
(13) Adj. equipment cost converted....... Step 5...................... =(Eqp * Dir Adj)/CF........ =(8)/(10) 0.00 0.01 0.11 0.11 0.00 0.00 0.00 0.00
(14) Adj. direct cost converted.......... Step 5...................... ........................... =(11)+(12)+(13) 0.22 1.16 0.23 0.23 0.00 0.10 0.10 0.00
(15) Work RVU............................ Setup File.................. PFS........................ .................. 0.97 33.75 0.22 0.00 0.22 0.17 0.00 0.17
(16) Dir--pct............................ Steps 6, 7.................. Surveys.................... .................. 0.26 0.18 0.29 0.29 0.29 0.29 0.29 0.29
(17) Ind--pct............................ Steps 6, 7.................. Surveys.................... .................. 0.74 0.82 0.71 0.71 0.71 0.71 0.71 0.71
(18) Ind. Alloc. Formula (1st part)...... Step 8...................... See Step 8................. .................. ((14)/(16)) ((14)/(16)) ((14)/(16)) ((14)/(16)) ((14)/(16)) ((14)/(16)) ((14)/(16)) ((14)/(16))
* (17) * (17) * (17) * (17) * (17) * (17) * (17) * (17)
(19) Ind. Alloc. (1st part).............. Step 8...................... ........................... See (18) 0.65 5.27 0.58 0.58 0.00 0.25 0.25 0.00
(20) Ind. Alloc. Formulas (2nd part)..... Step 8...................... See Step 8................. .................. (15) (15) (15)+(11) (11) (15) (15)+(11) (11) (15)
(21) Ind. Alloc. (2nd part).............. Step 8...................... ........................... See (20) 0.97 33.75 0.30 0.08 0.22 0.25 0.08 0.17
(22) Indirect Allocator (1st + 2nd)...... Step 8...................... ........................... =(19)+(21) 1.62 39.02 0.88 0.66 0.22 0.50 0.33 0.17
(23) Indirect Adjustment (Ind. Adj.)..... Steps 9-11.................. See footnote**............. .................. 0.37 0.37 0.37 0.37 0.37 0.37 0.37 0.37
(24) Adjusted indirect allocator......... Steps 9-11.................. =Ind Alloc * Ind Adj....... .................. 0.60 14.46 0.32 0.24 0.08 0.19 0.12 0.06
(25) Ind. Practice Cost Index (IPCI)..... Steps 12-16................. See Steps 12-16............ .................. 1.11 0.83 0.89 0.89 0.89 0.92 0.92 0.92
(26) Adjusted Indirect................... Step 17..................... = Adj.Ind Alloc * PCI...... =(24) * (25) 0.67 12.05 0.29 0.22 0.07 0.17 0.11 0.06
(27) MEI Rebasing Adjustment............. Step 18..................... PFS........................ .................. 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18
(28) MPPR Adjustment..................... Step 18..................... PFS........................ .................. 1.01 1.01 1.01 1.01 1.01 1.01 1.01 1.01
(29) PE RVU.............................. Step 18..................... =(Adj Dir + Adj Ind) * budn =((14)+(26)) * 1.06 15.69 0.62 0.53 0.09 0.32 0.25 0.07
* MEI Adj * MPPR Adj. budn * (27) * (28)
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Note: PE RVUs in table 2, row 29, may not match Addendum B due to rounding.
* The direct adj = [current pe rvus * CF * avg dir pct]/[sum direct inputs] = [Step 2]/[Step 3].
** The indirect adj = [current pe rvus * avg ind pct]/[sum of ind allocators] = [Step 9]/[Step 10].
[[Page 1673]]
2. On page 73276, third column,
a. Second full paragraph,
(1) Line 23, the figure ``1.181'' is corrected to read ``1.182.''
(2) Line 24, the figure ``1.358'' is corrected to read ``1.361.''
(3) Line 28, the figure ``1.358'' is corrected to read ``1.361.''
b. Last partial paragraph,
(1) Line 10, the figure ``0.9181'' is corrected to read ``0.9175.''
(2) Line 11, the figure ``1.181'' is corrected to read ``1.182.''
(3) Line 12, the figure ``1.358'' is corrected to read ``1.361.''
3. On page 73283,
a. Top half of the page,
(1) First column, first full paragraph,
(a) Line 1, the figure ``$25.5217'' is corrected to read
``$25.4999.''
(b) Line 3, the figure ``$15.8085'' is corrected to read
``$15.7999.''
(2) Second column, second partial paragraph, last line, the figure
``1.0045'' is corrected to read ``1.0043.''
(3) Third column, first partial paragraph,
(a) Line 6, the figure ``0.9181'' is corrected to read ``0.9175.''
(b) Line 15, the figure ``$25.5217'' is corrected to read
``$25.4999''
b. Bottom half of the page, in Table 45--Calculation of the CY 2011
PFS CF, the listed entries are corrected to read as follows:
------------------------------------------------------------------------
------------------------------------------------------------------------
CY 2011 RVU Budget Neutrality 0.4 percent
Adjustment. (1.0043).
CY 2011 Rescaling to Match MEI -8.3 percent
Weights Budget Neutrality (0.9175).
Adjustment.
CY 2011 Conversion Factor......... .................... $25.4999
------------------------------------------------------------------------
4. On pages 73283 and 73284, top of the page, in Table 46--
Calculation of the CY 2011 Anesthesia Conversion Factor, the listed
entries are corrected to read as follows:
------------------------------------------------------------------------
------------------------------------------------------------------------
CY 2011 Anesthesia Adjustment..... -2.4 percent
(0.9760).
CY 2011 Anesthesia Conversion .................... $15.7999
Factor.
------------------------------------------------------------------------
5. On page 73328, first column, last paragraph,
a. Line 4, the figure ``207'' is corrected to read ``206.''
b. Line 7, the figure ``84'' is corrected to read ``85.''
6. On page 73340, first column, first full paragraph,
a. Line 9, the number ``1.47'' is corrected to read ``2.60.''
b. Line 10, the phrase ``25th percentile'' is corrected to read
``low value.''
c. Line 14, the number ``1.47'' is corrected to read ``2.60.''
7. On page 73341, third column, last paragraph, line 12, the figure
``2.92'' is corrected to read ``3.37.''
8. On pages 73342 through 73349, in Table 53--AMA RUC
Recommendations and Interim Final Work RVUs for CY 2011 New, Revised,
and Potentially Misvalued Codes the listed entries are corrected to
read as follows:
----------------------------------------------------------------------------------------------------------------
Valued in relation
to a potentially AMA RUC- CY 2011
CPT code Short descriptor misvalued code recommended CMS decision interim final
screen work RVUs work RVUs
----------------------------------------------------------------------------------------------------------------
52332............. Cystoscopy and x 2.83 Disagree.......... 2.60
treatment.
64483............. Inj foramen epidural x 1.90 Disagree.......... 1.75
l/s.
77427............. Radiation tx x 3.45 Disagree.......... 3.37
management x5.
----------------------------------------------------------------------------------------------------------------
9. On page 73388, lower third of the page,
a. First column, first paragraph, last line, the figure
``$25.5217'' is corrected to read ``$25.4999.''
b. Table 60--CY 2011 RVUs for CPT Code 77080, the table is
corrected to read as follows:
Table 60--CY 2011 RVUs for CPT Code 77080
[Note: Calculated using the current law CY 2011 CF of $25.4999]
--------------------------------------------------------------------------------------------------------------------------------------------------------
CY 2011 CY 2011
CY 2011 CPT code Mod physician work nonfacility PE CY 2011 facility CY 2011
RVUs RVUs PE RVUs malpractice RVUs
--------------------------------------------------------------------------------------------------------------------------------------------------------
77080.......................................... 26............................. 0.31 0.10 0.10 0.01
77080.......................................... TC............................. 0.00 3.23 NA 0.18
77080.......................................... ............................... 0.31 3.33 NA 0.19
--------------------------------------------------------------------------------------------------------------------------------------------------------
10. On pages 73595 and 73596, in Table 101--CY 2011 PFS Final Rule
Total Allowed Charge Estimate Impact for RVU, MPPR, and MEI Rebasing
Changes, the table is corrected to read as follows:
BILLING CODE 4120-01-P
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11. On pages 73598 through 73600, in Table 102--Impact of Final
Rule with Comment Period and Estimated Physician Update on CY 2011
Payment for Selected Procedures, the table is corrected to read as
follows:
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B. Corrections to the Addenda
1. On pages 73630 through 73809, in Addendum B: CY 2011-Relative
Value Units and Related Information Used in Determining Medicare
Payments, the addendum is corrected to read as follows:
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3. On page 73831, in Addendum J: List of CPT \1\/HCPCS Codes Used
to Define Certain Designated Health Service Categories \2\ under
Section 1877 of the Social Security Act Effective January 1, 2011, the
listed entry is corrected to read as follows:
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4. On pages 73841 through 73859, in Addendum K: CY 2011 ESRD Wage
Index for Urban Areas Based on CBSA Labor Market Areas, the listed
entries are corrected to read as follows:
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4. On page 73859, in Addendum L: CY 2011 ESRD Wage Index for Rural
Areas Based on CBSA Labor Market Areas, the listed entry is corrected
to read as follows:
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III. Waiver of Proposed Rulemaking and Delay in Effective Date
We ordinarily publish a notice of proposed rulemaking in the
Federal Register to provide a period for public comment before the
provisions of a rule take effect in accordance with section 553(b) of
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we
can waive the notice and comment procedure if the Secretary finds, for
good cause, that the notice and comment process is impracticable,
unnecessary, or contrary to the public interest, and incorporates a
statement of the finding and the reasons for it in the rule.
Section 553(d) of the APA ordinarily requires a 30-day delay in the
effective date of final rules after the date of their publication. This
30-day delay in effective date can be waived, however, if an agency
finds for good cause that the delay is impracticable, unnecessary, or
contrary to the public interest, and the agency incorporates a
statement of the findings and its reasons in the rule issued.
This document merely corrects typographical and technical errors
made in the CY 2011 PFS final rule with comment period, which appeared
in the November 29, 2010 Federal Register (75 FR 73170), and is (with
limited exceptions not relevant to these corrections, but noted in the
rule), effective January 1, 2011. The provisions of the final rule with
comment period have been subjected previously to notice and comment
procedures. The corrections contained in this document are consistent
with, and do not make substantive changes to, the payment methodologies
and policies adopted in the CY 2011 PFS final rule with comment period.
As such, these corrections are being made to ensure the CY 2011 PFS
final rule with comment period accurately reflects the policies adopted
in that rule. Therefore, we find for good cause that it is unnecessary
and would be contrary to the public interest to undertake further
notice and comment procedures to incorporate these corrections into the
CY 2011 PFS final rule with comment period.
For the same reasons, we are also waiving the 30-day delay in
effective date for these corrections. We believe that it is in the
public interest to ensure that the CY 2011 PFS final rule with comment
period accurately states our policies as of the date they take effect.
Therefore, we find that delaying the effective date of these
corrections beyond the effective date of the final rule with comment
period would be contrary to the public interest. In so doing, we find
good cause to waive the 30-day delay in the effective date.
Authority: (Catalog of Federal Domestic Assistance Program No.
93.774, Medicare--Supplementary Medical Insurance Program)
Dated: December 29, 2010.
Dawn L. Smalls,
Executive Secretary to the Department.
[FR Doc. 2010-33264 Filed 12-30-10; 4:15 pm]
BILLING CODE 4120-01-C
