Medicare Program; Payment Policies Under the Physician Fee Schedule, Five-Year Review of Work Relative Value Units, Clinical Laboratory Fee Schedule: Signature on Requisition, and Other Revisions to Part B for CY 2012; Corrections, 227-232 [2011-33757]

Agencies

• Centers for Medicare & Medicaid Services
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 77, Number 2 (Wednesday, January 4, 2012)]
[Rules and Regulations]
[Pages 227-232]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-33757]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 410, 414, 415, and 495

[CMS-1524-CN and CMS-1436-CN]
RIN 0938-AQ25 and 0938-AQ00


Medicare Program; Payment Policies Under the Physician Fee 
Schedule, Five-Year Review of Work Relative Value Units, Clinical 
Laboratory Fee Schedule: Signature on Requisition, and Other Revisions 
to Part B for CY 2012; Corrections

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

ACTION: Correction of final rule with comment period.

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

SUMMARY: This document corrects technical errors and typographical 
errors in the final rule with comment period entitled ``Medicare 
Program; Payment Policies under the Physician Fee Schedule, Five-Year 
Review of Work Relative Value Units, Clinical Laboratory Fee Schedule: 
Signature on Requisition, and Other Revisions to Part B for CY 2012'' 
which appeared in the November 28, 2011 Federal Register.

DATES: This correcting document is effective January 1, 2012.

FOR FURTHER INFORMATION CONTACT:

Ryan Howe, (410) 786-3355, or Chava Sheffield, (410) 786-2298, for 
issues related to the physician fee schedule practice expense 
methodology and direct expense inputs.
Sara Vitolo, (410) 786-5714, for issues related to work RVUs.
Christine Estella, (410) 786-0485, for issues related to the Physician 
Quality Reporting System, incentives for Electronic Prescribing (eRx) 
and Physician Compare.
Jamie Hermansen, or (410) 786-2064, or Stephanie Frilling, (410) 786-
4507, for issues related to Annual Wellness Visit.
Rebecca Cole, (410) 786-4497, for issues related to physician payment 
not previously identified.

SUPPLEMENTARY INFORMATION: 

I. Background

    In FR Doc. 2011-28597 of November 28, 2011 (76 FR 73026), the final 
rule with comment period entitled ``Medicare Program; Payment Policies 
under the Physician Fee Schedule, Five-Year Review of Work Relative 
Value Units, Clinical Laboratory Fee Schedule: Signature on 
Requisition, and Other Revisions to Part B for CY 2012'' (hereinafter 
referred to as the CY 2012 PFS final rule with comment period) there 
were a number of technical errors that are identified and corrected in 
the Correction of Errors section. Accordingly, the corrections are 
effective January 1, 2012.
    We note that this correction notice corrects the CY 2012 PFS final 
rule with comment period which reflects laws in effect as of November 
1, 2011. Any statutory changes to PFS payment after November 1, 2011 
were not reflected in the CY 2012 PFS final rule with comment period 
and are therefore not reflected in this correction notice. Payment 
files reflecting current law as of January 1, 2012 were made available 
through usual CMS notices and data files.

II. Summary of Errors and Corrections to the Addenda Posted on the CMS 
Web Site

A. Errors in the Preamble

1. Errors in Work Relative Value Units (RVUs) and Time Information
    On pages 73028 and 73208, a discussion of CPT codes 96110 
(Developmental screening, with interpretation and report, per 
standardized instrument form) and G0451 (Development testing, with 
interpretation and report, per standardized instrument form) was 
omitted from the final rule due to an inadvertent error. We note that 
we had cited a discussion regarding these two codes several times 
throughout the preamble. We are correcting this error by including our 
intended discussion through this correcting document.
    On page 73141, we are correcting our response to comments to 
accurately reflect our policy regarding CPT codes 53445 (Insertion of 
inflatable urethral/bladder neck sphincter, including placement of 
pump, reservoir, and cuff) and 54410 (Removal and replacement of all 
component(s) of a multi-component, inflatable penile prosthesis at the 
same operative session). Due to an inadvertent error, the discussion of 
these codes did not reflect our discussion of revisions to the times 
for these codes for CY 2012. We include our discussion of time policies 
for these codes on an interim final basis for CY 2012.
    On page 73166, we are correcting an inadvertent error in Table 15: 
CY 2012 Work RVUs for Services Reviewed in the CY 2011 PFS Final Rule 
with Comment Period, the Fourth-Five Year Review, and the CY 2012 PFS 
Proposed Rule. This table incorrectly identified that no time change 
had occurred for CPT code 53445.
    On pages 73172 and 73178, we are correcting Table 16: CY 2011 and 
AMA RUC-Recommended Physician Time and Work Values for CY 2012 to 
accurately reflect time values for CPT codes 23415 (Coracoacromial 
ligament release, with or without acromioplasty), as well as revisions 
to the times for 53445 and 54410 already noted. The time values for CPT 
code 23415 that were listed in the CY 2012 PFS final rule time file 
were correct, but were inadvertently left out of Table 16. The time 
values for CPT codes 53345 and 54410 that were listed in the CY 2012 
PFS final rule time file were not correct; the time file has been 
corrected to reflect correct times for CPT codes 53445 and 54410, 
previously discussed. We note that the time file that we used to 
calculate RVUs for the CY 2012 PFS final rule with comment period did 
not reflect the correct finalized published times in Table 16 on pages 
73170 through 73181 for a limited number of codes. Specifically, we 
also have corrected the time values in the time file for CPT codes 
28725 (Arthrodesis; subtalar), 28730 (Arthrodesis, midtarsal or 
tarsometatarsal, multiple or transverse), 62223 (Creation of shunt; 
ventriculo-peritoneal, -pleural, other terminus), 65285 (Repair of 
laceration; cornea and/or sclera, perforating, with reposition or 
resection of uveal tissue), 73080 (Radiologic examination, elbow; 
complete, minimum of 3 views), 73610 (Radiologic examination, ankle; 
complete, minimum of 3 views), and 73630 (Radiologic examination, foot; 
complete, minimum of 3 views) to reflect the correct time values in 
Table 16.

[[Page 228]]

    On page 73173, in Table 16, we are also correcting a typographical 
error for CPT code 28725 (Arthrodesis; subtalar).
    On page 73190, we are correcting the status indicator of molecular 
pathology CPT codes that are new for CY 2012. We had intended to set 
the status indicator to allow reporting of these codes along with the 
laboratory CPT codes currently used to report these services. Due to an 
inadvertent error identifying the appropriate status indicator for 
tracking purposes, the published status indicator was incorrect.
    On page 73265, in our discussion of the compression system 
services, we are updating our references to sections of the CY 2012 PFS 
final rule with comment period to correspond to the corrections 
identified elsewhere in this correcting document.
2. Errors in the Annual Wellness Visit
    On pages 73306 through 73309, in our discussion of the Annual 
Wellness Visit, we made several technical and typographical errors in 
summarizing and responding to comments regarding the health risk 
assessment (HRA).
    On page 73310, in our discussion regarding personalized prevention 
plans as part of the annual wellness visit, we inadvertently made 
technical and typographical errors.
    On page 73311, in our discussion regarding a response to commenters 
on the physician's wellness team, we inadvertently made a technical 
error in our description of who comprises the wellness team.
3. Errors in the PE RVUs
    On page 73313, we are correcting a typographical error in Table 39: 
Final RVUs for AWV Services for HCPCS code G0438 (Annual wellness 
visit, includes a personalized prevention plan of service (PPPS), first 
visit).
    We are correcting a series of Practice Expense (PE) RVUs that 
appeared in Addenda B and C for CPT codes 90867 (Therapeutic repetitive 
transcranial magnetic stimulation (TMS) treatment; initial, including 
cortical mapping, motor threshold determination, delivery and 
management), 90868 (Therapeutic repetitive transcranial magnetic 
stimulation (TMS) treatment; subsequent delivery and management, per 
session), and 90869 (Therapeutic repetitive transcranial magnetic 
stimulation (TMS) treatment; subsequent motor threshold re-
determination with delivery management) that were incorrect as a result 
of a technical error. The price input for the new direct practice 
expense equipment item ``NeuroStar TMS Therapy System'' (EQ342) was 
incorrectly calculated. The corrected price is included in the 
corrected final CY 2012 direct PE database. The final PE RVUs displayed 
in the corrected versions of Addendum B and C reflect values resulting 
from the correction of this error.
    We also note that because work RVUs factor into the calculation for 
PE RVUs, and time values factor into direct PE input values and 
specialty-level allocation of indirect PE, PE RVUs for CPT codes with 
corrected work RVUs or time values may have also changed as a result of 
the corrected work RVUs and time values. These changes are reflected in 
Addenda B and C and the direct PE database.
    Further, we note that changes in PE RVUs for other codes not 
previously identified may occur due to various factors related to the 
relativity of the system including budget neutrality, changes in 
aggregate physician times, and adjustments to maintain PE RVU shares. 
These changes also are reflected in Addenda B and C. In order to 
account for these corrected values, we are correcting errors in Table 
85: Impact of Final Rule With Comment Period and Estimated Physician 
Update on CY 2012 Payment for Selected Procedures.
4. Errors in the Physician Quality Reporting System
    On page 73333, in our discussion of core measures directly below 
Table 42, we inadvertently made a typographical error in referencing a 
Table number.
    On page 73334, in our discussion of zero percent performance rates, 
we made a typographical error. Although the final requirement to not 
count measures with a zero percent performance rate is indicated 
throughout the rule, including Tables 40, 41, and 42, in a response on 
page 73334, we erroneously stated ``only'' instead of ``not.''
    On page 73336, in our discussion of measures groups, we made a 
typographical error in referencing a Table number.
    On page 73337, in our summary of the CY 2012 proposed rule 
regarding the reporting criteria for the group practice reporting 
option (GPRO), we inadvertently referenced the wrong Federal Register 
page number and also made a typographical error in referencing the 
number of NQF-endorsed quality measures we proposed.
    On page 73339, in our discussion of GPROs we inadvertently made a 
typographical error in referencing the dates. The correct year is 2012, 
which is the year in which the reporting period for the 2012 Physician 
Quality Reporting System lies.
    On page 73343, we made typographical errors in referencing Table 
numbers of the CY 2012 proposed rule. In addition, in our discussion of 
contact information, we incorrectly referenced the 2011 Physician 
Quality Reporting System instead of the 2012 Physician Quality 
Reporting System.
    On page 73345, in our discussion of core measures, we inadvertently 
made typographical errors in referencing Table numbers.
    On page 73348, in one of our responses to comments, we 
inadvertently made typographical errors in referencing two Table 
numbers.
    On page 73362, in Table 47, the measure entitled ``Ischemic 
Vascular Disease (IVD): Complete Lipid Profile and LDL Control <100'' 
was inadvertently listed twice.
    On page 73365, in Table 48, we are correcting measure numbers for 
several measures that were retired in 2010. Specifically, the Measure 
entitled ``Use of Appropriate Medications for Asthma'' and the Measure 
entitled ``Smoking and Smoking and Tobacco Use Cessation, Medical 
Assistance: a. Advising Smokers to Quit, b. Discussing Smoking and 
Tobacco Use Cessation Medications, c. Discussing Smoking and Tobacco 
Use Cessation Strategies'' were inadvertently listed with Physician 
Quality Reporting System numbers and should be listed as ``TBD.''
    On page 73368, third column, first full paragraph, we inadvertently 
excluded the COPD measures group as a measures group that also contains 
measures available for reporting as individual measures.
    On page 73373, in reference to Table 56, we inadvertently excluded 
a footnote to indicate that the CAD measures group contained measures 
that are also available for reporting as individual measures.
    On page 73383, in our response to commenters who urged CMS to 
reduce the number of GPRO measures a GPRO must report under the 
Physician Quality Reporting System, we inadvertently made an error in 
stating we finalized 30 measures available for reporting under the 
GPRO. As indicated in Table 71 and in the third column, first full 
paragraph on page 73383, we finalized 29 measures available for 
reporting under the GPRO.
    On page 73388, second column, first full paragraph, we incorrectly 
referenced the first quarter of 2012 instead of the first quarter of 
2013.

[[Page 229]]

5. Errors in the Electronic Prescribing (eRx) Incentive Program
    On page 73415, we inadvertently made a typographical error by 
referencing G code G8642 instead of G9642 (G8642 was the G-Code created 
in 2011 for the significant hardship exemption for professionals in 
rural areas with limited high speed Internet access).
6. Errors in the Impact Analysis
    On page 73457, In Table 85: Impact of Final Rule with Comment 
Period and Estimated Physician Update on CY 2012 Payment for Selected 
Procedures, we discuss the corrected work RVUs in section II.A.3. of 
this document, entitled ``Errors in the PE RVUs''.
7. Errors in the Addenda Listing
    On page 73469, in our discussion of the Addenda, we inadvertently 
listed Addendum C as reserved.

B. Errors in the Addenda Posted on the CMS Web Site

    On page 73469 of the CY 2012 PFS final rule with comment period, we 
noted that the Addenda A through H for the CY 2012 PFS final rule with 
comment period would only be available via the Internet. In this 
document, we note that we will be correcting the following Addenda:
     Addendum B--Relative Value Units and Related Information 
Used in Determining Medicare Payments for CY 2012.
     Addendum C.--Codes with Proposed RVUs Subject to Comment 
for CY 2012.
    We are removing HCPCS code G0450 from Addendum B. This code was 
incorrectly included in the final rule Addenda due to a technical 
error. In addition, we are correcting the status indicator in Addendum 
B for CPT code 96110.
    Additionally, due to a typographical error, we are correcting the 
physician work and malpractice RVUs that appeared in Addenda B and C 
for CPT code 90845 (Psychoanalysis). The correct physician work and 
malpractice RVUs were listed in the preamble text.
    Due to the changes previously noted in this section and in section 
II.A.3. of this document, we are correcting errors in these Addenda by 
replacing the Addenda in their entirety. In addition, we are correcting 
supporting tables that are available online, such as the time file and 
the direct PE input database. Errors to all updated tables are a result 
of the technical and typographical errors identified and summarized in 
this correcting document. As stated in the CY 2012 PFS final rule with 
comment period, Addenda B and C are available online at https://www.cms.gov/PhysicianFeeSched. To access supporting information on this 
correction notice, click on the link on the left side of the screen 
titled, ``PFS Federal Regulations Notices'' for a chronological list of 
PFS Federal Register and other related documents and select CMS-1524-
CN.

III. Waiver of Proposed Rulemaking and 30-Day 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 this 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 therefore in the notice.
    Section 553(d) of the APA ordinarily requires a 30-day delay in 
effective date of final rules after the date of their publication in 
the Federal Register. 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 in 
the preamble and addenda of the CY 2012 Physician Fee Schedule final 
rule with comment period. The provisions of that final rule with 
comment period have been subjected to notice and comment procedures. 
The corrections contained in this document are consistent with, and do 
not make substantive changes to, the policies and payment methodologies 
that were adopted in the CY 2012 PFS final rule with comment period. As 
a result, the corrections made through this correcting document are 
intended to ensure that the CY 2012 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 the corrections in this document into 
the CY 2012 PFS final rule with comment period. For the same reasons, 
we find that there is good cause to waive the 30-day delay in the 
effective date for these corrections. Further, we believe that it is in 
the public interest to ensure that the CY 2012 PFS final rule with 
comment period accurately reflects 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 effective date.

IV. Correction of Errors

0
In FR Doc. 2011-28597 of November 28, 2011 (76 FR 73026), the final 
rule with comment period, make the following corrections:
0
1. Page 73028, third column,
0
a. After line 31 (item ``(23)''), the text is corrected by adding a new 
item to read as follows ``(24) Central Nervous System Assessments/Tests 
(CPT codes 96110, G0451)''.
0
b. Line 32 (Item ``(24)''), the reference ``(24)'' is corrected to read 
``(25)''.
0
2. Page 73141, second column,
0
a. Second full paragraph that begins with the phrase ``Response: We 
agree with the AMA RUC'' and ends with the phrase ``CPT code 53445 for 
CY 2012'' is corrected to read as follows:
    ``Response: We agree with the AMA RUC that the 25th percentile work 
RVU of 13.00 is appropriate for this service. We are assigning an 
interim final work RVU of 13.00 to CPT code 53445 for CY 2012. CPT code 
53445 can be found in Addenda B and C to this CY 2012 PFS final rule.
    Regarding the physician time associated with CPT code 53445, in the 
CY 2012 PFS proposed rule (76 FR 42799 through 42800) we stated that 
since Medicare claims data indicate that this service is predominantly 
performed in the outpatient setting, that we did not believe that this 
service should reflect work that is typically associated with an 
inpatient service. In the CY 2012 PFS proposed rule, we proposed to 
accept the AMA RUC-recommended physician times, understanding that the 
AMA RUC was collecting additional information on the physician time 
associated with this CPT code (and CPT code 54410) through a specialty 
society survey. Following publication of the CY 2012 PFS proposed rule, 
we realized that we had not reviewed the additional specialty society 
survey information on physician time. After review, we do not believe 
it is appropriate for this service which is now predominantly furnished 
in the outpatient setting to continue to reflect work that is typically 
associated with an inpatient service. In order to ensure consistent 
treatment of physician time, we believe it is appropriate to apply our 
methodology described

[[Page 230]]

previously to address 23-hour stay site-of-service anomalies. 
Therefore, on an interim final basis for CY 2012, we are removing the 
subsequent observation care visit, reducing the discharge management 
day service to one-half, and adjusting the times accordingly. We are 
assigning CPT code 53445 the following times on an interim final basis 
for CY 2012: 50 minutes pre-service evaluation, 15 minutes pre-service 
positioning, 20 minutes dress, scrub, and wait, 90 minutes intra-
service time, 35 minutes post-service time, half of a hospital 
discharge management day service, 1 Level 2 established patient office 
or other outpatient visit, and 3 Level 3 established patient office or 
other outpatient visits. CMS time refinements can be found in Table 16.
    For CY 2009, CPT code 54410 (Removal and replacement of all 
component(s) of a multi-component, inflatable penile prosthesis at the 
same operative session) was identified as potentially misvalued through 
the site-of-service anomaly screen. As detailed in the CY 2012 PFS 
proposed rule (76 FR 42799), for CY 2012 we proposed a work RVU of 
15.18, which corresponded to the current (CY 2011) work RVU and the AMA 
RUC-recommended work RVU for this service. Regarding the physician time 
assigned to CPT code 54410, in the PFS proposed rule we proposed to 
remove the subsequent hospital care visit and keep the AMA RUC-
recommended physician times for the other components of this service, 
with the understanding that the AMA RUC was collecting additional 
information on the physician time associated with this CPT code (and 
CPT code 53445). We received no public comments on our proposal for CPT 
code 54410.
    We continue to believe that a work RVU of 15.18 appropriately 
reflects the physician work associated with this service. Therefore, we 
are assigning an interim final work RVU of 15.18 to CPT code 54410 for 
CY 2012. CPT code 54410 can be found in Addenda B and C to this CY 2012 
PFS final rule. Following publication of the CY 2012 PFS proposed rule, 
we realized that we had not reviewed the additional specialty society 
survey information on physician time for CPT code 54410 that we had 
received. After reviewing the additional information, we do not believe 
it is appropriate for this service which is now predominantly furnished 
in the outpatient setting to continue to reflect work that is typically 
associated with an inpatient service. In order to ensure consistent and 
appropriate treatment of physician time, we believe it is appropriate 
to apply our methodology described previously to address 23-hour stay 
site-of-service anomalies. Therefore, on an interim final basis for CY 
2012, we are removing the subsequent observation care visit, reducing 
the discharge management day service to one-half, and adjusting the 
times accordingly. We are assigning CPT code 54410 the following times 
on an interim final basis for CY 2012: 40 minutes pre-service 
evaluation, 10 minutes pre-service positioning, 15 minutes dress, 
scrub, and wait, 120 minutes intra-service time, 40 minutes post-
service time, half of a hospital discharge management day service, 1 
Level 2 established patient office or other outpatient visit, and 3 
Level 3 established patient office or other outpatient visits. CMS time 
refinements can be found in Table 16.''
0
b. Third full paragraph, line 5 through 9, the sentence, ``Also, for CY 
2012, we received no public comments on the CY 2012 proposed work RVUs 
for CPT codes 52341, 52342, 52343, 52344, 52345, 52346, 52400, 52500, 
54410, and 54530.'' is corrected to read ``For CY 2012, we received no 
public comments on the CY 2012 proposed work RVUs for CPT codes 52341, 
52342, 52343, 52344, 52345, 52346, 52400, 52500, and 54530''.
0
3. On page 73166, Table 15: CY 2012 Work RVUs for Services Reviewed in 
the CY 2011 PFS Final Rule with Comment Period, the Fourth-Five Year 
Review, and the CY 2012 PFS Proposed Rule, column 7, line 16 (CPT code 
53445), the ``'' (blank entry) is corrected to read ``Yes''.
0
4. Page 73172, Table 16: CY 2011 and AMA RUC-Recommended Physician Time 
and Work Values for CY 2012.
0
a. Line 8 (CPT code 23415),
0
(1) Column 15, the figure ``0'' is corrected to read ``0.5''.
0
(2) Column 20, the figure ``0'' is corrected to read ``2.0''.
0
(3) Column 21, the figure ``0'' is corrected to read ``2.0''.
0
b. Line 9 (CPT code 23415),
0
(1) Column 15, the figure ``0'' is corrected to read ``0.5''.
0
(2) Column 20, the figure ``0'' is corrected to read ``2.0''.
0
(3) Column 21, the figure ``0'' is corrected to read ``2.0''.
0
5. Page 73173, line 10--CPT code 28725, column 21, the figure ``0'' is 
corrected to read ``3.0''.
0
6. Page 73178,
0
a. Line 17 (CPT code 53445),
0
(1) Column 9, the figure ``25'' is corrected to read ``35''.
0
(2) Column 15, the figure ``1'' is corrected to read ``0.5''.
0
(3) Column 17, the figure ``1'' is corrected to read ``0''.
0
b. Line 20 (CPT code 54410),
0
(1) Column 9, the figure ``30'' is corrected to read ``40''.
0
(2) Column 15, the figure ``1'', is corrected to read ``0.5''.
0
7. Page 73190, upper fourth of the page, second column, first partial 
paragraph, and third column first partial paragraph, the sentences 
beginning with ``These molecular pathology codes'' and ending with 
``payment for these services'' are corrected to read as follows:

``These molecular pathology codes appear in Addendum B to this final 
rule with the procedure status indicator of 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 (for example, a 
telephone call from a hospital nurse regarding care of a patient)). 
While these services would traditionally be assigned a procedure status 
indicator of I (Not Valid for Medicare purposes. Medicare uses another 
code for the reporting of, and the payment for these services), 
assigning these CPT codes a procedure status indicator of B will allow 
CMS to gather claims information important to evaluating eventual 
pricing of these new molecular pathology CPT codes.''
0
8. Page 73208, third column,
0
a. Immediately after the end of the first partial paragraph ending with 
``CPT code 95939,'' the paragraph is corrected by adding a new 
paragraph to read as follows:
    ``(24) Central Nervous System Assessments/Tests (CPT Codes 96110, 
G0451)
    For CY 2012, the CPT Editorial Panel revised the long descriptor 
for CPT code 96110 from (Developmental testing; limited (e.g., 
Developmental Screening Test II, Early Language Milestone Screen), with 
interpretation and report) to (Developmental screening, with 
interpretation and report, per standardized instrument form). With this 
change, we believe that the service described by CPT code 96110 is a 
screening service and no longer falls within the scope of benefits of 
the Medicare program, as defined by the Social Security Act. Therefore, 
for CY 2012, we assigned CPT code 96110 a procedure status indicator of 
N (Non-covered service. These codes are non-covered services. Medicare 
payment may not be made for these codes. If RVUs are shown, they are 
not used for Medicare payment). In order to continue to make payment 
under the PFS for the

[[Page 231]]

testing services previously described under CPT code 96110, for CY 2012 
we created HCPCS code G0451 (Developmental testing, with interpretation 
and report, per standardized instrument form). In order to calculate 
resource-based RVUs for HCPCS code G0451, we crosswalked the 
utilization, direct practice expense inputs, and malpractice risk 
factor from CPT code 96110 to HCPCS code G0451. We note that CPT code 
96110 did not have physician work RVUs, therefore no physician work 
RVUs have been assigned to HCPCS code G0451. The CY 2012 interim final 
RVUs assigned to HCPCS code G0451 are included in Addenda B to this 
final rule with comment period.''
0
b. First full paragraph, line 1, the reference number ``(24)'' is 
corrected to read ``(25)''.
0
9. Page 73265,
0
a. First column, second partial paragraph, line 1, the reference 
``III.B.1.b.'' is corrected to read ``III.C.1.a.''.
0
b. Second column,
0
(1) First partial paragraph, line 10, the reference ``III.B.1.b.'' is 
corrected to read ``III.C.1.a.''.
0
(2) Second partial paragraph, line 6, the reference, ``III.B.1.b.'' is 
corrected to read ``III.C.1.a.''.
0
10. On page 73306,
0
a. Second column, first partial paragraph, lines 9 through 16, the 
sentence ``The remaining 22 comments provided feedback about the impact 
of the annual wellness visit as a whole requested modifications or 
additional elements to the annual wellness visit, and coverage for 
additional preventive serves and vaccines.'' is corrected to read ``The 
remaining 22 comments provided feedback about the impact of the annual 
wellness visit as a whole, requested modifications to, or additional 
elements added to the annual wellness visit, and coverage for 
additional preventive services and vaccines.''
0
b. Third column, first partial paragraph, line 2, the word ``supports'' 
is corrected to read ``supported''.
0
11. On page 73308, first column,
0
a. First full paragraph, lines 6 through 20, the sentence ``If positive 
tobacco use is identified during the annual wellness visit, additional 
questions can be asked by the health professional followed by the 
process of motivational interviewing (the health professional offers 
personalized information to the patient) and shared decision-making 
(the health professional work with the patient to discover what is 
important to the patient and the patient's motivation to change 
behavior) in the development of the personalized prevention plan during 
the annual wellness visit encounter.'' is corrected to read ``If 
positive tobacco use is identified during the annual wellness visit, 
additional questions can be asked by the health professional followed 
by the process of motivational interviewing and shared decision-making 
(the health professional offers personalized information to the patient 
and works with the patient to discover what is important to the patient 
and his or her motivation to change behavior) in the development of the 
personalized prevention plan during the annual wellness visit 
encounter.''
0
b. Second full paragraph, lines 8 through 15, the sentence ``We note 
that Medicare covers counseling to prevent tobacco use as an 
``additional preventive service'' under Medicare Part B (additional 
information available in Pub. 100-3, Medicare National Coverage 
Determinations Manual, Chapter 1, Section 210.41).'' is corrected to 
read ``We note that Medicare covers tobacco use cessation counseling as 
an ``additional preventive service'' under Medicare Part B (additional 
information available in Pub. 100-03, Medicare National Coverage 
Determinations Manual, Chapter 1, Section 210.4.1).''
0
c. Last partial paragraph, line 3 through the second column, line 6, 
the sentence ``One commenter agreed with the provisions of the proposed 
rule that did not include cognitive assessment as part of the HRA, 
however, the commenter believed that general questions about memory 
should be included in the HRA.'' is corrected to read ``One commenter 
agreed with the provisions of the proposed rule, which did not include 
cognitive assessment as part of the HRA. However, the commenter 
believed that general questions about memory should be included in the 
HRA.''
0
12. On page 73309, third column, second full paragraph, line 1, the 
phrase ``Comment: A few comments'' is corrected to read ``Comment: A 
few commenters''.
0
13. On page 73310, first column, second full paragraph, lines 5 and 6, 
the phrase ``but update the HRA'' is corrected to read ``but the 
patient should update the HRA.''
0
14. On page 73311, third column, first partial paragraph, line 1, the 
phrase ``working on his or her wellness team are needed on a particular 
day'' is corrected to read ``working on the physician's wellness team 
are needed on a particular day''.
0
15. On page 73313, Table 39: Final RVUs for AWV Services, line 2 (CPT 
code G0438), column 4, the figure ``4.99'' is corrected to read 
``4.89''.
0
16. On page 73333, second line immediately following Table 42, the 
reference to ``Table M 9'' is corrected to read ``Table 48''.
0
17. On page 73334, third column, third full paragraph, line 9, the 
phrase ``proposal to only count measures'' is corrected to read 
``proposal to not count measures''.
0
18. On page 73336, third column, last paragraph, line 17, the reference 
``Table 42'' is corrected to read ``Table 44''.
0
19. On page 73337, lower third of the page, third column,
0
a. Line 2, the reference ``(76 FR 32859)'' is corrected to read ``(76 
FR 42859)''.
0
b. Line 8, the phrase ``30 NQF-endorsed '' is corrected to read ``44 
NQF-endorsed''.
0
20. On page 73339, lower half of the page, second column, first full 
paragraph,
0
a. Lines 20 and 21, the date, ``January 1, 2011'' is corrected to read 
``January 1, 2012''.
0
b. Line 22, the date ``October 31, 2011'' is corrected to read 
``October 31, 2012''.
0
21. On page 73343, second column, first full paragraph,
0
a. Line 19, the reference to ``Tables 52 through 55'' is corrected to 
read ``Tables 29 through 56''.
0
b. Lines 20 and 21, the phrase ``2011 Physician Quality Reporting 
System'' is corrected to read as ``2012 Physician Quality Reporting 
System''.
0
22. On page 73345, top of the page (before the table), first column, 
last line, the reference ``Tables 48 and 49'' is corrected to read 
``Tables 47 and 48''.
0
23. On page 73348, first column, first response, line 9, the reference 
``Tables 48 and 49'' is corrected to read ``Tables 47 and 48''.
0
24. On page 73362, in Table 47, last line, the entry for the measure 
``Ischemic Vascular Disease (IVD): Complete Lipid Profile and LDL 
Control <100'' is corrected by deleting the entry.
0
25. On page 73365, in Table 48, first column (Physician Quality 
Reporting System Number),
0
a. Row 11, the figures ``114 & 115'' are corrected to read ``TBD''.
0
b. Row 25, the figure ``240'' is corrected to read ``TBD''.
0
26. On page 73368, third column, second full paragraph, lines 11 and 
12, the phrase ``CAP, and Asthma'' is corrected to read ``CAP, COPD, 
and Asthma''.
0
27. On page 73373, at the end of Table 56: Measures Included in the 
2012 CAD Measures Group, the table is corrected by adding a footnote to 
read as follows: ``The measures contained within this measures group 
are also available for reporting as individual measures.''

[[Page 232]]

0
28. On page 73383, first column, second full paragraph, line 2, the 
phrase ``30 of the 40 measures'' is corrected to read ``29 of the 41 
measures''.
0
29. On page 73388, second column, fourth full paragraph, line 7, the 
phrase ``than the end of the first quarter of 2012.'' is corrected to 
read ``than the end of the first quarter of 2013.''
0
30. On page 73415, third column, second full paragraph, line 4, the 
parenthetical phrase ``(report G-code G9642).'' is corrected to read 
``(report G-Code G8642).''
0
31. Page 73457, Table 85: Impact of Final Rule with Comment Period and 
Estimated Physician Update on CY 2012 Payment for Selected Procedures,
0
a. Line 10 (CPT code 43239),
0
(1) Column 10, ``351.95'' is corrected to read ``351.61''.
0
(2) Column 12, ``255.10'' is corrected to read ``254.85''.
0
b. Line 11(CPT code 66821),
0
(1) Column 10, ``326.42'' is corrected to read ``326.08''.
0
(2) Column 12, ``236.60'' is corrected to read ``236.35''.
0
c. Line 13, (CPT code 67210),
0
(1) Column 10, ``524.18'' is corrected to read ``523.84''.
0
(2) Column 12, ``379.94'' is corrected to read ``379.69''.
0
32. Page 73469, lower third of the page, second full paragraph, line 
20, the title ``Addendum C--[Reserved]'' is corrected to read 
``Addendum C.--Codes With Proposed RVUs Subject to Comment for CY 
2012''.

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: December 29, 2011.
Jennifer M. Cannistra,
Executive Secretary to the Department, Department of Health, Human 
Services.
[FR Doc. 2011-33757 Filed 12-30-11; 4:15 pm]
BILLING CODE 4120-01-P