Medicare: Physician fee schedule (CY 2006); payment policies and realtive value units,

[Federal Register: November 21, 2005 (Volume 70, Number 223)]

[Rules and Regulations]

[Page 70115-70476]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr21no05-10]

[[Page 70115]]

Part II

Department of Health and Human Services

Centers for Medicare & Medicaid Services

42 CFR Part 405, et al.

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

[[Page 70116]]

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.

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 http://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: http://www.access.gpo.gov/nara/index.html .

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 (http://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 for this procedure of $6,207,961.

Table 11.--Calculation of Indirect Expenses

Total direct NPWP methodology

Physician work * expense

Total (A)

(B)

(C)

(a) CPT 00002............................................ ................

$59.07

$59.07 (b) Allowed Services--NPWP............................... ................ ................

105,095 (c) Total NPWP Indirect Expense.......................... ................ ................ $6,207,961

NPWP Step 5--Calculation and Application of Indirect Scaling Factors

Similar to the direct costs, the indirect costs are scaled to ensure that the total of the charge-based PE costs across all procedures equates with the total 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 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

[[Page 70127]]

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 indirect costs for this procedure of $89.19.

Table 12.--Calculation and Application of Indirect Cost Scaling Factors

Specialty Standard methodology

Indirect costs Direct cost specific PE RVU (Sum of A and B) (A)

(B)

(C)

(a) Total--NPWP ``SMS'' Pool.......................... $9,407,404 (b) Total NPWP Indirect Expense.......................

6,207,961 (c) Scaling Factor....................................

1.51 (d) CPT 00002--Unscaled Value.........................

59.07 (e) CPT 00002--Scaled Value...........................

89.19

$59.07

$148.26

NPWP Step 6--Budget Neutrality and Final RVU Calculation

Similar to the calculation for codes with physician work, the BNF is applied to (multiplied by) the scaled direct and indirect expenses for each code to set the PE RVU for the upcoming year.

In Table 13, the sum of the scaled direct and indirect expenses for hypothetical code 00002 ($148.26) is multiplied by the BNF (0.022 in this example) to yield a PE RVU of 3.26.

Table 13.--Budget Neutrality and Final RVU Calculation

Total scaled direct and Budget neutrality Final PE RVU indirect inputs

factor

Code 00002.............................................

$148.26

0.022

2.96

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 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 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).

[[Page 70128]]

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 http://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 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 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 ``bottom-up'' 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.

[[Page 70129]]

(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 pre-1998 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 preferable and feasible to have an SMS-type survey of only indirect costs for all specialties; or whether a more formula-based methodology independent of the SMS data should be adopted, perhaps using the specialty-specific indirect-to-total 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 specialty- specific SMS PE/HR data for the purposes of determining the typical direct PE resources required to perform each service on the PFS. First, we have received recommendations on the procedure-specific inputs from the multi-specialty PEAC that were based on presentations from the relevant specialties after being closely scrutinized by the PEAC using standards and packages agreed to by all involved specialties. Second, the refined CPEP/RUC data are more current than the SMS data for the majority of specialties. Third, for direct costs, it appears more accurate to assume that the costs of the clinical staff, supplies and equipment are the same for a given service, regardless of the specialty that is performing it. This assumption does not hold true under the top-down direct cost methodology, where the specialty-specific 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 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

[[Page 70130]]

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 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 non-intuitive 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 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.

[[Page 70131]]

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.

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.

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

[[Page 70132]]

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 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 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

[[Page 70133]]

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 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 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

[[Page 70134]]

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 bottom-up 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 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 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 PEAC-refined 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.

[[Page 70135]]

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 bottom-up 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 conceptually, but expressed concerns that aggregate budget neutrality would be more difficult to control using a bottom-up approach than using the top-down. A medical group practice association, as well as a large multi-specialty 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 PEAC-refined 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 bottom-up 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 recommended that an unbiased SMS-type 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

[[Page 70136]]

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, 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 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

[[Page 70137]]

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 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 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,

[[Page 70138]]

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).

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 procedures. In the CY 2005 final rule (69 FR 66356), we eliminated the criteria for the payment of LOCM that had been included at Sec. 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 Q-codes. 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

[[Page 70139]]

(ASP) quarterly values are published on our Web site at the following address: http://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: 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 viewbox was not included because most codes assigned this room have also been assigned an alternator (automated film viewer) or a 4-panel viewbox.

(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, 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.

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

[[Page 70140]]

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 G-codes 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 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 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

[[Page 70141]]

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.

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 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

[[Page 70142]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.006

[[Page 70143]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.007

[[Page 70144]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.008

[[Page 70145]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.009

[[Page 70146]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.010

[[Page 70147]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.011

BILLING CODE 4120-01-C

[[Page 70148]]

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.

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 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 RUC-recommended 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

[[Page 70149]]

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.

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 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

[[Page 70150]]

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.

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 high-priced 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 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.

[[Page 70151]]

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 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 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

[[Page 70152]]

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, 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 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

[[Page 70153]]

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 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.

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 low-volume 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

[[Page 70154]]

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 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. 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

[[Page 70155]]

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 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 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

[[Page 70156]]

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 http://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 self- management 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 Sec. 410.78 and Sec. 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 Sec. 410.78 to add a registered dietitian and nutrition professional as defined in Sec. 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 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 face-to- 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

[[Page 70157]]

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, skill-based 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 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.

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

[[Page 70158]]

teaching insulin administration via telemedicine to a patient who had very high blood glucose levels''. However, training patients on the self-administration 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 Sec. 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 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 in-person.

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.

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 http://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 one-way video would be appropriate in situations when it enables the consulting physician to add value to the

[[Page 70159]]

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 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 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 in-person 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

[[Page 70160]]

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. 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 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 Sec. 410.78 and Sec. 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 Sec. 410.78 to add a registered dietitian and nutrition professional as defined in Sec. 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

[[Page 70161]]

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 revisions to the policy published November 7, 2003 (68 FR 63196 through 63395), where we revised Sec. 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 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

[[Page 70162]]

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 http://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 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 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

[[Page 70163]]

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 compared to the weights included in the proposed rule.

Table 16.--Revised to Reflect Correction

Published Revised proposed Drugs

proposed weights weights

Epogen............................

78.83

69.33 Calcitriol........................

0.13

0.84 Doxercalciferol...................

1.74

1.48 Iron dextran......................

0.38

0.23 Iron sucrose......................

0.71

7.03 Levocarnitine.....................

0.89

0.77 Paricalcitol......................

17.37

14.61 Sodium ferric glut................

0.53

4.96 Alteplase, Recombinant............

0.18

0.56 Vancomycin........................

0.24

0.19

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 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 non-EPO 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 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 hospital- based 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

[[Page 70164]]

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 hospital-based 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 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.

Table 17

Average sales Drug

price plus 6% 2005

Epogen...............................................

$9.30 Calcitriol...........................................

0.75 Doxercalciferol......................................

2.19 Iron dextran.........................................

11.21 Iron sucrose.........................................

0.36 Levocarnitine........................................

12.30 Paricalcitol.........................................

3.92 Sodium ferric glut...................................

4.74 Alteplase, Recombinant...............................

30.61 Vancomycin...........................................

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

2005 average estimated Drugs

medicare payments using 95% of AWP

Epogen...............................................

$10.00 Calcitriol...........................................

1.36 Doxercalciferol......................................

3.98 Iron dextran.........................................

17.91 Iron sucrose.........................................

0.65 Levocarnitine........................................

36.48 Paricalcitol.........................................

5.32 Sodium ferric glut...................................

8.17 Alteplase, Recombinant...............................

31.89 Vancomycin...........................................

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

[[Continued on page 70165]]

From the Federal Register Online via GPO Access [wais.access.gpo.gov] ]

[[pp. 70165-70214]] 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

[[Continued from page 70164]]

[[Page 70165]]

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 hospital-based 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 hospital-based 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 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 Percent by which weights as a ASP+6% prices are Drugs

percentage of below 95% of AWP total drug

prices expenditures

Epogen............................

67.96

7.03 Calcitriol........................

0.45

44.74 Doxercalciferol...................

3.62

44.94 Iron dextran......................

0.11

37.40 Iron sucrose......................

7.79

44.50

[[Page 70166]]

Levocarnitine.....................

1.11

66.27 Paricalcitol......................

13.38

26.44 Sodium ferric glut................

4.64

41.96 Alteplase, Recombinant............

0.75

4.00 Vancomycin........................

0.20

22.20

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 hospital-based 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 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 hospital-based 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 Add-On

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 hospital-based and independent facilities, for 2006 we computed a combined weighted average growth in total drug expenditures of 12.3 percent, based on the relative proportions of EPO and non-EPO 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 hospital-based 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.

[[Page 70167]]

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 ``case-mix 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 x 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 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 core-based 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.

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

[[Page 70168]]

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: http://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 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 labor-related shares, 40.65 percent for 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 labor- related 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

[[Page 70169]]

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 hospital-based 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 labor-related 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 labor-related 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 x 0.9677 + $61.29 or $130.11. For independent facilities the rate would have been $68.94 x 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 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 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

[[Page 70170]]

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

Floor

Ceiling

Old MSA

New CBSA

2006.............................. 0.85 *............... None.................

75

25 2007.............................. 0.80 *............... None.................

50

50 2008.............................. Reassess............. None.................

25

75 2009.............................. Reassess............. None.................

0

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 x $135.00 + .25 x $145.00 = $137.50 CY 2007--.50 x $135.00 + .50 x $145.00 = $140.00 CY 2008--.25 x $135.00 + .75 x $145.00 = $142.00 CY 2009--0 x $135.00 + 1.0 x $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 composite payment rate under Sec. 413.186.

Response: ESRD facilities which have been granted exceptions to their composite payment rates, including those granted under the authority of Sec. 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 Sec. 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. 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 2-year 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

[[Page 70171]]

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 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 labor-related 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 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: http://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

[[Page 70172]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.012

[[Page 70173]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.013

[[Page 70174]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.014

[[Page 70175]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.015

[[Page 70176]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.016

[[Page 70177]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.017

[[Page 70178]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.018

[[Page 70179]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.019

[[Page 70180]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.020

[[Page 70181]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.021

[[Page 70182]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.022

[[Page 70183]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.023

[[Page 70184]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.024

[[Page 70185]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.025

[[Page 70186]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.026

[[Page 70187]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.027

[[Page 70188]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.028

[[Page 70189]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.029

[[Page 70190]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.030

[[Page 70191]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.031

[[Page 70192]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.032

[[Page 70193]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.033

[[Page 70194]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.034

[[Page 70195]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.035

[[Page 70196]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.036

[[Page 70197]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.037

[[Page 70198]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.038

[[Page 70199]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.039

[[Page 70200]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.040

[[Page 70201]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.041

[[Page 70202]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.042

[[Page 70203]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.043

[[Page 70204]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.044

[[Page 70205]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.045

[[Page 70206]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.046

[[Page 70207]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.047

[[Page 70208]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.048

[[Page 70209]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.049

[[Page 70210]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.050

[[Page 70211]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.051

[[Page 70212]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.052

BILLING CODE 4120-01-C

[[Page 70213]]

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 case-mix 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 http://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 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 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 case- mix 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

[[Page 70214]]

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 K-DOQI ``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 x 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. 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 Sec. 413.180 through Sec. 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 Sec. 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 Sec. 413.180(d) to remove the requirement 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 Sec. 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 Sec. 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

[[Continued on page 70215]]

From the Federal Register Online via GPO Access [wais.access.gpo.gov] ]

[[pp. 70215-70264]] 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

[[Continued from page 70214]]

[[Page 70215]]

an exception rate. We have incorporated these statutory provisions in our proposed regulatory changes to Sec. 413.170, Sec. 413.182, and Sec. 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 Sec. 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 Sec. 413.182(b), (c), and (e). However, we proposed to retain the exception criterion for self-dialysis training costs under Sec. 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 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 Sec. 413.182(a) and Sec. 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 Sec. Sec. 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 Sec. 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 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 Sec. 413.180 through Sec. 413.192 as proposed. However, we have added language to Sec. 413.180 regarding the intermediary notification discussed above. In addition, we are adding a technical clarification to proposed Sec. 413.170 to cross-reference Sec. 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

[[Page 70216]]

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 12-month period available associated with all sales subject to the ASP reporting requirements. The manufacturer then calculates a percentage using this summed amount as the numerator and the corresponding total sales data as the denominator. This results in a 12-month rolling average price concession percentage that is applied to the total in dollars for the sales subject to the ASP reporting requirement for the quarter being submitted to determine the price concession estimate for the quarter. The methodology is specified in Sec. 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 12-month 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 Sec. 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 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 Sec. 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 Sec. 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

[[Page 70217]]

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 12-month 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 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 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 Sec. 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 (http://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.

[[Page 70218]]

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 x 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 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 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

[[Page 70219]]

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 add-on 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 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 FDA-approved 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); anti-inflammatory 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 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

[[Page 70220]]

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' 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 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 cross-walking 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 pre- and 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

[[Page 70221]]

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 (http://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 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.

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.

[[Page 70222]]

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.'' 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 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

[[Page 70223]]

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 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 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

[[Page 70224]]

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 hospital-based 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 volume-weighted 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 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 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

[[Page 70225]]

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 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).

\1\ GAO, ``Medicare Payment for Covered Outpatient Drugs Exceed Providers' Costs,'' September 2001. OIG, ``Excessive Medicare Reimbursement for Albuterol,'' March 2002.

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 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.

\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.

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

[[Page 70226]]

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.

\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.

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 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 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 Sec. 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, in-home 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

[[Page 70227]]

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, in-home 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.

\5\ Office of the Inspector General, ``Review of Services Provided by Inhalation Drug Suppliers,'' September 2005, OEI-01-05- 00090.

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, 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 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 non-payment 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

[[Page 70228]]

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, 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 $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

[[Page 70229]]

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 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 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

[[Page 70230]]

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 90-day 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 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 30-day 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 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 Sec. 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.

[[Page 70231]]

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 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 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.

[[Page 70232]]

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 (Sec. 424.57(c)(12)). In 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 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

[[Page 70233]]

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 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 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.

[[Page 70234]]

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 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 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 Sec. 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.

[[Page 70235]]

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 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 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: http://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'

[[Page 70236]]

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 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 Sec. 414.906 through Sec. 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.

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 Sec. 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 Sec. 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

[[Page 70237]]

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 http://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 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 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

[[Page 70238]]

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 Old HCPCS code

J0881........................... Injection,

J0880 darbepoetin alfa,

Q0137 1 microgram (non- esrd use). J0885........................... Injection, epoetin

Q0136 alfa, (for non- esrd use), 1000 units. J7318........................... Hyaluronan (Sodium

J7317 Hyaluronate) or

J7320 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 re-weighted. 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 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 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

[[Page 70239]]

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)

Long description

J0128..................................... Abarelix injection. J0180..................................... Agalsidase beta injection. J0878..................................... Daptomycin injection. J1931..................................... Laronidase injection. J2357..................................... Omalizumab injection. J2469..................................... Palonosetron HCl. J2794..................................... Risperidone, long acting. J9035..................................... Bevacizumab injection. J9041..................................... Bortezomib injection. J9055..................................... Cetuximab injection. J9305..................................... Pemetrexed injection. J9264..................................... Paclitaxel protein bound particles. J2503..................................... Pegaptanib. J0278..................................... Amikacin. J9225..................................... Histrelin implant.

Table 25.--HCPCS Codes From Addendum A That Have Been Split

2006 Long

Discontinued HCPCS (effective 1/1/2006)

description

HCPCS

J1751........................... Iron Dextran 165...

J1750 J1752........................... Iron Dextran 267...

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 Sec. 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. (c) Process for Adding NDCs Within a HCPCS Code in an Approved CAP Vendor's Drug List

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 Sec. 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'

[[Page 70240]]

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 Sec. 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 Sec. 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 Sec. 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 Sec. 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 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 Sec. 414.906. This application process is reflected in the amended Sec. 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 Sec. 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 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

[[Page 70241]]

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 Sec. 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 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 Sec. 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 Sec. 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 Sec. 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.

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

[[Page 70242]]

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 Sec. 414.906(f)(2)(i). 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 Sec. 414.906(f)(2)(iii). vendor may request that CMS allow it to supply additional HCPCS codes under the CAP. Additional NDCs: Approved CAP vendor may Sec. 414.906(f)(2)(ii). 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 Sec. 414.906(f)(2)(iv). (``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 Sec. 414.906(f)(2)(iii). 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 Sec. 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 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

[[Page 70243]]

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: http://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[supreg]).

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 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 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

[[Page 70244]]

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. b. Vendor/Bidding Issues

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 Sec. 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 Verified-Accredited Wholesale Distributors \TM\ Program could play a key role in adherence to quality and performance 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 Verified-Accredited 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 Sec. 414.916.

[[Page 70245]]

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 Sec. 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 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. (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

[[Page 70246]]

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 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 Sec. 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 Sec. 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 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

[[Page 70247]]

interim final rule with comment (Sec. 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 http://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 http://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 drug-ordering 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 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 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

[[Page 70248]]

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 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 single-use 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 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

[[Page 70249]]

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.

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 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

[[Page 70250]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.053

BILLING CODE 4120-01-C

[[Page 70251]]

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 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'') 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 Sec. 414.914(h) also allow the participating CAP physician and the approved CAP vendor to enter into an arrangement for

[[Page 70252]]

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 anti-kickback statute and liability under section 1128A(a)(5) of the Act. Cost-sharing 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.

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. (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 Sec. 414.902. We also defined ``emergency situation'' for the purposes of the resupply provisions of the CAP in Sec. 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 Sec. 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

[[Page 70253]]

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 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 decision-making 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 Sec. 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.

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 Sec. 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

[[Page 70254]]

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 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 Sec. 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 Sec. 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 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 Sec. 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 Sec. 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

[[Page 70255]]

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 Sec. 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 Sec. 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 (specified in Sec. 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 Sec. 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 Sec. 414.914(g)(3) and Sec. 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 Sec. 414.914(g) state that the ``approved CAP vendor must provide assistance to beneficiaries experiencing financial difficulty in paying their cost sharing amounts * * *'' However, Sec. 414.914(g)(3) and Sec. 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 Sec. 414.914(g) and Sec. 414.914(h)(3) to require approved CAP vendors to have a cost sharing assistance program available if the beneficiary expressed a need for one.

Section 14.914(g)(3) and Sec. 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 Sec. 414.914(g)(3) and Sec. 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 Sec. 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 Sec. 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 Sec. 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

[[Page 70256]]

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 Sec. 1003.101 and Sec. 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 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 http://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 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

[[Page 70257]]

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 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. (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 non- participating 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

[[Page 70258]]

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 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 opt-out of CAP for any approved CAP 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 Sec. 414.908(a)(2), under which a participating CAP physician may choose a different approved CAP vendor mid-year 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 Sec. 414.914(h) are met) in Sec. 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

[[Page 70259]]

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 Sec. 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 Sec. 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 Sec. 414.908(a)(5) to state that if the approved CAP vendor refuses to ship to the participating CAP physician because the conditions of Sec. 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 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-by-beneficiary 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 Sec. 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 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 http://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

[[Page 70260]]

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 opt-out and does not take good faith efforts to correct his or her failure to maintain opt-out, current regulations at Sec. 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, Sec. 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 Sec. 405.435 in order to clarify that the consequences specified in Sec. 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 Sec. 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 Sec. 405.435(b)(1) through (b)(8) would be applicable from the date that the first violation of Sec. 405.435(a) occurred until the end of the opt-out period during which the violation occurred (unless the physician or practitioner takes good faith efforts to restore opt-out conditions, for example, by refunding the amounts in excess of the charge limits to beneficiaries with whom he or she did not sign a private contract). These good faith efforts must be made within 45 days of any notice by the carrier that the physician or practitioner has failed to maintain opt-out (where the carrier discovers the failure after the 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 Sec. 405.435 does not instruct Medicare carriers to 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 Sec. 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 Sec. 405.415 or the Medicare program could make mistaken payments due to the physician or practitioner billing Medicare in violation of Sec. 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 opt-out violation.

[[Page 70261]]

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 Sec. 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 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 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 well-established 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

[[Page 70262]]

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, 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 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

[[Page 70263]]

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 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

Current total CY 2006 total Procedure 1 74183 Procedure 2 72196 payment

payment

CY 2006 payment calculation

PC......................................

$117.00

$90.00

$207.00

$207.00

no reduction. TC......................................

978.00

529.00

1,507.00

1,374.75

978 + (.75 x $529). Global..................................

1,095.00

619.00

1,714.00

1,581.75

$207 + $978 + (0.75 x $529).

BILLING CODE 4120-01-U

[[Page 70264]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.054

[[Continued on page 70265]]

From the Federal Register Online via GPO Access [wais.access.gpo.gov] ]

[[pp. 70265-70314]] 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

[[Continued from page 70264]]

[[Page 70265]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.055

BILLING CODE 4120-01-C

[[Page 70266]]

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 condition-based payment system; a pay-for-performance 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 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 http://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 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

[[Page 70267]]

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 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 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 all-inclusive 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 Sec. 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

[[Page 70268]]

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 Sec. 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 co-payment 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 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 all-inclusive 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-to-face 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.

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

[[Page 70269]]

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 wrap-around 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.

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. 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 Sec. 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 cross-over 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

[[Page 70270]]

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 Sec. 422.204).

Comment: A commenter requested clarification that supplemental payments are available for Medicare-covered 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 Sec. 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 Sec. 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 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 Sec. 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 Sec. 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 Sec. 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 Sec. 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.

Therefore in Sec. 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 Hispanic-Americans 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.

[[Page 70271]]

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 African-American 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.

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 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 Hispanic-Americans 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

[[Page 70272]]

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 Hispanic-Americans age 65 and older as proposed.

P. Additional Issues

1. Corrections to Conditions for Medicare Payment (Sec. 424.22)

Two typographical errors in 42 CFR 424.22 were discovered. First, Sec. 424.22(d) erroneously refers to the definition of ``financial relationship'' in ``Sec. 411.351'' instead of ``Sec. 411.354''. In addition, footnote 1 of Sec. 424.22(a)(1)(iv) contains an error in the spelling of the word ``hospital.'' Therefore, we are revising Sec. 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 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 anti-cancer drugs.

One major specialty group opposed the continuation of the demonstration project stating that it is inconsistent with current efforts to build evidence-based medicine into the delivery of high quality care to Medicare patients.

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

[[Page 70273]]

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 http://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.

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. 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.

[[Page 70274]]

Table 28.--Codes Reviewed Under the Refinement Panel Process

Requested 2006 work CPT code*

Mod

Descriptor

2005 work RVU

work RVU RVU

97605.................... ........... Neg press wound tx, Bundled.................

0.55

0.55 50 cm.

* 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, 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 (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

[[Page 70275]]

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 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.

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

[[Page 70276]]

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.

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 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

[[Page 70277]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.056

[[Page 70278]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.057

[[Page 70279]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.058

[[Page 70280]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.059

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:

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 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.

[[Page 70281]]

Table 30.--AMA RUC Anesthesia Recommendations and CMS Decisions for New and Revised CPT Codes

RUC

2006 base * CPT CODE

Description recommendation

CMS decision

units

01965............. ANESTH, INC/MISSED AB

4.00 Agree......................

4.00 PROC. 01966............. ANESTH, INDUCED AB

4.00 Agree......................

4.00 PROCEDURE.

* 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 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 intra-service 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. 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); intra-arterial.--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, post-lingual hearing loss.--CPT codes 92630 and 92633 represent speech language pathology and audiology services. These CPT codes describe rehabilitative or therapeutic services. When speech-language 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

[[Page 70282]]

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 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; 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 intra-service 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 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

[[Page 70283]]

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 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 Sec. 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 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.

[[Page 70284]]

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 Sec. 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 Sec. 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.'' 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 Sec. 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 self-referral 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 (on-site) 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 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 Sec. 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

[[Page 70285]]

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 non-ionizing (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 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, 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

[[Page 70286]]

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 self- refer.

Response: We appreciate the commenter's willingness to share its 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 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 Sec. 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 self-referral 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 self- interest is present, as is the case in many (but not all) office-based (or non-hospital) 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

[[Page 70287]]

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 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 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

[[Page 70288]]

certain intrinsic checks against over-utilization.

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 Sec. 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 over- utilization, 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 physician-owned 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 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.

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 non-hospital entities or non-physician owned entities that currently furnish these services.

[[Page 70289]]

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 phased-in 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 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 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

[[Page 70290]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.060

[[Page 70291]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.061

[[Page 70292]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.062

[[Page 70293]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.063

[[Page 70294]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.064

[[Page 70295]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.065

BILLING CODE 4120-01-C

[[Page 70296]]

C. Annual Update to the Code List

In Sec. 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 http://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 self-referral prohibition:

EPO and other dialysis-related drugs furnished in or by an ESRD facility (Sec. 411.355(g)).

Preventive screening tests, immunizations or vaccines (Sec. 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 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 Sec. 411.355(g) (regarding EPO and other dialysis-related outpatient prescription drugs furnished in or by an ESRD facility) and in Sec. 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 Sec. 411.351. BILLING CODE 4120-01-U

[[Page 70297]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.066

[[Page 70298]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.067

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 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, language, voice, communication, and/or auditory processing. We had deleted this code in the Phase II physician self-referral 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

[[Page 70299]]

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 weighted-average 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 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; 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

[[Page 70300]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.068

BILLING CODE 4120-01-C

[[Page 70301]]

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 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 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

[[Page 70302]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.069

[[Page 70303]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.070

BILLING CODE 4120-01-C

[[Page 70304]]

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 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:

[GRAPHIC] [TIFF OMITTED] TR21NO05.000

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)

[GRAPHIC] [TIFF OMITTED] TR21NO05.001

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.

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:

(1) The estimated change in fees for physicians' services;

(2) The estimated change in the average number of Medicare fee-for- service 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 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.

[[Page 70305]]

Screening mammography, screening pap smears, and screening pelvic exams.

Diabetes outpatient self-management 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.

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 cost-sharing, 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).

\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.

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 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

[[Page 70306]]

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-for-performance will drive spending over the target, negatively impacting future updates, and thereby penalizing physicians for participating in pay-for-performance.

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 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 e-prescribing 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 G-Codes for quality indicators. The G-codes were established by Medicare to supplement claims data with clinical data pertinent to a variety of quality 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 volume-based 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

[[Page 70307]]

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 re-estimate the SGR and allowed 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 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.

[[Page 70308]]

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, government-induced 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 cost-based 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.

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 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

[[Page 70309]]

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 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

Current estimate

Fees................................... 2.8 percent (1.028)....... 2.7 percent (1.027). Enrollment............................. -2.5 percent (0.975)...... -3.1 percent (0.969). Real Per Capita GDP.................... 2.3 percent (1.023)....... 2.2 percent (1.022). Law and Regulation..................... 0.0 percent (1.000)....... 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 x 0.969 x 1.022 x 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 that was published in the CY 2005 Final Rule (69 FR 66386) and our current estimate.

Table 37.--2005 SGR Calculation

Estimate from CY 2005 Statutory factors

Final Rule

Current estimate

Fees................................... 1.3 percent (1.013)....... 0.8 percent (1.008). Enrollment............................. -0.3 percent (0.997)...... 0.3 percent (1.003). Real Per Capita GDP.................... 2.2 percent (1.022)....... 2.2 percent (1.022). Law and Regulation..................... 1.0 percent (1.010)....... 1.2 percent (1.010).

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 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

Estimate from CY Estimate from CY Statutory factors

2004 Final Rule 2005 Final Rule

Final

Fees............................ 2.7 percent (1.027) 1.4 percent (1.014) 1.3 percent (1.013). Enrollment...................... 1.7 percent (1.017) 1.7 percent (1.017) 1.3 percent (1.013). Real Per Capita GDP............. 2.8 percent (1.028) 2.2 percent (1.022) 2.1 percent (1.021). Law and Reg..................... 0.0 percent (1.000) 1.5 percent (1.015) 1.7 percent (1.017).

Total....................... 7.4 percent (1.074) 7.0 percent (1.070) 6.6 percent (1.066).

[[Page 70310]]

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 weighted- average of the MEI, laboratory and drug price changes for 2006.

Table 39

Weight Update

Physician........................................... 0.831 2.8 Laboratory.......................................... 0.072 0.0 Drugs............................................... 0.097 4.1 Weighted-average.................................... 1.000 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

2006

Overall...................... 39.536 million. 40.059 million. Medicare Advantage (MA)...... 5.070 million.. 6.654 million. Net.......................... 34.466 million. 33.405 million. Percent Increase............. ............... -3.1 percent.

An important factor affecting fee-for-service 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-for-service enrollment for 2006 becomes known.

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 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

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

A more detailed discussion of our revised estimates of the four elements of the 2005 SGR follows.

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

[[Page 70311]]

Medicare to pay for most drugs at 106 percent of ASP beginning January 1, 2005. We now estimate a weighted-average change in fees for drugs included in the SGR of -21.1 percent for 2005. The estimated weighted- average 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 Update

Physician.....................................

0.843

3.1 Laboratory....................................

0.070

0.0 Drugs.........................................

0.087

-21.1 Weighted-average..............................

1.000

0.8

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 Final Rule was 1.3 percent. The reduction from 1.3 percent to our current estimate of 0.8 percent is primarily due to application of the drug pricing changes required by sections 303 and 304 of the MMA.

Factor 2--The Percentage Change in the Average Number of Part B Enrollees From 2004 to 2005

OACT estimates that the average number of Medicare Part B fee-for- service enrollees (excluding beneficiaries enrolled in M+C plans) increased by 0.3 percent in 2005. Table 42 illustrates how we determined this figure.

Table 42

2004

2005

Overall...................... 39.048 million. 39.536 million. Medicare+Choice.............. 4.683 million.. 5.070 million. Net.......................... 34.366 million. 34.466 million. Percent Increase............. ............... 0.3 percent.

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-for-service 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 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 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

[[Page 70312]]

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 Update

Physician.....................................

0.833

2.9 Laboratory....................................

0.068

0.0 Drugs.........................................

0.099

-11.5 Weighted-average..............................

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 M+C plans) from 2003 to 2004 was 1.3 percent. Our calculation of this factor is based on complete data from 2004. Table 44 illustrates the calculation of this factor.

Table 44

2003

2004

Overall...................... 38.465 million. 39.048 million. Medicare+Choice.............. 4.655 million.. 4.683 million. Net.......................... 33.810 million. 34.366 million. Percent Increase............. ............... 1.3 percent.

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

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 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.

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 adjustments to either the conversion factor or RVUs.

With respect to the work RVUs, our policy has been to meet the budget-neutrality 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................. $37.8975. 2006 Update............................ -4.4 percent. 2006 Adjustment for Work RVU Changes... .9985. 2006 Conversion Factor................. $36.1770.

[[Page 70313]]

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

$17.7594. 2006 Update

-4.4 percent. 2006 Adjustment for Work RVU Changes .9985. 2006 Adjustment for PE Changes

1.00039. 2006 Anesthesia Conversion Factor

$16.9591.

IX. Telehealth Originating Site Facility Fee Payment Amount Update

Section 1834(m) of the Act establishes the payment amount for the Medicare 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 Facility fee

(percent)

Period

$20.00......................

N/A 10/01/2001-12/31/2002 $20.60......................

3.0 01/01/2003-12/31/2003 $21.20......................

2.9 01/01/2004-12/31/2004 $21.86......................

3.1 01/01/2005-12/31/2005 $22.47......................

2.8 01/01/2006-12/31/2006

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 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 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-

[[Page 70314]]

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 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 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

[[Continued on page 70315]]

From the Federal Register Online via GPO Access [wais.access.gpo.gov] ]

[[pp. 70315-70364]] 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

[[Continued from page 70314]]

[[Page 70315]]

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 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 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 budget-neutrality requirements in the statute by

[[Page 70316]]

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

2004 Medicare Description of family of imaging

allowed Percentage Family

procedures

charges ($ in impact millions)

01..................................... Ultrasound (Chest/Abdomen/Pelvis--Non-

$138

-3.4 Obstetrical). 02..................................... CT and CTA (Chest/Thorax/Abd/Pelvis)...

563

-9.5 03..................................... CT and CTA (Head/Brain/Orbit/

97

-1.3 Maxillofacial/Neck). 04..................................... MRI and MRA (Chest/Abd/Pelvis).........

105

-2.4 05..................................... MRI and MRA (Head/Brain/Neck)..........

532

-3.1

[[Page 70317]]

06..................................... MRI and MRA (spine)....................

540

-2.2 07..................................... CT (spine).............................

24

-2.1 08..................................... MRI and MRA (lower extremities)........

166

-1.6 09..................................... CT and CTA (lower extremities).........

5

-1.0 10..................................... MR and MRI (upper extremities and

107

-1.4 joints). 11..................................... CT and CTA (upper extremities).........

2

-0.7

Total for all procedures subject to

2,276

-4.2 multiple imaging reductions.

Using the same data, we also summarized the dollar value of the reductions by specialty. Specialty-specific 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 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 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

[[Page 70318]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.071

[[Page 70319]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.072

[[Page 70320]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.073

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 procedures because they are the most commonly provided by a broad spectrum of physician specialties. There are separate columns that show the change in the facility rates and the nonfacility rates. For an explanation of facility and nonfacility PE refer to section II.A. in the preamble of this final rule with comment. BILLING CODE 4120-01-U

[[Page 70321]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.074

[[Page 70322]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.075

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 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 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

[[Page 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.

[GRAPHIC] [TIFF OMITTED] TR21NO05.076

E. Medicare Telehealth Services

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.

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.

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.

BILLING CODE 4120-01-P

[[Page 70324]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.077

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 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, 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

[[Page 70325]]

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 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 hospital-based 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 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

[[Page 70326]]

[GRAPHIC] [TIFF OMITTED] TR21NO05.078

BILLING CODE 4120-01-C

[[Page 70327]]

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 opt-out 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 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 Sec. 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, Sec. 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.

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 Sec. 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

[[Page 70328]]

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 anti-competitive 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 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 self-referral 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 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 http://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).

[[Page 70329]]

Table 54.--Accounting Statement: Classification of Estimated Expenditures, From CY 2005 to the CY 2006 [In millions]

Category

Transfers

Annualized Monetized Transfers......... Negative transfer--Estimated decrease in expenditures $2668. From Whom To Whom?..................... 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

42 CFR Part 405

Administrative practice and procedure, Health facilities, Health professions, Kidney diseases, Medical devices, Medicare, Reporting and recordkeeping requirements, Rural areas, X-rays.

42 CFR Part 410

Health facilities, Health professions, Kidney diseases, Laboratories, Medicare, Reporting and recordkeeping requirements, Rural areas, X-rays.

42 CFR Part 411

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.

0 For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services amends 42 CFR chapter IV as set forth below:

PART 405--FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED

0 1. The authority citation for part 405 continues to read as follows:

Authority: Secs. 1102, 1861, 1862(a), 1871, 1874, 1881, and 1886(k) of the Social Security Act (42 U.S.C. 1302, 1395x, 1395y(a), 1395hh, 1395kk, 1395rr, and 1395ww(k)), and sec. 353 of the Public Health Service Act (42 U.S.C. 263a).

Subpart D--Private Contracts

0 2. Section 405.435 is amended by-- 0 A. Revising paragraph (b) introductory text. 0 B. Adding paragraph (d).

The revision and addition read as follows:

Sec. 405.435 Failure to maintain opt-out.

* * * * *

(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 days of the physician's or practitioner's discovery of the failure to maintain opt-out, whichever is earlier, to correct his or her violations of paragraph (a) of this section. 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

0 3. Add Sec. 405.2469 to read as follows:

Sec. 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.

[[Page 70330]]

(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 Sec. 405.2463.

PART 410--SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS

0 4. The authority citation for part 410 continues to read as follows:

Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).

Subpart B--Medical and Other Health Services

0 5. Section 410.23 is amended by-- 0 A. Revising paragraphs (a)(2)(i) through (iii). 0 B. Adding a new paragraph (a)(2)(iv).

The revision and addition read as follows:

Sec. 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. * * * * *

0 6. Section 410.78 is amended by-- 0 A. Revising paragraph (b) introductory text. 0 B. Adding paragraph (b)(2)(viii).

The revision and addition read as follows:

Sec. 410.78 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 Sec. 410.134. * * * * *

PART 411--EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT

0 7. The authority citation for part 411 continues to read as follows:

Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).

Subpart J--Financial Relationships Between Physicians and Entities Furnishing Designated Health Services

0 8. Section 411.351 is amended by-- 0 A. Revising the definition of ``Radiation therapy services and supplies''. 0 B. Revising the definition of ``Radiology and certain other imaging services''. 0 C. Revising the introductory text of paragraph (2) of the definition of ``Referral''.

The revisions read as follows:

Sec. 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 Sec. 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 imaging services are covered under section 1861(s)(3) of the Act and Sec. 410.32 and Sec. 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

0 9. The authority citation for part 413 continues to read as follows:

Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i), and (n), 1871, 1881, 1883, and 1886 of the Social Security Act (42 U.S.C. 1302, 1395D(D), 1395f(b), 1395g, 13951(a), (i), and (n), 1395hh, 1395rr, 1395tt, and 1395ww).

Subpart H--Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs

0 10. Section 413.170 is amended by revising paragraph (b) to read as follows:

Sec. 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 Sec. 413.184 of this subpart) may receive an exception to the prospective payment rates; and * * * * *

0 11. Section 413.174 is amended by-- 0 A. Revising paragraph (f).

[[Page 70331]]

0 B. Removing paragraph (g).

The revision reads as follows:

Sec. 413.174 Prospective rates for hospital-based 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 Sec. 414.904 of this subchapter.

(4) To independent ESRD facilities in accordance with the methodology specified in Sec. 405.517 of this subchapter.

0 12. Section 413.180 is amended by-- 0 A. Revising paragraphs (b) and (d) 0 B. Removing paragraphs (e) and (k). 0 C. Redesignating paragraphs (f) through (j) as paragraphs (e) through (i). 0 D. Revising newly redesignated paragraph (i). 0 E. Redesignating paragraphs (l) and (m) as paragraphs (j) and (k). 0 F. Revising newly redesignated paragraph (k).

The revisions read as follows:

Sec. 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 Sec. 413.174, and if these excess costs are attributable to one or more of the factors in Sec. 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. * * * * *

(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. 0 13. Section 413.182 is revised to read as follows:

Sec. 413.182 Criteria for approval of exception requests.

(a) CMS may approve exceptions to a pediatric ESRD facility's prospective payment rate if the pediatric ESRD facility did not have an approved exception rate as of October 1, 2002.

(b) The pediatric ESRD facility must demonstrate, by convincing objective evidence, that its total per treatment costs are reasonable and allowable under the relevant cost reimbursement principles of part 413 and that its per treatment costs in excess of its payment rate are directly attributable to any of the following criteria:

(1) Pediatric patient mix, as specified in Sec. 413.184.

(2) Self-dialysis training costs in pediatric facilities, as specified in Sec. 413.186.

0 14. Section 413.184 is amended by revising paragraphs (a) and (b)(1) to read as follows:

Sec. 413.184 Payment exception: Pediatric patient mix.

(a) Qualifications. To qualify for an exception to its prospective payment rate based on its pediatric patient mix a facility must demonstrate that--

(1) At least 50 percent of its patients are individuals under 18 years of age;

(2) Its nursing personnel costs are allocated properly between each mode of care;

(3) The additional nursing hours per treatment are not the result of an excess number of employees;

(4) Its pediatric patients require a significantly higher staff-to- patient ratio than typical adult patients; and

(5) These services, procedures, or supplies and 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 Sec. 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. * * * * *

Sec. 413.186 [Removed]

0 15. Section 413.186 is removed.

Sec. 413.188 [Removed]

0 16. Section 413.188 is removed.

Sec. 414.190 [Redesignated as Sec. 413.186]

0 17. Redesignate Sec. 413.190 as Sec. 413.186 and revise the newly designated Sec. 413.186 to read as follows:

Sec. 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

[[Page 70332]]

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 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.

Sec. 413.192 [Removed]

0 18. Section 413.192 is removed.

PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES

0 19. The authority citation for part 414 continues to read as follows:

Authority: Secs. 1102, 1871, and 1881(b)(1) of the Social Security Act (42 U.S.C. 1302, 1395hh, and 1395rr(b)(1)).

Subpart B--Physicians and Other Practitioners

0 20. Section 414.65 is amended by revising paragraph (a)(1) to read as follows:.

Sec. 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

0 21. Section 414.804(a) is amended by revising paragraph (a)(3)(iv) to read as follows:

Sec. 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 x $50,000) = $33,334 (net total sales amount); $33,334/10,000 = $3.33 (average sales price). * * * * *

0 22. Section 414.904 is amended by-- 0 A. Revising paragraph (a) introductory text. 0 B. Adding a new paragraph (d)(2)(iii). 0 C. Revising paragraphs (d)(3) and (e)(2).

The revisions and additions read as follows:

Sec. 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

[[Page 70333]]

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. * * * * *

0 23. Section 414.906 is amended by revising paragraph (f) to read as follows:

Sec. 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 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.

0 24. Section 414.908 is amended by-- 0 A. Revising paragraphs (a)(3)(v)(M). 0 B. Redesignating paragraphs (a)(3)(vi) through (a)(3) (xii) as (a)(3)(viii) through (a)(3)(xiv). 0 C. Adding new paragraphs (a)(3)(vi) and (a)(3)(vii). 0 D. Revising paragraph (a)(5).

The revisions and additions read as follows:

Sec. 414.908 Competitive acquisition program.

(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 to accept the changes to the approved CAP vendor's CAP drug list that have been approved in accordance with Sec. 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 Sec. 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. * * * * *

0 25. Section 414.914 is amended by-- 0 A. Redesignating paragraphs (f)(9) through (f)(11) as paragraphs (f)(14) through (f)(16). 0 B. Redesignating (f)(5) through (f)(8) as paragraphs (f)(9) through (f)(12) and paragraphs. 0 C. Adding new paragraphs (f)(5) through (f)(8) and (f)(13). 0 D. Revising paragraph (g)(3). 0 E. Revising paragraphs (h)(1) through (h)(3), (h)(5) and (h)(6), and (h)(8).

The revisions and additions read as follows:

Sec. 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-

[[Page 70334]]

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 Sec. 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 cost-sharing 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 Sec. 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 Sec. 414.914(g).

(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 cost-sharing 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 Sec. 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 Sec. 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

0 26. Section 414.1001 is revised to read as follows:

Sec. 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 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 30-day 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

0 27. The authority citation for part 424 continues to read as follows:

Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).

Sec. 424.22 [Amended]

0 28. In Sec. 424.22-- 0 A. The footnote for paragraph (a)(1)(iv), the term ``hosptial'' is removed and the term ``hospital'' is added in its place.

[[Page 70335]]

0 B. Paragraph (d), remove the reference to ``Sec. 411.351'' and add in its place the reference ``Sec. 411.354''.

PART 426--REVIEW OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL COVERAGE DETERMINATIONS

0 29. The authority citation for part 426 continues to read as follows:

Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).

0 30. The heading for Part 426 is revised to read as set forth above.

Subpart C--General Provisions for the Review of LCDs and NCDs

0 31. Section 426.340 is amended by revising paragraphs (e)(2) and (f)(2) to read as follows:

Sec. 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, non-facility PE, facility PE, and malpractice 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 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

[[Page 70336]]

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 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.

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.)

\1\ CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved.

\2\ Copyright 2005 American Dental Association. All rights reserved.

\3\ +Indicates RVUs are not used for Medicare payment.

[[Page 70337]]

Addendum B.--Relative Value Units (RVUs) and Related Information

Physician Non-

Mal- Non- CPT \1\ HCPCS \2\

Mod

Status

Description

work Facility Facility practice Facility Facility Global RVUs \3\ PE RVUs PE RVUs RVUs Total Total

0001F............. .............. I

Heart failure assessed 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0003T............. .............. C

Cervicography......... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0005F............. .............. I

Osteoarthritis

0.00 0.00 0.00 0.00 0.00 0.00

XXX assessed. 0008T............. .............. C

Upper gi endoscopy w/

0.00 0.00 0.00 0.00 0.00

.00

XXX suture. 0016T............. .............. C

Thermotx choroid vasc

0.00 0.00 0.00 0.00 0.00 0.00

XXX lesion. 0017T............. .............. C

Photocoagulat macular

0.00 0.00 0.00 0.00 0.00 0.00

XXX drusen. 0018T............. .............. C

Transcranial magnetic

0.00 0.00 0.00 0.00 0.00 0.00

XXX stimul. 0019T............. .............. C

Extracorp shock wv

0.00 0.00 0.00 0.00 0.00 0.00

XXX tx,ms nos. 0021T............. .............. C

Fetal oximetry,

0.00 0.00 0.00 0.00 0.00 0.00

XXX trnsvag/cerv. 0024T............. .............. C

Transcath cardiac

0.00 0.00 0.00 0.00 0.00 0.00

XXX reduction. 0026T............. .............. C

Measure remnant

0.00 0.00 0.00 0.00 0.00 0.00

XXX lipoproteins. 0027T............. .............. C

Endoscopic epidural

0.00 0.00 0.00 0.00 0.00 0.00

XXX lysis. 0028T............. .............. C

Dexa body composition

0.00 0.00 0.00 0.00 0.00 0.00

XXX study. 0029T............. .............. C

Magnetic tx for

0.00 0.00 0.00 0.00 0.00 0.00

XXX incontinence. 0030T............. .............. C

Antiprothrombin

0.00 0.00 0.00 0.00 0.00 0.00

XXX antibody. 0031T............. .............. C

Speculoscopy.......... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0032T............. .............. C

Speculoscopy w/direct

0.00 0.00 0.00 0.00 0.00 0.00

XXX sample. 0041T............. .............. C

Detect ur infect agnt

0.00 0.00 0.00 0.00 0.00 0.00

XXX w/cpas. 0042T............. .............. C

Ct perfusion w/

0.00 0.00 0.00 0.00 0.00 0.00

XXX contrast, cbf. 0043T............. .............. C

Co expired gas

0.00 0.00 0.00 0.00 0.00 0.00

XXX analysis. 0044T............. .............. C

Whole body photography 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0045T............. .............. C

Whole body photography 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0046T............. .............. C

Cath lavage, mammary

0.00 0.00 0.00 0.00 0.00 0.00

XXX duct(s. 0047T............. .............. C

Cath lavage, mammary

0.00 0.00 0.00 0.00 0.00 0.00

XXX duct(s). 0048T............. .............. C

Implant ventricular

0.00 0.00 0.00 0.00 0.00 0.00

XXX device. 0049T............. .............. C

External circulation

0.00 0.00 0.00 0.00 0.00 0.00

XXX assist. 0050T............. .............. C

Removal circulation

0.00 0.00 0.00 0.00 0.00 0.00

XXX assist. 0051T............. .............. C

Implant total heart

0.00 0.00 0.00 0.00 0.00 0.00

XXX system. 0052T............. .............. C

Replace component

0.00 0.00 0.00 0.00 0.00 0.00

XXX heart syst. 0053T............. .............. C

Replace component

0.00 0.00 0.00 0.00 0.00 0.00

XXX heart syst. 0054T............. .............. C

Bone surgery using

0.00 0.00 0.00 0.00 0.00 0.00

XXX computer. 0055T............. .............. C

Bone surgery using

0.00 0.00 0.00 0.00 0.00 0.00

XXX computer. 0056T............. .............. C

Bone surgery using

0.00 0.00 0.00 0.00 0.00 0.00

XXX computer. 0058T............. .............. C

Cryopreservation,

0.00 0.00 0.00 0.00 0.00 0.00

XXX ovary tiss. 0059T............. .............. C

Cryopreservation,

0.00 0.00 0.00 0.00 0.00 0.00

XXX oocyte. 0060T............. .............. C

Electrical impedance

0.00 0.00 0.00 0.00 0.00 0.00

XXX scan. 0061T............. .............. C

Destruction of tumor,

0.00 0.00 0.00 0.00 0.00 0.00

XXX breast. 0062T............. .............. C

Rep intradisc

0.00 0.00 0.00 0.00 0.00 0.00

XXX annulus;1 lev. 0063T............. .............. C

Rep intradisc

0.00 0.00 0.00 0.00 0.00 0.00

XXX annulus;>1lev. 0064T............. .............. C

Spectroscop eval

0.00 0.00 0.00 0.00 0.00 0.00

XXX expired gas. 0065T............. .............. C

Ocular photoscreen

0.00 0.00 0.00 0.00 0.00 0.00

XXX bilat. 0066T............. 26............ N

Ct colonography;screen 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0066T............. TC............ N

Ct colonography;screen 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0066T............. .............. N

Ct colonography;screen 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0067T............. 26............ C

Ct colonography;dx.... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0067T............. TC............ C

Ct colonography;dx.... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0067T............. .............. C

Ct colonography;dx.... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0068T............. .............. C

Interp/rept heart

0.00 0.00 0.00 0.00 0.00 0.00

XXX sound. 0069T............. .............. C

Analysis only heart

0.00 0.00 0.00 0.00 0.00 0.00

XXX sound. 0070T............. .............. C

Interp only heart

0.00 0.00 0.00 0.00 0.00 0.00

XXX sound. 0071T............. .............. C

U/s leiomyomata ablate 0.00 0.00 0.00 0.00 0.00 0.00

XXX 200. 0073T............. .............. A

Delivery, comp imrt... 0.00 18.07

NA 0.13 18.20

NA

XXX 0074T............. .............. N

Online physician e/m.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0075T............. 26............ C

Perq stent/chest vert

0.00 0.00 0.00 0.00 0.00 0.00

XXX art. 0075T............. TC............ C

Perq stent/chest vert

0.00 0.00 0.00 0.00 0.00 0.00

XXX art. 0075T............. .............. C

Perq stent/chest vert

0.00 0.00 0.00 0.00 0.00 0.00

XXX art. 0076T............. 26............ C

S&i stent/chest vert

0.00 0.00 0.00 0.00 0.00 0.00

XXX art. 0076T............. TC............ C

S&i stent/chest vert

0.00 0.00 0.00 0.00 0.00 0.00

XXX art. 0076T............. .............. C

S&i stent/chest vert

0.00 0.00 0.00 0.00 0.00 0.00

XXX art. 0077T............. .............. C

Cereb therm perfusion

0.00 0.00 0.00 0.00 0.00 0.00

XXX probe. 0078T............. .............. C

Endovasc aort repr w/

0.00 0.00 0.00 0.00 0.00 0.00

XXX device. 0079T............. .............. C

Endovasc visc extnsn

0.00 0.00 0.00 0.00 0.00 0.00

XXX repr. 0080T............. .............. C

Endovasc aort repr rad 0.00 0.00 0.00 0.00 0.00 0.00

XXX s&i. 0081T............. .............. C

Endovasc visc extnsn

0.00 0.00 0.00 0.00 0.00 0.00

XXX s&i. 0082T............. .............. C

Stereotactic rad

0.00 0.00 0.00 0.00 0.00 0.00

XXX delivery. 0083T............. .............. C

Stereotactic rad tx

0.00 0.00 0.00 0.00 0.00 0.00

XXX mngmt. 0084T............. .............. C

Temp prostate urethral 0.00 0.00 0.00 0.00 0.00 0.00

XXX stent. 0085T............. .............. C

Breath test heart

0.00 0.00 0.00 0.00 0.00 0.00

XXX reject. 0086T............. .............. C

L ventricle fill

0.00 0.00 0.00 0.00 0.00 0.00

XXX pressure. 0087T............. .............. C

Sperm eval hyaluronan. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0088T............. .............. C

Rf tongue base vol

0.00 0.00 0.00 0.00 0.00 0.00

XXX reduxn. 0089T............. .............. C

Actigraphy testing, 3- 0.00 0.00 0.00 0.00 0.00 0.00

XXX day. 0090T............. .............. C

Cervical artific disc. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0091T............. .............. C

Lumbar artific disc... 0.00 0.00 0.00 0.00 0.00 0.00

XXX

[[Page 70338]]

0092T............. .............. C

Artific disc addl..... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0093T............. .............. C

Cervical artific

0.00 0.00 0.00 0.00 0.00 0.00

XXX diskectomy. 0094T............. .............. C

Lumbar artific

0.00 0.00 0.00 0.00 0.00 0.00

XXX diskectomy. 0095T............. .............. C

Artific diskectomy

0.00 0.00 0.00 0.00 0.00 0.00

XXX addl. 0096T............. .............. C

Rev cervical artific

0.00 0.00 0.00 0.00 0.00 0.00

XXX disc. 0097T............. .............. C

Rev lumbar artific

0.00 0.00 0.00 0.00 0.00 0.00

XXX disc. 0098T............. .............. C

Rev artific disc addl. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0099T............. .............. C

Implant corneal ring.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0100T............. .............. C

Prosth retina

0.00 0.00 0.00 0.00 0.00 0.00

XXX receive&gen. 0101T............. .............. C

Extracorp shockwv

0.00 0.00 0.00 0.00 0.00 0.00

XXX tx,hi enrg. 0102T............. .............. C

Extracorp shockwv

0.00 0.00 0.00 0.00 0.00 0.00

XXX tx,anesth. 0103T............. .............. C

Holotranscobalamin.... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0104T............. .............. C

At rest cardio gas

0.00 0.00 0.00 0.00 0.00 0.00

XXX rebreathe. 0105T............. .............. C

Exerc cardio gas

0.00 0.00 0.00 0.00 0.00 0.00

XXX rebreathe. 0106T............. .............. C

Touch quant sensory

0.00 0.00 0.00 0.00 0.00 0.00

XXX test. 0107T............. .............. C

Vibrate quant sensory

0.00 0.00 0.00 0.00 0.00 0.00

XXX test. 0108T............. .............. C

Cool quant sensory

0.00 0.00 0.00 0.00 0.00 0.00

XXX test. 0109T............. .............. C

Heat quant sensory

0.00 0.00 0.00 0.00 0.00 0.00

XXX test. 0110T............. .............. C

Nos quant sensory test 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0111T............. .............. C

Rbc membranes fatty

0.00 0.00 0.00 0.00 0.00 0.00

XXX acids. 0115T............. .............. C

Med tx mngmt 15 min... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0116T............. .............. C

Med tx mngmt subsqt... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0117T............. .............. C

Med tx mngmt addl 15

0.00 0.00 0.00 0.00 0.00 0.00

XXX min. 0120T............. .............. C

Fibroadenoma

0.00 0.00 0.00 0.00 0.00 0.00

XXX cryoablate, ea. 0123T............. .............. C

Scleral fistulization. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0124T............. .............. C

Conjunctival drug

0.00 0.00 0.00 0.00 0.00 0.00

XXX placement. 0126T............. .............. C

Chd risk imt study.... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0130T............. .............. C

Chron care drug

0.00 0.00 0.00 0.00 0.00 0.00

XXX investigatn. 0133T............. .............. C

Esophageal implant

0.00 0.00 0.00 0.00 0.00 0.00

XXX injexn. 0135T............. .............. C

Perq cryoablate renal

0.00 0.00 0.00 0.00 0.00 0.00

XXX tumor. 0137T............. .............. C

Prostate saturation

0.00 0.00 0.00 0.00 0.00 0.00

XXX sampling. 0140T............. .............. C

Exhaled breath

0.00 0.00 0.00 0.00 0.00 0.00

XXX condensate ph. 0141T............. .............. C

Perq islet transplant. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0142T............. .............. C

Open islet transplant. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0143T............. .............. C

Laparoscopic islet

0.00 0.00 0.00 0.00 0.00 0.00

XXX transplnt. 0144T............. .............. C

CT heart wo dye; qual

0.00 0.00 0.00 0.00 0.00 0.00

XXX calc. 0145T............. .............. C

CT heart w/wo dye

0.00 0.00 0.00 0.00 0.00 0.00

XXX funct. 0146T............. .............. C

CCTA w/wo dye......... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0147T............. .............. C

CCTA w/wo, quan

0.00 0.00 0.00 0.00 0.00 0.00

XXX calcium. 0148T............. .............. C

CCTA w/wo, strxr...... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0149T............. .............. C

CCTA w/wo, strxr quan

0.00 0.00 0.00 0.00 0.00 0.00

XXX calc. 0150T............. .............. C

CCTA w/wo, disease

0.00 0.00 0.00 0.00 0.00 0.00

XXX strxr. 0151T............. .............. C

CT heart funct add-on. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0152T............. .............. C

Computer chest add-on. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0153T............. .............. C

Implant aneur sensor

0.00 0.00 0.00 0.00 0.00 0.00

XXX add-on. 0154T............. .............. C

Implant aneur sensor

0.00 0.00 0.00 0.00 0.00 0.00

XXX study. 0500F............. .............. I

Initial prenatal care

0.00 0.00 0.00 0.00 0.00 0.00

XXX visit. 0501F............. .............. I

Prenatal flow sheet... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 0502F............. .............. I

Subsequent prenatal

0.00 0.00 0.00 0.00 0.00 0.00

XXX care. 0503F............. .............. I

Postpartum care visit. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 1000F............. .............. I

Tobacco use, smoking,

0.00 0.00 0.00 0.00 0.00 0.00

XXX assess. 1001F............. .............. I

Tobacco use, non-

0.00 0.00 0.00 0.00 0.00 0.00

XXX smoking. 10021............. .............. A

Fna w/o image......... 1.27 2.16 0.54 0.10 3.53 1.91

XXX 10022............. .............. A

Fna w/image........... 1.27 2.55 0.42 0.08 3.90 1.77

XXX 1002F............. .............. I

Assess anginal symptom/ 0.00 0.00 0.00 0.00 0.00 0.00

XXX level. 1003F............. .............. I

Level of activity

0.00 0.00 0.00 0.00 0.00 0.00

XXX assess. 10040............. .............. A

Acne surgery.......... 1.18 1.01 0.79 0.05 2.24 2.02

010 1004F............. .............. I

Clin symp vol ovrld

0.00 0.00 0.00 0.00 0.00 0.00

XXX assess. 1005F............. .............. I

Asthma symptoms

0.00 0.00 0.00 0.00 0.00 0.00

XXX evaluate. 10060............. .............. A

Drainage of skin

1.17 1.21 0.93 0.12 2.50 2.22

010 abscess. 10061............. .............. A

Drainage of skin

2.40 1.83 1.50 0.26 4.49 4.16

010 abscess. 1006F............. .............. I

Osteoarthritis assess. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 1007F............. .............. I

Anti-inflm/anlgsc otc

0.00 0.00 0.00 0.00 0.00 0.00

XXX assess. 10080............. .............. A

Drainage of pilonidal

1.17 3.11 1.11 0.11 4.39 2.39

010 cyst. 10081............. .............. A

Drainage of pilonidal

2.45 4.08 1.50 0.24 6.77 4.19

010 cyst. 1008F............. .............. I

Gi/renal risk assess.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 10120............. .............. A

Remove foreign body... 1.22 2.18 0.97 0.12 3.52 2.31

010 10121............. .............. A

Remove foreign body... 2.69 3.52 1.79 0.33 6.54 4.81

010 10140............. .............. A

Drainage of hematoma/

1.53 1.78 1.29 0.19 3.50 3.01

010 fluid. 10160............. .............. A

Puncture drainage of

1.20 1.60 1.08 0.14 2.94 2.42

010 lesion. 10180............. .............. A

Complex drainage,

2.25 2.99 1.99 0.35 5.59 4.59

010 wound. 11000............. .............. A

Debride infected skin. 0.60 0.58 0.22 0.07 1.25 0.89

000 11001............. .............. A

Debride infected skin

0.30 0.23 0.11 0.04 0.57 0.45

ZZZ add-on. 11004............. .............. A

Debride genitalia &

10.31

NA 3.91 0.67

NA 14.89

000 perineum. 11005............. .............. A

Debride abdom wall.... 13.75

NA 5.58 0.96

NA 20.29

000

[[Page 70339]]

11006............. .............. A

Debride genit/per/

12.61

NA 4.86 1.28

NA 18.75

000 abdom wall. 11008............. .............. A

Remove mesh from abd

5.00

NA 2.03 0.61

NA 7.64

ZZZ wall. 11010............. .............. A

Debride skin, fx...... 4.19 6.89 2.63 0.66 11.74 7.48

010 11011............. .............. A

Debride skin/muscle,

4.94 8.18 2.35 0.74 13.86 8.03

000 fx. 11012............. .............. A

Debride skin/muscle/

6.87 12.14 3.85 1.16 20.17 11.88

000 bone, fx. 11040............. .............. A

Debride skin, partial. 0.50 0.52 0.21 0.06 1.08 0.77

000 11041............. .............. A

Debride skin, full.... 0.82 0.66 0.33 0.10 1.58 1.25

000 11042............. .............. A

Debride skin/tissue... 1.12 0.97 0.44 0.13 2.22 1.69

000 11043............. .............. A

Debride tissue/muscle. 2.38 3.39 2.60 0.32 6.09 5.30

010 11044............. .............. A

Debride tissue/muscle/ 3.06 4.46 3.76 0.43 7.95 7.25

010 bone. 11055............. .............. R

Trim skin lesion...... 0.43 0.56 0.17 0.05 1.04 0.65

000 11056............. .............. R

Trim skin lesions, 2

0.61 0.64 0.23 0.07 1.32 0.91

000 to 4. 11057............. .............. R

Trim skin lesions,

0.79 0.74 0.30 0.10 1.63 1.19

000 over 4. 11100............. .............. A

Biopsy, skin lesion... 0.81 1.25 0.37 0.03 2.09 1.21

000 11101............. .............. A

Biopsy, skin add-on... 0.41 0.33 0.19 0.02 0.76 0.62

ZZZ 11200............. .............. A

Removal of skin tags.. 0.77 1.04 0.76 0.04 1.85 1.57

010 11201............. .............. A

Remove skin tags add-

0.29 0.16 0.12 0.02 0.47 0.43

ZZZ on. 11300............. .............. A

Shave skin lesion..... 0.51 0.99 0.21 0.03 1.53 0.75

000 11301............. .............. A

Shave skin lesion..... 0.85 1.11 0.38 0.04 2.00 1.27

000 11302............. .............. A

Shave skin lesion..... 1.05 1.30 0.46 0.05 2.40 1.56

000 11303............. .............. A

Shave skin lesion..... 1.24 1.58 0.52 0.07 2.89 1.83

000 11305............. .............. A

Shave skin lesion..... 0.67 0.85 0.27 0.07 1.59 1.01

000 11306............. .............. A

Shave skin lesion..... 0.99 1.10 0.42 0.07 2.16 1.48

000 11307............. .............. A

Shave skin lesion..... 1.14 1.29 0.49 0.07 2.50 1.70

000 11308............. .............. A

Shave skin lesion..... 1.41 1.45 0.59 0.13 2.99 2.13

000 11310............. .............. A

Shave skin lesion..... 0.73 1.11 0.32 0.04 1.88 1.09

000 11311............. .............. A

Shave skin lesion..... 1.05 1.23 0.49 0.05 2.33 1.59

000 11312............. .............. A

Shave skin lesion..... 1.20 1.42 0.55 0.06 2.68 1.81

000 11313............. .............. A

Shave skin lesion..... 1.62 1.81 0.72 0.10 3.53 2.44

000 11400............. .............. A

Exc tr-ext b9+marg 0.5 0.85 2.00 0.88 0.06 2.91 1.79

010 2.76 3.07 1.65 0.32 6.15 4.73

010 4.0 cm. 11420............. .............. A

Exc h-f-nk-sp b9+marg

0.98 1.77 0.93 0.09 2.84 2.00

010 0.5 4 cm. 11440............. .............. A

Exc face-mm b9+marg

1.06 2.21 1.31 0.08 3.35 2.45

010 0.5 4.48 4.05 2.78 0.43 8.96 7.69

010 4 cm. 11450............. .............. A

Removal, sweat gland

2.73 5.04 2.03 0.34 8.11 5.10

090 lesion. 11451............. .............. A

Removal, sweat gland

3.94 6.62 2.55 0.53 11.09 7.02

090 lesion. 11462............. .............. A

Removal, sweat gland

2.51 5.12 2.02 0.32 7.95 4.85

090 lesion. 11463............. .............. A

Removal, sweat gland

3.94 6.84 2.69 0.54 11.32 7.17

090 lesion. 11470............. .............. A

Removal, sweat gland

3.25 5.07 2.27 0.40 8.72 5.92

090 lesion. 11471............. .............. A

Removal, sweat gland

4.40 6.72 2.77 0.58 11.70 7.75

090 lesion. 11600............. .............. A

Exc tr-ext mlg+marg

1.31 2.64 0.97 0.10 4.05 2.38

010 0.5 3.42 4.07 1.74 0.36 7.85 5.52

010 4 cm. 11620............. .............. A

Exc h-f-nk-sp mlg+marg 1.19 2.60 0.95 0.09 3.88 2.23

010 0.5 4 cm. 11640............. .............. A

Exc face-mm malig+marg 1.35 2.66 1.11 0.11 4.12 2.57

010 0.5 5.94 5.77 3.48 0.61 12.32 10.03

010 4 cm. 11719............. .............. R

Trim nail(s).......... 0.17 0.25 0.07 0.02 0.44 0.26

000 11720............. .............. A

Debride nail, 1-5..... 0.32 0.34 0.12 0.04 0.70 0.48

000 11721............. .............. A

Debride nail, 6 or

0.54 0.44 0.21 0.07 1.05 0.82

000 more. 11730............. .............. A

Removal of nail plate. 1.13 1.03 0.43 0.14 2.30 1.70

000

[[Page 70340]]

11732............. .............. A

Remove nail plate, add- 0.57 0.44 0.22 0.07 1.08 0.86

ZZZ on. 11740............. .............. A

Drain blood from under 0.37 0.55 0.35 0.04 0.96 0.76

000 nail. 11750............. .............. A

Removal of nail bed... 1.86 2.17 1.76 0.22 4.25 3.84

010 11752............. .............. A

Remove nail bed/finger 2.67 3.00 3.00 0.35 6.02 6.02

010 tip. 11755............. .............. A

Biopsy, nail unit..... 1.31 1.57 0.77 0.14 3.02 2.22

000 11760............. .............. A

Repair of nail bed.... 1.58 2.63 1.79 0.21 4.42 3.58

010 11762............. .............. A

Reconstruction of nail 2.89 2.89 2.35 0.36 6.14 5.60

010 bed. 11765............. .............. A

Excision of nail fold, 0.69 1.79 0.76 0.08 2.56 1.53

010 toe. 11770............. .............. A

Removal of pilonidal

2.61 3.49 1.50 0.33 6.43 4.44

010 lesion. 11771............. .............. A

Removal of pilonidal

5.73 5.66 3.32 0.74 12.13 9.79

090 lesion. 11772............. .............. A

Removal of pilonidal

6.97 7.52 5.08 0.89 15.38 12.94

090 lesion. 11900............. .............. A

Injection into skin

0.52 0.65 0.21 0.02 1.19 0.75

000 lesions. 11901............. .............. A

Added skin lesions

0.80 0.66 0.35 0.03 1.49 1.18

000 injection. 11920............. .............. R

Correct skin color

1.61 3.71 1.09 0.24 5.56 2.94

000 defects. 11921............. .............. R

Correct skin color

1.93 3.97 1.27 0.29 6.19 3.49

000 defects. 11922............. .............. R

Correct skin color

0.49 1.14 0.25 0.07 1.70 0.81

ZZZ defects. 11950............. .............. R

Therapy for contour

0.84 1.14 0.39 0.06 2.04 1.29

000 defects. 11951............. .............. R

Therapy for contour

1.19 1.49 0.51 0.11 2.79 1.81

000 defects. 11952............. .............. R

Therapy for contour

1.69 1.86 0.68 0.16 3.71 2.53

000 defects. 11954............. .............. R

Therapy for contour

1.85 2.45 0.90 0.25 4.55 3.00

000 defects. 11960............. .............. A

Insert tissue

9.07

NA 10.42 1.31

NA 20.80

090 expander(s). 11970............. .............. A

Replace tissue

7.05

NA 6.15 1.05

NA 14.25

090 expander. 11971............. .............. A

Remove tissue

2.13 9.14 3.80 0.32 11.59 6.25

090 expander(s). 11975............. .............. N

Insert contraceptive

+1.48 1.42 0.57 0.17 3.07 2.22

XXX cap. 11976............. .............. R

Removal of

1.78 1.72 0.68 0.21 3.71 2.67

000 contraceptive cap. 11977............. .............. N

Removal/reinsert

+3.30 2.28 1.26 0.37 5.95 4.93

XXX contra cap. 11980............. .............. A

Implant hormone

1.48 1.08 0.54 0.13 2.69 2.15

000 pellet(s). 11981............. .............. A

Insert drug implant

1.48 1.70 0.68 0.12 3.30 2.28

XXX device. 11982............. .............. A

Remove drug implant

1.78 1.95 0.83 0.17 3.90 2.78

XXX device. 11983............. .............. A

Remove/insert drug

3.30 2.29 1.47 0.23 5.82 5.00

XXX implant. 12001............. .............. A

Repair superficial

1.70 1.99 0.77 0.15 3.84 2.62

010 wound(s). 12002............. .............. A

Repair superficial

1.86 2.05 0.90 0.17 4.08 2.93

010 wound(s). 12004............. .............. A

Repair superficial

2.24 2.33 1.01 0.21 4.78 3.46

010 wound(s). 12005............. .............. A

Repair superficial

2.86 2.83 1.20 0.27 5.96 4.33

010 wound(s). 12006............. .............. A

Repair superficial

3.66 3.40 1.51 0.35 7.41 5.52

010 wound(s). 12007............. .............. A

Repair superficial

4.11 3.83 1.82 0.45 8.39 6.38

010 wound(s). 12011............. .............. A

Repair superficial

1.76 2.14 0.78 0.16 4.06 2.70

010 wound(s). 12013............. .............. A

Repair superficial

1.99 2.28 0.93 0.18 4.45 3.10

010 wound(s). 12014............. .............. A

Repair superficial

2.46 2.58 1.06 0.23 5.27 3.75

010 wound(s). 12015............. .............. A

Repair superficial

3.19 3.14 1.25 0.29 6.62 4.73

010 wound(s). 12016............. .............. A

Repair superficial

3.92 3.56 1.52 0.37 7.85 5.81

010 wound(s). 12017............. .............. A

Repair superficial

4.70

NA 1.90 0.47

NA 7.07

010 wound(s). 12018............. .............. A

Repair superficial

5.52

NA 2.26 0.64

NA 8.42

010 wound(s). 12020............. .............. A

Closure of split wound 2.62 3.83 1.93 0.30 6.75 4.85

010 12021............. .............. A

Closure of split wound 1.84 1.83 1.41 0.24 3.91 3.49

010 12031............. .............. A

Layer closure of

2.15 2.29 0.96 0.17 4.61 3.28

010 wound(s). 12032............. .............. A

Layer closure of

2.47 3.85 1.80 0.16 6.48 4.43

010 wound(s). 12034............. .............. A

Layer closure of

2.92 3.20 1.45 0.25 6.37 4.62

010 wound(s). 12035............. .............. A

Layer closure of

3.42 5.21 2.16 0.39 9.02 5.97

010 wound(s). 12036............. .............. A

Layer closure of

4.04 5.57 2.55 0.55 10.16 7.14

010 wound(s). 12037............. .............. A

Layer closure of

4.66 6.11 2.97 0.66 11.43 8.29

010 wound(s). 12041............. .............. A

Layer closure of

2.37 2.55 1.13 0.19 5.11 3.69

010 wound(s). 12042............. .............. A

Layer closure of

2.74 3.27 1.46 0.17 6.18 4.37

010 wound(s). 12044............. .............. A

Layer closure of

3.14 3.22 1.60 0.27 6.63 5.01

010 wound(s). 12045............. .............. A

Layer closure of

3.63 5.28 2.29 0.41 9.32 6.33

010 wound(s). 12046............. .............. A

Layer closure of

4.24 6.52 2.76 0.54 11.30 7.54

010 wound(s). 12047............. .............. A

Layer closure of

4.64 6.36 3.09 0.58 11.58 8.31

010 wound(s). 12051............. .............. A

Layer closure of

2.47 3.28 1.45 0.20 5.95 4.12

010 wound(s). 12052............. .............. A

Layer closure of

2.77 3.23 1.43 0.17 6.17 4.37

010 wound(s). 12053............. .............. A

Layer closure of

3.12 3.25 1.53 0.23 6.60 4.88

010 wound(s). 12054............. .............. A

Layer closure of

3.45 3.57 1.63 0.30 7.32 5.38

010 wound(s). 12055............. .............. A

Layer closure of

4.42 4.49 2.13 0.45 9.36 7.00

010 wound(s). 12056............. .............. A

Layer closure of

5.23 6.77 3.06 0.59 12.59 8.88

010 wound(s). 12057............. .............. A

Layer closure of

5.95 6.15 3.76 0.56 12.66 10.27

010 wound(s). 13100............. .............. A

Repair of wound or

3.12 4.06 2.31 0.26 7.44 5.69

010 lesion. 13101............. .............. A

Repair of wound or

3.91 4.67 2.69 0.26 8.84 6.86

010 lesion. 13102............. .............. A

Repair wound/lesion

1.24 1.17 0.57 0.13 2.54 1.94

ZZZ add-on. 13120............. .............. A

Repair of wound or

3.30 4.15 2.35 0.26 7.71 5.91

010 lesion. 13121............. .............. A

Repair of wound or

4.32 4.86 2.80 0.25 9.43 7.37

010 lesion. 13122............. .............. A

Repair wound/lesion

1.44 1.51 0.63 0.15 3.10 2.22

ZZZ add-on. 13131............. .............. A

Repair of wound or

3.78 4.37 2.69 0.26 8.41 6.73

010 lesion. 13132............. .............. A

Repair of wound or

5.94 5.92 4.17 0.32 12.18 10.43

010 lesion. 13133............. .............. A

Repair wound/lesion

2.19 1.66 1.03 0.18 4.03 3.40

ZZZ add-on. 13150............. .............. A

Repair of wound or

3.80 4.88 2.77 0.34 9.02 6.91

010 lesion. 13151............. .............. A

Repair of wound or

4.44 4.81 3.15 0.31 9.56 7.90

010 lesion.

[[Page 70341]]

13152............. .............. A

Repair of wound or

6.32 6.05 4.05 0.40 12.77 10.77

010 lesion. 13153............. .............. A

Repair wound/lesion

2.38 1.94 1.14 0.24 4.56 3.76

ZZZ add-on. 13160............. .............. A

Late closure of wound. 10.46

NA 7.18 1.54

NA 19.18

090 14000............. .............. A

Skin tissue

5.88 7.87 5.48 0.59 14.34 11.95

090 rearrangement. 14001............. .............. A

Skin tissue

8.46 9.44 7.09 0.82 18.72 16.37

090 rearrangement. 14020............. .............. A

Skin tissue

6.58 8.63 6.55 0.64 15.85 13.77

090 rearrangement. 14021............. .............. A

Skin tissue

10.04 10.01 8.30 0.81 20.86 19.15

090 rearrangement. 14040............. .............. A

Skin tissue

7.86 8.83 7.22 0.62 17.31 15.70

090 rearrangement. 14041............. .............. A

Skin tissue

11.47 10.62 8.70 0.73 22.82 20.90

090 rearrangement. 14060............. .............. A

Skin tissue

8.49 8.81 7.45 0.68 17.98 16.62

090 rearrangement. 14061............. .............. A

Skin tissue

12.27 11.63 9.53 0.76 24.66 22.56

090 rearrangement. 14300............. .............. A

Skin tissue

11.74 11.16 9.20 1.16 24.06 22.10

090 rearrangement. 14350............. .............. A

Skin tissue

9.60

NA 7.16 1.34

NA 18.10

090 rearrangement. 15000............. .............. A

Wound prep, 1st 100 sq 3.99 3.80 2.19 0.54 8.33 6.72

000 cm. 15001............. .............. A

Wound prep, addl 100

1.00 1.35 0.41 0.14 2.49 1.55

ZZZ sq cm. 15040............. .............. A

Harvest cultured skin

2.00 4.57 1.13 0.24 6.81 3.37

000 graft. 15050............. .............. A

Skin pinch graft...... 4.29 6.93 5.12 0.57 11.79 9.98

090 15100............. .............. A

Skin splt grft, trnk/

9.04 12.62 7.84 1.28 22.94 18.16

090 arm/leg. 15101............. .............. A

Skin splt grft t/a/l,

1.72 3.74 1.17 0.24 5.70 3.13

ZZZ add-on. 15110............. .............. A

Epidrm autogrft trnk/

9.50 10.70 7.02 1.31 21.51 17.83

090 arm/leg. 15111............. .............. A

Epidrm autogrft t/a/l

1.85 1.29 0.79 0.26 3.40 2.90

ZZZ add-on. 15115............. .............. A

Epidrm a-grft face/nck/ 9.81 9.25 7.37 1.15 20.21 18.33

090 hf/g. 15116............. .............. A

Epidrm a-grft f/n/hf/g 2.50 1.58 1.12 0.33 4.41 3.95

ZZZ addl. 15120............. .............. A

Skn splt a-grft fac/

9.82 10.75 7.80 1.16 21.73 18.78

090 nck/hf/g. 15121............. .............. A

Skn splt a-grft f/n/hf/ 2.67 4.51 1.85 0.36 7.54 4.88

ZZZ g add. 15130............. .............. A

Derm autograft, trnk/

7.00 9.89 6.36 0.97 17.86 14.33

090 arm/leg. 15131............. .............. A

Derm autograft t/a/l

1.50 1.07 0.64 0.21 2.78 2.35

ZZZ add-on. 15135............. .............. A

Derm autograft face/

10.50 9.90 8.15 1.23 21.63 19.88

090 nck/hf/g. 15136............. .............. A

Derm autograft, f/n/hf/ 1.50 0.89 0.67 0.20 2.59 2.37

ZZZ g add. 15150............. .............. A

Cult epiderm grft t/

8.25 8.48 6.46 1.14 17.87 15.85

090 arm/leg. 15151............. .............. A

Cult epiderm grft t/a/ 2.00 1.31 0.85 0.28 3.59 3.13

ZZZ l addl. 15152............. .............. A

Cult epiderm graft t/a/ 2.50 1.56 1.06 0.35 4.41 3.91

ZZZ l +%. 15155............. .............. A

Cult epiderm graft, f/ 9.00 7.84 6.98 1.05 17.89 17.03

090 n/hf/g. 15156............. .............. A

Cult epidrm grft f/n/

2.75 1.56 1.24 0.36 4.67 4.35

ZZZ hfg add. 15157............. .............. A

Cult epiderm grft f/n/ 3.00 1.78 1.35 0.39 5.17 4.74

ZZZ hfg +%. 15170............. .............. A

Acell graft trunk/arms/ 5.00 3.84 2.37 0.55 9.39 7.92

090 legs. 15171............. .............. A

Acell graft t/arm/leg

1.55 0.68 0.62 0.19 2.42 2.36

ZZZ add-on. 15175............. .............. A

Acellular graft, f/n/

7.00 5.44 4.01 0.82 13.26 11.83

090 hf/g. 15176............. .............. A

Acell graft, f/n/hf/g

2.45 1.11 0.99 0.29 3.85 3.73

ZZZ add-on. 15200............. .............. A

Skin full graft, trunk 8.02 9.43 6.22 0.98 18.43 15.22

090 15201............. .............. A

Skin full graft trunk

1.32 2.57 0.62 0.19 4.08 2.13

ZZZ add-on. 15220............. .............. A

Skin full graft sclp/

7.86 9.21 6.70 0.84 17.91 15.40

090 arm/leg. 15221............. .............. A

Skin full graft add-on 1.19 2.33 0.56 0.16 3.68 1.91

ZZZ 15240............. .............. A

Skin full grft face/

9.03 10.23 7.97 0.92 20.18 17.92

090 genit/hf. 15241............. .............. A

Skin full graft add-on 1.86 2.45 0.91 0.23 4.54 3.00

ZZZ 15260............. .............. A

Skin full graft een & 10.04 10.24 8.60 0.69 20.97 19.33

090 lips. 15261............. .............. A

Skin full graft add-on 2.23 2.70 1.40 0.21 5.14 3.84

ZZZ 15300............. .............. A

Apply skinallogrft, t/ 3.99 3.21 2.24 0.49 7.69 6.72

090 arm/lg. 15301............. .............. A

Apply sknallogrft t/a/ 1.00 0.47 0.40 0.14 1.61 1.54

ZZZ l addl. 15320............. .............. A

Apply skin allogrft f/ 4.70 3.63 2.54 0.58 8.91 7.82

090 n/hf/g. 15321............. .............. A

Aply sknallogrft f/n/

1.50 0.69 0.59 0.21 2.40 2.30

ZZZ hfg add. 15330............. .............. A

Aply acell alogrft t/

3.99 3.20 2.23 0.49 7.68 6.71

090 arm/leg. 15331............. .............. A

Aply acell grft t/a/l

1.00 0.46 0.40 0.14 1.60 1.54

ZZZ add-on. 15335............. .............. A

Apply acell graft, f/n/ 4.50 3.48 2.45 0.55 8.53 7.50

090 hf/g. 15336............. .............. A

Aply acell grft f/n/hf/ 1.43 0.69 0.57 0.20 2.32 2.20

ZZZ g add. 15340............. .............. A

Apply cult skin

3.72 4.01 2.76 0.41 8.14 6.89

010 substitute. 15341............. .............. A

Apply cult skin sub

0.50 0.61 0.20 0.06 1.17 0.76

ZZZ add-on. 15360............. .............. A

Apply cult derm sub, t/ 3.87 4.48 3.09 0.43 8.78 7.39

090 a/l. 15361............. .............. A

Aply cult derm sub t/a/ 1.15 0.58 0.46 0.14 1.87 1.75

ZZZ l add. 15365............. .............. A

Apply cult derm sub f/ 4.15 4.56 3.20 0.46 9.17 7.81

090 n/hf/g. 15366............. .............. A

Apply cult derm f/hf/g 1.45 0.70 0.58 0.17 2.32 2.20

ZZZ add. 15400............. .............. A

Apply skin xenograft,

3.99 4.02 4.02 0.47 8.48 8.48

090 t/a/l. 15401............. .............. A

Apply skn xenogrft t/a/ 1.00 1.90 0.44 0.14 3.04 1.58

ZZZ l add. 15420............. .............. A

Apply skin xgraft, f/n/ 4.50 4.79 3.80 0.52 9.81 8.82

090 hf/g. 15421............. .............. A

Apply skn xgrft f/n/hf/ 1.50 1.32 0.62 0.21 3.03 2.33

ZZZ g add. 15430............. .............. A

Apply acellular

5.75 6.92 6.63 0.66 13.33 13.04

090 xenograft. 15431............. .............. C

Apply acellular xgraft 0.00 0.00 0.00 0.00 0.00 0.00

ZZZ add. 15570............. .............. A

Form skin pedicle flap 9.20 11.33 6.78 1.34 21.87 17.32

090 15572............. .............. A

Form skin pedicle flap 9.26 9.52 6.47 1.20 19.98 16.93

090 15574............. .............. A

Form skin pedicle flap 9.87 10.71 7.81 1.20 21.78 18.88

090 15576............. .............. A

Form skin pedicle flap 8.68 9.78 6.90 0.87 19.33 16.45

090 15600............. .............. A

Skin graft............ 1.91 7.62 3.07 0.27 9.80 5.25

090 15610............. .............. A

Skin graft............ 2.42 4.70 3.43 0.35 7.47 6.20

090 15620............. .............. A

Skin graft............ 2.94 7.80 3.89 0.35 11.09 7.18

090 15630............. .............. A

Skin graft............ 3.27 7.06 4.16 0.34 10.67 7.77

090

[[Page 70342]]

15650............. .............. A

Transfer skin pedicle

3.96 7.16 4.22 0.42 11.54 8.60

090 flap. 15732............. .............. A

Muscle-skin graft,

17.81 18.09 12.25 1.99 37.89 32.05

090 head/neck. 15734............. .............. A

Muscle-skin graft,

17.76 18.16 12.41 2.61 38.53 32.78

090 trunk. 15736............. .............. A

Muscle-skin graft, arm 16.25 18.28 11.25 2.45 36.98 29.95

090 15738............. .............. A

Muscle-skin graft, leg 17.89 18.02 11.75 2.65 38.56 32.29

090 15740............. .............. A

Island pedicle flap

10.23 10.16 8.28 0.63 21.02 19.14

090 graft. 15750............. .............. A

Neurovascular pedicle 11.39

NA 9.07 1.42

NA 21.88

090 graft. 15756............. .............. A

Free myo/skin flap

35.18

NA 20.62 4.61

NA 60.41

090 microvasc. 15757............. .............. A

Free skin flap,

35.18

NA 21.65 3.89

NA 60.72

090 microvasc. 15758............. .............. A

Free fascial flap,

35.05

NA 21.63 4.23

NA 60.91

090 microvasc. 15760............. .............. A

Composite skin graft.. 8.73 10.05 7.28 0.85 19.63 16.86

090 15770............. .............. A

Derma-fat-fascia graft 7.51

NA 6.70 1.05

NA 15.26

090 15775............. .............. R

Hair transplant punch

3.95 4.24 1.30 0.52 8.71 5.77

000 grafts. 15776............. .............. R

Hair transplant punch

5.53 5.37 2.81 0.72 11.62 9.06

000 grafts. 15780............. .............. A

Abrasion treatment of

7.28 11.55 8.27 0.67 19.50 16.22

090 skin. 15781............. .............. A

Abrasion treatment of

4.84 6.93 5.38 0.34 12.11 10.56

090 skin. 15782............. .............. A

Abrasion treatment of

4.31 9.88 6.57 0.34 14.53 11.22

090 skin. 15783............. .............. A

Abrasion treatment of

4.28 6.89 4.19 0.28 11.45 8.75

090 skin. 15786............. .............. A

Abrasion, lesion,

2.03 3.36 1.32 0.11 5.50 3.46

010 single. 15787............. .............. A

Abrasion, lesions, add- 0.33 1.09 0.16 0.04 1.46 0.53

ZZZ on. 15788............. .............. R

Chemical peel, face,

2.09 6.73 3.09 0.11 8.93 5.29

090 epiderm. 15789............. .............. R

Chemical peel, face,

4.91 8.11 4.81 0.20 13.22 9.92

090 dermal. 15792............. .............. R

Chemical peel,

1.86 7.11 4.46 0.13 9.10 6.45

090 nonfacial. 15793............. .............. A

Chemical peel,

3.73 6.30 4.39 0.19 10.22 8.31

090 nonfacial. 15819............. .............. A

Plastic surgery, neck. 9.37

NA 7.20 0.97

NA 17.54

090 15820............. .............. A

Revision of lower

5.14 6.99 5.58 0.40 12.53 11.12

090 eyelid. 15821............. .............. A

Revision of lower

5.71 7.37 5.73 0.45 13.53 11.89

090 eyelid. 15822............. .............. A

Revision of upper

4.44 5.85 4.50 0.37 10.66 9.31

090 eyelid. 15823............. .............. A

Revision of upper

7.04 7.87 6.45 0.50 15.41 13.99

090 eyelid. 15824............. .............. R

Removal of forehead

0.00 0.00 0.00 0.00 0.00 0.00

000 wrinkles. 15825............. .............. R

Removal of neck

0.00 0.00 0.00 0.00 0.00 0.00

000 wrinkles. 15826............. .............. R

Removal of brow

0.00 0.00 0.00 0.00 0.00 0.00

000 wrinkles. 15828............. .............. R

Removal of face

0.00 0.00 0.00 0.00 0.00 0.00

000 wrinkles. 15829............. .............. R

Removal of skin

0.00 0.00 0.00 0.00 0.00 0.00

000 wrinkles. 15831............. .............. A

Excise excessive skin 12.38

NA 8.18 1.75

NA 22.31

090 tissue. 15832............. .............. A

Excise excessive skin 11.57

NA 8.36 1.66

NA 21.59

090 tissue. 15833............. .............. A

Excise excessive skin 10.62

NA 8.23 1.49

NA 20.34

090 tissue. 15834............. .............. A

Excise excessive skin 10.83

NA 7.71 1.61

NA 20.15

090 tissue. 15835............. .............. A

Excise excessive skin 11.65

NA 7.56 1.60

NA 20.81

090 tissue. 15836............. .............. A

Excise excessive skin

9.33

NA 6.80 1.34

NA 17.47

090 tissue. 15837............. .............. A

Excise excessive skin

8.42 8.57 7.39 1.18 18.17 16.99

090 tissue. 15838............. .............. A

Excise excessive skin

7.12

NA 6.08 0.58

NA 13.78

090 tissue. 15839............. .............. A

Excise excessive skin

9.37 8.85 6.41 1.22 19.44 17.00

090 tissue. 15840............. .............. A

Graft for face nerve

13.24

NA 10.00 1.32

NA 24.56

090 palsy. 15841............. .............. A

Graft for face nerve

23.23

NA 15.03 2.54

NA 40.80

090 palsy. 15842............. .............. A

Flap for face nerve

37.90

NA 22.98 4.93

NA 65.81

090 palsy. 15845............. .............. A

Skin and muscle

12.55

NA 9.33 0.81

NA 22.69

090 repair, face. 15850............. .............. B

Removal of sutures.... +0.78 1.56 0.30 0.05 2.39 1.13

XXX 15851............. .............. A

Removal of sutures.... 0.86 1.68 0.31 0.06 2.60 1.23

000 15852............. .............. A

Dressing change not

0.86 1.85 0.33 0.09 2.80 1.28

000 for burn. 15860............. .............. A

Test for blood flow in 1.95 0.83 0.78 0.27 3.05 3.00

000 graft. 15876............. .............. R

Suction assisted

0.00 0.00 0.00 0.00 0.00 0.00

000 lipectomy. 15877............. .............. R

Suction assisted

0.00 0.00 0.00 0.00 0.00 0.00

000 lipectomy. 15878............. .............. R

Suction assisted

0.00 0.00 0.00 0.00 0.00 0.00

000 lipectomy. 15879............. .............. R

Suction assisted

0.00 0.00 0.00 0.00 0.00 0.00

000 lipectomy. 15920............. .............. A

Removal of tail bone

7.94

NA 5.57 1.04

NA 14.55

090 ulcer. 15922............. .............. A

Removal of tail bone

9.89

NA 7.23 1.42

NA 18.54

090 ulcer. 15931............. .............. A

Remove sacrum pressure 9.23

NA 5.70 1.25

NA 16.18

090 sore. 15933............. .............. A

Remove sacrum pressure 10.83

NA 7.87 1.52

NA 20.22

090 sore. 15934............. .............. A

Remove sacrum pressure 12.67

NA 8.06 1.78

NA 22.51

090 sore. 15935............. .............. A

Remove sacrum pressure 14.55

NA 10.35 2.09

NA 26.99

090 sore. 15936............. .............. A

Remove sacrum pressure 12.36

NA 8.24 1.76

NA 22.36

090 sore. 15937............. .............. A

Remove sacrum pressure 14.19

NA 9.85 2.06

NA 26.10

090 sore. 15940............. .............. A

Remove hip pressure

9.33

NA 6.19 1.31

NA 16.83

090 sore. 15941............. .............. A

Remove hip pressure

11.41

NA 9.48 1.66

NA 22.55

090 sore. 15944............. .............. A

Remove hip pressure

11.44

NA 8.62 1.65

NA 21.71

090 sore. 15945............. .............. A

Remove hip pressure

12.67

NA 9.67 1.84

NA 24.18

090 sore. 15946............. .............. A

Remove hip pressure

21.54

NA 14.41 3.16

NA 39.11

090 sore. 15950............. .............. A

Remove thigh pressure

7.53

NA 5.43 1.04

NA 14.00

090 sore. 15951............. .............. A

Remove thigh pressure 10.70

NA 7.88 1.49

NA 20.07

090 sore. 15952............. .............. A

Remove thigh pressure 11.37

NA 7.77 1.60

NA 20.74

090 sore. 15953............. .............. A

Remove thigh pressure 12.61

NA 9.02 1.79

NA 23.42

090 sore. 15956............. .............. A

Remove thigh pressure 15.50

NA 10.80 2.21

NA 28.51

090 sore. 15958............. .............. A

Remove thigh pressure 15.46

NA 11.07 2.25

NA 28.78

090 sore. 15999............. .............. C

Removal of pressure

0.00 0.00 0.00 0.00 0.00 0.00

YYY sore.

[[Page 70343]]

16000............. .............. A

Initial treatment of

0.89 0.86 0.26 0.08 1.83 1.23

000 burn(s). 16020............. .............. A

Dress/debrid p-thick

0.80 1.29 0.58 0.08 2.17 1.46

000 burn, s. 16025............. .............. A

Dress/debrid p-thick

1.85 1.77 0.96 0.19 3.81 3.00

000 burn, m. 16030............. .............. A

Dress/debrid p-thick

2.08 2.18 1.12 0.24 4.50 3.44

000 burn, l. 16035............. .............. A

Incision of burn scab, 3.74

NA 1.58 0.46

NA 5.78

090 initi. 16036............. .............. A

Escharotomy; add'l

1.50

NA 0.60 0.20

NA 2.30

ZZZ incision. 17000............. .............. A

Destroy benign/premlg

0.60 0.97 0.54 0.03 1.60 1.17

010 lesion. 17003............. .............. A

Destroy lesions, 2-14. 0.15 0.11 0.07 0.01 0.27 0.23

ZZZ 17004............. .............. A

Destroy lesions, 15 or 2.79 2.31 1.59 0.11 5.21 4.49

010 more. 17106............. .............. A

Destruction of skin

4.58 4.61 3.34 0.35 9.54 8.27

090 lesions. 17107............. .............. A

Destruction of skin

9.15 7.22 5.47 0.63 17.00 15.25

090 lesions. 17108............. .............. A

Destruction of skin

13.18 9.29 7.68 0.54 23.01 21.40

090 lesions. 17110............. .............. A

Destruct lesion, 1-14. 0.65 1.62 0.70 0.05 2.32 1.40

010 17111............. .............. A

Destruct lesion, 15 or 0.92 1.67 0.81 0.05 2.64 1.78

010 more. 17250............. .............. A

Chemical cautery,

0.50 1.22 0.34 0.06 1.78 0.90

000 tissue. 17260............. .............. A

Destruction of skin

0.91 1.28 0.67 0.04 2.23 1.62

010 lesions. 17261............. .............. A

Destruction of skin

1.17 1.61 0.83 0.05 2.83 2.05

010 lesions. 17262............. .............. A

Destruction of skin

1.58 1.89 1.02 0.06 3.53 2.66

010 lesions. 17263............. .............. A

Destruction of skin

1.79 2.06 1.09 0.07 3.92 2.95

010 lesions. 17264............. .............. A

Destruction of skin

1.94 2.23 1.12 0.08 4.25 3.14

010 lesions. 17266............. .............. A

Destruction of skin

2.34 2.51 1.22 0.09 4.94 3.65

010 lesions. 17270............. .............. A

Destruction of skin

1.32 1.70 0.87 0.05 3.07 2.24

010 lesions. 17271............. .............. A

Destruction of skin

1.49 1.78 0.98 0.06 3.33 2.53

010 lesions. 17272............. .............. A

Destruction of skin

1.77 2.00 1.11 0.07 3.84 2.95

010 lesions. 17273............. .............. A

Destruction of skin

2.05 2.21 1.21 0.08 4.34 3.34

010 lesions. 17274............. .............. A

Destruction of skin

2.59 2.57 1.44 0.10 5.26 4.13

010 lesions. 17276............. .............. A

Destruction of skin

3.20 2.95 1.68 0.16 6.31 5.04

010 lesions. 17280............. .............. A

Destruction of skin

1.17 1.61 0.81 0.05 2.83 2.03

010 lesions. 17281............. .............. A

Destruction of skin

1.72 1.91 1.09 0.07 3.70 2.88

010 lesions. 17282............. .............. A

Destruction of skin

2.04 2.16 1.24 0.08 4.28 3.36

010 lesions. 17283............. .............. A

Destruction of skin

2.64 2.55 1.49 0.11 5.30 4.24

010 lesions. 17284............. .............. A

Destruction of skin

3.21 2.93 1.76 0.13 6.27 5.10

010 lesions. 17286............. .............. A

Destruction of skin

4.43 3.68 2.45 0.23 8.34 7.11

010 lesions. 17304............. .............. A

1 stage mohs, up to 5

7.59 8.26 3.57 0.30 16.15 11.46

000 spec. 17305............. .............. A

2 stage mohs, up to 5

2.85 3.90 1.34 0.11 6.86 4.30

000 spec. 17306............. .............. A

3 stage mohs, up to 5

2.85 3.92 1.35 0.11 6.88 4.31

000 spec. 17307............. .............. A

Mohs addl stage up to

2.85 3.57 1.36 0.11 6.53 4.32

000 5 spec. 17310............. .............. A

Mohs any stage > 5

0.95 1.62 0.46 0.03 2.60 1.44

ZZZ spec each. 17340............. .............. A

Cryotherapy of skin... 0.76 0.37 0.36 0.05 1.18 1.17

010 17360............. .............. A

Skin peel therapy..... 1.43 1.44 0.87 0.06 2.93 2.36

010 17380............. .............. R

Hair removal by

0.00 0.00 0.00 0.00 0.00 0.00

000 electrolysis. 17999............. .............. C

Skin tissue procedure. 0.00 0.00 0.00 0.00 0.00 0.00

YYY 19000............. .............. A

Drainage of breast

0.84 1.99 0.31 0.08 2.91 1.23

000 lesion. 19001............. .............. A

Drain breast lesion

0.42 0.25 0.14 0.04 0.71 0.60

ZZZ add-on. 19020............. .............. A

Incision of breast

3.56 6.35 2.68 0.45 10.36 6.69

090 lesion. 19030............. .............. A

Injection for breast x- 1.53 2.87 0.50 0.09 4.49 2.12

000 ray. 19100............. .............. A

Bx breast percut w/o

1.27 2.09 0.42 0.16 3.52 1.85

000 image. 19101............. .............. A

Biopsy of breast, open 3.18 4.51 1.92 0.39 8.08 5.49

010 19102............. .............. A

Bx breast percut w/

2.00 3.84 0.66 0.14 5.98 2.80

000 image. 19103............. .............. A

Bx breast percut w/

3.69 11.52 1.23 0.30 15.51 5.22

000 device. 19110............. .............. A

Nipple exploration.... 4.29 5.81 2.87 0.57 10.67 7.73

090 19112............. .............. A

Excise breast duct

3.66 6.08 2.69 0.48 10.22 6.83

090 fistula. 19120............. .............. A

Removal of breast

5.55 4.55 3.07 0.73 10.83 9.35

090 lesion. 19125............. .............. A

Excision, breast

6.05 4.79 3.29 0.80 11.64 10.14

090 lesion. 19126............. .............. A

Excision, addl breast

2.93

NA 1.00 0.38

NA 4.31

ZZZ lesion. 19140............. .............. A

Removal of breast

5.13 7.16 3.40 0.69 12.98 9.22

090 tissue. 19160............. .............. A

Partial mastectomy.... 5.98

NA 3.43 0.79

NA 10.20

090 19162............. .............. A

P-mastectomy w/ln

13.51

NA 6.35 1.79

NA 21.65

090 removal. 19180............. .............. A

Removal of breast..... 8.79

NA 5.03 1.18

NA 15.00

090 19182............. .............. A

Removal of breast..... 7.72

NA 4.76 1.04

NA 13.52

090 19200............. .............. A

Removal of breast..... 15.47

NA 7.98 1.92

NA 25.37

090 19220............. .............. A

Removal of breast..... 15.70

NA 8.25 2.07

NA 26.02

090 19240............. .............. A

Removal of breast..... 15.98

NA 8.22 2.12

NA 26.32

090 19260............. .............. A

Removal of chest wall 15.42

NA 11.18 2.13

NA 28.73

090 lesion. 19271............. .............. A

Revision of chest wall 18.87

NA 18.00 2.62

NA 39.49

090 19272............. .............. A

Extensive chest wall

21.52

NA 18.98 2.99

NA 43.49

090 surgery. 19290............. .............. A

Place needle wire,

1.27 2.86 0.42 0.07 4.20 1.76

000 breast. 19291............. .............. A

Place needle wire,

0.63 1.21 0.21 0.04 1.88 0.88

ZZZ breast. 19295............. .............. A

Place breast clip,

0.00 2.70

NA 0.01 2.71

NA

ZZZ percut. 19296............. .............. A

Place po breast cath

3.63 125.75 1.53 0.36 129.74 5.52

000 for rad. 19297............. .............. A

Place breast cath for

1.72

NA 0.64 0.17

NA 2.53

ZZZ rad. 19298............. .............. A

Place breast rad tube/ 6.00 42.28 2.42 0.43 48.71 8.85

000 caths. 19316............. .............. A

Suspension of breast.. 10.67

NA 7.53 1.64

NA 19.84

090 19318............. .............. A

Reduction of large

15.60

NA 11.20 2.92

NA 29.72

090 breast. 19324............. .............. A

Enlarge breast........ 5.84

NA 4.90 0.84

NA 11.58

090

[[Page 70344]]

19325............. .............. A

Enlarge breast with

8.44

NA 6.54 1.33

NA 16.31

090 implant. 19328............. .............. A

Removal of breast

5.67

NA 5.03 0.91

NA 11.61

090 implant. 19330............. .............. A

Removal of implant

7.58

NA 6.05 1.26

NA 14.89

090 material. 19340............. .............. A

Immediate breast

6.32

NA 3.12 1.06

NA 10.50

ZZZ prosthesis. 19342............. .............. A

Delayed breast

11.18

NA 8.95 1.83

NA 21.96

090 prosthesis. 19350............. .............. A

Breast reconstruction. 8.91 13.88 7.19 1.41 24.20 17.51

090 19355............. .............. A

Correct inverted

7.56 10.28 4.71 0.92 18.76 13.19

090 nipple(s). 19357............. .............. A

Breast reconstruction. 18.13

NA 15.66 2.93

NA 36.72

090 19361............. .............. A

Breast reconstruction. 19.23

NA 12.47 2.92

NA 34.62

090 19364............. .............. A

Breast reconstruction. 40.94

NA 23.61 6.22

NA 70.77

090 19366............. .............. A

Breast reconstruction. 21.25

NA 11.61 3.24

NA 36.10

090 19367............. .............. A

Breast reconstruction. 25.69

NA 16.74 4.03

NA 46.46

090 19368............. .............. A

Breast reconstruction. 32.37

NA 18.97 5.52

NA 56.86

090 19369............. .............. A

Breast reconstruction. 29.78

NA 18.45 4.50

NA 52.73

090 19370............. .............. A

Surgery of breast

8.04

NA 6.92 1.29

NA 16.25

090 capsule. 19371............. .............. A

Removal of breast

9.34

NA 7.84 1.62

NA 18.80

090 capsule. 19380............. .............. A

Revise breast

9.13

NA 7.72 1.44

NA 18.29

090 reconstruction. 19396............. .............. A

Design custom breast

2.17 1.08 0.99 0.30 3.55 3.46

000 implant. 19499............. .............. C

Breast surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 20000............. .............. A

Incision of abscess... 2.12 2.70 1.74 0.25 5.07 4.11

010 20005............. .............. A

Incision of deep

3.41 3.50 2.26 0.46 7.37 6.13

010 abscess. 2000F............. .............. I

Blood pressure measure 0.00 0.00 0.00 0.00 0.00 0.00

XXX 2001F............. .............. I

Weight record......... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 2002F............. .............. I

Clin sign vol ovrld

0.00 0.00 0.00 0.00 0.00 0.00

XXX assess. 2003F............. .............. I

Auscultation heart

0.00 0.00 0.00 0.00 0.00 0.00

XXX perform. 2004F............. .............. I

Initial exam involved

0.00 0.00 0.00 0.00 0.00 0.00

XXX joints. 20100............. .............. A

Explore wound, neck... 10.06

NA 4.47 1.21

NA 15.74

010 20101............. .............. A

Explore wound, chest.. 3.22 5.94 1.62 0.44 9.60 5.28

010 20102............. .............. A

Explore wound, abdomen 3.93 7.48 1.91 0.49 11.90 6.33

010 20103............. .............. A

Explore wound,

5.29 8.60 3.40 0.75 14.64 9.44

010 extremity. 20150............. .............. A

Excise epiphyseal bar. 13.67

NA 7.05 2.03

NA 22.75

090 20200............. .............. A

Muscle biopsy......... 1.46 3.04 0.75 0.23 4.73 2.44

000 20205............. .............. A

Deep muscle biopsy.... 2.35 3.90 1.19 0.33 6.58 3.87

000 20206............. .............. A

Needle biopsy, muscle. 0.99 6.52 0.63 0.07 7.58 1.69

000 20220............. .............. A

Bone biopsy, trocar/

1.27 4.57 0.79 0.08 5.92 2.14

000 needle. 20225............. .............. A

Bone biopsy, trocar/

1.87 24.52 1.13 0.22 26.61 3.22

000 needle. 20240............. .............. A

Bone biopsy,

3.23

NA 2.56 0.44

NA 6.23

010 excisional. 20245............. .............. A

Bone biopsy,

7.77

NA 6.59 1.31

NA 15.67

010 excisional. 20250............. .............. A

Open bone biopsy...... 5.02

NA 3.51 1.02

NA 9.55

010 20251............. .............. A

Open bone biopsy...... 5.55

NA 4.17 1.15

NA 10.87

010 20500............. .............. A

Injection of sinus

1.23 2.27 1.53 0.12 3.62 2.88

010 tract. 20501............. .............. A

Inject sinus tract for 0.76 2.92 0.25 0.04 3.72 1.05

000 x-ray. 20520............. .............. A

Removal of foreign

1.85 2.92 1.77 0.21 4.98 3.83

010 body. 20525............. .............. A

Removal of foreign

3.49 9.17 2.63 0.51 13.17 6.63

010 body. 20526............. .............. A

Ther injection, carp

0.94 0.97 0.52 0.13 2.04 1.59

000 tunnel. 20550............. .............. A

Inj tendon sheath/

0.75 0.71 0.23 0.09 1.55 1.07

000 ligament. 20551............. .............. A

Inj tendon origin/

0.75 0.68 0.33 0.08 1.51 1.16

000 insertion. 20552............. .............. A

Inj trigger point, 1/2 0.66 0.72 0.20 0.05 1.43 0.91

000 muscl. 20553............. .............. A

Inject trigger points, 0.75 0.82 0.22 0.04 1.61 1.01

000 =/> 3. 20600............. .............. A

Drain/inject, joint/

0.66 0.65 0.35 0.08 1.39 1.09

000 bursa. 20605............. .............. A

Drain/inject, joint/

0.68 0.76 0.36 0.08 1.52 1.12

000 bursa. 20610............. .............. A

Drain/inject, joint/

0.79 0.95 0.42 0.11 1.85 1.32

000 bursa. 20612............. .............. A

Aspirate/inj ganglion

0.70 0.71 0.36 0.10 1.51 1.16

000 cyst. 20615............. .............. A

Treatment of bone cyst 2.28 3.52 1.85 0.20 6.00 4.33

010 20650............. .............. A

Insert and remove bone 2.23 2.37 1.55 0.31 4.91 4.09

010 pin. 20660............. .............. A

Apply, rem fixation

2.51 3.06 1.61 0.59 6.16 4.71

000 device. 20661............. .............. A

Application of head

4.88

NA 4.92 1.14

NA 10.94

090 brace. 20662............. .............. A

Application of pelvis

6.06

NA 5.54 0.56

NA 12.16

090 brace. 20663............. .............. A

Application of thigh

5.42

NA 4.84 0.94

NA 11.20

090 brace. 20664............. .............. A

Halo brace application 8.05

NA 7.06 1.74

NA 16.85

090 20665............. .............. A

Removal of fixation

1.31 2.16 1.35 0.19 3.66 2.85

010 device. 20670............. .............. A

Removal of support

1.74 11.57 2.11 0.28 13.59 4.13

010 implant. 20680............. .............. A

Removal of support

3.34 8.81 3.73 0.56 12.71 7.63

090 implant. 20690............. .............. A

Apply bone fixation

3.51

NA 2.52 0.59

NA 6.62

090 device. 20692............. .............. A

Apply bone fixation

6.40

NA 3.78 1.05

NA 11.23

090 device. 20693............. .............. A

Adjust bone fixation

5.85

NA 5.46 0.98

NA 12.29

090 device. 20694............. .............. A

Remove bone fixation

4.15 7.16 4.05 0.71 12.02 8.91

090 device. 20802............. .............. A

Replantation, arm,

41.09

NA 21.01 3.81

NA 65.91

090 complete. 20805............. .............. A

Replant forearm,

49.93

NA 34.41 4.84

NA 89.18

090 complete. 20808............. .............. A

Replantation hand,

61.56

NA 42.34 6.86

NA 110.76

090 complete. 20816............. .............. A

Replantation digit,

30.89

NA 37.90 4.52

NA 73.31

090 complete. 20822............. .............. A

Replantation digit,

25.55

NA 34.69 4.18

NA 64.42

090 complete. 20824............. .............. A

Replantation thumb,

30.89

NA 36.65 4.61

NA 72.15

090 complete. 20827............. .............. A

Replantation thumb,

26.37

NA 36.58 3.66

NA 66.61

090 complete. 20838............. .............. A

Replantation foot,

41.35

NA 22.34 1.12

NA 64.81

090 complete.

[[Page 70345]]

20900............. .............. A

Removal of bone for

5.57 8.45 5.69 0.94 14.96 12.20

090 graft. 20902............. .............. A

Removal of bone for

7.54

NA 6.90 1.30

NA 15.74

090 graft. 20910............. .............. A

Remove cartilage for

5.33

NA 5.20 0.71

NA 11.24

090 graft. 20912............. .............. A

Remove cartilage for

6.34

NA 5.81 0.69

NA 12.84

090 graft. 20920............. .............. A

Removal of fascia for

5.30

NA 4.23 0.66

NA 10.19

090 graft. 20922............. .............. A

Removal of fascia for

6.60 7.56 4.88 0.70 14.86 12.18

090 graft. 20924............. .............. A

Removal of tendon for

6.47

NA 5.90 1.04

NA 13.41

090 graft. 20926............. .............. A

Removal of tissue for

5.52

NA 4.76 0.87

NA 11.15

090 graft. 20930............. .............. B

Spinal bone allograft. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 20931............. .............. A

Spinal bone allograft. 1.81

NA 0.93 0.43

NA 3.17

ZZZ 20936............. .............. B

Spinal bone autograft. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 20937............. .............. A

Spinal bone autograft. 2.79

NA 1.45 0.54

NA 4.78

ZZZ 20938............. .............. A

Spinal bone autograft. 3.02

NA 1.56 0.64

NA 5.22

ZZZ 20950............. .............. A

Fluid pressure, muscle 1.26 6.86 0.99 0.20 8.32 2.45

000 20955............. .............. A

Fibula bone graft,

39.15

NA 24.34 4.89

NA 68.38

090 microvasc. 20956............. .............. A

Iliac bone graft,

39.21

NA 24.81 7.01

NA 71.03

090 microvasc. 20957............. .............. A

Mt bone graft,

40.59

NA 18.99 7.05

NA 66.63

090 microvasc. 20962............. .............. A

Other bone graft,

39.21

NA 26.60 6.55

NA 72.36

090 microvasc. 20969............. .............. A

Bone/skin graft,

43.85

NA 26.71 4.79

NA 75.35

090 microvasc. 20970............. .............. A

Bone/skin graft, iliac 43.00

NA 25.45 6.60

NA 75.05

090 crest. 20972............. .............. A

Bone/skin graft,

42.93

NA 20.64 5.30

NA 68.87

090 metatarsal. 20973............. .............. A

Bone/skin graft, great 45.69

NA 25.23 5.54

NA 76.46

090 toe. 20974............. .............. A

Electrical bone

0.62 0.69 0.54 0.11 1.42 1.27

000 stimulation. 20975............. .............. A

Electrical bone

2.60

NA 1.71 0.51

NA 4.82

000 stimulation. 20979............. .............. A

Us bone stimulation... 0.62 0.80 0.34 0.09 1.51 1.05

000 20982............. .............. A

Ablate, bone tumor(s)

7.27 109.86 2.98 0.69 117.82 10.94

000 perq. 20999............. .............. C

Musculoskeletal

0.00 0.00 0.00 0.00 0.00 0.00

YYY surgery. 21010............. .............. A

Incision of jaw joint. 10.12

NA 7.11 1.11

NA 18.34

090 21015............. .............. A

Resection of facial

5.28

NA 5.02 0.70

NA 11.00

090 tumor. 21025............. .............. A

Excision of bone,

10.04 12.28 9.38 1.32 23.64 20.74

090 lower jaw. 21026............. .............. A

Excision of facial

4.84 7.88 6.34 0.60 13.32 11.78

090 bone(s). 21029............. .............. A

Contour of face bone

7.70 9.40 7.03 0.94 18.04 15.67

090 lesion. 21030............. .............. A

Excise max/zygoma b9

4.49 6.35 5.04 0.54 11.38 10.07

090 tumor. 21031............. .............. A

Remove exostosis,

3.24 5.18 3.63 0.48 8.90 7.35

090 mandible. 21032............. .............. A

Remove exostosis,

3.24 5.36 3.52 0.47 9.07 7.23

090 maxilla. 21034............. .............. A

Excise max/zygoma mlg 16.15 15.97 12.70 1.71 33.83 30.56

090 tumor. 21040............. .............. A

Excise mandible lesion 4.49 6.41 4.73 0.54 11.44 9.76

090 21044............. .............. A

Removal of jaw bone

11.84

NA 9.40 1.12

NA 22.36

090 lesion. 21045............. .............. A

Extensive jaw surgery. 16.15

NA 12.39 1.52

NA 30.06

090 21046............. .............. A

Remove mandible cyst

12.98

NA 11.93 1.85

NA 26.76

090 complex. 21047............. .............. A

Excise lwr jaw cyst w/ 18.72

NA 13.48 2.12

NA 34.32

090 repair. 21048............. .............. A

Remove maxilla cyst

13.48

NA 12.17 1.76

NA 27.41

090 complex. 21049............. .............. A

Excis uppr jaw cyst w/ 17.97

NA 13.06 1.59

NA 32.62

090 repair. 21050............. .............. A

Removal of jaw joint.. 10.75

NA 9.47 1.47

NA 21.69

090 21060............. .............. A

Remove jaw joint

10.21

NA 8.63 1.38

NA 20.22

090 cartilage. 21070............. .............. A

Remove coronoid

8.19

NA 7.12 1.27

NA 16.58

090 process. 21076............. .............. A

Prepare face/oral

13.40 12.39 10.03 1.99 27.78 25.42

010 prosthesis. 21077............. .............. A

Prepare face/oral

33.70 31.42 26.08 4.55 69.67 64.33

090 prosthesis. 21079............. .............. A

Prepare face/oral

22.31 21.56 17.20 3.15 47.02 42.66

090 prosthesis. 21080............. .............. A

Prepare face/oral

25.06 24.56 19.42 3.74 53.36 48.22

090 prosthesis. 21081............. .............. A

Prepare face/oral

22.85 22.36 17.54 3.20 48.41 43.59

090 prosthesis. 21082............. .............. A

Prepare face/oral

20.84 19.40 15.78 3.11 43.35 39.73

090 prosthesis. 21083............. .............. A

Prepare face/oral

19.27 18.84 14.47 2.88 40.99 36.62

090 prosthesis. 21084............. .............. A

Prepare face/oral

22.48 22.50 17.75 2.18 47.16 42.41

090 prosthesis. 21085............. .............. A

Prepare face/oral

8.99 8.31 6.80 1.27 18.57 17.06

010 prosthesis. 21086............. .............. A

Prepare face/oral

24.88 23.81 19.49 3.71 52.40 48.08

090 prosthesis. 21087............. .............. A

Prepare face/oral

24.88 23.35 19.25 3.44 51.67 47.57

090 prosthesis. 21088............. .............. C

Prepare face/oral

0.00 0.00 0.00 0.00 0.00 0.00

090 prosthesis. 21089............. .............. C

Prepare face/oral

0.00 0.00 0.00 0.00 0.00 0.00

090 prosthesis. 21100............. .............. A

Maxillofacial fixation 4.21 11.56 4.75 0.34 16.11 9.30

090 21110............. .............. A

Interdental fixation.. 5.20 9.59 8.38 0.72 15.51 14.30

090 21116............. .............. A

Injection, jaw joint x- 0.81 4.34 0.33 0.06 5.21 1.20

000 ray. 21120............. .............. A

Reconstruction of chin 4.92 10.61 7.51 0.60 16.13 13.03

090 21121............. .............. A

Reconstruction of chin 7.63 9.76 7.84 0.90 18.29 16.37

090 21122............. .............. A

Reconstruction of chin 8.51

NA 8.64 1.07

NA 18.22

090 21123............. .............. A

Reconstruction of chin 11.14

NA 10.83 1.40

NA 23.37

090 21125............. .............. A

Augmentation, lower

10.60 55.38 8.34 0.79 66.77 19.73

090 jaw bone. 21127............. .............. A

Augmentation, lower

11.10 42.92 9.48 1.52 55.54 22.10

090 jaw bone. 21137............. .............. A

Reduction of forehead. 9.81

NA 7.75 1.32

NA 18.88

090 21138............. .............. A

Reduction of forehead. 12.17

NA 9.56 1.74

NA 23.47

090 21139............. .............. A

Reduction of forehead. 14.59

NA 11.09 1.18

NA 26.86

090 21141............. .............. A

Reconstruct midface,

18.07

NA 13.69 2.35

NA 34.11

090 lefort. 21142............. .............. A

Reconstruct midface,

18.78

NA 12.86 2.38

NA 34.02

090 lefort. 21143............. .............. A

Reconstruct midface,

19.55

NA 14.35 1.66

NA 35.56

090 lefort. 21145............. .............. A

Reconstruct midface,

19.91

NA 13.94 2.84

NA 36.69

090 lefort.

[[Page 70346]]

21146............. .............. A

Reconstruct midface,

20.68

NA 15.37 3.09

NA 39.14

090 lefort. 21147............. .............. A

Reconstruct midface,

21.74

NA 15.09 1.84

NA 38.67

090 lefort. 21150............. .............. A

Reconstruct midface,

25.20

NA 16.81 2.55

NA 44.56

090 lefort. 21151............. .............. A

Reconstruct midface,

28.26

NA 23.02 2.30

NA 53.58

090 lefort. 21154............. .............. A

Reconstruct midface,

30.47

NA 23.19 2.48

NA 56.14

090 lefort. 21155............. .............. A

Reconstruct midface,

34.40

NA 23.96 6.64

NA 65.00

090 lefort. 21159............. .............. A

Reconstruct midface,

42.32

NA 29.16 8.18

NA 79.66

090 lefort. 21160............. .............. A

Reconstruct midface,

46.37

NA 27.55 4.13

NA 78.05

090 lefort. 21172............. .............. A

Reconstruct orbit/

27.76

NA 13.79 3.55

NA 45.10

090 forehead. 21175............. .............. A

Reconstruct orbit/

33.12

NA 17.84 4.83

NA 55.79

090 forehead. 21179............. .............. A

Reconstruct entire

22.22

NA 14.17 2.80

NA 39.19

090 forehead. 21180............. .............. A

Reconstruct entire

25.15

NA 15.42 3.48

NA 44.05

090 forehead. 21181............. .............. A

Contour cranial bone

9.89

NA 7.48 1.32

NA 18.69

090 lesion. 21182............. .............. A

Reconstruct cranial

32.14

NA 19.17 2.80

NA 54.11

090 bone. 21183............. .............. A

Reconstruct cranial

35.26

NA 20.89 4.47

NA 60.62

090 bone. 21184............. .............. A

Reconstruct cranial

38.18

NA 22.00 5.70

NA 65.88

090 bone. 21188............. .............. A

Reconstruction of

22.43

NA 18.92 1.69

NA 43.04

090 midface. 21193............. .............. A

Reconst lwr jaw w/o

17.12

NA 12.69 2.23

NA 32.04

090 graft. 21194............. .............. A

Reconst lwr jaw w/

19.81

NA 13.79 2.02

NA 35.62

090 graft. 21195............. .............. A

Reconst lwr jaw w/o

17.21

NA 14.86 1.64

NA 33.71

090 fixation. 21196............. .............. A

Reconst lwr jaw w/

18.88

NA 15.74 2.07

NA 36.69

090 fixation. 21198............. .............. A

Reconstr lwr jaw

14.14

NA 12.74 1.44

NA 28.32

090 segment. 21199............. .............. A

Reconstr lwr jaw w/

15.98

NA 9.14 1.39

NA 26.51

090 advance. 21206............. .............. A

Reconstruct upper jaw 14.08

NA 12.67 1.33

NA 28.08

090 bone. 21208............. .............. A

Augmentation of facial 10.21 22.39 9.61 1.09 33.69 20.91

090 bones. 21209............. .............. A

Reduction of facial

6.71 10.83 8.09 0.90 18.44 15.70

090 bones. 21210............. .............. A

Face bone graft....... 10.21 24.94 9.38 1.30 36.45 20.89

090 21215............. .............. A

Lower jaw bone graft.. 10.75 42.00 9.39 1.53 54.28 21.67

090 21230............. .............. A

Rib cartilage graft... 10.75

NA 8.06 1.29

NA 20.10

090 21235............. .............. A

Ear cartilage graft... 6.71 9.87 6.43 0.61 17.19 13.75

090 21240............. .............. A

Reconstruction of jaw 14.03

NA 12.08 2.24

NA 28.35

090 joint. 21242............. .............. A

Reconstruction of jaw 12.93

NA 11.54 1.78

NA 26.25

090 joint. 21243............. .............. A

Reconstruction of jaw 20.76

NA 17.48 3.25

NA 41.49

090 joint. 21244............. .............. A

Reconstruction of

11.84

NA 12.13 1.25

NA 25.22

090 lower jaw. 21245............. .............. A

Reconstruction of jaw. 11.84 14.44 9.88 1.19 27.47 22.91

090 21246............. .............. A

Reconstruction of jaw. 12.45

NA 9.07 1.35

NA 22.87

090 21247............. .............. A

Reconstruct lower jaw 22.60

NA 17.40 2.83

NA 42.83

090 bone. 21248............. .............. A

Reconstruction of jaw. 11.46 12.17 9.43 1.55 25.18 22.44

090 21249............. .............. A

Reconstruction of jaw. 17.49 16.77 12.73 2.48 36.74 32.70

090 21255............. .............. A

Reconstruct lower jaw 16.69

NA 16.18 2.38

NA 35.25

090 bone. 21256............. .............. A

Reconstruction of

16.17

NA 11.85 1.50

NA 29.52

090 orbit. 21260............. .............. A

Revise eye sockets.... 16.50

NA 12.80 0.97

NA 30.27

090 21261............. .............. A

Revise eye sockets.... 31.44

NA 24.30 3.42

NA 59.16

090 21263............. .............. A

Revise eye sockets.... 28.38

NA 19.13 2.62

NA 50.13

090 21267............. .............. A

Revise eye sockets.... 18.87

NA 19.83 1.70

NA 40.40

090 21268............. .............. A

Revise eye sockets.... 24.44

NA 20.27 3.65

NA 48.36

090 21270............. .............. A

Augmentation, cheek

10.21 11.68 7.27 0.72 22.61 18.20

090 bone. 21275............. .............. A

Revision, orbitofacial 11.22

NA 8.18 1.29

NA 20.69

090 bones. 21280............. .............. A

Revision of eyelid.... 6.02

NA 5.94 0.42

NA 12.38

090 21282............. .............. A

Revision of eyelid.... 3.48

NA 4.49 0.26

NA 8.23

090 21295............. .............. A

Revision of jaw muscle/ 1.53

NA 2.54 0.16

NA 4.23

090 bone. 21296............. .............. A

Revision of jaw muscle/ 4.24

NA 4.92 0.34

NA 9.50

090 bone. 21299............. .............. C

Cranio/maxillofacial

0.00 0.00 0.00 0.00 0.00 0.00

YYY surgery. 21300............. .............. A

Treatment of skull

0.72 2.37 0.26 0.13 3.22 1.11

000 fracture. 21310............. .............. A

Treatment of nose

0.58 2.29 0.15 0.05 2.92 0.78

000 fracture. 21315............. .............. A

Treatment of nose

1.51 4.24 1.89 0.14 5.89 3.54

010 fracture. 21320............. .............. A

Treatment of nose

1.85 3.92 1.62 0.18 5.95 3.65

010 fracture. 21325............. .............. A

Treatment of nose

3.76

NA 8.64 0.31

NA 12.71

090 fracture. 21330............. .............. A

Treatment of nose

5.37

NA 9.73 0.56

NA 15.66

090 fracture. 21335............. .............. A

Treatment of nose

8.60

NA 9.65 0.74

NA 18.99

090 fracture. 21336............. .............. A

Treat nasal septal

5.71

NA 9.64 0.55

NA 15.90

090 fracture. 21337............. .............. A

Treat nasal septal

2.70 6.14 3.58 0.28 9.12 6.56

090 fracture. 21338............. .............. A

Treat nasoethmoid

6.45

NA 14.06 0.82

NA 21.33

090 fracture. 21339............. .............. A

Treat nasoethmoid

8.08

NA 13.94 0.96

NA 22.98

090 fracture. 21340............. .............. A

Treatment of nose

10.75

NA 8.42 1.15

NA 20.32

090 fracture. 21343............. .............. A

Treatment of sinus

12.93

NA 15.51 1.47

NA 29.91

090 fracture. 21344............. .............. A

Treatment of sinus

19.69

NA 16.55 2.43

NA 38.67

090 fracture. 21345............. .............. A

Treat nose/jaw

8.15 9.87 7.19 0.92 18.94 16.26

090 fracture. 21346............. .............. A

Treat nose/jaw

10.59

NA 12.24 1.21

NA 24.04

090 fracture. 21347............. .............. A

Treat nose/jaw

12.67

NA 16.24 1.47

NA 30.38

090 fracture. 21348............. .............. A

Treat nose/jaw

16.66

NA 11.14 2.48

NA 30.28

090 fracture. 21355............. .............. A

Treat cheek bone

3.76 6.25 3.49 0.34 10.35 7.59

010 fracture. 21356............. .............. A

Treat cheek bone

4.14 7.14 4.56 0.46 11.74 9.16

010 fracture. 21360............. .............. A

Treat cheek bone

6.45

NA 5.95 0.74

NA 13.14

090 fracture. 21365............. .............. A

Treat cheek bone

14.93

NA 10.86 1.69

NA 27.48

090 fracture.

[[Page 70347]]

21366............. .............. A

Treat cheek bone

17.74

NA 11.36 2.49

NA 31.59

090 fracture. 21385............. .............. A

Treat eye socket

9.15

NA 8.30 0.97

NA 18.42

090 fracture. 21386............. .............. A

Treat eye socket

9.15

NA 7.09 0.97

NA 17.21

090 fracture. 21387............. .............. A

Treat eye socket

9.69

NA 8.98 1.08

NA 19.75

090 fracture. 21390............. .............. A

Treat eye socket

10.11

NA 7.82 0.90

NA 18.83

090 fracture. 21395............. .............. A

Treat eye socket

12.66

NA 9.05 1.44

NA 23.15

090 fracture. 21400............. .............. A

Treat eye socket

1.40 2.62 1.88 0.15 4.17 3.43

090 fracture. 21401............. .............. A

Treat eye socket

3.26 8.01 3.50 0.38 11.65 7.14

090 fracture. 21406............. .............. A

Treat eye socket

7.00

NA 6.10 0.73

NA 13.83

090 fracture. 21407............. .............. A

Treat eye socket

8.60

NA 6.88 0.94

NA 16.42

090 fracture. 21408............. .............. A

Treat eye socket

12.36

NA 8.91 1.44

NA 22.71

090 fracture. 21421............. .............. A

Treat mouth roof

5.13 9.36 8.33 0.73 15.22 14.19

090 fracture. 21422............. .............. A

Treat mouth roof

8.31

NA 8.10 0.99

NA 17.40

090 fracture. 21423............. .............. A

Treat mouth roof

10.38

NA 9.35 1.27

NA 21.00

090 fracture. 21431............. .............. A

Treat craniofacial

7.04

NA 9.55 0.70

NA 17.29

090 fracture. 21432............. .............. A

Treat craniofacial

8.60

NA 8.08 0.81

NA 17.49

090 fracture. 21433............. .............. A

Treat craniofacial

25.31

NA 16.45 2.78

NA 44.54

090 fracture. 21435............. .............. A

Treat craniofacial

17.22

NA 12.74 1.98

NA 31.94

090 fracture. 21436............. .............. A

Treat craniofacial

28.00

NA 18.27 3.09

NA 49.36

090 fracture. 21440............. .............. A

Treat dental ridge

2.70 7.12 6.18 0.38 10.20 9.26

090 fracture. 21445............. .............. A

Treat dental ridge

5.37 9.78 8.39 0.78 15.93 14.54

090 fracture. 21450............. .............. A

Treat lower jaw

2.97 7.40 6.89 0.33 10.70 10.19

090 fracture. 21451............. .............. A

Treat lower jaw

4.86 9.38 8.42 0.63 14.87 13.91

090 fracture. 21452............. .............. A

Treat lower jaw

1.98 13.06 4.62 0.27 15.31 6.87

090 fracture. 21453............. .............. A

Treat lower jaw

5.53 10.77 10.76 0.74 17.04 17.03

090 fracture. 21454............. .............. A

Treat lower jaw

6.45

NA 6.28 0.82

NA 13.55

090 fracture. 21461............. .............. A

Treat lower jaw

8.08 24.53 12.70 0.98 33.59 21.76

090 fracture. 21462............. .............. A

Treat lower jaw

9.78 27.69 12.75 1.27 38.74 23.80

090 fracture. 21465............. .............. A

Treat lower jaw

11.89

NA 9.84 1.50

NA 23.23

090 fracture. 21470............. .............. A

Treat lower jaw

15.32

NA 12.05 1.96

NA 29.33

090 fracture. 21480............. .............. A

Reset dislocated jaw.. 0.61 1.78 0.19 0.06 2.45 0.86

000 21485............. .............. A

Reset dislocated jaw.. 3.98 8.24 7.68 0.51 12.73 12.17

090 21490............. .............. A

Repair dislocated jaw. 11.84

NA 9.72 1.96

NA 23.52

090 21495............. .............. A

Treat hyoid bone

5.68

NA 8.44 0.46

NA 14.58

090 fracture. 21497............. .............. A

Interdental wiring.... 3.85 8.47 7.66 0.50 12.82 12.01

090 21499............. .............. C

Head surgery procedure 0.00 0.00 0.00 0.00 0.00 0.00

YYY 21501............. .............. A

Drain neck/chest

3.80 6.44 3.83 0.43 10.67 8.06

090 lesion. 21502............. .............. A

Drain chest lesion.... 7.11

NA 5.65 0.97

NA 13.73

090 21510............. .............. A

Drainage of bone

5.73

NA 5.68 0.80

NA 12.21

090 lesion. 21550............. .............. A

Biopsy of neck/chest.. 2.06 3.59 1.72 0.16 5.81 3.94

010 21555............. .............. A

Remove lesion, neck/

4.34 5.53 3.20 0.56 10.43 8.10

090 chest. 21556............. .............. A

Remove lesion, neck/

5.56

NA 4.11 0.65

NA 10.32

090 chest. 21557............. .............. A

Remove tumor, neck/

8.87

NA 5.37 1.08

NA 15.32

090 chest. 21600............. .............. A

Partial removal of rib 6.88

NA 5.75 0.99

NA 13.62

090 21610............. .............. A

Partial removal of rib 14.59

NA 8.89 3.07

NA 26.55

090 21615............. .............. A

Removal of rib........ 9.86

NA 6.70 1.45

NA 18.01

090 21616............. .............. A

Removal of rib and

12.02

NA 8.04 1.86

NA 21.92

090 nerves. 21620............. .............. A

Partial removal of

6.78

NA 5.99 0.98

NA 13.75

090 sternum. 21627............. .............. A

Sternal debridement... 6.80

NA 6.32 1.02

NA 14.14

090 21630............. .............. A

Extensive sternum

17.35

NA 11.87 2.58

NA 31.80

090 surgery. 21632............. .............. A

Extensive sternum

18.11

NA 11.14 2.65

NA 31.90

090 surgery. 21685............. .............. A

Hyoid myotomy &

12.98

NA 10.00 1.06

NA 24.04

090 suspension. 21700............. .............. A

Revision of neck

6.18

NA 4.45 0.32

NA 10.95

090 muscle. 21705............. .............. A

Revision of neck

9.59

NA 5.60 1.43

NA 16.62

090 muscle/rib. 21720............. .............. A

Revision of neck

5.67 2.47 2.47 0.91 9.05 9.05

090 muscle. 21725............. .............. A

Revision of neck

6.98

NA 5.46 1.21

NA 13.65

090 muscle. 21740............. .............. A

Reconstruction of

16.48

NA 8.54 2.36

NA 27.38

090 sternum. 21742............. .............. C

Repair stern/nuss w/o

0.00 0.00 0.00 0.00 0.00 0.00

090 scope. 21743............. .............. C

Repair sternum/nuss w/ 0.00 0.00 0.00 0.00 0.00 0.00

090 scope. 21750............. .............. A

Repair of sternum

10.75

NA 6.13 1.63

NA 18.51

090 separation. 21800............. .............. A

Treatment of rib

0.96

NA 1.34 0.09

NA 2.39

090 fracture. 21805............. .............. A

Treatment of rib

2.75

NA 3.21 0.38

NA 6.34

090 fracture. 21810............. .............. A

Treatment of rib

6.85

NA 4.98 0.94

NA 12.77

090 fracture(s). 21820............. .............. A

Treat sternum fracture 1.28 1.83 1.77 0.16 3.27 3.21

090 21825............. .............. A

Treat sternum fracture 7.40

NA 6.41 1.11

NA 14.92

090 21899............. .............. C

Neck/chest surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 21920............. .............. A

Biopsy soft tissue of

2.06 3.29 1.47 0.14 5.49 3.67

010 back. 21925............. .............. A

Biopsy soft tissue of

4.48 5.18 3.25 0.60 10.26 8.33

090 back. 21930............. .............. A

Remove lesion, back or 4.99 5.73 3.41 0.66 11.38 9.06

090 flank. 21935............. .............. A

Remove tumor, back.... 17.93

NA 9.65 2.47

NA 30.05

090 22010............. .............. A

I&d, p-spine, c/t/cerv- 11.05

NA 8.91 1.73

NA 21.69

090 thor. 22015............. .............. A

I&d, p-spine, l/s/ls.. 10.94

NA 8.85 1.71

NA 21.50

090 22100............. .............. A

Remove part of neck

9.72

NA 7.55 2.13

NA 19.40

090 vertebra. 22101............. .............. A

Remove part, thorax

9.80

NA 7.77 1.90

NA 19.47

090 vertebra. 22102............. .............. A

Remove part, lumbar

9.80

NA 8.13 1.87

NA 19.80

090 vertebra.

[[Page 70348]]

22103............. .............. A

Remove extra spine

2.34

NA 1.21 0.44

NA 3.99

ZZZ segment. 22110............. .............. A

Remove part of neck

12.72

NA 9.19 2.76

NA 24.67

090 vertebra. 22112............. .............. A

Remove part, thorax

12.79

NA 9.30 2.52

NA 24.61

090 vertebra. 22114............. .............. A

Remove part, lumbar

12.79

NA 9.28 2.63

NA 24.70

090 vertebra. 22116............. .............. A

Remove extra spine

2.32

NA 1.17 0.50

NA 3.99

ZZZ segment. 22210............. .............. A

Revision of neck spine 23.78

NA 15.45 5.44

NA 44.67

090 22212............. .............. A

Revision of thorax

19.39

NA 13.31 3.90

NA 36.60

090 spine. 22214............. .............. A

Revision of lumbar

19.42

NA 13.85 3.91

NA 37.18

090 spine. 22216............. .............. A

Revise, extra spine

6.03

NA 3.14 1.29

NA 10.46

ZZZ segment. 22220............. .............. A

Revision of neck spine 21.34

NA 13.66 5.06

NA 40.06

090 22222............. .............. A

Revision of thorax

21.49

NA 11.16 4.12

NA 36.77

090 spine. 22224............. .............. A

Revision of lumbar

21.49

NA 14.26 4.18

NA 39.93

090 spine. 22226............. .............. A

Revise, extra spine

6.03

NA 3.10 1.29

NA 10.42

ZZZ segment. 22305............. .............. A

Treat spine process

2.05 2.32 1.93 0.39 4.76 4.37

090 fracture. 22310............. .............. A

Treat spine fracture.. 2.61 2.81 2.36 0.50 5.92 5.47

090 22315............. .............. A

Treat spine fracture.. 8.83 9.71 7.35 1.85 20.39 18.03

090 22318............. .............. A

Treat odontoid fx w/o 21.47

NA 13.42 5.28

NA 40.17

090 graft. 22319............. .............. A

Treat odontoid fx w/

23.96

NA 14.75 6.03

NA 44.74

090 graft. 22325............. .............. A

Treat spine fracture.. 18.27

NA 12.11 3.87

NA 34.25

090 22326............. .............. A

Treat neck spine

19.56

NA 12.74 4.42

NA 36.72

090 fracture. 22327............. .............. A

Treat thorax spine

19.17

NA 12.40 3.98

NA 35.55

090 fracture. 22328............. .............. A

Treat each add spine

4.60

NA 2.27 0.94

NA 7.81

ZZZ fx. 22505............. .............. A

Manipulation of spine. 1.87

NA 0.94 0.36

NA 3.17

010 22520............. .............. A

Percut vertebroplasty

8.90 61.84 5.11 1.71 72.45 15.72

010 thor. 22521............. .............. A

Percut vertebroplasty

8.33 56.13 4.96 1.60 66.06 14.89

010 lumb. 22522............. .............. A

Percut vertebroplasty

4.30

NA 1.68 0.82

NA 6.80

ZZZ add'l. 22523............. .............. A

Percut kyphoplasty,

8.94

NA 5.92 1.43

NA 16.29

010 thor. 22524............. .............. A

Percut kyphoplasty,

8.54

NA 5.71 1.36

NA 15.61

010 lumbar. 22525............. .............. A

Percut kyphoplasty,

4.47

NA 2.28 0.72

NA 7.47

ZZZ add-on. 22532............. .............. A

Lat thorax spine

23.96

NA 14.86 4.34

NA 43.16

090 fusion. 22533............. .............. A

Lat lumbar spine

23.09

NA 13.63 3.15

NA 39.87

090 fusion. 22534............. .............. A

Lat thor/lumb, add'l

5.99

NA 3.04 1.25

NA 10.28

ZZZ seg. 22548............. .............. A

Neck spine fusion..... 25.78

NA 15.85 5.59

NA 47.22

090 22554............. .............. A

Neck spine fusion..... 18.59

NA 12.38 4.45

NA 35.42

090 22556............. .............. A

Thorax spine fusion... 23.42

NA 14.77 4.34

NA 42.53

090 22558............. .............. A

Lumbar spine fusion... 22.25

NA 13.33 3.15

NA 38.73

090 22585............. .............. A

Additional spinal

5.52

NA 2.80 1.25

NA 9.57

ZZZ fusion. 22590............. .............. A

Spine & skull spinal

20.48

NA 13.36 4.78

NA 38.62

090 fusion. 22595............. .............. A

Neck spinal fusion.... 19.36

NA 12.87 4.40

NA 36.63

090 22600............. .............. A

Neck spine fusion..... 16.12

NA 11.22 3.72

NA 31.06

090 22610............. .............. A

Thorax spine fusion... 16.00

NA 11.44 3.52

NA 30.96

090 22612............. .............. A

Lumbar spine fusion... 20.97

NA 14.24 4.46

NA 39.67

090 22614............. .............. A

Spine fusion, extra

6.43

NA 3.36 1.38

NA 11.17

ZZZ segment. 22630............. .............. A

Lumbar spine fusion... 20.81

NA 13.64 4.72

NA 39.17

090 22632............. .............. A

Spine fusion, extra

5.22

NA 2.67 1.16

NA 9.05

ZZZ segment. 22800............. .............. A

Fusion of spine....... 18.22

NA 12.81 3.75

NA 34.78

090 22802............. .............. A

Fusion of spine....... 30.83

NA 19.65 6.15

NA 56.63

090 22804............. .............. A

Fusion of spine....... 36.22

NA 22.76 6.98

NA 65.96

090 22808............. .............. A

Fusion of spine....... 26.23

NA 16.35 4.92

NA 47.50

090 22810............. .............. A

Fusion of spine....... 30.22

NA 18.41 5.13

NA 53.76

090 22812............. .............. A

Fusion of spine....... 32.65

NA 20.12 5.28

NA 58.05

090 22818............. .............. A

Kyphectomy, 1-2

31.78

NA 18.92 6.45

NA 57.15

090 segments. 22819............. .............. A

Kyphectomy, 3 or more. 36.39

NA 20.11 7.65

NA 64.15

090 22830............. .............. A

Exploration of spinal 10.83

NA 7.98 2.29

NA 21.10

090 fusion. 22840............. .............. A

Insert spine fixation 12.52

NA 6.51 2.78

NA 21.81

ZZZ device. 22841............. .............. B

Insert spine fixation

0.00 0.00 0.00 0.00 0.00 0.00

XXX device. 22842............. .............. A

Insert spine fixation 12.56

NA 6.52 2.74

NA 21.82

ZZZ device. 22843............. .............. A

Insert spine fixation 13.44

NA 6.62 2.85

NA 22.91

ZZZ device. 22844............. .............. A

Insert spine fixation 16.42

NA 8.78 3.18

NA 28.38

ZZZ device. 22845............. .............. A

Insert spine fixation 11.94

NA 6.09 2.85

NA 20.88

ZZZ device. 22846............. .............. A

Insert spine fixation 12.40

NA 6.35 2.95

NA 21.70

ZZZ device. 22847............. .............. A

Insert spine fixation 13.78

NA 7.04 2.99

NA 23.81

ZZZ device. 22848............. .............. A

Insert pelv fixation

5.99

NA 3.19 1.15

NA 10.33

ZZZ device. 22849............. .............. A

Reinsert spinal

18.48

NA 11.76 3.89

NA 34.13

090 fixation. 22850............. .............. A

Remove spine fixation

9.51

NA 7.01 2.04

NA 18.56

090 device. 22851............. .............. A

Apply spine prosth

6.70

NA 3.37 1.49

NA 11.56

ZZZ device. 22852............. .............. A

Remove spine fixation

9.00

NA 6.81 1.89

NA 17.70

090 device. 22855............. .............. A

Remove spine fixation 15.11

NA 9.69 3.51

NA 28.31

090 device. 22899............. .............. C

Spine surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 22900............. .............. A

Remove abdominal wall

5.79

NA 3.23 0.76

NA 9.78

090 lesion. 22999............. .............. C

Abdomen surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 23000............. .............. A

Removal of calcium

4.35 8.55 4.43 0.68 13.58 9.46

090 deposits. 23020............. .............. A

Release shoulder joint 8.92

NA 7.58 1.54

NA 18.04

090 23030............. .............. A

Drain shoulder lesion. 3.42 7.41 2.91 0.57 11.40 6.90

010 23031............. .............. A

Drain shoulder bursa.. 2.74 7.88 2.73 0.46 11.08 5.93

010

[[Page 70349]]

23035............. .............. A

Drain shoulder bone

8.60

NA 8.29 1.47

NA 18.36

090 lesion. 23040............. .............. A

Exploratory shoulder

9.19

NA 7.88 1.60

NA 18.67

090 surgery. 23044............. .............. A

Exploratory shoulder

7.11

NA 6.45 1.24

NA 14.80

090 surgery. 23065............. .............. A

Biopsy shoulder

2.27 2.49 1.62 0.20 4.96 4.09

010 tissues. 23066............. .............. A

Biopsy shoulder

4.15 7.69 3.99 0.63 12.47 8.77

090 tissues. 23075............. .............. A

Removal of shoulder

2.39 3.67 1.79 0.34 6.40 4.52

010 lesion. 23076............. .............. A

Removal of shoulder

7.62

NA 5.57 1.13

NA 14.32

090 lesion. 23077............. .............. A

Remove tumor of

16.07

NA 10.24 2.33

NA 28.64

090 shoulder. 23100............. .............. A

Biopsy of shoulder

6.02

NA 5.67 1.04

NA 12.73

090 joint. 23101............. .............. A

Shoulder joint surgery 5.57

NA 5.35 0.96

NA 11.88

090 23105............. .............. A

Remove shoulder joint

8.22

NA 7.14 1.42

NA 16.78

090 lining. 23106............. .............. A

Incision of collarbone 5.95

NA 5.72 0.99

NA 12.66

090 joint. 23107............. .............. A

Explore treat shoulder 8.61

NA 7.41 1.49

NA 17.51

090 joint. 23120............. .............. A

Partial removal,

7.10

NA 6.48 1.23

NA 14.81

090 collar bone. 23125............. .............. A

Removal of collar bone 9.38

NA 7.58 1.62

NA 18.58

090 23130............. .............. A

Remove shoulder bone,

7.54

NA 7.15 1.30

NA 15.99

090 part. 23140............. .............. A

Removal of bone lesion 6.88

NA 5.24 1.08

NA 13.20

090 23145............. .............. A

Removal of bone lesion 9.08

NA 7.46 1.49

NA 18.03

090 23146............. .............. A

Removal of bone lesion 7.82

NA 7.13 1.35

NA 16.30

090 23150............. .............. A

Removal of humerus

8.47

NA 6.94 1.32

NA 16.73

090 lesion. 23155............. .............. A

Removal of humerus

10.33

NA 8.35 1.80

NA 20.48

090 lesion. 23156............. .............. A

Removal of humerus

8.67

NA 7.40 1.50

NA 17.57

090 lesion. 23170............. .............. A

Remove collar bone

6.85

NA 6.04 1.12

NA 14.01

090 lesion. 23172............. .............. A

Remove shoulder blade

6.89

NA 6.30 1.01

NA 14.20

090 lesion. 23174............. .............. A

Remove humerus lesion. 9.50

NA 8.38 1.65

NA 19.53

090 23180............. .............. A

Remove collar bone

8.52

NA 9.02 1.47

NA 19.01

090 lesion. 23182............. .............. A

Remove shoulder blade

8.14

NA 8.57 1.37

NA 18.08

090 lesion. 23184............. .............. A

Remove humerus lesion. 9.37

NA 9.34 1.63

NA 20.34

090 23190............. .............. A

Partial removal of

7.23

NA 6.19 1.17

NA 14.59

090 scapula. 23195............. .............. A

Removal of head of

9.80

NA 7.75 1.70

NA 19.25

090 humerus. 23200............. .............. A

Removal of collar bone 12.06

NA 8.75 1.93

NA 22.74

090 23210............. .............. A

Removal of shoulder

12.47

NA 9.02 2.02

NA 23.51

090 blade. 23220............. .............. A

Partial removal of

14.54

NA 10.85 2.48

NA 27.87

090 humerus. 23221............. .............. A

Partial removal of

17.71

NA 11.75 3.05

NA 32.51

090 humerus. 23222............. .............. A

Partial removal of

23.88

NA 15.83 3.94

NA 43.65

090 humerus. 23330............. .............. A

Remove shoulder

1.85 3.69 1.89 0.24 5.78 3.98

010 foreign body. 23331............. .............. A

Remove shoulder

7.37

NA 6.81 1.27

NA 15.45

090 foreign body. 23332............. .............. A

Remove shoulder

11.60

NA 9.35 2.02

NA 22.97

090 foreign body. 23350............. .............. A

Injection for shoulder 1.00 3.47 0.33 0.06 4.53 1.39

000 x-ray. 23395............. .............. A

Muscle

16.82

NA 12.90 2.93

NA 32.65

090 transfer,shoulder/arm. 23397............. .............. A

Muscle transfers...... 16.11

NA 11.40 2.73

NA 30.24

090 23400............. .............. A

Fixation of shoulder

13.52

NA 10.10 2.29

NA 25.91

090 blade. 23405............. .............. A

Incision of tendon &

8.36

NA 6.94 1.45

NA 16.75

090 muscle. 23406............. .............. A

Incise tendon(s) &

10.77

NA 8.36 1.87

NA 21.00

090 muscle(s). 23410............. .............. A

Repair rotator cuff,

12.43

NA 9.43 2.16

NA 24.02

090 acute. 23412............. .............. A

Repair rotator cuff,

13.29

NA 9.92 2.31

NA 25.52

090 chronic. 23415............. .............. A

Release of shoulder

9.96

NA 8.01 1.73

NA 19.70

090 ligament. 23420............. .............. A

Repair of shoulder.... 13.28

NA 10.87 2.31

NA 26.46

090 23430............. .............. A

Repair biceps tendon.. 9.97

NA 8.12 1.73

NA 19.82

090 23440............. .............. A

Remove/transplant

10.46

NA 8.28 1.82

NA 20.56

090 tendon. 23450............. .............. A

Repair shoulder

13.38

NA 9.87 2.32

NA 25.57

090 capsule. 23455............. .............. A

Repair shoulder

14.35

NA 10.47 2.49

NA 27.31

090 capsule. 23460............. .............. A

Repair shoulder

15.35

NA 11.40 2.66

NA 29.41

090 capsule. 23462............. .............. A

Repair shoulder

15.28

NA 10.78 2.59

NA 28.65

090 capsule. 23465............. .............. A

Repair shoulder

15.83

NA 11.21 2.76

NA 29.80

090 capsule. 23466............. .............. A

Repair shoulder

14.20

NA 11.40 2.46

NA 28.06

090 capsule. 23470............. .............. A

Reconstruct shoulder

17.12

NA 12.29 2.98

NA 32.39

090 joint. 23472............. .............. A

Reconstruct shoulder

21.07

NA 14.45 3.66

NA 39.18

090 joint. 23480............. .............. A

Revision of collar

11.16

NA 8.80 1.94

NA 21.90

090 bone. 23485............. .............. A

Revision of collar

13.41

NA 9.92 2.33

NA 25.66

090 bone. 23490............. .............. A

Reinforce clavicle.... 11.84

NA 8.72 1.47

NA 22.03

090 23491............. .............. A

Reinforce shoulder

14.19

NA 10.74 2.46

NA 27.39

090 bones. 23500............. .............. A

Treat clavicle

2.08 2.88 2.53 0.30 5.26 4.91

090 fracture. 23505............. .............. A

Treat clavicle

3.68 4.42 3.85 0.61 8.71 8.14

090 fracture. 23515............. .............. A

Treat clavicle

7.40

NA 6.57 1.28

NA 15.25

090 fracture. 23520............. .............. A

Treat clavicle

2.16 2.86 2.75 0.34 5.36 5.25

090 dislocation. 23525............. .............. A

Treat clavicle

3.59 4.55 3.95 0.46 8.60 8.00

090 dislocation. 23530............. .............. A

Treat clavicle

7.30

NA 5.95 1.20

NA 14.45

090 dislocation. 23532............. .............. A

Treat clavicle

8.00

NA 6.99 1.38

NA 16.37

090 dislocation. 23540............. .............. A

Treat clavicle

2.23 2.87 2.37 0.29 5.39 4.89

090 dislocation. 23545............. .............. A

Treat clavicle

3.25 4.20 3.37 0.35 7.80 6.97

090 dislocation. 23550............. .............. A

Treat clavicle

7.23

NA 6.39 1.25

NA 14.87

090 dislocation. 23552............. .............. A

Treat clavicle

8.44

NA 7.34 1.46

NA 17.24

090 dislocation. 23570............. .............. A

Treat shoulder blade

2.23 3.02 2.90 0.36 5.61 5.49

090 fx. 23575............. .............. A

Treat shoulder blade

4.05 4.89 4.32 0.59 9.53 8.96

090 fx.

[[Page 70350]]

23585............. .............. A

Treat scapula fracture 8.95

NA 7.66 1.54

NA 18.15

090 23600............. .............. A

Treat humerus fracture 2.93 4.56 3.56 0.48 7.97 6.97

090 23605............. .............. A

Treat humerus fracture 4.86 6.17 5.12 0.84 11.87 10.82

090 23615............. .............. A

Treat humerus fracture 9.34

NA 8.86 1.62

NA 19.82

090 23616............. .............. A

Treat humerus fracture 21.24

NA 14.18 3.69

NA 39.11

090 23620............. .............. A

Treat humerus fracture 2.40 3.62 2.99 0.40 6.42 5.79

090 23625............. .............. A

Treat humerus fracture 3.92 4.95 4.29 0.67 9.54 8.88

090 23630............. .............. A

Treat humerus fracture 7.34

NA 6.65 1.27

NA 15.26

090 23650............. .............. A

Treat shoulder

3.38 3.78 2.77 0.30 7.46 6.45

090 dislocation. 23655............. .............. A

Treat shoulder

4.56

NA 4.18 0.69

NA 9.43

090 dislocation. 23660............. .............. A

Treat shoulder

7.48

NA 6.40 1.29

NA 15.17

090 dislocation. 23665............. .............. A

Treat dislocation/

4.46 5.35 4.73 0.71 10.52 9.90

090 fracture. 23670............. .............. A

Treat dislocation/

7.89

NA 6.85 1.36

NA 16.10

090 fracture. 23675............. .............. A

Treat dislocation/

6.04 6.85 5.85 1.01 13.90 12.90

090 fracture. 23680............. .............. A

Treat dislocation/

10.04

NA 8.13 1.75

NA 19.92

090 fracture. 23700............. .............. A

Fixation of shoulder.. 2.52

NA 2.18 0.44

NA 5.14

010 23800............. .............. A

Fusion of shoulder

14.14

NA 10.44 2.35

NA 26.93

090 joint. 23802............. .............. A

Fusion of shoulder

16.58

NA 10.20 2.70

NA 29.48

090 joint. 23900............. .............. A

Amputation of arm &

19.69

NA 11.74 3.18

NA 34.61

090 girdle. 23920............. .............. A

Amputation at shoulder 14.59

NA 9.95 2.46

NA 27.00

090 joint. 23921............. .............. A

Amputation follow-up

5.48

NA 5.09 0.78

NA 11.35

090 surgery. 23929............. .............. C

Shoulder surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 23930............. .............. A

Drainage of arm lesion 2.94 6.34 2.32 0.43 9.71 5.69

010 23931............. .............. A

Drainage of arm bursa. 1.79 5.93 2.18 0.28 8.00 4.25

010 23935............. .............. A

Drain arm/elbow bone

6.08

NA 5.93 1.05

NA 13.06

090 lesion. 24000............. .............. A

Exploratory elbow

5.81

NA 5.43 0.97

NA 12.21

090 surgery. 24006............. .............. A

Release elbow joint... 9.30

NA 7.77 1.50

NA 18.57

090 24065............. .............. A

Biopsy arm/elbow soft

2.08 3.22 1.75 0.17 5.47 4.00

010 tissue. 24066............. .............. A

Biopsy arm/elbow soft

5.20 8.96 4.14 0.80 14.96 10.14

090 tissue. 24075............. .............. A

Remove arm/elbow

3.91 7.37 3.41 0.56 11.84 7.88

090 lesion. 24076............. .............. A

Remove arm/elbow

6.29

NA 4.87 0.95

NA 12.11

090 lesion. 24077............. .............. A

Remove tumor of arm/

11.74

NA 7.76 1.72

NA 21.22

090 elbow. 24100............. .............. A

Biopsy elbow joint

4.92

NA 4.53 0.85

NA 10.30

090 lining. 24101............. .............. A

Explore/treat elbow

6.12

NA 5.95 1.03

NA 13.10

090 joint. 24102............. .............. A

Remove elbow joint

8.02

NA 6.88 1.33

NA 16.23

090 lining. 24105............. .............. A

Removal of elbow bursa 3.60

NA 4.40 0.61

NA 8.61

090 24110............. .............. A

Remove humerus lesion. 7.38

NA 6.68 1.28

NA 15.34

090 24115............. .............. A

Remove/graft bone

9.62

NA 7.23 1.67

NA 18.52

090 lesion. 24116............. .............. A

Remove/graft bone

11.79

NA 9.10 2.05

NA 22.94

090 lesion. 24120............. .............. A

Remove elbow lesion... 6.64

NA 5.94 1.10

NA 13.68

090 24125............. .............. A

Remove/graft bone

7.88

NA 6.18 1.06

NA 15.12

090 lesion. 24126............. .............. A

Remove/graft bone

8.30

NA 7.04 1.16

NA 16.50

090 lesion. 24130............. .............. A

Removal of head of

6.24

NA 6.04 1.04

NA 13.32

090 radius. 24134............. .............. A

Removal of arm bone

9.72

NA 8.88 1.64

NA 20.24

090 lesion. 24136............. .............. A

Remove radius bone

7.98

NA 7.24 1.38

NA 16.60

090 lesion. 24138............. .............. A

Remove elbow bone

8.04

NA 7.80 1.34

NA 17.18

090 lesion. 24140............. .............. A

Partial removal of arm 9.17

NA 9.13 1.51

NA 19.81

090 bone. 24145............. .............. A

Partial removal of

7.57

NA 8.08 1.25

NA 16.90

090 radius. 24147............. .............. A

Partial removal of

7.53

NA 8.62 1.30

NA 17.45

090 elbow. 24149............. .............. A

Radical resection of

14.18

NA 11.65 2.34

NA 28.17

090 elbow. 24150............. .............. A

Extensive humerus

13.25

NA 10.02 2.32

NA 25.59

090 surgery. 24151............. .............. A

Extensive humerus

15.56

NA 11.54 2.59

NA 29.69

090 surgery. 24152............. .............. A

Extensive radius

10.04

NA 7.75 1.48

NA 19.27

090 surgery. 24153............. .............. A

Extensive radius

11.52

NA 5.59 0.74

NA 17.85

090 surgery. 24155............. .............. A

Removal of elbow joint 11.71

NA 8.42 1.92

NA 22.05

090 24160............. .............. A

Remove elbow joint

7.82

NA 6.91 1.30

NA 16.03

090 implant. 24164............. .............. A

Remove radius head

6.22

NA 5.79 1.03

NA 13.04

090 implant. 24200............. .............. A

Removal of arm foreign 1.76 3.42 1.63 0.20 5.38 3.59

010 body. 24201............. .............. A

Removal of arm foreign 4.55 9.84 4.24 0.72 15.11 9.51

090 body. 24220............. .............. A

Injection for elbow x- 1.31 3.64 0.44 0.08 5.03 1.83

000 ray. 24300............. .............. A

Manipulate elbow w/

3.74

NA 5.73 0.65

NA 10.12

090 anesth. 24301............. .............. A

Muscle/tendon transfer 10.18

NA 8.20 1.66

NA 20.04

090 24305............. .............. A

Arm tendon lengthening 7.44

NA 6.73 1.15

NA 15.32

090 24310............. .............. A

Revision of arm tendon 5.97

NA 5.60 0.96

NA 12.53

090 24320............. .............. A

Repair of arm tendon.. 10.54

NA 7.55 1.73

NA 19.82

090 24330............. .............. A

Revision of arm

9.59

NA 7.90 1.60

NA 19.09

090 muscles. 24331............. .............. A

Revision of arm

10.63

NA 8.70 1.77

NA 21.10

090 muscles. 24332............. .............. A

Tenolysis, triceps.... 7.44

NA 6.79 1.23

NA 15.46

090 24340............. .............. A

Repair of biceps

7.88

NA 7.00 1.36

NA 16.24

090 tendon. 24341............. .............. A

Repair arm tendon/

7.89

NA 7.94 1.36

NA 17.19

090 muscle. 24342............. .............. A

Repair of ruptured

10.60

NA 8.54 1.85

NA 20.99

090 tendon. 24343............. .............. A

Repr elbow lat ligmnt

8.64

NA 8.17 1.43

NA 18.24

090 w/tiss. 24344............. .............. A

Reconstruct elbow lat 13.98

NA 11.55 2.36

NA 27.89

090 ligmnt. 24345............. .............. A

Repr elbw med ligmnt w/ 8.64

NA 8.04 1.44

NA 18.12

090 tissu. 24346............. .............. A

Reconstruct elbow med 13.98

NA 11.37 2.33

NA 27.68

090 ligmnt.

[[Page 70351]]

24350............. .............. A

Repair of tennis elbow 5.24

NA 5.60 0.87

NA 11.71

090 24351............. .............. A

Repair of tennis elbow 5.90

NA 5.94 1.02

NA 12.86

090 24352............. .............. A

Repair of tennis elbow 6.42

NA 6.20 1.10

NA 13.72

090 24354............. .............. A

Repair of tennis elbow 6.47

NA 6.17 1.07

NA 13.71

090 24356............. .............. A

Revision of tennis

6.67

NA 6.33 1.11

NA 14.11

090 elbow. 24360............. .............. A

Reconstruct elbow

12.32

NA 9.50 2.05

NA 23.87

090 joint. 24361............. .............. A

Reconstruct elbow

14.06

NA 10.61 2.18

NA 26.85

090 joint. 24362............. .............. A

Reconstruct elbow

14.97

NA 10.07 2.60

NA 27.64

090 joint. 24363............. .............. A

Replace elbow joint... 18.46

NA 13.75 3.01

NA 35.22

090 24365............. .............. A

Reconstruct head of

8.38

NA 7.22 1.41

NA 17.01

090 radius. 24366............. .............. A

Reconstruct head of

9.12

NA 7.56 1.52

NA 18.20

090 radius. 24400............. .............. A

Revision of humerus... 11.04

NA 8.88 1.92

NA 21.84

090 24410............. .............. A

Revision of humerus... 14.80

NA 10.34 2.57

NA 27.71

090 24420............. .............. A

Revision of humerus... 13.42

NA 10.57 2.17

NA 26.16

090 24430............. .............. A

Repair of humerus..... 12.79

NA 9.77 2.21

NA 24.77

090 24435............. .............. A

Repair humerus with

13.15

NA 10.91 2.27

NA 26.33

090 graft. 24470............. .............. A

Revision of elbow

8.73

NA 7.74 1.48

NA 17.95

090 joint. 24495............. .............. A

Decompression of

8.11

NA 8.77 1.18

NA 18.06

090 forearm. 24498............. .............. A

Reinforce humerus..... 11.90

NA 9.29 2.06

NA 23.25

090 24500............. .............. A

Treat humerus fracture 3.21 4.86 3.69 0.50 8.57 7.40

090 24505............. .............. A

Treat humerus fracture 5.16 6.62 5.41 0.89 12.67 11.46

090 24515............. .............. A

Treat humerus fracture 11.63

NA 9.41 2.02

NA 23.06

090 24516............. .............. A

Treat humerus fracture 11.63

NA 9.14 2.02

NA 22.79

090 24530............. .............. A

Treat humerus fracture 3.49 5.22 4.05 0.57 9.28 8.11

090 24535............. .............. A

Treat humerus fracture 6.86 7.86 6.64 1.18 15.90 14.68

090 24538............. .............. A

Treat humerus fracture 9.42

NA 8.73 1.64

NA 19.79

090 24545............. .............. A

Treat humerus fracture 10.44

NA 8.47 1.82

NA 20.73

090 24546............. .............. A

Treat humerus fracture 15.67

NA 11.35 2.73

NA 29.75

090 24560............. .............. A

Treat humerus fracture 2.80 4.49 3.20 0.44 7.73 6.44

090 24565............. .............. A

Treat humerus fracture 5.55 6.63 5.54 0.93 13.11 12.02

090 24566............. .............. A

Treat humerus fracture 7.78

NA 8.18 1.30

NA 17.26

090 24575............. .............. A

Treat humerus fracture 10.64

NA 8.42 1.86

NA 20.92

090 24576............. .............. A

Treat humerus fracture 2.86 4.77 3.72 0.46 8.09 7.04

090 24577............. .............. A

Treat humerus fracture 5.78 6.95 5.86 0.95 13.68 12.59

090 24579............. .............. A

Treat humerus fracture 11.58

NA 8.86 2.02

NA 22.46

090 24582............. .............. A

Treat humerus fracture 8.54

NA 9.14 1.48

NA 19.16

090 24586............. .............. A

Treat elbow fracture.. 15.19

NA 11.26 2.64

NA 29.09

090 24587............. .............. A

Treat elbow fracture.. 15.14

NA 11.05 2.52

NA 28.71

090 24600............. .............. A

Treat elbow

4.22 4.87 3.51 0.50 9.59 8.23

090 dislocation. 24605............. .............. A

Treat elbow

5.41

NA 5.38 0.89

NA 11.68

090 dislocation. 24615............. .............. A

Treat elbow

9.41

NA 7.84 1.60

NA 18.85

090 dislocation. 24620............. .............. A

Treat elbow fracture.. 6.97

NA 6.27 1.07

NA 14.31

090 24635............. .............. A

Treat elbow fracture.. 13.17

NA 14.09 2.28

NA 29.54

090 24640............. .............. A

Treat elbow

1.20 1.85 0.80 0.12 3.17 2.12

010 dislocation. 24650............. .............. A

Treat radius fracture. 2.16 3.79 2.76 0.35 6.30 5.27

090 24655............. .............. A

Treat radius fracture. 4.39 5.97 4.80 0.70 11.06 9.89

090 24665............. .............. A

Treat radius fracture. 8.13

NA 7.53 1.41

NA 17.07

090 24666............. .............. A

Treat radius fracture. 9.48

NA 8.09 1.62

NA 19.19

090 24670............. .............. A

Treat ulnar fracture.. 2.54 4.12 3.08 0.41 7.07 6.03

090 24675............. .............. A

Treat ulnar fracture.. 4.71 6.02 4.98 0.81 11.54 10.50

090 24685............. .............. A

Treat ulnar fracture.. 8.79

NA 7.54 1.52

NA 17.85

090 24800............. .............. A

Fusion of elbow joint. 11.18

NA 8.77 1.63

NA 21.58

090 24802............. .............. A

Fusion/graft of elbow 13.67

NA 10.41 2.37

NA 26.45

090 joint. 24900............. .............. A

Amputation of upper

9.59

NA 7.08 1.53

NA 18.20

090 arm. 24920............. .............. A

Amputation of upper

9.53

NA 6.96 1.61

NA 18.10

090 arm. 24925............. .............. A

Amputation follow-up

7.06

NA 6.10 1.14

NA 14.30

090 surgery. 24930............. .............. A

Amputation follow-up

10.23

NA 7.26 1.67

NA 19.16

090 surgery. 24931............. .............. A

Amputate upper arm &

12.70

NA 5.74 1.89

NA 20.33

090 implant. 24935............. .............. A

Revision of amputation 15.54

NA 8.04 2.13

NA 25.71

090 24940............. .............. C

Revision of upper arm. 0.00 0.00 0.00 0.00 0.00 0.00

090 24999............. .............. C

Upper arm/elbow

0.00 0.00 0.00 0.00 0.00 0.00

YYY surgery. 25000............. .............. A

Incision of tendon

3.37

NA 6.89 0.55

NA 10.81

090 sheath. 25001............. .............. A

Incise flexor carpi

3.37

NA 4.24 0.55

NA 8.16

090 radialis. 25020............. .............. A

Decompress forearm 1

5.91

NA 9.59 0.93

NA 16.43

090 space. 25023............. .............. A

Decompress forearm 1

12.94

NA 14.98 2.03

NA 29.95

090 space. 25024............. .............. A

Decompress forearm 2

9.49

NA 7.49 1.36

NA 18.34

090 spaces. 25025............. .............. A

Decompress forearm 2

16.52

NA 10.00 1.82

NA 28.34

090 spaces. 25028............. .............. A

Drainage of forearm

5.24

NA 8.18 0.81

NA 14.23

090 lesion. 25031............. .............. A

Drainage of forearm

4.13

NA 7.94 0.63

NA 12.70

090 bursa. 25035............. .............. A

Treat forearm bone

7.35

NA 13.63 1.24

NA 22.22

090 lesion. 25040............. .............. A

Explore/treat wrist

7.17

NA 7.32 1.15

NA 15.64

090 joint. 25065............. .............. A

Biopsy forearm soft

1.99 3.23 1.91 0.15 5.37 4.05

010 tissues. 25066............. .............. A

Biopsy forearm soft

4.12

NA 7.08 0.64

NA 11.84

090 tissues. 25075............. .............. A

Removal forearm lesion 3.73

NA 5.91 0.55

NA 10.19

090 subcu. 25076............. .............. A

Removal forearm lesion 4.91

NA 9.57 0.74

NA 15.22

090 deep.

[[Page 70352]]

25077............. .............. A

Remove tumor, forearm/ 9.75

NA 12.12 1.42

NA 23.29

090 wrist. 25085............. .............. A

Incision of wrist

5.49

NA 7.14 0.85

NA 13.48

090 capsule. 25100............. .............. A

Biopsy of wrist joint. 3.89

NA 5.29 0.59

NA 9.77

090 25101............. .............. A

Explore/treat wrist

4.68

NA 5.91 0.75

NA 11.34

090 joint. 25105............. .............. A

Remove wrist joint

5.84

NA 7.32 0.92

NA 14.08

090 lining. 25107............. .............. A

Remove wrist joint

6.42

NA 8.36 0.99

NA 15.77

090 cartilage. 25110............. .............. A

Remove wrist tendon

3.91

NA 7.07 0.62

NA 11.60

090 lesion. 25111............. .............. A

Remove wrist tendon

3.38

NA 4.71 0.53

NA 8.62

090 lesion. 25112............. .............. A

Reremove wrist tendon

4.52

NA 5.27 0.70

NA 10.49

090 lesion. 25115............. .............. A

Remove wrist/forearm

8.81

NA 14.07 1.31

NA 24.19

090 lesion. 25116............. .............. A

Remove wrist/forearm

7.10

NA 13.18 1.11

NA 21.39

090 lesion. 25118............. .............. A

Excise wrist tendon

4.36

NA 5.76 0.68

NA 10.80

090 sheath. 25119............. .............. A

Partial removal of

6.03

NA 7.62 0.96

NA 14.61

090 ulna. 25120............. .............. A

Removal of forearm

6.09

NA 12.12 1.00

NA 19.21

090 lesion. 25125............. .............. A

Remove/graft forearm

7.47

NA 12.88 1.06

NA 21.41

090 lesion. 25126............. .............. A

Remove/graft forearm

7.54

NA 13.05 1.27

NA 21.86

090 lesion. 25130............. .............. A

Removal of wrist

5.25

NA 6.44 0.80

NA 12.49

090 lesion. 25135............. .............. A

Remove & graft wrist

6.88

NA 7.53 1.02

NA 15.43

090 lesion. 25136............. .............. A

Remove & graft wrist

5.96

NA 6.61 1.03

NA 13.60

090 lesion. 25145............. .............. A

Remove forearm bone

6.36

NA 12.09 1.01

NA 19.46

090 lesion. 25150............. .............. A

Partial removal of

7.08

NA 8.23 1.14

NA 16.45

090 ulna. 25151............. .............. A

Partial removal of

7.38

NA 12.76 1.18

NA 21.32

090 radius. 25170............. .............. A

Extensive forearm

11.07

NA 15.19 1.77

NA 28.03

090 surgery. 25210............. .............. A

Removal of wrist bone. 5.94

NA 6.81 0.88

NA 13.63

090 25215............. .............. A

Removal of wrist bones 7.88

NA 8.78 1.19

NA 17.85

090 25230............. .............. A

Partial removal of

5.22

NA 6.16 0.79

NA 12.17

090 radius. 25240............. .............. A

Partial removal of

5.16

NA 6.97 0.81

NA 12.94

090 ulna. 25246............. .............. A

Injection for wrist x- 1.45 3.45 0.48 0.09 4.99 2.02

000 ray. 25248............. .............. A

Remove forearm foreign 5.13

NA 8.54 0.72

NA 14.39

090 body. 25250............. .............. A

Removal of wrist

6.59

NA 6.12 1.01

NA 13.72

090 prosthesis. 25251............. .............. A

Removal of wrist

9.56

NA 7.94 1.26

NA 18.76

090 prosthesis. 25259............. .............. A

Manipulate wrist w/

3.74

NA 5.74 0.62

NA 10.10

090 anesthes. 25260............. .............. A

Repair forearm tendon/ 7.79

NA 13.35 1.19

NA 22.33

090 muscle. 25263............. .............. A

Repair forearm tendon/ 7.81

NA 13.30 1.18

NA 22.29

090 muscle. 25265............. .............. A

Repair forearm tendon/ 9.87

NA 14.35 1.47

NA 25.69

090 muscle. 25270............. .............. A

Repair forearm tendon/ 5.99

NA 12.06 0.95

NA 19.00

090 muscle. 25272............. .............. A

Repair forearm tendon/ 7.03

NA 12.83 1.11

NA 20.97

090 muscle. 25274............. .............. A

Repair forearm tendon/ 8.74

NA 13.66 1.36

NA 23.76

090 muscle. 25275............. .............. A

Repair forearm tendon

8.49

NA 7.60 1.31

NA 17.40

090 sheath. 25280............. .............. A

Revise wrist/forearm

7.21

NA 12.67 1.08

NA 20.96

090 tendon. 25290............. .............. A

Incise wrist/forearm

5.28

NA 15.03 0.82

NA 21.13

090 tendon. 25295............. .............. A

Release wrist/forearm

6.54

NA 12.19 1.00

NA 19.73

090 tendon. 25300............. .............. A

Fusion of tendons at

8.79

NA 8.47 1.26

NA 18.52

090 wrist. 25301............. .............. A

Fusion of tendons at

8.39

NA 8.08 1.29

NA 17.76

090 wrist. 25310............. .............. A

Transplant forearm

8.13

NA 13.07 1.21

NA 22.41

090 tendon. 25312............. .............. A

Transplant forearm

9.56

NA 13.98 1.41

NA 24.95

090 tendon. 25315............. .............. A

Revise palsy hand

10.18

NA 14.44 1.58

NA 26.20

090 tendon(s). 25316............. .............. A

Revise palsy hand

12.31

NA 16.27 1.74

NA 30.32

090 tendon(s). 25320............. .............. A

Repair/revise wrist

10.75

NA 11.42 1.61

NA 23.78

090 joint. 25332............. .............. A

Revise wrist joint.... 11.39

NA 9.20 1.83

NA 22.42

090 25335............. .............. A

Realignment of hand... 12.86

NA 11.62 1.92

NA 26.40

090 25337............. .............. A

Reconstruct ulna/

10.15

NA 11.11 1.61

NA 22.87

090 radioulnar. 25350............. .............. A

Revision of radius.... 8.77

NA 14.01 1.46

NA 24.24

090 25355............. .............. A

Revision of radius.... 10.15

NA 14.65 1.73

NA 26.53

090 25360............. .............. A

Revision of ulna...... 8.42

NA 13.91 1.41

NA 23.74

090 25365............. .............. A

Revise radius & ulna.. 12.38

NA 15.69 2.15

NA 30.22

090 25370............. .............. A

Revise radius or ulna. 13.34

NA 16.12 2.28

NA 31.74

090 25375............. .............. A

Revise radius & ulna.. 13.02

NA 16.47 2.26

NA 31.75

090 25390............. .............. A

Shorten radius or ulna 10.38

NA 14.62 1.65

NA 26.65

090 25391............. .............. A

Lengthen radius or

13.63

NA 16.60 2.21

NA 32.44

090 ulna. 25392............. .............. A

Shorten radius & ulna. 13.93

NA 16.01 2.10

NA 32.04

090 25393............. .............. A

Lengthen radius & ulna 15.85

NA 17.63 2.76

NA 36.24

090 25394............. .............. A

Repair carpal bone,

10.38

NA 8.08 1.59

NA 20.05

090 shorten. 25400............. .............. A

Repair radius or ulna. 10.90

NA 15.23 1.82

NA 27.95

090 25405............. .............. A

Repair/graft radius or 14.36

NA 17.32 2.32

NA 34.00

090 ulna. 25415............. .............. A

Repair radius & ulna.. 13.33

NA 16.56 2.17

NA 32.06

090 25420............. .............. A

Repair/graft radius & 16.31

NA 18.32 2.61

NA 37.24

090 ulna. 25425............. .............. A

Repair/graft radius or 13.19

NA 21.45 2.08

NA 36.72

090 ulna. 25426............. .............. A

Repair/graft radius & 15.80

NA 16.60 2.54

NA 34.94

090 ulna. 25430............. .............. A

Vasc graft into carpal 9.24

NA 7.36 1.27

NA 17.87

090 bone. 25431............. .............. A

Repair nonunion carpal 10.42

NA 8.42 1.90

NA 20.74

090 bone. 25440............. .............. A

Repair/graft wrist

10.42

NA 9.43 1.63

NA 21.48

090 bone. 25441............. .............. A

Reconstruct wrist

12.88

NA 10.03 2.07

NA 24.98

090 joint. 25442............. .............. A

Reconstruct wrist

10.83

NA 8.91 1.53

NA 21.27

090 joint. 25443............. .............. A

Reconstruct wrist

10.37

NA 8.80 1.37

NA 20.54

090 joint.

[[Page 70353]]

25444............. .............. A

Reconstruct wrist

11.13

NA 9.06 1.71

NA 21.90

090 joint. 25445............. .............. A

Reconstruct wrist

9.68

NA 8.01 1.55

NA 19.24

090 joint. 25446............. .............. A

Wrist replacement..... 16.53

NA 11.95 2.47

NA 30.95

090 25447............. .............. A

Repair wrist joint(s). 10.35

NA 8.68 1.61

NA 20.64

090 25449............. .............. A

Remove wrist joint

14.47

NA 10.70 2.21

NA 27.38

090 implant. 25450............. .............. A

Revision of wrist

7.86

NA 10.22 1.36

NA 19.44

090 joint. 25455............. .............. A

Revision of wrist

9.48

NA 10.89 0.96

NA 21.33

090 joint. 25490............. .............. A

Reinforce radius...... 9.53

NA 13.77 1.43

NA 24.73

090 25491............. .............. A

Reinforce ulna........ 9.95

NA 14.50 1.60

NA 26.05

090 25492............. .............. A

Reinforce radius and

12.31

NA 15.34 2.14

NA 29.79

090 ulna. 25500............. .............. A

Treat fracture of

2.45 3.58 2.72 0.35 6.38 5.52

090 radius. 25505............. .............. A

Treat fracture of

5.20 6.56 5.44 0.90 12.66 11.54

090 radius. 25515............. .............. A

Treat fracture of

9.17

NA 7.48 1.59

NA 18.24

090 radius. 25520............. .............. A

Treat fracture of

6.25 6.88 6.08 1.08 14.21 13.41

090 radius. 25525............. .............. A

Treat fracture of

12.22

NA 10.02 2.12

NA 24.36

090 radius. 25526............. .............. A

Treat fracture of

12.96

NA 13.54 2.19

NA 28.69

090 radius. 25530............. .............. A

Treat fracture of ulna 2.09 3.77 2.87 0.34 6.20 5.30

090 25535............. .............. A

Treat fracture of ulna 5.13 6.03 5.31 0.89 12.05 11.33

090 25545............. .............. A

Treat fracture of ulna 8.89

NA 7.68 1.53

NA 18.10

090 25560............. .............. A

Treat fracture radius

2.44 3.70 2.61 0.35 6.49 5.40

090 & ulna. 25565............. .............. A

Treat fracture radius

5.62 6.72 5.44 0.93 13.27 11.99

090 & ulna. 25574............. .............. A

Treat fracture radius

7.00

NA 7.22 1.21

NA 15.43

090 & ulna. 25575............. .............. A

Treat fracture radius/ 10.43

NA 9.54 1.81

NA 21.78

090 ulna. 25600............. .............. A

Treat fracture radius/ 2.63 4.10 2.98 0.42 7.15 6.03

090 ulna. 25605............. .............. A

Treat fracture radius/ 5.80 7.25 6.24 1.00 14.05 13.04

090 ulna. 25611............. .............. A

Treat fracture radius/ 7.76

NA 8.99 1.34

NA 18.09

090 ulna. 25620............. .............. A

Treat fracture radius/ 8.54

NA 7.28 1.42

NA 17.24

090 ulna. 25622............. .............. A

Treat wrist bone

2.61 4.28 3.11 0.41 7.30 6.13

090 fracture. 25624............. .............. A

Treat wrist bone

4.52 6.32 5.08 0.76 11.60 10.36

090 fracture. 25628............. .............. A

Treat wrist bone

8.42

NA 7.84 1.37

NA 17.63

090 fracture. 25630............. .............. A

Treat wrist bone

2.88 4.19 2.95 0.45 7.52 6.28

090 fracture. 25635............. .............. A

Treat wrist bone

4.38 5.96 3.91 0.74 11.08 9.03

090 fracture. 25645............. .............. A

Treat wrist bone

7.24

NA 6.65 1.20

NA 15.09

090 fracture. 25650............. .............. A

Treat wrist bone

3.05 4.32 3.18 0.45 7.82 6.68

090 fracture. 25651............. .............. A

Pin ulnar styloid

5.35

NA 5.50 0.86

NA 11.71

090 fracture. 25652............. .............. A

Treat fracture ulnar

7.59

NA 7.02 1.21

NA 15.82

090 styloid. 25660............. .............. A

Treat wrist

4.75

NA 4.72 0.58

NA 10.05

090 dislocation. 25670............. .............. A

Treat wrist

7.91

NA 7.01 1.28

NA 16.20

090 dislocation. 25671............. .............. A

Pin radioulnar

5.99

NA 6.17 1.00

NA 13.16

090 dislocation. 25675............. .............. A

Treat wrist

4.66 5.67 4.66 0.62 10.95 9.94

090 dislocation. 25676............. .............. A

Treat wrist

8.03

NA 7.32 1.34

NA 16.69

090 dislocation. 25680............. .............. A

Treat wrist fracture.. 5.98

NA 4.75 0.78

NA 11.51

090 25685............. .............. A

Treat wrist fracture.. 9.77

NA 7.82 1.60

NA 19.19

090 25690............. .............. A

Treat wrist

5.49

NA 5.52 0.88

NA 11.89

090 dislocation. 25695............. .............. A

Treat wrist

8.33

NA 7.11 1.32

NA 16.76

090 dislocation. 25800............. .............. A

Fusion of wrist joint. 9.75

NA 9.12 1.57

NA 20.44

090 25805............. .............. A

Fusion/graft of wrist 11.26

NA 10.28 1.80

NA 23.34

090 joint. 25810............. .............. A

Fusion/graft of wrist 10.55

NA 9.93 1.67

NA 22.15

090 joint. 25820............. .............. A

Fusion of hand bones.. 7.44

NA 7.87 1.22

NA 16.53

090 25825............. .............. A

Fuse hand bones with

9.26

NA 9.26 1.41

NA 19.93

090 graft. 25830............. .............. A

Fusion, radioulnar jnt/ 10.04

NA 14.45 1.55

NA 26.04

090 ulna. 25900............. .............. A

Amputation of forearm. 9.00

NA 12.60 1.30

NA 22.90

090 25905............. .............. A

Amputation of forearm. 9.11

NA 12.33 1.40

NA 22.84

090 25907............. .............. A

Amputation follow-up

7.79

NA 11.79 1.10

NA 20.68

090 surgery. 25909............. .............. A

Amputation follow-up

8.95

NA 12.31 1.44

NA 22.70

090 surgery. 25915............. .............. A

Amputation of forearm. 17.05

NA 18.93 2.93

NA 38.91

090 25920............. .............. A

Amputate hand at wrist 8.67

NA 7.87 1.35

NA 17.89

090 25922............. .............. A

Amputate hand at wrist 7.41

NA 7.07 1.12

NA 15.60

090 25924............. .............. A

Amputation follow-up

8.45

NA 8.11 1.32

NA 17.88

090 surgery. 25927............. .............. A

Amputation of hand.... 8.79

NA 11.71 1.27

NA 21.77

090 25929............. .............. A

Amputation follow-up

7.58

NA 5.89 1.14

NA 14.61

090 surgery. 25931............. .............. A

Amputation follow-up

7.80

NA 11.49 1.15

NA 20.44

090 surgery. 25999............. .............. C

Forearm or wrist

0.00 0.00 0.00 0.00 0.00 0.00

YYY surgery. 26010............. .............. A

Drainage of finger

1.54 5.58 1.63 0.18 7.30 3.35

010 abscess. 26011............. .............. A

Drainage of finger

2.19 8.84 2.33 0.33 11.36 4.85

010 abscess. 26020............. .............. A

Drain hand tendon

4.66

NA 5.37 0.73

NA 10.76

090 sheath. 26025............. .............. A

Drainage of palm bursa 4.81

NA 5.13 0.76

NA 10.70

090 26030............. .............. A

Drainage of palm

5.92

NA 5.74 0.92

NA 12.58

090 bursa(s). 26034............. .............. A

Treat hand bone lesion 6.22

NA 6.37 1.01

NA 13.60

090 26035............. .............. A

Decompress fingers/

9.50

NA 7.89 1.47

NA 18.86

090 hand. 26037............. .............. A

Decompress fingers/

7.24

NA 6.34 1.13

NA 14.71

090 hand. 26040............. .............. A

Release palm

3.33

NA 4.06 0.53

NA 7.92

090 contracture. 26045............. .............. A

Release palm

5.55

NA 5.66 0.93

NA 12.14

090 contracture. 26055............. .............. A

Incise finger tendon

2.69 14.39 3.95 0.43 17.51 7.07

090 sheath. 26060............. .............. A

Incision of finger

2.81

NA 3.52 0.45

NA 6.78

090 tendon.

[[Page 70354]]

26070............. .............. A

Explore/treat hand

3.68

NA 3.37 0.48

NA 7.53

090 joint. 26075............. .............. A

Explore/treat finger

3.78

NA 3.79 0.53

NA 8.10

090 joint. 26080............. .............. A

Explore/treat finger

4.23

NA 4.86 0.66

NA 9.75

090 joint. 26100............. .............. A

Biopsy hand joint

3.66

NA 4.14 0.54

NA 8.34

090 lining. 26105............. .............. A

Biopsy finger joint

3.70

NA 4.24 0.59

NA 8.53

090 lining. 26110............. .............. A

Biopsy finger joint

3.52

NA 4.05 0.53

NA 8.10

090 lining. 26115............. .............. A

Removal hand lesion

3.85 13.13 4.78 0.59 17.57 9.22

090 subcut. 26116............. .............. A

Removal hand lesion,

5.52

NA 6.02 0.84

NA 12.38

090 deep. 26117............. .............. A

Remove tumor, hand/

8.54

NA 7.08 1.26

NA 16.88

090 finger. 26121............. .............. A

Release palm

7.53

NA 6.98 1.17

NA 15.68

090 contracture. 26123............. .............. A

Release palm

9.28

NA 8.88 1.43

NA 19.59

090 contracture. 26125............. .............. A

Release palm

4.60

NA 2.45 0.70

NA 7.75

ZZZ contracture. 26130............. .............. A

Remove wrist joint

5.41

NA 5.36 0.94

NA 11.71

090 lining. 26135............. .............. A

Revise finger joint,

6.95

NA 6.48 1.07

NA 14.50

090 each. 26140............. .............. A

Revise finger joint,

6.16

NA 6.06 0.92

NA 13.14

090 each. 26145............. .............. A

Tendon excision, palm/ 6.31

NA 6.07 0.97

NA 13.35

090 finger. 26160............. .............. A

Remove tendon sheath

3.15 12.41 4.13 0.49 16.05 7.77

090 lesion. 26170............. .............. A

Removal of palm

4.76

NA 4.95 0.69

NA 10.40

090 tendon, each. 26180............. .............. A

Removal of finger

5.17

NA 5.43 0.78

NA 11.38

090 tendon. 26185............. .............. A

Remove finger bone.... 5.24

NA 6.05 0.81

NA 12.10

090 26200............. .............. A

Remove hand bone

5.50

NA 5.37 0.88

NA 11.75

090 lesion. 26205............. .............. A

Remove/graft bone

7.69

NA 6.91 1.20

NA 15.80

090 lesion. 26210............. .............. A

Removal of finger

5.14

NA 5.44 0.79

NA 11.37

090 lesion. 26215............. .............. A

Remove/graft finger

7.09

NA 6.33 0.98

NA 14.40

090 lesion. 26230............. .............. A

Partial removal of

6.32

NA 5.93 1.01

NA 13.26

090 hand bone. 26235............. .............. A

Partial removal,

6.18

NA 5.83 0.95

NA 12.96

090 finger bone. 26236............. .............. A

Partial removal,

5.31

NA 5.34 0.81

NA 11.46

090 finger bone. 26250............. .............. A

Extensive hand surgery 7.54

NA 6.45 1.07

NA 15.06

090 26255............. .............. A

Extensive hand surgery 12.41

NA 9.40 1.68

NA 23.49

090 26260............. .............. A

Extensive finger

7.02

NA 6.20 1.01

NA 14.23

090 surgery. 26261............. .............. A

Extensive finger

9.08

NA 6.19 1.14

NA 16.41

090 surgery. 26262............. .............. A

Partial removal of

5.66

NA 5.35 0.88

NA 11.89

090 finger. 26320............. .............. A

Removal of implant

3.97

NA 4.32 0.59

NA 8.88

090 from hand. 26340............. .............. A

Manipulate finger w/

2.50

NA 4.89 0.39

NA 7.78

090 anesth. 26350............. .............. A

Repair finger/hand

5.98

NA 14.65 0.93

NA 21.56

090 tendon. 26352............. .............. A

Repair/graft hand

7.67

NA 15.40 1.13

NA 24.20

090 tendon. 26356............. .............. A

Repair finger/hand

8.06

NA 18.42 1.21

NA 27.69

090 tendon. 26357............. .............. A

Repair finger/hand

8.57

NA 15.68 1.33

NA 25.58

090 tendon. 26358............. .............. A

Repair/graft hand

9.13

NA 16.69 1.38

NA 27.20

090 tendon. 26370............. .............. A

Repair finger/hand

7.10

NA 15.15 1.12

NA 23.37

090 tendon. 26372............. .............. A

Repair/graft hand

8.75

NA 16.58 1.40

NA 26.73

090 tendon. 26373............. .............. A

Repair finger/hand

8.15

NA 16.09 1.23

NA 25.47

090 tendon. 26390............. .............. A

Revise hand/finger

9.18

NA 13.32 1.40

NA 23.90

090 tendon. 26392............. .............. A

Repair/graft hand

10.24

NA 16.77 1.57

NA 28.58

090 tendon. 26410............. .............. A

Repair hand tendon.... 4.62

NA 11.97 0.73

NA 17.32

090 26412............. .............. A

Repair/graft hand

6.30

NA 13.31 0.97

NA 20.58

090 tendon. 26415............. .............. A

Excision, hand/finger

8.33

NA 11.81 0.98

NA 21.12

090 tendon. 26416............. .............. A

Graft hand or finger

9.36

NA 14.63 0.79

NA 24.78

090 tendon. 26418............. .............. A

Repair finger tendon.. 4.24

NA 12.36 0.67

NA 17.27

090 26420............. .............. A

Repair/graft finger

6.76

NA 13.67 1.07

NA 21.50

090 tendon. 26426............. .............. A

Repair finger/hand

6.14

NA 13.20 0.95

NA 20.29

090 tendon. 26428............. .............. A

Repair/graft finger

7.20

NA 13.90 1.09

NA 22.19

090 tendon. 26432............. .............. A

Repair finger tendon.. 4.01

NA 10.29 0.64

NA 14.94

090 26433............. .............. A

Repair finger tendon.. 4.55

NA 10.82 0.72

NA 16.09

090 26434............. .............. A

Repair/graft finger

6.08

NA 11.57 0.93

NA 18.58

090 tendon. 26437............. .............. A

Realignment of tendons 5.81

NA 11.60 0.89

NA 18.30

090 26440............. .............. A

Release palm/finger

5.01

NA 13.47 0.75

NA 19.23

090 tendon. 26442............. .............. A

Release palm & finger

8.15

NA 15.99 1.20

NA 25.34

090 tendon. 26445............. .............. A

Release hand/finger

4.30

NA 13.18 0.65

NA 18.13

090 tendon. 26449............. .............. A

Release forearm/hand

6.99

NA 15.82 1.06

NA 23.87

090 tendon. 26450............. .............. A

Incision of palm

3.66

NA 7.35 0.59

NA 11.60

090 tendon. 26455............. .............. A

Incision of finger

3.63

NA 7.30 0.58

NA 11.51

090 tendon. 26460............. .............. A

Incise hand/finger

3.45

NA 7.16 0.55

NA 11.16

090 tendon. 26471............. .............. A

Fusion of finger

5.72

NA 11.27 0.88

NA 17.87

090 tendons. 26474............. .............. A

Fusion of finger

5.31

NA 11.42 0.76

NA 17.49

090 tendons. 26476............. .............. A

Tendon lengthening.... 5.17

NA 10.96 0.79

NA 16.92

090 26477............. .............. A

Tendon shortening..... 5.14

NA 11.09 0.81

NA 17.04

090 26478............. .............. A

Lengthening of hand

5.79

NA 11.87 0.90

NA 18.56

090 tendon. 26479............. .............. A

Shortening of hand

5.73

NA 11.59 0.92

NA 18.24

090 tendon. 26480............. .............. A

Transplant hand tendon 6.68

NA 15.08 1.02

NA 22.78

090 26483............. .............. A

Transplant/graft hand

8.28

NA 15.54 1.26

NA 25.08

090 tendon. 26485............. .............. A

Transplant palm tendon 7.69

NA 15.40 1.15

NA 24.24

090 26489............. .............. A

Transplant/graft palm

9.54

NA 12.09 1.26

NA 22.89

090 tendon. 26490............. .............. A

Revise thumb tendon... 8.40

NA 12.86 1.21

NA 22.47

090 26492............. .............. A

Tendon transfer with

9.61

NA 13.64 1.40

NA 24.65

090 graft.

[[Page 70355]]

26494............. .............. A

Hand tendon/muscle

8.46

NA 13.01 1.28

NA 22.75

090 transfer. 26496............. .............. A

Revise thumb tendon... 9.58

NA 13.27 1.45

NA 24.30

090 26497............. .............. A

Finger tendon transfer 9.56

NA 13.61 1.41

NA 24.58

090 26498............. .............. A

Finger tendon transfer 13.98

NA 16.21 2.10

NA 32.29

090 26499............. .............. A

Revision of finger.... 8.97

NA 13.08 1.35

NA 23.40

090 26500............. .............. A

Hand tendon

5.95

NA 11.47 0.90

NA 18.32

090 reconstruction. 26502............. .............. A

Hand tendon

7.13

NA 12.05 1.13

NA 20.31

090 reconstruction. 26504............. .............. A

Hand tendon

7.46

NA 12.62 1.24

NA 21.32

090 reconstruction. 26508............. .............. A

Release thumb

6.00

NA 11.71 0.98

NA 18.69

090 contracture. 26510............. .............. A

Thumb tendon transfer. 5.42

NA 11.37 0.79

NA 17.58

090 26516............. .............. A

Fusion of knuckle

7.14

NA 12.27 1.10

NA 20.51

090 joint. 26517............. .............. A

Fusion of knuckle

8.82

NA 13.54 1.41

NA 23.77

090 joints. 26518............. .............. A

Fusion of knuckle

9.01

NA 13.43 1.35

NA 23.79

090 joints. 26520............. .............. A

Release knuckle

5.29

NA 13.93 0.80

NA 20.02

090 contracture. 26525............. .............. A

Release finger

5.32

NA 14.01 0.81

NA 20.14

090 contracture. 26530............. .............. A

Revise knuckle joint.. 6.68

NA 6.16 1.04

NA 13.88

090 26531............. .............. A

Revise knuckle with

7.90

NA 7.14 1.17

NA 16.21

090 implant. 26535............. .............. A

Revise finger joint... 5.23

NA 3.75 0.71

NA 9.69

090 26536............. .............. A

Revise/implant finger

6.36

NA 9.68 0.96

NA 17.00

090 joint. 26540............. .............. A

Repair hand joint..... 6.42

NA 11.90 0.99

NA 19.31

090 26541............. .............. A

Repair hand joint with 8.61

NA 13.43 1.28

NA 23.32

090 graft. 26542............. .............. A

Repair hand joint with 6.77

NA 12.06 1.02

NA 19.85

090 graft. 26545............. .............. A

Reconstruct finger

6.91

NA 12.17 1.05

NA 20.13

090 joint. 26546............. .............. A

Repair nonunion hand.. 8.91

NA 15.07 1.44

NA 25.42

090 26548............. .............. A

Reconstruct finger

8.02

NA 12.89 1.20

NA 22.11

090 joint. 26550............. .............. A

Construct thumb

21.21

NA 17.63 2.45

NA 41.29

090 replacement. 26551............. .............. A

Great toe-hand

46.51

NA 32.53 7.96

NA 87.00

090 transfer. 26553............. .............. A

Single transfer, toe- 46.20

NA 22.75 2.41

NA 71.36

090 hand. 26554............. .............. A

Double transfer, toe- 54.87

NA 37.64 9.41

NA 101.92

090 hand. 26555............. .............. A

Positional change of

16.61

NA 18.23 2.48

NA 37.32

090 finger. 26556............. .............. A

Toe joint transfer.... 47.19

NA 33.42 2.57

NA 83.18

090 26560............. .............. A

Repair of web finger.. 5.37

NA 9.83 0.85

NA 16.05

090 26561............. .............. A

Repair of web finger.. 10.90

NA 12.38 1.45

NA 24.73

090 26562............. .............. A

Repair of web finger.. 14.98

NA 17.19 2.23

NA 34.40

090 26565............. .............. A

Correct metacarpal

6.73

NA 12.04 1.00

NA 19.77

090 flaw. 26567............. .............. A

Correct finger

6.81

NA 11.98 1.04

NA 19.83

090 deformity. 26568............. .............. A

Lengthen metacarpal/

9.07

NA 15.47 1.49

NA 26.03

090 finger. 26580............. .............. A

Repair hand deformity. 18.15

NA 13.68 2.28

NA 34.11

090 26587............. .............. A

Reconstruct extra

14.03

NA 9.24 1.53

NA 24.80

090 finger. 26590............. .............. A

Repair finger

17.93

NA 13.98 2.77

NA 34.68

090 deformity. 26591............. .............. A

Repair muscles of hand 3.25

NA 9.65 0.48

NA 13.38

090 26593............. .............. A

Release muscles of

5.30

NA 11.16 0.78

NA 17.24

090 hand. 26596............. .............. A

Excision constricting

8.94

NA 8.85 1.43

NA 19.22

090 tissue. 26600............. .............. A

Treat metacarpal

1.96 3.62 2.66 0.30 5.88 4.92

090 fracture. 26605............. .............. A

Treat metacarpal

2.85 4.57 3.66 0.49 7.91 7.00

090 fracture. 26607............. .............. A

Treat metacarpal

5.35

NA 6.29 0.87

NA 12.51

090 fracture. 26608............. .............. A

Treat metacarpal

5.35

NA 6.27 0.88

NA 12.50

090 fracture. 26615............. .............. A

Treat metacarpal

5.32

NA 5.32 0.86

NA 11.50

090 fracture. 26641............. .............. A

Treat thumb

3.93 4.58 3.54 0.39 8.90 7.86

090 dislocation. 26645............. .............. A

Treat thumb fracture.. 4.40 5.18 4.20 0.67 10.25 9.27

090 26650............. .............. A

Treat thumb fracture.. 5.71

NA 6.71 0.94

NA 13.36

090 26665............. .............. A

Treat thumb fracture.. 7.59

NA 6.63 0.90

NA 15.12

090 26670............. .............. A

Treat hand dislocation 3.68 4.27 2.95 0.39 8.34 7.02

090 26675............. .............. A

Treat hand dislocation 4.63 5.49 4.48 0.77 10.89 9.88

090 26676............. .............. A

Pin hand dislocation.. 5.51

NA 6.71 0.91

NA 13.13

090 26685............. .............. A

Treat hand dislocation 6.97

NA 6.16 1.09

NA 14.22

090 26686............. .............. A

Treat hand dislocation 7.93

NA 6.92 1.24

NA 16.09

090 26700............. .............. A

Treat knuckle

3.68 3.77 2.87 0.35 7.80 6.90

090 dislocation. 26705............. .............. A

Treat knuckle

4.18 5.35 4.31 0.66 10.19 9.15

090 dislocation. 26706............. .............. A

Pin knuckle

5.11

NA 5.10 0.81

NA 11.02

090 dislocation. 26715............. .............. A

Treat knuckle

5.73

NA 5.53 0.91

NA 12.17

090 dislocation. 26720............. .............. A

Treat finger fracture, 1.66 2.79 2.06 0.24 4.69 3.96

090 each. 26725............. .............. A

Treat finger fracture, 3.33 4.78 3.51 0.53 8.64 7.37

090 each. 26727............. .............. A

Treat finger fracture, 5.22

NA 6.25 0.84

NA 12.31

090 each. 26735............. .............. A

Treat finger fracture, 5.97

NA 5.57 0.95

NA 12.49

090 each. 26740............. .............. A

Treat finger fracture, 1.94 3.14 2.71 0.31 5.39 4.96

090 each. 26742............. .............. A

Treat finger fracture, 3.84 5.00 3.89 0.58 9.42 8.31

090 each. 26746............. .............. A

Treat finger fracture, 5.80

NA 5.58 0.91

NA 12.29

090 each. 26750............. .............. A

Treat finger fracture, 1.70 2.49 2.02 0.22 4.41 3.94

090 each. 26755............. .............. A

Treat finger fracture, 3.10 4.43 3.01 0.42 7.95 6.53

090 each. 26756............. .............. A

Pin finger fracture,

4.38

NA 5.74 0.71

NA 10.83

090 each. 26765............. .............. A

Treat finger fracture, 4.16

NA 4.40 0.66

NA 9.22

090 each. 26770............. .............. A

Treat finger

3.02 3.44 2.42 0.27 6.73 5.71

090 dislocation. 26775............. .............. A

Treat finger

3.70 5.21 3.82 0.54 9.45 8.06

090 dislocation. 26776............. .............. A

Pin finger dislocation 4.79

NA 6.02 0.77

NA 11.58

090

[[Page 70356]]

26785............. .............. A

Treat finger

4.20

NA 4.54 0.68

NA 9.42

090 dislocation. 26820............. .............. A

Thumb fusion with

8.25

NA 13.29 1.30

NA 22.84

090 graft. 26841............. .............. A

Fusion of thumb....... 7.12

NA 13.27 1.18

NA 21.57

090 26842............. .............. A

Thumb fusion with

8.23

NA 13.41 1.32

NA 22.96

090 graft. 26843............. .............. A

Fusion of hand joint.. 7.60

NA 12.39 1.15

NA 21.14

090 26844............. .............. A

Fusion/graft of hand

8.72

NA 13.40 1.33

NA 23.45

090 joint. 26850............. .............. A

Fusion of knuckle..... 6.96

NA 12.24 1.06

NA 20.26

090 26852............. .............. A

Fusion of knuckle with 8.45

NA 12.93 1.22

NA 22.60

090 graft. 26860............. .............. A

Fusion of finger joint 4.68

NA 11.22 0.73

NA 16.63

090 26861............. .............. A

Fusion of finger jnt,

1.74

NA 0.93 0.27

NA 2.94

ZZZ add-on. 26862............. .............. A

Fusion/graft of finger 7.36

NA 12.38 1.10

NA 20.84

090 joint. 26863............. .............. A

Fuse/graft added joint 3.89

NA 2.12 0.56

NA 6.57

ZZZ 26910............. .............. A

Amputate metacarpal

7.59

NA 11.25 1.16

NA 20.00

090 bone. 26951............. .............. A

Amputation of finger/

4.58

NA 10.18 0.71

NA 15.47

090 thumb. 26952............. .............. A

Amputation of finger/

6.30

NA 11.69 0.95

NA 18.94

090 thumb. 26989............. .............. C

Hand/finger surgery... 0.00 0.00 0.00 0.00 0.00 0.00

YYY 26990............. .............. A

Drainage of pelvis

7.47

NA 7.23 1.22

NA 15.92

090 lesion. 26991............. .............. A

Drainage of pelvis

6.67 11.19 5.45 1.11 18.97 13.23

090 bursa. 26992............. .............. A

Drainage of bone

13.00

NA 10.41 2.16

NA 25.57

090 lesion. 27000............. .............. A

Incision of hip tendon 5.61

NA 5.30 0.98

NA 11.89

090 27001............. .............. A

Incision of hip tendon 6.93

NA 6.11 1.24

NA 14.28

090 27003............. .............. A

Incision of hip tendon 7.33

NA 6.50 1.12

NA 14.95

090 27005............. .............. A

Incision of hip tendon 9.65

NA 7.84 1.72

NA 19.21

090 27006............. .............. A

Incision of hip

9.67

NA 8.00 1.69

NA 19.36

090 tendons. 27025............. .............. A

Incision of hip/thigh 11.14

NA 8.57 1.84

NA 21.55

090 fascia. 27030............. .............. A

Drainage of hip joint. 12.99

NA 9.67 2.26

NA 24.92

090 27033............. .............. A

Exploration of hip

13.37

NA 9.95 2.32

NA 25.64

090 joint. 27035............. .............. A

Denervation of hip

16.66

NA 11.26 2.15

NA 30.07

090 joint. 27036............. .............. A

Excision of hip joint/ 12.86

NA 10.03 2.26

NA 25.15

090 muscle. 27040............. .............. A

Biopsy of soft tissues 2.87 5.25 2.02 0.27 8.39 5.16

010 27041............. .............. A

Biopsy of soft tissues 9.88

NA 6.66 1.35

NA 17.89

090 27047............. .............. A

Remove hip/pelvis

7.44 7.13 4.78 1.03 15.60 13.25

090 lesion. 27048............. .............. A

Remove hip/pelvis

6.24

NA 4.81 0.92

NA 11.97

090 lesion. 27049............. .............. A

Remove tumor, hip/

13.64

NA 8.42 2.06

NA 24.12

090 pelvis. 27050............. .............. A

Biopsy of sacroiliac

4.35

NA 4.43 0.60

NA 9.38

090 joint. 27052............. .............. A

Biopsy of hip joint... 6.22

NA 5.90 1.08

NA 13.20

090 27054............. .............. A

Removal of hip joint

8.53

NA 7.36 1.47

NA 17.36

090 lining. 27060............. .............. A

Removal of ischial

5.42

NA 4.38 0.80

NA 10.60

090 bursa. 27062............. .............. A

Remove femur lesion/

5.36

NA 5.21 0.93

NA 11.50

090 bursa. 27065............. .............. A

Removal of hip bone

5.89

NA 5.46 1.01

NA 12.36

090 lesion. 27066............. .............. A

Removal of hip bone

10.31

NA 8.46 1.79

NA 20.56

090 lesion. 27067............. .............. A

Remove/graft hip bone 13.81

NA 10.69 1.84

NA 26.34

090 lesion. 27070............. .............. A

Partial removal of hip 10.70

NA 9.16 1.74

NA 21.60

090 bone. 27071............. .............. A

Partial removal of hip 11.44

NA 10.15 1.92

NA 23.51

090 bone. 27075............. .............. A

Extensive hip surgery. 34.95

NA 19.26 5.64

NA 59.85

090 27076............. .............. A

Extensive hip surgery. 22.09

NA 14.55 3.70

NA 40.34

090 27077............. .............. A

Extensive hip surgery. 39.94

NA 22.73 6.12

NA 68.79

090 27078............. .............. A

Extensive hip surgery. 13.42

NA 9.97 2.22

NA 25.61

090 27079............. .............. A

Extensive hip surgery. 13.73

NA 9.57 1.94

NA 25.24

090 27080............. .............. A

Removal of tail bone.. 6.38

NA 4.84 0.93

NA 12.15

090 27086............. .............. A

Remove hip foreign

1.87 4.56 1.83 0.25 6.68 3.95

010 body. 27087............. .............. A

Remove hip foreign

8.53

NA 6.68 1.35

NA 16.56

090 body. 27090............. .............. A

Removal of hip

11.13

NA 8.81 1.94

NA 21.88

090 prosthesis. 27091............. .............. A

Removal of hip

22.11

NA 14.03 3.84

NA 39.98

090 prosthesis. 27093............. .............. A

Injection for hip x-

1.30 4.47 0.48 0.13 5.90 1.91

000 ray. 27095............. .............. A

Injection for hip x-

1.50 5.74 0.52 0.14 7.38 2.16

000 ray. 27096............. .............. A

Inject sacroiliac

1.40 4.36 0.33 0.08 5.84 1.81

000 joint. 27097............. .............. A

Revision of hip tendon 8.79

NA 6.43 1.57

NA 16.79

090 27098............. .............. A

Transfer tendon to

8.82

NA 7.04 0.95

NA 16.81

090 pelvis. 27100............. .............. A

Transfer of abdominal 11.06

NA 8.69 1.85

NA 21.60

090 muscle. 27105............. .............. A

Transfer of spinal

11.75

NA 9.19 1.72

NA 22.66

090 muscle. 27110............. .............. A

Transfer of iliopsoas 13.24

NA 9.14 2.18

NA 24.56

090 muscle. 27111............. .............. A

Transfer of iliopsoas 12.13

NA 9.16 1.94

NA 23.23

090 muscle. 27120............. .............. A

Reconstruction of hip 17.98

NA 11.87 3.08

NA 32.93

090 socket. 27122............. .............. A

Reconstruction of hip 14.96

NA 11.07 2.61

NA 28.64

090 socket. 27125............. .............. A

Partial hip

14.67

NA 10.65 2.54

NA 27.86

090 replacement. 27130............. .............. A

Total hip arthroplasty 20.09

NA 13.34 3.50

NA 36.93

090 27132............. .............. A

Total hip arthroplasty 23.27

NA 15.68 4.04

NA 42.99

090 27134............. .............. A

Revise hip joint

28.48

NA 17.84 4.94

NA 51.26

090 replacement. 27137............. .............. A

Revise hip joint

21.14

NA 13.97 3.67

NA 38.78

090 replacement. 27138............. .............. A

Revise hip joint

22.14

NA 14.43 3.84

NA 40.41

090 replacement. 27140............. .............. A

Transplant femur ridge 12.22

NA 9.44 2.11

NA 23.77

090 27146............. .............. A

Incision of hip bone.. 17.40

NA 12.17 2.96

NA 32.53

090 27147............. .............. A

Revision of hip bone.. 20.55

NA 13.29 3.57

NA 37.41

090 27151............. .............. A

Incision of hip bones. 22.48

NA 7.97 3.91

NA 34.36

090

[[Page 70357]]

27156............. .............. A

Revision of hip bones. 24.59

NA 16.11 4.21

NA 44.91

090 27158............. .............. A

Revision of pelvis.... 19.71

NA 11.00 3.16

NA 33.87

090 27161............. .............. A

Incision of neck of

16.68

NA 12.14 2.94

NA 31.76

090 femur. 27165............. .............. A

Incision/fixation of

17.88

NA 12.95 3.10

NA 33.93

090 femur. 27170............. .............. A

Repair/graft femur

16.05

NA 11.33 2.81

NA 30.19

090 head/neck. 27175............. .............. A

Treat slipped

8.45

NA 6.69 1.46

NA 16.60

090 epiphysis. 27176............. .............. A

Treat slipped

12.03

NA 9.04 2.22

NA 23.29

090 epiphysis. 27177............. .............. A

Treat slipped

15.06

NA 10.92 2.61

NA 28.59

090 epiphysis. 27178............. .............. A

Treat slipped

11.97

NA 8.44 2.08

NA 22.49

090 epiphysis. 27179............. .............. A

Revise head/neck of

12.96

NA 10.02 2.25

NA 25.23

090 femur. 27181............. .............. A

Treat slipped

14.66

NA 10.23 1.57

NA 26.46

090 epiphysis. 27185............. .............. A

Revision of femur

9.17

NA 7.54 2.39

NA 19.10

090 epiphysis. 27187............. .............. A

Reinforce hip bones... 13.52

NA 10.35 2.37

NA 26.24

090 27193............. .............. A

Treat pelvic ring

5.55 5.10 5.10 0.96 11.61 11.61

090 fracture. 27194............. .............. A

Treat pelvic ring

9.64

NA 7.67 1.65

NA 18.96

090 fracture. 27200............. .............. A

Treat tail bone

1.84 2.23 2.16 0.28 4.35 4.28

090 fracture. 27202............. .............. A

Treat tail bone

7.03

NA 16.91 1.06

NA 25.00

090 fracture. 27215............. .............. A

Treat pelvic

10.03

NA 7.10 1.97

NA 19.10

090 fracture(s). 27216............. .............. A

Treat pelvic ring

15.17

NA 9.62 2.63

NA 27.42

090 fracture. 27217............. .............. A

Treat pelvic ring

14.09

NA 10.17 2.41

NA 26.67

090 fracture. 27218............. .............. A

Treat pelvic ring

20.12

NA 11.43 3.48

NA 35.03

090 fracture. 27220............. .............. A

Treat hip socket

6.17 5.74 5.65 1.07 12.98 12.89

090 fracture. 27222............. .............. A

Treat hip socket

12.68

NA 10.00 2.19

NA 24.87

090 fracture. 27226............. .............. A

Treat hip wall

14.89

NA 7.83 2.48

NA 25.20

090 fracture. 27227............. .............. A

Treat hip fracture(s). 23.41

NA 15.44 4.05

NA 42.90

090 27228............. .............. A

Treat hip fracture(s). 27.12

NA 17.67 4.66

NA 49.45

090 27230............. .............. A

Treat thigh fracture.. 5.49 5.53 5.11 0.95 11.97 11.55

090 27232............. .............. A

Treat thigh fracture.. 10.66

NA 7.19 1.85

NA 19.70

090 27235............. .............. A

Treat thigh fracture.. 12.14

NA 9.48 2.11

NA 23.73

090 27236............. .............. A

Treat thigh fracture.. 15.58

NA 11.08 2.71

NA 29.37

090 27238............. .............. A

Treat thigh fracture.. 5.51

NA 5.15 0.89

NA 11.55

090 27240............. .............. A

Treat thigh fracture.. 12.48

NA 9.50 2.16

NA 24.14

090 27244............. .............. A

Treat thigh fracture.. 15.92

NA 11.33 2.77

NA 30.02

090 27245............. .............. A

Treat thigh fracture.. 20.28

NA 13.78 3.52

NA 37.58

090 27246............. .............. A

Treat thigh fracture.. 4.70 4.47 4.43 0.81 9.98 9.94

090 27248............. .............. A

Treat thigh fracture.. 10.43

NA 8.23 1.81

NA 20.47

090 27250............. .............. A

Treat hip dislocation. 6.94

NA 4.63 0.62

NA 12.19

090 27252............. .............. A

Treat hip dislocation. 10.37

NA 7.45 1.66

NA 19.48

090 27253............. .............. A

Treat hip dislocation. 12.90

NA 9.81 2.24

NA 24.95

090 27254............. .............. A

Treat hip dislocation. 18.23

NA 12.05 3.17

NA 33.45

090 27256............. .............. A

Treat hip dislocation. 4.11 3.53 2.09 0.46 8.10 6.66

010 27257............. .............. A

Treat hip dislocation. 5.21

NA 2.82 0.69

NA 8.72

010 27258............. .............. A

Treat hip dislocation. 15.41

NA 10.90 2.64

NA 28.95

090 27259............. .............. A

Treat hip dislocation. 21.52

NA 14.16 3.74

NA 39.42

090 27265............. .............. A

Treat hip dislocation. 5.04

NA 4.80 0.63

NA 10.47

090 27266............. .............. A

Treat hip dislocation. 7.48

NA 6.36 1.29

NA 15.13

090 27275............. .............. A

Manipulation of hip

2.27

NA 2.11 0.39

NA 4.77

010 joint. 27280............. .............. A

Fusion of sacroiliac

13.37

NA 10.29 2.53

NA 26.19

090 joint. 27282............. .............. A

Fusion of pubic bones. 11.32

NA 8.02 1.86

NA 21.20

090 27284............. .............. A

Fusion of hip joint... 23.41

NA 14.80 3.92

NA 42.13

090 27286............. .............. A

Fusion of hip joint... 23.41

NA 15.84 3.12

NA 42.37

090 27290............. .............. A

Amputation of leg at

23.25

NA 14.10 3.43

NA 40.78

090 hip. 27295............. .............. A

Amputation of leg at

18.62

NA 11.34 2.95

NA 32.91

090 hip. 27299............. .............. C

Pelvis/hip joint

0.00 0.00 0.00 0.00 0.00 0.00

YYY surgery. 27301............. .............. A

Drain thigh/knee

6.48 10.10 5.15 1.04 17.62 12.67

090 lesion. 27303............. .............. A

Drainage of bone

8.27

NA 7.00 1.43

NA 16.70

090 lesion. 27305............. .............. A

Incise thigh tendon &

5.91

NA 5.20 1.01

NA 12.12

090 fascia. 27306............. .............. A

Incision of thigh

4.61

NA 4.73 0.85

NA 10.19

090 tendon. 27307............. .............. A

Incision of thigh

5.79

NA 5.40 1.04

NA 12.23

090 tendons. 27310............. .............. A

Exploration of knee

9.26

NA 7.60 1.61

NA 18.47

090 joint. 27315............. .............. A

Partial removal, thigh 6.96

NA 4.96 1.09

NA 13.01

090 nerve. 27320............. .............. A

Partial removal, thigh 6.29

NA 5.25 1.06

NA 12.60

090 nerve. 27323............. .............. A

Biopsy, thigh soft

2.28 3.52 1.89 0.24 6.04 4.41

010 tissues. 27324............. .............. A

Biopsy, thigh soft

4.89

NA 4.19 0.75

NA 9.83

090 tissues. 27327............. .............. A

Removal of thigh

4.46 6.01 3.73 0.64 11.11 8.83

090 lesion. 27328............. .............. A

Removal of thigh

5.56

NA 4.38 0.84

NA 10.78

090 lesion. 27329............. .............. A

Remove tumor, thigh/

14.12

NA 9.05 2.14

NA 25.31

090 knee. 27330............. .............. A

Biopsy, knee joint

4.96

NA 4.58 0.86

NA 10.40

090 lining. 27331............. .............. A

Explore/treat knee

5.87

NA 5.54 1.02

NA 12.43

090 joint. 27332............. .............. A

Removal of knee

8.26

NA 7.14 1.43

NA 16.83

090 cartilage. 27333............. .............. A

Removal of knee

7.29

NA 6.69 1.26

NA 15.24

090 cartilage. 27334............. .............. A

Remove knee joint

8.69

NA 7.43 1.51

NA 17.63

090 lining. 27335............. .............. A

Remove knee joint

9.99

NA 8.24 1.74

NA 19.97

090 lining. 27340............. .............. A

Removal of kneecap

4.17

NA 4.57 0.72

NA 9.46

090 bursa. 27345............. .............. A

Removal of knee cyst.. 5.91

NA 5.64 1.00

NA 12.55

090

[[Page 70358]]

27347............. .............. A

Remove knee cyst...... 5.77

NA 5.44 0.98

NA 12.19

090 27350............. .............. A

Removal of kneecap.... 8.16

NA 7.26 1.41

NA 16.83

090 27355............. .............. A

Remove femur lesion... 7.64

NA 6.79 1.32

NA 15.75

090 27356............. .............. A

Remove femur lesion/

9.47

NA 7.87 1.65

NA 18.99

090 graft. 27357............. .............. A

Remove femur lesion/

10.51

NA 8.73 1.95

NA 21.19

090 graft. 27358............. .............. A

Remove femur lesion/

4.73

NA 2.53 0.82

NA 8.08

ZZZ fixation. 27360............. .............. A

Partial removal, leg

10.48

NA 9.58 1.83

NA 21.89

090 bone(s). 27365............. .............. A

Extensive leg surgery. 16.25

NA 11.71 2.79

NA 30.75

090 27370............. .............. A

Injection for knee x-

0.96 3.73 0.32 0.08 4.77 1.36

000 ray. 27372............. .............. A

Removal of foreign

5.06 10.08 4.70 0.84 15.98 10.60

090 body. 27380............. .............. A

Repair of kneecap

7.15

NA 7.30 1.24

NA 15.69

090 tendon. 27381............. .............. A

Repair/graft kneecap

10.32

NA 9.12 1.79

NA 21.23

090 tendon. 27385............. .............. A

Repair of thigh muscle 7.75

NA 7.65 1.36

NA 16.76

090 27386............. .............. A

Repair/graft of thigh 10.54

NA 9.54 1.85

NA 21.93

090 muscle. 27390............. .............. A

Incision of thigh

5.32

NA 5.12 0.92

NA 11.36

090 tendon. 27391............. .............. A

Incision of thigh

7.19

NA 6.58 1.23

NA 15.00

090 tendons. 27392............. .............. A

Incision of thigh

9.19

NA 7.61 1.57

NA 18.37

090 tendons. 27393............. .............. A

Lengthening of thigh

6.38

NA 5.85 1.10

NA 13.33

090 tendon. 27394............. .............. A

Lengthening of thigh

8.49

NA 7.24 1.47

NA 17.20

090 tendons. 27395............. .............. A

Lengthening of thigh

11.71

NA 9.35 2.04

NA 23.10

090 tendons. 27396............. .............. A

Transplant of thigh

7.85

NA 7.02 1.34

NA 16.21

090 tendon. 27397............. .............. A

Transplants of thigh

11.26

NA 9.07 1.82

NA 22.15

090 tendons. 27400............. .............. A

Revise thigh muscles/

9.01

NA 7.27 1.31

NA 17.59

090 tendons. 27403............. .............. A

Repair of knee

8.32

NA 7.20 1.44

NA 16.96

090 cartilage. 27405............. .............. A

Repair of knee

8.64

NA 7.51 1.51

NA 17.66

090 ligament. 27407............. .............. A

Repair of knee

10.26

NA 8.34 1.78

NA 20.38

090 ligament. 27409............. .............. A

Repair of knee

12.88

NA 9.98 2.24

NA 25.10

090 ligaments. 27412............. .............. A

Autochondrocyte

23.23

NA 14.84 4.35

NA 42.42

090 implant knee. 27415............. .............. A

Osteochondral knee

18.49

NA 12.59 4.35

NA 35.43

090 allograft. 27418............. .............. A

Repair degenerated

10.83

NA 8.93 1.88

NA 21.64

090 kneecap. 27420............. .............. A

Revision of unstable

9.82

NA 8.13 1.71

NA 19.66

090 kneecap. 27422............. .............. A

Revision of unstable

9.77

NA 8.14 1.70

NA 19.61

090 kneecap. 27424............. .............. A

Revision/removal of

9.80

NA 8.11 1.70

NA 19.61

090 kneecap. 27425............. .............. A

Lat retinacular

5.21

NA 5.54 0.90

NA 11.65

090 release open. 27427............. .............. A

Reconstruction, knee.. 9.35

NA 7.82 1.63

NA 18.80

090 27428............. .............. A

Reconstruction, knee.. 13.98

NA 11.27 2.42

NA 27.67

090 27429............. .............. A

Reconstruction, knee.. 15.50

NA 12.45 2.70

NA 30.65

090 27430............. .............. A

Revision of thigh

9.66

NA 8.02 1.69

NA 19.37

090 muscles. 27435............. .............. A

Incision of knee joint 9.48

NA 8.50 1.69

NA 19.67

090 27437............. .............. A

Revise kneecap........ 8.45

NA 7.26 1.49

NA 17.20

090 27438............. .............. A

Revise kneecap with

11.21

NA 8.56 1.95

NA 21.72

090 implant. 27440............. .............. A

Revision of knee joint 10.41

NA 6.01 1.81

NA 18.23

090 27441............. .............. A

Revision of knee joint 10.80

NA 6.73 1.88

NA 19.41

090 27442............. .............. A

Revision of knee joint 11.87

NA 8.94 2.09

NA 22.90

090 27443............. .............. A

Revision of knee joint 10.91

NA 8.75 1.90

NA 21.56

090 27445............. .............. A

Revision of knee joint 17.65

NA 12.39 3.08

NA 33.12

090 27446............. .............. A

Revision of knee joint 15.82

NA 11.30 2.80

NA 29.92

090 27447............. .............. A

Total knee

21.45

NA 14.64 3.79

NA 39.88

090 arthroplasty. 27448............. .............. A

Incision of thigh..... 11.04

NA 8.62 1.94

NA 21.60

090 27450............. .............. A

Incision of thigh..... 13.96

NA 10.61 2.42

NA 26.99

090 27454............. .............. A

Realignment of thigh

17.53

NA 12.54 3.12

NA 33.19

090 bone. 27455............. .............. A

Realignment of knee... 12.80

NA 9.91 2.24

NA 24.95

090 27457............. .............. A

Realignment of knee... 13.43

NA 9.95 2.34

NA 25.72

090 27465............. .............. A

Shortening of thigh

13.85

NA 10.25 2.47

NA 26.57

090 bone. 27466............. .............. A

Lengthening of thigh

16.31

NA 11.86 2.77

NA 30.94

090 bone. 27468............. .............. A

Shorten/lengthen

18.94

NA 12.39 3.30

NA 34.63

090 thighs. 27470............. .............. A

Repair of thigh....... 16.05

NA 11.82 2.79

NA 30.66

090 27472............. .............. A

Repair/graft of thigh. 17.69

NA 12.72 3.07

NA 33.48

090 27475............. .............. A

Surgery to stop leg

8.63

NA 7.23 1.36

NA 17.22

090 growth. 27477............. .............. A

Surgery to stop leg

9.84

NA 7.75 1.73

NA 19.32

090 growth. 27479............. .............. A

Surgery to stop leg

12.78

NA 9.67 2.78

NA 25.23

090 growth. 27485............. .............. A

Surgery to stop leg

8.83

NA 7.42 1.53

NA 17.78

090 growth. 27486............. .............. A

Revise/replace knee

19.24

NA 13.53 3.36

NA 36.13

090 joint. 27487............. .............. A

Revise/replace knee

25.23

NA 16.60 4.39

NA 46.22

090 joint. 27488............. .............. A

Removal of knee

15.72

NA 11.73 2.74

NA 30.19

090 prosthesis. 27495............. .............. A

Reinforce thigh....... 15.53

NA 11.44 2.71

NA 29.68

090 27496............. .............. A

Decompression of thigh/ 6.10

NA 5.62 0.99

NA 12.71

090 knee. 27497............. .............. A

Decompression of thigh/ 7.16

NA 5.45 1.15

NA 13.76

090 knee. 27498............. .............. A

Decompression of thigh/ 7.98

NA 5.97 1.24

NA 15.19

090 knee. 27499............. .............. A

Decompression of thigh/ 8.99

NA 6.84 1.47

NA 17.30

090 knee. 27500............. .............. A

Treatment of thigh

5.91 6.14 5.00 1.02 13.07 11.93

090 fracture. 27501............. .............. A

Treatment of thigh

5.91 5.81 5.40 1.03 12.75 12.34

090 fracture. 27502............. .............. A

Treatment of thigh

10.56

NA 8.13 1.78

NA 20.47

090 fracture. 27503............. .............. A

Treatment of thigh

10.56

NA 8.31 1.84

NA 20.71

090 fracture. 27506............. .............. A

Treatment of thigh

17.42

NA 12.82 3.03

NA 33.27

090 fracture.

[[Page 70359]]

27507............. .............. A

Treatment of thigh

13.97

NA 9.87 2.42

NA 26.26

090 fracture. 27508............. .............. A

Treatment of thigh

5.82 6.48 5.50 0.97 13.27 12.29

090 fracture. 27509............. .............. A

Treatment of thigh

7.70

NA 7.98 1.34

NA 17.02

090 fracture. 27510............. .............. A

Treatment of thigh

9.12

NA 7.35 1.53

NA 18.00

090 fracture. 27511............. .............. A

Treatment of thigh

13.62

NA 11.23 2.37

NA 27.22

090 fracture. 27513............. .............. A

Treatment of thigh

17.89

NA 13.92 3.12

NA 34.93

090 fracture. 27514............. .............. A

Treatment of thigh

17.27

NA 13.39 3.00

NA 33.66

090 fracture. 27516............. .............. A

Treat thigh fx growth

5.36 6.37 5.53 0.81 12.54 11.70

090 plate. 27517............. .............. A

Treat thigh fx growth

8.77

NA 7.47 1.22

NA 17.46

090 plate. 27519............. .............. A

Treat thigh fx growth 15.00

NA 11.62 2.55

NA 29.17

090 plate. 27520............. .............. A

Treat kneecap fracture 2.86 4.55 3.45 0.47 7.88 6.78

090 27524............. .............. A

Treat kneecap fracture 9.99

NA 8.25 1.74

NA 19.98

090 27530............. .............. A

Treat knee fracture... 3.77 5.33 4.43 0.65 9.75 8.85

090 27532............. .............. A

Treat knee fracture... 7.29 7.38 6.47 1.26 15.93 15.02

090 27535............. .............. A

Treat knee fracture... 11.48

NA 10.14 2.00

NA 23.62

090 27536............. .............. A

Treat knee fracture... 15.63

NA 11.64 2.73

NA 30.00

090 27538............. .............. A

Treat knee fracture(s) 4.86 6.15 5.21 0.84 11.85 10.91

090 27540............. .............. A

Treat knee fracture... 13.08

NA 9.54 2.27

NA 24.89

090 27550............. .............. A

Treat knee dislocation 5.75 6.03 4.94 0.76 12.54 11.45

090 27552............. .............. A

Treat knee dislocation 7.89

NA 6.97 1.36

NA 16.22

090 27556............. .............. A

Treat knee dislocation 14.39

NA 11.68 2.50

NA 28.57

090 27557............. .............. A

Treat knee dislocation 16.74

NA 13.16 2.97

NA 32.87

090 27558............. .............. A

Treat knee dislocation 17.69

NA 13.08 3.08

NA 33.85

090 27560............. .............. A

Treat kneecap

3.81 4.85 3.19 0.40 9.06 7.40

090 dislocation. 27562............. .............. A

Treat kneecap

5.78

NA 4.78 0.94

NA 11.50

090 dislocation. 27566............. .............. A

Treat kneecap

12.21

NA 9.35 2.12

NA 23.68

090 dislocation. 27570............. .............. A

Fixation of knee joint 1.74

NA 1.78 0.30

NA 3.82

010 27580............. .............. A

Fusion of knee........ 19.34

NA 14.84 3.37

NA 37.55

090 27590............. .............. A

Amputate leg at thigh. 12.01

NA 6.69 1.74

NA 20.44

090 27591............. .............. A

Amputate leg at thigh. 12.66

NA 8.67 2.02

NA 23.35

090 27592............. .............. A

Amputate leg at thigh. 10.00

NA 6.19 1.45

NA 17.64

090 27594............. .............. A

Amputation follow-up

6.91

NA 5.18 1.02

NA 13.11

090 surgery. 27596............. .............. A

Amputation follow-up

10.58

NA 6.83 1.57

NA 18.98

090 surgery. 27598............. .............. A

Amputate lower leg at 10.51

NA 7.04 1.65

NA 19.20

090 knee. 27599............. .............. C

Leg surgery procedure. 0.00 0.00 0.00 0.00 0.00 0.00

YYY 27600............. .............. A

Decompression of lower 5.64

NA 4.54 0.86

NA 11.04

090 leg. 27601............. .............. A

Decompression of lower 5.63

NA 4.86 0.80

NA 11.29

090 leg. 27602............. .............. A

Decompression of lower 7.34

NA 5.14 1.10

NA 13.58

090 leg. 27603............. .............. A

Drain lower leg lesion 4.93 7.51 4.17 0.74 13.18 9.84

090 27604............. .............. A

Drain lower leg bursa. 4.46 6.10 3.97 0.69 11.25 9.12

090 27605............. .............. A

Incision of achilles

2.87 7.70 2.33 0.41 10.98 5.61

010 tendon. 27606............. .............. A

Incision of achilles

4.13

NA 3.37 0.69

NA 8.19

010 tendon. 27607............. .............. A

Treat lower leg bone

7.96

NA 6.19 1.31

NA 15.46

090 lesion. 27610............. .............. A

Explore/treat ankle

8.33

NA 7.02 1.40

NA 16.75

090 joint. 27612............. .............. A

Exploration of ankle

7.32

NA 6.11 1.13

NA 14.56

090 joint. 27613............. .............. A

Biopsy lower leg soft

2.17 3.24 1.81 0.20 5.61 4.18

010 tissue. 27614............. .............. A

Biopsy lower leg soft

5.65 7.15 4.45 0.78 13.58 10.88

090 tissue. 27615............. .............. A

Remove tumor, lower

12.54

NA 9.42 1.83

NA 23.79

090 leg. 27618............. .............. A

Remove lower leg

5.08 6.03 4.00 0.72 11.83 9.80

090 lesion. 27619............. .............. A

Remove lower leg

8.39 9.54 5.97 1.25 19.18 15.61

090 lesion. 27620............. .............. A

Explore/treat ankle

5.97

NA 5.48 0.97

NA 12.42

090 joint. 27625............. .............. A

Remove ankle joint

8.29

NA 6.48 1.28

NA 16.05

090 lining. 27626............. .............. A

Remove ankle joint

8.90

NA 6.94 1.48

NA 17.32

090 lining. 27630............. .............. A

Removal of tendon

4.79 7.58 4.39 0.74 13.11 9.92

090 lesion. 27635............. .............. A

Remove lower leg bone

7.77

NA 6.76 1.31

NA 15.84

090 lesion. 27637............. .............. A

Remove/graft leg bone

9.84

NA 8.31 1.66

NA 19.81

090 lesion. 27638............. .............. A

Remove/graft leg bone 10.55

NA 8.31 1.84

NA 20.70

090 lesion. 27640............. .............. A

Partial removal of

11.35

NA 10.34 1.88

NA 23.57

090 tibia. 27641............. .............. A

Partial removal of

9.23

NA 8.36 1.46

NA 19.05

090 fibula. 27645............. .............. A

Extensive lower leg

14.15

NA 12.08 2.41

NA 28.64

090 surgery. 27646............. .............. A

Extensive lower leg

12.64

NA 11.06 2.05

NA 25.75

090 surgery. 27647............. .............. A

Extensive ankle/heel

12.22

NA 7.63 1.75

NA 21.60

090 surgery. 27648............. .............. A

Injection for ankle x- 0.96 3.53 0.33 0.08 4.57 1.37

000 ray. 27650............. .............. A

Repair achilles tendon 9.68

NA 7.53 1.59

NA 18.80

090 27652............. .............. A

Repair/graft achilles 10.31

NA 8.05 1.71

NA 20.07

090 tendon. 27654............. .............. A

Repair of achilles

10.00

NA 7.16 1.58

NA 18.74

090 tendon. 27656............. .............. A

Repair leg fascia

4.56 8.55 3.78 0.69 13.80 9.03

090 defect. 27658............. .............. A

Repair of leg tendon,

4.97

NA 4.57 0.79

NA 10.33

090 each. 27659............. .............. A

Repair of leg tendon,

6.80

NA 5.66 1.09

NA 13.55

090 each. 27664............. .............. A

Repair of leg tendon,

4.58

NA 4.56 0.76

NA 9.90

090 each. 27665............. .............. A

Repair of leg tendon,

5.39

NA 4.98 0.89

NA 11.26

090 each. 27675............. .............. A

Repair lower leg

7.17

NA 5.75 1.11

NA 14.03

090 tendons. 27676............. .............. A

Repair lower leg

8.41

NA 6.77 1.37

NA 16.55

090 tendons. 27680............. .............. A

Release of lower leg

5.73

NA 5.12 0.93

NA 11.78

090 tendon. 27681............. .............. A

Release of lower leg

6.81

NA 5.93 1.15

NA 13.89

090 tendons.

[[Page 70360]]

27685............. .............. A

Revision of lower leg

6.49 7.31 5.48 0.97 14.77 12.94

090 tendon. 27686............. .............. A

Revise lower leg

7.45

NA 6.51 1.24

NA 15.20

090 tendons. 27687............. .............. A

Revision of calf

6.23

NA 5.33 1.00

NA 12.56

090 tendon. 27690............. .............. A

Revise lower leg

8.70

NA 6.37 1.33

NA 16.40

090 tendon. 27691............. .............. A

Revise lower leg

9.95

NA 7.78 1.64

NA 19.37

090 tendon. 27692............. .............. A

Revise additional leg

1.87

NA 0.93 0.32

NA 3.12

ZZZ tendon. 27695............. .............. A

Repair of ankle

6.50

NA 5.89 1.05

NA 13.44

090 ligament. 27696............. .............. A

Repair of ankle

8.26

NA 6.45 1.28

NA 15.99

090 ligaments. 27698............. .............. A

Repair of ankle

9.35

NA 6.96 1.47

NA 17.78

090 ligament. 27700............. .............. A

Revision of ankle

9.28

NA 5.70 1.30

NA 16.28

090 joint. 27702............. .............. A

Reconstruct ankle

13.65

NA 10.49 2.37

NA 26.51

090 joint. 27703............. .............. A

Reconstruction, ankle 15.85

NA 11.26 2.76

NA 29.87

090 joint. 27704............. .............. A

Removal of ankle

7.61

NA 5.61 1.27

NA 14.49

090 implant. 27705............. .............. A

Incision of tibia..... 10.36

NA 8.19 1.80

NA 20.35

090 27707............. .............. A

Incision of fibula.... 4.36

NA 4.95 0.76

NA 10.07

090 27709............. .............. A

Incision of tibia &

9.94

NA 8.15 1.73

NA 19.82

090 fibula. 27712............. .............. A

Realignment of lower

14.23

NA 10.77 2.47

NA 27.47

090 leg. 27715............. .............. A

Revision of lower leg. 14.37

NA 10.80 2.49

NA 27.66

090 27720............. .............. A

Repair of tibia....... 11.77

NA 9.43 2.04

NA 23.24

090 27722............. .............. A

Repair/graft of tibia. 11.80

NA 9.16 2.05

NA 23.01

090 27724............. .............. A

Repair/graft of tibia. 18.17

NA 12.40 3.16

NA 33.73

090 27725............. .............. A

Repair of lower leg... 15.57

NA 11.94 2.71

NA 30.22

090 27727............. .............. A

Repair of lower leg... 13.99

NA 10.37 2.43

NA 26.79

090 27730............. .............. A

Repair of tibia

7.40

NA 6.44 1.72

NA 15.56

090 epiphysis. 27732............. .............. A

Repair of fibula

5.31

NA 4.94 0.77

NA 11.02

090 epiphysis. 27734............. .............. A

Repair lower leg

8.47

NA 6.30 1.35

NA 16.12

090 epiphyses. 27740............. .............. A

Repair of leg

9.29

NA 8.01 1.62

NA 18.92

090 epiphyses. 27742............. .............. A

Repair of leg

10.28 5.58 5.58 1.79 17.65 17.65

090 epiphyses. 27745............. .............. A

Reinforce tibia....... 10.05

NA 8.19 1.75

NA 19.99

090 27750............. .............. A

Treatment of tibia

3.19 4.77 3.86 0.55 8.51 7.60

090 fracture. 27752............. .............. A

Treatment of tibia

5.83 6.67 5.69 1.01 13.51 12.53

090 fracture. 27756............. .............. A

Treatment of tibia

6.77

NA 6.48 1.17

NA 14.42

090 fracture. 27758............. .............. A

Treatment of tibia

11.65

NA 9.21 2.03

NA 22.89

090 fracture. 27759............. .............. A

Treatment of tibia

13.74

NA 10.34 2.38

NA 26.46

090 fracture. 27760............. .............. A

Treatment of ankle

3.01 4.69 3.60 0.48 8.18 7.09

090 fracture. 27762............. .............. A

Treatment of ankle

5.24 6.35 5.29 0.85 12.44 11.38

090 fracture. 27766............. .............. A

Treatment of ankle

8.35

NA 7.24 1.44

NA 17.03

090 fracture. 27780............. .............. A

Treatment of fibula

2.65 4.19 3.22 0.41 7.25 6.28

090 fracture. 27781............. .............. A

Treatment of fibula

4.39 5.51 4.65 0.73 10.63 9.77

090 fracture. 27784............. .............. A

Treatment of fibula

7.10

NA 6.49 1.23

NA 14.82

090 fracture. 27786............. .............. A

Treatment of ankle

2.84 4.47 3.34 0.46 7.77 6.64

090 fracture. 27788............. .............. A

Treatment of ankle

4.44 5.66 4.66 0.74 10.84 9.84

090 fracture. 27792............. .............. A

Treatment of ankle

7.65

NA 6.98 1.32

NA 15.95

090 fracture. 27808............. .............. A

Treatment of ankle

2.83 4.81 3.71 0.46 8.10 7.00

090 fracture. 27810............. .............. A

Treatment of ankle

5.12 6.26 5.16 0.82 12.20 11.10

090 fracture. 27814............. .............. A

Treatment of ankle

10.66

NA 8.58 1.85

NA 21.09

090 fracture. 27816............. .............. A

Treatment of ankle

2.89 4.39 3.42 0.43 7.71 6.74

090 fracture. 27818............. .............. A

Treatment of ankle

5.49 6.39 5.18 0.82 12.70 11.49

090 fracture. 27822............. .............. A

Treatment of ankle

10.98

NA 10.68 1.91

NA 23.57

090 fracture. 27823............. .............. A

Treatment of ankle

12.98

NA 11.50 2.25

NA 26.73

090 fracture. 27824............. .............. A

Treat lower leg

2.89 4.07 3.57 0.45 7.41 6.91

090 fracture. 27825............. .............. A

Treat lower leg

6.18 6.62 5.40 1.02 13.82 12.60

090 fracture. 27826............. .............. A

Treat lower leg

8.53

NA 8.85 1.47

NA 18.85

090 fracture. 27827............. .............. A

Treat lower leg

14.04

NA 12.80 2.43

NA 29.27

090 fracture. 27828............. .............. A

Treat lower leg

16.21

NA 13.97 2.81

NA 32.99

090 fracture. 27829............. .............. A

Treat lower leg joint. 5.48

NA 6.80 0.95

NA 13.23

090 27830............. .............. A

Treat lower leg

3.78 4.40 3.86 0.54 8.72 8.18

090 dislocation. 27831............. .............. A

Treat lower leg

4.55

NA 4.47 0.73

NA 9.75

090 dislocation. 27832............. .............. A

Treat lower leg

6.48

NA 6.19 1.03

NA 13.70

090 dislocation. 27840............. .............. A

Treat ankle

4.57

NA 3.77 0.46

NA 8.80

090 dislocation. 27842............. .............. A

Treat ankle

6.20

NA 5.13 1.00

NA 12.33

090 dislocation. 27846............. .............. A

Treat ankle

9.78

NA 7.95 1.70

NA 19.43

090 dislocation. 27848............. .............. A

Treat ankle

11.18

NA 9.74 1.94

NA 22.86

090 dislocation. 27860............. .............. A

Fixation of ankle

2.34

NA 1.99 0.39

NA 4.72

010 joint. 27870............. .............. A

Fusion of ankle joint, 13.89

NA 10.55 2.36

NA 26.80

090 open. 27871............. .............. A

Fusion of tibiofibular 9.16

NA 7.60 1.59

NA 18.35

090 joint. 27880............. .............. A

Amputation of lower

11.83

NA 7.15 1.75

NA 20.73

090 leg. 27881............. .............. A

Amputation of lower

12.32

NA 8.87 1.98

NA 23.17

090 leg. 27882............. .............. A

Amputation of lower

8.93

NA 6.50 1.29

NA 16.72

090 leg. 27884............. .............. A

Amputation follow-up

8.20

NA 5.77 1.22

NA 15.19

090 surgery. 27886............. .............. A

Amputation follow-up

9.31

NA 6.53 1.40

NA 17.24

090 surgery. 27888............. .............. A

Amputation of foot at

9.66

NA 7.52 1.51

NA 18.69

090 ankle. 27889............. .............. A

Amputation of foot at

9.97

NA 6.49 1.46

NA 17.92

090 ankle. 27892............. .............. A

Decompression of leg.. 7.38

NA 5.61 1.10

NA 14.09

090 27893............. .............. A

Decompression of leg.. 7.34

NA 5.48 1.10

NA 13.92

090

[[Page 70361]]

27894............. .............. A

Decompression of leg.. 10.47

NA 7.79 1.65

NA 19.91

090 27899............. .............. C

Leg/ankle surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 28001............. .............. A

Drainage of bursa of

2.73 2.99 1.96 0.33 6.05 5.02

010 foot. 28002............. .............. A

Treatment of foot

4.61 5.00 3.78 0.61 10.22 9.00

010 infection. 28003............. .............. A

Treatment of foot

8.40 6.25 5.24 1.12 15.77 14.76

090 infection. 28005............. .............. A

Treat foot bone lesion 8.67

NA 6.06 1.16

NA 15.89

090 28008............. .............. A

Incision of foot

4.44 4.56 3.21 0.57 9.57 8.22

090 fascia. 28010............. .............. A

Incision of toe tendon 2.84 2.38 2.38 0.36 5.58 5.58

090 28011............. .............. A

Incision of toe

4.13

NA 3.31 0.59

NA 8.03

090 tendons. 28020............. .............. A

Exploration of foot

5.00 6.03 4.14 0.72 11.75 9.86

090 joint. 28022............. .............. A

Exploration of foot

4.66 5.21 3.86 0.62 10.49 9.14

090 joint. 28024............. .............. A

Exploration of toe

4.37 5.23 3.93 0.58 10.18 8.88

090 joint. 28030............. .............. A

Removal of foot nerve. 6.14

NA 3.66 0.74

NA 10.54

090 28035............. .............. A

Decompression of tibia 5.08 5.87 4.10 0.70 11.65 9.88

090 nerve. 28043............. .............. A

Excision of foot

3.53 3.82 3.18 0.46 7.81 7.17

090 lesion. 28045............. .............. A

Excision of foot

4.71 5.39 3.61 0.63 10.73 8.95

090 lesion. 28046............. .............. A

Resection of tumor,

10.16 8.79 6.49 1.36 20.31 18.01

090 foot. 28050............. .............. A

Biopsy of foot joint

4.24 4.90 3.60 0.60 9.74 8.44

090 lining. 28052............. .............. A

Biopsy of foot joint

3.93 4.92 3.44 0.53 9.38 7.90

090 lining. 28054............. .............. A

Biopsy of toe joint

3.44 4.73 3.24 0.46 8.63 7.14

090 lining. 28060............. .............. A

Partial removal, foot

5.22 5.49 3.88 0.70 11.41 9.80

090 fascia. 28062............. .............. A

Removal of foot fascia 6.51 6.53 4.02 0.83 13.87 11.36

090 28070............. .............. A

Removal of foot joint

5.09 5.23 3.82 0.73 11.05 9.64

090 lining. 28072............. .............. A

Removal of foot joint

4.57 5.54 4.31 0.68 10.79 9.56

090 lining. 28080............. .............. A

Removal of foot lesion 3.57 5.12 3.69 0.47 9.16 7.73

090 28086............. .............. A

Excise foot tendon

4.77 8.00 4.69 0.76 13.53 10.22

090 sheath. 28088............. .............. A

Excise foot tendon

3.85 5.77 3.90 0.61 10.23 8.36

090 sheath. 28090............. .............. A

Removal of foot lesion 4.40 5.15 3.46 0.59 10.14 8.45

090 28092............. .............. A

Removal of toe lesions 3.63 5.23 3.53 0.49 9.35 7.65

090 28100............. .............. A

Removal of ankle/heel

5.65 7.98 4.70 0.82 14.45 11.17

090 lesion. 28102............. .............. A

Remove/graft foot

7.72

NA 5.96 1.14

NA 14.82

090 lesion. 28103............. .............. A

Remove/graft foot

6.49

NA 4.62 0.91

NA 12.02

090 lesion. 28104............. .............. A

Removal of foot lesion 5.11 5.50 3.93 0.70 11.31 9.74

090 28106............. .............. A

Remove/graft foot

7.15

NA 4.44 0.97

NA 12.56

090 lesion. 28107............. .............. A

Remove/graft foot

5.55 6.54 4.21 0.74 12.83 10.50

090 lesion. 28108............. .............. A

Removal of toe lesions 4.15 4.60 3.26 0.53 9.28 7.94

090 28110............. .............. A

Part removal of

4.07 5.23 3.23 0.54 9.84 7.84

090 metatarsal. 28111............. .............. A

Part removal of

5.00 6.29 3.66 0.67 11.96 9.33

090 metatarsal. 28112............. .............. A

Part removal of

4.48 5.82 3.58 0.61 10.91 8.67

090 metatarsal. 28113............. .............. A

Part removal of

4.78 6.07 4.32 0.63 11.48 9.73

090 metatarsal. 28114............. .............. A

Removal of metatarsal

9.78 11.65 8.39 1.42 22.85 19.59

090 heads. 28116............. .............. A

Revision of foot...... 7.74 6.81 5.18 1.03 15.58 13.95

090 28118............. .............. A

Removal of heel bone.. 5.95 6.26 4.35 0.84 13.05 11.14

090 28119............. .............. A

Removal of heel spur.. 5.38 5.44 3.73 0.70 11.52 9.81

090 28120............. .............. A

Part removal of ankle/ 5.39 7.30 4.42 0.77 13.46 10.58

090 heel. 28122............. .............. A

Partial removal of

7.28 6.85 5.28 0.98 15.11 13.54

090 foot bone. 28124............. .............. A

Partial removal of toe 4.80 5.00 3.66 0.60 10.40 9.06

090 28126............. .............. A

Partial removal of toe 3.51 4.22 3.00 0.45 8.18 6.96

090 28130............. .............. A

Removal of ankle bone. 8.10

NA 6.73 1.26

NA 16.09

090 28140............. .............. A

Removal of metatarsal. 6.90 7.24 4.77 0.92 15.06 12.59

090 28150............. .............. A

Removal of toe........ 4.08 4.84 3.29 0.53 9.45 7.90

090 28153............. .............. A

Partial removal of toe 3.65 4.32 2.69 0.47 8.44 6.81

090 28160............. .............. A

Partial removal of toe 3.73 4.57 3.34 0.49 8.79 7.56

090 28171............. .............. A

Extensive foot surgery 9.59

NA 5.44 1.33

NA 16.36

090 28173............. .............. A

Extensive foot surgery 8.79 7.61 5.21 1.12 17.52 15.12

090 28175............. .............. A

Extensive foot surgery 6.04 5.72 3.71 0.73 12.49 10.48

090 28190............. .............. A

Removal of foot

1.96 3.40 1.48 0.22 5.58 3.66

010 foreign body. 28192............. .............. A

Removal of foot

4.63 5.49 3.65 0.61 10.73 8.89

090 foreign body. 28193............. .............. A

Removal of foot

5.72 5.62 3.93 0.73 12.07 10.38

090 foreign body. 28200............. .............. A

Repair of foot tendon. 4.59 5.10 3.56 0.61 10.30 8.76

090 28202............. .............. A

Repair/graft of foot

6.83 7.23 4.50 0.91 14.97 12.24

090 tendon. 28208............. .............. A

Repair of foot tendon. 4.36 4.82 3.31 0.58 9.76 8.25

090 28210............. .............. A

Repair/graft of foot

6.34 6.23 4.03 0.81 13.38 11.18

090 tendon. 28220............. .............. A

Release of foot tendon 4.52 4.68 3.43 0.57 9.77 8.52

090 28222............. .............. A

Release of foot

5.61 5.25 4.13 0.69 11.55 10.43

090 tendons. 28225............. .............. A

Release of foot tendon 3.65 4.29 2.91 0.46 8.40 7.02

090 28226............. .............. A

Release of foot

4.52 4.80 3.75 0.58 9.90 8.85

090 tendons. 28230............. .............. A

Incision of foot

4.23 4.68 3.68 0.55 9.46 8.46

090 tendon(s). 28232............. .............. A

Incision of toe tendon 3.38 4.53 3.32 0.44 8.35 7.14

090 28234............. .............. A

Incision of foot

3.36 4.68 3.36 0.44 8.48 7.16

090 tendon. 28238............. .............. A

Revision of foot

7.72 7.26 4.94 1.06 16.04 13.72

090 tendon. 28240............. .............. A

Release of big toe.... 4.35 4.64 3.49 0.58 9.57 8.42

090 28250............. .............. A

Revision of foot

5.91 5.64 4.14 0.82 12.37 10.87

090 fascia. 28260............. .............. A

Release of midfoot

7.95 6.34 5.00 1.14 15.43 14.09

090 joint. 28261............. .............. A

Revision of foot

11.71 8.63 7.32 1.57 21.91 20.60

090 tendon.

[[Page 70362]]

28262............. .............. A

Revision of foot and

15.81 13.59 10.94 2.59 31.99 29.34

090 ankle. 28264............. .............. A

Release of midfoot

10.33 7.75 7.30 1.54 19.62 19.17

090 joint. 28270............. .............. A

Release of foot

4.75 4.90 3.74 0.62 10.27 9.11

090 contracture. 28272............. .............. A

Release of toe joint,

3.79 4.19 2.86 0.46 8.44 7.11

090 each. 28280............. .............. A

Fusion of toes........ 5.18 6.26 4.49 0.73 12.17 10.40

090 28285............. .............. A

Repair of hammertoe... 4.58 4.87 3.43 0.59 10.04 8.60

090 28286............. .............. A

Repair of hammertoe... 4.55 4.80 3.26 0.57 9.92 8.38

090 28288............. .............. A

Partial removal of

4.73 5.95 4.89 0.65 11.33 10.27

090 foot bone. 28289............. .............. A

Repair hallux rigidus. 7.03 8.00 5.78 1.02 16.05 13.83

090 28290............. .............. A

Correction of bunion.. 5.65 6.27 4.73 0.82 12.74 11.20

090 28292............. .............. A

Correction of bunion.. 7.03 7.48 5.55 0.91 15.42 13.49

090 28293............. .............. A

Correction of bunion.. 9.14 10.77 6.12 1.13 21.04 16.39

090 28294............. .............. A

Correction of bunion.. 8.55 7.45 4.72 1.09 17.09 14.36

090 28296............. .............. A

Correction of bunion.. 9.17 8.17 5.43 1.19 18.53 15.79

090 28297............. .............. A

Correction of bunion.. 9.17 8.97 6.27 1.32 19.46 16.76

090 28298............. .............. A

Correction of bunion.. 7.93 7.23 5.01 1.05 16.21 13.99

090 28299............. .............. A

Correction of bunion.. 10.56 8.79 6.08 1.37 20.72 18.01

090 28300............. .............. A

Incision of heel bone. 9.53

NA 7.05 1.54

NA 18.12

090 28302............. .............. A

Incision of ankle bone 9.54

NA 6.90 1.42

NA 17.86

090 28304............. .............. A

Incision of midfoot

9.15 7.96 5.75 1.27 18.38 16.17

090 bones. 28305............. .............. A

Incise/graft midfoot

10.48

NA 6.74 1.27

NA 18.49

090 bones. 28306............. .............. A

Incision of metatarsal 5.85 6.85 4.18 0.84 13.54 10.87

090 28307............. .............. A

Incision of metatarsal 6.32 11.05 5.30 0.90 18.27 12.52

090 28308............. .............. A

Incision of metatarsal 5.28 5.76 3.69 0.70 11.74 9.67

090 28309............. .............. A

Incision of

12.76

NA 7.97 2.04

NA 22.77

090 metatarsals. 28310............. .............. A

Revision of big toe... 5.42 5.76 3.56 0.70 11.88 9.68

090 28312............. .............. A

Revision of toe....... 4.54 5.45 3.64 0.63 10.62 8.81

090 28313............. .............. A

Repair deformity of

5.00 5.29 4.84 0.73 11.02 10.57

090 toe. 28315............. .............. A

Removal of sesamoid

4.85 4.90 3.34 0.63 10.38 8.82

090 bone. 28320............. .............. A

Repair of foot bones.. 9.17

NA 6.73 1.43

NA 17.33

090 28322............. .............. A

Repair of metatarsals. 8.33 9.20 6.35 1.27 18.80 15.95

090 28340............. .............. A

Resect enlarged toe

6.97 6.46 4.25 0.84 14.27 12.06

090 tissue. 28341............. .............. A

Resect enlarged toe... 8.40 6.95 4.82 1.01 16.36 14.23

090 28344............. .............. A

Repair extra toe(s)... 4.25 5.76 3.64 0.51 10.52 8.40

090 28345............. .............. A

Repair webbed toe(s).. 5.91 6.21 4.69 0.80 12.92 11.40

090 28360............. .............. A

Reconstruct cleft foot 13.32

NA 10.52 2.28

NA 26.12

090 28400............. .............. A

Treatment of heel

2.16 3.64 3.06 0.35 6.15 5.57

090 fracture. 28405............. .............. A

Treatment of heel

4.56 4.84 4.63 0.73 10.13 9.92

090 fracture. 28406............. .............. A

Treatment of heel

6.30

NA 6.81 1.11

NA 14.22

090 fracture. 28415............. .............. A

Treat heel fracture... 15.95

NA 13.32 2.66

NA 31.93

090 28420............. .............. A

Treat/graft heel

16.62

NA 12.95 2.80

NA 32.37

090 fracture. 28430............. .............. A

Treatment of ankle

2.09 3.40 2.57 0.31 5.80 4.97

090 fracture. 28435............. .............. A

Treatment of ankle

3.39 3.89 3.75 0.55 7.83 7.69

090 fracture. 28436............. .............. A

Treatment of ankle

4.70

NA 5.93 0.81

NA 11.44

090 fracture. 28445............. .............. A

Treat ankle fracture.. 15.60

NA 11.06 2.58

NA 29.24

090 28450............. .............. A

Treat midfoot

1.90 3.12 2.48 0.28 5.30 4.66

090 fracture, each. 28455............. .............. A

Treat midfoot

3.09 3.43 3.43 0.44 6.96 6.96

090 fracture, each. 28456............. .............. A

Treat midfoot fracture 2.68

NA 4.16 0.44

NA 7.28

090 28465............. .............. A

Treat midfoot

7.00

NA 6.33 1.10

NA 14.43

090 fracture, each. 28470............. .............. A

Treat metatarsal

1.99 3.13 2.45 0.30 5.42 4.74

090 fracture. 28475............. .............. A

Treat metatarsal

2.97 3.34 3.22 0.44 6.75 6.63

090 fracture. 28476............. .............. A

Treat metatarsal

3.37

NA 4.99 0.54

NA 8.90

090 fracture. 28485............. .............. A

Treat metatarsal

5.70

NA 5.46 0.83

NA 11.99

090 fracture. 28490............. .............. A

Treat big toe fracture 1.09 2.02 1.64 0.14 3.25 2.87

090 28495............. .............. A

Treat big toe fracture 1.58 2.18 2.07 0.20 3.96 3.85

090 28496............. .............. A

Treat big toe fracture 2.33 8.27 3.20 0.36 10.96 5.89

090 28505............. .............. A

Treat big toe fracture 3.80 8.12 3.91 0.56 12.48 8.27

090 28510............. .............. A

Treatment of toe

1.09 1.53 1.53 0.14 2.76 2.76

090 fracture. 28515............. .............. A

Treatment of toe

1.46 1.90 1.90 0.18 3.54 3.54

090 fracture. 28525............. .............. A

Treat toe fracture.... 3.32 7.53 3.44 0.49 11.34 7.25

090 28530............. .............. A

Treat sesamoid bone

1.06 1.44 1.44 0.14 2.64 2.64

090 fracture. 28531............. .............. A

Treat sesamoid bone

2.35 7.28 2.07 0.34 9.97 4.76

090 fracture. 28540............. .............. A

Treat foot dislocation 2.04 2.41 2.41 0.26 4.71 4.71

090 28545............. .............. A

Treat foot dislocation 2.45 2.35 2.35 0.37 5.17 5.17

090 28546............. .............. A

Treat foot dislocation 3.20 6.93 4.39 0.52 10.65 8.11

090 28555............. .............. A

Repair foot

6.29 9.93 5.69 1.04 17.26 13.02

090 dislocation. 28570............. .............. A

Treat foot dislocation 1.66 2.43 2.34 0.23 4.32 4.23

090 28575............. .............. A

Treat foot dislocation 3.31 3.73 3.73 0.56 7.60 7.60

090 28576............. .............. A

Treat foot dislocation 4.16

NA 4.18 0.69

NA 9.03

090 28585............. .............. A

Repair foot

7.98 7.34 5.85 1.25 16.57 15.08

090 dislocation. 28600............. .............. A

Treat foot dislocation 1.89 2.82 2.69 0.27 4.98 4.85

090 28605............. .............. A

Treat foot dislocation 2.71 3.13 3.13 0.40 6.24 6.24

090 28606............. .............. A

Treat foot dislocation 4.89

NA 4.70 0.82

NA 10.41

090 28615............. .............. A

Repair foot

7.76

NA 8.06 1.30

NA 17.12

090 dislocation. 28630............. .............. A

Treat toe dislocation. 1.70 1.57 1.00 0.20 3.47 2.90

010

[[Page 70363]]

28635............. .............. A

Treat toe dislocation. 1.91 2.03 1.53 0.26 4.20 3.70

010 28636............. .............. A

Treat toe dislocation. 2.77 3.88 2.63 0.43 7.08 5.83

010 28645............. .............. A

Repair toe dislocation 4.21 4.96 3.28 0.57 9.74 8.06

090 28660............. .............. A

Treat toe dislocation. 1.23 1.26 0.79 0.13 2.62 2.15

010 28665............. .............. A

Treat toe dislocation. 1.92

NA 1.43 0.26

NA 3.61

010 28666............. .............. A

Treat toe dislocation. 2.66 5.90 2.59 0.43 8.99 5.68

010 28675............. .............. A

Repair of toe

2.92 7.16 3.36 0.45 10.53 6.73

090 dislocation. 28705............. .............. A

Fusion of foot bones.. 18.77

NA 12.47 3.08

NA 34.32

090 28715............. .............. A

Fusion of foot bones.. 13.08

NA 9.78 2.16

NA 25.02

090 28725............. .............. A

Fusion of foot bones.. 11.59

NA 8.26 1.86

NA 21.71

090 28730............. .............. A

Fusion of foot bones.. 10.74

NA 8.50 1.70

NA 20.94

090 28735............. .............. A

Fusion of foot bones.. 10.83

NA 7.84 1.68

NA 20.35

090 28737............. .............. A

Revision of foot bones 9.63

NA 6.82 1.47

NA 17.92

090 28740............. .............. A

Fusion of foot bones.. 8.01 10.89 6.48 1.22 20.12 15.71

090 28750............. .............. A

Fusion of big toe

7.29 11.94 6.68 1.13 20.36 15.10

090 joint. 28755............. .............. A

Fusion of big toe

4.73 6.12 3.76 0.65 11.50 9.14

090 joint. 28760............. .............. A

Fusion of big toe

7.74 7.99 5.53 1.05 16.78 14.32

090 joint. 28800............. .............. A

Amputation of midfoot. 8.20

NA 5.81 1.15

NA 15.16

090 28805............. .............. A

Amputation thru

8.38

NA 5.66 1.18

NA 15.22

090 metatarsal. 28810............. .............. A

Amputation toe &

6.20

NA 4.48 0.86

NA 11.54

090 metatarsal. 28820............. .............. A

Amputation of toe..... 4.40 7.57 3.79 0.61 12.58 8.80

090 28825............. .............. A

Partial amputation of

3.58 7.01 3.49 0.50 11.09 7.57

090 toe. 28890............. .............. A

High energy eswt,

3.30 5.73 2.09 0.41 9.44 5.80

090 plantar f. 28899............. .............. C

Foot/toes surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 29000............. .............. A

Application of body

2.25 2.97 1.74 0.41 5.63 4.40

000 cast. 29010............. .............. A

Application of body

2.06 3.29 1.78 0.45 5.80 4.29

000 cast. 29015............. .............. A

Application of body

2.41 2.98 1.60 0.28 5.67 4.29

000 cast. 29020............. .............. A

Application of body

2.11 3.19 1.41 0.28 5.58 3.80

000 cast. 29025............. .............. A

Application of body

2.40 3.15 1.86 0.44 5.99 4.70

000 cast. 29035............. .............. A

Application of body

1.77 3.62 1.58 0.28 5.67 3.63

000 cast. 29040............. .............. A

Application of body

2.22 2.47 1.51 0.36 5.05 4.09

000 cast. 29044............. .............. A

Application of body

2.12 3.98 1.91 0.35 6.45 4.38

000 cast. 29046............. .............. A

Application of body

2.41 3.24 2.10 0.42 6.07 4.93

000 cast. 29049............. .............. A

Application of figure

0.89 1.30 0.53 0.13 2.32 1.55

000 eight. 29055............. .............. A

Application of

1.78 2.99 1.47 0.30 5.07 3.55

000 shoulder cast. 29058............. .............. A

Application of

1.31 1.56 0.72 0.17 3.04 2.20

000 shoulder cast. 29065............. .............. A

Application of long

0.87 1.33 0.75 0.15 2.35 1.77

000 arm cast. 29075............. .............. A

Application of forearm 0.77 1.26 0.68 0.13 2.16 1.58

000 cast. 29085............. .............. A

Apply hand/wrist cast. 0.87 1.28 0.63 0.14 2.29 1.64

000 29086............. .............. A

Apply finger cast..... 0.62 0.96 0.49 0.07 1.65 1.18

000 29105............. .............. A

Apply long arm splint. 0.87 1.23 0.51 0.12 2.22 1.50

000 29125............. .............. A

Apply forearm splint.. 0.59 1.02 0.39 0.07 1.68 1.05

000 29126............. .............. A

Apply forearm splint.. 0.77 1.21 0.46 0.07 2.05 1.30

000 29130............. .............. A

Application of finger

0.50 0.47 0.17 0.06 1.03 0.73

000 splint. 29131............. .............. A

Application of finger

0.55 0.74 0.24 0.03 1.32 0.82

000 splint. 29200............. .............. A

Strapping of chest.... 0.65 0.72 0.34 0.04 1.41 1.03

000 29220............. .............. A

Strapping of low back. 0.64 0.72 0.39 0.04 1.40 1.07

000 29240............. .............. A

Strapping of shoulder. 0.71 0.85 0.36 0.06 1.62 1.13

000 29260............. .............. A

Strapping of elbow or

0.55 0.74 0.32 0.05 1.34 0.92

000 wrist. 29280............. .............. A

Strapping of hand or

0.51 0.80 0.32 0.03 1.34 0.86

000 finger. 29305............. .............. A

Application of hip

2.03 3.35 1.77 0.35 5.73 4.15

000 cast. 29325............. .............. A

Application of hip

2.32 3.54 1.96 0.40 6.26 4.68

000 casts. 29345............. .............. A

Application of long

1.40 1.77 1.06 0.24 3.41 2.70

000 leg cast. 29355............. .............. A

Application of long

1.53 1.71 1.12 0.26 3.50 2.91

000 leg cast. 29358............. .............. A

Apply long leg cast

1.43 2.07 1.09 0.25 3.75 2.77

000 brace. 29365............. .............. A

Application of long

1.18 1.66 0.95 0.20 3.04 2.33

000 leg cast. 29405............. .............. A

Apply short leg cast.. 0.86 1.22 0.71 0.14 2.22 1.71

000 29425............. .............. A

Apply short leg cast.. 1.01 1.23 0.74 0.15 2.39 1.90

000 29435............. .............. A

Apply short leg cast.. 1.18 1.56 0.93 0.20 2.94 2.31

000 29440............. .............. A

Addition of walker to

0.57 0.69 0.27 0.08 1.34 0.92

000 cast. 29445............. .............. A

Apply rigid leg cast.. 1.78 1.81 0.96 0.27 3.86 3.01

000 29450............. .............. A

Application of leg

2.08 1.47 1.09 0.27 3.82 3.44

000 cast. 29505............. .............. A

Application, long leg

0.69 1.18 0.45 0.08 1.95 1.22

000 splint. 29515............. .............. A

Application lower leg

0.73 0.87 0.46 0.09 1.69 1.28

000 splint. 29520............. .............. A

Strapping of hip...... 0.54 0.85 0.47 0.03 1.42 1.04

000 29530............. .............. A

Strapping of knee..... 0.57 0.79 0.33 0.05 1.41 0.95

000 29540............. .............. A

Strapping of ankle and/ 0.51 0.42 0.31 0.06 0.99 0.88

000 or ft. 29550............. .............. A

Strapping of toes..... 0.47 0.42 0.28 0.06 0.95 0.81

000 29580............. .............. A

Application of paste

0.57 0.65 0.35 0.07 1.29 0.99

000 boot. 29590............. .............. A

Application of foot

0.76 0.51 0.29 0.09 1.36 1.14

000 splint. 29700............. .............. A

Removal/revision of

0.57 0.89 0.28 0.08 1.54 0.93

000 cast. 29705............. .............. A

Removal/revision of

0.76 0.82 0.38 0.13 1.71 1.27

000 cast. 29710............. .............. A

Removal/revision of

1.34 1.53 0.70 0.20 3.07 2.24

000 cast. 29715............. .............. A

Removal/revision of

0.94 1.17 0.40 0.09 2.20 1.43

000 cast. 29720............. .............. A

Repair of body cast... 0.68 1.16 0.39 0.12 1.96 1.19

000

[[Page 70364]]

29730............. .............. A

Windowing of cast..... 0.75 0.81 0.35 0.12 1.68 1.22

000 29740............. .............. A

Wedging of cast....... 1.12 1.15 0.49 0.18 2.45 1.79

000 29750............. .............. A

Wedging of clubfoot

1.26 1.06 0.58 0.21 2.53 2.05

000 cast. 29799............. .............. C

Casting/strapping

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 29800............. .............. A

Jaw arthroscopy/

6.42

NA 6.99 0.99

NA 14.40

090 surgery. 29804............. .............. A

Jaw arthroscopy/

8.13

NA 7.64 1.38

NA 17.15

090 surgery. 29805............. .............. A

Shoulder arthroscopy,

5.88

NA 5.69 1.02

NA 12.59

090 dx. 29806............. .............. A

Shoulder arthroscopy/ 14.35

NA 11.19 2.49

NA 28.03

090 surgery. 29807............. .............. A

Shoulder arthroscopy/ 13.88

NA 11.02 2.41

NA 27.31

090 surgery. 29819............. .............. A

Shoulder arthroscopy/

7.61

NA 6.81 1.32

NA 15.74

090 surgery. 29820............. .............. A

Shoulder arthroscopy/

7.06

NA 6.24 1.22

NA 14.52

090 surgery. 29821............. .............. A

Shoulder arthroscopy/

7.71

NA 6.82 1.33

NA 15.86

090 surgery. 29822............. .............. A

Shoulder arthroscopy/

7.42

NA 6.71 1.28

NA 15.41

090 surgery. 29823............. .............. A

Shoulder arthroscopy/

8.16

NA 7.24 1.41

NA 16.81

090 surgery. 29824............. .............. A

Shoulder arthroscopy/

8.24

NA 7.55 1.42

NA 17.21

090 surgery. 29825............. .............. A

Shoulder arthroscopy/

7.61

NA 6.78 1.32

NA 15.71

090 surgery. 29826............. .............. A

Shoulder arthroscopy/

8.98

NA 7.55 1.55

NA 18.08

090 surgery. 29827............. .............. A

Arthroscop rotator

15.34

NA 11.56 2.66

NA 29.56

090 cuff repr. 29830............. .............. A

Elbow arthroscopy..... 5.75

NA 5.36 0.99

NA 12.10

090 29834............. .............. A

Elbow arthroscopy/

6.27

NA 5.85 1.08

NA 13.20

090 surgery. 29835............. .............. A

Elbow arthroscopy/

6.47

NA 5.90 1.13

NA 13.50

090 surgery. 29836............. .............. A

Elbow arthroscopy/

7.54

NA 6.81 1.22

NA 15.57

090 surgery. 29837............. .............. A

Elbow arthroscopy/

6.86

NA 6.15 1.19

NA 14.20

090 surgery. 29838............. .............. A

Elbow arthroscopy/

7.70

NA 6.91 1.30

NA 15.91

090 surgery. 29840............. .............. A

Wrist arthroscopy..... 5.53

NA 5.34 0.84

NA 11.71

090 29843............. .............. A

Wrist arthroscopy/

6.00

NA 5.64 0.92

NA 12.56

090 surgery. 29844............. .............. A

Wrist arthroscopy/

6.36

NA 5.84 1.04

NA 13.24

090 surgery. 29845............. .............. A

Wrist arthroscopy/

7.51

NA 6.49 0.99

NA 14.99

090 surgery. 29846............. .............. A

Wrist arthroscopy/

6.74

NA 6.07 1.07

NA 13.88

090 surgery. 29847............. .............. A

Wrist arthroscopy/

7.07

NA 6.21 1.08

NA 14.36

090 surgery. 29848............. .............. A

Wrist endoscopy/

5.43

NA 5.62 0.86

NA 11.91

090 surgery. 29850............. .............. A

Knee arthroscopy/

8.18

NA 5.05 1.25

NA 14.48

090 surgery. 29851............. .............. A

Knee arthroscopy/

13.08

NA 9.82 2.34

NA 25.24

090 surgery. 29855............. .............. A

Tibial arthroscopy/

10.60

NA 8.79 1.84

NA 21.23

090 surgery. 29856............. .............. A

Tibial arthroscopy/

14.12

NA 10.70 2.39

NA 27.21

090 surgery. 29860............. .............. A

Hip arthroscopy, dx... 8.04

NA 6.97 1.36

NA 16.37

090 29861............. .............. A

Hip arthroscopy/

9.14

NA 7.36 1.59

NA 18.09

090 surgery. 29862............. .............. A

Hip arthroscopy/

9.89

NA 8.58 1.62

NA 20.09

090 surgery. 29863............. .............. A

Hip arthroscopy/

9.89

NA 8.53 1.42

NA 19.84

090 surgery. 29866............. .............. A

Autgrft implnt, knee w/ 13.88

NA 11.38 2.39

NA 27.65

090 scope. 29867............. .............. A

Allgrft implnt, knee w/ 17.00

NA 13.26 2.78

NA 33.04

090 scope. 29868............. .............. A

Meniscal trnspl, knee 23.59

NA 16.84 4.35

NA 44.78

090 w/scpe. 29870............. .............. A

Knee arthroscopy, dx.. 5.06

NA 4.90 0.85

NA 10.81

090 29871............. .............. A

Knee arthroscopy/

6.54

NA 5.89 1.14

NA 13.57

090 drainage. 29873............. .............. A

Knee arthroscopy/

5.99

NA 6.59 1.04

NA 13.62

090 surgery. 29874............. .............. A

Knee arthroscopy/

7.04

NA 6.09 1.11

NA 14.24

090 surgery. 29875............. .............. A

Knee arthroscopy/

6.30

NA 5.87 1.09

NA 13.26

090 surgery. 29876............. .............. A

Knee arthroscopy/

7.91

NA 7.04 1.37

NA 16.32

090 surgery. 29877............. .............. A

Knee arthroscopy/

7.34

NA 6.76 1.28

NA 15.38

090 surgery. 29879............. .............. A

Knee arthroscopy/

8.03

NA 7.14 1.39

NA 16.56

090 surgery. 29880............. .............. A

Knee arthroscopy/

8.49

NA 7.38 1.47

NA 17.34

090 surgery. 29881............. .............. A

Knee arthroscopy/

7.75

NA 6.98 1.34

NA 16.07

090 surgery. 29882............. .............. A

Knee arthroscopy/

8.64

NA 7.26 1.50

NA 17.40

090 surgery. 29883............. .............. A

Knee arthroscopy/

11.03

NA 9.09 1.92

NA 22.04

090 surgery. 29884............. .............. A

Knee arthroscopy/

7.32

NA 6.72 1.27

NA 15.31

090 surgery. 29885............. .............. A

Knee arthroscopy/

9.08

NA 7.99 1.58

NA 18.65

090 surgery. 29886............. .............. A

Knee arthroscopy/

7.53

NA 6.87 1.30

NA 15.70

090 surgery. 29887............. .............. A

Knee arthroscopy/

9.03

NA 7.95 1.57

NA 18.55

090 surgery. 29888............. .............. A

Knee arthroscopy/

13.88

NA 10.23 2.41

NA 26.52

090 surgery. 29889............. .............. A

Knee arthroscopy/

15.98

NA 12.47 2.78

NA 31.23

090 surgery. 29891............. .............. A

Ankle arthroscopy/

8.39

NA 7.53 1.39

NA 17.31

090 surgery. 29892............. .............. A

Ankle arthroscopy/

8.99

NA 7.76 1.41

NA 18.16

090 surgery. 29893............. .............. A

Scope, plantar

5.21 6.30 4.00 0.63 12.14 9.84

090 fasciotomy. 29894............. .............. A

Ankle arthroscopy/

7.20

NA 5.49 1.15

NA 13.84

090 surgery. 29895............. .............. A

Ankle arthroscopy/

6.98

NA 5.49 1.11

NA 13.58

090 surgery. 29897............. .............. A

Ankle arthroscopy/

7.17

NA 5.90 1.17

NA 14.24

090 surgery. 29898............. .............. A

Ankle arthroscopy/

8.31

NA 6.21 1.28

NA 15.80

090 surgery. 29899............. .............. A

Ankle arthroscopy/

13.89

NA 10.57 2.40

NA 26.86

090 surgery. 29900............. .............. A

Mcp joint arthroscopy, 5.41

NA 5.88 0.94

NA 12.23

090 dx. 29901............. .............. A

Mcp joint arthroscopy, 6.12

NA 6.28 1.06

NA 13.46

090 surg. 29902............. .............. A

Mcp joint arthroscopy, 6.69

NA 6.56 1.12

NA 14.37

090 surg. 29999............. .............. C

Arthroscopy of joint.. 0.00 0.00 0.00 0.00 0.00 0.00

YYY 30000............. .............. A

Drainage of nose

1.43 4.08 1.39 0.12 5.63 2.94

010 lesion. 3000F............. .............. I

Blood press 140/

0.00 0.00 0.00 0.00 0.00 0.00

XXX 90 mmhg. 30100............. .............. A

Intranasal biopsy..... 0.94 1.98 0.82 0.07 2.99 1.83

000 30110............. .............. A

Removal of nose

1.63 3.25 1.57 0.14 5.02 3.34

010 polyp(s). 30115............. .............. A

Removal of nose

4.34

NA 5.78 0.41

NA 10.53

090 polyp(s). 30117............. .............. A

Removal of intranasal

3.16 13.18 4.64 0.26 16.60 8.06

090 lesion. 30118............. .............. A

Removal of intranasal

9.68

NA 9.22 0.78

NA 19.68

090 lesion. 30120............. .............. A

Revision of nose...... 5.26 6.51 6.02 0.52 12.29 11.80

090 30124............. .............. A

Removal of nose lesion 3.10

NA 3.62 0.25

NA 6.97

090 30125............. .............. A

Removal of nose lesion 7.15

NA 8.34 0.63

NA 16.12

090 30130............. .............. A

Excise inferior

3.37

NA 5.61 0.31

NA 9.29

090 turbinate. 30140............. .............. A

Resect inferior

3.42

NA 6.21 0.35

NA 9.98

090 turbinate. 30150............. .............. A

Partial removal of

9.13

NA 11.04 0.93

NA 21.10

090 nose. 30160............. .............. A

Removal of nose....... 9.57

NA 10.24 0.88

NA 20.69

090 30200............. .............. A

Injection treatment of 0.78 1.62 0.74 0.06 2.46 1.58

000 nose. 30210............. .............. A

Nasal sinus therapy... 1.08 2.11 1.31 0.09 3.28 2.48

010 30220............. .............. A

Insert nasal septal

1.54 4.24 1.53 0.12 5.90 3.19

010 button. 30300............. .............. A

Remove nasal foreign

1.04 4.64 1.92 0.08 5.76 3.04

010 body. 30310............. .............. A

Remove nasal foreign

1.96

NA 3.11 0.16

NA 5.23

010 body. 30320............. .............. A

Remove nasal foreign

4.51

NA 7.06 0.39

NA 11.96

090 body. 30400............. .............. R

Reconstruction of nose 9.82

NA 15.53 1.04

NA 26.39

090 30410............. .............. R

Reconstruction of nose 12.96

NA 18.42 1.42

NA 32.80

090 30420............. .............. R

Reconstruction of nose 15.86

NA 17.96 1.46

NA 35.28

090 30430............. .............. R

Revision of nose...... 7.20

NA 16.06 0.77

NA 24.03

090 30435............. .............. R

Revision of nose...... 11.69

NA 19.41 1.22

NA 32.32

090 30450............. .............. R

Revision of nose...... 18.62

NA 21.95 1.96

NA 42.53

090 30460............. .............. A

Revision of nose...... 9.95

NA 9.97 1.03

NA 20.95

090 30462............. .............. A

Revision of nose...... 19.54

NA 20.30 2.53

NA 42.37

090 30465............. .............. A

Repair nasal stenosis. 11.62

NA 12.00 1.06

NA 24.68

090 30520............. .............. A

Repair of nasal septum 5.69

NA 6.68 0.46

NA 12.83

090 30540............. .............. A

Repair nasal defect... 7.74

NA 9.30 0.67

NA 17.71

090 30545............. .............. A

Repair nasal defect... 11.36

NA 11.93 1.70

NA 24.99

090 30560............. .............. A

Release of nasal

1.26 4.78 2.14 0.10 6.14 3.50

010 adhesions. 30580............. .............. A

Repair upper jaw

6.68 7.79 5.81 0.89 15.36 13.38

090 fistula. 30600............. .............. A

Repair mouth/nose

6.01 7.54 5.03 0.70 14.25 11.74

090 fistula. 30620............. .............. A

Intranasal

5.96

NA 8.86 0.57

NA 15.39

090 reconstruction. 30630............. .............. A

Repair nasal septum

7.11

NA 7.97 0.61

NA 15.69

090 defect. 30801............. .............. A

Ablate inf turbinate,

1.09 4.14 1.93 0.09 5.32 3.11

010 superf. 30802............. .............. A

Cauterization, inner

2.03 4.62 2.37 0.16 6.81 4.56

010 nose. 30901............. .............. A

Control of nosebleed.. 1.21 1.36 0.32 0.11 2.68 1.64

000 30903............. .............. A

Control of nosebleed.. 1.54 2.72 0.50 0.13 4.39 2.17

000 30905............. .............. A

Control of nosebleed.. 1.97 3.52 0.76 0.17 5.66 2.90

000 30906............. .............. A

Repeat control of

2.45 3.90 1.20 0.20 6.55 3.85

000 nosebleed. 30915............. .............. A

Ligation, nasal sinus

7.19

NA 6.71 0.58

NA 14.48

090 artery. 30920............. .............. A

Ligation, upper jaw

9.82

NA 9.00 0.80

NA 19.62

090 artery. 30930............. .............. A

Ther fx, nasal inf

1.26

NA 1.62 0.12

NA 3.00

010 turbinate. 30999............. .............. C

Nasal surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 31000............. .............. A

Irrigation, maxillary

1.15 2.85 1.40 0.09 4.09 2.64

010 sinus. 31002............. .............. A

Irrigation, sphenoid

1.91

NA 3.25 0.15

NA 5.31

010 sinus. 31020............. .............. A

Exploration, maxillary 2.94 8.55 5.20 0.29 11.78 8.43

090 sinus. 31030............. .............. A

Exploration, maxillary 5.91 11.53 6.68 0.60 18.04 13.19

090 sinus. 31032............. .............. A

Explore sinus, remove

6.56

NA 7.25 0.59

NA 14.40

090 polyps. 31040............. .............. A

Exploration behind

9.41

NA 9.85 0.87

NA 20.13

090 upper jaw. 31050............. .............. A

Exploration, sphenoid

5.27

NA 6.37 0.49

NA 12.13

090 sinus. 31051............. .............. A

Sphenoid sinus surgery 7.10

NA 8.26 0.62

NA 15.98

090 31070............. .............. A

Exploration of frontal 4.27

NA 5.95 0.38

NA 10.60

090 sinus. 31075............. .............. A

Exploration of frontal 9.15

NA 9.76 0.75

NA 19.66

090 sinus. 31080............. .............. A

Removal of frontal

11.40

NA 13.57 1.23

NA 26.20

090 sinus. 31081............. .............. A

Removal of frontal

12.73

NA 14.04 2.46

NA 29.23

090 sinus. 31084............. .............. A

Removal of frontal

13.49

NA 13.54 1.19

NA 28.22

090 sinus. 31085............. .............. A

Removal of frontal

14.18

NA 14.00 1.72

NA 29.90

090 sinus. 31086............. .............. A

Removal of frontal

12.84

NA 13.32 1.07

NA 27.23

090 sinus. 31087............. .............. A

Removal of frontal

13.08

NA 12.57 1.44

NA 27.09

090 sinus. 31090............. .............. A

Exploration of sinuses 9.52

NA 12.59 0.94

NA 23.05

090 31200............. .............. A

Removal of ethmoid

4.96

NA 9.24 0.29

NA 14.49

090 sinus. 31201............. .............. A

Removal of ethmoid

8.36

NA 9.20 0.82

NA 18.38

090 sinus. 31205............. .............. A

Removal of ethmoid

10.22

NA 11.91 0.67

NA 22.80

090 sinus. 31225............. .............. A

Removal of upper jaw.. 19.20

NA 17.87 1.59

NA 38.66

090 31230............. .............. A

Removal of upper jaw.. 21.91

NA 19.42 1.77

NA 43.10

090 31231............. .............. A

Nasal endoscopy, dx... 1.10 3.39 0.88 0.09 4.58 2.07

000 31233............. .............. A

Nasal/sinus endoscopy, 2.18 4.31 1.48 0.20 6.69 3.86

000 dx. 31235............. .............. A

Nasal/sinus endoscopy, 2.64 4.92 1.72 0.26 7.82 4.62

000 dx. 31237............. .............. A

Nasal/sinus endoscopy, 2.98 5.21 1.89 0.28 8.47 5.15

000 surg. 31238............. .............. A

Nasal/sinus endoscopy, 3.26 5.25 2.10 0.27 8.78 5.63

000 surg. 31239............. .............. A

Nasal/sinus endoscopy, 8.69

NA 8.02 0.62

NA 17.33

010 surg. 31240............. .............. A

Nasal/sinus endoscopy, 2.61

NA 1.74 0.24

NA 4.59

000 surg.

[[Page 70366]]

31254............. .............. A

Revision of ethmoid

4.64

NA 2.86 0.45

NA 7.95

000 sinus. 31255............. .............. A

Removal of ethmoid

6.95

NA 4.12 0.73

NA 11.80

000 sinus. 31256............. .............. A

Exploration maxillary

3.29

NA 2.12 0.33

NA 5.74

000 sinus. 31267............. .............. A

Endoscopy, maxillary

5.45

NA 3.30 0.55

NA 9.30

000 sinus. 31276............. .............. A

Sinus endoscopy,

8.84

NA 5.13 0.92

NA 14.89

000 surgical. 31287............. .............. A

Nasal/sinus endoscopy, 3.91

NA 2.46 0.39

NA 6.76

000 surg. 31288............. .............. A

Nasal/sinus endoscopy, 4.57

NA 2.82 0.46

NA 7.85

000 surg. 31290............. .............. A

Nasal/sinus endoscopy, 17.21

NA 12.08 1.40

NA 30.69

010 surg. 31291............. .............. A

Nasal/sinus endoscopy, 18.16

NA 12.51 1.68

NA 32.35

010 surg. 31292............. .............. A

Nasal/sinus endoscopy, 14.74

NA 10.64 1.21

NA 26.59

010 surg. 31293............. .............. A

Nasal/sinus endoscopy, 16.19

NA 11.41 1.28

NA 28.88

010 surg. 31294............. .............. A

Nasal/sinus endoscopy, 19.03

NA 12.91 1.53

NA 33.47

010 surg. 31299............. .............. C

Sinus surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 31300............. .............. A

Removal of larynx

14.27

NA 15.02 1.17

NA 30.46

090 lesion. 31320............. .............. A

Diagnostic incision,

5.25

NA 10.33 0.46

NA 16.04

090 larynx. 31360............. .............. A

Removal of larynx..... 17.05

NA 16.77 1.38

NA 35.20

090 31365............. .............. A

Removal of larynx..... 24.12

NA 20.42 1.97

NA 46.51

090 31367............. .............. A

Partial removal of

21.83

NA 21.95 1.78

NA 45.56

090 larynx. 31368............. .............. A

Partial removal of

27.05

NA 25.56 2.20

NA 54.81

090 larynx. 31370............. .............. A

Partial removal of

21.35

NA 22.32 1.74

NA 45.41

090 larynx. 31375............. .............. A

Partial removal of

20.18

NA 20.44 1.63

NA 42.25

090 larynx. 31380............. .............. A

Partial removal of

20.18

NA 20.66 1.70

NA 42.54

090 larynx. 31382............. .............. A

Partial removal of

20.49

NA 21.67 1.67

NA 43.83

090 larynx. 31390............. .............. A

Removal of larynx &

27.49

NA 24.45 2.23

NA 54.17

090 pharynx. 31395............. .............. A

Reconstruct larynx &

31.04

NA 28.38 2.48

NA 61.90

090 pharynx. 31400............. .............. A

Revision of larynx.... 10.29

NA 13.81 0.83

NA 24.93

090 31420............. .............. A

Removal of epiglottis. 10.20

NA 9.57 0.83

NA 20.60

090 31500............. .............. A

Insert emergency

2.33

NA 0.55 0.17

NA 3.05

000 airway. 31502............. .............. A

Change of windpipe

0.65 0.31 0.28 0.05 1.01 0.98

000 airway. 31505............. .............. A

Diagnostic

0.61 1.45 0.61 0.05 2.11 1.27

000 laryngoscopy. 31510............. .............. A

Laryngoscopy with

1.92 3.31 1.25 0.16 5.39 3.33

000 biopsy. 31511............. .............. A

Remove foreign body,

2.16 3.13 1.06 0.19 5.48 3.41

000 larynx. 31512............. .............. A

Removal of larynx

2.07 3.21 1.36 0.18 5.46 3.61

000 lesion. 31513............. .............. A

Injection into vocal

2.10

NA 1.46 0.17

NA 3.73

000 cord. 31515............. .............. A

Laryngoscopy for

1.80 3.55 1.06 0.14 5.49 3.00

000 aspiration. 31520............. .............. A

Dx laryngoscopy,

2.56

NA 1.56 0.20

NA 4.32

000 newborn. 31525............. .............. A

Dx laryngoscopy excl

2.63 3.65 1.66 0.21 6.49 4.50

000 nb. 31526............. .............. A

Dx laryngoscopy w/oper 2.57

NA 1.72 0.21

NA 4.50

000 scope. 31527............. .............. A

Laryngoscopy for

3.27

NA 1.88 0.26

NA 5.41

000 treatment. 31528............. .............. A

Laryngoscopy and

2.37

NA 1.46 0.19

NA 4.02

000 dilation. 31529............. .............. A

Laryngoscopy and

2.68

NA 1.71 0.22

NA 4.61

000 dilation. 31530............. .............. A

Laryngoscopy w/fb

3.38

NA 1.96 0.29

NA 5.63

000 removal. 31531............. .............. A

Laryngoscopy w/fb & op 3.58

NA 2.28 0.29

NA 6.15

000 scope. 31535............. .............. A

Laryngoscopy w/biopsy. 3.16

NA 2.00 0.26

NA 5.42

000 31536............. .............. A

Laryngoscopy w/bx & op 3.55

NA 2.26 0.29

NA 6.10

000 scope. 31540............. .............. A

Laryngoscopy w/exc of

4.12

NA 2.55 0.33

NA 7.00

000 tumor. 31541............. .............. A

Larynscop w/tumr exc + 4.52

NA 2.79 0.37

NA 7.68

000 scope. 31545............. .............. A

Remove vc lesion w/

6.30

NA 3.48 0.37

NA 10.15

000 scope. 31546............. .............. A

Remove vc lesion scope/ 9.73

NA 4.98 0.78

NA 15.49

000 graft. 31560............. .............. A

Laryngoscop w/

5.45

NA 3.16 0.43

NA 9.04

000 arytenoidectom. 31561............. .............. A

Larynscop, remve cart

5.99

NA 3.38 0.49

NA 9.86

000 + scop. 31570............. .............. A

Laryngoscope w/vc inj. 3.86 5.69 2.39 0.31 9.86 6.56

000 31571............. .............. A

Laryngoscop w/vc inj + 4.26

NA 2.61 0.35

NA 7.22

000 scope. 31575............. .............. A

Diagnostic

1.10 1.91 0.89 0.09 3.10 2.08

000 laryngoscopy. 31576............. .............. A

Laryngoscopy with

1.97 3.67 1.29 0.14 5.78 3.40

000 biopsy. 31577............. .............. A

Remove foreign body,

2.47 3.77 1.53 0.21 6.45 4.21

000 larynx. 31578............. .............. A

Removal of larynx

2.84 4.29 1.52 0.23 7.36 4.59

000 lesion. 31579............. .............. A

Diagnostic

2.26 3.79 1.48 0.18 6.23 3.92

000 laryngoscopy. 31580............. .............. A

Revision of larynx.... 12.36

NA 15.96 1.00

NA 29.32

090 31582............. .............. A

Revision of larynx.... 21.59

NA 25.87 1.75

NA 49.21

090 31584............. .............. A

Treat larynx fracture. 19.61

NA 18.20 1.71

NA 39.52

090 31587............. .............. A

Revision of larynx.... 11.97

NA 9.29 0.97

NA 22.23

090 31588............. .............. A

Revision of larynx.... 13.09

NA 13.65 1.06

NA 27.80

090 31590............. .............. A

Reinnervate larynx.... 6.96

NA 15.58 0.84

NA 23.38

090 31595............. .............. A

Larynx nerve surgery.. 8.33

NA 10.58 0.68

NA 19.59

090 31599............. .............. C

Larynx surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 31600............. .............. A

Incision of windpipe.. 7.17

NA 3.20 0.80

NA 11.17

000 31601............. .............. A

Incision of windpipe.. 4.44

NA 2.41 0.40

NA 7.25

000 31603............. .............. A

Incision of windpipe.. 4.14

NA 1.71 0.44

NA 6.29

000 31605............. .............. A

Incision of windpipe.. 3.57

NA 1.19 0.40

NA 5.16

000 31610............. .............. A

Incision of windpipe.. 8.75

NA 8.28 0.79

NA 17.82

090 31611............. .............. A

Surgery/speech

5.63

NA 7.08 0.46

NA 13.17

090 prosthesis. 31612............. .............. A

Puncture/clear

0.91 1.10 0.35 0.08 2.09 1.34

000 windpipe. 31613............. .............. A

Repair windpipe

4.58

NA 6.01 0.42

NA 11.01

090 opening. 31614............. .............. A

Repair windpipe

7.11

NA 8.74 0.58

NA 16.43

090 opening.

[[Page 70367]]

31615............. .............. A

Visualization of

2.09 2.60 1.20 0.16 4.85 3.45

000 windpipe. 31620............. .............. A

Endobronchial us add-

1.40 5.66 0.55 0.11 7.17 2.06

ZZZ on. 31622............. .............. A

Dx bronchoscope/wash.. 2.78 5.67 1.06 0.18 8.63 4.02

000 31623............. .............. A

Dx bronchoscope/brush. 2.88 6.44 1.05 0.13 9.45 4.06

000 31624............. .............. A

Dx bronchoscope/lavage 2.88 5.79 1.05 0.13 8.80 4.06

000 31625............. .............. A

Bronchoscopy w/

3.36 5.83 1.21 0.18 9.37 4.75

000 biopsy(s). 31628............. .............. A

Bronchoscopy/lung bx,

3.80 7.04 1.30 0.18 11.02 5.28

000 each. 31629............. .............. A

Bronchoscopy/needle

4.09 14.29 1.40 0.16 18.54 5.65

000 bx, each. 31630............. .............. A

Bronchoscopy dilate/fx 3.81

NA 1.72 0.32

NA 5.85

000 repr. 31631............. .............. A

Bronchoscopy, dilate w/ 4.36

NA 1.77 0.34

NA 6.47

000 stent. 31632............. .............. A

Bronchoscopy/lung bx,

1.03 0.81 0.31 0.18 2.02 1.52

ZZZ add'l. 31633............. .............. A

Bronchoscopy/needle bx 1.32 0.92 0.40 0.16 2.40 1.88

ZZZ add'l. 31635............. .............. A

Bronchoscopy w/fb

3.67 6.13 1.43 0.24 10.04 5.34

000 removal. 31636............. .............. A

Bronchoscopy, bronch

4.30

NA 1.77 0.31

NA 6.38

000 stents. 31637............. .............. A

Bronchoscopy, stent

1.58

NA 0.56 0.13

NA 2.27

ZZZ add-on. 31638............. .............. A

Bronchoscopy, revise

4.88

NA 1.98 0.22

NA 7.08

000 stent. 31640............. .............. A

Bronchoscopy w/tumor

4.93

NA 2.08 0.46

NA 7.47

000 excise. 31641............. .............. A

Bronchoscopy, treat

5.02

NA 1.89 0.35

NA 7.26

000 blockage. 31643............. .............. A

Diag bronchoscope/

3.49

NA 1.23 0.20

NA 4.92

000 catheter. 31645............. .............. A

Bronchoscopy, clear

3.16 5.15 1.12 0.16 8.47 4.44

000 airways. 31646............. .............. A

Bronchoscopy, reclear

2.72 4.87 1.00 0.14 7.73 3.86

000 airway. 31656............. .............. A

Bronchoscopy, inj for

2.17 7.31 0.83 0.15 9.63 3.15

000 x-ray. 31700............. .............. A

Insertion of airway

1.34 2.16 0.68 0.08 3.58 2.10

000 catheter. 31708............. .............. A

Instill airway

1.41 2.04 0.46 0.07 3.52 1.94

000 contrast dye. 31710............. .............. A

Insertion of airway

1.30

NA 0.41 0.12

NA 1.83

000 catheter. 31715............. .............. A

Injection for bronchus 1.11

NA 0.34 0.07

NA 1.52

000 x-ray. 31717............. .............. A

Bronchial brush biopsy 2.12 8.27 0.79 0.14 10.53 3.05

000 31720............. .............. A

Clearance of airways.. 1.06 0.33 0.33 0.07 1.46 1.46

000 31725............. .............. A

Clearance of airways.. 1.96 0.65 0.58 0.14 2.75 2.68

000 31730............. .............. A

Intro, windpipe wire/

2.85 2.20 1.00 0.21 5.26 4.06

000 tube. 31750............. .............. A

Repair of windpipe.... 13.00

NA 17.60 1.05

NA 31.65

090 31755............. .............. A

Repair of windpipe.... 15.91

NA 24.59 1.29

NA 41.79

090 31760............. .............. A

Repair of windpipe.... 22.32

NA 10.74 2.94

NA 36.00

090 31766............. .............. A

Reconstruction of

30.38

NA 13.69 4.52

NA 48.59

090 windpipe. 31770............. .............. A

Repair/graft of

22.48

NA 10.27 2.83

NA 35.58

090 bronchus. 31775............. .............. A

Reconstruct bronchus.. 23.50

NA 11.82 3.01

NA 38.33

090 31780............. .............. A

Reconstruct windpipe.. 17.69

NA 11.08 1.65

NA 30.42

090 31781............. .............. A

Reconstruct windpipe.. 23.49

NA 12.16 2.24

NA 37.89

090 31785............. .............. A

Remove windpipe lesion 17.20

NA 10.21 1.59

NA 29.00

090 31786............. .............. A

Remove windpipe lesion 23.94

NA 13.13 3.29

NA 40.36

090 31800............. .............. A

Repair of windpipe

7.42

NA 9.27 0.79

NA 17.48

090 injury. 31805............. .............. A

Repair of windpipe

13.11

NA 7.23 1.82

NA 22.16

090 injury. 31820............. .............. A

Closure of windpipe

4.48 5.68 3.66 0.38 10.54 8.52

090 lesion. 31825............. .............. A

Repair of windpipe

6.80 7.68 5.39 0.53 15.01 12.72

090 defect. 31830............. .............. A

Revise windpipe scar.. 4.49 5.78 3.99 0.44 10.71 8.92

090 31899............. .............. C

Airways surgical

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 32000............. .............. A

Drainage of chest..... 1.54 3.06 0.48 0.08 4.68 2.10

000 32002............. .............. A

Treatment of collapsed 2.19 3.22 1.06 0.12 5.53 3.37

000 lung. 32005............. .............. A

Treat lung lining

2.19 6.47 0.70 0.23 8.89 3.12

000 chemically. 32019............. .............. A

Insert pleural

4.17 20.02 1.65 0.42 24.61 6.24

000 catheter. 32020............. .............. A

Insertion of chest

3.97

NA 1.35 0.43

NA 5.75

000 tube. 32035............. .............. A

Exploration of chest.. 8.66

NA 5.87 1.26

NA 15.79

090 32036............. .............. A

Exploration of chest.. 9.67

NA 6.45 1.43

NA 17.55

090 32095............. .............. A

Biopsy through chest

8.35

NA 5.38 1.22

NA 14.95

090 wall. 32100............. .............. A

Exploration/biopsy of 15.22

NA 7.84 2.23

NA 25.29

090 chest. 32110............. .............. A

Explore/repair chest.. 22.97

NA 10.76 3.21

NA 36.94

090 32120............. .............. A

Re-exploration of

11.52

NA 7.09 1.63

NA 20.24

090 chest. 32124............. .............. A

Explore chest free

12.70

NA 7.23 1.89

NA 21.82

090 adhesions. 32140............. .............. A

Removal of lung

13.91

NA 7.70 1.96

NA 23.57

090 lesion(s). 32141............. .............. A

Remove/treat lung

13.98

NA 7.57 2.00

NA 23.55

090 lesions. 32150............. .............. A

Removal of lung

14.13

NA 7.62 2.00

NA 23.75

090 lesion(s). 32151............. .............. A

Remove lung foreign

14.19

NA 8.02 2.03

NA 24.24

090 body. 32160............. .............. A

Open chest heart

9.29

NA 5.28 1.31

NA 15.88

090 massage. 32200............. .............. A

Drain, open, lung

15.27

NA 8.63 2.13

NA 26.03

090 lesion. 32201............. .............. A

Drain, percut, lung

3.99 20.76 1.30 0.24 24.99 5.53

000 lesion. 32215............. .............. A

Treat chest lining.... 11.31

NA 6.92 1.68

NA 19.91

090 32220............. .............. A

Release of lung....... 23.96

NA 12.99 3.56

NA 40.51

090 32225............. .............. A

Partial release of

13.94

NA 7.67 2.06

NA 23.67

090 lung. 32310............. .............. A

Removal of chest

13.42

NA 7.41 1.99

NA 22.82

090 lining. 32320............. .............. A

Free/remove chest

23.96

NA 12.19 3.51

NA 39.66

090 lining. 32400............. .............. A

Needle biopsy chest

1.76 2.13 0.55 0.10 3.99 2.41

000 lining. 32402............. .............. A

Open biopsy chest

7.55

NA 5.12 1.07

NA 13.74

090 lining. 32405............. .............. A

Biopsy, lung or

1.93 0.67 0.63 0.11 2.71 2.67

000 mediastinum. 32420............. .............. A

Puncture/clear lung... 2.18

NA 0.68 0.12

NA 2.98

000 32440............. .............. A

Removal of lung....... 24.96

NA 12.93 3.68

NA 41.57

090

[[Page 70368]]

32442............. .............. A

Sleeve pneumonectomy.. 26.20

NA 14.80 3.84

NA 44.84

090 32445............. .............. A

Removal of lung....... 25.05

NA 14.10 3.71

NA 42.86

090 32480............. .............. A

Partial removal of

23.71

NA 12.09 3.49

NA 39.29

090 lung. 32482............. .............. A

Bilobectomy........... 24.96

NA 12.95 3.66

NA 41.57

090 32484............. .............. A

Segmentectomy......... 20.66

NA 11.41 3.03

NA 35.10

090 32486............. .............. A

Sleeve lobectomy...... 23.88

NA 13.28 3.51

NA 40.67

090 32488............. .............. A

Completion

25.67

NA 13.82 3.80

NA 43.29

090 pneumonectomy. 32491............. .............. R

Lung volume reduction. 21.22

NA 12.66 2.98

NA 36.86

090 32500............. .............. A

Partial removal of

21.97

NA 12.39 3.25

NA 37.61

090 lung. 32501............. .............. A

Repair bronchus add-on 4.68

NA 1.54 0.65

NA 6.87

ZZZ 32503............. .............. A

Resect apical lung

30.00

NA 15.11 4.37

NA 49.48

090 tumor. 32504............. .............. A

Resect apical lung tum/ 34.80

NA 16.72 5.07

NA 56.59

090 chest. 32540............. .............. A

Removal of lung lesion 14.62

NA 9.66 2.07

NA 26.35

090 32601............. .............. A

Thoracoscopy,

5.45

NA 2.36 0.80

NA 8.61

000 diagnostic. 32602............. .............. A

Thoracoscopy,

5.95

NA 2.53 0.87

NA 9.35

000 diagnostic. 32603............. .............. A

Thoracoscopy,

7.80

NA 3.04 1.14

NA 11.98

000 diagnostic. 32604............. .............. A

Thoracoscopy,

8.77

NA 3.46 1.25

NA 13.48

000 diagnostic. 32605............. .............. A

Thoracoscopy,

6.92

NA 2.91 1.00

NA 10.83

000 diagnostic. 32606............. .............. A

Thoracoscopy,

8.39

NA 3.34 1.22

NA 12.95

000 diagnostic. 32650............. .............. A

Thoracoscopy, surgical 10.73

NA 6.78 1.58

NA 19.09

090 32651............. .............. A

Thoracoscopy, surgical 12.89

NA 7.25 1.86

NA 22.00

090 32652............. .............. A

Thoracoscopy, surgical 18.63

NA 10.17 2.72

NA 31.52

090 32653............. .............. A

Thoracoscopy, surgical 12.85

NA 6.99 1.88

NA 21.72

090 32654............. .............. A

Thoracoscopy, surgical 12.42

NA 7.55 1.63

NA 21.60

090 32655............. .............. A

Thoracoscopy, surgical 13.08

NA 7.26 1.89

NA 22.23

090 32656............. .............. A

Thoracoscopy, surgical 12.89

NA 7.96 1.89

NA 22.74

090 32657............. .............. A

Thoracoscopy, surgical 13.63

NA 7.70 1.99

NA 23.32

090 32658............. .............. A

Thoracoscopy, surgical 11.61

NA 7.37 1.69

NA 20.67

090 32659............. .............. A

Thoracoscopy, surgical 11.57

NA 7.47 1.62

NA 20.66

090 32660............. .............. A

Thoracoscopy, surgical 17.40

NA 9.51 2.08

NA 28.99

090 32661............. .............. A

Thoracoscopy, surgical 13.23

NA 7.81 1.92

NA 22.96

090 32662............. .............. A

Thoracoscopy, surgical 16.42

NA 8.85 2.17

NA 27.44

090 32663............. .............. A

Thoracoscopy, surgical 18.44

NA 10.79 2.72

NA 31.95

090 32664............. .............. A

Thoracoscopy, surgical 14.18

NA 7.65 2.32

NA 24.15

090 32665............. .............. A

Thoracoscopy, surgical 15.52

NA 8.15 2.15

NA 25.82

090 32800............. .............. A

Repair lung hernia.... 13.67

NA 7.43 1.98

NA 23.08

090 32810............. .............. A

Close chest after

13.03

NA 7.54 1.93

NA 22.50

090 drainage. 32815............. .............. A

Close bronchial

23.12

NA 11.00 3.27

NA 37.39

090 fistula. 32820............. .............. A

Reconstruct injured

21.45

NA 12.20 2.52

NA 36.17

090 chest. 32850............. .............. X

Donor pneumonectomy... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 32851............. .............. A

Lung transplant,

38.57

NA 27.74 5.56

NA 71.87

090 single. 32852............. .............. A

Lung transplant with

41.74

NA 33.26 6.00

NA 81.00

090 bypass. 32853............. .............. A

Lung transplant,

47.74

NA 31.84 7.05

NA 86.63

090 double. 32854............. .............. A

Lung transplant with

50.90

NA 34.83 7.20

NA 92.93

090 bypass. 32855............. .............. C

Prepare donor lung,

0.00 0.00 0.00 0.00 0.00 0.00

XXX single. 32856............. .............. C

Prepare donor lung,

0.00 0.00 0.00 0.00 0.00 0.00

XXX double. 32900............. .............. A

Removal of rib(s)..... 20.24

NA 9.91 2.93

NA 33.08

090 32905............. .............. A

Revise & repair chest 20.72

NA 10.16 3.15

NA 34.03

090 wall. 32906............. .............. A

Revise & repair chest 26.73

NA 12.09 3.97

NA 42.79

090 wall. 32940............. .............. A

Revision of lung...... 19.40

NA 9.50 2.88

NA 31.78

090 32960............. .............. A

Therapeutic

1.84 1.74 0.56 0.16 3.74 2.56

000 pneumothorax. 32997............. .............. A

Total lung lavage..... 5.99

NA 1.92 0.55

NA 8.46

000 32999............. .............. C

Chest surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 33010............. .............. A

Drainage of heart sac. 2.24

NA 0.78 0.14

NA 3.16

000 33011............. .............. A

Repeat drainage of

2.24

NA 0.81 0.15

NA 3.20

000 heart sac. 33015............. .............. A

Incision of heart sac. 6.79

NA 4.96 0.65

NA 12.40

090 33020............. .............. A

Incision of heart sac. 12.59

NA 6.80 1.79

NA 21.18

090 33025............. .............. A

Incision of heart sac. 12.07

NA 6.37 1.80

NA 20.24

090 33030............. .............. A

Partial removal of

18.68

NA 9.55 2.83

NA 31.06

090 heart sac. 33031............. .............. A

Partial removal of

21.76

NA 10.06 3.13

NA 34.95

090 heart sac. 33050............. .............. A

Removal of heart sac

14.34

NA 7.86 2.14

NA 24.34

090 lesion. 33120............. .............. A

Removal of heart

24.52

NA 11.61 3.69

NA 39.82

090 lesion. 33130............. .............. A

Removal of heart

21.36

NA 10.14 3.00

NA 34.50

090 lesion. 33140............. .............. A

Heart revascularize

19.97

NA 10.91 2.85

NA 33.73

090 (tmr). 33141............. .............. A

Heart tmr w/other

4.83

NA 1.58 0.69

NA 7.10

ZZZ procedure. 33200............. .............. A

Insertion of heart

12.46

NA 6.86 1.70

NA 21.02

090 pacemaker. 33201............. .............. A

Insertion of heart

10.16

NA 6.60 1.36

NA 18.12

090 pacemaker. 33206............. .............. A

Insertion of heart

6.66

NA 4.47 0.52

NA 11.65

090 pacemaker. 33207............. .............. A

Insertion of heart

8.03

NA 4.67 0.59

NA 13.29

090 pacemaker. 33208............. .............. A

Insertion of heart

8.12

NA 4.78 0.56

NA 13.46

090 pacemaker. 33210............. .............. A

Insertion of heart

3.30

NA 1.25 0.18

NA 4.73

000 electrode. 33211............. .............. A

Insertion of heart

3.39

NA 1.31 0.21

NA 4.91

000 electrode. 33212............. .............. A

Insertion of pulse

5.51

NA 3.37 0.43

NA 9.31

090 generator. 33213............. .............. A

Insertion of pulse

6.36

NA 3.73 0.45

NA 10.54

090 generator. 33214............. .............. A

Upgrade of pacemaker

7.74

NA 4.90 0.58

NA 13.22

090 system.

[[Page 70369]]

33215............. .............. A

Reposition pacing-

4.75

NA 3.19 0.37

NA 8.31

090 defib lead. 33216............. .............. A

Insert lead pace-

5.77

NA 4.21 0.36

NA 10.34

090 defib, one. 33217............. .............. A

Insert lead pace-

5.74

NA 4.24 0.39

NA 10.37

090 defib, dual. 33218............. .............. A

Repair lead pace-

5.43

NA 4.31 0.37

NA 10.11

090 defib, one. 33220............. .............. A

Repair lead pace-

5.51

NA 4.28 0.37

NA 10.16

090 defib, dual. 33222............. .............. A

Revise pocket,

4.95

NA 4.30 0.42

NA 9.67

090 pacemaker. 33223............. .............. A

Revise pocket, pacing- 6.45

NA 4.60 0.45

NA 11.50

090 defib. 33224............. .............. A

Insert pacing lead &

9.04

NA 4.01 0.54

NA 13.59

000 connect. 33225............. .............. A

L ventric pacing lead

8.33

NA 3.26 0.45

NA 12.04

ZZZ add-on. 33226............. .............. A

Reposition l ventric

8.68

NA 3.83 0.59

NA 13.10

000 lead. 33233............. .............. A

Removal of pacemaker

3.29

NA 3.28 0.22

NA 6.79

090 system. 33234............. .............. A

Removal of pacemaker

7.81

NA 4.92 0.56

NA 13.29

090 system. 33235............. .............. A

Removal pacemaker

9.39

NA 6.83 0.73

NA 16.95

090 electrode. 33236............. .............. A

Remove electrode/

12.58

NA 7.45 1.68

NA 21.71

090 thoracotomy. 33237............. .............. A

Remove electrode/

13.69

NA 7.80 1.59

NA 23.08

090 thoracotomy. 33238............. .............. A

Remove electrode/

15.20

NA 8.22 2.02

NA 25.44

090 thoracotomy. 33240............. .............. A

Insert pulse generator 7.59

NA 4.59 0.41

NA 12.59

090 33241............. .............. A

Remove pulse generator 3.24

NA 2.97 0.18

NA 6.39

090 33243............. .............. A

Remove eltrd/

22.61

NA 11.49 2.09

NA 36.19

090 thoracotomy. 33244............. .............. A

Remove eltrd, transven 13.74

NA 8.92 0.99

NA 23.65

090 33245............. .............. A

Insert epic eltrd pace- 14.28

NA 7.92 2.01

NA 24.21

090 defib. 33246............. .............. A

Insert epic eltrd/

20.68

NA 10.31 2.63

NA 33.62

090 generator. 33249............. .............. A

Eltrd/insert pace-

14.21

NA 8.38 0.77

NA 23.36

090 defib. 33250............. .............. A

Ablate heart dysrhythm 21.82

NA 11.05 3.18

NA 36.05

090 focus. 33251............. .............. A

Ablate heart dysrhythm 24.84

NA 11.69 3.59

NA 40.12

090 focus. 33253............. .............. A

Reconstruct atria..... 31.01

NA 13.86 4.52

NA 49.39

090 33261............. .............. A

Ablate heart dysrhythm 24.84

NA 11.80 3.45

NA 40.09

090 focus. 33282............. .............. A

Implant pat-active ht

4.16

NA 4.03 0.23

NA 8.42

090 record. 33284............. .............. A

Remove pat-active ht

2.50

NA 3.54 0.14

NA 6.18

090 record. 33300............. .............. A

Repair of heart wound. 17.89

NA 9.26 2.65

NA 29.80

090 33305............. .............. A

Repair of heart wound. 21.41

NA 10.64 3.12

NA 35.17

090 33310............. .............. A

Exploratory heart

18.48

NA 9.61 2.58

NA 30.67

090 surgery. 33315............. .............. A

Exploratory heart

22.34

NA 10.91 3.27

NA 36.52

090 surgery. 33320............. .............. A

Repair major blood

16.76

NA 8.24 2.07

NA 27.07

090 vessel(s). 33321............. .............. A

Repair major vessel... 20.17

NA 9.81 2.90

NA 32.88

090 33322............. .............. A

Repair major blood

20.59

NA 10.39 2.85

NA 33.83

090 vessel(s). 33330............. .............. A

Insert major vessel

21.40

NA 10.29 2.81

NA 34.50

090 graft. 33332............. .............. A

Insert major vessel

23.92

NA 10.54 3.02

NA 37.48

090 graft. 33335............. .............. A

Insert major vessel

29.96

NA 13.37 4.27

NA 47.60

090 graft. 33400............. .............. A

Repair of aortic valve 28.46

NA 15.71 4.10

NA 48.27

090 33401............. .............. A

Valvuloplasty, open... 23.87

NA 13.54 3.56

NA 40.97

090 33403............. .............. A

Valvuloplasty, w/cp

24.85

NA 14.34 3.54

NA 42.73

090 bypass. 33404............. .............. A

Prepare heart-aorta

28.50

NA 14.58 4.32

NA 47.40

090 conduit. 33405............. .............. A

Replacement of aortic 34.95

NA 18.34 5.31

NA 58.60

090 valve. 33406............. .............. A

Replacement of aortic 37.44

NA 19.18 5.43

NA 62.05

090 valve. 33410............. .............. A

Replacement of aortic 32.41

NA 16.63 4.68

NA 53.72

090 valve. 33411............. .............. A

Replacement of aortic 36.20

NA 18.79 5.46

NA 60.45

090 valve. 33412............. .............. A

Replacement of aortic 41.94

NA 20.46 6.37

NA 68.77

090 valve. 33413............. .............. A

Replacement of aortic 43.43

NA 20.87 6.51

NA 70.81

090 valve. 33414............. .............. A

Repair of aortic valve 30.30

NA 14.17 4.56

NA 49.03

090 33415............. .............. A

Revision, subvalvular 27.11

NA 12.05 4.13

NA 43.29

090 tissue. 33416............. .............. A

Revise ventricle

30.30

NA 13.54 4.56

NA 48.40

090 muscle. 33417............. .............. A

Repair of aortic valve 28.49

NA 13.65 4.09

NA 46.23

090 33420............. .............. A

Revision of mitral

22.67

NA 9.59 1.81

NA 34.07

090 valve. 33422............. .............. A

Revision of mitral

25.90

NA 13.69 3.93

NA 43.52

090 valve. 33425............. .............. A

Repair of mitral valve 26.96

NA 13.09 4.06

NA 44.11

090 33426............. .............. A

Repair of mitral valve 32.95

NA 17.18 5.01

NA 55.14

090 33427............. .............. A

Repair of mitral valve 39.94

NA 19.42 6.07

NA 65.43

090 33430............. .............. A

Replacement of mitral 33.45

NA 17.34 5.08

NA 55.87

090 valve. 33460............. .............. A

Revision of tricuspid 23.56

NA 11.33 3.44

NA 38.33

090 valve. 33463............. .............. A

Valvuloplasty,

25.58

NA 12.95 3.86

NA 42.39

090 tricuspid. 33464............. .............. A

Valvuloplasty,

27.29

NA 13.56 4.14

NA 44.99

090 tricuspid. 33465............. .............. A

Replace tricuspid

28.75

NA 13.00 4.38

NA 46.13

090 valve. 33468............. .............. A

Revision of tricuspid 30.07

NA 13.69 4.06

NA 47.82

090 valve. 33470............. .............. A

Revision of pulmonary 20.78

NA 10.72 1.03

NA 32.53

090 valve. 33471............. .............. A

Valvotomy, pulmonary

22.22

NA 9.78 3.38

NA 35.38

090 valve. 33472............. .............. A

Revision of pulmonary 22.22

NA 11.89 3.54

NA 37.65

090 valve. 33474............. .............. A

Revision of pulmonary 23.01

NA 10.91 3.21

NA 37.13

090 valve. 33475............. .............. A

Replacement, pulmonary 32.95

NA 15.41 4.92

NA 53.28

090 valve. 33476............. .............. A

Revision of heart

25.73

NA 11.99 2.41

NA 40.13

090 chamber. 33478............. .............. A

Revision of heart

26.70

NA 13.09 3.88

NA 43.67

090 chamber. 33496............. .............. A

Repair, prosth valve

27.21

NA 12.78 4.12

NA 44.11

090 clot. 33500............. .............. A

Repair heart vessel

25.51

NA 11.49 3.86

NA 40.86

090 fistula. 33501............. .............. A

Repair heart vessel

17.75

NA 8.30 1.90

NA 27.95

090 fistula. 33502............. .............. A

Coronary artery

21.01

NA 11.10 2.99

NA 35.10

090 correction.

[[Page 70370]]

33503............. .............. A

Coronary artery graft. 21.75

NA 9.76 1.77

NA 33.28

090 33504............. .............. A

Coronary artery graft. 24.62

NA 11.84 3.35

NA 39.81

090 33505............. .............. A

Repair artery w/tunnel 26.80

NA 12.94 2.18

NA 41.92

090 33506............. .............. A

Repair artery,

35.45

NA 14.60 4.65

NA 54.70

090 translocation. 33507............. .............. A

Repair art, intramural 30.00

NA 13.68 4.05

NA 47.73

090 33508............. .............. A

Endoscopic vein

0.31

NA 0.10 0.04

NA 0.45

ZZZ harvest. 33510............. .............. A

CABG, vein, single.... 28.96

NA 16.38 4.40

NA 49.74

090 33511............. .............. A

CABG, vein, two....... 29.96

NA 17.12 4.55

NA 51.63

090 33512............. .............. A

CABG, vein, three..... 31.75

NA 17.65 4.66

NA 54.06

090 33513............. .............. A

CABG, vein, four...... 31.95

NA 17.83 4.87

NA 54.65

090 33514............. .............. A

CABG, vein, five...... 32.70

NA 18.10 4.76

NA 55.56

090 33516............. .............. A

Cabg, vein, six or

34.95

NA 18.85 5.11

NA 58.91

090 more. 33517............. .............. A

CABG, artery-vein,

2.57

NA 0.84 0.39

NA 3.80

ZZZ single. 33518............. .............. A

CABG, artery-vein, two 4.84

NA 1.58 0.73

NA 7.15

ZZZ 33519............. .............. A

CABG, artery-vein,

7.11

NA 2.33 1.04

NA 10.48

ZZZ three. 33521............. .............. A

CABG, artery-vein,

9.39

NA 3.08 1.37

NA 13.84

ZZZ four. 33522............. .............. A

CABG, artery-vein,

11.65

NA 3.82 1.77

NA 17.24

ZZZ five. 33523............. .............. A

Cabg, art-vein, six or 13.93

NA 4.54 2.12

NA 20.59

ZZZ more. 33530............. .............. A

Coronary artery,

5.85

NA 1.92 0.88

NA 8.65

ZZZ bypass/reop. 33533............. .............. A

CABG, arterial, single 29.96

NA 16.51 4.55

NA 51.02

090 33534............. .............. A

CABG, arterial, two... 32.15

NA 17.76 4.69

NA 54.60

090 33535............. .............. A

CABG, arterial, three. 34.45

NA 18.18 5.01

NA 57.64

090 33536............. .............. A

Cabg, arterial, four

37.44

NA 18.34 5.42

NA 61.20

090 or more. 33542............. .............. A

Removal of heart

28.81

NA 13.03 4.37

NA 46.21

090 lesion. 33545............. .............. A

Repair of heart damage 36.72

NA 15.67 5.19

NA 57.58

090 33548............. .............. A

Restore/remodel,

37.97

NA 19.35 5.51

NA 62.83

090 ventricle. 33572............. .............. A

Open coronary

4.44

NA 1.45 0.65

NA 6.54

ZZZ endarterectomy. 33600............. .............. A

Closure of valve...... 29.47

NA 12.55 4.41

NA 46.43

090 33602............. .............. A

Closure of valve...... 28.50

NA 12.48 3.81

NA 44.79

090 33606............. .............. A

Anastomosis/artery-

30.69

NA 13.71 4.40

NA 48.80

090 aorta. 33608............. .............. A

Repair anomaly w/

31.04

NA 14.14 4.73

NA 49.91

090 conduit. 33610............. .............. A

Repair by enlargement. 30.56

NA 13.64 4.55

NA 48.75

090 33611............. .............. A

Repair double

33.95

NA 14.17 4.36

NA 52.48

090 ventricle. 33612............. .............. A

Repair double

34.95

NA 15.19 5.28

NA 55.42

090 ventricle. 33615............. .............. A

Repair, modified

33.95

NA 13.18 4.31

NA 51.44

090 fontan. 33617............. .............. A

Repair single

36.94

NA 16.04 5.64

NA 58.62

090 ventricle. 33619............. .............. A

Repair single

44.93

NA 20.86 6.44

NA 72.23

090 ventricle. 33641............. .............. A

Repair heart septum

21.36

NA 9.60 3.22

NA 34.18

090 defect. 33645............. .............. A

Revision of heart

24.78

NA 11.80 3.78

NA 40.36

090 veins. 33647............. .............. A

Repair heart septum

28.69

NA 13.81 3.31

NA 45.81

090 defects. 33660............. .............. A

Repair of heart

29.96

NA 13.52 4.48

NA 47.96

090 defects. 33665............. .............. A

Repair of heart

28.56

NA 13.87 3.99

NA 46.42

090 defects. 33670............. .............. A

Repair of heart

34.95

NA 13.21 4.64

NA 52.80

090 chambers. 33681............. .............. A

Repair heart septum

30.56

NA 14.72 4.44

NA 49.72

090 defect. 33684............. .............. A

Repair heart septum

29.61

NA 13.66 3.38

NA 46.65

090 defect. 33688............. .............. A

Repair heart septum

30.57

NA 10.50 4.72

NA 45.79

090 defect. 33690............. .............. A

Reinforce pulmonary

19.52

NA 10.19 1.96

NA 31.67

090 artery. 33692............. .............. A

Repair of heart

30.70

NA 13.96 4.57

NA 49.23

090 defects. 33694............. .............. A

Repair of heart

33.95

NA 14.26 5.26

NA 53.47

090 defects. 33697............. .............. A

Repair of heart

35.95

NA 14.91 4.08

NA 54.94

090 defects. 33702............. .............. A

Repair of heart

26.50

NA 12.60 3.67

NA 42.77

090 defects. 33710............. .............. A

Repair of heart

29.67

NA 14.00 4.42

NA 48.09

090 defects. 33720............. .............. A

Repair of heart defect 26.52

NA 12.32 3.83

NA 42.67

090 33722............. .............. A

Repair of heart defect 28.37

NA 13.89 1.30

NA 43.56

090 33730............. .............. A

Repair heart-vein

34.20

NA 14.16 5.01

NA 53.37

090 defect(s). 33732............. .............. A

Repair heart-vein

28.12

NA 13.42 3.67

NA 45.21

090 defect. 33735............. .............. A

Revision of heart

21.36

NA 8.98 1.91

NA 32.25

090 chamber. 33736............. .............. A

Revision of heart

23.48

NA 11.88 3.08

NA 38.44

090 chamber. 33737............. .............. A

Revision of heart

21.73

NA 10.96 3.24

NA 35.93

090 chamber. 33750............. .............. A

Major vessel shunt.... 21.38

NA 10.24 1.16

NA 32.78

090 33755............. .............. A

Major vessel shunt.... 21.76

NA 8.83 3.25

NA 33.84

090 33762............. .............. A

Major vessel shunt.... 21.76

NA 10.18 3.13

NA 35.07

090 33764............. .............. A

Major vessel shunt &

21.76

NA 10.25 3.00

NA 35.01

090 graft. 33766............. .............. A

Major vessel shunt.... 22.73

NA 11.70 3.69

NA 38.12

090 33767............. .............. A

Major vessel shunt.... 24.46

NA 11.75 3.81

NA 40.02

090 33768............. .............. A

Cavopulmonary shunting 8.00

NA 2.67 1.19

NA 11.86

ZZZ 33770............. .............. A

Repair great vessels

36.94

NA 14.72 5.72

NA 57.38

090 defect. 33771............. .............. A

Repair great vessels

34.60

NA 12.42 5.66

NA 52.68

090 defect. 33774............. .............. A

Repair great vessels

30.93

NA 14.70 4.80

NA 50.43

090 defect. 33775............. .............. A

Repair great vessels

32.15

NA 15.03 4.98

NA 52.16

090 defect. 33776............. .............. A

Repair great vessels

33.99

NA 15.85 5.07

NA 54.91

090 defect. 33777............. .............. A

Repair great vessels

33.41

NA 15.66 5.47

NA 54.54

090 defect. 33778............. .............. A

Repair great vessels

39.94

NA 16.94 6.18

NA 63.06

090 defect. 33779............. .............. A

Repair great vessels

36.16

NA 15.41 2.91

NA 54.48

090 defect. 33780............. .............. A

Repair great vessels

41.69

NA 19.14 3.67

NA 64.50

090 defect.

[[Page 70371]]

33781............. .............. A

Repair great vessels

36.40

NA 13.37 5.95

NA 55.72

090 defect. 33786............. .............. A

Repair arterial trunk. 38.94

NA 16.76 5.69

NA 61.39

090 33788............. .............. A

Revision of pulmonary 26.58

NA 11.98 4.02

NA 42.58

090 artery. 33800............. .............. A

Aortic suspension..... 16.22

NA 8.13 2.45

NA 26.80

090 33802............. .............. A

Repair vessel defect.. 17.63

NA 9.25 2.26

NA 29.14

090 33803............. .............. A

Repair vessel defect.. 19.57

NA 9.79 3.19

NA 32.55

090 33813............. .............. A

Repair septal defect.. 20.62

NA 10.94 3.12

NA 34.68

090 33814............. .............. A

Repair septal defect.. 25.73

NA 12.68 3.84

NA 42.25

090 33820............. .............. A

Revise major vessel... 16.27

NA 8.38 2.34

NA 26.99

090 33822............. .............. A

Revise major vessel... 17.29

NA 8.98 2.67

NA 28.94

090 33824............. .............. A

Revise major vessel... 19.49

NA 10.01 2.88

NA 32.38

090 33840............. .............. A

Remove aorta

20.60

NA 10.32 2.15

NA 33.07

090 constriction. 33845............. .............. A

Remove aorta

22.09

NA 11.38 3.21

NA 36.68

090 constriction. 33851............. .............. A

Remove aorta

21.24

NA 10.71 3.17

NA 35.12

090 constriction. 33852............. .............. A

Repair septal defect.. 23.67

NA 11.39 2.15

NA 37.21

090 33853............. .............. A

Repair septal defect.. 31.67

NA 14.86 4.47

NA 51.00

090 33860............. .............. A

Ascending aortic graft 37.94

NA 16.50 5.74

NA 60.18

090 33861............. .............. A

Ascending aortic graft 41.94

NA 17.76 6.35

NA 66.05

090 33863............. .............. A

Ascending aortic graft 44.93

NA 18.74 6.57

NA 70.24

090 33870............. .............. A

Transverse aortic arch 43.93

NA 18.43 6.60

NA 68.96

090 graft. 33875............. .............. A

Thoracic aortic graft. 33.01

NA 14.13 4.88

NA 52.02

090 33877............. .............. A

Thoracoabdominal graft 42.54

NA 16.36 5.92

NA 64.82

090 33880............. .............. A

Endovasc taa repr incl 33.00

NA 13.51 2.74

NA 49.25

090 subcl. 33881............. .............. A

Endovasc taa repr w/o 28.00

NA 11.99 2.32

NA 42.31

090 subcl. 33883............. .............. A

Insert endovasc

20.00

NA 9.21 2.10

NA 31.31

090 prosth, taa. 33884............. .............. A

Endovasc prosth, taa,

8.20

NA 2.58 0.86

NA 11.64

ZZZ add-on. 33886............. .............. A

Endovasc prosth,

17.00

NA 8.25 1.79

NA 27.04

090 delayed. 33889............. .............. A

Artery transpose/

15.92

NA 5.19 2.17

NA 23.28

000 endovas taa. 33891............. .............. A

Car-car bp grft/

20.00

NA 6.98 2.72

NA 29.70

000 endovas taa. 33910............. .............. A

Remove lung artery

24.55

NA 11.46 3.69

NA 39.70

090 emboli. 33915............. .............. A

Remove lung artery

20.99

NA 9.66 1.44

NA 32.09

090 emboli. 33916............. .............. A

Surgery of great

25.79

NA 11.37 3.66

NA 40.82

090 vessel. 33917............. .............. A

Repair pulmonary

24.46

NA 12.22 3.69

NA 40.37

090 artery. 33920............. .............. A

Repair pulmonary

31.90

NA 13.86 4.37

NA 50.13

090 atresia. 33922............. .............. A

Transect pulmonary

23.48

NA 10.93 3.09

NA 37.50

090 artery. 33924............. .............. A

Remove pulmonary shunt 5.49

NA 1.85 0.82

NA 8.16

ZZZ 33925............. .............. A

Rpr pul art unifocal w/ 29.50

NA 14.70 4.60

NA 48.80

090 o cpb. 33926............. .............. A

Repr pul art, unifocal 42.00

NA 17.73 6.20

NA 65.93

090 w/cpb. 33930............. .............. X

Removal of donor heart/ 0.00 0.00 0.00 0.00 0.00 0.00

XXX lung. 33933............. .............. C

Prepare donor heart/

0.00 0.00 0.00 0.00 0.00 0.00

XXX lung. 33935............. .............. R

Transplantation, heart/ 60.87

NA 28.85 9.03

NA 98.75

090 lung. 33940............. .............. X

Removal of donor heart 0.00 0.00 0.00 0.00 0.00 0.00

XXX 33944............. .............. C

Prepare donor heart... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 33945............. .............. R

Transplantation of

42.04

NA 21.45 6.24

NA 69.73

090 heart. 33960............. .............. A

External circulation

19.33

NA 4.92 2.66

NA 26.91

000 assist. 33961............. .............. A

External circulation

10.91

NA 3.62 0.88

NA 15.41

ZZZ assist. 33967............. .............. A

Insert ia percut

4.84

NA 1.85 0.35

NA 7.04

000 device. 33968............. .............. A

Remove aortic assist

0.64

NA 0.23 0.07

NA 0.94

000 device. 33970............. .............. A

Aortic circulation

6.74

NA 2.29 0.82

NA 9.85

000 assist. 33971............. .............. A

Aortic circulation

9.68

NA 6.02 1.25

NA 16.95

090 assist. 33973............. .............. A

Insert balloon device. 9.75

NA 3.32 1.26

NA 14.33

000 33974............. .............. A

Remove intra-aortic

14.39

NA 7.90 1.73

NA 24.02

090 balloon. 33975............. .............. A

Implant ventricular

20.97

NA 6.30 3.06

NA 30.33

XXX device. 33976............. .............. A

Implant ventricular

22.97

NA 7.57 3.25

NA 33.79

XXX device. 33977............. .............. A

Remove ventricular

19.26

NA 11.10 2.80

NA 33.16

090 device. 33978............. .............. A

Remove ventricular

21.70

NA 11.78 3.30

NA 36.78

090 device. 33979............. .............. A

Insert intracorporeal 45.93

NA 14.96 6.95

NA 67.84

XXX device. 33980............. .............. A

Remove intracorporeal 56.17

NA 25.31 8.56

NA 90.04

090 device. 33999............. .............. C

Cardiac surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 34001............. .............. A

Removal of artery clot 12.89

NA 6.73 1.84

NA 21.46

090 34051............. .............. A

Removal of artery clot 15.19

NA 7.80 2.20

NA 25.19

090 34101............. .............. A

Removal of artery clot 9.99

NA 5.37 1.41

NA 16.77

090 34111............. .............. A

Removal of arm artery

9.99

NA 5.37 1.40

NA 16.76

090 clot. 34151............. .............. A

Removal of artery clot 24.96

NA 10.43 3.55

NA 38.94

090 34201............. .............. A

Removal of artery clot 10.01

NA 5.43 1.45

NA 16.89

090 34203............. .............. A

Removal of leg artery 16.48

NA 8.08 2.35

NA 26.91

090 clot. 34401............. .............. A

Removal of vein clot.. 24.96

NA 10.69 3.09

NA 38.74

090 34421............. .............. A

Removal of vein clot.. 11.98

NA 6.31 1.55

NA 19.84

090 34451............. .............. A

Removal of vein clot.. 26.96

NA 11.47 3.83

NA 42.26

090 34471............. .............. A

Removal of vein clot.. 10.16

NA 5.32 1.18

NA 16.66

090 34490............. .............. A

Removal of vein clot.. 9.85

NA 5.44 1.41

NA 16.70

090 34501............. .............. A

Repair valve, femoral 15.98

NA 8.51 2.34

NA 26.83

090 vein. 34502............. .............. A

Reconstruct vena cava. 26.91

NA 12.33 3.62

NA 42.86

090 34510............. .............. A

Transposition of vein 18.92

NA 9.44 2.32

NA 30.68

090 valve. 34520............. .............. A

Cross-over vein graft. 17.92

NA 8.47 2.28

NA 28.67

090

[[Page 70372]]

34530............. .............. A

Leg vein fusion....... 16.62

NA 8.63 1.73

NA 26.98

090 34800............. .............. A

Endovas aaa repr w/sm 20.72

NA 9.19 2.45

NA 32.36

090 tube. 34802............. .............. A

Endovas aaa repr w/2-p 22.97

NA 9.81 2.32

NA 35.10

090 part. 34803............. .............. A

Endovas aaa repr w/3-p 24.00

NA 10.24 2.00

NA 36.24

090 part. 34804............. .............. A

Endovas aaa repr w/1-p 22.97

NA 9.83 2.29

NA 35.09

090 part. 34805............. .............. A

Endovas aaa repr w/

21.85

NA 9.67 2.00

NA 33.52

090 long tube. 34808............. .............. A

Endovas iliac a device 4.12

NA 1.37 0.59

NA 6.08

ZZZ addon. 34812............. .............. A

Xpose for endoprosth,

6.74

NA 2.24 1.18

NA 10.16

000 femorl. 34813............. .............. A

Femoral endovas graft

4.79

NA 1.57 0.67

NA 7.03

ZZZ add-on. 34820............. .............. A

Xpose for endoprosth,

9.74

NA 3.24 1.50

NA 14.48

000 iliac. 34825............. .............. A

Endovasc extend

11.98

NA 6.16 1.28

NA 19.42

090 prosth, init. 34826............. .............. A

Endovasc exten prosth, 4.12

NA 1.37 0.44

NA 5.93

ZZZ add'l. 34830............. .............. A

Open aortic tube

32.54

NA 13.73 4.54

NA 50.81

090 prosth repr. 34831............. .............. A

Open aortoiliac prosth 35.29

NA 11.76 4.88

NA 51.93

090 repr. 34832............. .............. A

Open aortofemor prosth 35.29

NA 14.66 4.84

NA 54.79

090 repr. 34833............. .............. A

Xpose for endoprosth, 11.98

NA 4.44 1.69

NA 18.11

000 iliac. 34834............. .............. A

Xpose, endoprosth,

5.34

NA 2.20 0.76

NA 8.30

000 brachial. 34900............. .............. A

Endovasc iliac repr w/ 16.36

NA 7.60 1.99

NA 25.95

090 graft. 35001............. .............. A

Repair defect of

19.61

NA 9.58 2.80

NA 31.99

090 artery. 35002............. .............. A

Repair artery rupture, 20.97

NA 9.72 2.99

NA 33.68

090 neck. 35005............. .............. A

Repair defect of

18.09

NA 8.87 1.76

NA 28.72

090 artery. 35011............. .............. A

Repair defect of

17.97

NA 8.00 2.54

NA 28.51

090 artery. 35013............. .............. A

Repair artery rupture, 21.97

NA 9.70 3.09

NA 34.76

090 arm. 35021............. .............. A

Repair defect of

19.62

NA 9.44 2.86

NA 31.92

090 artery. 35022............. .............. A

Repair artery rupture, 23.15

NA 9.88 3.16

NA 36.19

090 chest. 35045............. .............. A

Repair defect of arm

17.54

NA 7.52 2.44

NA 27.50

090 artery. 35081............. .............. A

Repair defect of

27.97

NA 11.49 4.00

NA 43.46

090 artery. 35082............. .............. A

Repair artery rupture, 38.44

NA 15.33 5.42

NA 59.19

090 aorta. 35091............. .............. A

Repair defect of

35.35

NA 13.60 5.12

NA 54.07

090 artery. 35092............. .............. A

Repair artery rupture, 44.93

NA 17.68 6.38

NA 68.99

090 aorta. 35102............. .............. A

Repair defect of

30.71

NA 12.39 4.47

NA 47.57

090 artery. 35103............. .............. A

Repair artery rupture, 40.44

NA 15.89 5.74

NA 62.07

090 groin. 35111............. .............. A

Repair defect of

24.96

NA 10.49 3.46

NA 38.91

090 artery. 35112............. .............. A

Repair artery

29.96

NA 11.99 4.07

NA 46.02

090 rupture,spleen. 35121............. .............. A

Repair defect of

29.96

NA 12.40 4.29

NA 46.65

090 artery. 35122............. .............. A

Repair artery rupture, 34.95

NA 13.84 4.74

NA 53.53

090 belly. 35131............. .............. A

Repair defect of

24.96

NA 10.77 3.79

NA 39.52

090 artery. 35132............. .............. A

Repair artery rupture, 29.96

NA 12.41 4.29

NA 46.66

090 groin. 35141............. .............. A

Repair defect of

19.97

NA 8.94 2.89

NA 31.80

090 artery. 35142............. .............. A

Repair artery rupture, 23.27

NA 10.39 3.35

NA 37.01

090 thigh. 35151............. .............. A

Repair defect of

22.61

NA 10.01 3.23

NA 35.85

090 artery. 35152............. .............. A

Repair artery rupture, 25.58

NA 11.40 3.60

NA 40.58

090 knee. 35180............. .............. A

Repair blood vessel

13.60

NA 6.96 1.00

NA 21.56

090 lesion. 35182............. .............. A

Repair blood vessel

29.96

NA 12.83 4.35

NA 47.14

090 lesion. 35184............. .............. A

Repair blood vessel

17.97

NA 8.31 2.52

NA 28.80

090 lesion. 35188............. .............. A

Repair blood vessel

14.26

NA 7.65 2.15

NA 24.06

090 lesion. 35189............. .............. A

Repair blood vessel

27.96

NA 11.98 4.00

NA 43.94

090 lesion. 35190............. .............. A

Repair blood vessel

12.73

NA 6.49 1.79

NA 21.01

090 lesion. 35201............. .............. A

Repair blood vessel

16.12

NA 8.01 2.33

NA 26.46

090 lesion. 35206............. .............. A

Repair blood vessel

13.23

NA 6.57 1.86

NA 21.66

090 lesion. 35207............. .............. A

Repair blood vessel

10.13

NA 7.37 1.48

NA 18.98

090 lesion. 35211............. .............. A

Repair blood vessel

22.09

NA 10.64 3.19

NA 35.92

090 lesion. 35216............. .............. A

Repair blood vessel

18.72

NA 9.00 2.64

NA 30.36

090 lesion. 35221............. .............. A

Repair blood vessel

24.35

NA 9.96 3.36

NA 37.67

090 lesion. 35226............. .............. A

Repair blood vessel

14.48

NA 7.45 2.01

NA 23.94

090 lesion. 35231............. .............. A

Repair blood vessel

19.97

NA 9.79 2.88

NA 32.64

090 lesion. 35236............. .............. A

Repair blood vessel

17.08

NA 7.90 2.42

NA 27.40

090 lesion. 35241............. .............. A

Repair blood vessel

23.09

NA 11.15 3.52

NA 37.76

090 lesion. 35246............. .............. A

Repair blood vessel

26.41

NA 11.45 3.85

NA 41.71

090 lesion. 35251............. .............. A

Repair blood vessel

30.15

NA 11.82 4.12

NA 46.09

090 lesion. 35256............. .............. A

Repair blood vessel

18.33

NA 8.37 2.62

NA 29.32

090 lesion. 35261............. .............. A

Repair blood vessel

17.77

NA 8.03 2.60

NA 28.40

090 lesion. 35266............. .............. A

Repair blood vessel

14.89

NA 7.02 2.09

NA 24.00

090 lesion. 35271............. .............. A

Repair blood vessel

22.09

NA 10.54 3.15

NA 35.78

090 lesion. 35276............. .............. A

Repair blood vessel

24.21

NA 11.23 3.48

NA 38.92

090 lesion. 35281............. .............. A

Repair blood vessel

27.96

NA 11.73 3.96

NA 43.65

090 lesion. 35286............. .............. A

Repair blood vessel

16.14

NA 8.07 2.34

NA 26.55

090 lesion. 35301............. .............. A

Rechanneling of artery 18.67

NA 8.45 2.67

NA 29.79

090 35311............. .............. A

Rechanneling of artery 26.96

NA 11.77 3.41

NA 42.14

090 35321............. .............. A

Rechanneling of artery 15.98

NA 7.40 2.24

NA 25.62

090 35331............. .............. A

Rechanneling of artery 26.16

NA 11.26 3.82

NA 41.24

090 35341............. .............. A

Rechanneling of artery 25.07

NA 10.89 3.77

NA 39.73

090 35351............. .............. A

Rechanneling of artery 22.97

NA 9.62 3.34

NA 35.93

090 35355............. .............. A

Rechanneling of artery 18.47

NA 8.10 2.66

NA 29.23

090 35361............. .............. A

Rechanneling of artery 28.16

NA 11.73 4.14

NA 44.03

090

[[Page 70373]]

35363............. .............. A

Rechanneling of artery 30.15

NA 12.62 4.32

NA 47.09

090 35371............. .............. A

Rechanneling of artery 14.70

NA 6.97 2.13

NA 23.80

090 35372............. .............. A

Rechanneling of artery 17.97

NA 8.06 2.62

NA 28.65

090 35381............. .............. A

Rechanneling of artery 15.79

NA 7.83 2.25

NA 25.87

090 35390............. .............. A

Reoperation, carotid

3.19

NA 1.06 0.46

NA 4.71

ZZZ add-on. 35400............. .............. A

Angioscopy............ 3.00

NA 1.11 0.43

NA 4.54

ZZZ 35450............. .............. A

Repair arterial

10.05

NA 3.57 1.25

NA 14.87

000 blockage. 35452............. .............. A

Repair arterial

6.90

NA 2.61 0.94

NA 10.45

000 blockage. 35454............. .............. A

Repair arterial

6.03

NA 2.32 0.87

NA 9.22

000 blockage. 35456............. .............. A

Repair arterial

7.34

NA 2.77 1.04

NA 11.15

000 blockage. 35458............. .............. A

Repair arterial

9.48

NA 3.48 1.26

NA 14.22

000 blockage. 35459............. .............. A

Repair arterial

8.62

NA 3.18 1.21

NA 13.01

000 blockage. 35460............. .............. A

Repair venous blockage 6.03

NA 2.28 0.83

NA 9.14

000 35470............. .............. A

Repair arterial

8.62 89.12 3.36 0.69 98.43 12.67

000 blockage. 35471............. .............. A

Repair arterial

10.05 100.55 3.96 0.67 111.27 14.68

000 blockage. 35472............. .............. A

Repair arterial

6.90 64.54 2.75 0.58 72.02 10.23

000 blockage. 35473............. .............. A

Repair arterial

6.03 60.01 2.43 0.51 66.55 8.97

000 blockage. 35474............. .............. A

Repair arterial

7.35 87.98 2.90 0.57 95.90 10.82

000 blockage. 35475............. .............. R

Repair arterial

9.48 56.26 3.57 0.62 66.36 13.67

000 blockage. 35476............. .............. A

Repair venous blockage 6.03 44.86 2.36 0.34 51.23 8.73

000 35480............. .............. A

Atherectomy, open..... 11.06

NA 4.05 1.28

NA 16.39

000 35481............. .............. A

Atherectomy, open..... 7.60

NA 2.88 1.13

NA 11.61

000 35482............. .............. A

Atherectomy, open..... 6.64

NA 2.57 0.89

NA 10.10

000 35483............. .............. A

Atherectomy, open..... 8.09

NA 3.03 1.15

NA 12.27

000 35484............. .............. A

Atherectomy, open..... 10.42

NA 3.78 1.27

NA 15.47

000 35485............. .............. A

Atherectomy, open..... 9.48

NA 3.54 1.35

NA 14.37

000 35490............. .............. A

Atherectomy,

11.06

NA 4.71 0.71

NA 16.48

000 percutaneous. 35491............. .............. A

Atherectomy,

7.60

NA 3.30 0.74

NA 11.64

000 percutaneous. 35492............. .............. A

Atherectomy,

6.64

NA 3.20 0.43

NA 10.27

000 percutaneous. 35493............. .............. A

Atherectomy,

8.09

NA 3.81 0.56

NA 12.46

000 percutaneous. 35494............. .............. A

Atherectomy,

10.42

NA 4.47 0.59

NA 15.48

000 percutaneous. 35495............. .............. A

Atherectomy,

9.48

NA 4.40 0.69

NA 14.57

000 percutaneous. 35500............. .............. A

Harvest vein for

6.44

NA 2.03 0.93

NA 9.40

ZZZ bypass. 35501............. .............. A

Artery bypass graft... 19.16

NA 8.48 2.80

NA 30.44

090 35506............. .............. A

Artery bypass graft... 19.64

NA 9.49 2.86

NA 31.99

090 35507............. .............. A

Artery bypass graft... 19.64

NA 9.45 2.84

NA 31.93

090 35508............. .............. A

Artery bypass graft... 18.62

NA 9.47 2.77

NA 30.86

090 35509............. .............. A

Artery bypass graft... 18.04

NA 8.79 2.61

NA 29.44

090 35510............. .............. A

Artery bypass graft... 22.97

NA 10.20 2.11

NA 35.28

090 35511............. .............. A

Artery bypass graft... 21.17

NA 9.38 2.90

NA 33.45

090 35512............. .............. A

Artery bypass graft... 22.47

NA 10.03 2.11

NA 34.61

090 35515............. .............. A

Artery bypass graft... 18.62

NA 9.31 2.77

NA 30.70

090 35516............. .............. A

Artery bypass graft... 16.30

NA 6.82 2.33

NA 25.45

090 35518............. .............. A

Artery bypass graft... 21.17

NA 9.00 3.02

NA 33.19

090 35521............. .............. A

Artery bypass graft... 22.17

NA 9.86 3.12

NA 35.15

090 35522............. .............. A

Artery bypass graft... 21.73

NA 9.78 2.11

NA 33.62

090 35525............. .............. A

Artery bypass graft... 20.60

NA 9.40 2.11

NA 32.11

090 35526............. .............. A

Artery bypass graft... 29.91

NA 12.54 3.62

NA 46.07

090 35531............. .............. A

Artery bypass graft... 36.15

NA 14.51 5.16

NA 55.82

090 35533............. .............. A

Artery bypass graft... 27.96

NA 11.75 3.84

NA 43.55

090 35536............. .............. A

Artery bypass graft... 31.65

NA 12.98 4.61

NA 49.24

090 35541............. .............. A

Artery bypass graft... 25.76

NA 11.23 3.70

NA 40.69

090 35546............. .............. A

Artery bypass graft... 25.50

NA 10.89 3.69

NA 40.08

090 35548............. .............. A

Artery bypass graft... 21.54

NA 9.45 2.97

NA 33.96

090 35549............. .............. A

Artery bypass graft... 23.31

NA 10.40 3.29

NA 37.00

090 35551............. .............. A

Artery bypass graft... 26.63

NA 11.52 3.74

NA 41.89

090 35556............. .............. A

Artery bypass graft... 21.73

NA 9.75 3.09

NA 34.57

090 35558............. .............. A

Artery bypass graft... 21.17

NA 9.57 2.99

NA 33.73

090 35560............. .............. A

Artery bypass graft... 31.95

NA 13.35 4.74

NA 50.04

090 35563............. .............. A

Artery bypass graft... 24.16

NA 10.55 3.51

NA 38.22

090 35565............. .............. A

Artery bypass graft... 23.17

NA 10.16 3.29

NA 36.62

090 35566............. .............. A

Artery bypass graft... 26.88

NA 11.41 3.82

NA 42.11

090 35571............. .............. A

Artery bypass graft... 24.02

NA 10.87 3.42

NA 38.31

090 35572............. .............. A

Harvest

6.81

NA 2.25 0.99

NA 10.05

ZZZ femoropopliteal vein. 35583............. .............. A

Vein bypass graft..... 22.34

NA 10.18 3.16

NA 35.68

090 35585............. .............. A

Vein bypass graft..... 28.35

NA 12.25 4.01

NA 44.61

090 35587............. .............. A

Vein bypass graft..... 24.71

NA 11.48 3.51

NA 39.70

090 35600............. .............. A

Harvest artery for

4.94

NA 1.62 0.73

NA 7.29

ZZZ cabg. 35601............. .............. A

Artery bypass graft... 17.47

NA 8.64 2.49

NA 28.60

090 35606............. .............. A

Artery bypass graft... 18.68

NA 9.04 2.69

NA 30.41

090 35612............. .............. A

Artery bypass graft... 15.74

NA 7.90 2.08

NA 25.72

090 35616............. .............. A

Artery bypass graft... 15.68

NA 8.12 2.19

NA 25.99

090 35621............. .............. A

Artery bypass graft... 19.97

NA 8.70 2.91

NA 31.58

090 35623............. .............. A

Bypass graft, not vein 23.96

NA 10.52 3.45

NA 37.93

090 35626............. .............. A

Artery bypass graft... 27.71

NA 12.00 4.07

NA 43.78

090

[[Page 70374]]

35631............. .............. A

Artery bypass graft... 33.95

NA 13.87 4.95

NA 52.77

090 35636............. .............. A

Artery bypass graft... 29.46

NA 12.33 4.09

NA 45.88

090 35641............. .............. A

Artery bypass graft... 24.53

NA 11.09 3.53

NA 39.15

090 35642............. .............. A

Artery bypass graft... 17.95

NA 8.71 2.27

NA 28.93

090 35645............. .............. A

Artery bypass graft... 17.44

NA 8.29 2.49

NA 28.22

090 35646............. .............. A

Artery bypass graft... 30.95

NA 13.14 4.43

NA 48.52

090 35647............. .............. A

Artery bypass graft... 27.96

NA 11.80 3.98

NA 43.74

090 35650............. .............. A

Artery bypass graft... 18.97

NA 8.38 2.71

NA 30.06

090 35651............. .............. A

Artery bypass graft... 25.00

NA 10.75 3.35

NA 39.10

090 35654............. .............. A

Artery bypass graft... 24.96

NA 10.68 3.52

NA 39.16

090 35656............. .............. A

Artery bypass graft... 19.50

NA 8.62 2.79

NA 30.91

090 35661............. .............. A

Artery bypass graft... 18.97

NA 8.95 2.71

NA 30.63

090 35663............. .............. A

Artery bypass graft... 21.97

NA 10.00 3.10

NA 35.07

090 35665............. .............. A

Artery bypass graft... 20.97

NA 9.47 3.00

NA 33.44

090 35666............. .............. A

Artery bypass graft... 22.16

NA 10.67 3.15

NA 35.98

090 35671............. .............. A

Artery bypass graft... 19.30

NA 9.39 2.77

NA 31.46

090 35681............. .............. A

Composite bypass graft 1.60

NA 0.53 0.23

NA 2.36

ZZZ 35682............. .............. A

Composite bypass graft 7.19

NA 2.39 1.03

NA 10.61

ZZZ 35683............. .............. A

Composite bypass graft 8.49

NA 2.83 1.20

NA 12.52

ZZZ 35685............. .............. A

Bypass graft patency/

4.04

NA 1.35 0.58

NA 5.97

ZZZ patch. 35686............. .............. A

Bypass graft/av fist

3.34

NA 1.13 0.47

NA 4.94

ZZZ patency. 35691............. .............. A

Arterial transposition 18.02

NA 8.42 2.58

NA 29.02

090 35693............. .............. A

Arterial transposition 15.34

NA 7.74 2.21

NA 25.29

090 35694............. .............. A

Arterial transposition 19.13

NA 8.62 2.69

NA 30.44

090 35695............. .............. A

Arterial transposition 19.13

NA 8.57 2.73

NA 30.43

090 35697............. .............. A

Reimplant artery each. 3.00

NA 1.02 0.41

NA 4.43

ZZZ 35700............. .............. A

Reoperation, bypass

3.08

NA 1.02 0.44

NA 4.54

ZZZ graft. 35701............. .............. A

Exploration, carotid

8.49

NA 5.16 1.12

NA 14.77

090 artery. 35721............. .............. A

Exploration, femoral

7.17

NA 4.44 1.03

NA 12.64

090 artery. 35741............. .............. A

Exploration popliteal

7.99

NA 4.67 1.12

NA 13.78

090 artery. 35761............. .............. A

Exploration of artery/ 5.36

NA 4.02 0.75

NA 10.13

090 vein. 35800............. .............. A

Explore neck vessels.. 7.01

NA 4.66 0.95

NA 12.62

090 35820............. .............. A

Explore chest vessels. 12.86

NA 7.22 1.94

NA 22.02

090 35840............. .............. A

Explore abdominal

9.76

NA 5.30 1.34

NA 16.40

090 vessels. 35860............. .............. A

Explore limb vessels.. 5.54

NA 4.04 0.78

NA 10.36

090 35870............. .............. A

Repair vessel graft

22.14

NA 9.79 3.00

NA 34.93

090 defect. 35875............. .............. A

Removal of clot in

10.11

NA 5.20 1.41

NA 16.72

090 graft. 35876............. .............. A

Removal of clot in

16.97

NA 7.53 2.39

NA 26.89

090 graft. 35879............. .............. A

Revise graft w/vein... 15.98

NA 7.71 2.27

NA 25.96

090 35881............. .............. A

Revise graft w/vein... 17.97

NA 8.69 2.55

NA 29.21

090 35901............. .............. A

Excision, graft, neck. 8.18

NA 5.32 1.15

NA 14.65

090 35903............. .............. A

Excision, graft,

9.38

NA 6.17 1.30

NA 16.85

090 extremity. 35905............. .............. A

Excision, graft,

31.20

NA 13.22 4.43

NA 48.85

090 thorax. 35907............. .............. A

Excision, graft,

34.95

NA 14.20 4.91

NA 54.06

090 abdomen. 36000............. .............. A

Place needle in vein.. 0.18 0.57 0.05 0.01 0.76 0.24

XXX 36002............. .............. A

Pseudoaneurysm

1.96 2.87 0.97 0.17 5.00 3.10

000 injection trt. 36005............. .............. A

Injection ext

0.95 7.67 0.31 0.05 8.67 1.31

000 venography. 36010............. .............. A

Place catheter in vein 2.43 19.36 0.79 0.20 21.99 3.42

XXX 36011............. .............. A

Place catheter in vein 3.14 27.90 1.06 0.27 31.31 4.47

XXX 36012............. .............. A

Place catheter in vein 3.51 19.00 1.19 0.23 22.74 4.93

XXX 36013............. .............. A

Place catheter in

2.52 21.42 0.69 0.25 24.19 3.46

XXX artery. 36014............. .............. A

Place catheter in

3.02 20.18 1.03 0.19 23.39 4.24

XXX artery. 36015............. .............. A

Place catheter in

3.51 23.73 1.19 0.21 27.45 4.91

XXX artery. 36100............. .............. A

Establish access to

3.02 12.11 1.11 0.26 15.39 4.39

XXX artery. 36120............. .............. A

Establish access to

2.01 10.73 0.65 0.14 12.88 2.80

XXX artery. 36140............. .............. A

Establish access to

2.01 12.81 0.64 0.16 14.98 2.81

XXX artery. 36145............. .............. A

Artery to vein shunt.. 2.01 12.59 0.66 0.11 14.71 2.78

XXX 36160............. .............. A

Establish access to

2.52 13.52 0.84 0.26 16.30 3.62

XXX aorta. 36200............. .............. A

Place catheter in

3.02 16.56 1.01 0.24 19.82 4.27

XXX aorta. 36215............. .............. A

Place catheter in

4.67 27.11 1.61 0.27 32.05 6.55

XXX artery. 36216............. .............. A

Place catheter in

5.27 29.16 1.80 0.31 34.74 7.38

XXX artery. 36217............. .............. A

Place catheter in

6.29 55.60 2.18 0.44 62.33 8.91

XXX artery. 36218............. .............. A

Place catheter in

1.01 5.10 0.34 0.07 6.18 1.42

ZZZ artery. 36245............. .............. A

Place catheter in

4.67 32.18 1.68 0.31 37.16 6.66

XXX artery. 36246............. .............. A

Place catheter in

5.27 30.05 1.83 0.38 35.70 7.48

XXX artery. 36247............. .............. A

Place catheter in

6.29 49.65 2.15 0.47 56.41 8.91

XXX artery. 36248............. .............. A

Place catheter in

1.01 4.05 0.34 0.07 5.13 1.42

ZZZ artery. 36260............. .............. A

Insertion of infusion

9.70

NA 4.89 1.29

NA 15.88

090 pump. 36261............. .............. A

Revision of infusion

5.44

NA 3.67 0.70

NA 9.81

090 pump. 36262............. .............. A

Removal of infusion

4.01

NA 2.76 0.54

NA 7.31

090 pump. 36299............. .............. C

Vessel injection

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 36400............. .............. A

Bl draw 0.18 0.29 0.05 0.01 0.48 0.24

XXX 3 yrs.

[[Page 70375]]

36415............. .............. X

Routine venipuncture.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 36416............. .............. B

Capillary blood draw.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 36420............. .............. A

Vein access cutdown 0.76

NA 0.22 0.06

NA 1.04

XXX 1 yr. 36430............. .............. A

Blood transfusion

0.00 1.01

NA 0.06 1.07

NA

XXX service. 36440............. .............. A

Bl push transfuse, 2

1.03

NA 0.29 0.10

NA 1.42

XXX yr or 5 yr. 49507............. .............. A

Prp i/hern init block

9.56

NA 4.46 1.27

NA 15.29

090 >5 yr. 49520............. .............. A

Rerepair ing hernia,

9.62

NA 4.44 1.28

NA 15.34

090 reduce. 49521............. .............. A

Rerepair ing hernia,

11.95

NA 5.25 1.59

NA 18.79

090 blocked. 49525............. .............. A

Repair ing hernia,

8.56

NA 4.08 1.13

NA 13.77

090 sliding. 49540............. .............. A

Repair lumbar hernia.. 10.37

NA 4.75 1.37

NA 16.49

090 49550............. .............. A

Rpr rem hernia, init,

8.62

NA 4.13 1.14

NA 13.89

090 reduce. 49553............. .............. A

Rpr fem hernia, init

9.43

NA 4.42 1.24

NA 15.09

090 blocked. 49555............. .............. A

Rerepair fem hernia,

9.02

NA 4.27 1.20

NA 14.49

090 reduce. 49557............. .............. A

Rerepair fem hernia,

11.13

NA 4.99 1.47

NA 17.59

090 blocked. 49560............. .............. A

Rpr ventral hern init, 11.55

NA 5.15 1.52

NA 18.22

090 reduc. 49561............. .............. A

Rpr ventral hern init, 14.23

NA 6.07 1.88

NA 22.18

090 block. 49565............. .............. A

Rerepair ventrl hern, 11.55

NA 5.23 1.52

NA 18.30

090 reduce. 49566............. .............. A

Rerepair ventrl hern, 14.38

NA 6.14 1.90

NA 22.42

090 block. 49568............. .............. A

Hernia repair w/mesh.. 4.88

NA 1.67 0.64

NA 7.19

ZZZ 49570............. .............. A

Rpr epigastric hern,

5.68

NA 3.17 0.75

NA 9.60

090 reduce. 49572............. .............. A

Rpr epigastric hern,

6.72

NA 3.47 0.88

NA 11.07

090 blocked. 49580............. .............. A

Rpr umbil hern, reduc

4.10

NA 2.60 0.54

NA 7.24

090 5 yr. 49587............. .............. A

Rpr umbil hern, block

7.55

NA 3.74 0.99

NA 12.28

090 > 5 yr. 49590............. .............. A

Repair spigelian

8.53

NA 4.09 1.13

NA 13.75

090 hernia. 49600............. .............. A

Repair umbilical

10.94

NA 5.34 1.32

NA 17.60

090 lesion. 49605............. .............. A

Repair umbilical

75.89

NA 28.58 9.36

NA 113.83

090 lesion. 49606............. .............. A

Repair umbilical

18.57

NA 7.70 2.45

NA 28.72

090 lesion. 49610............. .............. A

Repair umbilical

10.48

NA 5.21 1.07

NA 16.76

090 lesion. 49611............. .............. A

Repair umbilical

8.91

NA 6.99 0.78

NA 16.68

090 lesion. 49650............. .............. A

Laparo hernia repair

6.26

NA 3.20 0.93

NA 10.39

090 initial. 49651............. .............. A

Laparo hernia repair

8.23

NA 4.05 1.14

NA 13.42

090 recur. 49659............. .............. C

Laparo proc, hernia

0.00 0.00 0.00 0.00 0.00 0.00

YYY repair. 49900............. .............. A

Repair of abdominal

12.26

NA 6.24 1.62

NA 20.12

090 wall. 49904............. .............. A

Omental flap, extra-

19.97

NA 15.25 2.69

NA 37.91

090 abdom. 49905............. .............. A

Omental flap, intra-

6.54

NA 2.30 0.75

NA 9.59

ZZZ abdom. 49906............. .............. C

Free omental flap,

0.00 0.00 0.00 0.00 0.00 0.00

090 microvasc. 49999............. .............. C

Abdomen surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 50010............. .............. A

Exploration of kidney. 10.96

NA 5.23 0.93

NA 17.12

090 50020............. .............. A

Renal abscess, open

14.64

NA 7.76 1.34

NA 23.74

090 drain.

[[Page 70389]]

50021............. .............. A

Renal abscess, percut

3.37 21.71 1.10 0.20 25.28 4.67

000 drain. 50040............. .............. A

Drainage of kidney.... 14.92

NA 6.82 1.03

NA 22.77

090 50045............. .............. A

Exploration of kidney. 15.44

NA 6.61 1.24

NA 23.29

090 50060............. .............. A

Removal of kidney

19.27

NA 7.84 1.36

NA 28.47

090 stone. 50065............. .............. A

Incision of kidney.... 20.76

NA 6.09 1.59

NA 28.44

090 50070............. .............. A

Incision of kidney.... 20.29

NA 8.23 1.44

NA 29.96

090 50075............. .............. A

Removal of kidney

25.30

NA 9.92 1.80

NA 37.02

090 stone. 50080............. .............. A

Removal of kidney

14.69

NA 6.29 1.04

NA 22.02

090 stone. 50081............. .............. A

Removal of kidney

21.77

NA 8.78 1.54

NA 32.09

090 stone. 50100............. .............. A

Revise kidney blood

16.07

NA 7.80 2.06

NA 25.93

090 vessels. 50120............. .............. A

Exploration of kidney. 15.89

NA 6.78 1.21

NA 23.88

090 50125............. .............. A

Explore and drain

16.50

NA 6.98 1.43

NA 24.91

090 kidney. 50130............. .............. A

Removal of kidney

17.26

NA 7.18 1.22

NA 25.66

090 stone. 50135............. .............. A

Exploration of kidney. 19.15

NA 7.79 1.33

NA 28.27

090 50200............. .............. A

Biopsy of kidney...... 2.63

NA 1.29 0.16

NA 4.08

000 50205............. .............. A

Biopsy of kidney...... 11.29

NA 5.02 1.30

NA 17.61

090 50220............. .............. A

Remove kidney, open... 17.12

NA 7.25 1.35

NA 25.72

090 50225............. .............. A

Removal kidney open,

20.20

NA 8.16 1.50

NA 29.86

090 complex. 50230............. .............. A

Removal kidney open,

22.04

NA 8.59 1.55

NA 32.18

090 radical. 50234............. .............. A

Removal of kidney &

22.37

NA 8.85 1.59

NA 32.81

090 ureter. 50236............. .............. A

Removal of kidney &

24.82

NA 10.27 1.76

NA 36.85

090 ureter. 50240............. .............. A

Partial removal of

21.97

NA 9.03 1.55

NA 32.55

090 kidney. 50250............. .............. A

Cryoablate renal mass 19.97

NA 9.18 1.39

NA 30.54

090 open. 50280............. .............. A

Removal of kidney

15.65

NA 6.70 1.19

NA 23.54

090 lesion. 50290............. .............. A

Removal of kidney

14.71

NA 6.47 1.41

NA 22.59

090 lesion. 50300............. .............. X

Remove cadaver donor

0.00 0.00 0.00 0.00 0.00 0.00

XXX kidney. 50320............. .............. A

Remove kidney, living 22.18

NA 10.68 2.35

NA 35.21

090 donor. 50323............. .............. C

Prep cadaver renal

0.00 0.00 0.00 0.00 0.00 0.00

XXX allograft. 50325............. .............. C

Prep donor renal graft 0.00 0.00 0.00 0.00 0.00 0.00

XXX 50327............. .............. A

Prep renal graft/

4.00

NA 1.35 0.29

NA 5.64

XXX venous. 50328............. .............. A

Prep renal graft/

3.50

NA 1.18 0.26

NA 4.94

XXX arterial. 50329............. .............. A

Prep renal graft/

3.34

NA 1.13 0.25

NA 4.72

XXX ureteral. 50340............. .............. A

Removal of kidney..... 12.13

NA 6.51 1.65

NA 20.29

090 50360............. .............. A

Transplantation of

31.48

NA 15.51 3.81

NA 50.80

090 kidney. 50365............. .............. A

Transplantation of

36.75

NA 18.24 4.42

NA 59.41

090 kidney. 50370............. .............. A

Remove transplanted

13.70

NA 7.16 1.67

NA 22.53

090 kidney. 50380............. .............. A

Reimplantation of

20.73

NA 12.05 2.50

NA 35.28

090 kidney. 50382............. .............. A

Change ureter stent,

5.50 36.22 1.87 0.34 42.06 7.71

000 percut. 50384............. .............. A

Remove ureter stent,

5.00 35.32 1.71 0.31 40.63 7.02

000 percut. 50387............. .............. A

Change ext/int ureter

2.00 18.26 0.67 0.12 20.38 2.79

000 stent. 50389............. .............. A

Remove renal tube w/

1.10 12.78 0.37 0.07 13.95 1.54

000 fluoro. 50390............. .............. A

Drainage of kidney

1.96

NA 0.64 0.12

NA 2.72

000 lesion. 50391............. .............. A

Instll rx agnt into

1.96 1.58 0.63 0.14 3.68 2.73

000 rnal tub. 50392............. .............. A

Insert kidney drain... 3.37

NA 1.52 0.20

NA 5.09

000 50393............. .............. A

Insert ureteral tube.. 4.15

NA 1.79 0.25

NA 6.19

000 50394............. .............. A

Injection for kidney x- 0.76 2.69 0.66 0.05 3.50 1.47

000 ray. 50395............. .............. A

Create passage to

3.37

NA 1.50 0.21

NA 5.08

000 kidney. 50396............. .............. A

Measure kidney

2.09

NA 1.08 0.13

NA 3.30

000 pressure. 50398............. .............. A

Change kidney tube.... 1.46 16.36 0.52 0.09 17.91 2.07

000 50400............. .............. A

Revision of kidney/

19.47

NA 7.89 1.38

NA 28.74

090 ureter. 50405............. .............. A

Revision of kidney/

23.89

NA 9.05 1.78

NA 34.72

090 ureter. 50500............. .............. A

Repair of kidney wound 19.54

NA 8.40 2.01

NA 29.95

090 50520............. .............. A

Close kidney-skin

17.20

NA 7.44 1.49

NA 26.13

090 fistula. 50525............. .............. A

Repair renal-abdomen

22.24

NA 9.02 1.83

NA 33.09

090 fistula. 50526............. .............. A

Repair renal-abdomen

23.98

NA 9.88 1.96

NA 35.82

090 fistula. 50540............. .............. A

Revision of horseshoe 19.90

NA 8.34 1.36

NA 29.60

090 kidney. 50541............. .............. A

Laparo ablate renal

15.98

NA 6.50 1.13

NA 23.61

090 cyst. 50542............. .............. A

Laparo ablate renal

19.97

NA 8.15 1.39

NA 29.51

090 mass. 50543............. .............. A

Laparo partial

25.46

NA 10.22 1.80

NA 37.48

090 nephrectomy. 50544............. .............. A

Laparoscopy,

22.37

NA 8.54 1.58

NA 32.49

090 pyeloplasty. 50545............. .............. A

Laparo radical

23.96

NA 9.21 1.70

NA 34.87

090 nephrectomy. 50546............. .............. A

Laparoscopic

20.45

NA 8.38 1.57

NA 30.40

090 nephrectomy. 50547............. .............. A

Laparo removal donor

25.46

NA 11.13 2.76

NA 39.35

090 kidney. 50548............. .............. A

Laparo remove w/ureter 24.36

NA 9.20 1.72

NA 35.28

090 50549............. .............. C

Laparoscope proc,

0.00 0.00 0.00 0.00 0.00 0.00

YYY renal. 50551............. .............. A

Kidney endoscopy...... 5.59 4.15 1.98 0.40 10.14 7.97

000 50553............. .............. A

Kidney endoscopy...... 5.98 4.37 2.18 0.39 10.74 8.55

000 50555............. .............. A

Kidney endoscopy &

6.52 4.82 2.34 0.45 11.79 9.31

000 biopsy. 50557............. .............. A

Kidney endoscopy &

6.61 4.59 2.30 0.47 11.67 9.38

000 treatment. 50561............. .............. A

Kidney endoscopy &

7.58 5.09 2.65 0.54 13.21 10.77

000 treatment. 50562............. .............. A

Renal scope w/tumor

10.90

NA 4.32 0.73

NA 15.95

090 resect. 50570............. .............. A

Kidney endoscopy...... 9.53

NA 3.22 0.68

NA 13.43

000 50572............. .............. A

Kidney endoscopy...... 10.33

NA 3.51 0.85

NA 14.69

000 50574............. .............. A

Kidney endoscopy &

11.00

NA 3.75 0.77

NA 15.52

000 biopsy. 50575............. .............. A

Kidney endoscopy...... 13.96

NA 4.64 0.99

NA 19.59

000

[[Page 70390]]

50576............. .............. A

Kidney endoscopy &

10.97

NA 3.67 0.78

NA 15.42

000 treatment. 50580............. .............. A

Kidney endoscopy &

11.84

NA 3.97 0.83

NA 16.64

000 treatment. 50590............. .............. A

Fragmenting of kidney

9.08 12.43 4.12 0.65 22.16 13.85

090 stone. 50592............. .............. A

Perc rf ablate renal

6.75 149.45 2.99 0.43 156.63 10.17

010 tumor. 50600............. .............. A

Exploration of ureter. 15.82

NA 6.68 1.13

NA 23.63

090 50605............. .............. A

Insert ureteral

15.44

NA 6.75 1.45

NA 23.64

090 support. 50610............. .............. A

Removal of ureter

15.90

NA 6.98 1.43

NA 24.31

090 stone. 50620............. .............. A

Removal of ureter

15.14

NA 6.35 1.07

NA 22.56

090 stone. 50630............. .............. A

Removal of ureter

14.92

NA 6.29 1.09

NA 22.30

090 stone. 50650............. .............. A

Removal of ureter..... 17.38

NA 7.24 1.23

NA 25.85

090 50660............. .............. A

Removal of ureter..... 19.52

NA 7.97 1.38

NA 28.87

090 50684............. .............. A

Injection for ureter x- 0.76 4.98 0.47 0.05 5.79 1.28

000 ray. 50686............. .............. A

Measure ureter

1.51 3.45 0.82 0.11 5.07 2.44

000 pressure. 50688............. .............. A

Change of ureter tube/ 1.17

NA 1.06 0.07

NA 2.30

010 stent. 50690............. .............. A

Injection for ureter x- 1.16 1.83 0.72 0.07 3.06 1.95

000 ray. 50700............. .............. A

Revision of ureter.... 15.19

NA 7.13 1.27

NA 23.59

090 50715............. .............. A

Release of ureter..... 18.87

NA 8.76 2.13

NA 29.76

090 50722............. .............. A

Release of ureter..... 16.33

NA 7.82 1.90

NA 26.05

090 50725............. .............. A

Release/revise ureter. 18.46

NA 8.06 1.52

NA 28.04

090 50727............. .............. A

Revise ureter......... 8.17

NA 4.28 0.61

NA 13.06

090 50728............. .............. A

Revise ureter......... 12.00

NA 5.57 1.00

NA 18.57

090 50740............. .............. A

Fusion of ureter &

18.39

NA 7.75 1.96

NA 28.10

090 kidney. 50750............. .............. A

Fusion of ureter &

19.48

NA 8.00 1.38

NA 28.86

090 kidney. 50760............. .............. A

Fusion of ureters..... 18.39

NA 7.69 1.55

NA 27.63

090 50770............. .............. A

Splicing of ureters... 19.48

NA 7.99 1.45

NA 28.92

090 50780............. .............. A

Reimplant ureter in

18.33

NA 7.60 1.51

NA 27.44

090 bladder. 50782............. .............. A

Reimplant ureter in

19.51

NA 8.79 1.61

NA 29.91

090 bladder. 50783............. .............. A

Reimplant ureter in

20.52

NA 8.23 1.98

NA 30.73

090 bladder. 50785............. .............. A

Reimplant ureter in

20.49

NA 8.31 1.45

NA 30.25

090 bladder. 50800............. .............. A

Implant ureter in

14.50

NA 6.48 1.19

NA 22.17

090 bowel. 50810............. .............. A

Fusion of ureter &

20.02

NA 9.11 2.31

NA 31.44

090 bowel. 50815............. .............. A

Urine shunt to

19.90

NA 8.46 1.54

NA 29.90

090 intestine. 50820............. .............. A

Construct bowel

21.86

NA 8.66 1.89

NA 32.41

090 bladder. 50825............. .............. A

Construct bowel

28.14

NA 11.15 2.07

NA 41.36

090 bladder. 50830............. .............. A

Revise urine flow..... 31.23

NA 12.20 2.37

NA 45.80

090 50840............. .............. A

Replace ureter by

19.97

NA 8.44 1.47

NA 29.88

090 bowel. 50845............. .............. A

Appendico-vesicostomy. 20.86

NA 8.92 1.57

NA 31.35

090 50860............. .............. A

Transplant ureter to

15.34

NA 6.63 1.29

NA 23.26

090 skin. 50900............. .............. A

Repair of ureter...... 13.60

NA 6.15 1.14

NA 20.89

090 50920............. .............. A

Closure ureter/skin

14.31

NA 6.58 1.01

NA 21.90

090 fistula. 50930............. .............. A

Closure ureter/bowel

18.69

NA 7.98 1.28

NA 27.95

090 fistula. 50940............. .............. A

Release of ureter..... 14.49

NA 6.41 1.26

NA 22.16

090 50945............. .............. A

Laparoscopy

16.97

NA 7.05 1.36

NA 25.38

090 ureterolithotomy. 50947............. .............. A

Laparo new ureter/

24.46

NA 9.71 2.16

NA 36.33

090 bladder. 50948............. .............. A

Laparo new ureter/

22.47

NA 8.71 1.70

NA 32.88

090 bladder. 50949............. .............. C

Laparoscope proc,

0.00 0.00 0.00 0.00 0.00 0.00

YYY ureter. 50951............. .............. A

Endoscopy of ureter... 5.83 4.30 2.06 0.41 10.54 8.30

000 50953............. .............. A

Endoscopy of ureter... 6.23 4.41 2.37 0.43 11.07 9.03

000 50955............. .............. A

Ureter endoscopy &

6.74 6.43 2.69 0.48 13.65 9.91

000 biopsy. 50957............. .............. A

Ureter endoscopy &

6.78 4.57 2.38 0.48 11.83 9.64

000 treatment. 50961............. .............. A

Ureter endoscopy &

6.04 4.37 2.19 0.41 10.82 8.64

000 treatment. 50970............. .............. A

Ureter endoscopy...... 7.13

NA 2.47 0.52

NA 10.12

000 50972............. .............. A

Ureter endoscopy &

6.88

NA 2.47 0.49

NA 9.84

000 catheter. 50974............. .............. A

Ureter endoscopy &

9.16

NA 3.11 0.64

NA 12.91

000 biopsy. 50976............. .............. A

Ureter endoscopy &

9.03

NA 3.07 0.66

NA 12.76

000 treatment. 50980............. .............. A

Ureter endoscopy &

6.84

NA 2.38 0.48

NA 9.70

000 treatment. 51000............. .............. A

Drainage of bladder... 0.78 1.95 0.24 0.05 2.78 1.07

000 51005............. .............. A

Drainage of bladder... 1.02 4.71 0.34 0.10 5.83 1.46

000 51010............. .............. A

Drainage of bladder... 3.52 5.62 1.88 0.28 9.42 5.68

010 51020............. .............. A

Incise & treat bladder 6.70

NA 3.86 0.47

NA 11.03

090 51030............. .............. A

Incise & treat bladder 6.76

NA 3.98 0.58

NA 11.32

090 51040............. .............. A

Incise & drain bladder 4.39

NA 2.77 0.31

NA 7.47

090 51045............. .............. A

Incise bladder/drain

6.76

NA 3.93 0.52

NA 11.21

090 ureter. 51050............. .............. A

Removal of bladder

6.91

NA 3.65 0.49

NA 11.05

090 stone. 51060............. .............. A

Removal of ureter

8.84

NA 4.51 0.62

NA 13.97

090 stone. 51065............. .............. A

Remove ureter calculus 8.84

NA 4.36 0.63

NA 13.83

090 51080............. .............. A

Drainage of bladder

5.95

NA 3.55 0.43

NA 9.93

090 abscess. 51500............. .............. A

Removal of bladder

10.12

NA 5.01 1.03

NA 16.16

090 cyst. 51520............. .............. A

Removal of bladder

9.28

NA 4.68 0.69

NA 14.65

090 lesion. 51525............. .............. A

Removal of bladder

13.95

NA 6.14 0.99

NA 21.08

090 lesion. 51530............. .............. A

Removal of bladder

12.36

NA 5.76 1.05

NA 19.17

090 lesion. 51535............. .............. A

Repair of ureter

12.55

NA 6.12 1.23

NA 19.90

090 lesion. 51550............. .............. A

Partial removal of

15.64

NA 6.74 1.31

NA 23.69

090 bladder. 51555............. .............. A

Partial removal of

21.20

NA 8.68 1.69

NA 31.57

090 bladder. 51565............. .............. A

Revise bladder &

21.59

NA 8.98 1.63

NA 32.20

090 ureter(s).

[[Page 70391]]

51570............. .............. A

Removal of bladder.... 24.20

NA 9.76 1.71

NA 35.67

090 51575............. .............. A

Removal of bladder &

30.40

NA 12.05 2.16

NA 44.61

090 nodes. 51580............. .............. A

Remove bladder/revise 31.03

NA 12.52 2.24

NA 45.79

090 tract. 51585............. .............. A

Removal of bladder &

35.18

NA 13.73 2.48

NA 51.39

090 nodes. 51590............. .............. A

Remove bladder/revise 32.61

NA 12.64 2.27

NA 47.52

090 tract. 51595............. .............. A

Remove bladder/revise 37.08

NA 14.16 2.59

NA 53.83

090 tract. 51596............. .............. A

Remove bladder/create 39.46

NA 15.26 2.77

NA 57.49

090 pouch. 51597............. .............. A

Removal of pelvic

38.29

NA 14.86 2.81

NA 55.96

090 structures. 51600............. .............. A

Injection for bladder

0.88 5.06 0.29 0.06 6.00 1.23

000 x-ray. 51605............. .............. A

Preparation for

0.64 6.07 0.35 0.04 6.75 1.03

000 bladder xray. 51610............. .............. A

Injection for bladder

1.05 2.29 0.60 0.07 3.41 1.72

000 x-ray. 51700............. .............. A

Irrigation of bladder. 0.88 1.60 0.28 0.06 2.54 1.22

000 51701............. .............. A

Insert bladder

0.50 1.58 0.19 0.04 2.12 0.73

000 catheter. 51702............. .............. A

Insert temp bladder

0.50 2.09 0.24 0.04 2.63 0.78

000 cath. 51703............. .............. A

Insert bladder cath,

1.47 2.74 0.56 0.10 4.31 2.13

000 complex. 51705............. .............. A

Change of bladder tube 1.02 2.28 0.61 0.07 3.37 1.70

010 51710............. .............. A

Change of bladder tube 1.49 3.34 0.77 0.11 4.94 2.37

010 51715............. .............. A

Endoscopic injection/

3.73 3.91 1.35 0.29 7.93 5.37

000 implant. 51720............. .............. A

Treatment of bladder

1.96 1.75 0.69 0.14 3.85 2.79

000 lesion. 51725............. 26............ A

Simple cystometrogram. 1.51 0.49 0.49 0.12 2.12 2.12

000 51725............. TC............ A

Simple cystometrogram. 0.00 5.11

NA 0.04 5.15

NA

000 51725............. .............. A

Simple cystometrogram. 1.51 5.60

NA 0.16 7.27

NA

000 51726............. 26............ A

Complex cystometrogram 1.71 0.56 0.56 0.13 2.40 2.40

000 51726............. TC............ A

Complex cystometrogram 0.00 6.96

NA 0.05 7.01

NA

000 51726............. .............. A

Complex cystometrogram 1.71 7.52

NA 0.18 9.41

NA

000 51736............. 26............ A

Urine flow measurement 0.61 0.20 0.20 0.05 0.86 0.86

000 51736............. TC............ A

Urine flow measurement 0.00 0.38

NA 0.01 0.39

NA

000 51736............. .............. A

Urine flow measurement 0.61 0.58

NA 0.06 1.25

NA

000 51741............. 26............ A

Electro-uroflowmetry,

1.14 0.37 0.37 0.09 1.60 1.60

000 first. 51741............. TC............ A

Electro-uroflowmetry,

0.00 0.42

NA 0.02 0.44

NA

000 first. 51741............. .............. A

Electro-uroflowmetry,

1.14 0.79

NA 0.11 2.04

NA

000 first. 51772............. 26............ A

Urethra pressure

1.61 0.55 0.55 0.15 2.31 2.31

000 profile. 51772............. TC............ A

Urethra pressure

0.00 5.04

NA 0.05 5.09

NA

000 profile. 51772............. .............. A

Urethra pressure

1.61 5.59

NA 0.20 7.40

NA

000 profile. 51784............. 26............ A

Anal/urinary muscle

1.53 0.50 0.50 0.12 2.15 2.15

000 study. 51784............. TC............ A

Anal/urinary muscle

0.00 3.49

NA 0.04 3.53

NA

000 study. 51784............. .............. A

Anal/urinary muscle

1.53 3.99

NA 0.16 5.68

NA

000 study. 51785............. 26............ A

Anal/urinary muscle

1.53 0.50 0.50 0.11 2.14 2.14

000 study. 51785............. TC............ A

Anal/urinary muscle

0.00 3.95

NA 0.04 3.99

NA

000 study. 51785............. .............. A

Anal/urinary muscle

1.53 4.45

NA 0.15 6.13

NA

000 study. 51792............. 26............ A

Urinary reflex study.. 1.10 0.41 0.41 0.07 1.58 1.58

000 51792............. TC............ A

Urinary reflex study.. 0.00 5.60

NA 0.13 5.73

NA

000 51792............. .............. A

Urinary reflex study.. 1.10 6.01

NA 0.20 7.31

NA

000 51795............. 26............ A

Urine voiding pressure 1.53 0.50 0.50 0.12 2.15 2.15

000 study. 51795............. TC............ A

Urine voiding pressure 0.00 6.81

NA 0.10 6.91

NA

000 study. 51795............. .............. A

Urine voiding pressure 1.53 7.31

NA 0.22 9.06

NA

000 study. 51797............. 26............ A

Intraabdominal

1.60 0.53 0.53 0.12 2.25 2.25

000 pressure test. 51797............. TC............ A

Intraabdominal

0.00 5.27

NA 0.05 5.32

NA

000 pressure test. 51797............. .............. A

Intraabdominal

1.60 5.80

NA 0.17 7.57

NA

000 pressure test. 51798............. .............. A

Us urine capacity

0.00 0.34

NA 0.08 0.42

NA

XXX measure. 51800............. .............. A

Revision of bladder/

17.39

NA 7.58 1.32

NA 26.29

090 urethra. 51820............. .............. A

Revision of urinary

17.86

NA 8.30 1.74

NA 27.90

090 tract. 51840............. .............. A

Attach bladder/urethra 10.69

NA 5.58 1.06

NA 17.33

090 51841............. .............. A

Attach bladder/urethra 13.01

NA 6.39 1.24

NA 20.64

090 51845............. .............. A

Repair bladder neck... 9.72

NA 4.75 0.79

NA 15.26

090 51860............. .............. A

Repair of bladder

12.00

NA 5.77 1.16

NA 18.93

090 wound. 51865............. .............. A

Repair of bladder

15.02

NA 6.69 1.23

NA 22.94

090 wound. 51880............. .............. A

Repair of bladder

7.65

NA 3.96 0.72

NA 12.33

090 opening. 51900............. .............. A

Repair bladder/vagina 12.95

NA 6.08 1.21

NA 20.24

090 lesion. 51920............. .............. A

Close bladder-uterus

11.79

NA 5.65 1.18

NA 18.62

090 fistula. 51925............. .............. A

Hysterectomy/bladder

15.56

NA 8.63 2.03

NA 26.22

090 repair. 51940............. .............. A

Correction of bladder 28.39

NA 12.11 2.14

NA 42.64

090 defect. 51960............. .............. A

Revision of bladder & 22.98

NA 9.66 1.63

NA 34.27

090 bowel. 51980............. .............. A

Construct bladder

11.34

NA 5.39 0.86

NA 17.59

090 opening. 51990............. .............. A

Laparo urethral

12.48

NA 6.16 1.39

NA 20.03

090 suspension. 51992............. .............. A

Laparo sling operation 13.99

NA 6.22 1.41

NA 21.62

090 51999............. .............. C

Laparoscope proc,

0.00 0.00 0.00 0.00 0.00 0.00

YYY bladder. 52000............. .............. A

Cystoscopy............ 2.01 3.31 0.76 0.14 5.46 2.91

000 52001............. .............. A

Cystoscopy, removal of 5.44 5.08 1.87 0.39 10.91 7.70

000 clots. 52005............. .............. A

Cystoscopy & ureter

2.37 5.58 0.89 0.17 8.12 3.43

000 catheter. 52007............. .............. A

Cystoscopy and biopsy. 3.02 16.49 1.15 0.22 19.73 4.39

000 52010............. .............. A

Cystoscopy & duct

3.02 10.78 1.15 0.21 14.01 4.38

000 catheter. 52204............. .............. A

Cystoscopy............ 2.37 14.55 0.90 0.17 17.09 3.44

000 52214............. .............. A

Cystoscopy and

3.70 38.21 1.33 0.26 42.17 5.29

000 treatment. 52224............. .............. A

Cystoscopy and

3.14 36.56 1.15 0.22 39.92 4.51

000 treatment.

[[Page 70392]]

52234............. .............. A

Cystoscopy and

4.62

NA 1.66 0.33

NA 6.61

000 treatment. 52235............. .............. A

Cystoscopy and

5.44

NA 1.94 0.39

NA 7.77

000 treatment. 52240............. .............. A

Cystoscopy and

9.71

NA 3.31 0.69

NA 13.71

000 treatment. 52250............. .............. A

Cystoscopy and

4.49

NA 1.65 0.32

NA 6.46

000 radiotracer. 52260............. .............. A

Cystoscopy and

3.91

NA 1.42 0.28

NA 5.61

000 treatment. 52265............. .............. A

Cystoscopy and

2.94 13.38 1.11 0.22 16.54 4.27

000 treatment. 52270............. .............. A

Cystoscopy & revise

3.36 11.06 1.24 0.24 14.66 4.84

000 urethra. 52275............. .............. A

Cystoscopy & revise

4.69 15.60 1.66 0.33 20.62 6.68

000 urethra. 52276............. .............. A

Cystoscopy and

4.99

NA 1.79 0.35

NA 7.13

000 treatment. 52277............. .............. A

Cystoscopy and

6.16

NA 2.23 0.44

NA 8.83

000 treatment. 52281............. .............. A

Cystoscopy and

2.80 7.11 1.08 0.20 10.11 4.08

000 treatment. 52282............. .............. A

Cystoscopy, implant

6.39

NA 2.24 0.45

NA 9.08

000 stent. 52283............. .............. A

Cystoscopy and

3.73 3.95 1.38 0.26 7.94 5.37

000 treatment. 52285............. .............. A

Cystoscopy and

3.60 4.02 1.33 0.26 7.88 5.19

000 treatment. 52290............. .............. A

Cystoscopy and

4.58

NA 1.65 0.32

NA 6.55

000 treatment. 52300............. .............. A

Cystoscopy and

5.30

NA 1.91 0.38

NA 7.59

000 treatment. 52301............. .............. A

Cystoscopy and

5.50

NA 1.99 0.46

NA 7.95

000 treatment. 52305............. .............. A

Cystoscopy and

5.30

NA 1.86 0.38

NA 7.54

000 treatment. 52310............. .............. A

Cystoscopy and

2.81 4.70 1.03 0.20 7.71 4.04

000 treatment. 52315............. .............. A

Cystoscopy and

5.20 8.69 1.84 0.37 14.26 7.41

000 treatment. 52317............. .............. A

Remove bladder stone.. 6.71 29.02 2.29 0.48 36.21 9.48

000 52318............. .............. A

Remove bladder stone.. 9.18

NA 3.10 0.65

NA 12.93

000 52320............. .............. A

Cystoscopy and

4.69

NA 1.63 0.33

NA 6.65

000 treatment. 52325............. .............. A

Cystoscopy, stone

6.15

NA 2.12 0.44

NA 8.71

000 removal. 52327............. .............. A

Cystoscopy, inject

5.18 31.90 1.82 0.37 37.45 7.37

000 material. 52330............. .............. A

Cystoscopy and

5.03 38.93 1.76 0.36 44.32 7.15

000 treatment. 52332............. .............. A

Cystoscopy and

2.83 5.76 1.05 0.21 8.80 4.09

000 treatment. 52334............. .............. A

Create passage to

4.82

NA 1.74 0.35

NA 6.91

000 kidney. 52341............. .............. A

Cysto w/ureter

5.99

NA 2.22 0.43

NA 8.64

000 stricture tx. 52342............. .............. A

Cysto w/up stricture

6.49

NA 2.35 0.46

NA 9.30

000 tx. 52343............. .............. A

Cysto w/renal

7.19

NA 2.59 0.51

NA 10.29

000 stricture tx. 52344............. .............. A

Cysto/uretero,

7.69

NA 2.80 0.55

NA 11.04

000 stricture tx. 52345............. .............. A

Cysto/uretero w/up

8.19

NA 2.96 0.58

NA 11.73

000 stricture. 52346............. .............. A

Cystouretero w/renal

9.22

NA 3.29 0.65

NA 13.16

000 strict. 52351............. .............. A

Cystouretero & or

5.85

NA 2.15 0.41

NA 8.41

000 pyeloscope. 52352............. .............. A

Cystouretero w/stone

6.87

NA 2.51 0.49

NA 9.87

000 remove. 52353............. .............. A

Cystouretero w/

7.96

NA 2.86 0.57

NA 11.39

000 lithotripsy. 52354............. .............. A

Cystouretero w/biopsy. 7.33

NA 2.68 0.52

NA 10.53

000 52355............. .............. A

Cystouretero w/excise

8.81

NA 3.15 0.63

NA 12.59

000 tumor. 52400............. .............. A

Cystouretero w/congen

9.67

NA 3.74 0.68

NA 14.09

090 repr. 52402............. .............. A

Cystourethro cut

5.27

NA 1.70 0.40

NA 7.37

000 ejacul duct. 52450............. .............. A

Incision of prostate.. 7.63

NA 3.68 0.54

NA 11.85

090 52500............. .............. A

Revision of bladder

8.46

NA 3.93 0.60

NA 12.99

090 neck. 52510............. .............. A

Dilation prostatic

6.71

NA 3.12 0.48

NA 10.31

090 urethra. 52601............. .............. A

Prostatectomy (TURP).. 12.35

NA 5.11 0.87

NA 18.33

090 52606............. .............. A

Control postop

8.12

NA 3.56 0.57

NA 12.25

090 bleeding. 52612............. .............. A

Prostatectomy, first

7.97

NA 3.74 0.56

NA 12.27

090 stage. 52614............. .............. A

Prostatectomy, second

6.83

NA 3.35 0.48

NA 10.66

090 stage. 52620............. .............. A

Remove residual

6.60

NA 2.99 0.47

NA 10.06

090 prostate. 52630............. .............. A

Remove prostate

7.25

NA 3.20 0.51

NA 10.96

090 regrowth. 52640............. .............. A

Relieve bladder

6.61

NA 2.97 0.47

NA 10.05

090 contracture. 52647............. .............. A

Laser surgery of

10.34 74.15 4.54 0.73 85.22 15.61

090 prostate. 52648............. .............. A

Laser surgery of

11.19

NA 4.80 0.79

NA 16.78

090 prostate. 52700............. .............. A

Drainage of prostate

6.79

NA 3.19 0.48

NA 10.46

090 abscess. 53000............. .............. A

Incision of urethra... 2.28

NA 1.54 0.16

NA 3.98

010 53010............. .............. A

Incision of urethra... 3.63

NA 2.92 0.24

NA 6.79

090 53020............. .............. A

Incision of urethra... 1.77 3.01 0.67 0.13 4.91 2.57

000 53025............. .............. A

Incision of urethra... 1.13 3.74 0.51 0.08 4.95 1.72

000 53040............. .............. A

Drainage of urethra

6.39

NA 3.44 0.45

NA 10.28

090 abscess. 53060............. .............. A

Drainage of urethra

2.63 2.09 1.37 0.28 5.00 4.28

010 abscess. 53080............. .............. A

Drainage of urinary

6.28

NA 5.97 0.52

NA 12.77

090 leakage. 53085............. .............. A

Drainage of urinary

10.25

NA 7.42 0.92

NA 18.59

090 leakage. 53200............. .............. A

Biopsy of urethra..... 2.59 1.32 0.98 0.20 4.11 3.77

000 53210............. .............. A

Removal of urethra.... 12.55

NA 5.85 0.89

NA 19.29

090 53215............. .............. A

Removal of urethra.... 15.56

NA 6.64 1.10

NA 23.30

090 53220............. .............. A

Treatment of urethra

6.99

NA 3.72 0.49

NA 11.20

090 lesion. 53230............. .............. A

Removal of urethra

9.57

NA 4.72 0.73

NA 15.02

090 lesion. 53235............. .............. A

Removal of urethra

10.12

NA 4.91 0.72

NA 15.75

090 lesion. 53240............. .............. A

Surgery for urethra

6.44

NA 3.53 0.52

NA 10.49

090 pouch. 53250............. .............. A

Removal of urethra

5.88

NA 3.30 0.49

NA 9.67

090 gland. 53260............. .............. A

Treatment of urethra

2.98 2.25 1.42 0.25 5.48 4.65

010 lesion. 53265............. .............. A

Treatment of urethra

3.12 2.72 1.42 0.24 6.08 4.78

010 lesion. 53270............. .............. A

Removal of urethra

3.09 2.21 1.54 0.30 5.60 4.93

010 gland. 53275............. .............. A

Repair of urethra

4.52

NA 2.26 0.32

NA 7.10

010 defect. 53400............. .............. A

Revise urethra, stage 12.75

NA 6.04 0.98

NA 19.77

090 1.

[[Page 70393]]

53405............. .............. A

Revise urethra, stage 14.46

NA 6.33 1.10

NA 21.89

090 2. 53410............. .............. A

Reconstruction of

16.42

NA 7.07 1.16

NA 24.65

090 urethra. 53415............. .............. A

Reconstruction of

19.38

NA 7.35 1.37

NA 28.10

090 urethra. 53420............. .............. A

Reconstruct urethra,

14.06

NA 6.30 0.96

NA 21.32

090 stage 1. 53425............. .............. A

Reconstruct urethra,

15.96

NA 6.90 1.13

NA 23.99

090 stage 2. 53430............. .............. A

Reconstruction of

16.32

NA 7.01 1.15

NA 24.48

090 urethra. 53431............. .............. A

Reconstruct urethra/

19.86

NA 8.07 1.41

NA 29.34

090 bladder. 53440............. .............. A

Male sling procedure.. 13.60

NA 5.99 0.96

NA 20.55

090 53442............. .............. A

Remove/revise male

11.55

NA 5.45 0.82

NA 17.82

090 sling. 53444............. .............. A

Insert tandem cuff.... 13.38

NA 5.89 0.94

NA 20.21

090 53445............. .............. A

Insert uro/ves nck

14.04

NA 7.10 0.99

NA 22.13

090 sphincter. 53446............. .............. A

Remove uro sphincter.. 10.21

NA 5.23 0.72

NA 16.16

090 53447............. .............. A

Remove/replace ur

13.47

NA 6.44 0.95

NA 20.86

090 sphincter. 53448............. .............. A

Remov/replc ur

21.12

NA 9.07 1.50

NA 31.69

090 sphinctr comp. 53449............. .............. A

Repair uro sphincter.. 9.69

NA 4.73 0.68

NA 15.10

090 53450............. .............. A

Revision of urethra... 6.13

NA 3.30 0.43

NA 9.86

090 53460............. .............. A

Revision of urethra... 7.11

NA 3.70 0.50

NA 11.31

090 53500............. .............. A

Urethrlys, transvag w/ 12.19

NA 6.22 0.90

NA 19.31

090 scope. 53502............. .............. A

Repair of urethra

7.62

NA 3.99 0.62

NA 12.23

090 injury. 53505............. .............. A

Repair of urethra

7.62

NA 3.87 0.54

NA 12.03

090 injury. 53510............. .............. A

Repair of urethra

10.09

NA 5.17 0.74

NA 16.00

090 injury. 53515............. .............. A

Repair of urethra

13.29

NA 5.94 1.05

NA 20.28

090 injury. 53520............. .............. A

Repair of urethra

8.67

NA 4.48 0.61

NA 13.76

090 defect. 53600............. .............. A

Dilate urethra

1.21 1.14 0.43 0.09 2.44 1.73

000 stricture. 53601............. .............. A

Dilate urethra

0.98 1.27 0.37 0.07 2.32 1.42

000 stricture. 53605............. .............. A

Dilate urethra

1.28

NA 0.41 0.09

NA 1.78

000 stricture. 53620............. .............. A

Dilate urethra

1.62 2.00 0.59 0.11 3.73 2.32

000 stricture. 53621............. .............. A

Dilate urethra

1.35 2.08 0.49 0.10 3.53 1.94

000 stricture. 53660............. .............. A

Dilation of urethra... 0.71 1.31 0.31 0.05 2.07 1.07

000 53661............. .............. A

Dilation of urethra... 0.72 1.30 0.29 0.05 2.07 1.06

000 53665............. .............. A

Dilation of urethra... 0.76

NA 0.25 0.06

NA 1.07

000 53850............. .............. A

Prostatic microwave

9.44 94.33 3.95 0.67 104.44 14.06

090 thermotx. 53852............. .............. A

Prostatic rf thermotx. 9.87 89.03 4.38 0.70 99.60 14.95

090 53853............. .............. A

Prostatic water

5.23 55.50 2.86 0.37 61.10 8.46

090 thermother. 53899............. .............. C

Urology surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 54000............. .............. A

Slitting of prepuce... 1.54 2.92 0.93 0.11 4.57 2.58

010 54001............. .............. A

Slitting of prepuce... 2.19 3.19 1.11 0.15 5.53 3.45

010 54015............. .............. A

Drain penis lesion.... 5.31

NA 2.56 0.38

NA 8.25

010 54050............. .............. A

Destruction, penis

1.24 1.66 1.03 0.08 2.98 2.35

010 lesion(s). 54055............. .............. A

Destruction, penis

1.22 1.57 0.80 0.08 2.87 2.10

010 lesion(s). 54056............. .............. A

Cryosurgery, penis

1.24 1.69 1.13 0.06 2.99 2.43

010 lesion(s). 54057............. .............. A

Laser surg, penis

1.24 2.22 0.83 0.09 3.55 2.16

010 lesion(s). 54060............. .............. A

Excision of penis

1.93 3.11 1.06 0.13 5.17 3.12

010 lesion(s). 54065............. .............. A

Destruction, penis

2.42 2.64 1.23 0.13 5.19 3.78

010 lesion(s). 54100............. .............. A

Biopsy of penis....... 1.90 2.81 0.82 0.10 4.81 2.82

000 54105............. .............. A

Biopsy of penis....... 3.49 4.29 1.94 0.25 8.03 5.68

010 54110............. .............. A

Treatment of penis

10.11

NA 4.76 0.72

NA 15.59

090 lesion. 54111............. .............. A

Treat penis lesion,

13.55

NA 5.78 0.96

NA 20.29

090 graft. 54112............. .............. A

Treat penis lesion,

15.84

NA 6.81 1.11

NA 23.76

090 graft. 54115............. .............. A

Treatment of penis

6.14 4.38 3.46 0.43 10.95 10.03

090 lesion. 54120............. .............. A

Partial removal of

9.96

NA 4.68 0.68

NA 15.32

090 penis. 54125............. .............. A

Removal of penis...... 13.51

NA 5.84 0.95

NA 20.30

090 54130............. .............. A

Remove penis & nodes.. 20.11

NA 8.19 1.52

NA 29.82

090 54135............. .............. A

Remove penis & nodes.. 26.32

NA 10.19 1.87

NA 38.38

090 54150............. .............. A

Circumcision.......... 1.81 4.36 0.70 0.16 6.33 2.67

000 54152............. .............. A

Circumcision.......... 2.31

NA 1.20 0.19

NA 3.70

010 54160............. .............. A

Circumcision.......... 2.48 4.15 1.09 0.19 6.82 3.76

010 54161............. .............. A

Circumcision.......... 3.27

NA 1.56 0.23

NA 5.06

010 54162............. .............. A

Lysis penil circumic

3.00 4.66 1.44 0.21 7.87 4.65

010 lesion. 54163............. .............. A

Repair of circumcision 3.00

NA 2.01 0.21

NA 5.22

010 54164............. .............. A

Frenulotomy of penis.. 2.50

NA 1.84 0.18

NA 4.52

010 54200............. .............. A

Treatment of penis

1.06 1.80 0.97 0.08 2.94 2.11

010 lesion. 54205............. .............. A

Treatment of penis

7.92

NA 4.69 0.56

NA 13.17

090 lesion. 54220............. .............. A

Treatment of penis

2.42 3.85 0.95 0.17 6.44 3.54

000 lesion. 54230............. .............. A

Prepare penis study... 1.34 1.08 0.63 0.09 2.51 2.06

000 54231............. .............. A

Dynamic cavernosometry 2.04 1.37 0.87 0.16 3.57 3.07

000 54235............. .............. A

Penile injection...... 1.19 0.96 0.58 0.08 2.23 1.85

000 54240............. 26............ A

Penis study........... 1.31 0.43 0.43 0.11 1.85 1.85

000 54240............. TC............ A

Penis study........... 0.00 0.60

NA 0.06 0.66

NA

000 54240............. .............. A

Penis study........... 1.31 1.03

NA 0.17 2.51

NA

000 54250............. 26............ A

Penis study........... 2.22 0.71 0.71 0.16 3.09 3.09

000 54250............. TC............ A

Penis study........... 0.00 0.20

NA 0.02 0.22

NA

000 54250............. .............. A

Penis study........... 2.22 0.91

NA 0.18 3.31

NA

000 54300............. .............. A

Revision of penis..... 10.39

NA 5.58 0.76

NA 16.73

090 54304............. .............. A

Revision of penis..... 12.47

NA 6.34 0.88

NA 19.69

090

[[Page 70394]]

54308............. .............. A

Reconstruction of

11.81

NA 5.97 0.84

NA 18.62

090 urethra. 54312............. .............. A

Reconstruction of

13.55

NA 7.00 1.24

NA 1.79

090 urethra. 54316............. .............. A

Reconstruction of

16.79

NA 7.96 1.21

NA 25.96

090 urethra. 54318............. .............. A

Reconstruction of

11.23

NA 5.80 1.39

NA 18.42

090 urethra. 54322............. .............. A

Reconstruction of

12.99

NA 6.47 0.92

NA 20.38

090 urethra. 54324............. .............. A

Reconstruction of

16.29

NA 7.97 1.14

NA 25.40

090 urethra. 54326............. .............. A

Reconstruction of

15.70

NA 7.79 1.11

NA 24.60

090 urethra. 54328............. .............. A

Revise penis/urethra.. 15.63

NA 7.26 0.98

NA 23.87

090 54332............. .............. A

Revise penis/urethra.. 17.05

NA 7.74 1.21

NA 26.00

090 54336............. .............. A

Revise penis/urethra.. 20.01

NA 10.31 2.20

NA 32.52

090 54340............. .............. A

Secondary urethral

8.90

NA 5.04 0.63

NA 14.57

090 surgery. 54344............. .............. A

Secondary urethral

15.92

NA 7.76 1.54

NA 25.22

090 surgery. 54348............. .............. A

Secondary urethral

17.12

NA 8.36 1.23

NA 26.71

090 surgery. 54352............. .............. A

Reconstruct urethra/

24.70

NA 11.20 2.24

NA 38.14

090 penis. 54360............. .............. A

Penis plastic surgery. 11.91

NA 6.04 0.84

NA 18.79

090 54380............. .............. A

Repair penis.......... 13.16

NA 6.62 0.93

NA 20.71

090 54385............. .............. A

Repair penis.......... 15.37

NA 8.27 0.86

NA 24.50

090 54390............. .............. A

Repair penis and

21.58

NA 9.43 1.54

NA 32.55

090 bladder. 54400............. .............. A

Insert semi-rigid

8.98

NA 4.35 0.64

NA 13.97

090 prosthesis. 54401............. .............. A

Insert self-contd

10.26

NA 5.74 0.73

NA 16.73

090 prosthesis. 54405............. .............. A

Insert multi-comp

13.41

NA 5.93 0.95

NA 20.29

090 penis pros. 54406............. .............. A

Remove muti-comp penis 12.08

NA 5.43 0.86

NA 18.37

090 pros. 54408............. .............. A

Repair multi-comp

12.73

NA 5.74 0.90

NA 19.37

090 penis pros. 54410............. .............. A

Remove/replace penis

15.48

NA 6.63 1.10

NA 23.21

090 prosth. 54411............. .............. A

Remov/replc penis

15.98

NA 7.05 1.13

NA 24.16

090 pros, comp. 54415............. .............. A

Remove self-contd

8.19

NA 4.20 0.58

NA 12.97

090 penis pros. 54416............. .............. A

Remv/repl penis

10.85

NA 5.38 0.77

NA 17.00

090 contain pros. 54417............. .............. A

Remv/replc penis pros, 14.17

NA 6.18 1.00

NA 21.35

090 compl. 54420............. .............. A

Revision of penis..... 11.40

NA 5.58 0.81

NA 17.79

090 54430............. .............. A

Revision of penis..... 10.13

NA 5.11 0.72

NA 15.96

090 54435............. .............. A

Revision of penis..... 6.11

NA 3.62 0.43

NA 10.16

090 54440............. .............. C

Repair of penis....... 0.00 0.00 0.00 0.00 0.00 0.00

090 54450............. .............. A

Preputial stretching.. 1.12 0.95 0.44 0.08 2.15 1.64

000 54500............. .............. A

Biopsy of testis...... 1.31 0.61 0.56 0.10 2.02 1.97

000 54505............. .............. A

Biopsy of testis...... 3.45

NA 1.92 0.27

NA 5.64

010 54512............. .............. A

Excise lesion testis.. 8.57

NA 4.13 0.67

NA 13.37

090 54520............. .............. A

Removal of testis..... 5.22

NA 2.79 0.50

NA 8.51

090 54522............. .............. A

Orchiectomy, partial.. 9.49

NA 4.87 0.89

NA 15.25

090 54530............. .............. A

Removal of testis..... 8.57

NA 4.24 0.66

NA 13.47

090 54535............. .............. A

Extensive testis

12.14

NA 5.55 0.95

NA 18.64

090 surgery. 54550............. .............. A

Exploration for testis 7.77

NA 3.81 0.59

NA 12.17

090 54560............. .............. A

Exploration for testis 11.11

NA 5.16 0.90

NA 17.17

090 54600............. .............. A

Reduce testis torsion. 7.00

NA 3.55 0.51

NA 11.06

090 54620............. .............. A

Suspension of testis.. 4.89

NA 2.44 0.37

NA 7.70

010 54640............. .............. A

Suspension of testis.. 6.89

NA 3.74 0.62

NA 11.25

090 54650............. .............. A

Orchiopexy (Fowler-

11.43

NA 5.41 1.16

NA 18.00

090 Stephens). 54660............. .............. A

Revision of testis.... 5.10

NA 3.00 0.44

NA 8.54

090 54670............. .............. A

Repair testis injury.. 6.40

NA 3.54 0.47

NA 10.41

090 54680............. .............. A

Relocation of

12.63

NA 6.16 1.16

NA 19.95

090 testis(es). 54690............. .............. A

Laparoscopy,

10.94

NA 4.94 1.02

NA 16.90

090 orchiectomy. 54692............. .............. A

Laparoscopy,

12.86

NA 5.44 1.30

NA 19.60

090 orchiopexy. 54699............. .............. C

Laparoscope proc,

0.00 0.00 0.00 0.00 0.00 0.00

YYY testis. 54700............. .............. A

Drainage of scrotum... 3.42

NA 1.94 0.28

NA 5.64

010 54800............. .............. A

Biopsy of epididymis.. 2.33 0.94 0.90 0.23 3.50 3.46

000 54820............. .............. A

Exploration of

5.13

NA 2.94 0.40

NA 8.47

090 epididymis. 54830............. .............. A

Remove epididymis

5.37

NA 3.02 0.41

NA 8.80

090 lesion. 54840............. .............. A

Remove epididymis

5.19

NA 2.78 0.37

NA 8.34

090 lesion. 54860............. .............. A

Removal of epididymis. 6.31

NA 3.31 0.45

NA 10.07

090 54861............. .............. A

Removal of epididymis. 8.89

NA 4.31 0.63

NA 13.83

090 54900............. .............. A

Fusion of spermatic

13.18

NA 5.80 0.93

NA 19.91

090 ducts. 54901............. .............. A

Fusion of spermatic

17.91

NA 7.53 1.82

NA 27.26

090 ducts. 55000............. .............. A

Drainage of hydrocele. 1.43 2.07 0.65 0.11 3.61 2.19

000 55040............. .............. A

Removal of hydrocele.. 5.35

NA 2.90 0.43

NA 8.68

090 55041............. .............. A

Removal of hydroceles. 7.73

NA 3.97 0.60

NA 12.30

090 55060............. .............. A

Repair of hydrocele... 5.51

NA 3.08 0.46

NA 9.05

090 55100............. .............. A

Drainage of scrotum

2.13 3.68 1.56 0.17 5.98 3.86

010 abscess. 55110............. .............. A

Explore scrotum....... 5.69

NA 3.13 0.43

NA 9.25

090 55120............. .............. A

Removal of scrotum

5.08

NA 2.95 0.39

NA 8.42

090 lesion. 55150............. .............. A

Removal of scrotum.... 7.21

NA 3.84 0.56

NA 11.61

090 55175............. .............. A

Revision of scrotum... 5.23

NA 3.01 0.37

NA 8.61

090 55180............. .............. A

Revision of scrotum... 10.70

NA 5.37 0.90

NA 16.97

090 55200............. .............. A

Incision of sperm duct 4.23 12.35 2.38 0.33 16.91 6.94

090 55250............. .............. A

Removal of sperm

3.29 11.50 2.22 0.25 15.04 5.76

090 duct(s). 55300............. .............. A

Prepare, sperm duct x- 3.50

NA 1.31 0.25

NA 5.06

000 ray. 55400............. .............. A

Repair of sperm duct.. 8.48

NA 4.06 0.64

NA 13.18

090

[[Page 70395]]

55450............. .............. A

Ligation of sperm duct 4.11 7.01 1.87 0.29 11.41 6.27

010 55500............. .............. A

Removal of hydrocele.. 5.58

NA 3.09 0.55

NA 9.22

090 55520............. .............. A

Removal of sperm cord

6.02

NA 3.25 0.75

NA 10.02

090 lesion. 55530............. .............. A

Revise spermatic cord

5.65

NA 3.01 0.45

NA 9.11

090 veins. 55535............. .............. A

Revise spermatic cord

6.55

NA 3.40 0.47

NA 10.42

090 veins. 55540............. .............. A

Revise hernia & sperm

7.66

NA 3.80 0.94

NA 12.40

090 veins. 55550............. .............. A

Laparo ligate

6.56

NA 3.30 0.57

NA 10.43

090 spermatic vein. 55559............. .............. C

Laparo proc, spermatic 0.00 0.00 0.00 0.00 0.00 0.00

YYY cord. 55600............. .............. A

Incise sperm duct

6.37

NA 3.33 0.62

NA 10.32

090 pouch. 55605............. .............. A

Incise sperm duct

7.95

NA 4.29 0.64

NA 12.88

090 pouch. 55650............. .............. A

Remove sperm duct

11.78

NA 5.28 0.92

NA 17.98

090 pouch. 55680............. .............. A

Remove sperm pouch

5.18

NA 2.97 0.47

NA 8.62

090 lesion. 55700............. .............. A

Biopsy of prostate.... 1.57 4.20 0.64 0.11 5.88 2.32

000 55705............. .............. A

Biopsy of prostate.... 4.56

NA 2.30 0.32

NA 7.18

010 55720............. .............. A

Drainage of prostate

7.63

NA 3.82 0.95

NA 12.40

090 abscess. 55725............. .............. A

Drainage of prostate

8.67

NA 4.49 0.70

NA 13.86

090 abscess. 55801............. .............. A

Removal of prostate... 17.77

NA 7.62 1.34

NA 26.73

090 55810............. .............. A

Extensive prostate

22.55

NA 8.95 1.60

NA 33.10

090 surgery. 55812............. .............. A

Extensive prostate

27.47

NA 10.99 2.04

NA 40.50

090 surgery. 55815............. .............. A

Extensive prostate

30.41

NA 11.90 2.16

NA 44.47

090 surgery. 55821............. .............. A

Removal of prostate... 14.23

NA 6.21 1.01

NA 21.45

090 55831............. .............. A

Removal of prostate... 15.60

NA 6.66 1.10

NA 23.36

090 55840............. .............. A

Extensive prostate

22.66

NA 9.29 1.61

NA 33.56

090 surgery. 55842............. .............. A

Extensive prostate

24.34

NA 9.85 1.72

NA 35.91

090 surgery. 55845............. .............. A

Extensive prostate

28.51

NA 10.94 2.02

NA 41.47

090 surgery. 55859............. .............. A

Percut/needle insert, 12.50

NA 5.85 0.89

NA 19.24

090 pros. 55860............. .............. A

Surgical exposure,

14.43

NA 6.41 1.02

NA 21.86

090 prostate. 55862............. .............. A

Extensive prostate

18.36

NA 7.85 1.49

NA 27.70

090 surgery. 55865............. .............. A

Extensive prostate

22.84

NA 9.27 1.63

NA 33.74

090 surgery. 55866............. .............. A

Laparo radical

30.69

NA 11.73 2.16

NA 44.58

090 prostatectomy. 55870............. .............. A

Electroejaculation.... 2.58 1.53 1.08 0.16 4.27 3.82

000 55873............. .............. A

Cryoablate prostate... 19.44

NA 8.96 1.38

NA 29.78

090 55899............. .............. C

Genital surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 55970............. .............. N

Sex transformation, M

0.00 0.00 0.00 0.00 0.00 0.00

XXX to F. 55980............. .............. N

Sex transformation, F

0.00 0.00 0.00 0.00 0.00 0.00

XXX to M. 56405............. .............. A

I & D of vulva/

1.44 1.33 1.14 0.17 2.94 2.75

010 perineum. 56420............. .............. A

Drainage of gland

1.39 2.28 1.04 0.16 3.83 2.59

010 abscess. 56440............. .............. A

Surgery for vulva

2.84

NA 1.71 0.34

NA 4.89

010 lesion. 56441............. .............. A

Lysis of labial

1.97 1.82 1.41 0.20 3.99 3.58

010 lesion(s). 56501............. .............. A

Destroy, vulva

1.53 1.79 1.24 0.18 3.50 2.95

010 lesions, sim. 56515............. .............. A

Destroy vulva lesion/s 2.76 2.55 1.82 0.33 5.64 4.91

010 compl. 56605............. .............. A

Biopsy of vulva/

1.10 1.07 0.46 0.13 2.30 1.69

000 perineum. 56606............. .............. A

Biopsy of vulva/

0.55 0.49 0.22 0.07 1.11 0.84

ZZZ perineum. 56620............. .............. A

Partial removal of

7.46

NA 4.80 0.90

NA 13.16

090 vulva. 56625............. .............. A

Complete removal of

8.39

NA 5.33 1.02

NA 14.74

090 vulva. 56630............. .............. A

Extensive vulva

12.34

NA 6.85 1.49

NA 20.68

090 surgery. 56631............. .............. A

Extensive vulva

16.18

NA 8.83 1.95

NA 26.96

090 surgery. 56632............. .............. A

Extensive vulva

20.26

NA 9.54 2.38

NA 32.18

090 surgery. 56633............. .............. A

Extensive vulva

16.45

NA 8.61 1.97

NA 27.03

090 surgery. 56634............. .............. A

Extensive vulva

17.85

NA 9.45 2.16

NA 29.46

090 surgery. 56637............. .............. A

Extensive vulva

21.94

NA 11.09 2.60

NA 35.63

090 surgery. 56640............. .............. A

Extensive vulva

22.14

NA 10.64 2.88

NA 35.66

090 surgery. 56700............. .............. A

Partial removal of

2.52

NA 1.84 0.30

NA 4.66

010 hymen. 56720............. .............. A

Incision of hymen..... 0.68

NA 0.51 0.08

NA 1.27

000 56740............. .............. A

Remove vagina gland

4.56

NA 2.57 0.56

NA 7.69

010 lesion. 56800............. .............. A

Repair of vagina...... 3.88

NA 2.20 0.44

NA 6.52

010 56805............. .............. A

Repair clitoris....... 18.83

NA 9.44 2.14

NA 30.41

090 56810............. .............. A

Repair of perineum.... 4.12

NA 2.30 0.49

NA 6.91

010 56820............. .............. A

Exam of vulva w/scope. 1.50 1.31 0.65 0.18 2.99 2.33

000 56821............. .............. A

Exam/biopsy of vulva w/ 2.05 1.76 0.91 0.25 4.06 3.21

000 scope. 57000............. .............. A

Exploration of vagina. 2.97

NA 1.72 0.31

NA 5.00

010 57010............. .............. A

Drainage of pelvic

6.02

NA 3.81 0.71

NA 10.54

090 abscess. 57020............. .............. A

Drainage of pelvic

1.50 0.94 0.59 0.18 2.62 2.27

000 fluid. 57022............. .............. A

I & d vaginal

2.56

NA 1.49 0.26

NA 4.31

010 hematoma, pp. 57023............. .............. A

I & d vag hematoma,

4.74

NA 2.58 0.58

NA 7.90

010 non-ob. 57061............. .............. A

Destroy vag lesions,

1.25 1.65 1.12 0.15 3.05 2.52

010 simple. 57065............. .............. A

Destroy vag lesions,

2.61 2.30 1.67 0.31 5.22 4.59

010 complex. 57100............. .............. A

Biopsy of vagina...... 1.20 1.08 0.48 0.14 2.42 1.82

000 57105............. .............. A

Biopsy of vagina...... 1.69 1.80 1.42 0.20 3.69 3.31

010 57106............. .............. A

Remove vagina wall,

6.35

NA 4.19 0.73

NA 11.27

090 partial. 57107............. .............. A

Remove vagina tissue, 22.97

NA 10.49 2.71

NA 36.17

090 part. 57109............. .............. A

Vaginectomy partial w/ 26.96

NA 11.27 3.21

NA 41.44

090 nodes. 57110............. .............. A

Remove vagina wall,

14.27

NA 7.29 1.73

NA 23.29

090 complete. 57111............. .............. A

Remove vagina tissue, 26.96

NA 12.65 3.17

NA 42.78

090 compl. 57112............. .............. A

Vaginectomy w/nodes,

28.96

NA 12.13 3.07

NA 44.16

090 compl.

[[Page 70396]]

57120............. .............. A

Closure of vagina..... 7.40

NA 4.61 0.89

NA 12.90

090 57130............. .............. A

Remove vagina lesion.. 2.43 2.16 1.54 0.29 4.88 4.26

010 57135............. .............. A

Remove vagina lesion.. 2.67 2.27 1.65 0.31 5.25 4.63

010 57150............. .............. A

Treat vagina infection 0.55 1.10 0.21 0.07 1.72 0.83

000 57155............. .............. A

Insert uteri tandems/

6.26

NA 4.57 0.43

NA 11.26

090 ovoids. 57160............. .............. A

Insert pessary/other

0.89 1.01 0.34 0.10 2.00 1.33

000 device. 57170............. .............. A

Fitting of diaphragm/

0.91 1.48 0.33 0.11 2.50 1.35

000 cap. 57180............. .............. A

Treat vaginal bleeding 1.58 2.17 1.26 0.19 3.94 3.03

010 57200............. .............. A

Repair of vagina...... 3.93

NA 2.90 0.46

NA 7.29

090 57210............. .............. A

Repair vagina/perineum 5.16

NA 3.44 0.62

NA 9.22

090 57220............. .............. A

Revision of urethra... 4.30

NA 3.11 0.51

NA 7.92

090 57230............. .............. A

Repair of urethral

5.63

NA 3.41 0.54

NA 9.58

090 lesion. 57240............. .............. A

Repair bladder &

6.06

NA 3.82 0.62

NA 10.50

090 vagina. 57250............. .............. A

Repair rectum & vagina 5.52

NA 3.58 0.65

NA 9.75

090 57260............. .............. A

Repair of vagina...... 8.26

NA 4.84 0.97

NA 14.07

090 57265............. .............. A

Extensive repair of

11.32

NA 6.05 1.32

NA 18.69

090 vagina. 57267............. .............. A

Insert mesh/pelvic flr 4.88

NA 1.98 0.64

NA 7.50

ZZZ addon. 57268............. .............. A

Repair of bowel bulge. 6.75

NA 4.20 0.79

NA 11.74

090 57270............. .............. A

Repair of bowel pouch. 12.09

NA 6.26 1.42

NA 19.77

090 57280............. .............. A

Suspension of vagina.. 15.02

NA 7.38 1.67

NA 24.07

090 57282............. .............. A

Colpopexy,

6.86

NA 4.51 1.02

NA 12.39

090 extraperitoneal. 57283............. .............. A

Colpopexy,

10.84

NA 5.93 1.02

NA 17.79

090 intraperitoneal. 57284............. .............. A

Repair paravaginal

12.68

NA 7.16 1.41

NA 21.25

090 defect. 57287............. .............. A

Revise/remove sling

10.69

NA 5.49 0.90

NA 17.08

090 repair. 57288............. .............. A

Repair bladder defect. 13.00

NA 5.92 1.12

NA 20.04

090 57289............. .............. A

Repair bladder &

11.56

NA 6.05 1.21

NA 18.82

090 vagina. 57291............. .............. A

Construction of vagina 7.94

NA 4.93 0.93

NA 13.80

090 57292............. .............. A

Construct vagina with 13.07

NA 6.95 1.58

NA 21.60

090 graft. 57295............. .............. A

Change vaginal graft.. 7.45

NA 4.44 0.91

NA 12.80

090 57300............. .............. A

Repair rectum-vagina

7.60

NA 4.29 0.87

NA 12.76

090 fistula. 57305............. .............. A

Repair rectum-vagina

13.75

NA 6.28 1.72

NA 21.75

090 fistula. 57307............. .............. A

Fistula repair &

15.91

NA 7.01 2.01

NA 24.93

090 colostomy. 57308............. .............. A

Fistula repair,

9.93

NA 5.10 1.14

NA 16.17

090 transperine. 57310............. .............. A

Repair urethrovaginal

6.77

NA 3.84 0.54

NA 11.15

090 lesion. 57311............. .............. A

Repair urethrovaginal

7.97

NA 4.12 0.65

NA 12.74

090 lesion. 57320............. .............. A

Repair bladder-vagina

8.00

NA 4.37 0.69

NA 13.06

090 lesion. 57330............. .............. A

Repair bladder-vagina 12.33

NA 5.72 1.06

NA 19.11

090 lesion. 57335............. .............. A

Repair vagina......... 18.70

NA 9.05 1.91

NA 29.66

090 57400............. .............. A

Dilation of vagina.... 2.27

NA 1.11 0.26

NA 3.64

000 57410............. .............. A

Pelvic examination.... 1.75 2.02 0.89 0.18 3.95 2.82

000 57415............. .............. A

Remove vaginal foreign 2.17

NA 1.42 0.24

NA 3.83

010 body. 57420............. .............. A

Exam of vagina w/scope 1.60 1.35 0.67 0.19 3.14 2.46

000 57421............. .............. A

Exam/biopsy of vag w/

2.20 1.85 0.96 0.27 4.32 3.43

000 scope. 57425............. .............. A

Laparoscopy, surg,

15.73

NA 6.65 1.75

NA 24.13

090 colpopexy. 57452............. .............. A

Exam of cervix w/scope 1.50 1.28 0.76 0.18 2.96 2.44

000 57454............. .............. A

Bx/curett of cervix w/ 2.33 1.64 1.15 0.28 4.25 3.76

000 scope. 57455............. .............. A

Biopsy of cervix w/

1.99 1.72 0.87 0.24 3.95 3.10

000 scope. 57456............. .............. A

Endocerv curettage w/

1.85 1.65 0.82 0.22 3.72 2.89

000 scope. 57460............. .............. A

Bx of cervix w/scope,

2.83 5.86 1.38 0.34 9.03 4.55

000 leep. 57461............. .............. A

Conz of cervix w/

3.43 6.12 1.47 0.41 9.96 5.31

000 scope, leep. 57500............. .............. A

Biopsy of cervix...... 0.97 2.55 0.63 0.12 3.64 1.72

000 57505............. .............. A

Endocervical curettage 1.14 1.46 1.10 0.14 2.74 2.38

010 57510............. .............. A

Cauterization of

1.90 1.56 1.04 0.23 3.69 3.17

010 cervix. 57511............. .............. A

Cryocautery of cervix. 1.90 1.83 1.37 0.23 3.96 3.50

010 57513............. .............. A

Laser surgery of

1.90 1.72 1.40 0.23 3.85 3.53

010 cervix. 57520............. .............. A

Conization of cervix.. 4.03 3.94 2.88 0.49 8.46 7.40

090 57522............. .............. A

Conization of cervix.. 3.35 3.16 2.46 0.41 6.92 6.22

090 57530............. .............. A

Removal of cervix..... 4.78

NA 3.39 0.58

NA 8.75

090 57531............. .............. A

Removal of cervix,

27.96

NA 13.20 3.34

NA 44.50

090 radical. 57540............. .............. A

Removal of residual

12.20

NA 6.25 1.49

NA 19.94

090 cervix. 57545............. .............. A

Remove cervix/repair

13.01

NA 6.69 1.52

NA 21.22

090 pelvis. 57550............. .............. A

Removal of residual

5.52

NA 3.83 0.67

NA 10.02

090 cervix. 57555............. .............. A

Remove cervix/repair

8.94

NA 5.09 1.09

NA 15.12

090 vagina. 57556............. .............. A

Remove cervix, repair

8.36

NA 4.86 0.92

NA 14.14

090 bowel. 57700............. .............. A

Revision of cervix.... 3.54

NA 3.11 0.41

NA 7.06

090 57720............. .............. A

Revision of cervix.... 4.12

NA 3.11 0.49

NA 7.72

090 57800............. .............. A

Dilation of cervical

0.77 0.76 0.47 0.09 1.62 1.33

000 canal. 57820............. .............. A

D & c of residual

1.67 1.47 1.14 0.20 3.34 3.01

010 cervix. 58100............. .............. A

Biopsy of uterus

1.53 1.32 0.72 0.18 3.03 2.43

000 lining. 58110............. .............. A

Bx done w/colposcopy

0.77 0.55 0.31 0.09 1.41 1.17

ZZZ add-on. 58120............. .............. A

Dilation and curettage 3.27 2.31 1.88 0.39 5.97 5.54

010 58140............. .............. A

Myomectomy abdom

14.58

NA 7.12 1.81

NA 23.51

090 method. 58145............. .............. A

Myomectomy vag method. 8.03

NA 4.80 0.97

NA 13.80

090 58146............. .............. A

Myomectomy abdom

18.97

NA 9.03 2.32

NA 30.32

090 complex. 58150............. .............. A

Total hysterectomy.... 15.22

NA 7.50 1.84

NA 24.56

090

[[Page 70397]]

58152............. .............. A

Total hysterectomy.... 20.57

NA 9.88 2.47

NA 32.92

090 58180............. .............. A

Partial hysterectomy.. 15.27

NA 7.47 1.64

NA 24.38

090 58200............. .............. A

Extensive hysterectomy 21.56

NA 10.02 2.54

NA 34.12

090 58210............. .............. A

Extensive hysterectomy 28.81

NA 13.23 3.37

NA 45.41

090 58240............. .............. A

Removal of pelvis

38.33

NA 17.66 4.22

NA 60.21

090 contents. 58260............. .............. A

Vaginal hysterectomy.. 12.96

NA 6.71 1.57

NA 21.24

090 58262............. .............. A

Vag hyst including t/o 14.75

NA 7.40 1.79

NA 23.94

090 58263............. .............. A

Vag hyst w/t/o & vag

16.04

NA 7.90 1.94

NA 25.88

090 repair. 58267............. .............. A

Vag hyst w/urinary

17.01

NA 8.39 2.06

NA 27.46

090 repair. 58270............. .............. A

Vag hyst w/enterocele 14.24

NA 7.08 1.73

NA 23.05

090 repair. 58275............. .............. A

Hysterectomy/revise

15.74

NA 7.79 1.91

NA 25.44

090 vagina. 58280............. .............. A

Hysterectomy/revise

16.98

NA 8.27 2.06

NA 27.31

090 vagina. 58285............. .............. A

Extensive hysterectomy 22.23

NA 9.97 2.70

NA 34.90

090 58290............. .............. A

Vag hyst complex...... 18.97

NA 9.15 2.29

NA 30.41

090 58291............. .............. A

Vag hyst incl t/o,

20.76

NA 9.90 2.52

NA 33.18

090 complex. 58292............. .............. A

Vag hyst t/o & repair, 22.05

NA 10.39 2.67

NA 35.11

090 compl. 58293............. .............. A

Vag hyst w/uro repair, 23.03

NA 10.68 2.78

NA 36.49

090 compl. 58294............. .............. A

Vag hyst w/enterocele, 20.25

NA 9.58 2.39

NA 32.22

090 compl. 58300............. .............. N

Insert intrauterine

+1.01 1.42 0.38 0.12 2.55 1.51

XXX device. 58301............. .............. A

Remove intrauterine

1.27 1.32 0.48 0.15 2.74 1.90

000 device. 58321............. .............. A

Artificial

0.92 1.15 0.37 0.10 2.17 1.39

000 insemination. 58322............. .............. A

Artificial

1.10 1.20 0.42 0.13 2.43 1.65

000 insemination. 58323............. .............. A

Sperm washing......... 0.23 0.53 0.09 0.03 0.79 0.35

000 58340............. .............. A

Catheter for

0.88 3.17 0.65 0.09 4.14 1.62

000 hysterography. 58345............. .............. A

Reopen fallopian tube. 4.65

NA 2.44 0.41

NA 7.50

010 58346............. .............. A

Insert heyman uteri

6.74

NA 3.93 0.56

NA 11.23

090 capsule. 58350............. .............. A

Reopen fallopian tube. 1.01 1.49 0.92 0.12 2.62 2.05

010 58353............. .............. A

Endometr ablate,

3.55 35.76 2.06 0.43 39.74 6.04

010 thermal. 58356............. .............. A

Endometrial

6.36 61.61 2.70 0.82 68.79 9.88

010 cryoablation. 58400............. .............. A

Suspension of uterus.. 6.35

NA 3.94 0.75

NA 11.04

090 58410............. .............. A

Suspension of uterus.. 12.71

NA 6.45 1.45

NA 20.61

090 58520............. .............. A

Repair of ruptured

11.90

NA 6.05 1.47

NA 19.42

090 uterus. 58540............. .............. A

Revision of uterus.... 14.62

NA 6.97 1.78

NA 23.37

090 58545............. .............. A

Laparoscopic

14.58

NA 7.20 1.77

NA 23.55

090 myomectomy. 58546............. .............. A

Laparo-myomectomy,

18.97

NA 8.94 2.30

NA 30.21

090 complex. 58550............. .............. A

Laparo-asst vag

14.17

NA 7.31 1.72

NA 23.20

090 hysterectomy. 58552............. .............. A

Laparo-vag hyst incl t/ 15.98

NA 8.03 1.72

NA 25.73

090 o. 58553............. .............. A

Laparo-vag hyst,

18.97

NA 8.94 2.30

NA 30.21

090 complex. 58554............. .............. A

Laparo-vag hyst w/t/o, 21.97

NA 10.42 2.27

NA 34.66

090 compl. 58555............. .............. A

Hysteroscopy, dx, sep

3.33 2.20 1.55 0.40 5.93 5.28

000 proc. 58558............. .............. A

Hysteroscopy, biopsy.. 4.74

NA 2.18 0.57

NA 7.49

000 58559............. .............. A

Hysteroscopy, lysis... 6.16

NA 2.74 0.74

NA 9.64

000 58560............. .............. A

Hysteroscopy, resect

6.99

NA 3.09 0.84

NA 10.92

000 septum. 58561............. .............. A

Hysteroscopy, remove

9.99

NA 4.29 1.21

NA 15.49

000 myoma. 58562............. .............. A

Hysteroscopy, remove

5.20

NA 2.36 0.63

NA 8.19

000 fb. 58563............. .............. A

Hysteroscopy, ablation 6.16 56.35 2.76 0.74 63.25 9.66

000 58565............. .............. A

Hysteroscopy,

7.02 49.70 3.91 1.19 57.91 12.12

090 sterilization. 58578............. .............. C

Laparo proc, uterus... 0.00 0.00 0.00 0.00 0.00 0.00

YYY 58579............. .............. C

Hysteroscope procedure 0.00 0.00 0.00 0.00 0.00 0.00

YYY 58600............. .............. A

Division of fallopian

5.59

NA 3.34 0.66

NA 9.59

090 tube. 58605............. .............. A

Division of fallopian

4.99

NA 3.12 0.59

NA 8.70

090 tube. 58611............. .............. A

Ligate oviduct(s) add- 1.45

NA 0.57 0.18

NA 2.20

ZZZ on. 58615............. .............. A

Occlude fallopian

3.89

NA 2.71 0.47

NA 7.07

010 tube(s). 58660............. .............. A

Laparoscopy, lysis.... 11.27

NA 5.27 1.40

NA 17.94

090 58661............. .............. A

Laparoscopy, remove

11.03

NA 5.13 1.34

NA 17.50

010 adnexa. 58662............. .............. A

Laparoscopy, excise

11.77

NA 5.80 1.43

NA 19.00

090 lesions. 58670............. .............. A

Laparoscopy, tubal

5.59

NA 3.28 0.67

NA 9.54

090 cautery. 58671............. .............. A

Laparoscopy, tubal

5.59

NA 3.28 0.68

NA 9.55

090 block. 58672............. .............. A

Laparoscopy,

12.86

NA 6.20 1.60

NA 20.66

090 fimbrioplasty. 58673............. .............. A

Laparoscopy,

13.72

NA 6.59 1.69

NA 22.00

090 salpingostomy. 58679............. .............. C

Laparo proc, oviduct-

0.00 0.00 0.00 0.00 0.00 0.00

YYY ovary. 58700............. .............. A

Removal of fallopian

12.03

NA 6.00 1.51

NA 19.54

090 tube. 58720............. .............. A

Removal of ovary/

11.34

NA 5.79 1.39

NA 18.52

090 tube(s). 58740............. .............. A

Revise fallopian

13.98

NA 7.15 1.71

NA 22.84

090 tube(s). 58750............. .............. A

Repair oviduct........ 14.82

NA 7.38 1.84

NA 24.04

090 58752............. .............. A

Revise ovarian tube(s) 14.82

NA 6.96 1.80

NA 23.58

090 58760............. .............. A

Remove tubal

13.11

NA 6.73 1.79

NA 21.63

090 obstruction. 58770............. .............. A

Create new tubal

13.95

NA 6.92 1.73

NA 22.60

090 opening. 58800............. .............. A

Drainage of ovarian

4.13 3.65 2.91 0.43 8.21 7.47

090 cyst(s). 58805............. .............. A

Drainage of ovarian

5.87

NA 3.51 0.69

NA 10.07

090 cyst(s). 58820............. .............. A

Drain ovary abscess,

4.21

NA 3.30 0.52

NA 8.03

090 open. 58822............. .............. A

Drain ovary abscess,

10.11

NA 5.23 1.16

NA 16.50

090 percut. 58823............. .............. A

Drain pelvic abscess,

3.37 21.38 1.12 0.24 24.99 4.73

000 percut. 58825............. .............. A

Transposition,

10.96

NA 5.81 1.32

NA 18.09

090 ovary(s). 58900............. .............. A

Biopsy of ovary(s).... 5.98

NA 3.58 0.69

NA 10.25

090

[[Page 70398]]

58920............. .............. A

Partial removal of

11.34

NA 5.59 1.43

NA 18.36

090 ovary(s). 58925............. .............. A

Removal of ovarian

11.34

NA 5.70 1.41

NA 18.45

090 cyst(s). 58940............. .............. A

Removal of ovary(s)... 7.28

NA 4.11 0.91

NA 12.30

090 58943............. .............. A

Removal of ovary(s)... 18.40

NA 8.67 2.22

NA 29.29

090 58950............. .............. A

Resect ovarian

16.90

NA 8.42 2.04

NA 27.36

090 malignancy. 58951............. .............. A

Resect ovarian

22.35

NA 10.47 2.63

NA 35.45

090 malignancy. 58952............. .............. A

Resect ovarian

24.97

NA 11.78 3.02

NA 39.77

090 malignancy. 58953............. .............. A

Tah, rad dissect for

31.95

NA 14.58 3.83

NA 50.36

090 debulk. 58954............. .............. A

Tah rad debulk/lymph

34.95

NA 15.75 4.17

NA 54.87

090 remove. 58956............. .............. A

Bso, omentectomy w/tah 20.78

NA 10.34 4.00

NA 35.12

090 58960............. .............. A

Exploration of abdomen 14.63

NA 7.37 1.79

NA 23.79

090 58970............. .............. A

Retrieval of oocyte... 3.52 2.32 1.49 0.43 6.27 5.44

000 58974............. .............. C

Transfer of embryo.... 0.00 0.00 0.00 0.00 0.00 0.00

000 58976............. .............. A

Transfer of embryo.... 3.82 2.69 1.83 0.47 6.98 6.12

000 58999............. .............. C

Genital surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 59000............. .............. A

Amniocentesis,

1.30 2.08 0.67 0.31 3.69 2.28

000 diagnostic. 59001............. .............. A

Amniocentesis,

3.00

NA 1.41 0.71

NA 5.12

000 therapeutic. 59012............. .............. A

Fetal cord puncture,

3.44

NA 1.54 0.82

NA 5.80

000 prenatal. 59015............. .............. A

Chorion biopsy........ 2.20 1.55 1.04 0.52 4.27 3.76

000 59020............. 26............ A

Fetal contract stress

0.66 0.26 0.26 0.16 1.08 1.08

000 test. 59020............. TC............ A

Fetal contract stress

0.00 0.52

NA 0.10 0.62

NA

000 test. 59020............. .............. A

Fetal contract stress

0.66 0.78

NA 0.26 1.70

NA

000 test. 59025............. 26............ A

Fetal non-stress test. 0.53 0.21 0.21 0.13 0.87 0.87

000 59025............. TC............ A

Fetal non-stress test. 0.00 0.23

NA 0.02 0.25

NA

000 59025............. .............. A

Fetal non-stress test. 0.53 0.44

NA 0.15 1.12

NA

000 59030............. .............. A

Fetal scalp blood

1.99

NA 0.77 0.47

NA 3.23

000 sample. 59050............. .............. A

Fetal monitor w/report 0.89

NA 0.35 0.21

NA 1.45

XXX 59051............. .............. A

Fetal monitor/

0.74

NA 0.29 0.17

NA 1.20

XXX interpret only. 59070............. .............. A

Transabdom amnioinfus

5.24 5.16 2.32 0.28 10.68 7.84

000 w/us. 59072............. .............. A

Umbilical cord occlud

8.99

NA 3.13 0.16

NA 12.28

000 w/us. 59074............. .............. A

Fetal fluid drainage w/ 5.24 4.58 2.32 0.28 10.10 7.84

000 us. 59076............. .............. A

Fetal shunt placement, 8.99

NA 3.13 0.16

NA 12.28

000 w/us. 59100............. .............. A

Remove uterus lesion.. 12.33

NA 6.47 2.94

NA 21.74

090 59120............. .............. A

Treat ectopic

11.47

NA 6.26 2.72

NA 20.45

090 pregnancy. 59121............. .............. A

Treat ectopic

11.65

NA 6.34 2.78

NA 20.77

090 pregnancy. 59130............. .............. A

Treat ectopic

14.20

NA 4.80 3.38

NA 22.38

090 pregnancy. 59135............. .............. A

Treat ectopic

13.86

NA 7.24 3.30

NA 24.40

090 pregnancy. 59136............. .............. A

Treat ectopic

13.16

NA 6.62 3.13

NA 22.91

090 pregnancy. 59140............. .............. A

Treat ectopic

5.45 2.22 2.22 1.29 8.96 8.96

090 pregnancy. 59150............. .............. A

Treat ectopic

11.65

NA 6.01 2.78

NA 20.44

090 pregnancy. 59151............. .............. A

Treat ectopic

11.47

NA 6.07 2.73

NA 20.27

090 pregnancy. 59160............. .............. A

D & c after delivery.. 2.71 3.30 2.14 0.64 6.65 5.49

010 59200............. .............. A

Insert cervical

0.79 1.19 0.30 0.19 2.17 1.28

000 dilator. 59300............. .............. A

Episiotomy or vaginal

2.41 2.18 0.96 0.57 5.16 3.94

000 repair. 59320............. .............. A

Revision of cervix.... 2.48

NA 1.24 0.59

NA 4.31

000 59325............. .............. A

Revision of cervix.... 4.06

NA 1.90 0.88

NA 6.84

000 59350............. .............. A

Repair of uterus...... 4.94

NA 1.88 1.17

NA 7.99

000 59400............. .............. A

Obstetrical care...... 23.03

NA 15.36 5.48

NA 43.87

MMM 59409............. .............. A

Obstetrical care...... 13.48

NA 5.32 3.21

NA 22.01

MMM 59410............. .............. A

Obstetrical care...... 14.76

NA 6.32 3.51

NA 24.59

MMM 59412............. .............. A

Antepartum

1.71

NA 0.81 0.40

NA 2.92

MMM manipulation. 59414............. .............. A

Deliver placenta...... 1.61

NA 0.64 0.38

NA 2.63

MMM 59425............. .............. A

Antepartum care only.. 4.80 4.21 1.86 1.14 10.15 7.80

MMM 59426............. .............. A

Antepartum care only.. 8.27 7.56 3.23 1.97 17.80 13.47

MMM 59430............. .............. A

Care after delivery... 2.13 1.23 0.94 0.50 3.86 3.57

MMM 59510............. .............. A

Cesarean delivery..... 26.18

NA 17.31 6.23

NA 49.72

MMM 59514............. .............. A

Cesarean delivery only 15.95

NA 6.23 3.79

NA 25.97

MMM 59515............. .............. A

Cesarean delivery..... 17.34

NA 7.85 4.12

NA 29.31

MMM 59525............. .............. A

Remove uterus after

8.53

NA 3.31 1.94

NA 13.78

ZZZ cesarean. 59610............. .............. A

Vbac delivery......... 24.58

NA 15.91 5.85

NA 46.34

MMM 59612............. .............. A

Vbac delivery only.... 15.04

NA 6.07 3.58

NA 24.69

MMM 59614............. .............. A

Vbac care after

16.32

NA 6.95 3.88

NA 27.15

MMM delivery. 59618............. .............. A

Attempted vbac

27.74

NA 18.28 6.59

NA 52.61

MMM delivery. 59620............. .............. A

Attempted vbac

17.50

NA 6.78 4.16

NA 28.44

MMM delivery only. 59622............. .............. A

Attempted vbac after

18.90

NA 8.66 4.49

NA 32.05

MMM care. 59812............. .............. A

Treatment of

4.00

NA 2.55 0.95

NA 7.50

090 miscarriage. 59820............. .............. A

Care of miscarriage... 4.00 4.43 3.57 0.95 9.38 8.52

090 59821............. .............. A

Treatment of

4.46 4.28 3.41 1.06 9.80 8.93

090 miscarriage. 59830............. .............. A

Treat uterus infection 6.10

NA 3.99 1.44

NA 11.53

090 59840............. .............. R

Abortion.............. 3.01

NA 2.13 0.71

NA 5.85

010 59841............. .............. R

Abortion.............. 5.23 3.50 2.98 1.24 9.97 9.45

010 59850............. .............. R

Abortion.............. 5.90

NA 3.26 1.28

NA 10.44

090 59851............. .............. R

Abortion.............. 5.92

NA 3.75 1.28

NA 10.95

090 59852............. .............. R

Abortion.............. 8.23

NA 5.05 1.80

NA 15.08

090 59855............. .............. R

Abortion.............. 6.11

NA 3.55 1.45

NA 11.11

090

[[Page 70399]]

59856............. .............. R

Abortion.............. 7.47

NA 4.07 1.78

NA 13.32

090 59857............. .............. R

Abortion.............. 9.28

NA 4.72 2.01

NA 16.01

090 59866............. .............. R

Abortion (mpr)........ 3.99

NA 1.90 0.87

NA 6.76

000 59870............. .............. A

Evacuate mole of

6.00

NA 4.49 1.42

NA 11.91

090 uterus. 59871............. .............. A

Remove cerclage suture 2.13 1.75 1.13 0.50 4.38 3.76

000 59897............. .............. C

Fetal invas px w/us... 0.00 0.00 0.00 0.00 0.00 0.00

YYY 59898............. .............. C

Laparo proc, ob care/

0.00 0.00 0.00 0.00 0.00 0.00

YYY deliver. 59899............. .............. C

Maternity care

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 60000............. .............. A

Drain thyroid/tongue

1.76 1.93 1.71 0.15 3.84 3.62

010 cyst. 60001............. .............. A

Aspirate/inject

0.97 1.41 0.33 0.07 2.45 1.37

000 thyriod cyst. 60100............. .............. A

Biopsy of thyroid..... 1.56 1.40 0.53 0.10 3.06 2.19

000 60200............. .............. A

Remove thyroid lesion. 9.54

NA 6.00 1.01

NA 16.55

090 60210............. .............. A

Partial thyroid

10.86

NA 5.65 1.23

NA 17.74

090 excision. 60212............. .............. A

Partial thyroid

16.01

NA 7.69 1.94

NA 25.64

090 excision. 60220............. .............. A

Partial removal of

11.88

NA 6.16 1.32

NA 19.36

090 thyroid. 60225............. .............. A

Partial removal of

14.17

NA 7.42 1.64

NA 23.23

090 thyroid. 60240............. .............. A

Removal of thyroid.... 16.04

NA 7.60 1.85

NA 25.49

090 60252............. .............. A

Removal of thyroid.... 20.54

NA 10.12 2.29

NA 32.95

090 60254............. .............. A

Extensive thyroid

26.95

NA 14.18 2.60

NA 43.73

090 surgery. 60260............. .............. A

Repeat thyroid surgery 17.44

NA 8.67 1.93

NA 28.04

090 60270............. .............. A

Removal of thyroid.... 20.24

NA 10.48 2.32

NA 33.04

090 60271............. .............. A

Removal of thyroid.... 16.80

NA 8.60 1.74

NA 27.14

090 60280............. .............. A

Remove thyroid duct

5.86

NA 4.67 0.54

NA 11.07

090 lesion. 60281............. .............. A

Remove thyroid duct

8.52

NA 5.85 0.73

NA 15.10

090 lesion. 60500............. .............. A

Explore parathyroid

16.21

NA 7.42 2.00

NA 25.63

090 glands. 60502............. .............. A

Re-explore

20.32

NA 9.38 2.53

NA 32.23

090 parathyroids. 60505............. .............. A

Explore parathyroid

21.46

NA 10.95 2.64

NA 35.05

090 glands. 60512............. .............. A

Autotransplant

4.44

NA 1.62 0.53

NA 6.59

ZZZ parathyroid. 60520............. .............. A

Removal of thymus

16.78

NA 8.31 2.19

NA 27.28

090 gland. 60521............. .............. A

Removal of thymus

18.84

NA 9.57 2.81

NA 31.22

090 gland. 60522............. .............. A

Removal of thymus

23.06

NA 11.29 3.26

NA 37.61

090 gland. 60540............. .............. A

Explore adrenal gland. 17.00

NA 7.60 1.74

NA 26.34

090 60545............. .............. A

Explore adrenal gland. 19.85

NA 8.55 2.07

NA 30.47

090 60600............. .............. A

Remove carotid body

17.90

NA 10.99 2.19

NA 31.08

090 lesion. 60605............. .............. A

Remove carotid body

20.21

NA 12.29 2.49

NA 34.99

090 lesion. 60650............. .............. A

Laparoscopy

19.97

NA 8.00 2.28

NA 30.25

090 adrenalectomy. 60659............. .............. C

Laparo proc, endocrine 0.00 0.00 0.00 0.00 0.00 0.00

YYY 60699............. .............. C

Endocrine surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 61000............. .............. A

Remove cranial cavity

1.58

NA 0.95 0.13

NA 2.66

000 fluid. 61001............. .............. A

Remove cranial cavity

1.49

NA 1.06 0.16

NA 2.71

000 fluid. 61020............. .............. A

Remove brain cavity

1.51

NA 1.34 0.34

NA 3.19

000 fluid. 61026............. .............. A

Injection into brain

1.69

NA 1.39 0.33

NA 3.41

000 canal. 61050............. .............. A

Remove brain canal

1.51

NA 1.27 0.11

NA 2.89

000 fluid. 61055............. .............. A

Injection into brain

2.10

NA 1.42 0.17

NA 3.69

000 canal. 61070............. .............. A

Brain canal shunt

0.89

NA 1.01 0.17

NA 2.07

000 procedure. 61105............. .............. A

Twist drill hole...... 5.13

NA 3.94 1.32

NA 10.39

090 61107............. .............. A

Drill skull for

4.99

NA 2.54 1.29

NA 8.82

000 implantation. 61108............. .............. A

Drill skull for

10.17

NA 7.16 2.63

NA 19.96

090 drainage. 61120............. .............. A

Burr hole for puncture 8.75

NA 6.01 2.09

NA 16.85

090 61140............. .............. A

Pierce skull for

15.88

NA 9.91 4.11

NA 29.90

090 biopsy. 61150............. .............. A

Pierce skull for

17.54

NA 10.40 4.31

NA 32.25

090 drainage. 61151............. .............. A

Pierce skull for

12.40

NA 7.83 3.00

NA 23.23

090 drainage. 61154............. .............. A

Pierce skull & remove 14.97

NA 9.51 4.20

NA 28.68

090 clot. 61156............. .............. A

Pierce skull for

16.30

NA 9.86 4.22

NA 30.38

090 drainage. 61210............. .............. A

Pierce skull, implant

5.83

NA 2.92 1.50

NA 10.25

000 device. 61215............. .............. A

Insert brain-fluid

4.88

NA 4.01 1.26

NA 10.15

090 device. 61250............. .............. A

Pierce skull & explore 10.40

NA 6.87 2.76

NA 20.03

090 61253............. .............. A

Pierce skull & explore 12.34

NA 7.74 2.61

NA 22.69

090 61304............. .............. A

Open skull for

21.93

NA 12.87 5.61

NA 40.41

090 exploration. 61305............. .............. A

Open skull for

26.57

NA 15.35 6.07

NA 47.99

090 exploration. 61312............. .............. A

Open skull for

24.53

NA 15.08 6.34

NA 45.95

090 drainage. 61313............. .............. A

Open skull for

24.89

NA 14.84 6.43

NA 46.16

090 drainage. 61314............. .............. A

Open skull for

24.19

NA 13.07 6.26

NA 43.52

090 drainage. 61315............. .............. A

Open skull for

27.64

NA 16.06 7.14

NA 50.84

090 drainage. 61316............. .............. A

Implt cran bone flap

1.39

NA 0.60 0.35

NA 2.34

ZZZ to abdo. 61320............. .............. A

Open skull for

25.58

NA 14.79 6.60

NA 46.97

090 drainage. 61321............. .............. A

Open skull for

28.46

NA 16.17 7.12

NA 51.75

090 drainage. 61322............. .............. A

Decompressive

29.46

NA 15.71 7.61

NA 52.78

090 craniotomy. 61323............. .............. A

Decompressive

30.95

NA 16.13 8.01

NA 55.09

090 lobectomy. 61330............. .............. A

Decompress eye socket. 23.29

NA 13.76 2.31

NA 39.36

090 61332............. .............. A

Explore/biopsy eye

27.24

NA 15.64 4.82

NA 47.70

090 socket. 61333............. .............. A

Explore orbit/remove

27.91

NA 15.62 3.91

NA 47.44

090 lesion. 61334............. .............. A

Explore orbit/remove

18.24

NA 10.66 1.74

NA 30.64

090 object. 61340............. .............. A

Subtemporal

18.63

NA 11.15 4.83

NA 34.61

090 decompression. 61343............. .............. A

Incise skull (press

29.73

NA 16.85 7.62

NA 54.20

090 relief).

[[Page 70400]]

61345............. .............. A

Relieve cranial

27.16

NA 15.43 7.02

NA 49.61

090 pressure. 61440............. .............. A

Incise skull for

26.59

NA 14.24 6.88

NA 47.71

090 surgery. 61450............. .............. A

Incise skull for

25.91

NA 14.32 5.77

NA 46.00

090 surgery. 61458............. .............. A

Incise skull for brain 27.25

NA 15.55 7.01

NA 49.81

090 wound. 61460............. .............. A

Incise skull for

28.35

NA 16.46 6.02

NA 50.83

090 surgery. 61470............. .............. A

Incise skull for

26.02

NA 13.89 5.88

NA 45.79

090 surgery. 61480............. .............. A

Incise skull for

26.45

NA 15.31 6.71

NA 48.47

090 surgery. 61490............. .............. A

Incise skull for

25.62

NA 14.36 6.90

NA 46.88

090 surgery. 61500............. .............. A

Removal of skull

17.89

NA 10.83 4.10

NA 32.82

090 lesion. 61501............. .............. A

Remove infected skull 14.82

NA 9.23 3.21

NA 27.26

090 bone. 61510............. .............. A

Removal of brain

28.41

NA 16.74 7.33

NA 52.48

090 lesion. 61512............. .............. A

Remove brain lining

35.04

NA 19.73 9.05

NA 63.82

090 lesion. 61514............. .............. A

Removal of brain

25.22

NA 14.47 6.52

NA 46.21

090 abscess. 61516............. .............. A

Removal of brain

24.57

NA 14.30 6.33

NA 45.20

090 lesion. 61517............. .............. A

Implt brain chemotx

1.38

NA 0.64 0.35

NA 2.37

ZZZ add-on. 61518............. .............. A

Removal of brain

37.26

NA 21.15 9.62

NA 68.03

090 lesion. 61519............. .............. A

Remove brain lining

41.33

NA 22.71 10.60

NA 74.64

090 lesion. 61520............. .............. A

Removal of brain

54.76

NA 30.41 11.18

NA 96.35

090 lesion. 61521............. .............. A

Removal of brain

44.41

NA 24.28 11.36

NA 80.05

090 lesion. 61522............. .............. A

Removal of brain

29.41

NA 16.46 7.60

NA 53.47

090 abscess. 61524............. .............. A

Removal of brain

27.82

NA 15.71 7.14

NA 50.67

090 lesion. 61526............. .............. A

Removal of brain

52.09

NA 29.57 7.05

NA 88.71

090 lesion. 61530............. .............. A

Removal of brain

43.79

NA 25.12 6.13

NA 75.04

090 lesion. 61531............. .............. A

Implant brain

14.61

NA 9.15 3.78

NA 27.54

090 electrodes. 61533............. .............. A

Implant brain

19.68

NA 11.56 5.10

NA 36.34

090 electrodes. 61534............. .............. A

Removal of brain

20.94

NA 12.12 5.42

NA 38.48

090 lesion. 61535............. .............. A

Remove brain

11.61

NA 7.44 3.01

NA 22.06

090 electrodes. 61536............. .............. A

Removal of brain

35.47

NA 19.84 9.18

NA 64.49

090 lesion. 61537............. .............. A

Removal of brain

24.96

NA 14.78 6.92

NA 46.66

090 tissue. 61538............. .............. A

Removal of brain

26.77

NA 15.35 6.92

NA 49.04

090 tissue. 61539............. .............. A

Removal of brain

32.03

NA 17.81 8.30

NA 58.14

090 tissue. 61540............. .............. A

Removal of brain

29.96

NA 17.29 8.30

NA 55.55

090 tissue. 61541............. .............. A

Incision of brain

28.81

NA 16.25 6.58

NA 51.64

090 tissue. 61542............. .............. A

Removal of brain

30.97

NA 17.87 8.01

NA 56.85

090 tissue. 61543............. .............. A

Removal of brain

29.18

NA 16.43 7.54

NA 53.15

090 tissue. 61544............. .............. A

Remove & treat brain

25.46

NA 13.86 5.95

NA 45.27

090 lesion. 61545............. .............. A

Excision of brain

43.73

NA 24.28 10.60

NA 78.61

090 tumor. 61546............. .............. A

Removal of pituitary

31.25

NA 17.54 7.65

NA 56.44

090 gland. 61548............. .............. A

Removal of pituitary

21.50

NA 12.82 3.42

NA 37.74

090 gland. 61550............. .............. A

Release of skull seams 14.63

NA 6.95 0.98

NA 22.56

090 61552............. .............. A

Release of skull seams 19.53

NA 9.14 1.06

NA 29.73

090 61556............. .............. A

Incise skull/sutures.. 22.23

NA 11.39 4.64

NA 38.26

090 61557............. .............. A

Incise skull/sutures.. 22.35

NA 13.66 5.78

NA 41.79

090 61558............. .............. A

Excision of skull/

25.54

NA 14.23 1.36

NA 41.13

090 sutures. 61559............. .............. A

Excision of skull/

32.74

NA 19.37 8.48

NA 60.59

090 sutures. 61563............. .............. A

Excision of skull

26.79

NA 15.28 5.15

NA 47.22

090 tumor. 61564............. .............. A

Excision of skull

33.78

NA 18.33 8.75

NA 60.86

090 tumor. 61566............. .............. A

Removal of brain

30.95

NA 17.82 6.92

NA 55.69

090 tissue. 61567............. .............. A

Incision of brain

35.45

NA 20.73 6.52

NA 62.70

090 tissue. 61570............. .............. A

Remove foreign body,

24.56

NA 13.95 5.86

NA 44.37

090 brain. 61571............. .............. A

Incise skull for brain 26.35

NA 15.18 6.77

NA 48.30

090 wound. 61575............. .............. A

Skull base/brainstem

34.31

NA 19.69 5.32

NA 59.32

090 surgery. 61576............. .............. A

Skull base/brainstem

52.35

NA 34.83 5.56

NA 92.74

090 surgery. 61580............. .............. A

Craniofacial approach, 30.30

NA 25.65 3.36

NA 59.31

090 skull. 61581............. .............. A

Craniofacial approach, 34.55

NA 23.51 3.91

NA 61.97

090 skull. 61582............. .............. A

Craniofacial approach, 31.61

NA 27.38 7.19

NA 66.18

090 skull. 61583............. .............. A

Craniofacial approach, 36.16

NA 25.18 9.18

NA 70.52

090 skull. 61584............. .............. A

Orbitocranial approach/ 34.60

NA 24.59 8.16

NA 67.35

090 skull. 61585............. .............. A

Orbitocranial approach/ 38.55

NA 26.57 7.01

NA 72.13

090 skull. 61586............. .............. A

Resect nasopharynx,

25.06

NA 22.65 4.36

NA 52.07

090 skull. 61590............. .............. A

Infratemporal approach/ 41.72

NA 28.70 5.29

NA 75.71

090 skull. 61591............. .............. A

Infratemporal approach/ 43.61

NA 29.61 5.64

NA 78.86

090 skull. 61592............. .............. A

Orbitocranial approach/ 39.58

NA 26.58 10.04

NA 76.20

090 skull. 61595............. .............. A

Transtemporal approach/ 29.53

NA 22.41 3.97

NA 55.91

090 skull. 61596............. .............. A

Transcochlear approach/ 35.58

NA 24.51 3.39

NA 63.48

090 skull. 61597............. .............. A

Transcondylar approach/ 37.90

NA 23.06 8.81

NA 69.77

090 skull. 61598............. .............. A

Transpetrosal approach/ 33.36

NA 23.30 5.68

NA 62.34

090 skull. 61600............. .............. A

Resect/excise cranial 25.81

NA 19.83 3.78

NA 49.42

090 lesion. 61601............. .............. A

Resect/excise cranial 27.85

NA 20.55 6.61

NA 55.01

090 lesion. 61605............. .............. A

Resect/excise cranial 29.29

NA 22.02 2.85

NA 54.16

090 lesion. 61606............. .............. A

Resect/excise cranial 38.77

NA 25.22 8.94

NA 72.93

090 lesion. 61607............. .............. A

Resect/excise cranial 36.22

NA 23.85 6.88

NA 66.95

090 lesion. 61608............. .............. A

Resect/excise cranial 42.04

NA 26.66 10.72

NA 79.42

090 lesion. 61609............. .............. A

Transect artery, sinus 9.88

NA 4.86 2.55

NA 17.29

ZZZ 61610............. .............. A

Transect artery, sinus 29.63

NA 13.18 7.66

NA 50.47

ZZZ

[[Page 70401]]

61611............. .............. A

Transect artery, sinus 7.41

NA 3.83 1.88

NA 13.12

ZZZ 61612............. .............. A

Transect artery, sinus 27.84

NA 13.35 4.30

NA 45.49

ZZZ 61613............. .............. A

Remove aneurysm, sinus 40.80

NA 26.34 8.42

NA 75.56

090 61615............. .............. A

Resect/excise lesion, 32.02

NA 22.79 4.72

NA 59.53

090 skull. 61616............. .............. A

Resect/excise lesion, 43.27

NA 28.73 8.24

NA 80.24

090 skull. 61618............. .............. A

Repair dura........... 16.96

NA 10.47 3.71

NA 31.14

090 61619............. .............. A

Repair dura........... 20.68

NA 12.28 3.94

NA 36.90

090 61623............. .............. A

Endovasc tempory

9.95

NA 4.09 1.05

NA 15.09

000 vessel occl. 61624............. .............. A

Transcath occlusion,

20.12

NA 6.91 1.95

NA 28.98

000 cns. 61626............. .............. A

Transcath occlusion,

16.60

NA 5.53 1.24

NA 23.37

000 non-cns. 61630............. .............. N

Intracranial

0.00 0.00 0.00 0.00 0.00 0.00

090 angioplasty. 61635............. .............. N

Intracran angioplsty w/ 0.00 0.00 0.00 0.00 0.00 0.00

090 stent. 61640............. .............. N

Dilate ic vasospasm,

0.00 0.00 0.00 0.00 0.00 0.00

000 init. 61641............. .............. N

Dilate ic vasospasm

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ add-on. 61642............. .............. N

Dilate ic vasospasm

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ add-on. 61680............. .............. A

Intracranial vessel

30.66

NA 17.48 7.93

NA 56.07

090 surgery. 61682............. .............. A

Intracranial vessel

61.48

NA 32.30 15.85

NA 109.63

090 surgery. 61684............. .............. A

Intracranial vessel

39.75

NA 22.06 10.28

NA 72.09

090 surgery. 61686............. .............. A

Intracranial vessel

64.39

NA 34.82 16.66

NA 115.87

090 surgery. 61690............. .............. A

Intracranial vessel

29.27

NA 16.77 6.92

NA 52.96

090 surgery. 61692............. .............. A

Intracranial vessel

51.79

NA 27.55 13.39

NA 92.73

090 surgery. 61697............. .............. A

Brain aneurysm repr,

50.44

NA 28.09 12.81

NA 91.34

090 complx. 61698............. .............. A

Brain aneurysm repr,

48.34

NA 26.77 12.50

NA 87.61

090 complx. 61700............. .............. A

Brain aneurysm repr,

50.44

NA 27.88 12.98

NA 91.30

090 simple. 61702............. .............. A

Inner skull vessel

48.34

NA 26.11 10.76

NA 85.21

090 surgery. 61703............. .............. A

Clamp neck artery..... 17.44

NA 10.49 4.05

NA 31.98

090 61705............. .............. A

Revise circulation to 36.15

NA 19.31 8.84

NA 64.30

090 head. 61708............. .............. A

Revise circulation to 35.25

NA 15.19 2.50

NA 52.94

090 head. 61710............. .............. A

Revise circulation to 29.63

NA 13.68 4.51

NA 47.82

090 head. 61711............. .............. A

Fusion of skull

36.28

NA 19.86 9.39

NA 65.53

090 arteries. 61720............. .............. A

Incise skull/brain

16.74

NA 10.00 2.78

NA 29.52

090 surgery. 61735............. .............. A

Incise skull/brain

20.40

NA 12.20 2.72

NA 35.32

090 surgery. 61750............. .............. A

Incise skull/brain

18.17

NA 10.64 4.71

NA 33.52

090 biopsy. 61751............. .............. A

Brain biopsy w/ct/mr

17.59

NA 10.85 4.55

NA 32.99

090 guide. 61760............. .............. A

Implant brain

22.24

NA 8.74 5.40

NA 36.38

090 electrodes. 61770............. .............. A

Incise skull for

21.41

NA 12.29 3.54

NA 37.24

090 treatment. 61790............. .............. A

Treat trigeminal nerve 10.84

NA 5.93 2.81

NA 19.58

090 61791............. .............. A

Treat trigeminal tract 14.59

NA 8.94 3.39

NA 26.92

090 61793............. .............. A

Focus radiation beam.. 17.21

NA 10.15 4.45

NA 31.81

090 61795............. .............. A

Brain surgery using

4.03

NA 2.04 0.79

NA 6.86

ZZZ computer. 61850............. .............. A

Implant

12.37

NA 7.69 3.21

NA 23.27

090 neuroelectrodes. 61860............. .............. A

Implant

20.84

NA 12.09 4.94

NA 37.87

090 neuroelectrodes. 61863............. .............. A

Implant neuroelectrode 18.97

NA 11.80 5.41

NA 36.18

090 61864............. .............. A

Implant neuroelectrde, 4.49

NA 2.29 5.41

NA 12.19

ZZZ addl. 61867............. .............. A

Implant neuroelectrode 31.29

NA 18.07 5.41

NA 54.77

090 61868............. .............. A

Implant neuroelectrde, 7.91

NA 4.02 5.41

NA 17.34

ZZZ add'l. 61870............. .............. A

Implant

14.92

NA 9.73 3.86

NA 28.51

090 neuroelectrodes. 61875............. .............. A

Implant

15.04

NA 8.59 2.94

NA 26.57

090 neuroelectrodes. 61880............. .............. A

Revise/remove

6.28

NA 4.58 1.66

NA 12.52

090 neuroelectrode. 61885............. .............. A

Insrt/redo neurostim 1 5.84

NA 5.32 1.59

NA 12.75

090 array. 61886............. .............. A

Implant neurostim

7.99

NA 6.37 1.96

NA 16.32

090 arrays. 61888............. .............. A

Revise/remove

5.06

NA 3.68 1.33

NA 10.07

010 neuroreceiver. 62000............. .............. A

Treat skull fracture.. 12.51

NA 5.53 1.06

NA 19.10

090 62005............. .............. A

Treat skull fracture.. 16.15

NA 8.82 3.86

NA 28.83

090 62010............. .............. A

Treatment of head

19.78

NA 11.74 5.12

NA 36.64

090 injury. 62100............. .............. A

Repair brain fluid

22.00

NA 12.82 4.83

NA 39.65

090 leakage. 62115............. .............. A

Reduction of skull

21.63

NA 11.67 5.49

NA 38.79

090 defect. 62116............. .............. A

Reduction of skull

23.55

NA 13.40 6.09

NA 43.04

090 defect. 62117............. .............. A

Reduction of skull

26.56

NA 15.41 4.52

NA 46.49

090 defect. 62120............. .............. A

Repair skull cavity

23.31

NA 18.53 2.99

NA 44.83

090 lesion. 62121............. .............. A

Incise skull repair... 21.55

NA 15.49 4.16

NA 41.20

090 62140............. .............. A

Repair of skull defect 13.49

NA 8.34 3.46

NA 25.29

090 62141............. .............. A

Repair of skull defect 14.89

NA 9.07 3.75

NA 27.71

090 62142............. .............. A

Remove skull plate/

10.77

NA 7.01 2.72

NA 20.50

090 flap. 62143............. .............. A

Replace skull plate/

13.03

NA 8.06 3.36

NA 24.45

090 flap. 62145............. .............. A

Repair of skull &

18.79

NA 10.92 4.49

NA 34.20

090 brain. 62146............. .............. A

Repair of skull with

16.10

NA 9.66 3.61

NA 29.37

090 graft. 62147............. .............. A

Repair of skull with

19.31

NA 11.33 4.31

NA 34.95

090 graft. 62148............. .............. A

Retr bone flap to fix

2.00

NA 0.86 0.48

NA 3.34

ZZZ skull. 62160............. .............. A

Neuroendoscopy add-on. 3.00

NA 1.53 0.77

NA 5.30

ZZZ 62161............. .............. A

Dissect brain w/scope. 19.97

NA 12.13 5.17

NA 37.27

090 62162............. .............. A

Remove colloid cyst w/ 25.21

NA 14.89 5.89

NA 45.99

090 scope. 62163............. .............. A

Neuroendoscopy w/fb

15.48

NA 9.95 4.00

NA 29.43

090 removal. 62164............. .............. A

Remove brain tumor w/ 27.46

NA 14.99 5.36

NA 47.81

090 scope. 62165............. .............. A

Remove pituit tumor w/ 21.97

NA 13.42 3.00

NA 38.39

090 scope.

[[Page 70402]]

62180............. .............. A

Establish brain cavity 21.03

NA 12.32 4.97

NA 38.32

090 shunt. 62190............. .............. A

Establish brain cavity 11.05

NA 7.10 2.79

NA 20.94

090 shunt. 62192............. .............. A

Establish brain cavity 12.23

NA 7.64 3.01

NA 22.88

090 shunt. 62194............. .............. A

Replace/irrigate

5.02

NA 2.44 0.92

NA 8.38

010 catheter. 62200............. .............. A

Establish brain cavity 18.29

NA 10.87 4.64

NA 33.80

090 shunt. 62201............. .............. A

Brain cavity shunt w/ 14.84

NA 9.47 3.67

NA 27.98

090 scope. 62220............. .............. A

Establish brain cavity 12.98

NA 8.00 3.34

NA 24.32

090 shunt. 62223............. .............. A

Establish brain cavity 12.85

NA 8.26 3.13

NA 24.24

090 shunt. 62225............. .............. A

Replace/irrigate

5.40

NA 4.10 1.39

NA 10.89

090 catheter. 62230............. .............. A

Replace/revise brain

10.52

NA 6.50 2.70

NA 19.72

090 shunt. 62252............. 26............ A

Csf shunt reprogram... 0.74 0.37 0.37 0.19 1.30 1.30

XXX 62252............. TC............ A

Csf shunt reprogram... 0.00 1.10

NA 0.02 1.12

NA

XXX 62252............. .............. A

Csf shunt reprogram... 0.74 1.47

NA 0.21 2.42

NA

XXX 62256............. .............. A

Remove brain cavity

6.59

NA 4.70 1.71

NA 13.00

090 shunt. 62258............. .............. A

Replace brain cavity

14.52

NA 8.74 3.73

NA 26.99

090 shunt. 62263............. .............. A

Epidural lysis mult

6.13 12.73 3.20 0.41 19.27 9.74

010 sessions. 62264............. .............. A

Epidural lysis on

4.42 7.75 1.42 0.27 12.44 6.11

010 single day. 62268............. .............. A

Drain spinal cord cyst 4.73 11.56 2.15 0.43 16.72 7.31

000 62269............. .............. A

Needle biopsy, spinal

5.01 14.72 1.98 0.37 20.10 7.36

000 cord. 62270............. .............. A

Spinal fluid tap,

1.13 3.00 0.56 0.08 4.21 1.77

000 diagnostic. 62272............. .............. A

Drain cerebro spinal

1.35 3.62 0.71 0.18 5.15 2.24

000 fluid. 62273............. .............. A

Inject epidural patch. 2.15 2.72 0.71 0.13 5.00 2.99

000 62280............. .............. A

Treat spinal cord

2.63 6.95 1.01 0.30 9.88 3.94

010 lesion. 62281............. .............. A

Treat spinal cord

2.66 5.67 0.89 0.19 8.52 3.74

010 lesion. 62282............. .............. A

Treat spinal canal

2.33 8.38 0.92 0.17 10.88 3.42

010 lesion. 62284............. .............. A

Injection for

1.54 4.97 0.68 0.13 6.64 2.35

000 myelogram. 62287............. .............. A

Percutaneous

8.07

NA 5.57 0.58

NA 14.22

090 diskectomy. 62290............. .............. A

Inject for spine disk

3.00 7.15 1.38 0.23 10.38 4.61

000 x-ray. 62291............. .............. A

Inject for spine disk

2.91 5.95 1.23 0.26 9.12 4.40

000 x-ray. 62292............. .............. A

Injection into disk

7.85

NA 4.48 0.82

NA 13.15

090 lesion. 62294............. .............. A

Injection into spinal 11.81

NA 5.60 1.24

NA 18.65

090 artery. 62310............. .............. A

Inject spine c/t...... 1.91 4.82 0.65 0.12 6.85 2.68

000 62311............. .............. A

Inject spine l/s (cd). 1.54 4.93 0.59 0.09 6.56 2.22

000 62318............. .............. A

Inject spine w/cath, c/ 2.04 5.74 0.65 0.12 7.90 2.81

000 t. 62319............. .............. A

Inject spine w/cath l/ 1.87 4.99 0.61 0.11 6.97 2.59

000 s (cd). 62350............. .............. A

Implant spinal canal

6.86

NA 3.95 1.02

NA 11.83

090 cath. 62351............. .............. A

Implant spinal canal

9.99

NA 7.14 2.24

NA 19.37

090 cath. 62355............. .............. A

Remove spinal canal

5.44

NA 3.17 0.71

NA 9.32

090 catheter. 62360............. .............. A

Insert spine infusion

2.62

NA 2.69 0.34

NA 5.65

090 device. 62361............. .............. A

Implant spine infusion 5.41

NA 3.93 0.80

NA 10.14

090 pump. 62362............. .............. A

Implant spine infusion 7.03

NA 4.37 1.18

NA 12.58

090 pump. 62365............. .............. A

Remove spine infusion

5.41

NA 3.59 0.86

NA 9.86

090 device. 62367............. .............. A

Analyze spine infusion 0.48 0.61 0.10 0.03 1.12 0.61

XXX pump. 62368............. .............. A

Analyze spine infusion 0.75 0.69 0.17 0.06 1.50 0.98

XXX pump. 63001............. .............. A

Removal of spinal

15.80

NA 9.54 3.76

NA 29.10

090 lamina. 63003............. .............. A

Removal of spinal

15.93

NA 9.89 3.72

NA 29.54

090 lamina. 63005............. .............. A

Removal of spinal

14.90

NA 10.00 3.34

NA 28.24

090 lamina. 63011............. .............. A

Removal of spinal

14.50

NA 8.29 3.37

NA 26.16

090 lamina. 63012............. .............. A

Removal of spinal

15.38

NA 10.15 3.48

NA 29.01

090 lamina. 63015............. .............. A

Removal of spinal

19.32

NA 11.90 4.75

NA 35.97

090 lamina. 63016............. .............. A

Removal of spinal

19.17

NA 11.81 4.58

NA 35.56

090 lamina. 63017............. .............. A

Removal of spinal

15.92

NA 10.42 3.63

NA 29.97

090 lamina. 63020............. .............. A

Neck spine disk

14.79

NA 9.70 3.71

NA 28.20

090 surgery. 63030............. .............. A

Low back disk surgery. 11.98

NA 8.44 3.00

NA 23.42

090 63035............. .............. A

Spinal disk surgery

3.15

NA 1.59 0.79

NA 5.53

ZZZ add-on. 63040............. .............. A

Laminotomy, single

18.78

NA 11.53 4.67

NA 34.98

090 cervical. 63042............. .............. A

Laminotomy, single

17.44

NA 11.37 4.25

NA 33.06

090 lumbar. 63043............. .............. C

Laminotomy, add'l

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ cervical. 63044............. .............. C

Laminotomy, add'l

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ lumbar. 63045............. .............. A

Removal of spinal

16.48

NA 10.38 3.98

NA 30.84

090 lamina. 63046............. .............. A

Removal of spinal

15.78

NA 10.21 3.55

NA 29.54

090 lamina. 63047............. .............. A

Removal of spinal

14.59

NA 9.92 3.23

NA 27.74

090 lamina. 63048............. .............. A

Remove spinal lamina

3.26

NA 1.66 0.72

NA 5.64

ZZZ add-on. 63050............. .............. A

Cervical laminoplasty. 20.75

NA 11.87 4.66

NA 37.28

090 63051............. .............. A

C-laminoplasty w/graft/ 24.25

NA 13.51 4.66

NA 42.42

090 plate. 63055............. .............. A

Decompress spinal cord 21.96

NA 13.17 5.27

NA 40.40

090 63056............. .............. A

Decompress spinal cord 20.33

NA 12.60 4.75

NA 37.68

090 63057............. .............. A

Decompress spine cord

5.25

NA 2.64 1.22

NA 9.11

ZZZ add-on. 63064............. .............. A

Decompress spinal cord 24.57

NA 14.46 5.69

NA 44.72

090 63066............. .............. A

Decompress spine cord

3.26

NA 1.66 0.69

NA 5.61

ZZZ add-on. 63075............. .............. A

Neck spine disk

19.38

NA 12.12 4.62

NA 36.12

090 surgery. 63076............. .............. A

Neck spine disk

4.04

NA 2.06 0.96

NA 7.06

ZZZ surgery. 63077............. .............. A

Spine disk surgery,

21.41

NA 12.83 3.98

NA 38.22

090 thorax. 63078............. .............. A

Spine disk surgery,

3.28

NA 1.64 0.66

NA 5.58

ZZZ thorax. 63081............. .............. A

Removal of vertebral

23.69

NA 14.36 5.54

NA 43.59

090 body.

[[Page 70403]]

63082............. .............. A

Remove vertebral body

4.36

NA 2.23 1.02

NA 7.61

ZZZ add-on. 63085............. .............. A

Removal of vertebral

26.88

NA 15.51 4.48

NA 46.87

090 body. 63086............. .............. A

Remove vertebral body

3.19

NA 1.59 0.59

NA 5.37

ZZZ add-on. 63087............. .............. A

Removal of vertebral

35.52

NA 19.51 6.20

NA 61.23

090 body. 63088............. .............. A

Remove vertebral body

4.32

NA 2.18 0.82

NA 7.32

ZZZ add-on. 63090............. .............. A

Removal of vertebral

28.12

NA 16.08 4.21

NA 48.41

090 body. 63091............. .............. A

Remove vertebral body

3.03

NA 1.46 0.48

NA 4.97

ZZZ add-on. 63101............. .............. A

Removal of vertebral

31.95

NA 19.33 5.69

NA 56.97

090 body. 63102............. .............. A

Removal of vertebral

31.95

NA 19.33 5.69

NA 56.97

090 body. 63103............. .............. A

Remove vertebral body

4.82

NA 2.51 0.69

NA 8.02

ZZZ add-on. 63170............. .............. A

Incise spinal cord

19.80

NA 11.89 4.86

NA 36.55

090 tract(s). 63172............. .............. A

Drainage of spinal

17.63

NA 10.67 4.48

NA 32.78

090 cyst. 63173............. .............. A

Drainage of spinal

21.96

NA 12.84 5.68

NA 40.48

090 cyst. 63180............. .............. A

Revise spinal cord

18.24

NA 11.01 3.95

NA 33.20

090 ligaments. 63182............. .............. A

Revise spinal cord

20.47

NA 10.98 5.30

NA 36.75

090 ligaments. 63185............. .............. A

Incise spinal column/ 15.02

NA 8.11 2.79

NA 25.92

090 nerves. 63190............. .............. A

Incise spinal column/ 17.42

NA 10.16 3.24

NA 30.82

090 nerves. 63191............. .............. A

Incise spinal column/ 17.51

NA 10.50 6.34

NA 34.35

090 nerves. 63194............. .............. A

Incise spinal column & 19.16

NA 11.74 3.26

NA 34.16

090 cord. 63195............. .............. A

Incise spinal column & 18.81

NA 11.07 4.87

NA 34.75

090 cord. 63196............. .............. A

Incise spinal column & 22.27

NA 13.42 5.76

NA 41.45

090 cord. 63197............. .............. A

Incise spinal column & 21.08

NA 12.24 5.36

NA 38.68

090 cord. 63198............. .............. A

Incise spinal column & 25.34

NA 8.45 6.43

NA 40.22

090 cord. 63199............. .............. A

Incise spinal column & 26.85

NA 15.07 1.40

NA 43.32

090 cord. 63200............. .............. A

Release of spinal cord 19.15

NA 11.32 4.96

NA 35.43

090 63250............. .............. A

Revise spinal cord

40.70

NA 19.98 9.01

NA 69.69

090 vessels. 63251............. .............. A

Revise spinal cord

41.14

NA 22.65 10.41

NA 74.20

090 vessels. 63252............. .............. A

Revise spinal cord

41.13

NA 22.29 10.64

NA 74.06

090 vessels. 63265............. .............. A

Excise intraspinal

21.53

NA 12.80 5.43

NA 39.76

090 lesion. 63266............. .............. A

Excise intraspinal

22.27

NA 13.21 5.54

NA 41.02

090 lesion. 63267............. .............. A

Excise intraspinal

17.92

NA 11.10 4.37

NA 33.39

090 lesion. 63268............. .............. A

Excise intraspinal

18.49

NA 10.39 3.69

NA 32.57

090 lesion. 63270............. .............. A

Excise intraspinal

26.76

NA 15.50 6.82

NA 49.08

090 lesion. 63271............. .............. A

Excise intraspinal

26.88

NA 15.61 6.90

NA 49.39

090 lesion. 63272............. .............. A

Excise intraspinal

25.28

NA 14.72 6.18

NA 46.18

090 lesion. 63273............. .............. A

Excise intraspinal

24.25

NA 14.37 5.74

NA 44.36

090 lesion. 63275............. .............. A

Biopsy/excise spinal

23.64

NA 13.80 5.80

NA 43.24

090 tumor. 63276............. .............. A

Biopsy/excise spinal

23.41

NA 13.71 5.83

NA 42.95

090 tumor. 63277............. .............. A

Biopsy/excise spinal

20.80

NA 12.55 5.01

NA 38.36

090 tumor. 63278............. .............. A

Biopsy/excise spinal

20.53

NA 12.42 4.55

NA 37.50

090 tumor. 63280............. .............. A

Biopsy/excise spinal

28.31

NA 16.35 7.27

NA 51.93

090 tumor. 63281............. .............. A

Biopsy/excise spinal

28.01

NA 16.21 7.17

NA 51.39

090 tumor. 63282............. .............. A

Biopsy/excise spinal

26.35

NA 15.36 6.76

NA 48.47

090 tumor. 63283............. .............. A

Biopsy/excise spinal

24.96

NA 14.69 6.26

NA 45.91

090 tumor. 63285............. .............. A

Biopsy/excise spinal

35.95

NA 19.99 9.18

NA 65.12

090 tumor. 63286............. .............. A

Biopsy/excise spinal

35.58

NA 19.95 9.21

NA 64.74

090 tumor. 63287............. .............. A

Biopsy/excise spinal

36.64

NA 20.47 9.39

NA 66.50

090 tumor. 63290............. .............. A

Biopsy/excise spinal

37.32

NA 20.64 9.02

NA 66.98

090 tumor. 63295............. .............. A

Repair of laminectomy

5.25

NA 2.15 1.03

NA 8.43

ZZZ defect. 63300............. .............. A

Removal of vertebral

24.39

NA 14.33 5.97

NA 44.69

090 body. 63301............. .............. A

Removal of vertebral

27.56

NA 15.59 5.39

NA 48.54

090 body. 63302............. .............. A

Removal of vertebral

27.77

NA 15.89 5.53

NA 49.19

090 body. 63303............. .............. A

Removal of vertebral

30.45

NA 16.95 4.68

NA 52.08

090 body. 63304............. .............. A

Removal of vertebral

30.28

NA 17.31 6.41

NA 54.00

090 body. 63305............. .............. A

Removal of vertebral

31.98

NA 18.09 5.71

NA 55.78

090 body. 63306............. .............. A

Removal of vertebral

32.17

NA 17.84 8.33

NA 58.34

090 body. 63307............. .............. A

Removal of vertebral

31.58

NA 16.85 4.46

NA 52.89

090 body. 63308............. .............. A

Remove vertebral body

5.24

NA 2.61 1.29

NA 9.14

ZZZ add-on. 63600............. .............. A

Remove spinal cord

14.00

NA 5.41 1.52

NA 20.93

090 lesion. 63610............. .............. A

Stimulation of spinal

8.72 59.85 2.26 0.86 69.43 11.84

000 cord. 63615............. .............. A

Remove lesion of

16.26

NA 9.29 2.84

NA 28.39

090 spinal cord. 63650............. .............. A

Implant

6.73

NA 3.18 0.53

NA 10.44

090 neuroelectrodes. 63655............. .............. A

Implant

10.27

NA 6.91 2.43

NA 19.61

090 neuroelectrodes. 63660............. .............. A

Revise/remove

6.15

NA 3.62 0.78

NA 10.55

090 neuroelectrode. 63685............. .............. A

Insrt/redo spine n

7.03

NA 4.15 1.05

NA 12.23

090 generator. 63688............. .............. A

Revise/remove

5.38

NA 3.56 0.89

NA 9.83

090 neuroreceiver. 63700............. .............. A

Repair of spinal

16.51

NA 10.33 3.52

NA 30.36

090 herniation. 63702............. .............. A

Repair of spinal

18.45

NA 11.06 4.12

NA 33.63

090 herniation. 63704............. .............. A

Repair of spinal

21.15

NA 12.95 4.57

NA 38.67

090 herniation. 63706............. .............. A

Repair of spinal

24.07

NA 13.61 6.23

NA 43.91

090 herniation. 63707............. .............. A

Repair spinal fluid

11.24

NA 7.72 2.51

NA 21.47

090 leakage. 63709............. .............. A

Repair spinal fluid

14.30

NA 9.42 3.09

NA 26.81

090 leakage. 63710............. .............. A

Graft repair of spine 14.05

NA 9.06 3.40

NA 26.51

090 defect. 63740............. .............. A

Install spinal shunt.. 11.34

NA 7.36 2.93

NA 21.63

090 63741............. .............. A

Install spinal shunt.. 8.24

NA 4.76 1.66

NA 14.66

090

[[Page 70404]]

63744............. .............. A

Revision of spinal

8.09

NA 5.27 1.89

NA 15.25

090 shunt. 63746............. .............. A

Removal of spinal

6.42

NA 3.78 1.53

NA 11.73

090 shunt. 64400............. .............. A

N block inj,

1.11 1.90 0.43 0.07 3.08 1.61

000 trigeminal. 64402............. .............. A

N block inj, facial... 1.25 1.61 0.60 0.09 2.95 1.94

000 64405............. .............. A

N block inj, occipital 1.32 1.46 0.46 0.08 2.86 1.86

000 64408............. .............. A

N block inj, vagus.... 1.41 1.58 0.85 0.10 3.09 2.36

000 64410............. .............. A

N block inj, phrenic.. 1.43 2.51 0.46 0.09 4.03 1.98

000 64412............. .............. A

N block inj, spinal

1.18 2.66 0.43 0.08 3.92 1.69

000 accessor. 64413............. .............. A

N block inj, cervical

1.40 1.85 0.50 0.08 3.33 1.98

000 plexus. 64415............. .............. A

N block inj, brachial

1.48 2.81 0.46 0.09 4.38 2.03

000 plexus. 64416............. .............. A

N block cont infuse, b 3.49

NA 0.79 0.31

NA 4.59

010 plex. 64417............. .............. A

N block inj, axillary. 1.44 3.04 0.49 0.11 4.59 2.04

000 64418............. .............. A

N block inj,

1.32 2.63 0.44 0.07 4.02 1.83

000 suprascapular. 64420............. .............. A

N block inj,

1.18 3.89 0.42 0.08 5.15 1.68

000 intercost, sng. 64421............. .............. A

N block inj,

1.68 6.10 0.52 0.11 7.89 2.31

000 intercost, mlt. 64425............. .............. A

N block inj, ilio-ing/ 1.75 1.65 0.54 0.13 3.53 2.42

000 hypogi. 64430............. .............. A

N block inj, pudendal. 1.46 2.52 0.55 0.10 4.08 2.11

000 64435............. .............. A

N block inj,

1.45 2.53 0.69 0.16 4.14 2.30

000 paracervical. 64445............. .............. A

N block inj, sciatic,

1.48 2.68 0.50 0.10 4.26 2.08

000 sng. 64446............. .............. A

N blk inj, sciatic,

3.25

NA 1.00 0.20

NA 4.45

010 cont inf. 64447............. .............. A

N block inj fem,

1.50

NA 0.43 0.09

NA 2.02

000 single. 64448............. .............. A

N block inj fem, cont

3.00

NA 0.81 0.18

NA 3.99

010 inf. 64449............. .............. A

N block inj, lumbar

3.00

NA 0.96 0.15

NA 4.11

010 plexus. 64450............. .............. A

N block, other

1.27 1.24 0.48 0.13 2.64 1.88

000 peripheral. 64470............. .............. A

Inj paravertebral c/t. 1.85 7.25 0.71 0.11 9.21 2.67

000 64472............. .............. A

Inj paravertebral c/t

1.29 2.34 0.34 0.08 3.71 1.71

ZZZ add-on. 64475............. .............. A

Inj paravertebral l/s. 1.41 6.90 0.63 0.10 8.41 2.14

000 64476............. .............. A

Inj paravertebral l/s

0.98 2.13 0.24 0.07 3.18 1.29

ZZZ add-on. 64479............. .............. A

Inj foramen epidural c/ 2.20 7.51 0.89 0.12 9.83 3.21

000 t. 64480............. .............. A

Inj foramen epidural

1.54 2.85 0.47 0.10 4.49 2.11

ZZZ add-on. 64483............. .............. A

Inj foramen epidural l/ 1.90 7.91 0.83 0.11 9.92 2.84

000 s. 64484............. .............. A

Inj foramen epidural

1.33 3.29 0.37 0.08 4.70 1.78

ZZZ add-on. 64505............. .............. A

N block, spenopalatine 1.36 1.24 0.66 0.10 2.70 2.12

000 gangl. 64508............. .............. A

N block, carotid sinus 1.12 3.33 0.74 0.07 4.52 1.93

000 s/p. 64510............. .............. A

N block, stellate

1.22 3.46 0.51 0.07 4.75 1.80

000 ganglion. 64517............. .............. A

N block inj, hypogas

2.20 2.73 0.87 0.11 5.04 3.18

000 plxs. 64520............. .............. A

N block, lumbar/

1.35 5.15 0.55 0.08 6.58 1.98

000 thoracic. 64530............. .............. A

N block inj, celiac

1.58 4.46 0.65 0.10 6.14 2.33

000 pelus. 64550............. .............. A

Apply neurostimulator. 0.18 0.28 0.05 0.01 0.47 0.24

000 64553............. .............. A

Implant

2.31 2.84 1.86 0.18 5.33 4.35

010 neuroelectrodes. 64555............. .............. A

Implant

2.27 3.11 1.19 0.19 5.57 3.65

010 neuroelectrodes. 64560............. .............. A

Implant

2.36 2.64 1.28 0.22 5.22 3.86

010 neuroelectrodes. 64561............. .............. A

Implant

6.73 30.14 2.78 0.51 37.38 10.02

010 neuroelectrodes. 64565............. .............. A

Implant

1.76 3.29 1.26 0.13 5.18 3.15

010 neuroelectrodes. 64573............. .............. A

Implant

7.49

NA 5.26 1.60

NA 14.35

090 neuroelectrodes. 64575............. .............. A

Implant

4.34

NA 2.68 0.61

NA 7.63

090 neuroelectrodes. 64577............. .............. A

Implant

4.61

NA 3.29 1.04

NA 8.94

090 neuroelectrodes. 64580............. .............. A

Implant

4.11

NA 3.56 0.36

NA 8.03

090 neuroelectrodes. 64581............. .............. A

Implant

13.48

NA 5.39 1.05

NA 19.92

090 neuroelectrodes. 64585............. .............. A

Revise/remove

2.06 11.31 2.14 0.20 13.57 4.40

010 neuroelectrode. 64590............. .............. A

Insrt/redo perph n

2.40 7.16 2.29 0.19 9.75 4.88

010 generator. 64595............. .............. A

Revise/remove

1.73 10.42 1.93 0.19 12.34 3.85

010 neuroreceiver. 64600............. .............. A

Injection treatment of 3.44 9.38 1.65 0.34 13.16 5.43

010 nerve. 64605............. .............. A

Injection treatment of 5.60 9.58 2.19 0.79 15.97 8.58

010 nerve. 64610............. .............. A

Injection treatment of 7.15 8.89 3.72 1.58 17.62 12.45

010 nerve. 64612............. .............. A

Destroy nerve, face

1.96 2.49 1.32 0.11 4.56 3.39

010 muscle. 64613............. .............. A

Destroy nerve, neck

1.96 2.94 1.22 0.11 5.01 3.29

010 muscle. 64614............. .............. A

Destroy nerve, extrem

2.20 3.23 1.31 0.10 5.53 3.61

010 musc. 64620............. .............. A

Injection treatment of 2.84 5.07 1.33 0.20 8.11 4.37

010 nerve. 64622............. .............. A

Destr paravertebrl

3.00 7.78 1.37 0.18 10.96 4.55

010 nerve l/s. 64623............. .............. A

Destr paravertebral n

0.99 2.97 0.22 0.06 4.02 1.27

ZZZ add-on. 64626............. .............. A

Destr paravertebrl

3.28 7.80 1.97 0.20 11.28 5.45

010 nerve c/t. 64627............. .............. A

Destr paravertebral n

1.16 4.54 0.27 0.07 5.77 1.50

ZZZ add-on. 64630............. .............. A

Injection treatment of 3.00 2.74 1.41 0.22 5.96 4.63

010 nerve. 64640............. .............. A

Injection treatment of 2.76 4.19 1.85 0.29 7.24 4.90

010 nerve. 64650............. .............. A

Chemodenerv eccrine

0.70 0.87 0.30 0.06 1.63 1.06

000 glands. 64653............. .............. A

Chemodenerv eccrine

0.88 0.92 0.38 0.08 1.88 1.34

000 glands. 64680............. .............. A

Injection treatment of 2.62 6.73 1.43 0.18 9.53 4.23

010 nerve. 64681............. .............. A

Injection treatment of 3.54 9.32 2.07 0.28 13.14 5.89

010 nerve. 64702............. .............. A

Revise finger/toe

4.22

NA 3.87 0.61

NA 8.70

090 nerve. 64704............. .............. A

Revise hand/foot nerve 4.56

NA 3.32 0.61

NA 8.49

090 64708............. .............. A

Revise arm/leg nerve.. 6.11

NA 4.87 0.96

NA 11.94

090 64712............. .............. A

Revision of sciatic

7.74

NA 4.97 0.95

NA 13.66

090 nerve. 64713............. .............. A

Revision of arm

10.98

NA 5.89 1.82

NA 18.69

090 nerve(s). 64714............. .............. A

Revise low back

10.31

NA 4.21 1.19

NA 15.71

090 nerve(s).

[[Page 70405]]

64716............. .............. A

Revision of cranial

6.30

NA 5.99 0.63

NA 12.92

090 nerve. 64718............. .............. A

Revise ulnar nerve at

5.98

NA 6.01 1.05

NA 13.04

090 elbow. 64719............. .............. A

Revise ulnar nerve at

4.84

NA 4.53 0.77

NA 10.14

090 wrist. 64721............. .............. A

Carpal tunnel surgery. 4.28

NA 5.38 0.73

NA 10.39

090 64722............. .............. A

Relieve pressure on

4.69

NA 3.05 0.48

NA 8.22

090 nerve(s). 64726............. .............. A

Release foot/toe nerve 4.17

NA 2.80 0.54

NA 7.51

090 64727............. .............. A

Internal nerve

3.10

NA 1.50 0.48

NA 5.08

ZZZ revision. 64732............. .............. A

Incision of brow nerve 4.40

NA 3.51 0.98

NA 8.89

090 64734............. .............. A

Incision of cheek

4.91

NA 4.06 0.89

NA 9.86

090 nerve. 64736............. .............. A

Incision of chin nerve 4.59

NA 4.03 0.52

NA 9.14

090 64738............. .............. A

Incision of jaw nerve. 5.72

NA 4.62 1.08

NA 11.42

090 64740............. .............. A

Incision of tongue

5.58

NA 5.13 0.69

NA 11.40

090 nerve. 64742............. .............. A

Incision of facial

6.21

NA 4.71 0.73

NA 11.65

090 nerve. 64744............. .............. A

Incise nerve, back of

5.23

NA 3.78 1.16

NA 10.17

090 head. 64746............. .............. A

Incise diaphragm nerve 5.92

NA 4.51 0.82

NA 11.25

090 64752............. .............. A

Incision of vagus

7.05

NA 4.29 0.93

NA 12.27

090 nerve. 64755............. .............. A

Incision of stomach

13.50

NA 5.65 1.83

NA 20.98

090 nerves. 64760............. .............. A

Incision of vagus

6.95

NA 3.46 0.81

NA 11.22

090 nerve. 64761............. .............. A

Incision of pelvis

6.40

NA 3.53 0.53

NA 10.46

090 nerve. 64763............. .............. A

Incise hip/thigh nerve 6.92

NA 5.21 0.94

NA 13.07

090 64766............. .............. A

Incise hip/thigh nerve 8.66

NA 5.26 1.06

NA 14.98

090 64771............. .............. A

Sever cranial nerve... 7.34

NA 5.57 1.23

NA 14.14

090 64772............. .............. A

Incision of spinal

7.20

NA 4.93 1.40

NA 13.53

090 nerve. 64774............. .............. A

Remove skin nerve

5.16

NA 3.84 0.74

NA 9.74

090 lesion. 64776............. .............. A

Remove digit nerve

5.11

NA 3.69 0.76

NA 9.56

090 lesion. 64778............. .............. A

Digit nerve surgery

3.11

NA 1.50 0.46

NA 5.07

ZZZ add-on. 64782............. .............. A

Remove limb nerve

6.22

NA 3.78 0.86

NA 10.86

090 lesion. 64783............. .............. A

Limb nerve surgery add- 3.71

NA 1.84 0.51

NA 6.06

ZZZ on. 64784............. .............. A

Remove nerve lesion... 9.81

NA 6.61 1.38

NA 17.80

090 64786............. .............. A

Remove sciatic nerve

15.44

NA 9.86 2.60

NA 27.90

090 lesion. 64787............. .............. A

Implant nerve end..... 4.29

NA 2.13 0.58

NA 7.00

ZZZ 64788............. .............. A

Remove skin nerve

4.60

NA 3.47 0.73

NA 8.80

090 lesion. 64790............. .............. A

Removal of nerve

11.29

NA 7.22 2.10

NA 20.61

090 lesion. 64792............. .............. A

Removal of nerve

14.90

NA 8.85 2.48

NA 26.23

090 lesion. 64795............. .............. A

Biopsy of nerve....... 3.01

NA 1.56 0.52

NA 5.09

000 64802............. .............. A

Remove sympathetic

9.14

NA 5.14 1.29

NA 15.57

090 nerves. 64804............. .............. A

Remove sympathetic

14.62

NA 7.18 2.14

NA 23.94

090 nerves. 64809............. .............. A

Remove sympathetic

13.65

NA 5.78 1.50

NA 20.93

090 nerves. 64818............. .............. A

Remove sympathetic

10.28

NA 5.30 1.33

NA 16.91

090 nerves. 64820............. .............. A

Remove sympathetic

10.35

NA 7.14 1.49

NA 18.98

090 nerves. 64821............. .............. A

Remove sympathetic

8.74

NA 7.36 1.24

NA 17.34

090 nerves. 64822............. .............. A

Remove sympathetic

8.74

NA 7.25 1.30

NA 17.29

090 nerves. 64823............. .............. A

Remove sympathetic

10.35

NA 8.15 1.57

NA 20.07

090 nerves. 64831............. .............. A

Repair of digit nerve. 9.43

NA 7.09 1.41

NA 17.93

090 64832............. .............. A

Repair nerve add-on... 5.65

NA 2.94 0.85

NA 9.44

ZZZ 64834............. .............. A

Repair of hand or foot 10.17

NA 7.11 1.54

NA 18.82

090 nerve. 64835............. .............. A

Repair of hand or foot 10.92

NA 7.71 1.73

NA 20.36

090 nerve. 64836............. .............. A

Repair of hand or foot 10.92

NA 7.68 1.67

NA 20.27

090 nerve. 64837............. .............. A

Repair nerve add-on... 6.25

NA 3.24 0.97

NA 10.46

ZZZ 64840............. .............. A

Repair of leg nerve... 13.00

NA 8.27 1.37

NA 22.64

090 64856............. .............. A

Repair/transpose nerve 13.78

NA 9.21 2.12

NA 25.11

090 64857............. .............. A

Repair arm/leg nerve.. 14.47

NA 9.66 2.21

NA 26.34

090 64858............. .............. A

Repair sciatic nerve.. 16.47

NA 10.80 3.33

NA 30.60

090 64859............. .............. A

Nerve surgery......... 4.25

NA 2.20 0.67

NA 7.12

ZZZ 64861............. .............. A

Repair of arm nerves.. 19.21

NA 11.80 4.08

NA 35.09

090 64862............. .............. A

Repair of low back

19.41

NA 11.96 4.31

NA 35.68

090 nerves. 64864............. .............. A

Repair of facial nerve 12.53

NA 8.79 1.26

NA 22.58

090 64865............. .............. A

Repair of facial nerve 15.22

NA 13.56 1.50

NA 30.28

090 64866............. .............. A

Fusion of facial/other 15.72

NA 13.20 2.04

NA 30.96

090 nerve. 64868............. .............. A

Fusion of facial/other 14.02

NA 11.46 1.43

NA 26.91

090 nerve. 64870............. .............. A

Fusion of facial/other 15.97

NA 8.75 1.30

NA 26.02

090 nerve. 64872............. .............. A

Subsequent repair of

1.99

NA 1.08 0.29

NA 3.36

ZZZ nerve. 64874............. .............. A

Repair & revise nerve

2.98

NA 1.53 0.42

NA 4.93

ZZZ add-on. 64876............. .............. A

Repair nerve/shorten

3.37

NA 1.75 0.47

NA 5.59

ZZZ bone. 64885............. .............. A

Nerve graft, head or

17.50

NA 11.63 1.63

NA 30.76

090 neck. 64886............. .............. A

Nerve graft, head or

20.72

NA 13.58 2.08

NA 36.38

090 neck. 64890............. .............. A

Nerve graft, hand or

15.13

NA 10.02 2.29

NA 27.44

090 foot. 64891............. .............. A

Nerve graft, hand or

16.12

NA 7.60 1.63

NA 25.35

090 foot. 64892............. .............. A

Nerve graft, arm or

14.63

NA 8.89 2.47

NA 25.99

090 leg. 64893............. .............. A

Nerve graft, arm or

15.58

NA 9.89 2.61

NA 28.08

090 leg. 64895............. .............. A

Nerve graft, hand or

19.22

NA 9.68 2.57

NA 31.47

090 foot. 64896............. .............. A

Nerve graft, hand or

20.46

NA 11.01 3.16

NA 34.63

090 foot. 64897............. .............. A

Nerve graft, arm or

18.21

NA 10.72 2.54

NA 31.47

090 leg. 64898............. .............. A

Nerve graft, arm or

19.47

NA 11.82 2.77

NA 34.06

090 leg. 64901............. .............. A

Nerve graft add-on.... 10.20

NA 5.28 1.37

NA 16.85

ZZZ

[[Page 70406]]

64902............. .............. A

Nerve graft add-on.... 11.81

NA 5.98 1.55

NA 19.34

ZZZ 64905............. .............. A

Nerve pedicle transfer 14.00

NA 8.51 2.00

NA 24.51

090 64907............. .............. A

Nerve pedicle transfer 18.80

NA 12.56 3.16

NA 34.52

090 64999............. .............. C

Nervous system surgery 0.00 0.00 0.00 0.00 0.00 0.00

YYY 65091............. .............. A

Revise eye............ 6.45

NA 8.37 0.32

NA 15.14

090 65093............. .............. A

Revise eye with

6.86

NA 8.74 0.34

NA 15.94

090 implant. 65101............. .............. A

Removal of eye........ 7.02

NA 9.55 0.35

NA 16.92

090 65103............. .............. A

Remove eye/insert

7.56

NA 9.76 0.37

NA 17.69

090 implant. 65105............. .............. A

Remove eye/attach

8.48

NA 10.49 0.42

NA 19.39

090 implant. 65110............. .............. A

Removal of eye........ 13.93

NA 13.71 0.81

NA 28.45

090 65112............. .............. A

Remove eye/revise

16.36

NA 16.18 1.30

NA 33.84

090 socket. 65114............. .............. A

Remove eye/revise

17.50

NA 16.39 1.02

NA 34.91

090 socket. 65125............. .............. A

Revise ocular implant. 3.12 8.83 3.61 0.19 12.14 6.92

090 65130............. .............. A

Insert ocular implant. 7.14

NA 9.19 0.35

NA 16.68

090 65135............. .............. A

Insert ocular implant. 7.32

NA 9.34 0.36

NA 17.02

090 65140............. .............. A

Attach ocular implant. 8.01

NA 9.90 0.40

NA 18.31

090 65150............. .............. A

Revise ocular implant. 6.25

NA 7.99 0.31

NA 14.55

090 65155............. .............. A

Reinsert ocular

8.65

NA 10.51 0.50

NA 19.66

090 implant. 65175............. .............. A

Removal of ocular

6.27

NA 8.50 0.31

NA 15.08

090 implant. 65205............. .............. A

Remove foreign body

0.71 0.64 0.29 0.03 1.38 1.03

000 from eye. 65210............. .............. A

Remove foreign body

0.84 0.81 0.38 0.04 1.69 1.26

000 from eye. 65220............. .............. A

Remove foreign body

0.71 0.64 0.28 0.05 1.40 1.04

000 from eye. 65222............. .............. A

Remove foreign body

0.93 0.89 0.38 0.04 1.86 1.35

000 from eye. 65235............. .............. A

Remove foreign body

7.56

NA 6.76 0.37

NA 14.69

090 from eye. 65260............. .............. A

Remove foreign body

10.94

NA 9.68 0.57

NA 21.19

090 from eye. 65265............. .............. A

Remove foreign body

12.57

NA 10.65 0.62

NA 23.84

090 from eye. 65270............. .............. A

Repair of eye wound... 1.90 5.24 1.39 0.09 7.23 3.38

010 65272............. .............. A

Repair of eye wound... 3.81 7.73 3.30 0.19 11.73 7.30

090 65273............. .............. A

Repair of eye wound... 4.35

NA 3.59 0.22

NA 8.16

090 65275............. .............. A

Repair of eye wound... 5.33 6.33 3.95 0.26 11.92 9.54

090 65280............. .............. A

Repair of eye wound... 7.65

NA 6.25 0.38

NA 14.28

090 65285............. .............. A

Repair of eye wound... 12.88

NA 9.24 0.64

NA 22.76

090 65286............. .............. A

Repair of eye wound... 5.50 11.17 4.63 0.27 16.94 10.40

090 65290............. .............. A

Repair of eye socket

5.40

NA 4.75 0.31

NA 10.46

090 wound. 65400............. .............. A

Removal of eye lesion. 6.05 8.35 6.14 0.30 14.70 12.49

090 65410............. .............. A

Biopsy of cornea...... 1.47 2.12 0.97 0.07 3.66 2.51

000 65420............. .............. A

Removal of eye lesion. 4.16 8.88 4.45 0.21 13.25 8.82

090 65426............. .............. A

Removal of eye lesion. 5.24 10.20 4.93 0.25 15.69 10.42

090 65430............. .............. A

Corneal smear......... 1.47 1.29 0.98 0.07 2.83 2.52

000 65435............. .............. A

Curette/treat cornea.. 0.92 1.00 0.71 0.04 1.96 1.67

000 65436............. .............. A

Curette/treat cornea.. 4.18 4.10 3.68 0.21 8.49 8.07

090 65450............. .............. A

Treatment of corneal

3.27 4.08 3.95 0.16 7.51 7.38

090 lesion. 65600............. .............. A

Revision of cornea.... 3.39 5.02 3.36 0.17 8.58 6.92

090 65710............. .............. A

Corneal transplant.... 12.33

NA 11.23 0.61

NA 24.17

090 65730............. .............. A

Corneal transplant.... 14.23

NA 12.05 0.70

NA 26.98

090 65750............. .............. A

Corneal transplant.... 14.98

NA 12.00 0.74

NA 27.72

090 65755............. .............. A

Corneal transplant.... 14.87

NA 11.92 0.73

NA 27.52

090 65760............. .............. N

Revision of cornea.... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 65765............. .............. N

Revision of cornea.... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 65767............. .............. N

Corneal tissue

0.00 0.00 0.00 0.00 0.00 0.00

XXX transplant. 65770............. .............. A

Revise cornea with

17.53

NA 13.24 0.87

NA 31.64

090 implant. 65771............. .............. N

Radial keratotomy..... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 65772............. .............. A

Correction of

4.28 5.55 4.14 0.21 10.04 8.63

090 astigmatism. 65775............. .............. A

Correction of

5.78

NA 5.97 0.28

NA 12.03

090 astigmatism. 65780............. .............. A

Ocular reconst,

10.23

NA 10.32 0.44

NA 20.99

090 transplant. 65781............. .............. A

Ocular reconst,

17.64

NA 13.71 0.44

NA 31.79

090 transplant. 65782............. .............. A

Ocular reconst,

14.98

NA 12.02 0.44

NA 27.44

090 transplant. 65800............. .............. A

Drainage of eye....... 1.91 1.80 1.18 0.09 3.80 3.18

000 65805............. .............. A

Drainage of eye....... 1.91 2.18 1.19 0.09 4.18 3.19

000 65810............. .............. A

Drainage of eye....... 4.86

NA 4.71 0.24

NA 9.81

090 65815............. .............. A

Drainage of eye....... 5.04 10.03 4.82 0.25 15.32 10.11

090 65820............. .............. A

Relieve inner eye

8.12

NA 9.08 0.40

NA 17.60

090 pressure. 65850............. .............. A

Incision of eye....... 10.50

NA 8.46 0.52

NA 19.48

090 65855............. .............. A

Laser surgery of eye.. 3.84 4.32 3.11 0.19 8.35 7.14

010 65860............. .............. A

Incise inner eye

3.54 4.05 2.51 0.18 7.77 6.23

090 adhesions. 65865............. .............. A

Incise inner eye

5.59

NA 5.64 0.28

NA 11.51

090 adhesions. 65870............. .............. A

Incise inner eye

6.26

NA 6.43 0.31

NA 13.00

090 adhesions. 65875............. .............. A

Incise inner eye

6.53

NA 6.81 0.32

NA 13.66

090 adhesions. 65880............. .............. A

Incise inner eye

7.08

NA 7.05 0.35

NA 14.48

090 adhesions. 65900............. .............. A

Remove eye lesion..... 10.91

NA 10.28 0.54

NA 21.73

090 65920............. .............. A

Remove implant of eye. 8.39

NA 8.19 0.41

NA 16.99

090 65930............. .............. A

Remove blood clot from 7.43

NA 6.85 0.37

NA 14.65

090 eye. 66020............. .............. A

Injection treatment of 1.59 3.13 1.44 0.08 4.80 3.11

010 eye. 66030............. .............. A

Injection treatment of 1.25 2.97 1.28 0.06 4.28 2.59

010 eye. 66130............. .............. A

Remove eye lesion..... 7.68 9.65 5.63 0.38 17.71 13.69

090

[[Page 70407]]

66150............. .............. A

Glaucoma surgery...... 8.29

NA 9.43 0.46

NA 18.18

090 66155............. .............. A

Glaucoma surgery...... 8.28

NA 9.38 0.41

NA 18.07

090 66160............. .............. A

Glaucoma surgery...... 10.15

NA 10.22 0.50

NA 20.87

090 66165............. .............. A

Glaucoma surgery...... 8.00

NA 9.27 0.40

NA 17.67

090 66170............. .............. A

Glaucoma surgery...... 12.14

NA 12.26 0.60

NA 25.00

090 66172............. .............. A

Incision of eye....... 15.02

NA 15.24 0.74

NA 31.00

090 66180............. .............. A

Implant eye shunt..... 14.53

NA 10.79 0.71

NA 26.03

090 66185............. .............. A

Revise eye shunt...... 8.13

NA 7.40 0.40

NA 15.93

090 66220............. .............. A

Repair eye lesion..... 7.76

NA 7.12 0.40

NA 15.28

090 66225............. .............. A

Repair/graft eye

11.03

NA 8.76 0.55

NA 20.34

090 lesion. 66250............. .............. A

Follow-up surgery of

5.97 11.72 5.50 0.30 17.99 11.77

090 eye. 66500............. .............. A

Incision of iris...... 3.70

NA 4.65 0.18

NA 8.53

090 66505............. .............. A

Incision of iris...... 4.07

NA 5.00 0.20

NA 9.27

090 66600............. .............. A

Remove iris and lesion 8.67

NA 8.24 0.43

NA 17.34

090 66605............. .............. A

Removal of iris....... 12.77

NA 10.05 0.77

NA 23.59

090 66625............. .............. A

Removal of iris....... 5.12

NA 4.74 0.26

NA 10.12

090 66630............. .............. A

Removal of iris....... 6.15

NA 5.73 0.31

NA 12.19

090 66635............. .............. A

Removal of iris....... 6.24

NA 5.76 0.31

NA 12.31

090 66680............. .............. A

Repair iris & ciliary

5.43

NA 5.29 0.27

NA 10.99

090 body. 66682............. .............. A

Repair iris & ciliary

6.20

NA 6.63 0.31

NA 13.14

090 body. 66700............. .............. A

Destruction, ciliary

4.77 5.26 3.94 0.24 10.27 8.95

090 body. 66710............. .............. A

Ciliary transsleral

4.77 5.18 3.85 0.23 10.18 8.85

090 therapy. 66711............. .............. A

Ciliary endoscopic

6.60

NA 6.49 0.30

NA 13.39

090 ablation. 66720............. .............. A

Destruction, ciliary

4.77 5.81 4.73 0.26 10.84 9.76

090 body. 66740............. .............. A

Destruction, ciliary

4.77 5.10 3.98 0.23 10.10 8.98

090 body. 66761............. .............. A

Revision of iris...... 4.06 5.61 4.32 0.20 9.87 8.58

090 66762............. .............. A

Revision of iris...... 4.57 5.67 4.30 0.23 10.47 9.10

090 66770............. .............. A

Removal of inner eye

5.17 6.10 4.81 0.26 11.53 10.24

090 lesion. 66820............. .............. A

Incision, secondary

3.88

NA 5.83 0.19

NA 9.90

090 cataract. 66821............. .............. A

After cataract laser

2.35 4.10 3.63 0.11 6.56 6.09

090 surgery. 66825............. .............. A

Reposition intraocular 8.22

NA 9.09 0.40

NA 17.71

090 lens. 66830............. .............. A

Removal of lens lesion 8.19

NA 6.97 0.36

NA 15.52

090 66840............. .............. A

Removal of lens

7.90

NA 6.88 0.39

NA 15.17

090 material. 66850............. .............. A

Removal of lens

9.10

NA 7.66 0.45

NA 17.21

090 material. 66852............. .............. A

Removal of lens

9.96

NA 8.12 0.49

NA 18.57

090 material. 66920............. .............. A

Extraction of lens.... 8.85

NA 7.32 0.44

NA 16.61

090 66930............. .............. A

Extraction of lens.... 10.16

NA 8.16 0.49

NA 18.81

090 66940............. .............. A

Extraction of lens.... 8.92

NA 7.62 0.43

NA 16.97

090 66982............. .............. A

Cataract surgery,

13.48

NA 9.89 0.63

NA 24.00

090 complex. 66983............. .............. A

Cataract surg w/iol, 1 8.98

NA 6.13 0.14

NA 15.25

090 stage. 66984............. .............. A

Cataract surg w/iol, 1 10.21

NA 7.44 0.39

NA 18.04

090 stage. 66985............. .............. A

Insert lens prosthesis 8.38

NA 7.47 0.36

NA 16.21

090 66986............. .............. A

Exchange lens

12.26

NA 9.20 0.60

NA 22.06

090 prosthesis. 66990............. .............. A

Ophthalmic endoscope

1.51

NA 0.69 0.07

NA 2.27

ZZZ add-on. 66999............. .............. C

Eye surgery procedure. 0.00 0.00 0.00 0.00 0.00 0.00

YYY 67005............. .............. A

Partial removal of eye 5.69

NA 4.87 0.28

NA 10.84

090 fluid. 67010............. .............. A

Partial removal of eye 6.86

NA 5.43 0.34

NA 12.63

090 fluid. 67015............. .............. A

Release of eye fluid.. 6.91

NA 6.47 0.34

NA 13.72

090 67025............. .............. A

Replace eye fluid..... 6.83 9.25 6.24 0.34 16.42 13.41

090 67027............. .............. A

Implant eye drug

10.83

NA 8.02 0.54

NA 19.39

090 system. 67028............. .............. A

Injection eye drug.... 2.52 2.71 1.46 0.12 5.35 4.10

000 67030............. .............. A

Incise inner eye

4.83

NA 5.87 0.24

NA 10.94

090 strands. 67031............. .............. A

Laser surgery, eye

3.66 4.61 3.65 0.18 8.45 7.49

090 strands. 67036............. .............. A

Removal of inner eye

11.87

NA 9.15 0.58

NA 21.60

090 fluid. 67038............. .............. A

Strip retinal membrane 21.21

NA 15.53 1.04

NA 37.78

090 67039............. .............. A

Laser treatment of

14.50

NA 12.22 0.71

NA 27.43

090 retina. 67040............. .............. A

Laser treatment of

17.20

NA 13.72 0.85

NA 31.77

090 retina. 67101............. .............. A

Repair detached retina 7.52 9.15 6.55 0.37 17.04 14.44

090 67105............. .............. A

Repair detached retina 7.40 8.10 6.17 0.37 15.87 13.94

090 67107............. .............. A

Repair detached retina 14.82

NA 11.33 0.73

NA 26.88

090 67108............. .............. A

Repair detached retina 20.79

NA 14.46 1.02

NA 36.27

090 67110............. .............. A

Repair detached retina 8.80 10.26 7.41 0.44 19.50 16.65

090 67112............. .............. A

Rerepair detached

16.83

NA 11.84 0.83

NA 29.50

090 retina. 67115............. .............. A

Release encircling

4.98

NA 5.09 0.25

NA 10.32

090 material. 67120............. .............. A

Remove eye implant

5.97 8.60 5.55 0.29 14.86 11.81

090 material. 67121............. .............. A

Remove eye implant

10.65

NA 8.55 0.53

NA 19.73

090 material. 67141............. .............. A

Treatment of retina... 5.19 5.87 4.87 0.26 11.32 10.32

090 67145............. .............. A

Treatment of retina... 5.36 5.74 4.94 0.27 11.37 10.57

090 67208............. .............. A

Treatment of retinal

6.69 6.14 5.53 0.33 13.16 12.55

090 lesion. 67210............. .............. A

Treatment of retinal

8.81 6.59 5.90 0.44 15.84 15.15

090 lesion. 67218............. .............. A

Treatment of retinal

18.50

NA 12.19 0.92

NA 31.61

090 lesion. 67220............. .............. A

Treatment of choroid

13.11 10.45 9.04 0.65 24.21 22.80

090 lesion. 67221............. .............. R

Ocular photodynamic

4.00 4.34 1.81 0.20 8.54 6.01

000 ther. 67225............. .............. A

Eye photodynamic ther

0.47 0.25 0.21 0.02 0.74 0.70

ZZZ add-on. 67227............. .............. A

Treatment of retinal

6.57 6.60 5.54 0.33 13.50 12.44

090 lesion.

[[Page 70408]]

67228............. .............. A

Treatment of retinal

12.72 11.51 8.56 0.63 24.86 21.91

090 lesion. 67250............. .............. A

Reinforce eye wall.... 8.65

NA 9.20 0.47

NA 18.32

090 67255............. .............. A

Reinforce/graft eye

8.89

NA 9.92 0.44

NA 19.25

090 wall. 67299............. .............. C

Eye surgery procedure. 0.00 0.00 0.00 0.00 0.00 0.00

YYY 67311............. .............. A

Revise eye muscle..... 6.64

NA 6.04 0.37

NA 13.05

090 67312............. .............. A

Revise two eye muscles 8.53

NA 6.77 0.43

NA 15.73

090 67314............. .............. A

Revise eye muscle..... 7.51

NA 6.57 0.39

NA 14.47

090 67316............. .............. A

Revise two eye muscles 9.65

NA 7.52 0.49

NA 17.66

090 67318............. .............. A

Revise eye muscle(s).. 7.84

NA 6.95 0.41

NA 15.20

090 67320............. .............. A

Revise eye muscle(s)

4.32

NA 1.96 0.22

NA 6.50

ZZZ add-on. 67331............. .............. A

Eye surgery follow-up

4.05

NA 1.84 0.21

NA 6.10

ZZZ add-on. 67332............. .............. A

Rerevise eye muscles

4.48

NA 2.03 0.23

NA 6.74

ZZZ add-on. 67334............. .............. A

Revise eye muscle w/

3.97

NA 1.80 0.20

NA 5.97

ZZZ suture. 67335............. .............. A

Eye suture during

2.49

NA 1.12 0.13

NA 3.74

ZZZ surgery. 67340............. .............. A

Revise eye muscle add- 4.92

NA 2.21 0.25

NA 7.38

ZZZ on. 67343............. .............. A

Release eye tissue.... 7.34

NA 6.53 0.37

NA 14.24

090 67345............. .............. A

Destroy nerve of eye

2.96 2.59 2.02 0.17 5.72 5.15

010 muscle. 67350............. .............. A

Biopsy eye muscle..... 2.87

NA 1.88 0.15

NA 4.90

000 67399............. .............. C

Eye muscle surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 67400............. .............. A

Explore/biopsy eye

9.75

NA 11.29 0.56

NA 21.60

090 socket. 67405............. .............. A

Explore/drain eye

7.92

NA 9.80 0.44

NA 18.16

090 socket. 67412............. .............. A

Explore/treat eye

9.49

NA 10.96 0.48

NA 20.93

090 socket. 67413............. .............. A

Explore/treat eye

9.99

NA 10.80 0.50

NA 21.29

090 socket. 67414............. .............. A

Explr/decompress eye

11.11

NA 12.07 0.65

NA 23.83

090 socket. 67415............. .............. A

Aspiration, orbital

1.76

NA 0.76 0.09

NA 2.61

000 contents. 67420............. .............. A

Explore/treat eye

20.03

NA 17.44 1.15

NA 38.62

090 socket. 67430............. .............. A

Explore/treat eye

13.37

NA 14.93 0.86

NA 29.16

090 socket. 67440............. .............. A

Explore/drain eye

13.07

NA 14.30 0.70

NA 28.07

090 socket. 67445............. .............. A

Explr/decompress eye

14.40

NA 13.95 0.90

NA 29.25

090 socket. 67450............. .............. A

Explore/biopsy eye

13.49

NA 14.73 0.68

NA 28.90

090 socket. 67500............. .............. A

Inject/treat eye

0.79 0.67 0.29 0.05 1.51 1.13

000 socket. 67505............. .............. A

Inject/treat eye

0.82 0.69 0.31 0.05 1.56 1.18

000 socket. 67515............. .............. A

Inject/treat eye

0.61 0.59 0.38 0.03 1.23 1.02

000 socket. 67550............. .............. A

Insert eye socket

10.17

NA 11.33 0.72

NA 22.22

090 implant. 67560............. .............. A

Revise eye socket

10.58

NA 11.40 0.60

NA 22.58

090 implant. 67570............. .............. A

Decompress optic nerve 13.56

NA 13.62 0.68

NA 27.86

090 67599............. .............. C

Orbit surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 67700............. .............. A

Drainage of eyelid

1.35 6.04 1.27 0.07 7.46 2.69

010 abscess. 67710............. .............. A

Incision of eyelid.... 1.02 5.39 1.21 0.05 6.46 2.28

010 67715............. .............. A

Incision of eyelid

1.22 5.39 1.29 0.06 6.67 2.57

010 fold. 67800............. .............. A

Remove eyelid lesion.. 1.38 1.62 1.04 0.07 3.07 2.49

010 67801............. .............. A

Remove eyelid lesions. 1.88 1.97 1.26 0.09 3.94 3.23

010 67805............. .............. A

Remove eyelid lesions. 2.22 2.53 1.65 0.11 4.86 3.98

010 67808............. .............. A

Remove eyelid

3.79

NA 3.78 0.19

NA 7.76

090 lesion(s). 67810............. .............. A

Biopsy of eyelid...... 1.48 3.34 0.68 0.06 4.88 2.22

000 67820............. .............. A

Revise eyelashes...... 0.89 0.60 0.56 0.04 1.53 1.49

000 67825............. .............. A

Revise eyelashes...... 1.38 1.74 1.41 0.07 3.19 2.86

010 67830............. .............. A

Revise eyelashes...... 1.70 5.55 1.50 0.08 7.33 3.28

010 67835............. .............. A

Revise eyelashes...... 5.55

NA 4.63 0.28

NA 10.46

090 67840............. .............. A

Remove eyelid lesion.. 2.04 5.49 1.65 0.10 7.63 3.79

010 67850............. .............. A

Treat eyelid lesion... 1.69 3.38 1.47 0.07 5.14 3.23

010 67875............. .............. A

Closure of eyelid by

1.35 3.31 0.94 0.07 4.73 2.36

000 suture. 67880............. .............. A

Revision of eyelid.... 3.79 6.63 3.81 0.19 10.61 7.79

090 67882............. .............. A

Revision of eyelid.... 5.06 7.65 4.82 0.25 12.96 10.13

090 67900............. .............. A

Repair brow defect.... 6.13 9.09 5.27 0.38 15.60 11.78

090 67901............. .............. A

Repair eyelid defect.. 7.39

NA 5.42 0.54

NA 13.35

090 67902............. .............. A

Repair eyelid defect.. 9.35

NA 5.48 0.60

NA 15.43

090 67903............. .............. A

Repair eyelid defect.. 6.36 9.59 5.53 0.47 16.42 12.36

090 67904............. .............. A

Repair eyelid defect.. 6.25 9.66 5.25 0.41 16.32 11.91

090 67906............. .............. A

Repair eyelid defect.. 6.78 5.39 5.04 0.46 12.63 12.28

090 67908............. .............. A

Repair eyelid defect.. 5.12 6.65 5.36 0.28 12.05 10.76

090 67909............. .............. A

Revise eyelid defect.. 5.39 8.05 4.96 0.31 13.75 10.66

090 67911............. .............. A

Revise eyelid defect.. 5.26

NA 4.79 0.31

NA 10.36

090 67912............. .............. A

Correction eyelid w/

5.67 18.98 5.55 0.28 24.93 11.50

090 implant. 67914............. .............. A

Repair eyelid defect.. 3.67 6.36 3.06 0.19 10.22 6.92

090 67915............. .............. A

Repair eyelid defect.. 3.18 6.00 2.81 0.16 9.34 6.15

090 67916............. .............. A

Repair eyelid defect.. 5.30 8.07 4.77 0.28 13.65 10.35

090 67917............. .............. A

Repair eyelid defect.. 6.01 8.48 5.08 0.36 14.85 11.45

090 67921............. .............. A

Repair eyelid defect.. 3.39 6.21 2.90 0.17 9.77 6.46

090 67922............. .............. A

Repair eyelid defect.. 3.06 5.93 2.76 0.15 9.14 5.97

090 67923............. .............. A

Repair eyelid defect.. 5.87 8.14 4.98 0.30 14.31 11.15

090 67924............. .............. A

Repair eyelid defect.. 5.78 8.95 4.69 0.30 15.03 10.77

090 67930............. .............. A

Repair eyelid wound... 3.60 5.73 2.18 0.19 9.52 5.97

010 67935............. .............. A

Repair eyelid wound... 6.21 8.54 4.42 0.39 15.14 11.02

090 67938............. .............. A

Remove eyelid foreign

1.33 5.40 1.26 0.06 6.79 2.65

010 body.

[[Page 70409]]

67950............. .............. A

Revision of eyelid.... 5.81 8.66 5.23 0.36 14.83 11.40

090 67961............. .............. A

Revision of eyelid.... 5.68 8.71 5.04 0.33 14.72 11.05

090 67966............. .............. A

Revision of eyelid.... 6.56 9.16 5.58 0.37 16.09 12.51

090 67971............. .............. A

Reconstruction of

9.78

NA 7.30 0.53

NA 17.61

090 eyelid. 67973............. .............. A

Reconstruction of

12.85

NA 9.34 0.75

NA 22.94

090 eyelid. 67974............. .............. A

Reconstruction of

12.82

NA 9.26 0.75

NA 22.83

090 eyelid. 67975............. .............. A

Reconstruction of

9.12

NA 6.97 0.50

NA 16.59

090 eyelid. 67999............. .............. C

Revision of eyelid.... 0.00 0.00 0.00 0.00 0.00 0.00

YYY 68020............. .............. A

Incise/drain eyelid

1.37 1.41 1.21 0.06 2.84 2.64

010 lining. 68040............. .............. A

Treatment of eyelid

0.85 0.71 0.43 0.04 1.60 1.32

000 lesions. 68100............. .............. A

Biopsy of eyelid

1.35 3.26 0.95 0.07 4.68 2.37

000 lining. 68110............. .............. A

Remove eyelid lining

1.77 4.11 1.65 0.09 5.97 3.51

010 lesion. 68115............. .............. A

Remove eyelid lining

2.36 5.98 1.92 0.12 8.46 4.40

010 lesion. 68130............. .............. A

Remove eyelid lining

4.92 8.74 4.61 0.24 13.90 9.77

090 lesion. 68135............. .............. A

Remove eyelid lining

1.84 1.82 1.65 0.09 3.75 3.58

010 lesion. 68200............. .............. A

Treat eyelid by

0.49 0.54 0.33 0.02 1.05 0.84

000 injection. 68320............. .............. A

Revise/graft eyelid

5.36 11.31 5.54 0.27 16.94 11.17

090 lining. 68325............. .............. A

Revise/graft eyelid

7.35

NA 6.56 0.44

NA 14.35

090 lining. 68326............. .............. A

Revise/graft eyelid

7.14

NA 6.43 0.35

NA 13.92

090 lining. 68328............. .............. A

Revise/graft eyelid

8.17

NA 7.31 0.54

NA 16.02

090 lining. 68330............. .............. A

Revise eyelid lining.. 4.82 9.44 4.73 0.24 14.50 9.79

090 68335............. .............. A

Revise/graft eyelid

7.18

NA 6.40 0.36

NA 13.94

090 lining. 68340............. .............. A

Separate eyelid

4.16 8.90 4.11 0.21 13.27 8.48

090 adhesions. 68360............. .............. A

Revise eyelid lining.. 4.36 8.06 4.19 0.22 12.64 8.77

090 68362............. .............. A

Revise eyelid lining.. 7.33

NA 6.42 0.36

NA 14.11

090 68371............. .............. A

Harvest eye tissue,

4.89

NA 4.74 0.44

NA 10.07

010 alograft. 68399............. .............. C

Eyelid lining surgery. 0.00 0.00 0.00 0.00 0.00 0.00

YYY 68400............. .............. A

Incise/drain tear

1.69 5.92 1.83 0.08 7.69 3.60

010 gland. 68420............. .............. A

Incise/drain tear sac. 2.30 6.21 2.11 0.11 8.62 4.52

010 68440............. .............. A

Incise tear duct

0.94 2.09 1.27 0.05 3.08 2.26

010 opening. 68500............. .............. A

Removal of tear gland. 11.00

NA 9.76 0.55

NA 21.31

090 68505............. .............. A

Partial removal, tear 10.92

NA 10.68 0.55

NA 22.15

090 gland. 68510............. .............. A

Biopsy of tear gland.. 4.60 7.35 2.10 0.23 12.18 6.93

000 68520............. .............. A

Removal of tear sac... 7.50

NA 7.44 0.37

NA 15.31

090 68525............. .............. A

Biopsy of tear sac.... 4.42

NA 2.03 0.22

NA 6.67

000 68530............. .............. A

Clearance of tear duct 3.65 8.19 2.65 0.18 12.02 6.48

010 68540............. .............. A

Remove tear gland

10.58

NA 9.42 0.52

NA 20.52

090 lesion. 68550............. .............. A

Remove tear gland

13.24

NA 11.38 0.80

NA 25.42

090 lesion. 68700............. .............. A

Repair tear ducts..... 6.59

NA 6.00 0.32

NA 12.91

090 68705............. .............. A

Revise tear duct

2.06 4.18 1.80 0.10 6.34 3.96

010 opening. 68720............. .............. A

Create tear sac drain. 8.95

NA 7.88 0.44

NA 17.27

090 68745............. .............. A

Create tear duct drain 8.62

NA 7.88 0.52

NA 17.02

090 68750............. .............. A

Create tear duct drain 8.65

NA 8.29 0.43

NA 17.37

090 68760............. .............. A

Close tear duct

1.73 3.55 1.63 0.09 5.37 3.45

010 opening. 68761............. .............. A

Close tear duct

1.36 2.28 1.32 0.06 3.70 2.74

010 opening. 68770............. .............. A

Close tear system

7.01 3.19 3.19 0.35 10.55 10.55

090 fistula. 68801............. .............. A

Dilate tear duct

0.94 1.95 1.48 0.05 2.94 2.47

010 opening. 68810............. .............. A

Probe nasolacrimal

1.90 3.67 2.68 0.10 5.67 4.68

010 duct. 68811............. .............. A

Probe nasolacrimal

2.35

NA 2.42 0.13

NA 4.90

010 duct. 68815............. .............. A

Probe nasolacrimal

3.20 8.26 2.82 0.17 11.63 6.19

010 duct. 68840............. .............. A

Explore/irrigate tear

1.25 1.60 1.12 0.06 2.91 2.43

010 ducts. 68850............. .............. A

Injection for tear sac 0.80 0.88 0.68 0.04 1.72 1.52

000 x-ray. 68899............. .............. C

Tear duct system

0.00 0.00 0.00 0.00 0.00 0.00

YYY surgery. 69000............. .............. A

Drain external ear

1.45 2.89 1.36 0.12 4.46 2.93

010 lesion. 69005............. .............. A

Drain external ear

2.11 2.94 1.84 0.17 5.22 4.12

010 lesion. 69020............. .............. A

Drain outer ear canal

1.48 4.00 2.07 0.12 5.60 3.67

010 lesion. 69090............. .............. N

Pierce earlobes....... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 69100............. .............. A

Biopsy of external ear 0.81 1.71 0.39 0.03 2.55 1.23

000 69105............. .............. A

Biopsy of external ear 0.85 2.35 0.77 0.07 3.27 1.69

000 canal. 69110............. .............. A

Remove external ear,

3.43 6.76 4.48 0.30 10.49 8.21

090 partial. 69120............. .............. A

Removal of external

4.04

NA 6.20 0.38

NA 10.62

090 ear. 69140............. .............. A

Remove ear canal

7.96

NA 13.32 0.65

NA 21.93

090 lesion(s). 69145............. .............. A

Remove ear canal

2.62 5.80 3.31 0.21 8.63 6.14

090 lesion(s). 69150............. .............. A

Extensive ear canal

13.41

NA 13.44 1.22

NA 28.07

090 surgery. 69155............. .............. A

Extensive ear/neck

20.77

NA 19.60 1.92

NA 42.29

090 surgery. 69200............. .............. A

Clear outer ear canal. 0.77 2.39 0.55 0.06 3.22 1.38

000 69205............. .............. A

Clear outer ear canal. 1.20

NA 1.36 0.10

NA 2.66

010 69210............. .............. A

Remove impacted ear

0.61 0.63 0.23 0.05 1.29 0.89

000 wax. 69220............. .............. A

Clean out mastoid

0.83 2.37 0.73 0.07 3.27 1.63

000 cavity. 69222............. .............. A

Clean out mastoid

1.40 3.86 2.07 0.12 5.38 3.59

010 cavity. 69300............. .............. R

Revise external ear... 6.35

NA 4.23 0.72

NA 11.30

YYY 69310............. .............. A

Rebuild outer ear

10.77

NA 16.33 0.85

NA 27.95

090 canal. 69320............. .............. A

Rebuild outer ear

16.93

NA 21.90 1.37

NA 40.20

090 canal. 69399............. .............. C

Outer ear surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 69400............. .............. A

Inflate middle ear

0.83 2.17 0.67 0.07 3.07 1.57

000 canal.

[[Page 70410]]

69401............. .............. A

Inflate middle ear

0.63 1.24 0.65 0.05 1.92 1.33

000 canal. 69405............. .............. A

Catheterize middle ear 2.63 3.51 2.32 0.21 6.35 5.16

010 canal. 69420............. .............. A

Incision of eardrum... 1.33 3.16 1.59 0.11 4.60 3.03

010 69421............. .............. A

Incision of eardrum... 1.73

NA 2.17 0.15

NA 4.05

010 69424............. .............. A

Remove ventilating

0.85 2.19 0.68 0.07 3.11 1.60

000 tube. 69433............. .............. A

Create eardrum opening 1.52 3.10 1.64 0.13 4.75 3.29

010 69436............. .............. A

Create eardrum opening 1.96

NA 2.30 0.19

NA 4.45

010 69440............. .............. A

Exploration of middle

7.56

NA 8.80 0.61

NA 16.97

090 ear. 69450............. .............. A

Eardrum revision...... 5.56

NA 7.05 0.45

NA 13.06

090 69501............. .............. A

Mastoidectomy......... 9.06

NA 9.03 0.73

NA 18.82

090 69502............. .............. A

Mastoidectomy......... 12.36

NA 11.62 1.00

NA 24.98

090 69505............. .............. A

Remove mastoid

12.97

NA 17.24 1.05

NA 31.26

090 structures. 69511............. .............. A

Extensive mastoid

13.50

NA 17.52 1.09

NA 32.11

090 surgery. 69530............. .............. A

Extensive mastoid

19.16

NA 21.69 1.54

NA 42.39

090 surgery. 69535............. .............. A

Remove part of

36.09

NA 32.05 2.92

NA 71.06

090 temporal bone. 69540............. .............. A

Remove ear lesion..... 1.20 3.75 1.98 0.10 5.05 3.28

010 69550............. .............. A

Remove ear lesion..... 10.97

NA 14.90 0.89

NA 26.76

090 69552............. .............. A

Remove ear lesion..... 19.43

NA 20.73 1.59

NA 41.75

090 69554............. .............. A

Remove ear lesion..... 33.11

NA 30.42 2.91

NA 66.44

090 69601............. .............. A

Mastoid surgery

13.22

NA 12.71 1.07

NA 27.00

090 revision. 69602............. .............. A

Mastoid surgery

13.56

NA 13.27 1.10

NA 27.93

090 revision. 69603............. .............. A

Mastoid surgery

14.00

NA 18.41 1.14

NA 33.55

090 revision. 69604............. .............. A

Mastoid surgery

14.00

NA 13.73 1.14

NA 28.87

090 revision. 69605............. .............. A

Mastoid surgery

18.46

NA 21.01 1.50

NA 40.97

090 revision. 69610............. .............. A

Repair of eardrum..... 4.42 5.57 3.28 0.36 10.35 8.06

010 69620............. .............. A

Repair of eardrum..... 5.88 11.15 6.31 0.48 17.51 12.67

090 69631............. .............. A

Repair eardrum

9.85

NA 11.23 0.80

NA 21.88

090 structures. 69632............. .............. A

Rebuild eardrum

12.73

NA 13.51 1.03

NA 27.27

090 structures. 69633............. .............. A

Rebuild eardrum

12.08

NA 13.09 0.98

NA 26.15

090 structures. 69635............. .............. A

Repair eardrum

13.31

NA 16.79 1.08

NA 31.18

090 structures. 69636............. .............. A

Rebuild eardrum

15.20

NA 19.36 1.23

NA 35.79

090 structures. 69637............. .............. A

Rebuild eardrum

15.09

NA 19.28 1.22

NA 35.59

090 structures. 69641............. .............. A

Revise middle ear &

12.69

NA 12.82 1.03

NA 26.54

090 mastoid. 69642............. .............. A

Revise middle ear &

16.81

NA 16.33 1.36

NA 34.50

090 mastoid. 69643............. .............. A

Revise middle ear &

15.30

NA 14.86 1.24

NA 31.40

090 mastoid. 69644............. .............. A

Revise middle ear &

16.94

NA 20.46 1.37

NA 38.77

090 mastoid. 69645............. .............. A

Revise middle ear &

16.36

NA 20.08 1.33

NA 37.77

090 mastoid. 69646............. .............. A

Revise middle ear &

17.96

NA 20.82 1.46

NA 40.24

090 mastoid. 69650............. .............. A

Release middle ear

9.65

NA 9.94 0.78

NA 20.37

090 bone. 69660............. .............. A

Revise middle ear bone 11.88

NA 11.21 0.96

NA 24.05

090 69661............. .............. A

Revise middle ear bone 15.72

NA 14.74 1.27

NA 31.73

090 69662............. .............. A

Revise middle ear bone 15.42

NA 13.79 1.25

NA 30.46

090 69666............. .............. A

Repair middle ear

9.74

NA 10.00 0.79

NA 20.53

090 structures. 69667............. .............. A

Repair middle ear

9.75

NA 10.01 0.79

NA 20.55

090 structures. 69670............. .............. A

Remove mastoid air

11.49

NA 11.74 0.93

NA 24.16

090 cells. 69676............. .............. A

Remove middle ear

9.51

NA 10.78 0.81

NA 21.10

090 nerve. 69700............. .............. A

Close mastoid fistula. 8.22

NA 9.27 0.67

NA 18.16

090 69710............. .............. N

Implant/replace

0.00 0.00 0.00 0.00 0.00 0.00

XXX hearing aid. 69711............. .............. A

Remove/repair hearing 10.42

NA 10.82 0.83

NA 22.07

090 aid. 69714............. .............. A

Implant temple bone w/ 13.98

NA 12.70 1.13

NA 27.81

090 stimul. 69715............. .............. A

Temple bne implnt w/

18.22

NA 15.07 1.48

NA 34.77

090 stimulat. 69717............. .............. A

Temple bone implant

14.96

NA 14.51 0.90

NA 30.37

090 revision. 69718............. .............. A

Revise temple bone

18.47

NA 15.34 3.21

NA 37.02

090 implant. 69720............. .............. A

Release facial nerve.. 14.36

NA 14.56 1.16

NA 30.08

090 69725............. .............. A

Release facial nerve.. 25.34

NA 20.19 2.44

NA 47.97

090 69740............. .............. A

Repair facial nerve... 15.94

NA 13.45 1.27

NA 30.66

090 69745............. .............. A

Repair facial nerve... 16.66

NA 15.01 1.14

NA 32.81

090 69799............. .............. C

Middle ear surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 69801............. .............. A

Incise inner ear...... 8.55

NA 9.49 0.69

NA 18.73

090 69802............. .............. A

Incise inner ear...... 13.08

NA 12.36 1.06

NA 26.50

090 69805............. .............. A

Explore inner ear..... 13.80

NA 11.91 1.12

NA 26.83

090 69806............. .............. A

Explore inner ear..... 12.33

NA 11.07 1.00

NA 24.40

090 69820............. .............. A

Establish inner ear

10.32

NA 11.25 0.90

NA 22.47

090 window. 69840............. .............. A

Revise inner ear

10.24

NA 13.21 0.79

NA 24.24

090 window. 69905............. .............. A

Remove inner ear...... 11.08

NA 11.38 0.90

NA 23.36

090 69910............. .............. A

Remove inner ear &

13.61

NA 11.95 1.07

NA 26.63

090 mastoid. 69915............. .............. A

Incise inner ear nerve 21.20

NA 16.51 1.69

NA 39.40

090 69930............. .............. A

Implant cochlear

16.78

NA 14.79 1.36

NA 32.93

090 device. 69949............. .............. C

Inner ear surgery

0.00 0.00 0.00 0.00 0.00 0.00

YYY procedure. 69950............. .............. A

Incise inner ear nerve 25.60

NA 18.95 2.28

NA 46.83

090 69955............. .............. A

Release facial nerve.. 27.00

NA 21.44 2.48

NA 50.92

090 69960............. .............. A

Release inner ear

27.00

NA 20.11 2.17

NA 49.28

090 canal. 69970............. .............. A

Remove inner ear

29.99

NA 23.34 2.41

NA 55.74

090 lesion. 69979............. .............. C

Temporal bone surgery. 0.00 0.00 0.00 0.00 0.00 0.00

YYY 69990............. .............. R

Microsurgery add-on... 3.46

NA 1.80 0.89

NA 6.15

ZZZ

[[Page 70411]]

70010............. 26............ A

Contrast x-ray of

1.19 0.39 0.39 0.05 1.63 1.63

XXX brain. 70010............. TC............ A

Contrast x-ray of

0.00 4.34

NA 0.22 4.56

NA

XXX brain. 70010............. .............. A

Contrast x-ray of

1.19 4.73

NA 0.27 6.19

NA

XXX brain. 70015............. 26............ A

Contrast x-ray of

1.19 0.39 0.39 0.08 1.66 1.66

XXX brain. 70015............. TC............ A

Contrast x-ray of

0.00 1.35

NA 0.08 1.43

NA

XXX brain. 70015............. .............. A

Contrast x-ray of

1.19 1.74

NA 0.16 3.09

NA

XXX brain. 70030............. 26............ A

X-ray eye for foreign

0.17 0.06 0.06 0.01 0.24 0.24

XXX body. 70030............. TC............ A

X-ray eye for foreign

0.00 0.42

NA 0.02 0.44

NA

XXX body. 70030............. .............. A

X-ray eye for foreign

0.17 0.48

NA 0.03 0.68

NA

XXX body. 70100............. 26............ A

X-ray exam of jaw..... 0.18 0.06 0.06 0.01 0.25 0.25

XXX 70100............. TC............ A

X-ray exam of jaw..... 0.00 0.52

NA 0.02 0.54

NA

XXX 70100............. .............. A

X-ray exam of jaw..... 0.18 0.58

NA 0.03 0.79

NA

XXX 70110............. 26............ A

X-ray exam of jaw..... 0.25 0.08 0.08 0.01 0.34 0.34

XXX 70110............. TC............ A

X-ray exam of jaw..... 0.00 0.62

NA 0.04 0.66

NA

XXX 70110............. .............. A

X-ray exam of jaw..... 0.25 0.70

NA 0.05 1.00

NA

XXX 70120............. 26............ A

X-ray exam of mastoids 0.18 0.06 0.06 0.01 0.25 0.25

XXX 70120............. TC............ A

X-ray exam of mastoids 0.00 0.62

NA 0.04 0.66

NA

XXX 70120............. .............. A

X-ray exam of mastoids 0.18 0.68

NA 0.05 0.91

NA

XXX 70130............. 26............ A

X-ray exam of mastoids 0.34 0.11 0.11 0.02 0.47 0.47

XXX 70130............. TC............ A

X-ray exam of mastoids 0.00 0.78

NA 0.05 0.83

NA

XXX 70130............. .............. A

X-ray exam of mastoids 0.34 0.89

NA 0.07 1.30

NA

XXX 70134............. 26............ A

X-ray exam of middle

0.34 0.11 0.11 0.02 0.47 0.47

XXX ear. 70134............. TC............ A

X-ray exam of middle

0.00 0.73

NA 0.05 0.78

NA

XXX ear. 70134............. .............. A

X-ray exam of middle

0.34 0.84

NA 0.07 1.25

NA

XXX ear. 70140............. 26............ A

X-ray exam of facial

0.19 0.06 0.06 0.01 0.26 0.26

XXX bones. 70140............. TC............ A

X-ray exam of facial

0.00 0.62

NA 0.04 0.66

NA

XXX bones. 70140............. .............. A

X-ray exam of facial

0.19 0.68

NA 0.05 0.92

NA

XXX bones. 70150............. 26............ A

X-ray exam of facial

0.26 0.08 0.08 0.01 0.35 0.35

XXX bones. 70150............. TC............ A

X-ray exam of facial

0.00 0.78

NA 0.05 0.83

NA

XXX bones. 70150............. .............. A

X-ray exam of facial

0.26 0.86

NA 0.06 1.18

NA

XXX bones. 70160............. 26............ A

X-ray exam of nasal

0.17 0.06 0.06 0.01 0.24 0.24

XXX bones. 70160............. TC............ A

X-ray exam of nasal

0.00 0.52

NA 0.02 0.54

NA

XXX bones. 70160............. .............. A

X-ray exam of nasal

0.17 0.58

NA 0.03 0.78

NA

XXX bones. 70170............. 26............ A

X-ray exam of tear

0.30 0.10 0.10 0.01 0.41 0.41

XXX duct. 70170............. TC............ A

X-ray exam of tear

0.00 0.95

NA 0.06 1.01

NA

XXX duct. 70170............. .............. A

X-ray exam of tear

0.30 1.05

NA 0.07 1.42

NA

XXX duct. 70190............. 26............ A

X-ray exam of eye

0.21 0.07 0.07 0.01 0.29 0.29

XXX sockets. 70190............. TC............ A

X-ray exam of eye

0.00 0.62

NA 0.04 0.66

NA

XXX sockets. 70190............. .............. A

X-ray exam of eye

0.21 0.69

NA 0.05 0.95

NA

XXX sockets. 70200............. 26............ A

X-ray exam of eye

0.28 0.09 0.09 0.01 0.38 0.38

XXX sockets. 70200............. TC............ A

X-ray exam of eye

0.00 0.78

NA 0.05 0.83

NA

XXX sockets. 70200............. .............. A

X-ray exam of eye

0.28 0.87

NA 0.06 1.21

NA

XXX sockets. 70210............. 26............ A

X-ray exam of sinuses. 0.17 0.06 0.06 0.01 0.24 0.24

XXX 70210............. TC............ A

X-ray exam of sinuses. 0.00 0.62

NA 0.04 0.66

NA

XXX 70210............. .............. A

X-ray exam of sinuses. 0.17 0.68

NA 0.05 0.90

NA

XXX 70220............. 26............ A

X-ray exam of sinuses. 0.25 0.08 0.08 0.01 0.34 0.34

XXX 70220............. TC............ A

X-ray exam of sinuses. 0.00 0.78

NA 0.05 0.83

NA

XXX 70220............. .............. A

X-ray exam of sinuses. 0.25 0.86

NA 0.06 1.17

NA

XXX 70240............. 26............ A

X-ray exam, pituitary

0.19 0.06 0.06 0.01 0.26 0.26

XXX saddle. 70240............. TC............ A

X-ray exam, pituitary

0.00 0.42

NA 0.02 0.44

NA

XXX saddle. 70240............. .............. A

X-ray exam, pituitary

0.19 0.48

NA 0.03 0.70

NA

XXX saddle. 70250............. 26............ A

X-ray exam of skull... 0.24 0.08 0.08 0.01 0.33 0.33

XXX 70250............. TC............ A

X-ray exam of skull... 0.00 0.62

NA 0.04 0.66

NA

XXX 70250............. .............. A

X-ray exam of skull... 0.24 0.70

NA 0.05 0.99

NA

XXX 70260............. 26............ A

X-ray exam of skull... 0.34 0.11 0.11 0.02 0.47 0.47

XXX 70260............. TC............ A

X-ray exam of skull... 0.00 0.89

NA 0.06 0.95

NA

XXX 70260............. .............. A

X-ray exam of skull... 0.34 1.00

NA 0.08 1.42

NA

XXX 70300............. 26............ A

X-ray exam of teeth... 0.10 0.05 0.05 0.01 0.16 0.16

XXX 70300............. TC............ A

X-ray exam of teeth... 0.00 0.26

NA 0.02 0.28

NA

XXX 70300............. .............. A

X-ray exam of teeth... 0.10 0.31

NA 0.03 0.44

NA

XXX 70310............. 26............ A

X-ray exam of teeth... 0.16 0.08 0.08 0.01 0.25 0.25

XXX 70310............. TC............ A

X-ray exam of teeth... 0.00 0.42

NA 0.02 0.44

NA

XXX 70310............. .............. A

X-ray exam of teeth... 0.16 0.50

NA 0.03 0.69

NA

XXX 70320............. 26............ A

Full mouth x-ray of

0.22 0.08 0.08 0.01 0.31 0.31

XXX teeth. 70320............. TC............ A

Full mouth x-ray of

0.00 0.78

NA 0.05 0.83

NA

XXX teeth. 70320............. .............. A

Full mouth x-ray of

0.22 0.86

NA 0.06 1.14

NA

XXX teeth. 70328............. 26............ A

X-ray exam of jaw

0.18 0.06 0.06 0.01 0.25 0.25

XXX joint. 70328............. TC............ A

X-ray exam of jaw

0.00 0.49

NA 0.02 0.51

NA

XXX joint. 70328............. .............. A

X-ray exam of jaw

0.18 0.55

NA 0.03 0.76

NA

XXX joint. 70330............. 26............ A

X-ray exam of jaw

0.24 0.08 0.08 0.01 0.33 0.33

XXX joints. 70330............. TC............ A

X-ray exam of jaw

0.00 0.84

NA 0.05 0.89

NA

XXX joints. 70330............. .............. A

X-ray exam of jaw

0.24 0.92

NA 0.06 1.22

NA

XXX joints. 70332............. 26............ A

X-ray exam of jaw

0.54 0.20 0.20 0.02 0.76 0.76

XXX joint. 70332............. TC............ A

X-ray exam of jaw

0.00 2.11

NA 0.12 2.23

NA

XXX joint. 70332............. .............. A

X-ray exam of jaw

0.54 2.31

NA 0.14 2.99

NA

XXX joint.

[[Page 70412]]

70336............. 26............ A

Magnetic image, jaw

1.48 0.49 0.49 0.07 2.04 2.04

XXX joint. 70336............. TC............ A

Magnetic image, jaw

0.00 11.23

NA 0.59 11.82

NA

XXX joint. 70336............. .............. A

Magnetic image, jaw

1.48 11.72

NA 0.66 13.86

NA

XXX joint. 70350............. 26............ A

X-ray head for

0.17 0.07 0.07 0.01 0.25 0.25

XXX orthodontia. 70350............. TC............ A

X-ray head for

0.00 0.38

NA 0.02 0.40

NA

XXX orthodontia. 70350............. .............. A

X-ray head for

0.17 0.45

NA 0.03 0.65

NA

XXX orthodontia. 70355............. 26............ A

Panoramic x-ray of

0.20 0.07 0.07 0.01 0.28 0.28

XXX jaws. 70355............. TC............ A

Panoramic x-ray of

0.00 0.57

NA 0.04 0.61

NA

XXX jaws. 70355............. .............. A

Panoramic x-ray of

0.20 0.64

NA 0.05 0.89

NA

XXX jaws. 70360............. 26............ A

X-ray exam of neck.... 0.17 0.06 0.06 0.01 0.24 0.24

XXX 70360............. TC............ A

X-ray exam of neck.... 0.00 0.42

NA 0.02 0.44

NA

XXX 70360............. .............. A

X-ray exam of neck.... 0.17 0.48

NA 0.03 0.68

NA

XXX 70370............. 26............ A

Throat x-ray &

0.32 0.10 0.10 0.01 0.43 0.43

XXX fluoroscopy. 70370............. TC............ A

Throat x-ray &

0.00 1.31

NA 0.07 1.38

NA

XXX fluoroscopy. 70370............. .............. A

Throat x-ray &

0.32 1.41

NA 0.08 1.81

NA

XXX fluoroscopy. 70371............. 26............ A

Speech evaluation,

0.84 0.28 0.28 0.04 1.16 1.16

XXX complex. 70371............. TC............ A

Speech evaluation,

0.00 2.11

NA 0.12 2.23

NA

XXX complex. 70371............. .............. A

Speech evaluation,

0.84 2.39

NA 0.16 3.39

NA

XXX complex. 70373............. 26............ A

Contrast x-ray of

0.44 0.14 0.14 0.02 0.60 0.60

XXX larynx. 70373............. TC............ A

Contrast x-ray of

0.00 1.79

NA 0.11 1.90

NA

XXX larynx. 70373............. .............. A

Contrast x-ray of

0.44 1.93

NA 0.13 2.50

NA

XXX larynx. 70380............. 26............ A

X-ray exam of salivary 0.17 0.06 0.06 0.01 0.24 0.24

XXX gland. 70380............. TC............ A

X-ray exam of salivary 0.00 0.67

NA 0.04 0.71

NA

XXX gland. 70380............. .............. A

X-ray exam of salivary 0.17 0.73

NA 0.05 0.95

NA

XXX gland. 70390............. 26............ A

X-ray exam of salivary 0.38 0.12 0.12 0.02 0.52 0.52

XXX duct. 70390............. TC............ A

X-ray exam of salivary 0.00 1.79

NA 0.11 1.90

NA

XXX duct. 70390............. .............. A

X-ray exam of salivary 0.38 1.91

NA 0.13 2.42

NA

XXX duct. 70450............. 26............ A

Ct head/brain w/o dye. 0.85 0.28 0.28 0.04 1.17 1.17

XXX 70450............. TC............ A

Ct head/brain w/o dye. 0.00 4.73

NA 0.25 4.98

NA

XXX 70450............. .............. A

Ct head/brain w/o dye. 0.85 5.01

NA 0.29 6.15

NA

XXX 70460............. 26............ A

Ct head/brain w/dye... 1.13 0.37 0.37 0.05 1.55 1.55

XXX 70460............. TC............ A

Ct head/brain w/dye... 0.00 5.68

NA 0.30 5.98

NA

XXX 70460............. .............. A

Ct head/brain w/dye... 1.13 6.05

NA 0.35 7.53

NA

XXX 70470............. 26............ A

Ct head/brain w/o & w/ 1.27 0.42 0.42 0.06 1.75 1.75

XXX dye. 70470............. TC............ A

Ct head/brain w/o & w/ 0.00 7.09

NA 0.37 7.46

NA

XXX dye. 70470............. .............. A

Ct head/brain w/o & w/ 1.27 7.51

NA 0.43 9.21

NA

XXX dye. 70480............. 26............ A

Ct orbit/ear/fossa w/o 1.28 0.42 0.42 0.06 1.76 1.76

XXX dye. 70480............. TC............ A

Ct orbit/ear/fossa w/o 0.00 4.73

NA 0.25 4.98

NA

XXX dye. 70480............. .............. A

Ct orbit/ear/fossa w/o 1.28 5.15

NA 0.31 6.74

NA

XXX dye. 70481............. 26............ A

Ct orbit/ear/fossa w/

1.38 0.45 0.45 0.06 1.89 1.89

XXX dye. 70481............. TC............ A

Ct orbit/ear/fossa w/

0.00 5.68

NA 0.30 5.98

NA

XXX dye. 70481............. .............. A

Ct orbit/ear/fossa w/

1.38 6.13

NA 0.36 7.87

NA

XXX dye. 70482............. 26............ A

Ct orbit/ear/fossa w/

1.45 0.48 0.48 0.06 1.99 1.99

XXX o&w/dye. 70482............. TC............ A

Ct orbit/ear/fossa w/

0.00 7.09

NA 0.37 7.46

NA

XXX o&w/dye. 70482............. .............. A

Ct orbit/ear/fossa w/

1.45 7.57

NA 0.43 9.45

NA

XXX o&w/dye. 70486............. 26............ A

Ct maxillofacial w/o

1.14 0.37 0.37 0.05 1.56 1.56

XXX dye. 70486............. TC............ A

Ct maxillofacial w/o

0.00 4.73

NA 0.25 4.98

NA

XXX dye. 70486............. .............. A

Ct maxillofacial w/o

1.14 5.10

NA 0.30 6.54

NA

XXX dye. 70487............. 26............ A

Ct maxillofacial w/dye 1.30 0.43 0.43 0.06 1.79 1.79

XXX 70487............. TC............ A

Ct maxillofacial w/dye 0.00 5.68

NA 0.30 5.98

NA

XXX 70487............. .............. A

Ct maxillofacial w/dye 1.30 6.11

NA 0.36 7.77

NA

XXX 70488............. 26............ A

Ct maxillofacial w/o & 1.42 0.46 0.46 0.06 1.94 1.94

XXX w/dye. 70488............. TC............ A

Ct maxillofacial w/o & 0.00 7.09

NA 0.37 7.46

NA

XXX w/dye. 70488............. .............. A

Ct maxillofacial w/o & 1.42 7.55

NA 0.43 9.40

NA

XXX w/dye. 70490............. 26............ A

Ct soft tissue neck w/ 1.28 0.42 0.42 0.06 1.76 1.76

XXX o dye. 70490............. TC............ A

Ct soft tissue neck w/ 0.00 4.73

NA 0.25 4.98

NA

XXX o dye. 70490............. .............. A

Ct soft tissue neck w/ 1.28 5.15

NA 0.31 6.74

NA

XXX o dye. 70491............. 26............ A

Ct soft tissue neck w/ 1.38 0.45 0.45 0.06 1.89 1.89

XXX dye. 70491............. TC............ A

Ct soft tissue neck w/ 0.00 5.68

NA 0.30 5.98

NA

XXX dye. 70491............. .............. A

Ct soft tissue neck w/ 1.38 6.13

NA 0.36 7.87

NA

XXX dye. 70492............. 26............ A

Ct sft tsue nck w/o &

1.45 0.47 0.47 0.06 1.98 1.98

XXX w/dye. 70492............. TC............ A

Ct sft tsue nck w/o &

0.00 7.09

NA 0.37 7.46

NA

XXX w/dye. 70492............. .............. A

Ct sft tsue nck w/o &

1.45 7.56

NA 0.43 9.44

NA

XXX w/dye. 70496............. 26............ A

Ct angiography, head.. 1.75 0.57 0.57 0.08 2.40 2.40

XXX 70496............. TC............ A

Ct angiography, head.. 0.00 10.63

NA 0.58 11.21

NA

XXX 70496............. .............. A

Ct angiography, head.. 1.75 11.20

NA 0.66 13.61

NA

XXX 70498............. 26............ A

Ct angiography, neck.. 1.75 0.57 0.57 0.08 2.40 2.40

XXX 70498............. TC............ A

Ct angiography, neck.. 0.00 10.63

NA 0.58 11.21

NA

XXX 70498............. .............. A

Ct angiography, neck.. 1.75 11.20

NA 0.66 13.61

NA

XXX 70540............. 26............ A

Mri orbit/face/neck w/ 1.35 0.44 0.44 0.06 1.85 1.85

XXX o dye. 70540............. TC............ A

Mri orbit/face/neck w/ 0.00 11.23

NA 0.39 11.62

NA

XXX o dye. 70540............. .............. A

Mri orbit/face/neck w/ 1.35 11.67

NA 0.45 13.47

NA

XXX o dye. 70542............. 26............ A

Mri orbit/face/neck w/ 1.62 0.53 0.53 0.07 2.22 2.22

XXX dye. 70542............. TC............ A

Mri orbit/face/neck w/ 0.00 13.48

NA 0.47 13.95

NA

XXX dye. 70542............. .............. A

Mri orbit/face/neck w/ 1.62 14.01

NA 0.54 16.17

NA

XXX dye.

[[Page 70413]]

70543............. 26............ A

Mri orbt/fac/nck w/o & 2.15 0.71 0.71 0.10 2.96 2.96

XXX w/dye. 70543............. TC............ A

Mri orbt/fac/nck w/o & 0.00 24.95

NA 0.84 25.79

NA

XXX w/dye. 70543............. .............. A

Mri orbt/fac/nck w/o & 2.15 25.66

NA 0.94 28.75

NA

XXX w/dye. 70544............. 26............ A

Mr angiography head w/ 1.20 0.40 0.40 0.05 1.65 1.65

XXX o dye. 70544............. TC............ A

Mr angiography head w/ 0.00 11.23

NA 0.59 11.82

NA

XXX o dye. 70544............. .............. A

Mr angiography head w/ 1.20 11.63

NA 0.64 13.47

NA

XXX o dye. 70545............. 26............ A

Mr angiography head w/ 1.20 0.39 0.39 0.05 1.64 1.64

XXX dye. 70545............. TC............ A

Mr angiography head w/ 0.00 11.23

NA 0.59 11.82

NA

XXX dye. 70545............. .............. A

Mr angiography head w/ 1.20 11.62

NA 0.64 13.46

NA

XXX dye. 70546............. 26............ A

Mr angiograph head w/

1.80 0.59 0.59 0.08 2.47 2.47

XXX o&w/dye. 70546............. TC............ A

Mr angiograph head w/

0.00 22.47

NA 0.59 23.06

NA

XXX o&w/dye. 70546............. .............. A

Mr angiograph head w/

1.80 23.06

NA 0.67 25.53

NA

XXX o&w/dye. 70547............. 26............ A

Mr angiography neck w/ 1.20 0.39 0.39 0.05 1.64 1.64

XXX o dye. 70547............. TC............ A

Mr angiography neck w/ 0.00 11.23

NA 0.59 11.82

NA

XXX o dye. 70547............. .............. A

Mr angiography neck w/ 1.20 11.62

NA 0.64 13.46

NA

XXX o dye. 70548............. 26............ A

Mr angiography neck w/ 1.20 0.39 0.39 0.05 1.64 1.64

XXX dye. 70548............. TC............ A

Mr angiography neck w/ 0.00 11.23

NA 0.59 11.82

NA

XXX dye. 70548............. .............. A

Mr angiography neck w/ 1.20 11.62

NA 0.64 13.46

NA

XXX dye. 70549............. 26............ A

Mr angiograph neck w/

1.80 0.59 0.59 0.08 2.47 2.47

XXX o&w/dye. 70549............. TC............ A

Mr angiograph neck w/

0.00 22.47

NA 0.59 23.06

NA

XXX o&w/dye. 70549............. .............. A

Mr angiograph neck w/

1.80 23.06

NA 0.67 25.53

NA

XXX o&w/dye. 70551............. 26............ A

Mri brain w/o dye..... 1.48 0.49 0.49 0.07 2.04 2.04

XXX 70551............. TC............ A

Mri brain w/o dye..... 0.00 11.23

NA 0.59 11.82

NA

XXX 70551............. .............. A

Mri brain w/o dye..... 1.48 11.72

NA 0.66 13.86

NA

XXX 70552............. 26............ A

Mri brain w/dye....... 1.78 0.59 0.59 0.08 2.45 2.45

XXX 70552............. TC............ A

Mri brain w/dye....... 0.00 13.48

NA 0.70 14.18

NA

XXX 70552............. .............. A

Mri brain w/dye....... 1.78 14.07

NA 0.78 16.63

NA

XXX 70553............. 26............ A

Mri brain w/o & w/dye. 2.36 0.78 0.78 0.10 3.24 3.24

XXX 70553............. TC............ A

Mri brain w/o & w/dye. 0.00 24.95

NA 1.31 26.26

NA

XXX 70553............. .............. A

Mri brain w/o & w/dye. 2.36 25.73

NA 1.41 29.50

NA

XXX 70557............. 26............ A

Mri brain w/o dye..... 2.90 1.13 1.13 0.08 4.11 4.11

XXX 70557............. TC............ C

Mri brain w/o dye..... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 70557............. .............. C

Mri brain w/o dye..... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 70558............. 26............ A

Mri brain w/dye....... 3.20 1.24 1.24 0.10 4.54 4.54

XXX 70558............. TC............ C

Mri brain w/dye....... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 70558............. .............. C

Mri brain w/dye....... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 70559............. 26............ A

Mri brain w/o & w/dye. 3.20 1.24 1.24 0.12 4.56 4.56

XXX 70559............. TC............ C

Mri brain w/o & w/dye. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 70559............. .............. C

Mri brain w/o & w/dye. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 71010............. 26............ A

Chest x-ray........... 0.18 0.06 0.06 0.01 0.25 0.25

XXX 71010............. TC............ A

Chest x-ray........... 0.00 0.47

NA 0.02 0.49

NA

XXX 71010............. .............. A

Chest x-ray........... 0.18 0.53

NA 0.03 0.74

NA

XXX 71015............. 26............ A

Chest x-ray........... 0.21 0.07 0.07 0.01 0.29 0.29

XXX 71015............. TC............ A

Chest x-ray........... 0.00 0.52

NA 0.02 0.54

NA

XXX 71015............. .............. A

Chest x-ray........... 0.21 0.59

NA 0.03 0.83

NA

XXX 71020............. 26............ A

Chest x-ray........... 0.22 0.07 0.07 0.01 0.30 0.30

XXX 71020............. TC............ A

Chest x-ray........... 0.00 0.62

NA 0.04 0.66

NA

XXX 71020............. .............. A

Chest x-ray........... 0.22 0.69

NA 0.05 0.96

NA

XXX 71021............. 26............ A

Chest x-ray........... 0.27 0.09 0.09 0.01 0.37 0.37

XXX 71021............. TC............ A

Chest x-ray........... 0.00 0.73

NA 0.05 0.78

NA

XXX 71021............. .............. A

Chest x-ray........... 0.27 0.82

NA 0.06 1.15

NA

XXX 71022............. 26............ A

Chest x-ray........... 0.31 0.10 0.10 0.01 0.42 0.42

XXX 71022............. TC............ A

Chest x-ray........... 0.00 0.73

NA 0.05 0.78

NA

XXX 71022............. .............. A

Chest x-ray........... 0.31 0.83

NA 0.06 1.20

NA

XXX 71023............. 26............ A

Chest x-ray and

0.38 0.13 0.13 0.01 0.52 0.52

XXX fluoroscopy. 71023............. TC............ A

Chest x-ray and

0.00 0.78

NA 0.05 0.83

NA

XXX fluoroscopy. 71023............. .............. A

Chest x-ray and

0.38 0.91

NA 0.06 1.35

NA

XXX fluoroscopy. 71030............. 26............ A

Chest x-ray........... 0.31 0.10 0.10 0.01 0.42 0.42

XXX 71030............. TC............ A

Chest x-ray........... 0.00 0.78

NA 0.05 0.83

NA

XXX 71030............. .............. A

Chest x-ray........... 0.31 0.88

NA 0.06 1.25

NA

XXX 71034............. 26............ A

Chest x-ray and

0.46 0.16 0.16 0.02 0.64 0.64

XXX fluoroscopy. 71034............. TC............ A

Chest x-ray and

0.00 1.44

NA 0.08 1.52

NA

XXX fluoroscopy. 71034............. .............. A

Chest x-ray and

0.46 1.60

NA 0.10 2.16

NA

XXX fluoroscopy. 71035............. 26............ A

Chest x-ray........... 0.18 0.06 0.06 0.01 0.25 0.25

XXX 71035............. TC............ A

Chest x-ray........... 0.00 0.52

NA 0.02 0.54

NA

XXX 71035............. .............. A

Chest x-ray........... 0.18 0.58

NA 0.03 0.79

NA

XXX 71040............. 26............ A

Contrast x-ray of

0.58 0.19 0.19 0.03 0.80 0.80

XXX bronchi. 71040............. TC............ A

Contrast x-ray of

0.00 1.46

NA 0.08 1.54

NA

XXX bronchi. 71040............. .............. A

Contrast x-ray of

0.58 1.65

NA 0.11 2.34

NA

XXX bronchi. 71060............. 26............ A

Contrast x-ray of

0.74 0.24 0.24 0.03 1.01 1.01

XXX bronchi. 71060............. TC............ A

Contrast x-ray of

0.00 2.21

NA 0.13 2.34

NA

XXX bronchi. 71060............. .............. A

Contrast x-ray of

0.74 2.45

NA 0.16 3.35

NA

XXX bronchi. 71090............. 26............ A

X-ray & pacemaker

0.54 0.21 0.21 0.02 0.77 0.77

XXX insertion. 71090............. TC............ A

X-ray & pacemaker

0.00 1.68

NA 0.11 1.79

NA

XXX insertion. 71090............. .............. A

X-ray & pacemaker

0.54 1.89

NA 0.13 2.56

NA

XXX insertion.

[[Page 70414]]

71100............. 26............ A

X-ray exam of ribs.... 0.22 0.07 0.07 0.01 0.30 0.30

XXX 71100............. TC............ A

X-ray exam of ribs.... 0.00 0.57

NA 0.04 0.61

NA

XXX 71100............. .............. A

X-ray exam of ribs.... 0.22 0.64

NA 0.05 0.91

NA

XXX 71101............. 26............ A

X-ray exam of ribs/

0.27 0.09 0.09 0.01 0.37 0.37

XXX chest. 71101............. TC............ A

X-ray exam of ribs/

0.00 0.67

NA 0.04 0.71

NA

XXX chest. 71101............. .............. A

X-ray exam of ribs/

0.27 0.76

NA 0.05 1.08

NA

XXX chest. 71110............. 26............ A

X-ray exam of ribs.... 0.27 0.09 0.09 0.01 0.37 0.37

XXX 71110............. TC............ A

X-ray exam of ribs.... 0.00 0.78

NA 0.05 0.83

NA

XXX 71110............. .............. A

X-ray exam of ribs.... 0.27 0.87

NA 0.06 1.20

NA

XXX 71111............. 26............ A

X-ray exam of ribs/

0.32 0.10 0.10 0.01 0.43 0.43

XXX chest. 71111............. TC............ A

X-ray exam of ribs/

0.00 0.89

NA 0.06 0.95

NA

XXX chest. 71111............. .............. A

X-ray exam of ribs/

0.32 0.99

NA 0.07 1.38

NA

XXX chest. 71120............. 26............ A

X-ray exam of

0.20 0.07 0.07 0.01 0.28 0.28

XXX breastbone. 71120............. TC............ A

X-ray exam of

0.00 0.65

NA 0.04 0.69

NA

XXX breastbone. 71120............. .............. A

X-ray exam of

0.20 0.72

NA 0.05 0.97

NA

XXX breastbone. 71130............. 26............ A

X-ray exam of

0.22 0.07 0.07 0.01 0.30 0.30

XXX breastbone. 71130............. TC............ A

X-ray exam of

0.00 0.71

NA 0.04 0.75

NA

XXX breastbone. 71130............. .............. A

X-ray exam of

0.22 0.78

NA 0.05 1.05

NA

XXX breastbone. 71250............. 26............ A

Ct thorax w/o dye..... 1.16 0.38 0.38 0.05 1.59 1.59

XXX 71250............. TC............ A

Ct thorax w/o dye..... 0.00 5.93

NA 0.31 6.24

NA

XXX 71250............. .............. A

Ct thorax w/o dye..... 1.16 6.31

NA 0.36 7.83

NA

XXX 71260............. 26............ A

Ct thorax w/dye....... 1.24 0.41 0.41 0.05 1.70 1.70

XXX 71260............. TC............ A

Ct thorax w/dye....... 0.00 7.09

NA 0.37 7.46

NA

XXX 71260............. .............. A

Ct thorax w/dye....... 1.24 7.50

NA 0.42 9.16

NA

XXX 71270............. 26............ A

Ct thorax w/o & w/dye. 1.38 0.45 0.45 0.06 1.89 1.89

XXX 71270............. TC............ A

Ct thorax w/o & w/dye. 0.00 8.88

NA 0.46 9.34

NA

XXX 71270............. .............. A

Ct thorax w/o & w/dye. 1.38 9.33

NA 0.52 11.23

NA

XXX 71275............. 26............ A

Ct angiography, chest. 1.92 0.63 0.63 0.09 2.64 2.64

XXX 71275............. TC............ A

Ct angiography, chest. 0.00 12.42

NA 0.39 12.81

NA

XXX 71275............. .............. A

Ct angiography, chest. 1.92 13.05

NA 0.48 15.45

NA

XXX 71550............. 26............ A

Mri chest w/o dye..... 1.46 0.48 0.48 0.06 2.00 2.00

XXX 71550............. TC............ A

Mri chest w/o dye..... 0.00 11.23

NA 0.45 11.68

NA

XXX 71550............. .............. A

Mri chest w/o dye..... 1.46 11.71

NA 0.51 13.68

NA

XXX 71551............. 26............ A

Mri chest w/dye....... 1.73 0.57 0.57 0.08 2.38 2.38

XXX 71551............. TC............ A

Mri chest w/dye....... 0.00 13.48

NA 0.52 14.00

NA

XXX 71551............. .............. A

Mri chest w/dye....... 1.73 14.05

NA 0.60 16.38

NA

XXX 71552............. 26............ A

Mri chest w/o & w/dye. 2.26 0.74 0.74 0.10 3.10 3.10

XXX 71552............. TC............ A

Mri chest w/o & w/dye. 0.00 24.95

NA 0.68 25.63

NA

XXX 71552............. .............. A

Mri chest w/o & w/dye. 2.26 25.69

NA 0.78 28.73

NA

XXX 71555............. 26............ R

Mri angio chest w or w/ 1.81 0.60 0.60 0.08 2.49 2.49

XXX o dye. 71555............. TC............ R

Mri angio chest w or w/ 0.00 11.23

NA 0.59 11.82

NA

XXX o dye. 71555............. .............. R

Mri angio chest w or w/ 1.81 11.83

NA 0.67 14.31

NA

XXX o dye. 72010............. 26............ A

X-ray exam of spine... 0.45 0.15 0.15 0.02 0.62 0.62

XXX 72010............. TC............ A

X-ray exam of spine... 0.00 1.02

NA 0.06 1.08

NA

XXX 72010............. .............. A

X-ray exam of spine... 0.45 1.17

NA 0.08 1.70

NA

XXX 72020............. 26............ A

X-ray exam of spine... 0.15 0.05 0.05 0.01 0.21 0.21

XXX 72020............. TC............ A

X-ray exam of spine... 0.00 0.42

NA 0.02 0.44

NA

XXX 72020............. .............. A

X-ray exam of spine... 0.15 0.47

NA 0.03 0.65

NA

XXX 72040............. 26............ A

X-ray exam of neck

0.22 0.07 0.07 0.01 0.30 0.30

XXX spine. 72040............. TC............ A

X-ray exam of neck

0.00 0.60

NA 0.04 0.64

NA

XXX spine. 72040............. .............. A

X-ray exam of neck

0.22 0.67

NA 0.05 0.94

NA

XXX spine. 72050............. 26............ A

X-ray exam of neck

0.31 0.10 0.10 0.01 0.42 0.42

XXX spine. 72050............. TC............ A

X-ray exam of neck

0.00 0.89

NA 0.06 0.95

NA

XXX spine. 72050............. .............. A

X-ray exam of neck

0.31 0.99

NA 0.07 1.37

NA

XXX spine. 72052............. 26............ A

X-ray exam of neck

0.36 0.12 0.12 0.02 0.50 0.50

XXX spine. 72052............. TC............ A

X-ray exam of neck

0.00 1.13

NA 0.06 1.19

NA

XXX spine. 72052............. .............. A

X-ray exam of neck

0.36 1.25

NA 0.08 1.69

NA

XXX spine. 72069............. 26............ A

X-ray exam of trunk

0.22 0.08 0.08 0.01 0.31 0.31

XXX spine. 72069............. TC............ A

X-ray exam of trunk

0.00 0.49

NA 0.02 0.51

NA

XXX spine. 72069............. .............. A

X-ray exam of trunk

0.22 0.57

NA 0.03 0.82

NA

XXX spine. 72070............. 26............ A

X-ray exam of thoracic 0.22 0.07 0.07 0.01 0.30 0.30

XXX spine. 72070............. TC............ A

X-ray exam of thoracic 0.00 0.65

NA 0.04 0.69

NA

XXX spine. 72070............. .............. A

X-ray exam of thoracic 0.22 0.72

NA 0.05 0.99

NA

XXX spine. 72072............. 26............ A

X-ray exam of thoracic 0.22 0.07 0.07 0.01 0.30 0.30

XXX spine. 72072............. TC............ A

X-ray exam of thoracic 0.00 0.73

NA 0.05 0.78

NA

XXX spine. 72072............. .............. A

X-ray exam of thoracic 0.22 0.80

NA 0.06 1.08

NA

XXX spine. 72074............. 26............ A

X-ray exam of thoracic 0.22 0.07 0.07 0.01 0.30 0.30

XXX spine. 72074............. TC............ A

X-ray exam of thoracic 0.00 0.91

NA 0.06 0.97

NA

XXX spine. 72074............. .............. A

X-ray exam of thoracic 0.22 0.98

NA 0.07 1.27

NA

XXX spine. 72080............. 26............ A

X-ray exam of trunk

0.22 0.07 0.07 0.01 0.30 0.30

XXX spine. 72080............. TC............ A

X-ray exam of trunk

0.00 0.67

NA 0.04 0.71

NA

XXX spine. 72080............. .............. A

X-ray exam of trunk

0.22 0.74

NA 0.05 1.01

NA

XXX spine. 72090............. 26............ A

X-ray exam of trunk

0.28 0.09 0.09 0.01 0.38 0.38

XXX spine. 72090............. TC............ A

X-ray exam of trunk

0.00 0.67

NA 0.04 0.71

NA

XXX spine. 72090............. .............. A

X-ray exam of trunk

0.28 0.76

NA 0.05 1.09

NA

XXX spine.

[[Continued on page 70415]]

From the Federal Register Online via GPO Access [wais.access.gpo.gov] ]

[[pp. 70415-70464]] 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

[[Continued from page 70414]]

[[Page 70415]]

72100............. 26............ A

X-ray exam of lower

0.22 0.07 0.07 0.01 0.30 0.30

XXX spine. 72100............. TC............ A

X-ray exam of lower

0.00 0.67

NA 0.04 0.71

NA

XXX spine. 72100............. .............. A

X-ray exam of lower

0.22 0.74

NA 0.05 1.01

NA

XXX spine. 72110............. 26............ A

X-ray exam of lower

0.31 0.10 0.10 0.01 0.42 0.42

XXX spine. 72110............. TC............ A

X-ray exam of lower

0.00 0.91

NA 0.06 0.97

NA

XXX spine. 72110............. .............. A

X-ray exam of lower

0.31 1.01

NA 0.07 1.39

NA

XXX spine. 72114............. 26............ A

X-ray exam of lower

0.36 0.12 0.12 0.02 0.50 0.50

XXX spine. 72114............. TC............ A

X-ray exam of lower

0.00 1.19

NA 0.06 1.25

NA

XXX spine. 72114............. .............. A

X-ray exam of lower

0.36 1.31

NA 0.08 1.75

NA

XXX spine. 72120............. 26............ A

X-ray exam of lower

0.22 0.07 0.07 0.01 0.30 0.30

XXX spine. 72120............. TC............ A

X-ray exam of lower

0.00 0.89

NA 0.06 0.95

NA

XXX spine. 72120............. .............. A

X-ray exam of lower

0.22 0.96

NA 0.07 1.25

NA

XXX spine. 72125............. 26............ A

Ct neck spine w/o dye. 1.16 0.38 0.38 0.05 1.59 1.59

XXX 72125............. TC............ A

Ct neck spine w/o dye. 0.00 5.93

NA 0.31 6.24

NA

XXX 72125............. .............. A

Ct neck spine w/o dye. 1.16 6.31

NA 0.36 7.83

NA

XXX 72126............. 26............ A

Ct neck spine w/dye... 1.22 0.40 0.40 0.05 1.67 1.67

XXX 72126............. TC............ A

Ct neck spine w/dye... 0.00 7.09

NA 0.37 7.46

NA

XXX 72126............. .............. A

Ct neck spine w/dye... 1.22 7.49

NA 0.42 9.13

NA

XXX 72127............. 26............ A

Ct neck spine w/o & w/ 1.27 0.42 0.42 0.06 1.75 1.75

XXX dye. 72127............. TC............ A

Ct neck spine w/o & w/ 0.00 8.88

NA 0.46 9.34

NA

XXX dye. 72127............. .............. A

Ct neck spine w/o & w/ 1.27 9.30

NA 0.52 11.09

NA

XXX dye. 72128............. 26............ A

Ct chest spine w/o dye 1.16 0.38 0.38 0.05 1.59 1.59

XXX 72128............. TC............ A

Ct chest spine w/o dye 0.00 5.93

NA 0.31 6.24

NA

XXX 72128............. .............. A

Ct chest spine w/o dye 1.16 6.31

NA 0.36 7.83

NA

XXX 72129............. 26............ A

Ct chest spine w/dye.. 1.22 0.40 0.40 0.05 1.67 1.67

XXX 72129............. TC............ A

Ct chest spine w/dye.. 0.00 7.09

NA 0.37 7.46

NA

XXX 72129............. .............. A

Ct chest spine w/dye.. 1.22 7.49

NA 0.42 9.13

NA

XXX 72130............. 26............ A

Ct chest spine w/o & w/ 1.27 0.42 0.42 0.06 1.75 1.75

XXX dye. 72130............. TC............ A

Ct chest spine w/o & w/ 0.00 8.88

NA 0.46 9.34

NA

XXX dye. 72130............. .............. A

Ct chest spine w/o & w/ 1.27 9.30

NA 0.52 11.09

NA

XXX dye. 72131............. 26............ A

Ct lumbar spine w/o

1.16 0.38 0.38 0.05 1.59 1.59

XXX dye. 72131............. TC............ A

Ct lumbar spine w/o

0.00 5.93

NA 0.31 6.24

NA

XXX dye. 72131............. .............. A

Ct lumbar spine w/o

1.16 6.31

NA 0.36 7.83

NA

XXX dye. 72132............. 26............ A

Ct lumbar spine w/dye. 1.22 0.40 0.40 0.05 1.67 1.67

XXX 72132............. TC............ A

Ct lumbar spine w/dye. 0.00 7.09

NA 0.37 7.46

NA

XXX 72132............. .............. A

Ct lumbar spine w/dye. 1.22 7.49

NA 0.42 9.13

NA

XXX 72133............. 26............ A

Ct lumbar spine w/o &

1.27 0.42 0.42 0.06 1.75 1.75

XXX w/dye. 72133............. TC............ A

Ct lumbar spine w/o &

0.00 8.88

NA 0.46 9.34

NA

XXX w/dye. 72133............. .............. A

Ct lumbar spine w/o &

1.27 9.30

NA 0.52 11.09

NA

XXX w/dye. 72141............. 26............ A

Mri neck spine w/o dye 1.60 0.53 0.53 0.07 2.20 2.20

XXX 72141............. TC............ A

Mri neck spine w/o dye 0.00 11.23

NA 0.59 11.82

NA

XXX 72141............. .............. A

Mri neck spine w/o dye 1.60 11.76

NA 0.66 14.02

NA

XXX 72142............. 26............ A

Mri neck spine w/dye.. 1.92 0.64 0.64 0.09 2.65 2.65

XXX 72142............. TC............ A

Mri neck spine w/dye.. 0.00 13.48

NA 0.70 14.18

NA

XXX 72142............. .............. A

Mri neck spine w/dye.. 1.92 14.12

NA 0.79 16.83

NA

XXX 72146............. 26............ A

Mri chest spine w/o

1.60 0.53 0.53 0.07 2.20 2.20

XXX dye. 72146............. TC............ A

Mri chest spine w/o

0.00 12.48

NA 0.64 13.12

NA

XXX dye. 72146............. .............. A

Mri chest spine w/o

1.60 13.01

NA 0.71 15.32

NA

XXX dye. 72147............. 26............ A

Mri chest spine w/dye. 1.92 0.63 0.63 0.09 2.64 2.64

XXX 72147............. TC............ A

Mri chest spine w/dye. 0.00 13.48

NA 0.70 14.18

NA

XXX 72147............. .............. A

Mri chest spine w/dye. 1.92 14.11

NA 0.79 16.82

NA

XXX 72148............. 26............ A

Mri lumbar spine w/o

1.48 0.49 0.49 0.07 2.04 2.04

XXX dye. 72148............. TC............ A

Mri lumbar spine w/o

0.00 12.48

NA 0.64 13.12

NA

XXX dye. 72148............. .............. A

Mri lumbar spine w/o

1.48 12.97

NA 0.71 15.16

NA

XXX dye. 72149............. 26............ A

Mri lumbar spine w/dye 1.78 0.60 0.60 0.08 2.46 2.46

XXX 72149............. TC............ A

Mri lumbar spine w/dye 0.00 13.48

NA 0.70 14.18

NA

XXX 72149............. .............. A

Mri lumbar spine w/dye 1.78 14.08

NA 0.78 16.64

NA

XXX 72156............. 26............ A

Mri neck spine w/o & w/ 2.57 0.85 0.85 0.11 3.53 3.53

XXX dye. 72156............. TC............ A

Mri neck spine w/o & w/ 0.00 24.95

NA 1.31 26.26

NA

XXX dye. 72156............. .............. A

Mri neck spine w/o & w/ 2.57 25.80

NA 1.42 29.79

NA

XXX dye. 72157............. 26............ A

Mri chest spine w/o &

2.57 0.84 0.84 0.11 3.52 3.52

XXX w/dye. 72157............. TC............ A

Mri chest spine w/o &

0.00 24.95

NA 1.31 26.26

NA

XXX w/dye. 72157............. .............. A

Mri chest spine w/o &

2.57 25.79

NA 1.42 29.78

NA

XXX w/dye. 72158............. 26............ A

Mri lumbar spine w/o & 2.36 0.78 0.78 0.10 3.24 3.24

XXX w/dye. 72158............. TC............ A

Mri lumbar spine w/o & 0.00 24.95

NA 1.31 26.26

NA

XXX w/dye. 72158............. .............. A

Mri lumbar spine w/o & 2.36 25.73

NA 1.41 29.50

NA

XXX w/dye. 72159............. 26............ N

Mr angio spine w/o&w/ +1.80 0.69 0.69 0.10 2.59 2.59

XXX dye. 72159............. TC............ N

Mr angio spine w/o&w/ +0.00 12.27 12.27 0.64 12.91 12.91

XXX dye. 72159............. .............. N

Mr angio spine w/o&w/ +1.80 12.96 12.96 0.74 15.50 15.50

XXX dye. 72170............. 26............ A

X-ray exam of pelvis.. 0.17 0.06 0.06 0.01 0.24 0.24

XXX 72170............. TC............ A

X-ray exam of pelvis.. 0.00 0.52

NA 0.02 0.54

NA

XXX 72170............. .............. A

X-ray exam of pelvis.. 0.17 0.58

NA 0.03 0.78

NA

XXX 72190............. 26............ A

X-ray exam of pelvis.. 0.21 0.07 0.07 0.01 0.29 0.29

XXX 72190............. TC............ A

X-ray exam of pelvis.. 0.00 0.67

NA 0.04 0.71

NA

XXX 72190............. .............. A

X-ray exam of pelvis.. 0.21 0.74

NA 0.05 1.00

NA

XXX

[[Page 70416]]

72191............. 26............ A

Ct angiograph pelv w/

1.81 0.60 0.60 0.08 2.49 2.49

XXX o&w/dye. 72191............. TC............ A

Ct angiograph pelv w/

0.00 12.06

NA 0.39 12.45

NA

XXX o&w/dye. 72191............. .............. A

Ct angiograph pelv w/

1.81 12.66

NA 0.47 14.94

NA

XXX o&w/dye. 72192............. 26............ A

Ct pelvis w/o dye..... 1.09 0.36 0.36 0.05 1.50 1.50

XXX 72192............. TC............ A

Ct pelvis w/o dye..... 0.00 5.93

NA 0.31 6.24

NA

XXX 72192............. .............. A

Ct pelvis w/o dye..... 1.09 6.29

NA 0.36 7.74

NA

XXX 72193............. 26............ A

Ct pelvis w/dye....... 1.16 0.38 0.38 0.05 1.59 1.59

XXX 72193............. TC............ A

Ct pelvis w/dye....... 0.00 6.86

NA 0.36 7.22

NA

XXX 72193............. .............. A

Ct pelvis w/dye....... 1.16 7.24

NA 0.41 8.81

NA

XXX 72194............. 26............ A

Ct pelvis w/o & w/dye. 1.22 0.40 0.40 0.05 1.67 1.67

XXX 72194............. TC............ A

Ct pelvis w/o & w/dye. 0.00 8.51

NA 0.43 8.94

NA

XXX 72194............. .............. A

Ct pelvis w/o & w/dye. 1.22 8.91

NA 0.48 10.61

NA

XXX 72195............. 26............ A

Mri pelvis w/o dye.... 1.46 0.48 0.48 0.06 2.00 2.00

XXX 72195............. TC............ A

Mri pelvis w/o dye.... 0.00 11.23

NA 0.45 11.68

NA

XXX 72195............. .............. A

Mri pelvis w/o dye.... 1.46 11.71

NA 0.51 13.68

NA

XXX 72196............. 26............ A

Mri pelvis w/dye...... 1.73 0.57 0.57 0.08 2.38 2.38

XXX 72196............. TC............ A

Mri pelvis w/dye...... 0.00 13.48

NA 0.52 14.00

NA

XXX 72196............. .............. A

Mri pelvis w/dye...... 1.73 14.05

NA 0.60 16.38

NA

XXX 72197............. 26............ A

Mri pelvis w/o & w/dye 2.26 0.74 0.74 0.10 3.10 3.10

XXX 72197............. TC............ A

Mri pelvis w/o & w/dye 0.00 24.95

NA 0.92 25.87

NA

XXX 72197............. .............. A

Mri pelvis w/o & w/dye 2.26 25.69

NA 1.02 28.97

NA

XXX 72198............. 26............ A

Mr angio pelvis w/o &

1.80 0.59 0.59 0.08 2.47 2.47

XXX w/dye. 72198............. TC............ A

Mr angio pelvis w/o &

0.00 11.23

NA 0.59 11.82

NA

XXX w/dye. 72198............. .............. A

Mr angio pelvis w/o &

1.80 11.82

NA 0.67 14.29

NA

XXX w/dye. 72200............. 26............ A

X-ray exam sacroiliac

0.17 0.06 0.06 0.01 0.24 0.24

XXX joints. 72200............. TC............ A

X-ray exam sacroiliac

0.00 0.52

NA 0.02 0.54

NA

XXX joints. 72200............. .............. A

X-ray exam sacroiliac

0.17 0.58

NA 0.03 0.78

NA

XXX joints. 72202............. 26............ A

X-ray exam sacroiliac

0.19 0.06 0.06 0.01 0.26 0.26

XXX joints. 72202............. TC............ A

X-ray exam sacroiliac

0.00 0.62

NA 0.04 0.66

NA

XXX joints. 72202............. .............. A

X-ray exam sacroiliac

0.19 0.68

NA 0.05 0.92

NA

XXX joints. 72220............. 26............ A

X-ray exam of tailbone 0.17 0.06 0.06 0.01 0.24 0.24

XXX 72220............. TC............ A

X-ray exam of tailbone 0.00 0.57

NA 0.04 0.61

NA

XXX 72220............. .............. A

X-ray exam of tailbone 0.17 0.63

NA 0.05 0.85

NA

XXX 72240............. 26............ A

Contrast x-ray of neck 0.91 0.29 0.29 0.04 1.24 1.24

XXX spine. 72240............. TC............ A

Contrast x-ray of neck 0.00 4.76

NA 0.25 5.01

NA

XXX spine. 72240............. .............. A

Contrast x-ray of neck 0.91 5.05

NA 0.29 6.25

NA

XXX spine. 72255............. 26............ A

Contrast x-ray, thorax 0.91 0.27 0.27 0.04 1.22 1.22

XXX spine. 72255............. TC............ A

Contrast x-ray, thorax 0.00 4.34

NA 0.22 4.56

NA

XXX spine. 72255............. .............. A

Contrast x-ray, thorax 0.91 4.61

NA 0.26 5.78

NA

XXX spine. 72265............. 26............ A

Contrast x-ray, lower

0.83 0.25 0.25 0.04 1.12 1.12

XXX spine. 72265............. C............. A

Contrast x-ray, lower

0.00 4.08

NA 0.22 4.30

NA

XXX spine. 72265............. .............. A

Contrast x-ray, lower

0.83 4.33

NA 0.26 5.42

NA

XXX spine. 72270............. 26............ A

Contrast x-ray, spine. 1.33 0.42 0.42 0.06 1.81 1.81

XXX 72270............. TC............ A

Contrast x-ray, spine. 0.00 6.12

NA 0.33 6.45

NA

XXX 72270............. .............. A

Contrast x-ray, spine. 1.33 6.54

NA 0.39 8.26

NA

XXX 72275............. 26............ A

Epidurography......... 0.76 0.20 0.20 0.04 1.00 1.00

XXX 72275............. TC............ A

Epidurography......... 0.00 2.11

NA 0.22 2.33

NA

XXX 72275............. .............. A

Epidurography......... 0.76 2.31

NA 0.26 3.33

NA

XXX 72285............. 26............ A

X-ray c/t spine disk.. 1.16 0.36 0.36 0.07 1.59 1.59

XXX 72285............. TC............ A

X-ray c/t spine disk.. 0.00 8.40

NA 0.43 8.83

NA

XXX 72285............. .............. A

X-ray c/t spine disk.. 1.16 8.76

NA 0.50 10.42

NA

XXX 72295............. 26............ A

X-ray of lower spine

0.83 0.27 0.27 0.06 1.16 1.16

XXX disk. 72295............. TC............ A

X-ray of lower spine

0.00 7.88

NA 0.40 8.28

NA

XXX disk. 72295............. .............. A

X-ray of lower spine

0.83 8.15

NA 0.46 9.44

NA

XXX disk. 73000............. 26............ A

X-ray exam of collar

0.16 0.05 0.05 0.01 0.22 0.22

XXX bone. 73000............. TC............ A

X-ray exam of collar

0.00 0.52

NA 0.02 0.54

NA

XXX bone. 73000............. .............. A

X-ray exam of collar

0.16 0.57

NA 0.03 0.76

NA

XXX bone. 73010............. 26............ A

X-ray exam of shoulder 0.17 0.06 0.06 0.01 0.24 0.24

XXX blade. 73010............. TC............ A

X-ray exam of shoulder 0.00 0.52

NA 0.02 0.54

NA

XXX blade. 73010............. .............. A

X-ray exam of shoulder 0.17 0.58

NA 0.03 0.78

NA

XXX blade. 73020............. 26............ A

X-ray exam of shoulder 0.15 0.05 0.05 0.01 0.21 0.21

XXX 73020............. TC............ A

X-ray exam of shoulder 0.00 0.47

NA 0.02 0.49

NA

XXX 73020............. .............. A

X-ray exam of shoulder 0.15 0.52

NA 0.03 0.70

NA

XXX 73030............. 26............ A

X-ray exam of shoulder 0.18 0.06 0.06 0.01 0.25 0.25

XXX 73030............. TC............ A

X-ray exam of shoulder 0.00 0.57

NA 0.04 0.61

NA

XXX 73030............. .............. A

X-ray exam of shoulder 0.18 0.63

NA 0.05 0.86

NA

XXX 73040............. 26............ A

Contrast x-ray of

0.54 0.18 0.18 0.02 0.74 0.74

XXX shoulder. 73040............. TC............ A

Contrast x-ray of

0.00 2.11

NA 0.12 2.23

NA

XXX shoulder. 73040............. .............. A

Contrast x-ray of

0.54 2.29

NA 0.14 2.97

NA

XXX shoulder. 73050............. 26............ A

X-ray exam of

0.20 0.07 0.07 0.01 0.28 0.28

XXX shoulders. 73050............. TC............ A

X-ray exam of

0.00 0.67

NA 0.04 0.71

NA

XXX shoulders. 73050............. .............. A

X-ray exam of

0.20 0.74

NA 0.05 0.99

NA

XXX shoulders. 73060............. 26............ A

X-ray exam of humerus. 0.17 0.06 0.06 0.01 0.24 0.24

XXX 73060............. TC............ A

X-ray exam of humerus. 0.00 0.57

NA 0.04 0.61

NA

XXX 73060............. .............. A

X-ray exam of humerus. 0.17 0.63

NA 0.05 0.85

NA

XXX

[[Page 70417]]

73070............. 26............ A

X-ray exam of elbow... 0.15 0.05 0.05 0.01 0.21 0.21

XXX 73070............. TC............ A

X-ray exam of elbow... 0.00 0.52

NA 0.02 0.54

NA

XXX 73070............. .............. A

X-ray exam of elbow... 0.15 0.57

NA 0.03 0.75

NA

XXX 73080............. 26............ A

X-ray exam of elbow... 0.17 0.06 0.06 0.01 0.24 0.24

XXX 73080............. TC............ A

X-ray exam of elbow... 0.00 0.57

NA 0.04 0.61

NA

XXX 73080............. .............. A

X-ray exam of elbow... 0.17 0.63

NA 0.05 0.85

NA

XXX 73085............. 26............ A

Contrast x-ray of

0.54 0.19 0.19 0.02 0.75 0.75

XXX elbow. 73085............. TC............ A

Contrast x-ray of

0.00 2.11

NA 0.12 2.23

NA

XXX elbow. 73085............. .............. A

Contrast x-ray of

0.54 2.30

NA 0.14 2.98

NA

XXX elbow. 73090............. 26............ A

X-ray exam of forearm. 0.16 0.05 0.05 0.01 0.22 0.22

XXX 73090............. TC............ A

X-ray exam of forearm. 0.00 0.52

NA 0.02 0.54

NA

XXX 73090............. .............. A

X-ray exam of forearm. 0.16 0.57

NA 0.03 0.76

NA

XXX 73092............. 26............ A

X-ray exam of arm,

0.16 0.05 0.05 0.01 0.22 0.22

XXX infant. 73092............. TC............ A

X-ray exam of arm,

0.00 0.49

NA 0.02 0.51

NA

XXX infant. 73092............. .............. A

X-ray exam of arm,

0.16 0.54

NA 0.03 0.73

NA

XXX infant. 73100............. 26............ A

X-ray exam of wrist... 0.16 0.05 0.05 0.01 0.22 0.22

XXX 73100............. TC............ A

X-ray exam of wrist... 0.00 0.49

NA 0.02 0.51

NA

XXX 73100............. .............. A

X-ray exam of wrist... 0.16 0.54

NA 0.03 0.73

NA

XXX 73110............. 26............ A

X-ray exam of wrist... 0.17 0.06 0.06 0.01 0.24 0.24

XXX 73110............. TC............ A

X-ray exam of wrist... 0.00 0.53

NA 0.02 0.55

NA

XXX 73110............. .............. A

X-ray exam of wrist... 0.17 0.59

NA 0.03 0.79

NA

XXX 73115............. 26............ A

Contrast x-ray of

0.54 0.18 0.18 0.02 0.74 0.74

XXX wrist. 73115............. TC............ A

Contrast x-ray of

0.00 1.58

NA 0.10 1.68

NA

XXX wrist. 73115............. .............. A

Contrast x-ray of

0.54 1.76

NA 0.12 2.42

NA

XXX wrist. 73120............. 26............ A

X-ray exam of hand.... 0.16 0.05 0.05 0.01 0.22 0.22

XXX 73120............. TC............ A

X-ray exam of hand.... 0.00 0.49

NA 0.02 0.51

NA

XXX 73120............. .............. A

X-ray exam of hand.... 0.16 0.54

NA 0.03 0.73

NA

XXX 73130............. 26............ A

X-ray exam of hand.... 0.17 0.06 0.06 0.01 0.24 0.24

XXX 73130............. TC............ A

X-ray exam of hand.... 0.00 0.53

NA 0.02 0.55

NA

XXX 73130............. .............. A

X-ray exam of hand.... 0.17 0.59

NA 0.03 0.79

NA

XXX 73140............. 26............ A

X-ray exam of

0.13 0.04 0.04 0.01 0.18 0.18

XXX finger(s). 73140............. TC............ A

X-ray exam of

0.00 0.42

NA 0.02 0.44

NA

XXX finger(s). 73140............. .............. A

X-ray exam of

0.13 0.46

NA 0.03 0.62

NA

XXX finger(s). 73200............. 26............ A

Ct upper extremity w/o 1.09 0.36 0.36 0.05 1.50 1.50

XXX dye. 73200............. TC............ A

Ct upper extremity w/o 0.00 4.97

NA 0.25 5.22

NA

XXX dye. 73200............. .............. A

Ct upper extremity w/o 1.09 5.33

NA 0.30 6.72

NA

XXX dye. 73201............. 26............ A

Ct upper extremity w/

1.16 0.38 0.38 0.05 1.59 1.59

XXX dye. 73201............. TC............ A

Ct upper extremity w/

0.00 5.93

NA 0.31 6.24

NA

XXX dye. 73201............. .............. A

Ct upper extremity w/

1.16 6.31

NA 0.36 7.83

NA

XXX dye. 73202............. 26............ A

Ct uppr extremity w/

1.22 0.40 0.40 0.05 1.67 1.67

XXX o&w/dye. 73202............. TC............ A

Ct uppr extremity w/

0.00 7.44

NA 0.39 7.83

NA

XXX o&w/dye. 73202............. .............. A

Ct uppr extremity w/

1.22 7.84

NA 0.44 9.50

NA

XXX o&w/dye. 73206............. 26............ A

Ct angio upr extrm w/

1.81 0.59 0.59 0.08 2.48 2.48

XXX o&w/dye. 73206............. TC............ A

Ct angio upr extrm w/

0.00 10.99

NA 0.39 11.38

NA

XXX o&w/dye. 73206............. .............. A

Ct angio upr extrm w/

1.81 11.58

NA 0.47 13.86

NA

XXX o&w/dye. 73218............. 26............ A

Mri upper extremity w/ 1.35 0.44 0.44 0.06 1.85 1.85

XXX o dye. 73218............. TC............ A

Mri upper extremity w/ 0.00 11.23

NA 0.39 11.62

NA

XXX o dye. 73218............. .............. A

Mri upper extremity w/ 1.35 11.67

NA 0.45 13.47

NA

XXX o dye. 73219............. 26............ A

Mri upper extremity w/ 1.62 0.54 0.54 0.07 2.23 2.23

XXX dye. 73219............. TC............ A

Mri upper extremity w/ 0.00 13.48

NA 0.47 13.95

NA

XXX dye. 73219............. .............. A

Mri upper extremity w/ 1.62 14.02

NA 0.54 16.18

NA

XXX dye. 73220............. 26............ A

Mri uppr extremity w/

2.15 0.71 0.71 0.10 2.96 2.96

XXX o&w/dye. 73220............. TC............ A

Mri uppr extremity w/

0.00 24.95

NA 0.84 25.79

NA

XXX o&w/dye. 73220............. .............. A

Mri uppr extremity w/

2.15 25.66

NA 0.94 28.75

NA

XXX o&w/dye. 73221............. 26............ A

Mri joint upr extrem w/ 1.35 0.44 0.44 0.06 1.85 1.85

XXX o dye. 73221............. TC............ A

Mri joint upr extrem w/ 0.00 11.23

NA 0.39 11.62

NA

XXX o dye. 73221............. .............. A

Mri joint upr extrem w/ 1.35 11.67

NA 0.45 13.47

NA

XXX o dye. 73222............. 26............ A

Mri joint upr extrem w/ 1.62 0.53 0.53 0.07 2.22 2.22

XXX dye. 73222............. TC............ A

Mri joint upr extrem w/ 0.00 13.48

NA 0.47 13.95

NA

XXX dye. 73222............. .............. A

Mri joint upr extrem w/ 1.62 14.01

NA 0.54 16.17

NA

XXX dye. 73223............. 26............ A

Mri joint upr extr w/

2.15 0.71 0.71 0.10 2.96 2.96

XXX o&w/dye. 73223............. TC............ A

Mri joint upr extr w/

0.00 24.95

NA 0.84 25.79

NA

XXX o&w/dye. 73223............. .............. A

Mri joint upr extr w/

2.15 25.66

NA 0.94 28.75

NA

XXX o&w/dye. 73225............. 26............ N

Mr angio upr extr w/

+1.73 0.67 0.67 0.10 2.50 2.50

XXX o&w/dye. 73225............. TC............ N

Mr angio upr extr w/

+0.00 11.04 11.04 0.59 11.63 11.63

XXX o&w/dye. 73225............. .............. N

Mr angio upr extr w/

+1.73 11.71 11.71 0.69 14.13 14.13

XXX o&w/dye. 73500............. 26............ A

X-ray exam of hip..... 0.17 0.06 0.06 0.01 0.24 0.24

XXX 73500............. TC............ A

X-ray exam of hip..... 0.00 0.47

NA 0.02 0.49

NA

XXX 73500............. .............. A

X-ray exam of hip..... 0.17 0.53

NA 0.03 0.73

NA

XXX 73510............. 26............ A

X-ray exam of hip..... 0.21 0.07 0.07 0.01 0.29 0.29

XXX 73510............. TC............ A

X-ray exam of hip..... 0.00 0.57

NA 0.04 0.61

NA

XXX 73510............. .............. A

X-ray exam of hip..... 0.21 0.64

NA 0.05 0.90

NA

XXX 73520............. 26............ A

X-ray exam of hips.... 0.26 0.09 0.09 0.01 0.36 0.36

XXX 73520............. TC............ A

X-ray exam of hips.... 0.00 0.67

NA 0.04 0.71

NA

XXX 73520............. .............. A

X-ray exam of hips.... 0.26 0.76

NA 0.05 1.07

NA

XXX

[[Page 70418]]

73525............. 26............ A

Contrast x-ray of hip. 0.54 0.18 0.18 0.03 0.75 0.75

XXX 73525............. TC............ A

Contrast x-ray of hip. 0.00 2.11

NA 0.12 2.23

NA

XXX 73525............. .............. A

Contrast x-ray of hip. 0.54 2.29

NA 0.15 2.98

NA

XXX 73530............. 26............ A

X-ray exam of hip..... 0.29 0.10 0.10 0.01 0.40 0.40

XXX 73530............. TC............ A

X-ray exam of hip..... 0.00 0.52

NA 0.02 0.54

NA

XXX 73530............. .............. A

X-ray exam of hip..... 0.29 0.62

NA 0.03 0.94

NA

XXX 73540............. 26............ A

X-ray exam of pelvis & 0.20 0.07 0.07 0.01 0.28 0.28

XXX hips. 73540............. TC............ A

X-ray exam of pelvis & 0.00 0.57

NA 0.04 0.61

NA

XXX hips. 73540............. .............. A

X-ray exam of pelvis & 0.20 0.64

NA 0.05 0.89

NA

XXX hips. 73542............. 26............ A

X-ray exam, sacroiliac 0.59 0.16 0.16 0.03 0.78 0.78

XXX joint. 73542............. TC............ A

X-ray exam, sacroiliac 0.00 2.11

NA 0.12 2.23

NA

XXX joint. 73542............. .............. A

X-ray exam, sacroiliac 0.59 2.27

NA 0.15 3.01

NA

XXX joint. 73550............. 26............ A

X-ray exam of thigh... 0.17 0.06 0.06 0.01 0.24 0.24

XXX 73550............. TC............ A

X-ray exam of thigh... 0.00 0.57

NA 0.04 0.61

NA

XXX 73550............. .............. A

X-ray exam of thigh... 0.17 0.63

NA 0.05 0.85

NA

XXX 73560............. 26............ A

X-ray exam of knee, 1

0.17 0.06 0.06 0.01 0.24 0.24

XXX or 2. 73560............. TC............ A

X-ray exam of knee, 1

0.00 0.52

NA 0.02 0.54

NA

XXX or 2. 73560............. .............. A

X-ray exam of knee, 1

0.17 0.58

NA 0.03 0.78

NA

XXX or 2. 73562............. 26............ A

X-ray exam of knee, 3. 0.18 0.06 0.06 0.01 0.25 0.25

XXX 73562............. TC............ A

X-ray exam of knee, 3. 0.00 0.57

NA 0.04 0.61

NA

XXX 73562............. .............. A

X-ray exam of knee, 3. 0.18 0.63

NA 0.05 0.86

NA

XXX 73564............. 26............ A

X-ray exam, knee, 4 or 0.22 0.07 0.07 0.01 0.30 0.30

XXX more. 73564............. TC............ A

X-ray exam, knee, 4 or 0.00 0.62

NA 0.04 0.66

NA

XXX more. 73564............. .............. A

X-ray exam, knee, 4 or 0.22 0.69

NA 0.05 0.96

NA

XXX more. 73565............. 26............ A

X-ray exam of knees... 0.17 0.06 0.06 0.01 0.24 0.24

XXX 73565............. TC............ A

X-ray exam of knees... 0.00 0.49

NA 0.02 0.51

NA

XXX 73565............. .............. A

X-ray exam of knees... 0.17 0.55

NA 0.03 0.75

NA

XXX 73580............. 26............ A

Contrast x-ray of knee 0.54 0.17 0.17 0.03 0.74 0.74

XXX joint. 73580............. TC............ A

Contrast x-ray of knee 0.00 2.63

NA 0.14 2.77

NA

XXX joint. 73580............. .............. A

Contrast x-ray of knee 0.54 2.80

NA 0.17 3.51

NA

XXX joint. 73590............. 26............ A

X-ray exam of lower

0.17 0.06 0.06 0.01 0.24 0.24

XXX leg. 73590............. TC............ A

X-ray exam of lower

0.00 0.52

NA 0.02 0.54

NA

XXX leg. 73590............. .............. A

X-ray exam of lower

0.17 0.58

NA 0.03 0.78

NA

XXX leg. 73592............. 26............ A

X-ray exam of leg,

0.16 0.05 0.05 0.01 0.22 0.22

XXX infant. 73592............. TC............ A

X-ray exam of leg,

0.00 0.49

NA 0.02 0.51

NA

XXX infant. 73592............. .............. A

X-ray exam of leg,

0.16 0.54

NA 0.03 0.73

NA

XXX infant. 73600............. 26............ A

X-ray exam of ankle... 0.16 0.05 0.05 0.01 0.22 0.22

XXX 73600............. TC............ A

X-ray exam of ankle... 0.00 0.49

NA 0.02 0.51

NA

XXX 73600............. .............. A

X-ray exam of ankle... 0.16 0.54

NA 0.03 0.73

NA

XXX 73610............. 26............ A

X-ray exam of ankle... 0.17 0.06 0.06 0.01 0.24 0.24

XXX 73610............. TC............ A

X-ray exam of ankle... 0.00 0.53

NA 0.02 0.55

NA

XXX 73610............. .............. A

X-ray exam of ankle... 0.17 0.59

NA 0.03 0.79

NA

XXX 73615............. 26............ A

Contrast x-ray of

0.54 0.18 0.18 0.03 0.75 0.75

XXX ankle. 73615............. TC............ A

Contrast x-ray of

0.00 2.11

NA 0.12 2.23

NA

XXX ankle. 73615............. .............. A

Contrast x-ray of

0.54 2.29

NA 0.15 2.98

NA

XXX ankle. 73620............. 26............ A

X-ray exam of foot.... 0.16 0.05 0.05 0.01 0.22 0.22

XXX 73620............. TC............ A

X-ray exam of foot.... 0.00 0.49

NA 0.02 0.51

NA

XXX 73620............. .............. A

X-ray exam of foot.... 0.16 0.54

NA 0.03 0.73

NA

XXX 73630............. 26............ A

X-ray exam of foot.... 0.17 0.06 0.06 0.01 0.24 0.24

XXX 73630............. TC............ A

X-ray exam of foot.... 0.00 0.53

NA 0.02 0.55

NA

XXX 73630............. .............. A

X-ray exam of foot.... 0.17 0.59

NA 0.03 0.79

NA

XXX 73650............. 26............ A

X-ray exam of heel.... 0.16 0.05 0.05 0.01 0.22 0.22

XXX 73650............. TC............ A

X-ray exam of heel.... 0.00 0.47

NA 0.02 0.49

NA

XXX 73650............. .............. A

X-ray exam of heel.... 0.16 0.52

NA 0.03 0.71

NA

XXX 73660............. 26............ A

X-ray exam of toe(s).. 0.13 0.04 0.04 0.01 0.18 0.18

XXX 73660............. TC............ A

X-ray exam of toe(s).. 0.00 0.42

NA 0.02 0.44

NA

XXX 73660............. .............. A

X-ray exam of toe(s).. 0.13 0.46

NA 0.03 0.62

NA

XXX 73700............. 26............ A

Ct lower extremity w/o 1.09 0.36 0.36 0.05 1.50 1.50

XXX dye. 73700............. TC............ A

Ct lower extremity w/o 0.00 4.97

NA 0.25 5.22

NA

XXX dye. 73700............. .............. A

Ct lower extremity w/o 1.09 5.33

NA 0.30 6.72

NA

XXX dye. 73701............. 26............ A

Ct lower extremity w/

1.16 0.38 0.38 0.05 1.59 1.59

XXX dye. 73701............. TC............ A

Ct lower extremity w/

0.00 5.93

NA 0.31 6.24

NA

XXX dye. 73701............. .............. A

Ct lower extremity w/

1.16 6.31

NA 0.36 7.83

NA

XXX dye. 73702............. 26............ A

Ct lwr extremity w/o&w/ 1.22 0.40 0.40 0.05 1.67 1.67

XXX dye. 73702............. TC............ A

Ct lwr extremity w/o&w/ 0.00 7.44

NA 0.39 7.83

NA

XXX dye. 73702............. .............. A

Ct lwr extremity w/o&w/ 1.22 7.84

NA 0.44 9.50

NA

XXX dye. 73706............. 26............ A

Ct angio lwr extr w/

1.90 0.62 0.62 0.08 2.60 2.60

XXX o&w/dye. 73706............. TC............ A

Ct angio lwr extr w/

0.00 10.99

NA 0.39 11.38

NA

XXX o&w/dye. 73706............. .............. A

Ct angio lwr extr w/

1.90 11.61

NA 0.47 13.98

NA

XXX o&w/dye. 73718............. 26............ A

Mri lower extremity w/ 1.35 0.44 0.44 0.06 1.85 1.85

XXX o dye. 73718............. TC............ A

Mri lower extremity w/ 0.00 11.23

NA 0.39 11.62

NA

XXX o dye. 73718............. .............. A

Mri lower extremity w/ 1.35 11.67

NA 0.45 13.47

NA

XXX o dye. 73719............. 26............ A

Mri lower extremity w/ 1.62 0.53 0.53 0.07 2.22 2.22

XXX dye. 73719............. TC............ A

Mri lower extremity w/ 0.00 13.48

NA 0.47 13.95

NA

XXX dye. 73719............. .............. A

Mri lower extremity w/ 1.62 14.01

NA 0.54 16.17

NA

XXX dye.

[[Page 70419]]

73720............. 26............ A

Mri lwr extremity w/

2.15 0.70 0.70 0.10 2.95 2.95

XXX o&w/dye. 73720............. TC............ A

Mri lwr extremity w/

0.00 24.95

NA 0.84 25.79

NA

XXX o&w/dye. 73720............. .............. A

Mri lwr extremity w/

2.15 25.65

NA 0.94 28.74

NA

XXX o&w/dye. 73721............. 26............ A

Mri jnt of lwr extre w/ 1.35 0.44 0.44 0.06 1.85 1.85

XXX o dye. 73721............. TC............ A

Mri jnt of lwr extre w/ 0.00 11.23

NA 0.39 11.62

NA

XXX o dye. 73721............. .............. A

Mri jnt of lwr extre w/ 1.35 11.67

NA 0.45 13.47

NA

XXX o dye. 73722............. 26............ A

Mri joint of lwr extr

1.62 0.53 0.53 0.07 2.22 2.22

XXX w/dye. 73722............. TC............ A

Mri joint of lwr extr

0.00 13.48

NA 0.47 13.95

NA

XXX w/dye. 73722............. .............. A

Mri joint of lwr extr

1.62 14.01

NA 0.54 16.17

NA

XXX w/dye. 73723............. 26............ A

Mri joint lwr extr w/

2.15 0.71 0.71 0.10 2.96 2.96

XXX o&w/dye. 73723............. TC............ A

Mri joint lwr extr w/

0.00 24.95

NA 0.84 25.79

NA

XXX o&w/dye. 73723............. .............. A

Mri joint lwr extr w/

2.15 25.66

NA 0.94 28.75

NA

XXX o&w/dye. 73725............. 26............ R

Mr ang lwr ext w or w/ 1.82 0.60 0.60 0.08 2.50 2.50

XXX o dye. 73725............. TC............ R

Mr ang lwr ext w or w/ 0.00 11.23

NA 0.59 11.82

NA

XXX o dye. 73725............. .............. R

Mr ang lwr ext w or w/ 1.82 11.83

NA 0.67 14.32

NA

XXX o dye. 74000............. 26............ A

X-ray exam of abdomen. 0.18 0.06 0.06 0.01 0.25 0.25

XXX 74000............. TC............ A

X-ray exam of abdomen. 0.00 0.52

NA 0.02 0.54

NA

XXX 74000............. .............. A

X-ray exam of abdomen. 0.18 0.58

NA 0.03 0.79

NA

XXX 74010............. 26............ A

X-ray exam of abdomen. 0.23 0.08 0.08 0.01 0.32 0.32

XXX 74010............. TC............ A

X-ray exam of abdomen. 0.00 0.57

NA 0.04 0.61

NA

XXX 74010............. .............. A

X-ray exam of abdomen. 0.23 0.65

NA 0.05 0.93

NA

XXX 74020............. 26............ A

X-ray exam of abdomen. 0.27 0.09 0.09 0.01 0.37 0.37

XXX 74020............. TC............ A

X-ray exam of abdomen. 0.00 0.62

NA 0.04 0.66

NA

XXX 74020............. .............. A

X-ray exam of abdomen. 0.27 0.71

NA 0.05 1.03

NA

XXX 74022............. 26............ A

X-ray exam series,

0.32 0.10 0.10 0.01 0.43 0.43

XXX abdomen. 74022............. TC............ A

X-ray exam series,

0.00 0.73

NA 0.05 0.78

NA

XXX abdomen. 74022............. .............. A

X-ray exam series,

0.32 0.83

NA 0.06 1.21

NA

XXX abdomen. 74150............. 26............ A

Ct abdomen w/o dye.... 1.19 0.39 0.39 0.05 1.63 1.63

XXX 74150............. TC............ A

Ct abdomen w/o dye.... 0.00 5.68

NA 0.30 5.98

NA

XXX 74150............. .............. A

Ct abdomen w/o dye.... 1.19 6.07

NA 0.35 7.61

NA

XXX 74160............. 26............ A

Ct abdomen w/dye...... 1.27 0.42 0.42 0.06 1.75 1.75

XXX 74160............. TC............ A

Ct abdomen w/dye...... 0.00 6.86

NA 0.36 7.22

NA

XXX 74160............. .............. A

Ct abdomen w/dye...... 1.27 7.28

NA 0.42 8.97

NA

XXX 74170............. 26............ A

Ct abdomen w/o & w/dye 1.40 0.46 0.46 0.06 1.92 1.92

XXX 74170............. TC............ A

Ct abdomen w/o & w/dye 0.00 8.51

NA 0.43 8.94

NA

XXX 74170............. .............. A

Ct abdomen w/o & w/dye 1.40 8.97

NA 0.49 10.86

NA

XXX 74175............. 26............ A

Ct angio abdom w/o & w/ 1.90 0.62 0.62 0.08 2.60 2.60

XXX dye. 74175............. TC............ A

Ct angio abdom w/o & w/ 0.00 12.06

NA 0.39 12.45

NA

XXX dye. 74175............. .............. A

Ct angio abdom w/o & w/ 1.90 12.68

NA 0.47 15.05

NA

XXX dye. 74181............. 26............ A

Mri abdomen w/o dye... 1.46 0.48 0.48 0.06 2.00 2.00

XXX 74181............. TC............ A

Mri abdomen w/o dye... 0.00 11.23

NA 0.45 11.68

NA

XXX 74181............. .............. A

Mri abdomen w/o dye... 1.46 11.71

NA 0.51 13.68

NA

XXX 74182............. 26............ A

Mri abdomen w/dye..... 1.73 0.57 0.57 0.08 2.38 2.38

XXX 74182............. TC............ A

Mri abdomen w/dye..... 0.00 13.48

NA 0.52 14.00

NA

XXX 74182............. .............. A

Mri abdomen w/dye..... 1.73 14.05

NA 0.60 16.38

NA

XXX 74183............. 26............ A

Mri abdomen w/o & w/

2.26 0.74 0.74 0.10 3.10 3.10

XXX dye. 74183............. TC............ A

Mri abdomen w/o & w/

0.00 24.95

NA 0.92 25.87

NA

XXX dye. 74183............. .............. A

Mri abdomen w/o & w/

2.26 25.69

NA 1.02 28.97

NA

XXX dye. 74185............. 26............ R

Mri angio, abdom w orw/ 1.80 0.59 0.59 0.08 2.47 2.47

XXX o dye. 74185............. TC............ R

Mri angio, abdom w orw/ 0.00 11.23

NA 0.59 11.82

NA

XXX o dye. 74185............. .............. R

Mri angio, abdom w orw/ 1.80 11.82

NA 0.67 14.29

NA

XXX o dye. 74190............. 26............ A

X-ray exam of

0.48 0.16 0.16 0.02 0.66 0.66

XXX peritoneum. 74190............. TC............ A

X-ray exam of

0.00 1.31

NA 0.07 1.38

NA

XXX peritoneum. 74190............. .............. A

X-ray exam of

0.48 1.47

NA 0.09 2.04

NA

XXX peritoneum. 74210............. 26............ A

Contrst x-ray exam of

0.36 0.12 0.12 0.02 0.50 0.50

XXX throat. 74210............. TC............ A

Contrst x-ray exam of

0.00 1.19

NA 0.06 1.25

NA

XXX throat. 74210............. .............. A

Contrst x-ray exam of

0.36 1.31

NA 0.08 1.75

NA

XXX throat. 74220............. 26............ A

Contrast x-ray,

0.46 0.15 0.15 0.02 0.63 0.63

XXX esophagus. 74220............. TC............ A

Contrast x-ray,

0.00 1.19

NA 0.06 1.25

NA

XXX esophagus. 74220............. .............. A

Contrast x-ray,

0.46 1.34

NA 0.08 1.88

NA

XXX esophagus. 74230............. 26............ A

Cine/vid x-ray, throat/ 0.53 0.17 0.17 0.02 0.72 0.72

XXX esoph. 74230............. TC............ A

Cine/vid x-ray, throat/ 0.00 1.31

NA 0.07 1.38

NA

XXX esoph. 74230............. .............. A

Cine/vid x-ray, throat/ 0.53 1.48

NA 0.09 2.10

NA

XXX esoph. 74235............. 26............ A

Remove esophagus

1.19 0.39 0.39 0.05 1.63 1.63

XXX obstruction. 74235............. TC............ C

Remove esophagus

0.00 0.00 0.00 0.00 0.00 0.00

XXX obstruction. 74235............. .............. C

Remove esophagus

0.00 0.00 0.00 0.00 0.00 0.00

XXX obstruction. 74240............. 26............ A

X-ray exam, upper gi

0.69 0.23 0.23 0.03 0.95 0.95

XXX tract. 74240............. TC............ A

X-ray exam, upper gi

0.00 1.46

NA 0.08 1.54

NA

XXX tract. 74240............. .............. A

X-ray exam, upper gi

0.69 1.69

NA 0.11 2.49

NA

XXX tract. 74241............. 26............ A

X-ray exam, upper gi

0.69 0.23 0.23 0.03 0.95 0.95

XXX tract. 74241............. TC............ A

X-ray exam, upper gi

0.00 1.49

NA 0.08 1.57

NA

XXX tract. 74241............. .............. A

X-ray exam, upper gi

0.69 1.72

NA 0.11 2.52

NA

XXX tract. 74245............. 26............ A

X-ray exam, upper gi

0.91 0.30 0.30 0.04 1.25 1.25

XXX tract. 74245............. TC............ A

X-ray exam, upper gi

0.00 2.39

NA 0.13 2.52

NA

XXX tract. 74245............. .............. A

X-ray exam, upper gi

0.91 2.69

NA 0.17 3.77

NA

XXX tract.

[[Page 70420]]

74246............. 26............ A

Contrst x-ray uppr gi

0.69 0.23 0.23 0.03 0.95 0.95

XXX tract. 74246............. TC............ A

Contrst x-ray uppr gi

0.00 1.64

NA 0.10 1.74

NA

XXX tract. 74246............. .............. A

Contrst x-ray uppr gi

0.69 1.87

NA 0.13 2.69

NA

XXX tract. 74247............. 26............ A

Contrst x-ray uppr gi

0.69 0.23 0.23 0.03 0.95 0.95

XXX tract. 74247............. TC............ A

Contrst x-ray uppr gi

0.00 1.68

NA 0.11 1.79

NA

XXX tract. 74247............. .............. A

Contrst x-ray uppr gi

0.69 1.91

NA 0.14 2.74

NA

XXX tract. 74249............. 26............ A

Contrst x-ray uppr gi

0.91 0.30 0.30 0.04 1.25 1.25

XXX tract. 74249............. TC............ A

Contrst x-ray uppr gi

0.00 2.58

NA 0.14 2.72

NA

XXX tract. 74249............. .............. A

Contrst x-ray uppr gi

0.91 2.88

NA 0.18 3.97

NA

XXX tract. 74250............. 26............ A

X-ray exam of small

0.47 0.15 0.15 0.02 0.64 0.64

XXX bowel. 74250............. TC............ A

X-ray exam of small

0.00 1.31

NA 0.07 1.38

NA

XXX bowel. 74250............. .............. A

X-ray exam of small

0.47 1.46

NA 0.09 2.02

NA

XXX bowel. 74251............. 26............ A

X-ray exam of small

0.69 0.23 0.23 0.03 0.95 0.95

XXX bowel. 74251............. TC............ A

X-ray exam of small

0.00 1.31

NA 0.07 1.38

NA

XXX bowel. 74251............. .............. A

X-ray exam of small

0.69 1.54

NA 0.10 2.33

NA

XXX bowel. 74260............. 26............ A

X-ray exam of small

0.50 0.16 0.16 0.02 0.68 0.68

XXX bowel. 74260............. TC............ A

X-ray exam of small

0.00 1.49

NA 0.08 1.57

NA

XXX bowel. 74260............. .............. A

X-ray exam of small

0.50 1.65

NA 0.10 2.25

NA

XXX bowel. 74270............. 26............ A

Contrast x-ray exam of 0.69 0.23 0.23 0.03 0.95 0.95

XXX colon. 74270............. TC............ A

Contrast x-ray exam of 0.00 1.70

NA 0.11 1.81

NA

XXX colon. 74270............. .............. A

Contrast x-ray exam of 0.69 1.93

NA 0.14 2.76

NA

XXX colon. 74280............. 26............ A

Contrast x-ray exam of 0.99 0.32 0.32 0.04 1.35 1.35

XXX colon. 74280............. TC............ A

Contrast x-ray exam of 0.00 2.24

NA 0.13 2.37

NA

XXX colon. 74280............. .............. A

Contrast x-ray exam of 0.99 2.56

NA 0.17 3.72

NA

XXX colon. 74283............. 26............ A

Contrast x-ray exam of 2.02 0.66 0.66 0.09 2.77 2.77

XXX colon. 74283............. TC............ A

Contrast x-ray exam of 0.00 2.57

NA 0.14 2.71

NA

XXX colon. 74283............. .............. A

Contrast x-ray exam of 2.02 3.23

NA 0.23 5.48

NA

XXX colon. 74290............. 26............ A

Contrast x-ray,

0.32 0.10 0.10 0.01 0.43 0.43

XXX gallbladder. 74290............. TC............ A

Contrast x-ray,

0.00 0.73

NA 0.05 0.78

NA

XXX gallbladder. 74290............. .............. A

Contrast x-ray,

0.32 0.83

NA 0.06 1.21

NA

XXX gallbladder. 74291............. 26............ A

Contrast x-rays,

0.20 0.07 0.07 0.01 0.28 0.28

XXX gallbladder. 74291............. TC............ A

Contrast x-rays,

0.00 0.42

NA 0.02 0.44

NA

XXX gallbladder. 74291............. .............. A

Contrast x-rays,

0.20 0.49

NA 0.03 0.72

NA

XXX gallbladder. 74300............. 26............ A

X-ray bile ducts/

0.36 0.12 0.12 0.02 0.50 0.50

XXX pancreas. 74300............. TC............ C

X-ray bile ducts/

0.00 0.00 0.00 0.00 0.00 0.00

XXX pancreas. 74300............. .............. C

X-ray bile ducts/

0.00 0.00 0.00 0.00 0.00 0.00

XXX pancreas. 74301............. 26............ A

X-rays at surgery add- 0.21 0.07 0.07 0.01 0.29 0.29

ZZZ on. 74301............. TC............ C

X-rays at surgery add- 0.00 0.00 0.00 0.00 0.00 0.00

ZZZ on. 74301............. .............. C

X-rays at surgery add- 0.00 0.00 0.00 0.00 0.00 0.00

ZZZ on. 74305............. 26............ A

X-ray bile ducts/

0.42 0.14 0.14 0.02 0.58 0.58

XXX pancreas. 74305............. TC............ A

X-ray bile ducts/

0.00 0.78

NA 0.05 0.83

NA

XXX pancreas. 74305............. .............. A

X-ray bile ducts/

0.42 0.92

NA 0.07 1.41

NA

XXX pancreas. 74320............. 26............ A

Contrast x-ray of bile 0.54 0.18 0.18 0.02 0.74 0.74

XXX ducts. 74320............. TC............ A

Contrast x-ray of bile 0.00 3.16

NA 0.17 3.33

NA

XXX ducts. 74320............. .............. A

Contrast x-ray of bile 0.54 3.34

NA 0.19 4.07

NA

XXX ducts. 74327............. 26............ A

X-ray bile stone

0.70 0.23 0.23 0.03 0.96 0.96

XXX removal. 74327............. TC............ A

X-ray bile stone

0.00 1.77

NA 0.11 1.88

NA

XXX removal. 74327............. .............. A

X-ray bile stone

0.70 2.00

NA 0.14 2.84

NA

XXX removal. 74328............. 26............ A

X-ray bile duct

0.70 0.23 0.23 0.03 0.96 0.96

XXX endoscopy. 74328............. TC............ A

X-ray bile duct

0.00 3.16

NA 0.17 3.33

NA

XXX endoscopy. 74328............. .............. A

X-ray bile duct

0.70 3.39

NA 0.20 4.29

NA

XXX endoscopy. 74329............. 26............ A

X-ray for pancreas

0.70 0.23 0.23 0.03 0.96 0.96

XXX endoscopy. 74329............. TC............ C

X-ray for pancreas

0.00 0.00 0.00 0.00 0.00 0.00

XXX endoscopy. 74329............. .............. C

X-ray for pancreas

0.00 0.00 0.00 0.00 0.00 0.00

XXX endoscopy. 74330............. 26............ A

X-ray bile/panc

0.90 0.29 0.29 0.04 1.23 1.23

XXX endoscopy. 74330............. TC............ A

X-ray bile/panc

0.00 3.16

NA 0.17 3.33

NA

XXX endoscopy. 74330............. .............. A

X-ray bile/panc

0.90 3.45

NA 0.21 4.56

NA

XXX endoscopy. 74340............. 26............ A

X-ray guide for GI

0.54 0.18 0.18 0.02 0.74 0.74

XXX tube. 74340............. TC............ A

X-ray guide for GI

0.00 2.63

NA 0.14 2.77

NA

XXX tube. 74340............. .............. A

X-ray guide for GI

0.54 2.81

NA 0.16 3.51

NA

XXX tube. 74350............. 26............ A

X-ray guide, stomach

0.76 0.25 0.25 0.03 1.04 1.04

XXX tube. 74350............. TC............ A

X-ray guide, stomach

0.00 3.16

NA 0.17 3.33

NA

XXX tube. 74350............. .............. A

X-ray guide, stomach

0.76 3.41

NA 0.20 4.37

NA

XXX tube. 74355............. 26............ A

X-ray guide,

0.76 0.25 0.25 0.03 1.04 1.04

XXX intestinal tube. 74355............. TC............ A

X-ray guide,

0.00 2.63

NA 0.14 2.77

NA

XXX intestinal tube. 74355............. .............. A

X-ray guide,

0.76 2.88

NA 0.17 3.81

NA

XXX intestinal tube. 74360............. 26............ A

X-ray guide, GI

0.54 0.19 0.19 0.02 0.75 0.75

XXX dilation. 74360............. TC............ A

X-ray guide, GI

0.00 3.16

NA 0.17 3.33

NA

XXX dilation. 74360............. .............. A

X-ray guide, GI

0.54 3.35

NA 0.19 4.08

NA

XXX dilation. 74363............. 26............ A

X-ray, bile duct

0.88 0.29 0.29 0.04 1.21 1.21

XXX dilation. 74363............. TC............ C

X-ray, bile duct

0.00 0.00 0.00 0.00 0.00 0.00

XXX dilation. 74363............. .............. C

X-ray, bile duct

0.00 0.00 0.00 0.00 0.00 0.00

XXX dilation. 74400............. 26............ A

Contrst x-ray, urinary 0.49 0.16 0.16 0.02 0.67 0.67

XXX tract. 74400............. TC............ A

Contrst x-ray, urinary 0.00 1.68

NA 0.11 1.79

NA

XXX tract. 74400............. .............. A

Contrst x-ray, urinary 0.49 1.84

NA 0.13 2.46

NA

XXX tract.

[[Page 70421]]

74410............. 26............ A

Contrst x-ray, urinary 0.49 0.16 0.16 0.02 0.67 0.67

XXX tract. 74410............. TC............ A

Contrst x-ray, urinary 0.00 1.96

NA 0.11 2.07

NA

XXX tract. 74410............. .............. A

Contrst x-ray, urinary 0.49 2.12

NA 0.13 2.74

NA

XXX tract. 74415............. 26............ A

Contrst x-ray, urinary 0.49 0.16 0.16 0.02 0.67 0.67

XXX tract. 74415............. TC............ A

Contrst x-ray, urinary 0.00 2.13

NA 0.12 2.25

NA

XXX tract. 74415............. .............. A

Contrst x-ray, urinary 0.49 2.29

NA 0.14 2.92

NA

XXX tract. 74420............. 26............ A

Contrst x-ray, urinary 0.36 0.12 0.12 0.02 0.50 0.50

XXX tract. 74420............. TC............ A

Contrst x-ray, urinary 0.00 2.63

NA 0.14 2.77

NA

XXX tract. 74420............. .............. A

Contrst x-ray, urinary 0.36 2.75

NA 0.16 3.27

NA

XXX tract. 74425............. 26............ A

Contrst x-ray, urinary 0.36 0.12 0.12 0.02 0.50 0.50

XXX tract. 74425............. TC............ A

Contrst x-ray, urinary 0.00 1.31

NA 0.07 1.38

NA

XXX tract. 74425............. .............. A

Contrst x-ray, urinary 0.36 1.43

NA 0.09 1.88

NA

XXX tract. 74430............. 26............ A

Contrast x-ray,

0.32 0.10 0.10 0.02 0.44 0.44

XXX bladder. 74430............. TC............ A

Contrast x-ray,

0.00 1.05

NA 0.06 1.11

NA

XXX bladder. 74430............. .............. A

Contrast x-ray,

0.32 1.15

NA 0.08 1.55

NA

XXX bladder. 74440............. 26............ A

X-ray, male genital

0.38 0.12 0.12 0.02 0.52 0.52

XXX tract. 74440............. TC............ A

X-ray, male genital

0.00 1.13

NA 0.06 1.19

NA

XXX tract. 74440............. .............. A

X-ray, male genital

0.38 1.25

NA 0.08 1.71

NA

XXX tract. 74445............. 26............ A

X-ray exam of penis... 1.14 0.37 0.37 0.07 1.58 1.58

XXX 74445............. TC............ A

X-ray exam of penis... 0.00 1.13

NA 0.06 1.19

NA

XXX 74445............. .............. A

X-ray exam of penis... 1.14 1.50

NA 0.13 2.77

NA

XXX 74450............. 26............ A

X-ray, urethra/bladder 0.33 0.11 0.11 0.02 0.46 0.46

XXX 74450............. TC............ A

X-ray, urethra/bladder 0.00 1.46

NA 0.08 1.54

NA

XXX 74450............. .............. A

X-ray, urethra/bladder 0.33 1.57

NA 0.10 2.00

NA

XXX 74455............. 26............ A

X-ray, urethra/bladder 0.33 0.11 0.11 0.02 0.46 0.46

XXX 74455............. TC............ A

X-ray, urethra/bladder 0.00 1.58

NA 0.10 1.68

NA

XXX 74455............. .............. A

X-ray, urethra/bladder 0.33 1.69

NA 0.12 2.14

NA

XXX 74470............. 26............ A

X-ray exam of kidney

0.54 0.18 0.18 0.02 0.74 0.74

XXX lesion. 74470............. TC............ A

X-ray exam of kidney

0.00 1.25

NA 0.07 1.32

NA

XXX lesion. 74470............. .............. A

X-ray exam of kidney

0.54 1.43

NA 0.09 2.06

NA

XXX lesion. 74475............. 26............ A

X-ray control, cath

0.54 0.18 0.18 0.02 0.74 0.74

XXX insert. 74475............. TC............ A

X-ray control, cath

0.00 4.08

NA 0.22 4.30

NA

XXX insert. 74475............. .............. A

X-ray control, cath

0.54 4.26

NA 0.24 5.04

NA

XXX insert. 74480............. 26............ A

X-ray control, cath

0.54 0.18 0.18 0.02 0.74 0.74

XXX insert. 74480............. TC............ A

X-ray control, cath

0.00 4.08

NA 0.22 4.30

NA

XXX insert. 74480............. .............. A

X-ray control, cath

0.54 4.26

NA 0.24 5.04

NA

XXX insert. 74485............. 26............ A

X-ray guide, GU

0.54 0.17 0.17 0.03 0.74 0.74

XXX dilation. 74485............. TC............ A

X-ray guide, GU

0.00 3.16

NA 0.17 3.33

NA

XXX dilation. 74485............. .............. A

X-ray guide, GU

0.54 3.33

NA 0.20 4.07

NA

XXX dilation. 74710............. 26............ A

X-ray measurement of

0.34 0.11 0.11 0.02 0.47 0.47

XXX pelvis. 74710............. TC............ A

X-ray measurement of

0.00 1.05

NA 0.06 1.11

NA

XXX pelvis. 74710............. .............. A

X-ray measurement of

0.34 1.16

NA 0.08 1.58

NA

XXX pelvis. 74740............. 26............ A

X-ray, female genital

0.38 0.13 0.13 0.02 0.53 0.53

XXX tract. 74740............. TC............ A

X-ray, female genital

0.00 1.31

NA 0.07 1.38

NA

XXX tract. 74740............. .............. A

X-ray, female genital

0.38 1.44

NA 0.09 1.91

NA

XXX tract. 74742............. 26............ A

X-ray, fallopian tube. 0.61 0.20 0.20 0.03 0.84 0.84

XXX 74742............. TC............ C

X-ray, fallopian tube. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 74742............. .............. C

X-ray, fallopian tube. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 74775............. 26............ A

X-ray exam of perineum 0.62 0.21 0.21 0.03 0.86 0.86

XXX 74775............. TC............ A

X-ray exam of perineum 0.00 1.46

NA 0.08 1.54

NA

XXX 74775............. .............. A

X-ray exam of perineum 0.62 1.67

NA 0.11 2.40

NA

XXX 75552............. 26............ A

Heart mri for morph w/ 1.60 0.53 0.53 0.07 2.20 2.20

XXX o dye. 75552............. TC............ A

Heart mri for morph w/ 0.00 11.23

NA 0.59 11.82

NA

XXX o dye. 75552............. .............. A

Heart mri for morph w/ 1.60 11.76

NA 0.66 14.02

NA

XXX o dye. 75553............. 26............ A

Heart mri for morph w/ 2.00 0.65 0.65 0.07 2.72 2.72

XXX dye. 75553............. TC............ A

Heart mri for morph w/ 0.00 11.23

NA 0.59 11.82

NA

XXX dye. 75553............. .............. A

Heart mri for morph w/ 2.00 11.88

NA 0.66 14.54

NA

XXX dye. 75554............. 26............ A

Cardiac MRI/function.. 1.83 0.64 0.64 0.07 2.54 2.54

XXX 75554............. TC............ A

Cardiac MRI/function.. 0.00 11.23

NA 0.59 11.82

NA

XXX 75554............. .............. A

Cardiac MRI/function.. 1.83 11.87

NA 0.66 14.36

NA

XXX 75555............. 26............ A

Cardiac MRI/limited

1.74 0.64 0.64 0.07 2.45 2.45

XXX study. 75555............. TC............ A

Cardiac MRI/limited

0.00 11.23

NA 0.59 11.82

NA

XXX study. 75555............. .............. A

Cardiac MRI/limited

1.74 11.87

NA 0.66 14.27

NA

XXX study. 75556............. .............. N

Cardiac MRI/flow

0.00 0.00 0.00 0.00 0.00 0.00

XXX mapping. 75600............. 26............ A

Contrast x-ray exam of 0.49 0.19 0.19 0.02 0.70 0.70

XXX aorta. 75600............. TC............ A

Contrast x-ray exam of 0.00 12.64

NA 0.65 13.29

NA

XXX aorta. 75600............. .............. A

Contrast x-ray exam of 0.49 12.83

NA 0.67 13.99

NA

XXX aorta. 75605............. 26............ A

Contrast x-ray exam of 1.14 0.40 0.40 0.05 1.59 1.59

XXX aorta. 75605............. TC............ A

Contrast x-ray exam of 0.00 12.64

NA 0.65 13.29

NA

XXX aorta. 75605............. .............. A

Contrast x-ray exam of 1.14 13.04

NA 0.70 14.88

NA

XXX aorta. 75625............. 26............ A

Contrast x-ray exam of 1.14 0.38 0.38 0.06 1.58 1.58

XXX aorta. 75625............. TC............ A

Contrast x-ray exam of 0.00 12.64

NA 0.65 13.29

NA

XXX aorta. 75625............. .............. A

Contrast x-ray exam of 1.14 13.02

NA 0.71 14.87

NA

XXX aorta. 75630............. 26............ A

X-ray aorta, leg

1.79 0.61 0.61 0.11 2.51 2.51

XXX arteries. 75630............. TC............ A

X-ray aorta, leg

0.00 13.17

NA 0.69 13.86

NA

XXX arteries.

[[Page 70422]]

75630............. .............. A

X-ray aorta, leg

1.79 13.78

NA 0.80 16.37

NA

XXX arteries. 75635............. 26............ A

Ct angio abdominal

2.40 0.79 0.79 0.11 3.30 3.30

XXX arteries. 75635............. TC............ A

Ct angio abdominal

0.00 15.96

NA 0.39 16.35

NA

XXX arteries. 75635............. .............. A

Ct angio abdominal

2.40 16.75

NA 0.50 19.65

NA

XXX arteries. 75650............. 26............ A

Artery x-rays, head &

1.49 0.49 0.49 0.07 2.05 2.05

XXX neck. 75650............. TC............ A

Artery x-rays, head &

0.00 12.64

NA 0.65 13.29

NA

XXX neck. 75650............. .............. A

Artery x-rays, head &

1.49 13.13

NA 0.72 15.34

NA

XXX neck. 75658............. 26............ A

Artery x-rays, arm.... 1.31 0.47 0.47 0.07 1.85 1.85

XXX 75658............. TC............ A

Artery x-rays, arm.... 0.00 12.64

NA 0.65 13.29

NA

XXX 75658............. .............. A

Artery x-rays, arm.... 1.31 13.11

NA 0.72 15.14

NA

XXX 75660............. 26............ A

Artery x-rays, head &

1.31 0.44 0.44 0.06 1.81 1.81

XXX neck. 75660............. TC............ A

Artery x-rays, head &

0.00 12.64

NA 0.65 13.29

NA

XXX neck. 75660............. .............. A

Artery x-rays, head &

1.31 13.08

NA 0.71 15.10

NA

XXX neck. 75662............. 26............ A

Artery x-rays, head &

1.66 0.59 0.59 0.06 2.31 2.31

XXX neck. 75662............. TC............ A

Artery x-rays, head &

0.00 12.64

NA 0.65 13.29

NA

XXX neck. 75662............. .............. A

Artery x-rays, head &

1.66 13.23

NA 0.71 15.60

NA

XXX neck. 75665............. 26............ A

Artery x-rays, head &

1.31 0.44 0.44 0.09 1.84 1.84

XXX neck. 75665............. TC............ A

Artery x-rays, head &

0.00 12.64

NA 0.65 13.29

NA

XXX neck. 75665............. .............. A

Artery x-rays, head &

1.31 13.08

NA 0.74 15.13

NA

XXX neck. 75671............. 26............ A

Artery x-rays, head &

1.66 0.55 0.55 0.07 2.28 2.28

XXX neck. 75671............. TC............ A

Artery x-rays, head &

0.00 12.64

NA 0.65 13.29

NA

XXX neck. 75671............. .............. A

Artery x-rays, head &

1.66 13.19

NA 0.72 15.57

NA

XXX neck. 75676............. 26............ A

Artery x-rays, neck... 1.31 0.44 0.44 0.07 1.82 1.82

XXX 75676............. TC............ A

Artery x-rays, neck... 0.00 12.64

NA 0.65 13.29

NA

XXX 75676............. .............. A

Artery x-rays, neck... 1.31 13.08

NA 0.72 15.11

NA

XXX 75680............. 26............ A

Artery x-rays, neck... 1.66 0.55 0.55 0.07 2.28 2.28

XXX 75680............. TC............ A

Artery x-rays, neck... 0.00 12.64

NA 0.65 13.29

NA

XXX 75680............. .............. A

Artery x-rays, neck... 1.66 13.19

NA 0.72 15.57

NA

XXX 75685............. 26............ A

Artery x-rays, spine.. 1.31 0.43 0.43 0.06 1.80 1.80

XXX 75685............. TC............ A

Artery x-rays, spine.. 0.00 12.64

NA 0.65 13.29

NA

XXX 75685............. .............. A

Artery x-rays, spine.. 1.31 13.07

NA 0.71 15.09

NA

XXX 75705............. 26............ A

Artery x-rays, spine.. 2.18 0.73 0.73 0.13 3.04 3.04

XXX 75705............. TC............ A

Artery x-rays, spine.. 0.00 12.64

NA 0.65 13.29

NA

XXX 75705............. .............. A

Artery x-rays, spine.. 2.18 13.37

NA 0.78 16.33

NA

XXX 75710............. 26............ A

Artery x-rays, arm/leg 1.14 0.39 0.39 0.07 1.60 1.60

XXX 75710............. TC............ A

Artery x-rays, arm/leg 0.00 12.64

NA 0.65 13.29

NA

XXX 75710............. .............. A

Artery x-rays, arm/leg 1.14 13.03

NA 0.72 14.89

NA

XXX 75716............. 26............ A

Artery x-rays, arms/

1.31 0.43 0.43 0.07 1.81 1.81

XXX legs. 75716............. TC............ A

Artery x-rays, arms/

0.00 12.64

NA 0.65 13.29

NA

XXX legs. 75716............. .............. A

Artery x-rays, arms/

1.31 13.07

NA 0.72 15.10

NA

XXX legs. 75722............. 26............ A

Artery x-rays, kidney. 1.14 0.40 0.40 0.05 1.59 1.59

XXX 75722............. TC............ A

Artery x-rays, kidney. 0.00 12.64

NA 0.65 13.29

NA

XXX 75722............. .............. A

Artery x-rays, kidney. 1.14 13.04

NA 0.70 14.88

NA

XXX 75724............. 26............ A

Artery x-rays, kidneys 1.49 0.56 0.56 0.05 2.10 2.10

XXX 75724............. TC............ A

Artery x-rays, kidneys 0.00 12.64

NA 0.65 13.29

NA

XXX 75724............. .............. A

Artery x-rays, kidneys 1.49 13.20

NA 0.70 15.39

NA

XXX 75726............. 26............ A

Artery x-rays, abdomen 1.14 0.37 0.37 0.05 1.56 1.56

XXX 75726............. TC............ A

Artery x-rays, abdomen 0.00 12.64

NA 0.65 13.29

NA

XXX 75726............. .............. A

Artery x-rays, abdomen 1.14 13.01

NA 0.70 14.85

NA

XXX 75731............. 26............ A

Artery x-rays, adrenal 1.14 0.37 0.37 0.06 1.57 1.57

XXX gland. 75731............. TC............ A

Artery x-rays, adrenal 0.00 12.64

NA 0.65 13.29

NA

XXX gland. 75731............. .............. A

Artery x-rays, adrenal 1.14 13.01

NA 0.71 14.86

NA

XXX gland. 75733............. 26............ A

Artery x-rays,

1.31 0.44 0.44 0.06 1.81 1.81

XXX adrenals. 75733............. TC............ A

Artery x-rays,

0.00 12.64

NA 0.65 13.29

NA

XXX adrenals. 75733............. .............. A

Artery x-rays,

1.31 13.08

NA 0.71 15.10

NA

XXX adrenals. 75736............. 26............ A

Artery x-rays, pelvis. 1.14 0.38 0.38 0.06 1.58 1.58

XXX 75736............. TC............ A

Artery x-rays, pelvis. 0.00 12.64

NA 0.65 13.29

NA

XXX 75736............. .............. A

Artery x-rays, pelvis. 1.14 13.02

NA 0.71 14.87

NA

XXX 75741............. 26............ A

Artery x-rays, lung... 1.31 0.43 0.43 0.06 1.80 1.80

XXX 75741............. TC............ A

Artery x-rays, lung... 0.00 12.64

NA 0.65 13.29

NA

XXX 75741............. .............. A

Artery x-rays, lung... 1.31 13.07

NA 0.71 15.09

NA

XXX 75743............. 26............ A

Artery x-rays, lungs.. 1.66 0.54 0.54 0.07 2.27 2.27

XXX 75743............. TC............ A

Artery x-rays, lungs.. 0.00 12.64

NA 0.65 13.29

NA

XXX 75743............. .............. A

Artery x-rays, lungs.. 1.66 13.18

NA 0.72 15.56

NA

XXX 75746............. 26............ A

Artery x-rays, lung... 1.14 0.38 0.38 0.05 1.57 1.57

XXX 75746............. TC............ A

Artery x-rays, lung... 0.00 12.64

NA 0.65 13.29

NA

XXX 75746............. .............. A

Artery x-rays, lung... 1.14 13.02

NA 0.70 14.86

NA

XXX 75756............. 26............ A

Artery x-rays, chest.. 1.14 0.45 0.45 0.04 1.63 1.63

XXX 75756............. TC............ A

Artery x-rays, chest.. 0.00 12.64

NA 0.65 13.29

NA

XXX 75756............. .............. A

Artery x-rays, chest.. 1.14 13.09

NA 0.69 14.92

NA

XXX 75774............. 26............ A

Artery x-ray, each

0.36 0.12 0.12 0.02 0.50 0.50

ZZZ vessel. 75774............. TC............ A

Artery x-ray, each

0.00 12.64

NA 0.65 13.29

NA

ZZZ vessel. 75774............. .............. A

Artery x-ray, each

0.36 12.76

NA 0.67 13.79

NA

ZZZ vessel. 75790............. 26............ A

Visualize A-V shunt... 1.84 0.60 0.60 0.09 2.53 2.53

XXX 75790............. TC............ A

Visualize A-V shunt... 0.00 1.35

NA 0.08 1.43

NA

XXX

[[Page 70423]]

75790............. .............. A

Visualize A-V shunt... 1.84 1.95

NA 0.17 3.96

NA

XXX 75801............. 26............ A

Lymph vessel x-ray,

0.81 0.27 0.27 0.08 1.16 1.16

XXX arm/leg. 75801............. TC............ A

Lymph vessel x-ray,

0.00 5.43

NA 0.29 5.72

NA

XXX arm/leg. 75801............. .............. A

Lymph vessel x-ray,

0.81 5.70

NA 0.37 6.88

NA

XXX arm/leg. 75803............. 26............ A

Lymph vessel x-

1.17 0.38 0.38 0.05 1.60 1.60

XXX ray,arms/legs. 75803............. TC............ A

Lymph vessel x-

0.00 5.43

NA 0.29 5.72

NA

XXX ray,arms/legs. 75803............. .............. A

Lymph vessel x-

1.17 5.81

NA 0.34 7.32

NA

XXX ray,arms/legs. 75805............. 26............ A

Lymph vessel x-ray,

0.81 0.27 0.27 0.05 1.13 1.13

XXX trunk. 75805............. TC............ A

Lymph vessel x-ray,

0.00 6.12

NA 0.33 6.45

NA

XXX trunk. 75805............. .............. A

Lymph vessel x-ray,

0.81 6.39

NA 0.38 7.58

NA

XXX trunk. 75807............. 26............ A

Lymph vessel x-ray,

1.17 0.38 0.38 0.05 1.60 1.60

XXX trunk. 75807............. TC............ C

Lymph vessel x-ray,

0.00 0.00 0.00 0.00 0.00 0.00

XXX trunk. 75807............. .............. C

Lymph vessel x-ray,

0.00 0.00 0.00 0.00 0.00 0.00

XXX trunk. 75809............. 26............ A

Nonvascular shunt, x-

0.47 0.15 0.15 0.02 0.64 0.64

XXX ray. 75809............. TC............ A

Nonvascular shunt, x-

0.00 0.78

NA 0.05 0.83

NA

XXX ray. 75809............. .............. A

Nonvascular shunt, x-

0.47 0.93

NA 0.07 1.47

NA

XXX ray. 75810............. 26............ A

Vein x-ray, spleen/

1.14 0.37 0.37 0.05 1.56 1.56

XXX liver. 75810............. TC............ A

Vein x-ray, spleen/

0.00 12.64

NA 0.65 13.29

NA

XXX liver. 75810............. .............. A

Vein x-ray, spleen/

1.14 13.01

NA 0.70 14.85

NA

XXX liver. 75820............. 26............ A

Vein x-ray, arm/leg... 0.70 0.23 0.23 0.03 0.96 0.96

XXX 75820............. TC............ A

Vein x-ray, arm/leg... 0.00 0.95

NA 0.06 1.01

NA

XXX 75820............. .............. A

Vein x-ray, arm/leg... 0.70 1.18

NA 0.09 1.97

NA

XXX 75822............. 26............ A

Vein x-ray, arms/legs. 1.06 0.35 0.35 0.05 1.46 1.46

XXX 75822............. TC............ A

Vein x-ray, arms/legs. 0.00 1.48

NA 0.08 1.56

NA

XXX 75822............. .............. A

Vein x-ray, arms/legs. 1.06 1.83

NA 0.13 3.02

NA

XXX 75825............. 26............ A

Vein x-ray, trunk..... 1.14 0.37 0.37 0.07 1.58 1.58

XXX 75825............. TC............ A

Vein x-ray, trunk..... 0.00 12.64

NA 0.65 13.29

NA

XXX 75825............. .............. A

Vein x-ray, trunk..... 1.14 13.01

NA 0.72 14.87

NA

XXX 75827............. 26............ A

Vein x-ray, chest..... 1.14 0.37 0.37 0.05 1.56 1.56

XXX 75827............. TC............ A

Vein x-ray, chest..... 0.00 12.64

NA 0.65 13.29

NA

XXX 75827............. .............. A

Vein x-ray, chest..... 1.14 13.01

NA 0.70 14.85

NA

XXX 75831............. 26............ A

Vein x-ray, kidney.... 1.14 0.37 0.37 0.06 1.57 1.57

XXX 75831............. TC............ A

Vein x-ray, kidney.... 0.00 12.64

NA 0.65 13.29

NA

XXX 75831............. .............. A

Vein x-ray, kidney.... 1.14 13.01

NA 0.71 14.86

NA

XXX 75833............. 26............ A

Vein x-ray, kidneys... 1.49 0.49 0.49 0.09 2.07 2.07

XXX 75833............. TC............ A

Vein x-ray, kidneys... 0.00 12.64

NA 0.65 13.29

NA

XXX 75833............. .............. A

Vein x-ray, kidneys... 1.49 13.13

NA 0.74 15.36

NA

XXX 75840............. 26............ A

Vein x-ray, adrenal

1.14 0.38 0.38 0.07 1.59 1.59

XXX gland. 75840............. TC............ A

Vein x-ray, adrenal

0.00 12.64

NA 0.65 13.29

NA

XXX gland. 75840............. .............. A

Vein x-ray, adrenal

1.14 13.02

NA 0.72 14.88

NA

XXX gland. 75842............. 26............ A

Vein x-ray, adrenal

1.49 0.48 0.48 0.07 2.04 2.04

XXX glands. 75842............. TC............ A

Vein x-ray, adrenal

0.00 12.64

NA 0.65 13.29

NA

XXX glands. 75842............. .............. A

Vein x-ray, adrenal

1.49 13.12

NA 0.72 15.33

NA

XXX glands. 75860............. 26............ A

Vein x-ray, neck...... 1.14 0.39 0.39 0.04 1.57 1.57

XXX 75860............. TC............ A

Vein x-ray, neck...... 0.00 12.64

NA 0.65 13.29

NA

XXX 75860............. .............. A

Vein x-ray, neck...... 1.14 13.03

NA 0.69 14.86

NA

XXX 75870............. 26............ A

Vein x-ray, skull..... 1.14 0.39 0.39 0.05 1.58 1.58

XXX 75870............. TC............ A

Vein x-ray, skull..... 0.00 12.64

NA 0.65 13.29

NA

XXX 75870............. .............. A

Vein x-ray, skull..... 1.14 13.03

NA 0.70 14.87

NA

XXX 75872............. 26............ A

Vein x-ray, skull..... 1.14 0.37 0.37 0.14 1.65 1.65

XXX 75872............. TC............ A

Vein x-ray, skull..... 0.00 12.64

NA 0.65 13.29

NA

XXX 75872............. .............. A

Vein x-ray, skull..... 1.14 13.01

NA 0.79 14.94

NA

XXX 75880............. 26............ A

Vein x-ray, eye socket 0.70 0.23 0.23 0.03 0.96 0.96

XXX 75880............. TC............ A

Vein x-ray, eye socket 0.00 0.95

NA 0.06 1.01

NA

XXX 75880............. .............. A

Vein x-ray, eye socket 0.70 1.18

NA 0.09 1.97

NA

XXX 75885............. 26............ A

Vein x-ray, liver..... 1.44 0.47 0.47 0.06 1.97 1.97

XXX 75885............. TC............ A

Vein x-ray, liver..... 0.00 12.64

NA 0.65 13.29

NA

XXX 75885............. .............. A

Vein x-ray, liver..... 1.44 13.11

NA 0.71 15.26

NA

XXX 75887............. 26............ A

Vein x-ray, liver..... 1.44 0.47 0.47 0.06 1.97 1.97

XXX 75887............. TC............ A

Vein x-ray, liver..... 0.00 12.64

NA 0.65 13.29

NA

XXX 75887............. .............. A

Vein x-ray, liver..... 1.44 13.11

NA 0.71 15.26

NA

XXX 75889............. 26............ A

Vein x-ray, liver..... 1.14 0.37 0.37 0.05 1.56 1.56

XXX 75889............. TC............ A

Vein x-ray, liver..... 0.00 12.64

NA 0.65 13.29

NA

XXX 75889............. .............. A

Vein x-ray, liver..... 1.14 13.01

NA 0.70 14.85

NA

XXX 75891............. 26............ A

Vein x-ray, liver..... 1.14 0.37 0.37 0.05 1.56 1.56

XXX 75891............. TC............ A

Vein x-ray, liver..... 0.00 12.64

NA 0.65 13.29

NA

XXX 75891............. .............. A

Vein x-ray, liver..... 1.14 13.01

NA 0.70 14.85

NA

XXX 75893............. 26............ A

Venous sampling by

0.54 0.18 0.18 0.02 0.74 0.74

XXX catheter. 75893............. TC............ A

Venous sampling by

0.00 12.64

NA 0.65 13.29

NA

XXX catheter. 75893............. .............. A

Venous sampling by

0.54 12.82

NA 0.67 14.03

NA

XXX catheter. 75894............. 26............ A

X-rays, transcath

1.31 0.43 0.43 0.08 1.82 1.82

XXX therapy. 75894............. TC............ A

X-rays, transcath

0.00 24.20

NA 1.27 25.47

NA

XXX therapy. 75894............. .............. A

X-rays, transcath

1.31 24.63

NA 1.35 27.29

NA

XXX therapy. 75896............. 26............ A

X-rays, transcath

1.31 0.45 0.45 0.05 1.81 1.81

XXX therapy. 75896............. TC............ A

X-rays, transcath

0.00 21.05

NA 1.10 22.15

NA

XXX therapy.

[[Page 70424]]

75896............. .............. A

X-rays, transcath

1.31 21.50

NA 1.15 23.96

NA

XXX therapy. 75898............. 26............ A

Follow-up angiography. 1.65 0.55 0.55 0.07 2.27 2.27

XXX 75898............. TC............ A

Follow-up angiography. 0.00 1.05

NA 0.06 1.11

NA

XXX 75898............. .............. A

Follow-up angiography. 1.65 1.60

NA 0.13 3.38

NA

XXX 75900............. 26............ A

Intravascular cath

0.49 0.16 0.16 0.03 0.68 0.68

XXX exchange. 75900............. TC............ C

Intravascular cath

0.00 0.00 0.00 0.00 0.00 0.00

XXX exchange. 75900............. .............. C

Intravascular cath

0.00 0.00 0.00 0.00 0.00 0.00

XXX exchange. 75901............. 26............ A

Remove cva device

0.49 0.16 0.16 0.02 0.67 0.67

XXX obstruct. 75901............. TC............ A

Remove cva device

0.00 1.31

NA 0.83 2.14

NA

XXX obstruct. 75901............. .............. A

Remove cva device

0.49 1.47

NA 0.85 2.81

NA

XXX obstruct. 75902............. 26............ A

Remove cva lumen

0.39 0.13 0.13 0.02 0.54 0.54

XXX obstruct. 75902............. TC............ A

Remove cva lumen

0.00 1.31

NA 0.83 2.14

NA

XXX obstruct. 75902............. .............. A

Remove cva lumen

0.39 1.44

NA 0.85 2.68

NA

XXX obstruct. 75940............. 26............ A

X-ray placement, vein

0.54 0.18 0.18 0.04 0.76 0.76

XXX filter. 75940............. TC............ A

X-ray placement, vein

0.00 12.64

NA 0.65 13.29

NA

XXX filter. 75940............. .............. A

X-ray placement, vein

0.54 12.82

NA 0.69 14.05

NA

XXX filter. 75945............. 26............ A

Intravascular us...... 0.40 0.14 0.14 0.04 0.58 0.58

XXX 75945............. TC............ A

Intravascular us...... 0.00 4.57

NA 0.24 4.81

NA

XXX 75945............. .............. A

Intravascular us...... 0.40 4.71

NA 0.28 5.39

NA

XXX 75946............. 26............ A

Intravascular us add-

0.40 0.14 0.14 0.05 0.59 0.59

ZZZ on. 75946............. TC............ C

Intravascular us add-

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ on. 75946............. .............. C

Intravascular us add-

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ on. 75952............. 26............ A

Endovasc repair abdom

4.49 1.49 1.49 0.43 6.41 6.41

XXX aorta. 75952............. TC............ C

Endovasc repair abdom

0.00 0.00 0.00 0.00 0.00 0.00

XXX aorta. 75952............. .............. C

Endovasc repair abdom

0.00 0.00 0.00 0.00 0.00 0.00

XXX aorta. 75953............. 26............ A

Abdom aneurysm endovas 1.36 0.45 0.45 0.13 1.94 1.94

XXX rpr. 75953............. TC............ C

Abdom aneurysm endovas 0.00 0.00 0.00 0.00 0.00 0.00

XXX rpr. 75953............. .............. C

Abdom aneurysm endovas 0.00 0.00 0.00 0.00 0.00 0.00

XXX rpr. 75954............. 26............ A

Iliac aneurysm endovas 2.25 0.78 0.78 0.15 3.18 3.18

XXX rpr. 75954............. TC............ C

Iliac aneurysm endovas 0.00 0.00 0.00 0.00 0.00 0.00

XXX rpr. 75954............. .............. C

Iliac aneurysm endovas 0.00 0.00 0.00 0.00 0.00 0.00

XXX rpr. 75956............. 26............ A

Xray, endovasc thor ao 7.00 2.71 2.71 0.69 10.40 10.40

XXX repr. 75956............. TC............ C

Xray, endovasc thor ao 0.00 0.00 0.00 0.00 0.00 0.00

XXX repr. 75956............. .............. C

Xray, endovasc thor ao 0.00 0.00 0.00 0.00 0.00 0.00

XXX repr. 75957............. 26............ A

Xray, endovasc thor ao 6.00 2.32 2.32 0.59 8.91 8.91

XXX repr. 75957............. TC............ C

Xray, endovasc thor ao 0.00 0.00 0.00 0.00 0.00 0.00

XXX repr. 75957............. .............. C

Xray, endovasc thor ao 0.00 0.00 0.00 0.00 0.00 0.00

XXX repr. 75958............. 26............ A

Xray, place prox ext

4.00 1.55 1.55 0.39 5.94 5.94

XXX thor ao. 75958............. TC............ C

Xray, place prox ext

0.00 0.00 0.00 0.00 0.00 0.00

XXX thor ao. 75958............. .............. C

Xray, place prox ext

0.00 0.00 0.00 0.00 0.00 0.00

XXX thor ao. 75959............. 26............ A

Xray, place dist ext

3.50 1.36 1.36 0.34 5.20 5.20

XXX thor ao. 75959............. TC............ C

Xray, place dist ext

0.00 0.00 0.00 0.00 0.00 0.00

XXX thor ao. 75959............. .............. C

Xray, place dist ext

0.00 0.00 0.00 0.00 0.00 0.00

XXX thor ao. 75960............. 26............ A

Transcath iv stent

0.82 0.28 0.28 0.05 1.15 1.15

XXX rs&i. 75960............. TC............ A

Transcath iv stent

0.00 14.94

NA 0.77 15.71

NA

XXX rs&i. 75960............. .............. A

Transcath iv stent

0.82 15.22

NA 0.82 16.86

NA

XXX rs&i. 75961............. 26............ A

Retrieval, broken

4.24 1.39 1.39 0.18 5.81 5.81

XXX catheter. 75961............. TC............ A

Retrieval, broken

0.00 10.53

NA 0.55 11.08

NA

XXX catheter. 75961............. .............. A

Retrieval, broken

4.24 11.92

NA 0.73 16.89

NA

XXX catheter. 75962............. 26............ A

Repair arterial

0.54 0.18 0.18 0.03 0.75 0.75

XXX blockage. 75962............. TC............ A

Repair arterial

0.00 15.79

NA 0.83 16.62

NA

XXX blockage. 75962............. .............. A

Repair arterial

0.54 15.97

NA 0.86 17.37

NA

XXX blockage. 75964............. 26............ A

Repair artery

0.36 0.12 0.12 0.03 0.51 0.51

ZZZ blockage, each. 75964............. TC............ A

Repair artery

0.00 8.41

NA 0.43 8.84

NA

ZZZ blockage, each. 75964............. .............. A

Repair artery

0.36 8.53

NA 0.46 9.35

NA

ZZZ blockage, each. 75966............. 26............ A

Repair arterial

1.31 0.46 0.46 0.06 1.83 1.83

XXX blockage. 75966............. TC............ A

Repair arterial

0.00 15.79

NA 0.83 16.62

NA

XXX blockage. 75966............. .............. A

Repair arterial

1.31 16.25

NA 0.89 18.45

NA

XXX blockage. 75968............. 26............ A

Repair artery

0.36 0.13 0.13 0.02 0.51 0.51

ZZZ blockage, each. 75968............. TC............ A

Repair artery

0.00 8.41

NA 0.43 8.84

NA

ZZZ blockage, each. 75968............. .............. A

Repair artery

0.36 8.54

NA 0.45 9.35

NA

ZZZ blockage, each. 75970............. 26............ A

Vascular biopsy....... 0.83 0.28 0.28 0.04 1.15 1.15

XXX 75970............. TC............ A

Vascular biopsy....... 0.00 11.57

NA 0.60 12.17

NA

XXX 75970............. .............. A

Vascular biopsy....... 0.83 11.85

NA 0.64 13.32

NA

XXX 75978............. 26............ A

Repair venous blockage 0.54 0.18 0.18 0.02 0.74 0.74

XXX 75978............. TC............ A

Repair venous blockage 0.00 15.79

NA 0.83 16.62

NA

XXX 75978............. .............. A

Repair venous blockage 0.54 15.97

NA 0.85 17.36

NA

XXX 75980............. 26............ A

Contrast xray exam

1.44 0.47 0.47 0.06 1.97 1.97

XXX bile duct. 75980............. TC............ A

Contrast xray exam

0.00 5.43

NA 0.29 5.72

NA

XXX bile duct. 75980............. .............. A

Contrast xray exam

1.44 5.90

NA 0.35 7.69

NA

XXX bile duct. 75982............. 26............ A

Contrast xray exam

1.44 0.47 0.47 0.06 1.97 1.97

XXX bile duct. 75982............. TC............ C

Contrast xray exam

0.00 0.00 0.00 0.00 0.00 0.00

XXX bile duct. 75982............. .............. C

Contrast xray exam

0.00 0.00 0.00 0.00 0.00 0.00

XXX bile duct. 75984............. 26............ A

Xray control catheter

0.72 0.23 0.23 0.03 0.98 0.98

XXX change. 75984............. TC............ A

Xray control catheter

0.00 1.96

NA 0.11 2.07

NA

XXX change.

[[Page 70425]]

75984............. .............. A

Xray control catheter

0.72 2.19

NA 0.14 3.05

NA

XXX change. 75989............. 26............ A

Abscess drainage under 1.19 0.39 0.39 0.05 1.63 1.63

XXX x-ray. 75989............. TC............ A

Abscess drainage under 0.00 3.16

NA 0.17 3.33

NA

XXX x-ray. 75989............. .............. A

Abscess drainage under 1.19 3.55

NA 0.22 4.96

NA

XXX x-ray. 75992............. 26............ A

Atherectomy, x-ray

0.54 0.19 0.19 0.03 0.76 0.76

XXX exam. 75992............. TC............ A

Atherectomy, x-ray

0.00 15.79

NA 0.83 16.62

NA

XXX exam. 75992............. .............. A

Atherectomy, x-ray

0.54 15.98

NA 0.86 17.38

NA

XXX exam. 75993............. 26............ A

Atherectomy, x-ray

0.36 0.13 0.13 0.02 0.51 0.51

ZZZ exam. 75993............. TC............ C

Atherectomy, x-ray

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ exam. 75993............. .............. C

Atherectomy, x-ray

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ exam. 75994............. 26............ A

Atherectomy, x-ray

1.31 0.46 0.46 0.07 1.84 1.84

XXX exam. 75994............. TC............ C

Atherectomy, x-ray

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 75994............. .............. C

Atherectomy, x-ray

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 75995............. 26............ A

Atherectomy, x-ray

1.31 0.47 0.47 0.05 1.83 1.83

XXX exam. 75995............. TC............ C

Atherectomy, x-ray

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 75995............. .............. C

Atherectomy, x-ray

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 75996............. 26............ A

Atherectomy, x-ray

0.36 0.12 0.12 0.02 0.50 0.50

ZZZ exam. 75996............. TC............ C

Atherectomy, x-ray

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ exam. 75996............. .............. C

Atherectomy, x-ray

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ exam. 75998............. 26............ A

Fluoroguide for vein

0.38 0.13 0.13 0.01 0.52 0.52

ZZZ device. 75998............. TC............ A

Fluoroguide for vein

0.00 1.31

NA 0.10 1.41

NA

ZZZ device. 75998............. .............. A

Fluoroguide for vein

0.38 1.44

NA 0.11 1.93

NA

ZZZ device. 76000............. 26............ A

Fluoroscope

0.17 0.05 0.05 0.01 0.23 0.23

XXX examination. 76000............. TC............ A

Fluoroscope

0.00 1.31

NA 0.07 1.38

NA

XXX examination. 76000............. .............. A

Fluoroscope

0.17 1.36

NA 0.08 1.61

NA

XXX examination. 76001............. 26............ A

Fluoroscope exam,

0.67 0.22 0.22 0.05 0.94 0.94

XXX extensive. 76001............. TC............ A

Fluoroscope exam,

0.00 2.63

NA 0.14 2.77

NA

XXX extensive. 76001............. .............. A

Fluoroscope exam,

0.67 2.85

NA 0.19 3.71

NA

XXX extensive. 76003............. 26............ A

Needle localization by 0.54 0.17 0.17 0.02 0.73 0.73

XXX x-ray. 76003............. TC............ A

Needle localization by 0.00 1.31

NA 0.07 1.38

NA

XXX x-ray. 76003............. .............. A

Needle localization by 0.54 1.48

NA 0.09 2.11

NA

XXX x-ray. 76005............. 26............ A

Fluoroguide for spine

0.60 0.15 0.15 0.03 0.78 0.78

XXX inject. 76005............. TC............ A

Fluoroguide for spine

0.00 1.31

NA 0.07 1.38

NA

XXX inject. 76005............. .............. A

Fluoroguide for spine

0.60 1.46

NA 0.10 2.16

NA

XXX inject. 76006............. .............. A

X-ray stress view..... 0.41 0.18 0.18 0.06 0.65 0.65

XXX 76010............. 26............ A

X-ray, nose to rectum. 0.18 0.06 0.06 0.01 0.25 0.25

XXX 76010............. TC............ A

X-ray, nose to rectum. 0.00 0.52

NA 0.02 0.54

NA

XXX 76010............. .............. A

X-ray, nose to rectum. 0.18 0.58

NA 0.03 0.79

NA

XXX 76012............. 26............ A

Percut vertebroplasty

1.31 0.47 0.47 0.10 1.88 1.88

XXX fluor. 76012............. TC............ C

Percut vertebroplasty

0.00 0.00 0.00 0.00 0.00 0.00

XXX fluor. 76012............. .............. C

Percut vertebroplasty

0.00 0.00 0.00 0.00 0.00 0.00

XXX fluor. 76013............. 26............ A

Percut vertebroplasty, 1.38 0.48 0.48 0.07 1.93 1.93

XXX ct. 76013............. TC............ C

Percut vertebroplasty, 0.00 0.00 0.00 0.00 0.00 0.00

XXX ct. 76013............. .............. C

Percut vertebroplasty, 0.00 0.00 0.00 0.00 0.00 0.00

XXX ct. 76020............. 26............ A

X-rays for bone age... 0.19 0.06 0.06 0.01 0.26 0.26

XXX 76020............. TC............ A

X-rays for bone age... 0.00 0.52

NA 0.02 0.54

NA

XXX 76020............. .............. A

X-rays for bone age... 0.19 0.58

NA 0.03 0.80

NA

XXX 76040............. 26............ A

X-rays, bone

0.27 0.09 0.09 0.01 0.37 0.37

XXX evaluation. 76040............. TC............ A

X-rays, bone

0.00 0.78

NA 0.05 0.83

NA

XXX evaluation. 76040............. .............. A

X-rays, bone

0.27 0.87

NA 0.06 1.20

NA

XXX evaluation. 76061............. 26............ A

X-rays, bone survey... 0.45 0.15 0.15 0.02 0.62 0.62

XXX 76061............. TC............ A

X-rays, bone survey... 0.00 1.00

NA 0.06 1.06

NA

XXX 76061............. .............. A

X-rays, bone survey... 0.45 1.15

NA 0.08 1.68

NA

XXX 76062............. 26............ A

X-rays, bone survey... 0.54 0.18 0.18 0.02 0.74 0.74

XXX 76062............. TC............ A

X-rays, bone survey... 0.00 1.44

NA 0.08 1.52

NA

XXX 76062............. .............. A

X-rays, bone survey... 0.54 1.62

NA 0.10 2.26

NA

XXX 76065............. 26............ A

X-rays, bone

0.70 0.23 0.23 0.03 0.96 0.96

XXX evaluation. 76065............. TC............ A

X-rays, bone

0.00 0.73

NA 0.05 0.78

NA

XXX evaluation. 76065............. .............. A

X-rays, bone

0.70 0.96

NA 0.08 1.74

NA

XXX evaluation. 76066............. 26............ A

Joint survey, single

0.31 0.10 0.10 0.02 0.43 0.43

XXX view. 76066............. TC............ A

Joint survey, single

0.00 1.11

NA 0.06 1.17

NA

XXX view. 76066............. .............. A

Joint survey, single

0.31 1.21

NA 0.08 1.60

NA

XXX view. 76070............. 26............ A

Ct bone density, axial 0.25 0.08 0.08 0.01 0.34 0.34

XXX 76070............. TC............ A

Ct bone density, axial 0.00 2.96

NA 0.16 3.12

NA

XXX 76070............. .............. A

Ct bone density, axial 0.25 3.04

NA 0.17 3.46

NA

XXX 76071............. 26............ A

Ct bone density,

0.22 0.07 0.07 0.01 0.30 0.30

XXX peripheral. 76071............. TC............ A

Ct bone density,

0.00 2.96

NA 0.05 3.01

NA

XXX peripheral. 76071............. .............. A

Ct bone density,

0.22 3.03

NA 0.06 3.31

NA

XXX peripheral. 76075............. 26............ A

Dxa bone density,

0.30 0.10 0.10 0.01 0.41 0.41

XXX axial. 76075............. TC............ A

Dxa bone density,

0.00 3.10

NA 0.17 3.27

NA

XXX axial. 76075............. .............. A

Dxa bone density,

0.30 3.20

NA 0.18 3.68

NA

XXX axial. 76076............. 26............ A

Dxa bone density/

0.22 0.08 0.08 0.01 0.31 0.31

XXX peripheral. 76076............. TC............ A

Dxa bone density/

0.00 0.75

NA 0.05 0.80

NA

XXX peripheral. 76076............. .............. A

Dxa bone density/

0.22 0.83

NA 0.06 1.11

NA

XXX peripheral. 76077............. 26............ A

Dxa bone density/v-

0.17 0.06 0.06 0.01 0.24 0.24

XXX fracture.

[[Page 70426]]

76077............. TC............ A

Dxa bone density/v-

0.00 0.75

NA 0.05 0.80

NA

XXX fracture. 76077............. .............. A

Dxa bone density/v-

0.17 0.81

NA 0.06 1.04

NA

XXX fracture. 76078............. 26............ A

Radiographic

0.20 0.07 0.07 0.01 0.28 0.28

XXX absorptiometry. 76078............. TC............ A

Radiographic

0.00 0.75

NA 0.05 0.80

NA

XXX absorptiometry. 76078............. .............. A

Radiographic

0.20 0.82

NA 0.06 1.08

NA

XXX absorptiometry. 76080............. 26............ A

X-ray exam of fistula. 0.54 0.18 0.18 0.02 0.74 0.74

XXX 76080............. TC............ A

X-ray exam of fistula. 0.00 1.05

NA 0.06 1.11

NA

XXX 76080............. .............. A

X-ray exam of fistula. 0.54 1.23

NA 0.08 1.85

NA

XXX 76082............. 26............ A

Computer mammogram add- 0.06 0.02 0.02 0.01 0.09 0.09

ZZZ on. 76082............. TC............ A

Computer mammogram add- 0.00 0.42

NA 0.01 0.43

NA

ZZZ on. 76082............. .............. A

Computer mammogram add- 0.06 0.44

NA 0.02 0.52

NA

ZZZ on. 76083............. 26............ A

Computer mammogram add- 0.06 0.02 0.02 0.01 0.09 0.09

ZZZ on. 76083............. TC............ A

Computer mammogram add- 0.00 0.42

NA 0.01 0.43

NA

ZZZ on. 76083............. .............. A

Computer mammogram add- 0.06 0.44

NA 0.02 0.52

NA

ZZZ on. 76086............. 26............ A

X-ray of mammary duct. 0.36 0.12 0.12 0.02 0.50 0.50

XXX 76086............. TC............ A

X-ray of mammary duct. 0.00 2.63

NA 0.14 2.77

NA

XXX 76086............. .............. A

X-ray of mammary duct. 0.36 2.75

NA 0.16 3.27

NA

XXX 76088............. 26............ A

X-ray of mammary ducts 0.45 0.15 0.15 0.02 0.62 0.62

XXX 76088............. TC............ A

X-ray of mammary ducts 0.00 3.67

NA 0.19 3.86

NA

XXX 76088............. .............. A

X-ray of mammary ducts 0.45 3.82

NA 0.21 4.48

NA

XXX 76090............. 26............ A

Mammogram, one breast. 0.70 0.23 0.23 0.03 0.96 0.96

XXX 76090............. TC............ A

Mammogram, one breast. 0.00 1.05

NA 0.06 1.11

NA

XXX 76090............. .............. A

Mammogram, one breast. 0.70 1.28

NA 0.09 2.07

NA

XXX 76091............. 26............ A

Mammogram, both

0.87 0.28 0.28 0.04 1.19 1.19

XXX breasts. 76091............. TC............ A

Mammogram, both

0.00 1.31

NA 0.07 1.38

NA

XXX breasts. 76091............. .............. A

Mammogram, both

0.87 1.59

NA 0.11 2.57

NA

XXX breasts. 76092............. 26............ A

Mammogram, screening.. 0.70 0.23 0.23 0.03 0.96 0.96

XXX 76092............. TC............ A

Mammogram, screening.. 0.00 1.23

NA 0.07 1.30

NA

XXX 76092............. .............. A

Mammogram, screening.. 0.70 1.46

NA 0.10 2.26

NA

XXX 76093............. 26............ A

Magnetic image, breast 1.63 0.53 0.53 0.07 2.23 2.23

XXX 76093............. TC............ A

Magnetic image, breast 0.00 17.67

NA 0.92 18.59

NA

XXX 76093............. .............. A

Magnetic image, breast 1.63 18.20

NA 0.99 20.82

NA

XXX 76094............. 26............ A

Magnetic image, both

1.63 0.53 0.53 0.07 2.23 2.23

XXX breasts. 76094............. TC............ A

Magnetic image, both

0.00 23.98

NA 1.24 25.22

NA

XXX breasts. 76094............. .............. A

Magnetic image, both

1.63 24.51

NA 1.31 27.45

NA

XXX breasts. 76095............. 26............ A

Stereotactic breast

1.59 0.52 0.52 0.09 2.20 2.20

XXX biopsy. 76095............. TC............ A

Stereotactic breast

0.00 7.18

NA 0.37 7.55

NA

XXX biopsy. 76095............. .............. A

Stereotactic breast

1.59 7.70

NA 0.46 9.75

NA

XXX biopsy. 76096............. 26............ A

X-ray of needle wire,

0.56 0.18 0.18 0.02 0.76 0.76

XXX breast. 76096............. TC............ A

X-ray of needle wire,

0.00 1.31

NA 0.07 1.38

NA

XXX breast. 76096............. .............. A

X-ray of needle wire,

0.56 1.49

NA 0.09 2.14

NA

XXX breast. 76098............. 26............ A

X-ray exam, breast

0.16 0.05 0.05 0.01 0.22 0.22

XXX specimen. 76098............. TC............ A

X-ray exam, breast

0.00 0.42

NA 0.02 0.44

NA

XXX specimen. 76098............. .............. A

X-ray exam, breast

0.16 0.47

NA 0.03 0.66

NA

XXX specimen. 76100............. 26............ A

X-ray exam of body

0.58 0.19 0.19 0.03 0.80 0.80

XXX section. 76100............. TC............ A

X-ray exam of body

0.00 1.25

NA 0.07 1.32

NA

XXX section. 76100............. .............. A

X-ray exam of body

0.58 1.44

NA 0.10 2.12

NA

XXX section. 76101............. 26............ A

Complex body section x- 0.58 0.19 0.19 0.03 0.80 0.80

XXX ray. 76101............. TC............ A

Complex body section x- 0.00 1.42

NA 0.08 1.50

NA

XXX ray. 76101............. .............. A

Complex body section x- 0.58 1.61

NA 0.11 2.30

NA

XXX ray. 76102............. 26............ A

Complex body section x- 0.58 0.19 0.19 0.03 0.80 0.80

XXX rays. 76102............. TC............ A

Complex body section x- 0.00 1.74

NA 0.11 1.85

NA

XXX rays. 76102............. .............. A

Complex body section x- 0.58 1.93

NA 0.14 2.65

NA

XXX rays. 76120............. 26............ A

Cine/video x-rays..... 0.38 0.13 0.13 0.02 0.53 0.53

XXX 76120............. TC............ A

Cine/video x-rays..... 0.00 1.05

NA 0.06 1.11

NA

XXX 76120............. .............. A

Cine/video x-rays..... 0.38 1.18

NA 0.08 1.64

NA

XXX 76125............. 26............ A

Cine/video x-rays add- 0.27 0.09 0.09 0.01 0.37 0.37

ZZZ on. 76125............. TC............ A

Cine/video x-rays add- 0.00 0.78

NA 0.05 0.83

NA

ZZZ on. 76125............. .............. A

Cine/video x-rays add- 0.27 0.87

NA 0.06 1.20

NA

ZZZ on. 76140............. .............. I

X-ray consultation.... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 76150............. .............. A

X-ray exam, dry

0.00 0.42

NA 0.02 0.44

NA

XXX process. 76350............. .............. C

Special x-ray contrast 0.00 0.00 0.00 0.00 0.00 0.00

XXX study. 76355............. 26............ A

Ct scan for

1.21 0.40 0.40 0.05 1.66 1.66

XXX localization. 76355............. TC............ A

Ct scan for

0.00 8.28

NA 0.42 8.70

NA

XXX localization. 76355............. .............. A

Ct scan for

1.21 8.68

NA 0.47 10.36

NA

XXX localization. 76360............. 26............ A

Ct scan for needle

1.16 0.38 0.38 0.05 1.59 1.59

XXX biopsy. 76360............. TC............ A

Ct scan for needle

0.00 8.28

NA 0.42 8.70

NA

XXX biopsy. 76360............. .............. A

Ct scan for needle

1.16 8.66

NA 0.47 10.29

NA

XXX biopsy. 76362............. 26............ A

Ct guide for tissue

3.99 1.30 1.30 0.18 5.47 5.47

XXX ablation. 76362............. TC............ A

Ct guide for tissue

0.00 8.28

NA 1.46 9.74

NA

XXX ablation. 76362............. .............. A

Ct guide for tissue

3.99 9.58

NA 1.64 15.21

NA

XXX ablation. 76370............. 26............ A

Ct scan for therapy

0.85 0.28 0.28 0.04 1.17 1.17

XXX guide. 76370............. TC............ A

Ct scan for therapy

0.00 2.96

NA 0.16 3.12

NA

XXX guide. 76370............. .............. A

Ct scan for therapy

0.85 3.24

NA 0.20 4.29

NA

XXX guide. 76376............. 26............ A

3d render w/o

0.20 0.07 0.07 0.02 0.29 0.29

XXX postprocess.

[[Page 70427]]

76376............. TC............ A

3d render w/o

0.00 3.43

NA 0.08 3.51

NA

XXX postprocess. 76376............. .............. A

3d render w/o

0.20 3.50

NA 0.10 3.80

NA

XXX postprocess. 76377............. 26............ A

3d rendering w/

0.79 0.27 0.27 0.08 1.14 1.14

XXX postprocess. 76377............. TC............ A

3d rendering w/

0.00 3.43

NA 0.31 3.74

NA

XXX postprocess. 76377............. .............. A

3d rendering w/

0.79 3.70

NA 0.39 4.88

NA

XXX postprocess. 76380............. 26............ A

CAT scan follow-up

0.98 0.32 0.32 0.04 1.34 1.34

XXX study. 76380............. TC............ A

CAT scan follow-up

0.00 3.51

NA 0.18 3.69

NA

XXX study. 76380............. .............. A

CAT scan follow-up

0.98 3.83

NA 0.22 5.03

NA

XXX study. 76390............. 26............ N

Mr spectroscopy....... +1.40 0.47 0.47 0.07 1.94 1.94

XXX 76390............. TC............ N

Mr spectroscopy....... +0.00 11.04 11.04 0.59 11.63 11.63

XXX 76390............. .............. N

Mr spectroscopy....... +1.40 11.51 11.51 0.66 13.57 13.57

XXX 76393............. 26............ A

Mr guidance for needle 1.50 0.50 0.50 0.09 2.09 2.09

XXX place. 76393............. TC............ A

Mr guidance for needle 0.00 11.23

NA 0.55 11.78

NA

XXX place. 76393............. .............. A

Mr guidance for needle 1.50 11.73

NA 0.64 13.87

NA

XXX place. 76394............. 26............ A

Mri for tissue

4.24 1.38 1.38 0.24 5.86 5.86

XXX ablation. 76394............. TC............ A

Mri for tissue

0.00 11.23

NA 1.57 12.80

NA

XXX ablation. 76394............. .............. A

Mri for tissue

4.24 12.61

NA 1.81 18.66

NA

XXX ablation. 76400............. 26............ A

Magnetic image, bone

1.60 0.52 0.52 0.07 2.19 2.19

XXX marrow. 76400............. TC............ A

Magnetic image, bone

0.00 11.23

NA 0.59 11.82

NA

XXX marrow. 76400............. .............. A

Magnetic image, bone

1.60 11.75

NA 0.66 14.01

NA

XXX marrow. 76496............. 26............ C

Fluoroscopic procedure 0.00 0.00 0.00 0.00 0.00 0.00

XXX 76496............. TC............ C

Fluoroscopic procedure 0.00 0.00 0.00 0.00 0.00 0.00

XXX 76496............. .............. C

Fluoroscopic procedure 0.00 0.00 0.00 0.00 0.00 0.00

XXX 76497............. 26............ C

Ct procedure.......... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 76497............. TC............ C

Ct procedure.......... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 76497............. .............. C

Ct procedure.......... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 76498............. 26............ C

Mri procedure......... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 76498............. TC............ C

Mri procedure......... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 76498............. .............. C

Mri procedure......... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 76499............. 26............ C

Radiographic procedure 0.00 0.00 0.00 0.00 0.00 0.00

XXX 76499............. TC............ C

Radiographic procedure 0.00 0.00 0.00 0.00 0.00 0.00

XXX 76499............. .............. C

Radiographic procedure 0.00 0.00 0.00 0.00 0.00 0.00

XXX 76506............. 26............ A

Echo exam of head..... 0.63 0.24 0.24 0.06 0.93 0.93

XXX 76506............. TC............ A

Echo exam of head..... 0.00 1.42

NA 0.08 1.50

NA

XXX 76506............. .............. A

Echo exam of head..... 0.63 1.66

NA 0.14 2.43

NA

XXX 76510............. 26............ A

Ophth us, b & quant a. 1.55 0.68 0.68 0.03 2.26 2.26

XXX 76510............. TC............ A

Ophth us, b & quant a. 0.00 2.19

NA 0.07 2.26

NA

XXX 76510............. .............. A

Ophth us, b & quant a. 1.55 2.87

NA 0.10 4.52

NA

XXX 76511............. 26............ A

Ophth us, quant a only 0.94 0.40 0.40 0.03 1.37 1.37

XXX 76511............. TC............ A

Ophth us, quant a only 0.00 2.04

NA 0.07 2.11

NA

XXX 76511............. .............. A

Ophth us, quant a only 0.94 2.44

NA 0.10 3.48

NA

XXX 76512............. 26............ A

Ophth us, b w/non-

0.94 0.42 0.42 0.02 1.38 1.38

XXX quant a. 76512............. TC............ A

Ophth us, b w/non-

0.00 1.82

NA 0.10 1.92

NA

XXX quant a. 76512............. .............. A

Ophth us, b w/non-

0.94 2.24

NA 0.12 3.30

NA

XXX quant a. 76513............. 26............ A

Echo exam of eye,

0.66 0.29 0.29 0.02 0.97 0.97

XXX water bath. 76513............. TC............ A

Echo exam of eye,

0.00 1.52

NA 0.10 1.62

NA

XXX water bath. 76513............. .............. A

Echo exam of eye,

0.66 1.81

NA 0.12 2.59

NA

XXX water bath. 76514............. 26............ A

Echo exam of eye,

0.17 0.08 0.08 0.01 0.26 0.26

XXX thickness. 76514............. TC............ A

Echo exam of eye,

0.00 0.05

NA 0.01 0.06

NA

XXX thickness. 76514............. .............. A

Echo exam of eye,

0.17 0.13

NA 0.02 0.32

NA

XXX thickness. 76516............. 26............ A

Echo exam of eye...... 0.54 0.24 0.24 0.01 0.79 0.79

XXX 76516............. TC............ A

Echo exam of eye...... 0.00 1.22

NA 0.07 1.29

NA

XXX 76516............. .............. A

Echo exam of eye...... 0.54 1.46

NA 0.08 2.08

NA

XXX 76519............. 26............ A

Echo exam of eye...... 0.54 0.24 0.24 0.01 0.79 0.79

XXX 76519............. TC............ A

Echo exam of eye...... 0.00 1.31

NA 0.07 1.38

NA

XXX 76519............. .............. A

Echo exam of eye...... 0.54 1.55

NA 0.08 2.17

NA

XXX 76529............. 26............ A

Echo exam of eye...... 0.57 0.24 0.24 0.02 0.83 0.83

XXX 76529............. TC............ A

Echo exam of eye...... 0.00 1.13

NA 0.08 1.21

NA

XXX 76529............. .............. A

Echo exam of eye...... 0.57 1.37

NA 0.10 2.04

NA

XXX 76536............. 26............ A

Us exam of head and

0.56 0.18 0.18 0.02 0.76 0.76

XXX neck. 76536............. TC............ A

Us exam of head and

0.00 1.42

NA 0.08 1.50

NA

XXX neck. 76536............. .............. A

Us exam of head and

0.56 1.60

NA 0.10 2.26

NA

XXX neck. 76604............. 26............ A

Us exam, chest, b-scan 0.55 0.18 0.18 0.02 0.75 0.75

XXX 76604............. TC............ A

Us exam, chest, b-scan 0.00 1.31

NA 0.07 1.38

NA

XXX 76604............. .............. A

Us exam, chest, b-scan 0.55 1.49

NA 0.09 2.13

NA

XXX 76645............. 26............ A

Us exam, breast(s).... 0.54 0.18 0.18 0.02 0.74 0.74

XXX 76645............. TC............ A

Us exam, breast(s).... 0.00 1.05

NA 0.06 1.11

NA

XXX 76645............. .............. A

Us exam, breast(s).... 0.54 1.23

NA 0.08 1.85

NA

XXX 76700............. 26............ A

Us exam, abdom,

0.81 0.27 0.27 0.04 1.12 1.12

XXX complete. 76700............. TC............ A

Us exam, abdom,

0.00 1.98

NA 0.11 2.09

NA

XXX complete. 76700............. .............. A

Us exam, abdom,

0.81 2.25

NA 0.15 3.21

NA

XXX complete. 76705............. 26............ A

Echo exam of abdomen.. 0.59 0.19 0.19 0.03 0.81 0.81

XXX 76705............. TC............ A

Echo exam of abdomen.. 0.00 1.42

NA 0.08 1.50

NA

XXX 76705............. .............. A

Echo exam of abdomen.. 0.59 1.61

NA 0.11 2.31

NA

XXX 76770............. 26............ A

Us exam abdo back

0.74 0.24 0.24 0.03 1.01 1.01

XXX wall, comp.

[[Page 70428]]

76770............. TC............ A

Us exam abdo back

0.00 1.98

NA 0.11 2.09

NA

XXX wall, comp. 76770............. .............. A

Us exam abdo back

0.74 2.22

NA 0.14 3.10

NA

XXX wall, comp. 76775............. 26............ A

Us exam abdo back

0.58 0.19 0.19 0.03 0.80 0.80

XXX wall, lim. 76775............. TC............ A

Us exam abdo back

0.00 1.42

NA 0.08 1.50

NA

XXX wall, lim. 76775............. .............. A

Us exam abdo back

0.58 1.61

NA 0.11 2.30

NA

XXX wall, lim. 76778............. 26............ A

Us exam kidney

0.74 0.24 0.24 0.03 1.01 1.01

XXX transplant. 76778............. TC............ A

Us exam kidney

0.00 1.98

NA 0.11 2.09

NA

XXX transplant. 76778............. .............. A

Us exam kidney

0.74 2.22

NA 0.14 3.10

NA

XXX transplant. 76800............. 26............ A

Us exam, spinal canal. 1.13 0.34 0.34 0.05 1.52 1.52

XXX 76800............. TC............ A

Us exam, spinal canal. 0.00 1.42

NA 0.08 1.50

NA

XXX 76800............. .............. A

Us exam, spinal canal. 1.13 1.76

NA 0.13 3.02

NA

XXX 76801............. 26............ A

Ob us /= 14 wks, sngl 0.99 0.34 0.34 0.04 1.37 1.37

XXX fetus. 76805............. TC............ A

Ob us >/= 14 wks, sngl 0.00 2.11

NA 0.12 2.23

NA

XXX fetus. 76805............. .............. A

Ob us >/= 14 wks, sngl 0.99 2.45

NA 0.16 3.60

NA

XXX fetus. 76810............. 26............ A

Ob us >/= 14 wks, addl 0.98 0.34 0.34 0.04 1.36 1.36

ZZZ fetus. 76810............. TC............ A

Ob us >/= 14 wks, addl 0.00 1.05

NA 0.22 1.27

NA

ZZZ fetus. 76810............. .............. A

Ob us >/= 14 wks, addl 0.98 1.39

NA 0.26 2.63

NA

ZZZ fetus. 76811............. 26............ A

Ob us, detailed, sngl

1.90 0.71 0.71 0.09 2.70 2.70

XXX fetus. 76811............. TC............ A

Ob us, detailed, sngl

0.00 3.54

NA 0.43 3.97

NA

XXX fetus. 76811............. .............. A

Ob us, detailed, sngl

1.90 4.25

NA 0.52 6.67

NA

XXX fetus. 76812............. 26............ A

Ob us, detailed, addl

1.78 0.66 0.66 0.08 2.52 2.52

ZZZ fetus. 76812............. TC............ A

Ob us, detailed, addl

0.00 1.05

NA 0.41 1.46

NA

ZZZ fetus. 76812............. .............. A

Ob us, detailed, addl

1.78 1.71

NA 0.49 3.98

NA

ZZZ fetus. 76815............. 26............ A

Ob us, limited,

0.65 0.23 0.23 0.03 0.91 0.91

XXX fetus(s). 76815............. TC............ A

Ob us, limited,

0.00 1.42

NA 0.08 1.50

NA

XXX fetus(s). 76815............. .............. A

Ob us, limited,

0.65 1.65

NA 0.11 2.41

NA

XXX fetus(s). 76816............. 26............ A

Ob us, follow-up, per

0.85 0.32 0.32 0.04 1.21 1.21

XXX fetus. 76816............. TC............ A

Ob us, follow-up, per

0.00 1.11

NA 0.06 1.17

NA

XXX fetus. 76816............. .............. A

Ob us, follow-up, per

0.85 1.43

NA 0.10 2.38

NA

XXX fetus. 76817............. 26............ A

Transvaginal us,

0.75 0.26 0.26 0.03 1.04 1.04

XXX obstetric. 76817............. TC............ A

Transvaginal us,

0.00 1.52

NA 0.06 1.58

NA

XXX obstetric. 76817............. .............. A

Transvaginal us,

0.75 1.78

NA 0.09 2.62

NA

XXX obstetric. 76818............. 26............ A

Fetal biophys profile

1.05 0.39 0.39 0.05 1.49 1.49

XXX w/nst. 76818............. TC............ A

Fetal biophys profile

0.00 1.61

NA 0.10 1.71

NA

XXX w/nst. 76818............. .............. A

Fetal biophys profile

1.05 2.00

NA 0.15 3.20

NA

XXX w/nst. 76819............. 26............ A

Fetal biophys profil w/ 0.77 0.28 0.28 0.03 1.08 1.08

XXX o nst. 76819............. TC............ A

Fetal biophys profil w/ 0.00 1.61

NA 0.10 1.71

NA

XXX o nst. 76819............. .............. A

Fetal biophys profil w/ 0.77 1.89

NA 0.13 2.79

NA

XXX o nst. 76820............. 26............ A

Umbilical artery echo. 0.50 0.19 0.19 0.03 0.72 0.72

XXX 76820............. TC............ A

Umbilical artery echo. 0.00 1.61

NA 0.12 1.73

NA

XXX 76820............. .............. A

Umbilical artery echo. 0.50 1.80

NA 0.15 2.45

NA

XXX 76821............. 26............ A

Middle cerebral artery 0.70 0.27 0.27 0.03 1.00 1.00

XXX echo. 76821............. TC............ A

Middle cerebral artery 0.00 1.61

NA 0.12 1.73

NA

XXX echo. 76821............. .............. A

Middle cerebral artery 0.70 1.88

NA 0.15 2.73

NA

XXX echo. 76825............. 26............ A

Echo exam of fetal

1.67 0.60 0.60 0.07 2.34 2.34

XXX heart. 76825............. TC............ A

Echo exam of fetal

0.00 1.98

NA 0.11 2.09

NA

XXX heart. 76825............. .............. A

Echo exam of fetal

1.67 2.58

NA 0.18 4.43

NA

XXX heart. 76826............. 26............ A

Echo exam of fetal

0.83 0.29 0.29 0.03 1.15 1.15

XXX heart. 76826............. TC............ A

Echo exam of fetal

0.00 0.71

NA 0.05 0.76

NA

XXX heart. 76826............. .............. A

Echo exam of fetal

0.83 1.00

NA 0.08 1.91

NA

XXX heart. 76827............. 26............ A

Echo exam of fetal

0.58 0.21 0.21 0.02 0.81 0.81

XXX heart. 76827............. TC............ A

Echo exam of fetal

0.00 1.72

NA 0.12 1.84

NA

XXX heart. 76827............. .............. A

Echo exam of fetal

0.58 1.93

NA 0.14 2.65

NA

XXX heart. 76828............. 26............ A

Echo exam of fetal

0.56 0.22 0.22 0.03 0.81 0.81

XXX heart. 76828............. TC............ A

Echo exam of fetal

0.00 1.11

NA 0.08 1.19

NA

XXX heart. 76828............. .............. A

Echo exam of fetal

0.56 1.33

NA 0.11 2.00

NA

XXX heart. 76830............. 26............ A

Transvaginal us, non-

0.69 0.23 0.23 0.03 0.95 0.95

XXX ob. 76830............. TC............ A

Transvaginal us, non-

0.00 1.52

NA 0.10 1.62

NA

XXX ob. 76830............. .............. A

Transvaginal us, non-

0.69 1.75

NA 0.13 2.57

NA

XXX ob. 76831............. 26............ A

Echo exam, uterus..... 0.72 0.25 0.25 0.03 1.00 1.00

XXX 76831............. TC............ A

Echo exam, uterus..... 0.00 1.52

NA 0.10 1.62

NA

XXX 76831............. .............. A

Echo exam, uterus..... 0.72 1.77

NA 0.13 2.62

NA

XXX 76856............. 26............ A

Us exam, pelvic,

0.69 0.23 0.23 0.03 0.95 0.95

XXX complete. 76856............. TC............ A

Us exam, pelvic,

0.00 1.52

NA 0.10 1.62

NA

XXX complete. 76856............. .............. A

Us exam, pelvic,

0.69 1.75

NA 0.13 2.57

NA

XXX complete. 76857............. 26............ A

Us exam, pelvic,

0.38 0.12 0.12 0.02 0.52 0.52

XXX limited. 76857............. TC............ A

Us exam, pelvic,

0.00 1.71

NA 0.06 1.77

NA

XXX limited. 76857............. .............. A

Us exam, pelvic,

0.38 1.83

NA 0.08 2.29

NA

XXX limited. 76870............. 26............ A

Us exam, scrotum...... 0.64 0.21 0.21 0.03 0.88 0.88

XXX

[[Page 70429]]

76870............. TC............ A

Us exam, scrotum...... 0.00 1.52

NA 0.10 1.62

NA

XXX 76870............. .............. A

Us exam, scrotum...... 0.64 1.73

NA 0.13 2.50

NA

XXX 76872............. 26............ A

Us, transrectal....... 0.69 0.22 0.22 0.04 0.95 0.95

XXX 76872............. TC............ A

Us, transrectal....... 0.00 2.03

NA 0.10 2.13

NA

XXX 76872............. .............. A

Us, transrectal....... 0.69 2.25

NA 0.14 3.08

NA

XXX 76873............. 26............ A

Echograp trans r, pros 1.55 0.50 0.50 0.09 2.14 2.14

XXX study. 76873............. TC............ A

Echograp trans r, pros 0.00 2.11

NA 0.16 2.27

NA

XXX study. 76873............. .............. A

Echograp trans r, pros 1.55 2.61

NA 0.25 4.41

NA

XXX study. 76880............. 26............ A

Us exam, extremity.... 0.59 0.19 0.19 0.03 0.81 0.81

XXX 76880............. TC............ A

Us exam, extremity.... 0.00 1.42

NA 0.08 1.50

NA

XXX 76880............. .............. A

Us exam, extremity.... 0.59 1.61

NA 0.11 2.31

NA

XXX 76885............. 26............ A

Us exam infant hips,

0.74 0.24 0.24 0.03 1.01 1.01

XXX dynamic. 76885............. TC............ A

Us exam infant hips,

0.00 1.52

NA 0.10 1.62

NA

XXX dynamic. 76885............. .............. A

Us exam infant hips,

0.74 1.76

NA 0.13 2.63

NA

XXX dynamic. 76886............. 26............ A

Us exam infant hips,

0.62 0.20 0.20 0.03 0.85 0.85

XXX static. 76886............. TC............ A

Us exam infant hips,

0.00 1.42

NA 0.08 1.50

NA

XXX static. 76886............. .............. A

Us exam infant hips,

0.62 1.62

NA 0.11 2.35

NA

XXX static. 76930............. 26............ A

Echo guide,

0.67 0.25 0.25 0.02 0.94 0.94

XXX cardiocentesis. 76930............. TC............ A

Echo guide,

0.00 1.52

NA 0.10 1.62

NA

XXX cardiocentesis. 76930............. .............. A

Echo guide,

0.67 1.77

NA 0.12 2.56

NA

XXX cardiocentesis. 76932............. 26............ A

Echo guide for heart

0.67 0.25 0.25 0.02 0.94 0.94

XXX biopsy. 76932............. TC............ A

Echo guide for heart

0.00 1.52

NA 0.10 1.62

NA

XXX biopsy. 76932............. .............. A

Echo guide for heart

0.67 1.77

NA 0.12 2.56

NA

XXX biopsy. 76936............. 26............ A

Echo guide for artery

1.99 0.66 0.66 0.13 2.78 2.78

XXX repair. 76936............. TC............ A

Echo guide for artery

0.00 6.31

NA 0.34 6.65

NA

XXX repair. 76936............. .............. A

Echo guide for artery

1.99 6.97

NA 0.47 9.43

NA

XXX repair. 76937............. 26............ A

Us guide, vascular

0.30 0.10 0.10 0.03 0.43 0.43

ZZZ access. 76937............. TC............ A

Us guide, vascular

0.00 0.38

NA 0.10 0.48

NA

ZZZ access. 76937............. .............. A

Us guide, vascular

0.30 0.48

NA 0.13 0.91

NA

ZZZ access. 76940............. 26............ A

Us guide, tissue

2.00 0.65 0.65 0.31 2.96 2.96

XXX ablation. 76940............. TC............ A

Us guide, tissue

0.00 1.52

NA 0.29 1.81

NA

XXX ablation. 76940............. .............. A

Us guide, tissue

2.00 2.17

NA 0.60 4.77

NA

XXX ablation. 76941............. 26............ A

Echo guide for

1.34 0.47 0.47 0.07 1.88 1.88

XXX transfusion. 76941............. TC............ A

Echo guide for

0.00 1.53

NA 0.08 1.61

NA

XXX transfusion. 76941............. .............. A

Echo guide for

1.34 2.00

NA 0.15 3.49

NA

XXX transfusion. 76942............. 26............ A

Echo guide for biopsy. 0.67 0.22 0.22 0.03 0.92 0.92

XXX 76942............. TC............ A

Echo guide for biopsy. 0.00 2.82

NA 0.10 2.92

NA

XXX 76942............. .............. A

Echo guide for biopsy. 0.67 3.04

NA 0.13 3.84

NA

XXX 76945............. 26............ A

Echo guide, villus

0.67 0.22 0.22 0.03 0.92 0.92

XXX sampling. 76945............. TC............ A

Echo guide, villus

0.00 1.53

NA 0.08 1.61

NA

XXX sampling. 76945............. .............. A

Echo guide, villus

0.67 1.75

NA 0.11 2.53

NA

XXX sampling. 76946............. 26............ A

Echo guide for

0.38 0.14 0.14 0.02 0.54 0.54

XXX amniocentesis. 76946............. TC............ A

Echo guide for

0.00 1.52

NA 0.10 1.62

NA

XXX amniocentesis. 76946............. .............. A

Echo guide for

0.38 1.66

NA 0.12 2.16

NA

XXX amniocentesis. 76948............. 26............ A

Echo guide, ova

0.38 0.13 0.13 0.02 0.53 0.53

XXX aspiration. 76948............. TC............ A

Echo guide, ova

0.00 1.52

NA 0.10 1.62

NA

XXX aspiration. 76948............. .............. A

Echo guide, ova

0.38 1.65

NA 0.12 2.15

NA

XXX aspiration. 76950............. 26............ A

Echo guidance

0.58 0.19 0.19 0.03 0.80 0.80

XXX radiotherapy. 76950............. TC............ A

Echo guidance

0.00 1.31

NA 0.07 1.38

NA

XXX radiotherapy. 76950............. .............. A

Echo guidance

0.58 1.50

NA 0.10 2.18

NA

XXX radiotherapy. 76965............. 26............ A

Echo guidance

1.34 0.43 0.43 0.08 1.85 1.85

XXX radiotherapy. 76965............. TC............ A

Echo guidance

0.00 5.59

NA 0.29 5.88

NA

XXX radiotherapy. 76965............. .............. A

Echo guidance

1.34 6.02

NA 0.37 7.73

NA

XXX radiotherapy. 76970............. 26............ A

Ultrasound exam follow- 0.40 0.13 0.13 0.02 0.55 0.55

XXX up. 76970............. TC............ A

Ultrasound exam follow- 0.00 1.05

NA 0.06 1.11

NA

XXX up. 76970............. .............. A

Ultrasound exam follow- 0.40 1.18

NA 0.08 1.66

NA

XXX up. 76975............. 26............ A

GI endoscopic

0.81 0.28 0.28 0.04 1.13 1.13

XXX ultrasound. 76975............. TC............ A

GI endoscopic

0.00 1.52

NA 0.10 1.62

NA

XXX ultrasound. 76975............. .............. A

GI endoscopic

0.81 1.80

NA 0.14 2.75

NA

XXX ultrasound. 76977............. 26............ A

Us bone density

0.05 0.02 0.02 0.01 0.08 0.08

XXX measure. 76977............. TC............ A

Us bone density

0.00 0.82

NA 0.05 0.87

NA

XXX measure. 76977............. .............. A

Us bone density

0.05 0.84

NA 0.06 0.95

NA

XXX measure. 76986............. 26............ A

Ultrasound guide

1.20 0.40 0.40 0.13 1.73 1.73

XXX intraoper. 76986............. TC............ A

Ultrasound guide

0.00 2.63

NA 0.14 2.77

NA

XXX intraoper. 76986............. .............. A

Ultrasound guide

1.20 3.03

NA 0.27 4.50

NA

XXX intraoper. 76999............. 26............ C

Echo examination

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 76999............. TC............ C

Echo examination

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 76999............. .............. C

Echo examination

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 77261............. .............. A

Radiation therapy

1.39 0.51 0.51 0.07 1.97 1.97

XXX planning. 77262............. .............. A

Radiation therapy

2.11 0.75 0.75 0.11 2.97 2.97

XXX planning. 77263............. .............. A

Radiation therapy

3.14 1.11 1.11 0.16 4.41 4.41

XXX planning. 77280............. 26............ A

Set radiation therapy

0.70 0.22 0.22 0.04 0.96 0.96

XXX field. 77280............. TC............ A

Set radiation therapy

0.00 3.48

NA 0.18 3.66

NA

XXX field. 77280............. .............. A

Set radiation therapy

0.70 3.70

NA 0.22 4.62

NA

XXX field. 77285............. 26............ A

Set radiation therapy

1.05 0.34 0.34 0.05 1.44 1.44

XXX field.

[[Page 70430]]

77285............. TC............ A

Set radiation therapy

0.00 5.59

NA 0.30 5.89

NA

XXX field. 77285............. .............. A

Set radiation therapy

1.05 5.93

NA 0.35 7.33

NA

XXX field. 77290............. 26............ A

Set radiation therapy

1.56 0.50 0.50 0.08 2.14 2.14

XXX field. 77290............. TC............ A

Set radiation therapy

0.00 6.53

NA 0.35 6.88

NA

XXX field. 77290............. .............. A

Set radiation therapy

1.56 7.03

NA 0.43 9.02

NA

XXX field. 77295............. 26............ A

Set radiation therapy

4.56 1.46 1.46 0.23 6.25 6.25

XXX field. 77295............. TC............ A

Set radiation therapy

0.00 28.01

NA 1.48 29.49

NA

XXX field. 77295............. .............. A

Set radiation therapy

4.56 29.47

NA 1.71 35.74

NA

XXX field. 77299............. 26............ C

Radiation therapy

0.00 0.00 0.00 0.00 0.00 0.00

XXX planning. 77299............. TC............ C

Radiation therapy

0.00 0.00 0.00 0.00 0.00 0.00

XXX planning. 77299............. .............. C

Radiation therapy

0.00 0.00 0.00 0.00 0.00 0.00

XXX planning. 77300............. 26............ A

Radiation therapy dose 0.62 0.20 0.20 0.03 0.85 0.85

XXX plan. 77300............. TC............ A

Radiation therapy dose 0.00 1.34

NA 0.07 1.41

NA

XXX plan. 77300............. .............. A

Radiation therapy dose 0.62 1.54

NA 0.10 2.26

NA

XXX plan. 77301............. 26............ A

Radiotherapy dose

7.99 2.57 2.57 0.40 10.96 10.96

XXX plan, imrt. 77301............. TC............ A

Radiotherapy dose

0.00 28.01

NA 1.48 29.49

NA

XXX plan, imrt. 77301............. .............. A

Radiotherapy dose

7.99 30.58

NA 1.88 40.45

NA

XXX plan, imrt. 77305............. 26............ A

Teletx isodose plan

0.70 0.23 0.23 0.04 0.97 0.97

XXX simple. 77305............. TC............ A

Teletx isodose plan

0.00 1.87

NA 0.11 1.98

NA

XXX simple. 77305............. .............. A

Teletx isodose plan

0.70 2.10

NA 0.15 2.95

NA

XXX simple. 77310............. 26............ A

Teletx isodose plan

1.05 0.34 0.34 0.05 1.44 1.44

XXX intermed. 77310............. TC............ A

Teletx isodose plan

0.00 2.34

NA 0.13 2.47

NA

XXX intermed. 77310............. .............. A

Teletx isodose plan

1.05 2.68

NA 0.18 3.91

NA

XXX intermed. 77315............. 26............ A

Teletx isodose plan

1.56 0.50 0.50 0.08 2.14 2.14

XXX complex. 77315............. TC............ A

Teletx isodose plan

0.00 2.67

NA 0.14 2.81

NA

XXX complex. 77315............. .............. A

Teletx isodose plan

1.56 3.17

NA 0.22 4.95

NA

XXX complex. 77321............. 26............ A

Special teletx port

0.95 0.30 0.30 0.05 1.30 1.30

XXX plan. 77321............. TC............ A

Special teletx port

0.00 4.05

NA 0.21 4.26

NA

XXX plan. 77321............. .............. A

Special teletx port

0.95 4.35

NA 0.26 5.56

NA

XXX plan. 77326............. 26............ A

Brachytx isodose calc

0.93 0.30 0.30 0.05 1.28 1.28

XXX simp. 77326............. TC............ A

Brachytx isodose calc

0.00 2.37

NA 0.13 2.50

NA

XXX simp. 77326............. .............. A

Brachytx isodose calc

0.93 2.67

NA 0.18 3.78

NA

XXX simp. 77327............. 26............ A

Brachytx isodose calc

1.39 0.44 0.44 0.07 1.90 1.90

XXX interm. 77327............. TC............ A

Brachytx isodose calc

0.00 3.48

NA 0.18 3.66

NA

XXX interm. 77327............. .............. A

Brachytx isodose calc

1.39 3.92

NA 0.25 5.56

NA

XXX interm. 77328............. 26............ A

Brachytx isodose plan

2.09 0.67 0.67 0.11 2.87 2.87

XXX compl. 77328............. TC............ A

Brachytx isodose plan

0.00 4.97

NA 0.25 5.22

NA

XXX compl. 77328............. .............. A

Brachytx isodose plan

2.09 5.64

NA 0.36 8.09

NA

XXX compl. 77331............. 26............ A

Special radiation

0.87 0.28 0.28 0.04 1.19 1.19

XXX dosimetry. 77331............. TC............ A

Special radiation

0.00 0.50

NA 0.02 0.52

NA

XXX dosimetry. 77331............. .............. A

Special radiation

0.87 0.78

NA 0.06 1.71

NA

XXX dosimetry. 77332............. 26............ A

Radiation treatment

0.54 0.17 0.17 0.03 0.74 0.74

XXX aid(s). 77332............. TC............ A

Radiation treatment

0.00 1.34

NA 0.07 1.41

NA

XXX aid(s). 77332............. .............. A

Radiation treatment

0.54 1.51

NA 0.10 2.15

NA

XXX aid(s). 77333............. 26............ A

Radiation treatment

0.84 0.27 0.27 0.04 1.15 1.15

XXX aid(s). 77333............. TC............ A

Radiation treatment

0.00 1.90

NA 0.11 2.01

NA

XXX aid(s). 77333............. .............. A

Radiation treatment

0.84 2.17

NA 0.15 3.16

NA

XXX aid(s). 77334............. 26............ A

Radiation treatment

1.24 0.40 0.40 0.06 1.70 1.70

XXX aid(s). 77334............. TC............ A

Radiation treatment

0.00 3.26

NA 0.17 3.43

NA

XXX aid(s). 77334............. .............. A

Radiation treatment

1.24 3.66

NA 0.23 5.13

NA

XXX aid(s). 77336............. .............. A

Radiation physics

0.00 2.99

NA 0.16 3.15

NA

XXX consult. 77370............. .............. A

Radiation physics

0.00 3.50

NA 0.18 3.68

NA

XXX consult. 77399............. 26............ C

External radiation

0.00 0.00 0.00 0.00 0.00 0.00

XXX dosimetry. 77399............. TC............ C

External radiation

0.00 0.00 0.00 0.00 0.00 0.00

XXX dosimetry. 77399............. .............. C

External radiation

0.00 0.00 0.00 0.00 0.00 0.00

XXX dosimetry. 77401............. .............. A

Radiation treatment

0.00 1.78

NA 0.11 1.89

NA

XXX delivery. 77402............. .............. A

Radiation treatment

0.00 1.78

NA 0.11 1.89

NA

XXX delivery. 77403............. .............. A

Radiation treatment

0.00 1.78

NA 0.11 1.89

NA

XXX delivery. 77404............. .............. A

Radiation treatment

0.00 1.78

NA 0.11 1.89

NA

XXX delivery. 77406............. .............. A

Radiation treatment

0.00 1.78

NA 0.11 1.89

NA

XXX delivery. 77407............. .............. A

Radiation treatment

0.00 2.10

NA 0.12 2.22

NA

XXX delivery. 77408............. .............. A

Radiation treatment

0.00 2.10

NA 0.12 2.22

NA

XXX delivery. 77409............. .............. A

Radiation treatment

0.00 2.10

NA 0.12 2.22

NA

XXX delivery. 77411............. .............. A

Radiation treatment

0.00 2.10

NA 0.12 2.22

NA

XXX delivery. 77412............. .............. A

Radiation treatment

0.00 2.34

NA 0.13 2.47

NA

XXX delivery. 77413............. .............. A

Radiation treatment

0.00 2.34

NA 0.13 2.47

NA

XXX delivery. 77414............. .............. A

Radiation treatment

0.00 2.34

NA 0.13 2.47

NA

XXX delivery. 77416............. .............. A

Radiation treatment

0.00 2.34

NA 0.13 2.47

NA

XXX delivery. 77417............. .............. A

Radiology port film(s) 0.00 0.59

NA 0.04 0.63

NA

XXX 77418............. .............. A

Radiation tx delivery, 0.00 18.07

NA 0.13 18.20

NA

XXX imrt. 77421............. 26............ A

Stereoscopic x-ray

0.39 0.13 0.13 0.02 0.54 0.54

XXX guidance. 77421............. TC............ A

Stereoscopic x-ray

0.00 3.36

NA 0.10 3.46

NA

XXX guidance. 77421............. .............. A

Stereoscopic x-ray

0.39 3.49

NA 0.12 4.00

NA

XXX guidance. 77422............. .............. A

Neutron beam tx,

0.00 1.71

NA 0.13 1.84

NA

XXX simple. 77423............. .............. A

Neutron beam tx,

0.00 2.26

NA 0.13 2.39

NA

XXX complex.

[[Page 70431]]

77427............. .............. A

Radiation tx

3.31 1.06 1.06 0.17 4.54 4.54

XXX management, x5. 77431............. .............. A

Radiation therapy

1.81 0.68 0.68 0.09 2.58 2.58

XXX management. 77432............. .............. A

Stereotactic radiation 7.92 2.91 2.91 0.41 11.24 11.24

XXX trmt. 77470............. 26............ A

Special radiation

2.09 0.67 0.67 0.11 2.87 2.87

XXX treatment. 77470............. TC............ A

Special radiation

0.00 11.18

NA 0.59 11.77

NA

XXX treatment. 77470............. .............. A

Special radiation

2.09 11.85

NA 0.70 14.64

NA

XXX treatment. 77499............. 26............ C

Radiation therapy

0.00 0.00 0.00 0.00 0.00 0.00

XXX management. 77499............. TC............ C

Radiation therapy

0.00 0.00 0.00 0.00 0.00 0.00

XXX management. 77499............. .............. C

Radiation therapy

0.00 0.00 0.00 0.00 0.00 0.00

XXX management. 77520............. .............. C

Proton trmt, simple w/ 0.00 0.00 0.00 0.00 0.00 0.00

XXX o comp. 77522............. .............. C

Proton trmt, simple w/ 0.00 0.00 0.00 0.00 0.00 0.00

XXX comp. 77523............. .............. C

Proton trmt,

0.00 0.00 0.00 0.00 0.00 0.00

XXX intermediate. 77525............. .............. C

Proton treatment,

0.00 0.00 0.00 0.00 0.00 0.00

XXX complex. 77600............. 26............ R

Hyperthermia treatment 1.56 0.50 0.50 0.08 2.14 2.14

XXX 77600............. TC............ R

Hyperthermia treatment 0.00 3.06

NA 0.16 3.22

NA

XXX 77600............. .............. R

Hyperthermia treatment 1.56 3.56

NA 0.24 5.36

NA

XXX 77605............. 26............ R

Hyperthermia treatment 2.09 0.66 0.66 0.16 2.91 2.91

XXX 77605............. TC............ R

Hyperthermia treatment 0.00 4.07

NA 0.22 4.29

NA

XXX 77605............. .............. R

Hyperthermia treatment 2.09 4.73

NA 0.38 7.20

NA

XXX 77610............. 26............ R

Hyperthermia treatment 1.56 0.51 0.51 0.08 2.15 2.15

XXX 77610............. TC............ R

Hyperthermia treatment 0.00 3.06

NA 0.16 3.22

NA

XXX 77610............. .............. R

Hyperthermia treatment 1.56 3.57

NA 0.24 5.37

NA

XXX 77615............. 26............ R

Hyperthermia treatment 2.09 0.66 0.66 0.11 2.86 2.86

XXX 77615............. TC............ R

Hyperthermia treatment 0.00 4.07

NA 0.22 4.29

NA

XXX 77615............. .............. R

Hyperthermia treatment 2.09 4.73

NA 0.33 7.15

NA

XXX 77620............. 26............ R

Hyperthermia treatment 1.56 0.52 0.52 0.20 2.28 2.28

XXX 77620............. TC............ R

Hyperthermia treatment 0.00 3.06

NA 0.16 3.22

NA

XXX 77620............. .............. R

Hyperthermia treatment 1.56 3.58

NA 0.36 5.50

NA

XXX 77750............. 26............ A

Infuse radioactive

4.90 1.58 1.58 0.25 6.73 6.73

090 materials. 77750............. TC............ A

Infuse radioactive

0.00 1.33

NA 0.07 1.40

NA

090 materials. 77750............. .............. A

Infuse radioactive

4.90 2.91

NA 0.32 8.13

NA

090 materials. 77761............. 26............ A

Apply intrcav radiat

3.80 1.09 1.09 0.19 5.08 5.08

090 simple. 77761............. TC............ A

Apply intrcav radiat

0.00 2.51

NA 0.14 2.65

NA

090 simple. 77761............. .............. A

Apply intrcav radiat

3.80 3.60

NA 0.33 7.73

NA

090 simple. 77762............. 26............ A

Apply intrcav radiat

5.71 1.84 1.84 0.29 7.84 7.84

090 interm. 77762............. TC............ A

Apply intrcav radiat

0.00 3.62

NA 0.19 3.81

NA

090 interm. 77762............. .............. A

Apply intrcav radiat

5.71 5.46

NA 0.48 11.65

NA

090 interm. 77763............. 26............ A

Apply intrcav radiat

8.56 2.75 2.75 0.43 11.74 11.74

090 compl. 77763............. TC............ A

Apply intrcav radiat

0.00 4.50

NA 0.23 4.73

NA

090 compl. 77763............. .............. A

Apply intrcav radiat

8.56 7.25

NA 0.66 16.47

NA

090 compl. 77776............. 26............ A

Apply interstit radiat 4.65 0.95 0.95 0.44 6.04 6.04

090 simpl. 77776............. TC............ A

Apply interstit radiat 0.00 2.19

NA 0.13 2.32

NA

090 simpl. 77776............. .............. A

Apply interstit radiat 4.65 3.14

NA 0.57 8.36

NA

090 simpl. 77777............. 26............ A

Apply interstit radiat 7.47 2.38 2.38 0.39 10.24 10.24

090 inter. 77777............. TC............ A

Apply interstit radiat 0.00 4.24

NA 0.22 4.46

NA

090 inter. 77777............. .............. A

Apply interstit radiat 7.47 6.62

NA 0.61 14.70

NA

090 inter. 77778............. 26............ A

Apply interstit radiat 11.17 3.58 3.58 0.57 15.32 15.32

090 compl. 77778............. TC............ A

Apply interstit radiat 0.00 5.14

NA 0.27 5.41

NA

090 compl. 77778............. .............. A

Apply interstit radiat 11.17 8.72

NA 0.84 20.73

NA

090 compl. 77781............. 26............ A

High intensity

1.66 0.53 0.53 0.08 2.27 2.27

090 brachytherapy. 77781............. TC............ A

High intensity

0.00 20.36

NA 1.06 21.42

NA

090 brachytherapy. 77781............. .............. A

High intensity

1.66 20.89

NA 1.14 23.69

NA

090 brachytherapy. 77782............. 26............ A

High intensity

2.49 0.80 0.80 0.13 3.42 3.42

090 brachytherapy. 77782............. TC............ A

High intensity

0.00 20.36

NA 1.06 21.42

NA

090 brachytherapy. 77782............. .............. A

High intensity

2.49 21.16

NA 1.19 24.84

NA

090 brachytherapy. 77783............. 26............ A

High intensity

3.72 1.19 1.19 0.19 5.10 5.10

090 brachytherapy. 77783............. TC............ A

High intensity

0.00 20.36

NA 1.06 21.42

NA

090 brachytherapy. 77783............. .............. A

High intensity

3.72 21.55

NA 1.25 26.52

NA

090 brachytherapy. 77784............. 26............ A

High intensity

5.60 1.80 1.80 0.29 7.69 7.69

090 brachytherapy. 77784............. TC............ A

High intensity

0.00 20.36

NA 1.06 21.42

NA

090 brachytherapy. 77784............. .............. A

High intensity

5.60 22.16

NA 1.35 29.11

NA

090 brachytherapy. 77789............. 26............ A

Apply surface

1.12 0.37 0.37 0.06 1.55 1.55

000 radiation. 77789............. TC............ A

Apply surface

0.00 0.45

NA 0.02 0.47

NA

000 radiation. 77789............. .............. A

Apply surface

1.12 0.82

NA 0.08 2.02

NA

000 radiation. 77790............. 26............ A

Radiation handling.... 1.05 0.34 0.34 0.05 1.44 1.44

XXX 77790............. TC............ A

Radiation handling.... 0.00 0.50

NA 0.02 0.52

NA

XXX 77790............. .............. A

Radiation handling.... 1.05 0.84

NA 0.07 1.96

NA

XXX 77799............. 26............ C

Radium/radioisotope

0.00 0.00 0.00 0.00 0.00 0.00

XXX therapy. 77799............. TC............ C

Radium/radioisotope

0.00 0.00 0.00 0.00 0.00 0.00

XXX therapy. 77799............. .............. C

Radium/radioisotope

0.00 0.00 0.00 0.00 0.00 0.00

XXX therapy. 78000............. 26............ A

Thyroid, single uptake 0.19 0.06 0.06 0.01 0.26 0.26

XXX 78000............. TC............ A

Thyroid, single uptake 0.00 0.97

NA 0.06 1.03

NA

XXX 78000............. .............. A

Thyroid, single uptake 0.19 1.03

NA 0.07 1.29

NA

XXX 78001............. 26............ A

Thyroid, multiple

0.26 0.09 0.09 0.01 0.36 0.36

XXX uptakes. 78001............. TC............ A

Thyroid, multiple

0.00 1.31

NA 0.07 1.38

NA

XXX uptakes.

[[Page 70432]]

78001............. .............. A

Thyroid, multiple

0.26 1.40

NA 0.08 1.74

NA

XXX uptakes. 78003............. 26............ A

Thyroid suppress/

0.33 0.11 0.11 0.01 0.45 0.45

XXX stimul. 78003............. TC............ A

Thyroid suppress/

0.00 0.97

NA 0.06 1.03

NA

XXX stimul. 78003............. .............. A

Thyroid suppress/

0.33 1.08

NA 0.07 1.48

NA

XXX stimul. 78006............. 26............ A

Thyroid imaging with

0.49 0.16 0.16 0.02 0.67 0.67

XXX uptake. 78006............. TC............ A

Thyroid imaging with

0.00 2.39

NA 0.13 2.52

NA

XXX uptake. 78006............. .............. A

Thyroid imaging with

0.49 2.55

NA 0.15 3.19

NA

XXX uptake. 78007............. 26............ A

Thyroid image, mult

0.50 0.17 0.17 0.02 0.69 0.69

XXX uptakes. 78007............. TC............ A

Thyroid image, mult

0.00 2.58

NA 0.14 2.72

NA

XXX uptakes. 78007............. .............. A

Thyroid image, mult

0.50 2.75

NA 0.16 3.41

NA

XXX uptakes. 78010............. 26............ A

Thyroid imaging....... 0.39 0.13 0.13 0.02 0.54 0.54

XXX 78010............. TC............ A

Thyroid imaging....... 0.00 1.83

NA 0.11 1.94

NA

XXX 78010............. .............. A

Thyroid imaging....... 0.39 1.96

NA 0.13 2.48

NA

XXX 78011............. 26............ A

Thyroid imaging with

0.45 0.15 0.15 0.02 0.62 0.62

XXX flow. 78011............. TC............ A

Thyroid imaging with

0.00 2.42

NA 0.13 2.55

NA

XXX flow. 78011............. .............. A

Thyroid imaging with

0.45 2.57

NA 0.15 3.17

NA

XXX flow. 78015............. 26............ A

Thyroid met imaging... 0.67 0.23 0.23 0.03 0.93 0.93

XXX 78015............. TC............ A

Thyroid met imaging... 0.00 2.58

NA 0.14 2.72

NA

XXX 78015............. .............. A

Thyroid met imaging... 0.67 2.81

NA 0.17 3.65

NA

XXX 78016............. 26............ A

Thyroid met imaging/

0.82 0.28 0.28 0.03 1.13 1.13

XXX studies. 78016............. TC............ A

Thyroid met imaging/

0.00 3.49

NA 0.18 3.67

NA

XXX studies. 78016............. .............. A

Thyroid met imaging/

0.82 3.77

NA 0.21 4.80

NA

XXX studies. 78018............. 26............ A

Thyroid met imaging,

0.86 0.30 0.30 0.04 1.20 1.20

XXX body. 78018............. TC............ A

Thyroid met imaging,

0.00 5.44

NA 0.29 5.73

NA

XXX body. 78018............. .............. A

Thyroid met imaging,

0.86 5.74

NA 0.33 6.93

NA

XXX body. 78020............. 26............ A

Thyroid met uptake.... 0.60 0.21 0.21 0.02 0.83 0.83

ZZZ 78020............. TC............ A

Thyroid met uptake.... 0.00 1.31

NA 0.14 1.45

NA

ZZZ 78020............. .............. A

Thyroid met uptake.... 0.60 1.52

NA 0.16 2.28

NA

ZZZ 78070............. 26............ A

Parathyroid nuclear

0.82 0.28 0.28 0.04 1.14 1.14

XXX imaging. 78070............. TC............ A

Parathyroid nuclear

0.00 4.28

NA 0.11 4.39

NA

XXX imaging. 78070............. .............. A

Parathyroid nuclear

0.82 4.56

NA 0.15 5.53

NA

XXX imaging. 78075............. 26............ A

Adrenal nuclear

0.74 0.26 0.26 0.03 1.03 1.03

XXX imaging. 78075............. TC............ A

Adrenal nuclear

0.00 5.44

NA 0.29 5.73

NA

XXX imaging. 78075............. .............. A

Adrenal nuclear

0.74 5.70

NA 0.32 6.76

NA

XXX imaging. 78099............. 26............ C

Endocrine nuclear

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 78099............. TC............ C

Endocrine nuclear

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 78099............. .............. C

Endocrine nuclear

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 78102............. 26............ A

Bone marrow imaging,

0.55 0.19 0.19 0.02 0.76 0.76

XXX ltd. 78102............. TC............ A

Bone marrow imaging,

0.00 2.05

NA 0.12 2.17

NA

XXX ltd. 78102............. .............. A

Bone marrow imaging,

0.55 2.24

NA 0.14 2.93

NA

XXX ltd. 78103............. 26............ A

Bone marrow imaging,

0.75 0.26 0.26 0.03 1.04 1.04

XXX mult. 78103............. TC............ A

Bone marrow imaging,

0.00 3.18

NA 0.17 3.35

NA

XXX mult. 78103............. .............. A

Bone marrow imaging,

0.75 3.44

NA 0.20 4.39

NA

XXX mult. 78104............. 26............ A

Bone marrow imaging,

0.80 0.27 0.27 0.03 1.10 1.10

XXX body. 78104............. TC............ A

Bone marrow imaging,

0.00 4.08

NA 0.22 4.30

NA

XXX body. 78104............. .............. A

Bone marrow imaging,

0.80 4.35

NA 0.25 5.40

NA

XXX body. 78110............. 26............ A

Plasma volume, single. 0.19 0.07 0.07 0.01 0.27 0.27

XXX 78110............. TC............ A

Plasma volume, single. 0.00 0.95

NA 0.06 1.01

NA

XXX 78110............. .............. A

Plasma volume, single. 0.19 1.02

NA 0.07 1.28

NA

XXX 78111............. 26............ A

Plasma volume,

0.22 0.08 0.08 0.01 0.31 0.31

XXX multiple. 78111............. TC............ A

Plasma volume,

0.00 2.58

NA 0.14 2.72

NA

XXX multiple. 78111............. .............. A

Plasma volume,

0.22 2.66

NA 0.15 3.03

NA

XXX multiple. 78120............. 26............ A

Red cell mass, single. 0.23 0.08 0.08 0.01 0.32 0.32

XXX 78120............. TC............ A

Red cell mass, single. 0.00 1.74

NA 0.11 1.85

NA

XXX 78120............. .............. A

Red cell mass, single. 0.23 1.82

NA 0.12 2.17

NA

XXX 78121............. 26............ A

Red cell mass,

0.32 0.11 0.11 0.01 0.44 0.44

XXX multiple. 78121............. TC............ A

Red cell mass,

0.00 2.92

NA 0.14 3.06

NA

XXX multiple. 78121............. .............. A

Red cell mass,

0.32 3.03

NA 0.15 3.50

NA

XXX multiple. 78122............. 26............ A

Blood volume.......... 0.45 0.16 0.16 0.02 0.63 0.63

XXX 78122............. TC............ A

Blood volume.......... 0.00 4.61

NA 0.24 4.85

NA

XXX 78122............. .............. A

Blood volume.......... 0.45 4.77

NA 0.26 5.48

NA

XXX 78130............. 26............ A

Red cell survival

0.61 0.21 0.21 0.03 0.85 0.85

XXX study. 78130............. TC............ A

Red cell survival

0.00 2.86

NA 0.14 3.00

NA

XXX study. 78130............. .............. A

Red cell survival

0.61 3.07

NA 0.17 3.85

NA

XXX study. 78135............. 26............ A

Red cell survival

0.64 0.22 0.22 0.03 0.89 0.89

XXX kinetics. 78135............. TC............ A

Red cell survival

0.00 4.88

NA 0.25 5.13

NA

XXX kinetics. 78135............. .............. A

Red cell survival

0.64 5.10

NA 0.28 6.02

NA

XXX kinetics. 78140............. 26............ A

Red cell sequestration 0.61 0.20 0.20 0.03 0.84 0.84

XXX 78140............. TC............ A

Red cell sequestration 0.00 3.94

NA 0.21 4.15

NA

XXX 78140............. .............. A

Red cell sequestration 0.61 4.14

NA 0.24 4.99

NA

XXX 78185............. 26............ A

Spleen imaging........ 0.40 0.14 0.14 0.02 0.56 0.56

XXX 78185............. TC............ A

Spleen imaging........ 0.00 2.37

NA 0.13 2.50

NA

XXX 78185............. .............. A

Spleen imaging........ 0.40 2.51

NA 0.15 3.06

NA

XXX 78190............. 26............ A

Platelet survival,

1.09 0.39 0.39 0.08 1.56 1.56

XXX kinetics. 78190............. TC............ A

Platelet survival,

0.00 5.73

NA 0.30 6.03

NA

XXX kinetics.

[[Page 70433]]

78190............. .............. A

Platelet survival,

1.09 6.12

NA 0.38 7.59

NA

XXX kinetics. 78191............. 26............ A

Platelet survival..... 0.61 0.20 0.20 0.03 0.84 0.84

XXX 78191............. TC............ A

Platelet survival..... 0.00 7.36

NA 0.37 7.73

NA

XXX 78191............. .............. A

Platelet survival..... 0.61 7.56

NA 0.40 8.57

NA

XXX 78195............. 26............ A

Lymph system imaging.. 1.20 0.41 0.41 0.06 1.67 1.67

XXX 78195............. TC............ A

Lymph system imaging.. 0.00 4.08

NA 0.22 4.30

NA

XXX 78195............. .............. A

Lymph system imaging.. 1.20 4.49

NA 0.28 5.97

NA

XXX 78199............. 26............ C

Blood/lymph nuclear

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78199............. TC............ C

Blood/lymph nuclear

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78199............. .............. C

Blood/lymph nuclear

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78201............. 26............ A

Liver imaging......... 0.44 0.15 0.15 0.02 0.61 0.61

XXX 78201............. TC............ A

Liver imaging......... 0.00 2.37

NA 0.13 2.50

NA

XXX 78201............. .............. A

Liver imaging......... 0.44 2.52

NA 0.15 3.11

NA

XXX 78202............. 26............ A

Liver imaging with

0.51 0.17 0.17 0.02 0.70 0.70

XXX flow. 78202............. TC............ A

Liver imaging with

0.00 2.89

NA 0.14 3.03

NA

XXX flow. 78202............. .............. A

Liver imaging with

0.51 3.06

NA 0.16 3.73

NA

XXX flow. 78205............. 26............ A

Liver imaging (3D).... 0.71 0.24 0.24 0.03 0.98 0.98

XXX 78205............. TC............ A

Liver imaging (3D).... 0.00 5.93

NA 0.31 6.24

NA

XXX 78205............. .............. A

Liver imaging (3D).... 0.71 6.17

NA 0.34 7.22

NA

XXX 78206............. 26............ A

Liver image (3d) with

0.96 0.33 0.33 0.04 1.33 1.33

XXX flow. 78206............. TC............ A

Liver image (3d) with

0.00 5.93

NA 0.11 6.04

NA

XXX flow. 78206............. .............. A

Liver image (3d) with

0.96 6.26

NA 0.15 7.37

NA

XXX flow. 78215............. 26............ A

Liver and spleen

0.49 0.16 0.16 0.02 0.67 0.67

XXX imaging. 78215............. TC............ A

Liver and spleen

0.00 2.95

NA 0.14 3.09

NA

XXX imaging. 78215............. .............. A

Liver and spleen

0.49 3.11

NA 0.16 3.76

NA

XXX imaging. 78216............. 26............ A

Liver & spleen image/

0.57 0.19 0.19 0.02 0.78 0.78

XXX flow. 78216............. TC............ A

Liver & spleen image/

0.00 3.49

NA 0.18 3.67

NA

XXX flow. 78216............. .............. A

Liver & spleen image/

0.57 3.68

NA 0.20 4.45

NA

XXX flow. 78220............. 26............ A

Liver function study.. 0.49 0.16 0.16 0.02 0.67 0.67

XXX 78220............. TC............ A

Liver function study.. 0.00 3.73

NA 0.19 3.92

NA

XXX 78220............. .............. A

Liver function study.. 0.49 3.89

NA 0.21 4.59

NA

XXX 78223............. 26............ A

Hepatobiliary imaging. 0.84 0.28 0.28 0.04 1.16 1.16

XXX 78223............. TC............ A

Hepatobiliary imaging. 0.00 3.67

NA 0.19 3.86

NA

XXX 78223............. .............. A

Hepatobiliary imaging. 0.84 3.95

NA 0.23 5.02

NA

XXX 78230............. 26............ A

Salivary gland imaging 0.45 0.15 0.15 0.02 0.62 0.62

XXX 78230............. TC............ A

Salivary gland imaging 0.00 2.19

NA 0.13 2.32

NA

XXX 78230............. .............. A

Salivary gland imaging 0.45 2.34

NA 0.15 2.94

NA

XXX 78231............. 26............ A

Serial salivary

0.52 0.18 0.18 0.02 0.72 0.72

XXX imaging. 78231............. TC............ A

Serial salivary

0.00 3.18

NA 0.17 3.35

NA

XXX imaging. 78231............. .............. A

Serial salivary

0.52 3.36

NA 0.19 4.07

NA

XXX imaging. 78232............. 26............ A

Salivary gland

0.47 0.16 0.16 0.02 0.65 0.65

XXX function exam. 78232............. TC............ A

Salivary gland

0.00 3.55

NA 0.18 3.73

NA

XXX function exam. 78232............. .............. A

Salivary gland

0.47 3.71

NA 0.20 4.38

NA

XXX function exam. 78258............. 26............ A

Esophageal motility

0.74 0.25 0.25 0.03 1.02 1.02

XXX study. 78258............. TC............ A

Esophageal motility

0.00 2.89

NA 0.14 3.03

NA

XXX study. 78258............. .............. A

Esophageal motility

0.74 3.14

NA 0.17 4.05

NA

XXX study. 78261............. 26............ A

Gastric mucosa imaging 0.69 0.24 0.24 0.03 0.96 0.96

XXX 78261............. TC............ A

Gastric mucosa imaging 0.00 4.11

NA 0.22 4.33

NA

XXX 78261............. .............. A

Gastric mucosa imaging 0.69 4.35

NA 0.25 5.29

NA

XXX 78262............. 26............ A

Gastroesophageal

0.68 0.23 0.23 0.03 0.94 0.94

XXX reflux exam. 78262............. TC............ A

Gastroesophageal

0.00 4.26

NA 0.22 4.48

NA

XXX reflux exam. 78262............. .............. A

Gastroesophageal

0.68 4.49

NA 0.25 5.42

NA

XXX reflux exam. 78264............. 26............ A

Gastric emptying study 0.78 0.26 0.26 0.03 1.07 1.07

XXX 78264............. TC............ A

Gastric emptying study 0.00 4.14

NA 0.22 4.36

NA

XXX 78264............. .............. A

Gastric emptying study 0.78 4.40

NA 0.25 5.43

NA

XXX 78267............. .............. X

Breath tst attain/anal 0.00 0.00 0.00 0.00 0.00 0.00

XXX c-14. 78268............. .............. X

Breath test analysis,

0.00 0.00 0.00 0.00 0.00 0.00

XXX c-14. 78270............. 26............ A

Vit B-12 absorption

0.20 0.07 0.07 0.01 0.28 0.28

XXX exam. 78270............. TC............ A

Vit B-12 absorption

0.00 1.55

NA 0.10 1.65

NA

XXX exam. 78270............. .............. A

Vit B-12 absorption

0.20 1.62

NA 0.11 1.93

NA

XXX exam. 78271............. 26............ A

Vit b-12 absrp exam,

0.20 0.07 0.07 0.01 0.28 0.28

XXX int fac. 78271............. TC............ A

Vit b-12 absrp exam,

0.00 1.64

NA 0.10 1.74

NA

XXX int fac. 78271............. .............. A

Vit b-12 absrp exam,

0.20 1.71

NA 0.11 2.02

NA

XXX int fac. 78272............. 26............ A

Vit B-12 absorp,

0.27 0.09 0.09 0.01 0.37 0.37

XXX combined. 78272............. TC............ A

Vit B-12 absorp,

0.00 2.33

NA 0.13 2.46

NA

XXX combined. 78272............. .............. A

Vit B-12 absorp,

0.27 2.42

NA 0.14 2.83

NA

XXX combined. 78278............. 26............ A

Acute GI blood loss

0.99 0.33 0.33 0.04 1.36 1.36

XXX imaging. 78278............. TC............ A

Acute GI blood loss

0.00 4.88

NA 0.25 5.13

NA

XXX imaging. 78278............. .............. A

Acute GI blood loss

0.99 5.21

NA 0.29 6.49

NA

XXX imaging. 78282............. 26............ A

GI protein loss exam.. 0.38 0.13 0.13 0.02 0.53 0.53

XXX 78282............. TC............ C

GI protein loss exam.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 78282............. .............. C

GI protein loss exam.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 78290............. 26............ A

Meckel's divert exam.. 0.68 0.23 0.23 0.03 0.94 0.94

XXX 78290............. TC............ A

Meckel's divert exam.. 0.00 3.06

NA 0.16 3.22

NA

XXX 78290............. .............. A

Meckel's divert exam.. 0.68 3.29

NA 0.19 4.16

NA

XXX

[[Page 70434]]

78291............. 26............ A

Leveen/shunt patency

0.88 0.30 0.30 0.04 1.22 1.22

XXX exam. 78291............. TC............ A

Leveen/shunt patency

0.00 3.07

NA 0.16 3.23

NA

XXX exam. 78291............. .............. A

Leveen/shunt patency

0.88 3.37

NA 0.20 4.45

NA

XXX exam. 78299............. 26............ C

GI nuclear procedure.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 78299............. TC............ C

GI nuclear procedure.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 78299............. .............. C

GI nuclear procedure.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 78300............. 26............ A

Bone imaging, limited

0.62 0.21 0.21 0.03 0.86 0.86

XXX area. 78300............. TC............ A

Bone imaging, limited

0.00 2.49

NA 0.14 2.63

NA

XXX area. 78300............. .............. A

Bone imaging, limited

0.62 2.70

NA 0.17 3.49

NA

XXX area. 78305............. 26............ A

Bone imaging, multiple 0.83 0.28 0.28 0.04 1.15 1.15

XXX areas. 78305............. TC............ A

Bone imaging, multiple 0.00 3.67

NA 0.19 3.86

NA

XXX areas. 78305............. .............. A

Bone imaging, multiple 0.83 3.95

NA 0.23 5.01

NA

XXX areas. 78306............. 26............ A

Bone imaging, whole

0.86 0.29 0.29 0.04 1.19 1.19

XXX body. 78306............. TC............ A

Bone imaging, whole

0.00 4.28

NA 0.22 4.50

NA

XXX body. 78306............. .............. A

Bone imaging, whole

0.86 4.57

NA 0.26 5.69

NA

XXX body. 78315............. 26............ A

Bone imaging, 3 phase. 1.02 0.34 0.34 0.04 1.40 1.40

XXX 78315............. TC............ A

Bone imaging, 3 phase. 0.00 4.79

NA 0.25 5.04

NA

XXX 78315............. .............. A

Bone imaging, 3 phase. 1.02 5.13

NA 0.29 6.44

NA

XXX 78320............. 26............ A

Bone imaging (3D)..... 1.04 0.36 0.36 0.04 1.44 1.44

XXX 78320............. TC............ A

Bone imaging (3D)..... 0.00 5.93

NA 0.31 6.24

NA

XXX 78320............. .............. A

Bone imaging (3D)..... 1.04 6.29

NA 0.35 7.68

NA

XXX 78350............. 26............ A

Bone mineral, single

0.22 0.07 0.07 0.01 0.30 0.30

XXX photon. 78350............. TC............ A

Bone mineral, single

0.00 0.75

NA 0.05 0.80

NA

XXX photon. 78350............. .............. A

Bone mineral, single

0.22 0.82

NA 0.06 1.10

NA

XXX photon. 78351............. .............. N

Bone mineral, dual

+0.30 1.72 0.12 0.01 2.03 0.43

XXX photon. 78399............. 26............ C

Musculoskeletal

0.00 0.00 0.00 0.00 0.00 0.00

XXX nuclear exam. 78399............. TC............ C

Musculoskeletal

0.00 0.00 0.00 0.00 0.00 0.00

XXX nuclear exam. 78399............. .............. C

Musculoskeletal

0.00 0.00 0.00 0.00 0.00 0.00

XXX nuclear exam. 78414............. 26............ A

Non-imaging heart

0.45 0.16 0.16 0.02 0.63 0.63

XXX function. 78414............. TC............ C

Non-imaging heart

0.00 0.00 0.00 0.00 0.00 0.00

XXX function. 78414............. .............. C

Non-imaging heart

0.00 0.00 0.00 0.00 0.00 0.00

XXX function. 78428............. 26............ A

Cardiac shunt imaging. 0.78 0.29 0.29 0.03 1.10 1.10

XXX 78428............. TC............ A

Cardiac shunt imaging. 0.00 2.26

NA 0.13 2.39

NA

XXX 78428............. .............. A

Cardiac shunt imaging. 0.78 2.55

NA 0.16 3.49

NA

XXX 78445............. 26............ A

Vascular flow imaging. 0.49 0.17 0.17 0.02 0.68 0.68

XXX 78445............. TC............ A

Vascular flow imaging. 0.00 1.87

NA 0.11 1.98

NA

XXX 78445............. .............. A

Vascular flow imaging. 0.49 2.04

NA 0.13 2.66

NA

XXX 78456............. 26............ A

Acute venous thrombus

1.00 0.34 0.34 0.04 1.38 1.38

XXX image. 78456............. TC............ A

Acute venous thrombus

0.00 3.99

NA 0.29 4.28

NA

XXX image. 78456............. .............. A

Acute venous thrombus

1.00 4.33

NA 0.33 5.66

NA

XXX image. 78457............. 26............ A

Venous thrombosis

0.77 0.26 0.26 0.03 1.06 1.06

XXX imaging. 78457............. TC............ A

Venous thrombosis

0.00 2.67

NA 0.14 2.81

NA

XXX imaging. 78457............. .............. A

Venous thrombosis

0.77 2.93

NA 0.17 3.87

NA

XXX imaging. 78458............. 26............ A

Ven thrombosis images, 0.90 0.32 0.32 0.04 1.26 1.26

XXX bilat. 78458............. TC............ A

Ven thrombosis images, 0.00 4.03

NA 0.21 4.24

NA

XXX bilat. 78458............. .............. A

Ven thrombosis images, 0.90 4.35

NA 0.25 5.50

NA

XXX bilat. 78459............. 26............ A

Heart muscle imaging

1.50 0.57 0.57 0.05 2.12 2.12

XXX (PET). 78459............. TC............ C

Heart muscle imaging

0.00 0.00 0.00 0.00 0.00 0.00

XXX (PET). 78459............. .............. C

Heart muscle imaging

0.00 0.00 0.00 0.00 0.00 0.00

XXX (PET). 78460............. 26............ A

Heart muscle blood,

0.86 0.29 0.29 0.04 1.19 1.19

XXX single. 78460............. TC............ A

Heart muscle blood,

0.00 2.37

NA 0.13 2.50

NA

XXX single. 78460............. .............. A

Heart muscle blood,

0.86 2.66

NA 0.17 3.69

NA

XXX single. 78461............. 26............ A

Heart muscle blood,

1.23 0.43 0.43 0.05 1.71 1.71

XXX multiple. 78461............. TC............ A

Heart muscle blood,

0.00 4.73

NA 0.25 4.98

NA

XXX multiple. 78461............. .............. A

Heart muscle blood,

1.23 5.16

NA 0.30 6.69

NA

XXX multiple. 78464............. 26............ A

Heart image (3d),

1.09 0.38 0.38 0.04 1.51 1.51

XXX single. 78464............. TC............ A

Heart image (3d),

0.00 7.09

NA 0.37 7.46

NA

XXX single. 78464............. .............. A

Heart image (3d),

1.09 7.47

NA 0.41 8.97

NA

XXX single. 78465............. 26............ A

Heart image (3d),

1.46 0.52 0.52 0.05 2.03 2.03

XXX multiple. 78465............. TC............ A

Heart image (3d),

0.00 11.82

NA 0.62 12.44

NA

XXX multiple. 78465............. .............. A

Heart image (3d),

1.46 12.34

NA 0.67 14.47

NA

XXX multiple. 78466............. 26............ A

Heart infarct image... 0.69 0.24 0.24 0.03 0.96 0.96

XXX 78466............. TC............ A

Heart infarct image... 0.00 2.63

NA 0.14 2.77

NA

XXX 78466............. .............. A

Heart infarct image... 0.69 2.87

NA 0.17 3.73

NA

XXX 78468............. 26............ A

Heart infarct image

0.80 0.27 0.27 0.03 1.10 1.10

XXX (ef). 78468............. TC............ A

Heart infarct image

0.00 3.67

NA 0.19 3.86

NA

XXX (ef). 78468............. .............. A

Heart infarct image

0.80 3.94

NA 0.22 4.96

NA

XXX (ef). 78469............. 26............ A

Heart infarct image

0.92 0.31 0.31 0.03 1.26 1.26

XXX (3D). 78469............. TC............ A

Heart infarct image

0.00 5.24

NA 0.28 5.52

NA

XXX (3D). 78469............. .............. A

Heart infarct image

0.92 5.55

NA 0.31 6.78

NA

XXX (3D). 78472............. 26............ A

Gated heart, planar,

0.98 0.34 0.34 0.04 1.36 1.36

XXX single. 78472............. TC............ A

Gated heart, planar,

0.00 5.53

NA 0.30 5.83

NA

XXX single. 78472............. .............. A

Gated heart, planar,

0.98 5.87

NA 0.34 7.19

NA

XXX single. 78473............. 26............ A

Gated heart, multiple. 1.47 0.51 0.51 0.06 2.04 2.04

XXX 78473............. TC............ A

Gated heart, multiple. 0.00 8.28

NA 0.42 8.70

NA

XXX

[[Page 70435]]

78473............. .............. A

Gated heart, multiple. 1.47 8.79

NA 0.48 10.74

NA

XXX 78478............. 26............ A

Heart wall motion add- 0.62 0.23 0.23 0.02 0.87 0.87

XXX on. 78478............. TC............ A

Heart wall motion add- 0.00 1.56

NA 0.10 1.66

NA

XXX on. 78478............. .............. A

Heart wall motion add- 0.62 1.79

NA 0.12 2.53

NA

XXX on. 78480............. 26............ A

Heart function add-on. 0.62 0.22 0.22 0.02 0.86 0.86

XXX 78480............. TC............ A

Heart function add-on. 0.00 1.56

NA 0.10 1.66

NA

XXX 78480............. .............. A

Heart function add-on. 0.62 1.78

NA 0.12 2.52

NA

XXX 78481............. 26............ A

Heart first pass,

0.98 0.36 0.36 0.03 1.37 1.37

XXX single. 78481............. TC............ A

Heart first pass,

0.00 5.24

NA 0.28 5.52

NA

XXX single. 78481............. .............. A

Heart first pass,

0.98 5.60

NA 0.31 6.89

NA

XXX single. 78483............. 26............ A

Heart first pass,

1.47 0.54 0.54 0.05 2.06 2.06

XXX multiple. 78483............. TC............ A

Heart first pass,

0.00 7.89

NA 0.41 8.30

NA

XXX multiple. 78483............. .............. A

Heart first pass,

1.47 8.43

NA 0.46 10.36

NA

XXX multiple. 78491............. 26............ A

Heart image (pet),

1.50 0.59 0.59 0.06 2.15 2.15

XXX single. 78491............. TC............ C

Heart image (pet),

0.00 0.00 0.00 0.00 0.00 0.00

XXX single. 78491............. .............. C

Heart image (pet),

0.00 0.00 0.00 0.00 0.00 0.00

XXX single. 78492............. 26............ A

Heart image (pet),

1.87 0.74 0.74 0.07 2.68 2.68

XXX multiple. 78492............. TC............ C

Heart image (pet),

0.00 0.00 0.00 0.00 0.00 0.00

XXX multiple. 78492............. .............. C

Heart image (pet),

0.00 0.00 0.00 0.00 0.00 0.00

XXX multiple. 78494............. 26............ A

Heart image, spect.... 1.19 0.42 0.42 0.05 1.66 1.66

XXX 78494............. TC............ A

Heart image, spect.... 0.00 7.09

NA 0.30 7.39

NA

XXX 78494............. .............. A

Heart image, spect.... 1.19 7.51

NA 0.35 9.05

NA

XXX 78496............. 26............ A

Heart first pass add-

0.50 0.18 0.18 0.02 0.70 0.70

ZZZ on. 78496............. TC............ A

Heart first pass add-

0.00 7.09

NA 0.30 7.39

NA

ZZZ on. 78496............. .............. A

Heart first pass add-

0.50 7.27

NA 0.32 8.09

NA

ZZZ on. 78499............. 26............ C

Cardiovascular nuclear 0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78499............. TC............ C

Cardiovascular nuclear 0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78499............. .............. C

Cardiovascular nuclear 0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78580............. 26............ A

Lung perfusion imaging 0.74 0.25 0.25 0.03 1.02 1.02

XXX 78580............. TC............ A

Lung perfusion imaging 0.00 3.44

NA 0.18 3.62

NA

XXX 78580............. .............. A

Lung perfusion imaging 0.74 3.69

NA 0.21 4.64

NA

XXX 78584............. 26............ A

Lung V/Q image single

0.99 0.33 0.33 0.04 1.36 1.36

XXX breath. 78584............. TC............ A

Lung V/Q image single

0.00 3.21

NA 0.17 3.38

NA

XXX breath. 78584............. .............. A

Lung V/Q image single

0.99 3.54

NA 0.21 4.74

NA

XXX breath. 78585............. 26............ A

Lung V/Q imaging...... 1.09 0.36 0.36 0.05 1.50 1.50

XXX 78585............. TC............ A

Lung V/Q imaging...... 0.00 5.66

NA 0.30 5.96

NA

XXX 78585............. .............. A

Lung V/Q imaging...... 1.09 6.02

NA 0.35 7.46

NA

XXX 78586............. 26............ A

Aerosol lung image,

0.40 0.13 0.13 0.02 0.55 0.55

XXX single. 78586............. TC............ A

Aerosol lung image,

0.00 2.60

NA 0.14 2.74

NA

XXX single. 78586............. .............. A

Aerosol lung image,

0.40 2.73

NA 0.16 3.29

NA

XXX single. 78587............. 26............ A

Aerosol lung image,

0.49 0.17 0.17 0.02 0.68 0.68

XXX multiple. 78587............. TC............ A

Aerosol lung image,

0.00 2.81

NA 0.14 2.95

NA

XXX multiple. 78587............. .............. A

Aerosol lung image,

0.49 2.98

NA 0.16 3.63

NA

XXX multiple. 78588............. 26............ A

Perfusion lung image.. 1.09 0.36 0.36 0.05 1.50 1.50

XXX 78588............. TC............ A

Perfusion lung image.. 0.00 3.21

NA 0.18 3.39

NA

XXX 78588............. .............. A

Perfusion lung image.. 1.09 3.57

NA 0.23 4.89

NA

XXX 78591............. 26............ A

Vent image, 1 breath,

0.40 0.13 0.13 0.02 0.55 0.55

XXX 1 proj. 78591............. TC............ A

Vent image, 1 breath,

0.00 2.86

NA 0.14 3.00

NA

XXX 1 proj. 78591............. .............. A

Vent image, 1 breath,

0.40 2.99

NA 0.16 3.55

NA

XXX 1 proj. 78593............. 26............ A

Vent image, 1 proj,

0.49 0.16 0.16 0.02 0.67 0.67

XXX gas. 78593............. TC............ A

Vent image, 1 proj,

0.00 3.46

NA 0.18 3.64

NA

XXX gas. 78593............. .............. A

Vent image, 1 proj,

0.49 3.62

NA 0.20 4.31

NA

XXX gas. 78594............. 26............ A

Vent image, mult proj, 0.53 0.18 0.18 0.02 0.73 0.73

XXX gas. 78594............. TC............ A

Vent image, mult proj, 0.00 4.99

NA 0.25 5.24

NA

XXX gas. 78594............. .............. A

Vent image, mult proj, 0.53 5.17

NA 0.27 5.97

NA

XXX gas. 78596............. 26............ A

Lung differential

1.27 0.42 0.42 0.05 1.74 1.74

XXX function. 78596............. TC............ A

Lung differential

0.00 7.09

NA 0.37 7.46

NA

XXX function. 78596............. .............. A

Lung differential

1.27 7.51

NA 0.42 9.20

NA

XXX function. 78599............. 26............ C

Respiratory nuclear

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78599............. TC............ C

Respiratory nuclear

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78599............. .............. C

Respiratory nuclear

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78600............. 26............ A

Brain imaging, ltd

0.44 0.15 0.15 0.02 0.61 0.61

XXX static. 78600............. TC............ A

Brain imaging, ltd

0.00 2.89

NA 0.14 3.03

NA

XXX static. 78600............. .............. A

Brain imaging, ltd

0.44 3.04

NA 0.16 3.64

NA

XXX static. 78601............. 26............ A

Brain imaging, ltd w/

0.51 0.17 0.17 0.02 0.70 0.70

XXX flow. 78601............. TC............ A

Brain imaging, ltd w/

0.00 3.41

NA 0.18 3.59

NA

XXX flow. 78601............. .............. A

Brain imaging, ltd w/

0.51 3.58

NA 0.20 4.29

NA

XXX flow. 78605............. 26............ A

Brain imaging,

0.53 0.18 0.18 0.02 0.73 0.73

XXX complete. 78605............. TC............ A

Brain imaging,

0.00 3.41

NA 0.18 3.59

NA

XXX complete. 78605............. .............. A

Brain imaging,

0.53 3.59

NA 0.20 4.32

NA

XXX complete. 78606............. 26............ A

Brain imaging, compl w/ 0.64 0.21 0.21 0.03 0.88 0.88

XXX flow. 78606............. TC............ A

Brain imaging, compl w/ 0.00 3.88

NA 0.21 4.09

NA

XXX flow. 78606............. .............. A

Brain imaging, compl w/ 0.64 4.09

NA 0.24 4.97

NA

XXX flow. 78607............. 26............ A

Brain imaging (3D).... 1.23 0.43 0.43 0.05 1.71 1.71

XXX 78607............. TC............ A

Brain imaging (3D).... 0.00 6.57

NA 0.35 6.92

NA

XXX

[[Page 70436]]

78607............. .............. A

Brain imaging (3D).... 1.23 7.00

NA 0.40 8.63

NA

XXX 78608............. 26............ A

Brain imaging (PET)... 1.50 0.51 0.51 0.06 2.07 2.07

XXX 78608............. TC............ C

Brain imaging (PET)... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 78608............. .............. C

Brain imaging (PET)... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 78609............. 26............ A

Brain imaging (PET)... 1.50 0.51 0.51 0.06 2.07 2.07

XXX 78609............. TC............ C

Brain imaging (PET)... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 78609............. .............. C

Brain imaging (PET)... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 78610............. 26............ A

Brain flow imaging

0.30 0.11 0.11 0.01 0.42 0.42

XXX only. 78610............. TC............ A

Brain flow imaging

0.00 1.58

NA 0.10 1.68

NA

XXX only. 78610............. .............. A

Brain flow imaging

0.30 1.69

NA 0.11 2.10

NA

XXX only. 78615............. 26............ A

Cerebral vascular flow 0.42 0.15 0.15 0.02 0.59 0.59

XXX image. 78615............. TC............ A

Cerebral vascular flow 0.00 3.86

NA 0.21 4.07

NA

XXX image. 78615............. .............. A

Cerebral vascular flow 0.42 4.01

NA 0.23 4.66

NA

XXX image. 78630............. 26............ A

Cerebrospinal fluid

0.68 0.23 0.23 0.03 0.94 0.94

XXX scan. 78630............. TC............ A

Cerebrospinal fluid

0.00 5.05

NA 0.27 5.32

NA

XXX scan. 78630............. .............. A

Cerebrospinal fluid

0.68 5.28

NA 0.30 6.26

NA

XXX scan. 78635............. 26............ A

CSF ventriculography.. 0.61 0.23 0.23 0.02 0.86 0.86

XXX 78635............. TC............ A

CSF ventriculography.. 0.00 2.55

NA 0.14 2.69

NA

XXX 78635............. .............. A

CSF ventriculography.. 0.61 2.78

NA 0.16 3.55

NA

XXX 78645............. 26............ A

CSF shunt evaluation.. 0.57 0.19 0.19 0.02 0.78 0.78

XXX 78645............. TC............ A

CSF shunt evaluation.. 0.00 3.44

NA 0.18 3.62

NA

XXX 78645............. .............. A

CSF shunt evaluation.. 0.57 3.63

NA 0.20 4.40

NA

XXX 78647............. 26............ A

Cerebrospinal fluid

0.90 0.31 0.31 0.04 1.25 1.25

XXX scan. 78647............. TC............ A

Cerebrospinal fluid

0.00 5.93

NA 0.31 6.24

NA

XXX scan. 78647............. .............. A

Cerebrospinal fluid

0.90 6.24

NA 0.35 7.49

NA

XXX scan. 78650............. 26............ A

CSF leakage imaging... 0.61 0.21 0.21 0.03 0.85 0.85

XXX 78650............. TC............ A

CSF leakage imaging... 0.00 4.65

NA 0.24 4.89

NA

XXX 78650............. .............. A

CSF leakage imaging... 0.61 4.86

NA 0.27 5.74

NA

XXX 78660............. 26............ A

Nuclear exam of tear

0.53 0.18 0.18 0.02 0.73 0.73

XXX flow. 78660............. TC............ A

Nuclear exam of tear

0.00 2.13

NA 0.12 2.25

NA

XXX flow. 78660............. .............. A

Nuclear exam of tear

0.53 2.31

NA 0.14 2.98

NA

XXX flow. 78699............. 26............ C

Nervous system nuclear 0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78699............. TC............ C

Nervous system nuclear 0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78699............. .............. C

Nervous system nuclear 0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78700............. 26............ A

Kidney imaging, static 0.45 0.15 0.15 0.02 0.62 0.62

XXX 78700............. TC............ A

Kidney imaging, static 0.00 3.06

NA 0.16 3.22

NA

XXX 78700............. .............. A

Kidney imaging, static 0.45 3.21

NA 0.18 3.84

NA

XXX 78701............. 26............ A

Kidney imaging with

0.49 0.16 0.16 0.02 0.67 0.67

XXX flow. 78701............. TC............ A

Kidney imaging with

0.00 3.57

NA 0.18 3.75

NA

XXX flow. 78701............. .............. A

Kidney imaging with

0.49 3.73

NA 0.20 4.42

NA

XXX flow. 78704............. 26............ A

Imaging renogram...... 0.74 0.25 0.25 0.03 1.02 1.02

XXX 78704............. TC............ A

Imaging renogram...... 0.00 3.96

NA 0.21 4.17

NA

XXX 78704............. .............. A

Imaging renogram...... 0.74 4.21

NA 0.24 5.19

NA

XXX 78707............. 26............ A

Kidney flow/function

0.96 0.32 0.32 0.04 1.32 1.32

XXX image. 78707............. TC............ A

Kidney flow/function

0.00 4.48

NA 0.23 4.71

NA

XXX image. 78707............. .............. A

Kidney flow/function

0.96 4.80

NA 0.27 6.03

NA

XXX image. 78708............. 26............ A

Kidney flow/function

1.21 0.41 0.41 0.05 1.67 1.67

XXX image. 78708............. TC............ A

Kidney flow/function

0.00 4.48

NA 0.23 4.71

NA

XXX image. 78708............. .............. A

Kidney flow/function

1.21 4.89

NA 0.28 6.38

NA

XXX image. 78709............. 26............ A

Kidney flow/function

1.41 0.47 0.47 0.06 1.94 1.94

XXX image. 78709............. TC............ A

Kidney flow/function

0.00 4.48

NA 0.23 4.71

NA

XXX image. 78709............. .............. A

Kidney flow/function

1.41 4.95

NA 0.29 6.65

NA

XXX image. 78710............. 26............ A

Kidney imaging (3D)... 0.66 0.22 0.22 0.03 0.91 0.91

XXX 78710............. TC............ A

Kidney imaging (3D)... 0.00 5.93

NA 0.31 6.24

NA

XXX 78710............. .............. A

Kidney imaging (3D)... 0.66 6.15

NA 0.34 7.15

NA

XXX 78715............. 26............ A

Renal vascular flow

0.30 0.11 0.11 0.01 0.42 0.42

XXX exam. 78715............. TC............ A

Renal vascular flow

0.00 1.58

NA 0.10 1.68

NA

XXX exam. 78715............. .............. A

Renal vascular flow

0.30 1.69

NA 0.11 2.10

NA

XXX exam. 78725............. 26............ A

Kidney function study. 0.38 0.13 0.13 0.02 0.53 0.53

XXX 78725............. TC............ A

Kidney function study. 0.00 1.79

NA 0.11 1.90

NA

XXX 78725............. .............. A

Kidney function study. 0.38 1.92

NA 0.13 2.43

NA

XXX 78730............. 26............ A

Urinary bladder

0.36 0.12 0.12 0.02 0.50 0.50

XXX retention. 78730............. TC............ A

Urinary bladder

0.00 1.46

NA 0.08 1.54

NA

XXX retention. 78730............. .............. A

Urinary bladder

0.36 1.58

NA 0.10 2.04

NA

XXX retention. 78740............. 26............ A

Ureteral reflux study. 0.57 0.19 0.19 0.03 0.79 0.79

XXX 78740............. TC............ A

Ureteral reflux study. 0.00 2.13

NA 0.12 2.25

NA

XXX 78740............. .............. A

Ureteral reflux study. 0.57 2.32

NA 0.15 3.04

NA

XXX 78760............. 26............ A

Testicular imaging.... 0.66 0.22 0.22 0.03 0.91 0.91

XXX 78760............. TC............ A

Testicular imaging.... 0.00 2.69

NA 0.14 2.83

NA

XXX 78760............. .............. A

Testicular imaging.... 0.66 2.91

NA 0.17 3.74

NA

XXX 78761............. 26............ A

Testicular imaging/

0.71 0.24 0.24 0.03 0.98 0.98

XXX flow. 78761............. TC............ A

Testicular imaging/

0.00 3.21

NA 0.17 3.38

NA

XXX flow. 78761............. .............. A

Testicular imaging/

0.71 3.45

NA 0.20 4.36

NA

XXX flow. 78799............. 26............ C

Genitourinary nuclear

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78799............. TC............ C

Genitourinary nuclear

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam.

[[Page 70437]]

78799............. .............. C

Genitourinary nuclear

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78800............. 26............ A

Tumor imaging, limited 0.66 0.22 0.22 0.04 0.92 0.92

XXX area. 78800............. TC............ A

Tumor imaging, limited 0.00 3.41

NA 0.18 3.59

NA

XXX area. 78800............. .............. A

Tumor imaging, limited 0.66 3.63

NA 0.22 4.51

NA

XXX area. 78801............. 26............ A

Tumor imaging, mult

0.79 0.27 0.27 0.05 1.11 1.11

XXX areas. 78801............. TC............ A

Tumor imaging, mult

0.00 4.23

NA 0.22 4.45

NA

XXX areas. 78801............. .............. A

Tumor imaging, mult

0.79 4.50

NA 0.27 5.56

NA

XXX areas. 78802............. 26............ A

Tumor imaging, whole

0.86 0.29 0.29 0.04 1.19 1.19

XXX body. 78802............. TC............ A

Tumor imaging, whole

0.00 5.55

NA 0.30 5.85

NA

XXX body. 78802............. .............. A

Tumor imaging, whole

0.86 5.84

NA 0.34 7.04

NA

XXX body. 78803............. 26............ A

Tumor imaging (3D).... 1.09 0.38 0.38 0.05 1.52 1.52

XXX 78803............. TC............ A

Tumor imaging (3D).... 0.00 6.57

NA 0.35 6.92

NA

XXX 78803............. .............. A

Tumor imaging (3D).... 1.09 6.95

NA 0.40 8.44

NA

XXX 78804............. 26............ A

Tumor imaging, whole

1.07 0.37 0.37 0.04 1.48 1.48

XXX body. 78804............. TC............ A

Tumor imaging, whole

0.00 11.09

NA 0.30 11.39

NA

XXX body. 78804............. .............. A

Tumor imaging, whole

1.07 11.46

NA 0.34 12.87

NA

XXX body. 78805............. 26............ A

Abscess imaging, ltd

0.73 0.25 0.25 0.03 1.01 1.01

XXX area. 78805............. TC............ A

Abscess imaging, ltd

0.00 3.41

NA 0.18 3.59

NA

XXX area. 78805............. .............. A

Abscess imaging, ltd

0.73 3.66

NA 0.21 4.60

NA

XXX area. 78806............. 26............ A

Abscess imaging, whole 0.86 0.29 0.29 0.04 1.19 1.19

XXX body. 78806............. TC............ A

Abscess imaging, whole 0.00 6.45

NA 0.35 6.80

NA

XXX body. 78806............. .............. A

Abscess imaging, whole 0.86 6.74

NA 0.39 7.99

NA

XXX body. 78807............. 26............ A

Nuclear localization/

1.09 0.39 0.39 0.04 1.52 1.52

XXX abscess. 78807............. TC............ A

Nuclear localization/

0.00 6.57

NA 0.35 6.92

NA

XXX abscess. 78807............. .............. A

Nuclear localization/

1.09 6.96

NA 0.39 8.44

NA

XXX abscess. 78811............. 26............ A

Tumor imaging (pet),

1.54 0.53 0.53 0.11 2.18 2.18

XXX limited. 78811............. TC............ C

Tumor imaging (pet),

0.00 0.00 0.00 0.00 0.00 0.00

XXX limited. 78811............. .............. C

Tumor imaging (pet),

0.00 0.00 0.00 0.00 0.00 0.00

XXX limited. 78812............. 26............ A

Tumor image (pet)/skul- 1.93 0.66 0.66 0.11 2.70 2.70

XXX thigh. 78812............. TC............ C

Tumor image (pet)/skul- 0.00 0.00 0.00 0.00 0.00 0.00

XXX thigh. 78812............. .............. C

Tumor image (pet)/skul- 0.00 0.00 0.00 0.00 0.00 0.00

XXX thigh. 78813............. 26............ A

Tumor image (pet) full 2.00 0.69 0.69 0.11 2.80 2.80

XXX body. 78813............. TC............ C

Tumor image (pet) full 0.00 0.00 0.00 0.00 0.00 0.00

XXX body. 78813............. .............. C

Tumor image (pet) full 0.00 0.00 0.00 0.00 0.00 0.00

XXX body. 78814............. 26............ A

Tumor image pet/ct,

2.20 0.76 0.76 0.11 3.07 3.07

XXX limited. 78814............. TC............ C

Tumor image pet/ct,

0.00 0.00 0.00 0.00 0.00 0.00

XXX limited. 78814............. .............. C

Tumor image pet/ct,

0.00 0.00 0.00 0.00 0.00 0.00

XXX limited. 78815............. 26............ A

Tumorimage pet/ct skul- 2.44 0.84 0.84 0.11 3.39 3.39

XXX thigh. 78815............. TC............ C

Tumorimage pet/ct skul- 0.00 0.00 0.00 0.00 0.00 0.00

XXX thigh. 78815............. .............. C

Tumorimage pet/ct skul- 0.00 0.00 0.00 0.00 0.00 0.00

XXX thigh. 78816............. 26............ A

Tumor image pet/ct

2.50 0.86 0.86 0.11 3.47 3.47

XXX full body. 78816............. TC............ C

Tumor image pet/ct

0.00 0.00 0.00 0.00 0.00 0.00

XXX full body. 78816............. .............. C

Tumor image pet/ct

0.00 0.00 0.00 0.00 0.00 0.00

XXX full body. 78890............. 26............ B

Nuclear medicine data +0.05 0.02 0.02 0.01 0.08 0.08

XXX proc. 78890............. TC............ B

Nuclear medicine data +0.00 1.31

NA 0.06 1.37

NA

XXX proc. 78890............. .............. B

Nuclear medicine data +0.05 1.33

NA 0.07 1.45

NA

XXX proc. 78891............. 26............ B

Nuclear med data proc. +0.10 0.04 0.04 0.01 0.15 0.15

XXX 78891............. TC............ B

Nuclear med data proc. +0.00 2.63

NA 0.13 2.76

NA

XXX 78891............. .............. B

Nuclear med data proc. +0.10 2.67

NA 0.14 2.91

NA

XXX 78999............. 26............ C

Nuclear diagnostic

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78999............. TC............ C

Nuclear diagnostic

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 78999............. .............. C

Nuclear diagnostic

0.00 0.00 0.00 0.00 0.00 0.00

XXX exam. 79005............. 26............ A

Nuclear rx, oral admin 1.80 0.60 0.60 0.08 2.48 2.48

XXX 79005............. TC............ A

Nuclear rx, oral admin 0.00 2.63

NA 0.14 2.77

NA

XXX 79005............. .............. A

Nuclear rx, oral admin 1.80 3.23

NA 0.22 5.25

NA

XXX 79101............. 26............ A

Nuclear rx, iv admin.. 1.96 0.67 0.67 0.08 2.71 2.71

XXX 79101............. TC............ A

Nuclear rx, iv admin.. 0.00 2.63

NA 0.14 2.77

NA

XXX 79101............. .............. A

Nuclear rx, iv admin.. 1.96 3.30

NA 0.22 5.48

NA

XXX 79200............. 26............ A

Nuclear rx, intracav

1.99 0.69 0.69 0.09 2.77 2.77

XXX admin. 79200............. TC............ A

Nuclear rx, intracav

0.00 2.63

NA 0.14 2.77

NA

XXX admin. 79200............. .............. A

Nuclear rx, intracav

1.99 3.32

NA 0.23 5.54

NA

XXX admin. 79300............. 26............ A

Nuclr rx, interstit

1.60 0.56 0.56 0.13 2.29 2.29

XXX colloid. 79300............. TC............ C

Nuclr rx, interstit

0.00 0.00 0.00 0.00 0.00 0.00

XXX colloid. 79300............. .............. C

Nuclr rx, interstit

0.00 0.00 0.00 0.00 0.00 0.00

XXX colloid. 79403............. 26............ A

Hematopoietic nuclear

2.25 0.89 0.89 0.10 3.24 3.24

XXX tx. 79403............. TC............ A

Hematopoietic nuclear

0.00 4.28

NA 0.14 4.42

NA

XXX tx. 79403............. .............. A

Hematopoietic nuclear

2.25 5.17

NA 0.24 7.66

NA

XXX tx. 79440............. 26............ A

Nuclear rx, intra-

1.99 0.72 0.72 0.08 2.79 2.79

XXX articular. 79440............. TC............ A

Nuclear rx, intra-

0.00 2.63

NA 0.14 2.77

NA

XXX articular. 79440............. .............. A

Nuclear rx, intra-

1.99 3.35

NA 0.22 5.56

NA

XXX articular. 79445............. 26............ A

Nuclear rx, intra-

2.40 0.82 0.82 0.12 3.34 3.34

XXX arterial. 79445............. TC............ C

Nuclear rx, intra-

0.00 0.00 0.00 0.00 0.00 0.00

XXX arterial. 79445............. .............. C

Nuclear rx, intra-

0.00 0.00 0.00 0.00 0.00 0.00

XXX arterial. 79999............. 26............ C

Nuclear medicine

0.00 0.00 0.00 0.00 0.00 0.00

XXX therapy. 79999............. TC............ C

Nuclear medicine

0.00 0.00 0.00 0.00 0.00 0.00

XXX therapy.

[[Page 70438]]

79999............. .............. C

Nuclear medicine

0.00 0.00 0.00 0.00 0.00 0.00

XXX therapy. 80500............. .............. A

Lab pathology

0.37 0.21 0.16 0.01 0.59 0.54

XXX consultation. 80502............. .............. A

Lab pathology

1.33 0.54 0.54 0.04 1.91 1.91

XXX consultation. 83020............. 26............ A

Hemoglobin

0.37 0.15 0.15 0.01 0.53 0.53

XXX electrophoresis. 83912............. 26............ A

Genetic examination... 0.37 0.12 0.12 0.01 0.50 0.50

XXX 84165............. 26............ A

Protein e-phoresis,

0.37 0.14 0.14 0.01 0.52 0.52

XXX serum. 84166............. 26............ A

Protein e-phoresis/

0.37 0.14 0.14 0.01 0.52 0.52

XXX urine/csf. 84181............. 26............ A

Western blot test..... 0.37 0.14 0.14 0.01 0.52 0.52

XXX 84182............. 26............ A

Protein, western blot

0.37 0.16 0.16 0.02 0.55 0.55

XXX test. 85060............. .............. A

Blood smear

0.45 0.18 0.18 0.02 0.65 0.65

XXX interpretation. 85097............. .............. A

Bone marrow

0.94 1.92 0.41 0.04 2.90 1.39

XXX interpretation. 85390............. 26............ A

Fibrinolysins screen.. 0.37 0.13 0.13 0.01 0.51 0.51

XXX 85396............. .............. A

Clotting assay, whole

0.37

NA 0.16 0.04

NA 0.57

XXX blood. 85576............. 26............ A

Blood platelet

0.37 0.16 0.16 0.01 0.54 0.54

XXX aggregation. 86077............. .............. A

Physician blood bank

0.94 0.39 0.39 0.03 1.36 1.36

XXX service. 86078............. .............. A

Physician blood bank

0.94 0.46 0.40 0.03 1.43 1.37

XXX service. 86079............. .............. A

Physician blood bank

0.94 0.45 0.41 0.03 1.42 1.38

XXX service. 86255............. 26............ A

Fluorescent antibody,

0.37 0.15 0.15 0.01 0.53 0.53

XXX screen. 86256............. 26............ A

Fluorescent antibody,

0.37 0.15 0.15 0.01 0.53 0.53

XXX titer. 86320............. 26............ A

Serum

0.37 0.15 0.15 0.01 0.53 0.53

XXX immunoelectrophoresis. 86325............. 26............ A

Other

0.37 0.13 0.13 0.01 0.51 0.51

XXX immunoelectrophoresis. 86327............. 26............ A

Immunoelectrophoresis

0.42 0.18 0.18 0.02 0.62 0.62

XXX assay. 86334............. 26............ A

Immunofix e-phoresis,

0.37 0.15 0.15 0.01 0.53 0.53

XXX serum. 86335............. 26............ A

Immunfix e-phorsis/

0.37 0.14 0.14 0.01 0.52 0.52

XXX urine/csf. 86485............. .............. C

Skin test, candida.... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 86490............. .............. A

Coccidioidomycosis

0.00 0.29

NA 0.02 0.31

NA

XXX skin test. 86510............. .............. A

Histoplasmosis skin

0.00 0.32

NA 0.02 0.34

NA

XXX test. 86580............. .............. A

TB intradermal test... 0.00 0.25

NA 0.02 0.27

NA

XXX 87164............. 26............ A

Dark field examination 0.37 0.12 0.12 0.01 0.50 0.50

XXX 87207............. 26............ A

Smear, special stain.. 0.37 0.16 0.16 0.01 0.54 0.54

XXX 88104............. 26............ A

Cytopathology, fluids. 0.56 0.24 0.24 0.02 0.82 0.82

XXX 88104............. TC............ A

Cytopathology, fluids. 0.00 0.61

NA 0.02 0.63

NA

XXX 88104............. .............. A

Cytopathology, fluids. 0.56 0.85

NA 0.04 1.45

NA

XXX 88106............. 26............ A

Cytopathology, fluids. 0.56 0.24 0.24 0.02 0.82 0.82

XXX 88106............. TC............ A

Cytopathology, fluids. 0.00 1.11

NA 0.02 1.13

NA

XXX 88106............. .............. A

Cytopathology, fluids. 0.56 1.35

NA 0.04 1.95

NA

XXX 88107............. 26............ A

Cytopathology, fluids. 0.76 0.33 0.33 0.03 1.12 1.12

XXX 88107............. TC............ A

Cytopathology, fluids. 0.00 1.21

NA 0.02 1.23

NA

XXX 88107............. .............. A

Cytopathology, fluids. 0.76 1.54

NA 0.05 2.35

NA

XXX 88108............. 26............ A

Cytopath, concentrate

0.56 0.24 0.24 0.02 0.82 0.82

XXX tech. 88108............. TC............ A

Cytopath, concentrate

0.00 0.97

NA 0.02 0.99

NA

XXX tech. 88108............. .............. A

Cytopath, concentrate

0.56 1.21

NA 0.04 1.81

NA

XXX tech. 88112............. 26............ A

Cytopath, cell enhance 1.18 0.51 0.51 0.02 1.71 1.71

XXX tech. 88112............. TC............ A

Cytopath, cell enhance 0.00 1.46

NA 0.02 1.48

NA

XXX tech. 88112............. .............. A

Cytopath, cell enhance 1.18 1.97

NA 0.04 3.19

NA

XXX tech. 88125............. 26............ A

Forensic cytopathology 0.26 0.11 0.11 0.01 0.38 0.38

XXX 88125............. TC............ A

Forensic cytopathology 0.00 0.16

NA 0.01 0.17

NA

XXX 88125............. .............. A

Forensic cytopathology 0.26 0.27

NA 0.02 0.55

NA

XXX 88141............. .............. A

Cytopath, c/v,

0.42 0.15 0.15 0.02 0.59 0.59

XXX interpret. 88160............. 26............ A

Cytopath smear, other

0.50 0.21 0.21 0.02 0.73 0.73

XXX source. 88160............. TC............ A

Cytopath smear, other

0.00 0.62

NA 0.02 0.64

NA

XXX source. 88160............. .............. A

Cytopath smear, other

0.50 0.83

NA 0.04 1.37

NA

XXX source. 88161............. 26............ A

Cytopath smear, other

0.50 0.21 0.21 0.02 0.73 0.73

XXX source. 88161............. TC............ A

Cytopath smear, other

0.00 0.73

NA 0.02 0.75

NA

XXX source. 88161............. .............. A

Cytopath smear, other

0.50 0.94

NA 0.04 1.48

NA

XXX source. 88162............. 26............ A

Cytopath smear, other

0.76 0.33 0.33 0.03 1.12 1.12

XXX source. 88162............. TC............ A

Cytopath smear, other

0.00 0.69

NA 0.02 0.71

NA

XXX source. 88162............. .............. A

Cytopath smear, other

0.76 1.02

NA 0.05 1.83

NA

XXX source. 88172............. 26............ A

Cytopathology eval of

0.60 0.26 0.26 0.02 0.88 0.88

XXX fna. 88172............. TC............ A

Cytopathology eval of

0.00 0.47

NA 0.02 0.49

NA

XXX fna. 88172............. .............. A

Cytopathology eval of

0.60 0.73

NA 0.04 1.37

NA

XXX fna. 88173............. 26............ A

Cytopath eval, fna,

1.39 0.59 0.59 0.05 2.03 2.03

XXX report. 88173............. TC............ A

Cytopath eval, fna,

0.00 1.55

NA 0.02 1.57

NA

XXX report. 88173............. .............. A

Cytopath eval, fna,

1.39 2.14

NA 0.07 3.60

NA

XXX report. 88182............. 26............ A

Cell marker study..... 0.77 0.33 0.33 0.03 1.13 1.13

XXX 88182............. TC............ A

Cell marker study..... 0.00 1.65

NA 0.04 1.69

NA

XXX 88182............. .............. A

Cell marker study..... 0.77 1.98

NA 0.07 2.82

NA

XXX 88184............. .............. A

Flowcytometry/ tc, 1

0.00 1.32

NA 0.02 1.34

NA

XXX marker. 88185............. .............. A

Flowcytometry/tc, add- 0.00 0.64

NA 0.02 0.66

NA

ZZZ on. 88187............. .............. A

Flowcytometry/read, 2- 1.36 0.45 0.45 0.01 1.82 1.82

XXX 8. 88188............. .............. A

Flowcytometry/read, 9- 1.69 0.57 0.57 0.01 2.27 2.27

XXX 15. 88189............. .............. A

Flowcytometry/read, 16 2.23 0.75 0.75 0.01 2.99 2.99

XXX & >. 88199............. 26............ C

Cytopathology

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 88199............. TC............ C

Cytopathology

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 88199............. .............. C

Cytopathology

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure.

[[Page 70439]]

88291............. .............. A

Cyto/molecular report. 0.52 0.17 0.17 0.02 0.71 0.71

XXX 88299............. .............. C

Cytogenetic study..... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 88300............. 26............ A

Surgical path, gross.. 0.08 0.03 0.03 0.01 0.12 0.12

XXX 88300............. TC............ A

Surgical path, gross.. 0.00 0.42

NA 0.01 0.43

NA

XXX 88300............. .............. A

Surgical path, gross.. 0.08 0.45

NA 0.02 0.55

NA

XXX 88302............. 26............ A

Tissue exam by

0.13 0.06 0.06 0.01 0.20 0.20

XXX pathologist. 88302............. TC............ A

Tissue exam by

0.00 0.97

NA 0.02 0.99

NA

XXX pathologist. 88302............. .............. A

Tissue exam by

0.13 1.03

NA 0.03 1.19

NA

XXX pathologist. 88304............. 26............ A

Tissue exam by

0.22 0.09 0.09 0.01 0.32 0.32

XXX pathologist. 88304............. TC............ A

Tissue exam by

0.00 1.23

NA 0.02 1.25

NA

XXX pathologist. 88304............. .............. A

Tissue exam by

0.22 1.32

NA 0.03 1.57

NA

XXX pathologist. 88305............. 26............ A

Tissue exam by

0.75 0.33 0.33 0.03 1.11 1.11

XXX pathologist. 88305............. TC............ A

Tissue exam by

0.00 1.58

NA 0.04 1.62

NA

XXX pathologist. 88305............. .............. A

Tissue exam by

0.75 1.91

NA 0.07 2.73

NA

XXX pathologist. 88307............. 26............ A

Tissue exam by

1.59 0.68 0.68 0.06 2.33 2.33

XXX pathologist. 88307............. TC............ A

Tissue exam by

0.00 2.48

NA 0.06 2.54

NA

XXX pathologist. 88307............. .............. A

Tissue exam by

1.59 3.16

NA 0.12 4.87

NA

XXX pathologist. 88309............. 26............ A

Tissue exam by

2.28 0.97 0.97 0.08 3.33 3.33

XXX pathologist. 88309............. TC............ A

Tissue exam by

0.00 3.43

NA 0.06 3.49

NA

XXX pathologist. 88309............. .............. A

Tissue exam by

2.28 4.40

NA 0.14 6.82

NA

XXX pathologist. 88311............. 26............ A

Decalcify tissue...... 0.24 0.10 0.10 0.01 0.35 0.35

XXX 88311............. TC............ A

Decalcify tissue...... 0.00 0.13

NA 0.01 0.14

NA

XXX 88311............. .............. A

Decalcify tissue...... 0.24 0.23

NA 0.02 0.49

NA

XXX 88312............. 26............ A

Special stains........ 0.54 0.23 0.23 0.02 0.79 0.79

XXX 88312............. TC............ A

Special stains........ 0.00 1.29

NA 0.01 1.30

NA

XXX 88312............. .............. A

Special stains........ 0.54 1.52

NA 0.03 2.09

NA

XXX 88313............. 26............ A

Special stains........ 0.24 0.10 0.10 0.01 0.35 0.35

XXX 88313............. TC............ A

Special stains........ 0.00 1.15

NA 0.01 1.16

NA

XXX 88313............. .............. A

Special stains........ 0.24 1.25

NA 0.02 1.51

NA

XXX 88314............. 26............ A

Histochemical stain... 0.45 0.19 0.19 0.02 0.66 0.66

XXX 88314............. TC............ A

Histochemical stain... 0.00 1.88

NA 0.02 1.90

NA

XXX 88314............. .............. A

Histochemical stain... 0.45 2.07

NA 0.04 2.56

NA

XXX 88318............. 26............ A

Chemical

0.42 0.18 0.18 0.02 0.62 0.62

XXX histochemistry. 88318............. TC............ A

Chemical

0.00 1.47

NA 0.01 1.48

NA

XXX histochemistry. 88318............. .............. A

Chemical

0.42 1.65

NA 0.03 2.10

NA

XXX histochemistry. 88319............. 26............ A

Enzyme histochemistry. 0.53 0.22 0.22 0.02 0.77 0.77

XXX 88319............. TC............ A

Enzyme histochemistry. 0.00 3.20

NA 0.02 3.22

NA

XXX 88319............. .............. A

Enzyme histochemistry. 0.53 3.42

NA 0.04 3.99

NA

XXX 88321............. .............. A

Microslide

1.30 0.79 0.56 0.05 2.14 1.91

XXX consultation. 88323............. 26............ A

Microslide

1.35 0.57 0.57 0.05 1.97 1.97

XXX consultation. 88323............. TC............ A

Microslide

0.00 1.21

NA 0.02 1.23

NA

XXX consultation. 88323............. .............. A

Microslide

1.35 1.78

NA 0.07 3.20

NA

XXX consultation. 88325............. .............. A

Comprehensive review

2.22 2.94 0.95 0.07 5.23 3.24

XXX of data. 88329............. .............. A

Path consult introp... 0.67 0.65 0.29 0.02 1.34 0.98

XXX 88331............. 26............ A

Path consult intraop,

1.19 0.51 0.51 0.04 1.74 1.74

XXX 1 bloc. 88331............. TC............ A

Path consult intraop,

0.00 0.59

NA 0.04 0.63

NA

XXX 1 bloc. 88331............. .............. A

Path consult intraop,

1.19 1.10

NA 0.08 2.37

NA

XXX 1 bloc. 88332............. 26............ A

Path consult intraop,

0.59 0.25 0.25 0.02 0.86 0.86

XXX add'l. 88332............. TC............ A

Path consult intraop,

0.00 0.21

NA 0.02 0.23

NA

XXX add'l. 88332............. .............. A

Path consult intraop,

0.59 0.46

NA 0.04 1.09

NA

XXX add'l. 88333............. 26............ A

Intraop cyto path

1.20 0.53 0.53 0.04 1.77 1.77

XXX consult, 1. 88333............. TC............ A

Intraop cyto path

0.00 0.55

NA 0.04 0.59

NA

XXX consult, 1. 88333............. .............. A

Intraop cyto path

1.20 1.08

NA 0.08 2.36

NA

XXX consult, 1. 88334............. 26............ A

Intraop cyto path

0.59 0.26 0.26 0.02 0.87 0.87

XXX consult, 2. 88334............. TC............ A

Intraop cyto path

0.00 0.34

NA 0.02 0.36

NA

XXX consult, 2. 88334............. .............. A

Intraop cyto path

0.59 0.60

NA 0.04 1.23

NA

XXX consult, 2. 88342............. 26............ A

Immunohistochemistry.. 0.85 0.36 0.36 0.03 1.24 1.24

XXX 88342............. TC............ A

Immunohistochemistry.. 0.00 1.10

NA 0.02 1.12

NA

XXX 88342............. .............. A

Immunohistochemistry.. 0.85 1.46

NA 0.05 2.36

NA

XXX 88346............. 26............ A

Immunofluorescent

0.86 0.36 0.36 0.03 1.25 1.25

XXX study. 88346............. TC............ A

Immunofluorescent

0.00 1.21

NA 0.02 1.23

NA

XXX study. 88346............. .............. A

Immunofluorescent

0.86 1.57

NA 0.05 2.48

NA

XXX study. 88347............. 26............ A

Immunofluorescent

0.86 0.35 0.35 0.03 1.24 1.24

XXX study. 88347............. TC............ A

Immunofluorescent

0.00 0.91

NA 0.02 0.93

NA

XXX study. 88347............. .............. A

Immunofluorescent

0.86 1.26

NA 0.05 2.17

NA

XXX study. 88348............. 26............ A

Electron microscopy... 1.51 0.64 0.64 0.06 2.21 2.21

XXX 88348............. TC............ A

Electron microscopy... 0.00 8.74

NA 0.07 8.81

NA

XXX 88348............. .............. A

Electron microscopy... 1.51 9.38

NA 0.13 11.02

NA

XXX 88349............. 26............ A

Scanning electron

0.76 0.33 0.33 0.03 1.12 1.12

XXX microscopy. 88349............. TC............ A

Scanning electron

0.00 3.24

NA 0.06 3.30

NA

XXX microscopy. 88349............. .............. A

Scanning electron

0.76 3.57

NA 0.09 4.42

NA

XXX microscopy. 88355............. 26............ A

Analysis, skeletal

1.85 0.79 0.79 0.07 2.71 2.71

XXX muscle. 88355............. TC............ A

Analysis, skeletal

0.00 8.00

NA 0.06 8.06

NA

XXX muscle. 88355............. .............. A

Analysis, skeletal

1.85 8.79

NA 0.13 10.77

NA

XXX muscle. 88356............. 26............ A

Analysis, nerve....... 3.02 1.26 1.26 0.12 4.40 4.40

XXX

[[Page 70440]]

88356............. TC............ A

Analysis, nerve....... 0.00 2.93

NA 0.07 3.00

NA

XXX 88356............. .............. A

Analysis, nerve....... 3.02 4.19

NA 0.19 7.40

NA

XXX 88358............. 26............ A

Analysis, tumor....... 0.95 0.40 0.40 0.10 1.45 1.45

XXX 88358............. TC............ A

Analysis, tumor....... 0.00 0.44

NA 0.07 0.51

NA

XXX 88358............. .............. A

Analysis, tumor....... 0.95 0.84

NA 0.17 1.96

NA

XXX 88360............. 26............ A

Tumor immunohistochem/ 1.10 0.47 0.47 0.06 1.63 1.63

XXX manual. 88360............. TC............ A

Tumor immunohistochem/ 0.00 1.26

NA 0.02 1.28

NA

XXX manual. 88360............. .............. A

Tumor immunohistochem/ 1.10 1.73

NA 0.08 2.91

NA

XXX manual. 88361............. 26............ A

Tumor immunohistochem/ 1.18 0.49 0.49 0.10 1.77 1.77

XXX comput. 88361............. TC............ A

Tumor immunohistochem/ 0.00 2.54

NA 0.07 2.61

NA

XXX comput. 88361............. .............. A

Tumor immunohistochem/ 1.18 3.03

NA 0.17 4.38

NA

XXX comput. 88362............. 26............ A

Nerve teasing

2.17 0.92 0.92 0.09 3.18 3.18

XXX preparations. 88362............. TC............ A

Nerve teasing

0.00 3.78

NA 0.06 3.84

NA

XXX preparations. 88362............. .............. A

Nerve teasing

2.17 4.70

NA 0.15 7.02

NA

XXX preparations. 88365............. 26............ A

Insitu hybridization

1.20 0.51 0.51 0.03 1.74 1.74

XXX (fish). 88365............. TC............ A

Insitu hybridization

0.00 1.62

NA 0.02 1.64

NA

XXX (fish). 88365............. .............. A

Insitu hybridization

1.20 2.13

NA 0.05 3.38

NA

XXX (fish). 88367............. 26............ A

Insitu hybridization,

1.30 0.54 0.54 0.06 1.90 1.90

XXX auto. 88367............. TC............ A

Insitu hybridization,

0.00 3.50

NA 0.06 3.56

NA

XXX auto. 88367............. .............. A

Insitu hybridization,

1.30 4.04

NA 0.12 5.46

NA

XXX auto. 88368............. 26............ A

Insitu hybridization,

1.40 0.60 0.60 0.06 2.06 2.06

XXX manual. 88368............. TC............ A

Insitu hybridization,

0.00 1.80

NA 0.06 1.86

NA

XXX manual. 88368............. .............. A

Insitu hybridization,

1.40 2.40

NA 0.12 3.92

NA

XXX manual. 88371............. 26............ A

Protein, western blot

0.37 0.13 0.13 0.01 0.51 0.51

XXX tissue. 88372............. 26............ A

Protein analysis w/

0.37 0.16 0.16 0.01 0.54 0.54

XXX probe. 88380............. 26............ C

Microdissection....... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 88380............. TC............ C

Microdissection....... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 88380............. .............. C

Microdissection....... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 88384............. 26............ C

Eval molecular probes, 0.00 0.00 0.00 0.00 0.00 0.00

XXX 11-50. 88384............. TC............ C

Eval molecular probes, 0.00 0.00 0.00 0.00 0.00 0.00

XXX 11-50. 88384............. .............. C

Eval molecular probes, 0.00 0.00 0.00 0.00 0.00 0.00

XXX 11-50. 88385............. 26............ A

Eval molecul probes,

1.50 0.65 0.65 0.06 2.21 2.21

XXX 51-250. 88385............. TC............ C

Eval molecul probes,

0.00 0.00 0.00 0.00 0.00 0.00

XXX 51-250. 88385............. .............. C

Eval molecul probes,

0.00 0.00 0.00 0.00 0.00 0.00

XXX 51-250. 88386............. 26............ A

Eval molecul probes,

1.88 0.82 0.82 0.08 2.78 2.78

XXX 251-500. 88386............. TC............ C

Eval molecul probes,

0.00 0.00 0.00 0.00 0.00 0.00

XXX 251-500. 88386............. .............. C

Eval molecul probes,

0.00 0.00 0.00 0.00 0.00 0.00

XXX 251-500. 88399............. 26............ C

Surgical pathology

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 88399............. TC............ C

Surgical pathology

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 88399............. .............. C

Surgical pathology

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 89049............. .............. A

Chct for mal

1.40 3.56 0.27 0.06 5.02 1.73

XXX hyperthermia. 89060............. 26............ A

Exam,synovial fluid

0.37 0.16 0.16 0.01 0.54 0.54

XXX crystals. 89100............. .............. A

Sample intestinal

0.60 1.84 0.21 0.03 2.47 0.84

XXX contents. 89105............. .............. A

Sample intestinal

0.50 2.23 0.17 0.02 2.75 0.69

XXX contents. 89130............. .............. A

Sample stomach

0.45 1.75 0.13 0.02 2.22 0.60

XXX contents. 89132............. .............. A

Sample stomach

0.19 1.55 0.06 0.01 1.75 0.26

XXX contents. 89135............. .............. A

Sample stomach

0.79 1.90 0.25 0.04 2.73 1.08

XXX contents. 89136............. .............. A

Sample stomach

0.21 1.74 0.09 0.01 1.96 0.31

XXX contents. 89140............. .............. A

Sample stomach

0.94 2.09 0.27 0.04 3.07 1.25

XXX contents. 89141............. .............. A

Sample stomach

0.85 2.80 0.33 0.03 3.68 1.21

XXX contents. 89220............. .............. A

Sputum specimen

0.00 0.43

NA 0.02 0.45

NA

XXX collection. 89230............. .............. A

Collect sweat for test 0.00 0.11

NA 0.02 0.13

NA

XXX 89240............. .............. C

Pathology lab

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 90281............. .............. I

Human ig, im.......... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90283............. .............. I

Human ig, iv.......... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90287............. .............. I

Botulinum antitoxin... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90288............. .............. I

Botulism ig, iv....... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90291............. .............. I

Cmv ig, iv............ 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90296............. .............. E

Diphtheria antitoxin.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90371............. .............. E

Hep b ig, im.......... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90375............. .............. E

Rabies ig, im/sc...... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90376............. .............. E

Rabies ig, heat

0.00 0.00 0.00 0.00 0.00 0.00

XXX treated. 90378............. .............. X

Rsv ig, im, 50mg...... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90379............. .............. I

Rsv ig, iv............ 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90384............. .............. I

Rh ig, full-dose, im.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90385............. .............. E

Rh ig, minidose, im... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90386............. .............. I

Rh ig, iv............. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90389............. .............. I

Tetanus ig, im........ 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90393............. .............. E

Vaccina ig, im........ 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90396............. .............. E

Varicella-zoster ig,

0.00 0.00 0.00 0.00 0.00 0.00

XXX im. 90399............. .............. I

Immune globulin....... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90465............. .............. A

Immune admin 1 inj, . 90657............. .............. X

Flu vaccine, 6-35 mo,

0.00 0.00 0.00 0.00 0.00 0.00

XXX im. 90658............. .............. X

Flu vaccine age 3 &

0.00 0.00 0.00 0.00 0.00 0.00

XXX over, im. 90660............. .............. X

Flu vaccine, nasal.... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90665............. .............. E

Lyme disease vaccine,

0.00 0.00 0.00 0.00 0.00 0.00

XXX im. 90669............. .............. N

Pneumococcal vacc, ped 0.00 0.00 0.00 0.00 0.00 0.00

XXX / 0.00 0.00 0.00 0.00 0.00 0.00

XXX = 7 im. 90715............. .............. E

Tdap vaccine >7 im.... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90716............. .............. E

Chicken pox vaccine,

0.00 0.00 0.00 0.00 0.00 0.00

XXX sc. 90717............. .............. E

Yellow fever vaccine,

0.00 0.00 0.00 0.00 0.00 0.00

XXX sc. 90718............. .............. E

Td vaccine > 7, im.... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90719............. .............. E

Diphtheria vaccine, im 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90720............. .............. E

Dtp/hib vaccine, im... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90721............. .............. E

Dtap/hib vaccine, im.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90723............. .............. I

Dtap-hep b-ipv

0.00 0.00 0.00 0.00 0.00 0.00

XXX vaccine, im. 90725............. .............. E

Cholera vaccine,

0.00 0.00 0.00 0.00 0.00 0.00

XXX injectable. 90727............. .............. E

Plague vaccine, im.... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90732............. .............. X

Pneumococcal vaccine.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90733............. .............. E

Meningococcal vaccine, 0.00 0.00 0.00 0.00 0.00 0.00

XXX sc. 90734............. .............. E

Meningococcal vaccine, 0.00 0.00 0.00 0.00 0.00 0.00

XXX im. 90735............. .............. E

Encephalitis vaccine,

0.00 0.00 0.00 0.00 0.00 0.00

XXX sc. 90736............. .............. E

Zoster vacc, sc....... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90740............. .............. X

Hepb vacc, ill pat 3

0.00 0.00 0.00 0.00 0.00 0.00

XXX dose im. 90743............. .............. X

Hep b vacc, adol, 2

0.00 0.00 0.00 0.00 0.00 0.00

XXX dose, im. 90744............. .............. X

Hepb vacc ped/adol 3

0.00 0.00 0.00 0.00 0.00 0.00

XXX dose im. 90746............. .............. X

Hep b vaccine, adult,

0.00 0.00 0.00 0.00 0.00 0.00

XXX im. 90747............. .............. X

Hepb vacc, ill pat 4

0.00 0.00 0.00 0.00 0.00 0.00

XXX dose im. 90748............. .............. I

Hep b/hib vaccine, im. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90749............. .............. E

Vaccine toxoid........ 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90760............. .............. A

Hydration iv infusion, 0.17 1.43 1.43 0.07 1.67 1.67

XXX init. 90761............. .............. A

Hydrate iv infusion,

0.09 0.40 0.40 0.04 0.53 0.53

ZZZ add-on. 90765............. .............. A

Ther/proph/diag iv

0.21 1.76 1.76 0.07 2.04 2.04

XXX inf, init. 90766............. .............. A

Ther/proph/dg iv inf,

0.18 0.46 0.46 0.04 0.68 0.68

ZZZ add-on. 90767............. .............. A

Tx/proph/dg addl seq

0.19 0.89 0.89 0.04 1.12 1.12

ZZZ iv inf. 90768............. .............. A

Ther/diag concurrent

0.17 0.44 0.44 0.04 0.65 0.65

ZZZ inf. 90772............. .............. A

Ther/proph/diag inj,

0.17 0.31 0.31 0.01 0.49 0.49

XXX sc/im.

[[Page 70442]]

90773............. .............. A

Ther/proph/diag inj,

0.17 0.32 0.32 0.02 0.51 0.51

XXX ia. 90774............. .............. A

Ther/proph/diag inj,

0.18 1.30 1.30 0.04 1.52 1.52

XXX iv push. 90775............. .............. A

Ther/proph/diag inj

0.10 0.57 0.57 0.04 0.71 0.71

ZZZ add-on. 90779............. .............. C

Ther/prop/diag inj/inf 0.00 0.00 0.00 0.00 0.00 0.00

XXX proc. 90801............. .............. A

Psy dx interview...... 2.80 1.17 0.93 0.06 4.03 3.79

XXX 90802............. .............. A

Intac psy dx interview 3.01 1.20 0.98 0.07 4.28 4.06

XXX 90804............. .............. A

Psytx, office, 20-30

1.21 0.49 0.38 0.03 1.73 1.62

XXX min. 90805............. .............. A

Psytx, off, 20-30 min

1.37 0.50 0.42 0.03 1.90 1.82

XXX w/e&m. 90806............. .............. A

Psytx, off, 45-50 min. 1.86 0.70 0.60 0.04 2.60 2.50

XXX 90807............. .............. A

Psytx, off, 45-50 min

2.02 0.70 0.63 0.05 2.77 2.70

XXX w/e&m. 90808............. .............. A

Psytx, office, 75-80

2.79 1.03 0.90 0.06 3.88 3.75

XXX min. 90809............. .............. A

Psytx, off, 75-80, w/

2.95 1.00 0.92 0.07 4.02 3.94

XXX e&m. 90810............. .............. A

Intac psytx, off, 20-

1.32 0.51 0.42 0.04 1.87 1.78

XXX 30 min. 90811............. .............. A

Intac psytx, 20-30, w/ 1.48 0.57 0.46 0.04 2.09 1.98

XXX e&m. 90812............. .............. A

Intac psytx, off, 45-

1.97 0.79 0.64 0.04 2.80 2.65

XXX 50 min. 90813............. .............. A

Intac psytx, 45-50 min 2.13 0.77 0.67 0.05 2.95 2.85

XXX w/e&m. 90814............. .............. A

Intac psytx, off, 75-

2.90 1.10 0.98 0.06 4.06 3.94

XXX 80 min. 90815............. .............. A

Intac psytx, 75-80 w/

3.06 1.05 0.95 0.07 4.18 4.08

XXX e&m. 90816............. .............. A

Psytx, hosp, 20-30 min 1.25

NA 0.46 0.03

NA 1.74

XXX 90817............. .............. A

Psytx, hosp, 20-30 min 1.41

NA 0.46 0.03

NA 1.90

XXX w/e&m. 90818............. .............. A

Psytx, hosp, 45-50 min 1.89

NA 0.69 0.04

NA 2.62

XXX 90819............. .............. A

Psytx, hosp, 45-50 min 2.05

NA 0.65 0.05

NA 2.75

XXX w/e&m. 90821............. .............. A

Psytx, hosp, 75-80 min 2.83

NA 1.01 0.06

NA 3.90

XXX 90822............. .............. A

Psytx, hosp, 75-80 min 2.99

NA 0.95 0.08

NA 4.02

XXX w/e&m. 90823............. .............. A

Intac psytx, hosp, 20- 1.36

NA 0.48 0.03

NA 1.87

XXX 30 min. 90824............. .............. A

Intac psytx, hsp 20-30 1.52

NA 0.49 0.04

NA 2.05

XXX w/e&m. 90826............. .............. A

Intac psytx, hosp, 45- 2.01

NA 0.72 0.05

NA 2.78

XXX 50 min. 90827............. .............. A

Intac psytx, hsp 45-50 2.16

NA 0.68 0.05

NA 2.89

XXX w/e&m. 90828............. .............. A

Intac psytx, hosp, 75- 2.94

NA 1.06 0.06

NA 4.06

XXX 80 min. 90829............. .............. A

Intac psytx, hsp 75-80 3.10

NA 0.98 0.07

NA 4.15

XXX w/e&m. 90845............. .............. A

Psychoanalysis........ 1.79 0.58 0.55 0.04 2.41 2.38

XXX 90846............. .............. R

Family psytx w/o

1.83 0.65 0.65 0.04 2.52 2.52

XXX patient. 90847............. .............. R

Family psytx w/patient 2.21 0.82 0.76 0.05 3.08 3.02

XXX 90849............. .............. R

Multiple family group

0.59 0.27 0.24 0.02 0.88 0.85

XXX psytx. 90853............. .............. A

Group psychotherapy... 0.59 0.25 0.23 0.01 0.85 0.83

XXX 90857............. .............. A

Intac group psytx..... 0.63 0.29 0.25 0.01 0.93 0.89

XXX 90862............. .............. A

Medication management. 0.95 0.40 0.32 0.02 1.37 1.29

XXX 90865............. .............. A

Narcosynthesis........ 2.84 1.36 0.91 0.12 4.32 3.87

XXX 90870............. .............. A

Electroconvulsive

1.88 1.94 0.59 0.04 3.86 2.51

000 therapy. 90875............. .............. N

Psychophysiological

+1.20 0.90 0.46 0.04 2.14 1.70

XXX therapy. 90876............. .............. N

Psychophysiological

+1.90 1.16 0.73 0.05 3.11 2.68

XXX therapy. 90880............. .............. A

Hypnotherapy.......... 2.19 1.04 0.69 0.05 3.28 2.93

XXX 90882............. .............. N

Environmental

0.00 0.00 0.00 0.00 0.00 0.00

XXX manipulation. 90885............. .............. B

Psy evaluation of

+0.97 0.37 0.37 0.02 1.36 1.36

XXX records. 90887............. .............. B

Consultation with

+1.48 0.82 0.56 0.04 2.34 2.08

XXX family. 90889............. .............. B

Preparation of report. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 90899............. .............. C

Psychiatric service/

0.00 0.00 0.00 0.00 0.00 0.00

XXX therapy. 90901............. .............. A

Biofeedback train, any 0.41 0.65 0.14 0.02 1.08 0.57

000 meth. 90911............. .............. A

Biofeedback peri/uro/

0.89 1.56 0.31 0.06 2.51 1.26

000 rectal. 90918............. .............. I

ESRD related services, +11.16 6.13 6.13 0.36 17.65 17.65

XXX month. 90919............. .............. I

ESRD related services, +8.53 4.01 4.01 0.29 12.83 12.83

XXX month. 90920............. .............. I

ESRD related services, +7.26 3.76 3.76 0.23 11.25 11.25

XXX month. 90921............. .............. I

ESRD related services, +4.46 2.45 2.45 0.14 7.05 7.05

XXX month. 90922............. .............. I

ESRD related services, +0.37 0.21 0.21 0.01 0.59 0.59

XXX day. 90923............. .............. I

Esrd related services, +0.28 0.13 0.13 0.01 0.42 0.42

XXX day. 90924............. .............. I

Esrd related services, +0.24 0.12 0.12 0.01 0.37 0.37

XXX day. 90925............. .............. I

Esrd related services, +0.15 0.08 0.08 0.01 0.24 0.24

XXX day. 90935............. .............. A

Hemodialysis, one

1.22

NA 0.67 0.04

NA 1.93

000 evaluation. 90937............. .............. A

Hemodialysis, repeated 2.11

NA 0.97 0.07

NA 3.15

000 eval. 90940............. .............. X

Hemodialysis access

0.00 0.00 0.00 0.00 0.00 0.00

XXX study. 90945............. .............. A

Dialysis, one

1.28

NA 0.69 0.04

NA 2.01

000 evaluation. 90947............. .............. A

Dialysis, repeated

2.16

NA 0.99 0.07

NA 3.22

000 eval. 90989............. .............. X

Dialysis training,

0.00 0.00 0.00 0.00 0.00 0.00

XXX complete. 90993............. .............. X

Dialysis training,

0.00 0.00 0.00 0.00 0.00 0.00

XXX incompl. 90997............. .............. A

Hemoperfusion......... 1.84

NA 0.66 0.06

NA 2.56

000 90999............. .............. C

Dialysis procedure.... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 91000............. 26............ A

Esophageal intubation. 0.73 0.25 0.25 0.03 1.01 1.01

000 91000............. TC............ A

Esophageal intubation. 0.00 0.08

NA 0.01 0.09

NA

000 91000............. .............. A

Esophageal intubation. 0.73 0.33

NA 0.04 1.10

NA

000 91010............. 26............ A

Esophagus motility

1.25 0.44 0.44 0.06 1.75 1.75

000 study. 91010............. TC............ A

Esophagus motility

0.00 3.98

NA 0.06 4.04

NA

000 study. 91010............. .............. A

Esophagus motility

1.25 4.42

NA 0.12 5.79

NA

000 study. 91011............. 26............ A

Esophagus motility

1.50 0.53 0.53 0.07 2.10 2.10

000 study. 91011............. TC............ A

Esophagus motility

0.00 4.71

NA 0.06 4.77

NA

000 study. 91011............. .............. A

Esophagus motility

1.50 5.24

NA 0.13 6.87

NA

000 study.

[[Page 70443]]

91012............. 26............ A

Esophagus motility

1.46 0.51 0.51 0.06 2.03 2.03

000 study. 91012............. TC............ A

Esophagus motility

0.00 5.26

NA 0.07 5.33

NA

000 study. 91012............. .............. A

Esophagus motility

1.46 5.77

NA 0.13 7.36

NA

000 study. 91020............. 26............ A

Gastric motility

1.44 0.49 0.49 0.07 2.00 2.00

000 studies. 91020............. TC............ A

Gastric motility

0.00 4.04

NA 0.06 4.10

NA

000 studies. 91020............. .............. A

Gastric motility

1.44 4.53

NA 0.13 6.10

NA

000 studies. 91022............. 26............ A

Duodenal motility

1.44 0.51 0.51 0.07 2.02 2.02

000 study. 91022............. TC............ A

Duodenal motility

0.00 3.90

NA 0.06 3.96

NA

000 study. 91022............. .............. A

Duodenal motility

1.44 4.41

NA 0.13 5.98

NA

000 study. 91030............. 26............ A

Acid perfusion of

0.91 0.32 0.32 0.04 1.27 1.27

000 esophagus. 91030............. TC............ A

Acid perfusion of

0.00 2.12

NA 0.02 2.14

NA

000 esophagus. 91030............. .............. A

Acid perfusion of

0.91 2.44

NA 0.06 3.41

NA

000 esophagus. 91034............. 26............ A

Gastroesophageal

0.97 0.34 0.34 0.06 1.37 1.37

000 reflux test. 91034............. TC............ A

Gastroesophageal

0.00 4.91

NA 0.06 4.97

NA

000 reflux test. 91034............. .............. A

Gastroesophageal

0.97 5.25

NA 0.12 6.34

NA

000 reflux test. 91035............. 26............ A

G-esoph reflx tst w/

1.59 0.56 0.56 0.06 2.21 2.21

000 electrod. 91035............. TC............ A

G-esoph reflx tst w/

0.00 10.27

NA 0.06 10.33

NA

000 electrod. 91035............. .............. A

G-esoph reflx tst w/

1.59 10.83

NA 0.12 12.54

NA

000 electrod. 91037............. 26............ A

Esoph imped function

0.97 0.34 0.34 0.06 1.37 1.37

000 test. 91037............. TC............ A

Esoph imped function

0.00 2.60

NA 0.06 2.66

NA

000 test. 91037............. .............. A

Esoph imped function

0.97 2.94

NA 0.12 4.03

NA

000 test. 91038............. 26............ A

Esoph imped funct test 1.10 0.39 0.39 0.06 1.55 1.55

000 > 1h. 91038............. TC............ A

Esoph imped funct test 0.00 1.84

NA 0.06 1.90

NA

000 > 1h. 91038............. .............. A

Esoph imped funct test 1.10 2.23

NA 0.12 3.45

NA

000 > 1h. 91040............. 26............ A

Esoph balloon

0.97 0.34 0.34 0.06 1.37 1.37

000 distension tst. 91040............. TC............ A

Esoph balloon

0.00 10.82

NA 0.06 10.88

NA

000 distension tst. 91040............. .............. A

Esoph balloon

0.97 11.16

NA 0.12 12.25

NA

000 distension tst. 91052............. 26............ A

Gastric analysis test. 0.79 0.28 0.28 0.03 1.10 1.10

000 91052............. TC............ A

Gastric analysis test. 0.00 2.18

NA 0.02 2.20

NA

000 91052............. .............. A

Gastric analysis test. 0.79 2.46

NA 0.05 3.30

NA

000 91055............. 26............ A

Gastric intubation for 0.94 0.27 0.27 0.05 1.26 1.26

000 smear. 91055............. TC............ A

Gastric intubation for 0.00 2.68

NA 0.02 2.70

NA

000 smear. 91055............. .............. A

Gastric intubation for 0.94 2.95

NA 0.07 3.96

NA

000 smear. 91060............. 26............ A

Gastric saline load

0.45 0.14 0.14 0.03 0.62 0.62

000 test. 91060............. TC............ A

Gastric saline load

0.00 1.83

NA 0.02 1.85

NA

000 test. 91060............. .............. A

Gastric saline load

0.45 1.97

NA 0.05 2.47

NA

000 test. 91065............. 26............ A

Breath hydrogen test.. 0.20 0.07 0.07 0.01 0.28 0.28

000 91065............. TC............ A

Breath hydrogen test.. 0.00 1.39

NA 0.02 1.41

NA

000 91065............. .............. A

Breath hydrogen test.. 0.20 1.46

NA 0.03 1.69

NA

000 91100............. .............. A

Pass intestine

1.08 2.80 0.28 0.07 3.95 1.43

000 bleeding tube. 91105............. .............. A

Gastric intubation

0.37 2.11 0.09 0.03 2.51 0.49

000 treatment. 91110............. 26............ A

Gi tract capsule

3.64 1.28 1.28 0.09 5.01 5.01

XXX endoscopy. 91110............. TC............ A

Gi tract capsule

0.00 20.96

NA 0.07 21.03

NA

XXX endoscopy. 91110............. .............. A

Gi tract capsule

3.64 22.24

NA 0.16 26.04

NA

XXX endoscopy. 91120............. 26............ A

Rectal sensation test. 0.97 0.34 0.34 0.07 1.38 1.38

XXX 91120............. TC............ A

Rectal sensation test. 0.00 10.67

NA 0.04 10.71

NA

XXX 91120............. .............. A

Rectal sensation test. 0.97 11.01

NA 0.11 12.09

NA

XXX 91122............. 26............ A

Anal pressure record.. 1.77 0.60 0.60 0.13 2.50 2.50

000 91122............. TC............ A

Anal pressure record.. 0.00 4.51

NA 0.08 4.59

NA

000 91122............. .............. A

Anal pressure record.. 1.77 5.11

NA 0.21 7.09

NA

000 91123............. .............. B

Irrigate fecal

0.00 0.00 0.00 0.00 0.00 0.00

XXX impaction. 91132............. 26............ A

Electrogastrography... 0.52 0.18 0.18 0.02 0.72 0.72

XXX 91132............. TC............ C

Electrogastrography... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 91132............. .............. C

Electrogastrography... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 91133............. 26............ A

Electrogastrography w/ 0.66 0.23 0.23 0.03 0.92 0.92

XXX test. 91133............. TC............ C

Electrogastrography w/ 0.00 0.00 0.00 0.00 0.00 0.00

XXX test. 91133............. .............. C

Electrogastrography w/ 0.00 0.00 0.00 0.00 0.00 0.00

XXX test. 91299............. 26............ C

Gastroenterology

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 91299............. TC............ C

Gastroenterology

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 91299............. .............. C

Gastroenterology

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 92002............. .............. A

Eye exam, new patient. 0.88 0.97 0.34 0.02 1.87 1.24

XXX 92004............. .............. A

Eye exam, new patient. 1.67 1.70 0.68 0.04 3.41 2.39

XXX 92012............. .............. A

Eye exam established

0.67 1.03 0.29 0.02 1.72 0.98

XXX pat. 92014............. .............. A

Eye exam & treatment.. 1.10 1.41 0.47 0.03 2.54 1.60

XXX 92015............. .............. N

Refraction............ +0.38 1.49 0.15 0.01 1.88 0.54

XXX 92018............. .............. A

New eye exam &

2.50

NA 1.07 0.07

NA 3.64

XXX treatment. 92019............. .............. A

Eye exam & treatment.. 1.31

NA 0.56 0.03

NA 1.90

XXX 92020............. .............. A

Special eye evaluation 0.37 0.34 0.16 0.01 0.72 0.54

XXX 92060............. 26............ A

Special eye evaluation 0.69 0.29 0.29 0.02 1.00 1.00

XXX 92060............. TC............ A

Special eye evaluation 0.00 0.44

NA 0.01 0.45

NA

XXX 92060............. .............. A

Special eye evaluation 0.69 0.73

NA 0.03 1.45

NA

XXX 92065............. 26............ A

Orthoptic/pleoptic

0.37 0.15 0.15 0.01 0.53 0.53

XXX training. 92065............. TC............ A

Orthoptic/pleoptic

0.00 0.38

NA 0.01 0.39

NA

XXX training. 92065............. .............. A

Orthoptic/pleoptic

0.37 0.53

NA 0.02 0.92

NA

XXX training. 92070............. .............. A

Fitting of contact

0.70 1.07 0.32 0.02 1.79 1.04

XXX lens.

[[Page 70444]]

92081............. 26............ A

Visual field

0.36 0.15 0.15 0.01 0.52 0.52

XXX examination(s). 92081............. TC............ A

Visual field

0.00 0.79

NA 0.01 0.80

NA

XXX examination(s). 92081............. .............. A

Visual field

0.36 0.94

NA 0.02 1.32

NA

XXX examination(s). 92082............. 26............ A

Visual field

0.44 0.19 0.19 0.01 0.64 0.64

XXX examination(s). 92082............. TC............ A

Visual field

0.00 1.04

NA 0.01 1.05

NA

XXX examination(s). 92082............. .............. A

Visual field

0.44 1.23

NA 0.02 1.69

NA

XXX examination(s). 92083............. 26............ A

Visual field

0.50 0.22 0.22 0.01 0.73 0.73

XXX examination(s). 92083............. TC............ A

Visual field

0.00 1.21

NA 0.01 1.22

NA

XXX examination(s). 92083............. .............. A

Visual field

0.50 1.43

NA 0.02 1.95

NA

XXX examination(s). 92100............. A............. ............... Serial tonometry

0.92 1.35 0.36 0.02 2.29 1.30

XXX exam(s). 92120............. .............. A

Tonography & eye

0.81 1.07 0.32 0.02 1.90 1.15

XXX evaluation. 92130............. .............. A

Water provocation

0.81 1.28 0.37 0.02 2.11 1.20

XXX tonography. 92135............. 26............ A

Opthalmic dx imaging.. 0.35 0.15 0.15 0.01 0.51 0.51

XXX 92135............. TC............ A

Opthalmic dx imaging.. 0.00 0.64

NA 0.01 0.65

NA

XXX 92135............. .............. A

Opthalmic dx imaging.. 0.35 0.79

NA 0.02 1.16

NA

XXX 92136............. 26............ A

Ophthalmic biometry... 0.54 0.24 0.24 0.01 0.79 0.79

XXX 92136............. TC............ A

Ophthalmic biometry... 0.00 1.41

NA 0.07 1.48

NA

XXX 92136............. .............. A

Ophthalmic biometry... 0.54 1.65

NA 0.08 2.27

NA

XXX 92140............. .............. A

Glaucoma provocative

0.50 0.99 0.21 0.01 1.50 0.72

XXX tests. 92225............. .............. A

Special eye exam,

0.38 0.22 0.16 0.01 0.61 0.55

XXX initial. 92226............. .............. A

Special eye exam,

0.33 0.21 0.14 0.01 0.55 0.48

XXX subsequent. 92230............. .............. A

Eye exam with photos.. 0.60 1.53 0.20 0.02 2.15 0.82

XXX 92235............. 26............ A

Eye exam with photos.. 0.81 0.37 0.37 0.02 1.20 1.20

XXX 92235............. TC............ A

Eye exam with photos.. 0.00 2.25

NA 0.06 2.31

NA

XXX 92235............. .............. A

Eye exam with photos.. 0.81 2.62

NA 0.08 3.51

NA

XXX 92240............. 26............ A

Icg angiography....... 1.10 0.50 0.50 0.03 1.63 1.63

XXX 92240............. TC............ A

Icg angiography....... 0.00 5.62

NA 0.06 5.68

NA

XXX 92240............. .............. A

Icg angiography....... 1.10 6.12

NA 0.09 7.31

NA

XXX 92250............. 26............ A

Eye exam with photos.. 0.44 0.19 0.19 0.01 0.64 0.64

XXX 92250............. TC............ A

Eye exam with photos.. 0.00 1.34

NA 0.01 1.35

NA

XXX 92250............. .............. A

Eye exam with photos.. 0.44 1.53

NA 0.02 1.99

NA

XXX 92260............. .............. A

Ophthalmoscopy/

0.20 0.26 0.09 0.01 0.47 0.30

XXX dynamometry. 92265............. 26............ A

Eye muscle evaluation. 0.81 0.28 0.28 0.04 1.13 1.13

XXX 92265............. TC............ A

Eye muscle evaluation. 0.00 1.21

NA 0.02 1.23

NA

XXX 92265............. .............. A

Eye muscle evaluation. 0.81 1.49

NA 0.06 2.36

NA

XXX 92270............. 26............ A

Electro-oculography... 0.81 0.33 0.33 0.03 1.17 1.17

XXX 92270............. TC............ A

Electro-oculography... 0.00 1.20

NA 0.02 1.22

NA

XXX 92270............. .............. A

Electro-oculography... 0.81 1.53

NA 0.05 2.39

NA

XXX 92275............. 26............ A

Electroretinography... 1.01 0.43 0.43 0.03 1.47 1.47

XXX 92275............. TC............ A

Electroretinography... 0.00 1.51

NA 0.02 1.53

NA

XXX 92275............. .............. A

Electroretinography... 1.01 1.94

NA 0.05 3.00

NA

XXX 92283............. 26............ A

Color vision

0.17 0.07 0.07 0.01 0.25 0.25

XXX examination. 92283............. TC............ A

Color vision

0.00 0.77

NA 0.01 0.78

NA

XXX examination. 92283............. .............. A

Color vision

0.17 0.84

NA 0.02 1.03

NA

XXX examination. 92284............. 26............ A

Dark adaptation eye

0.24 0.08 0.08 0.01 0.33 0.33

XXX exam. 92284............. TC............ A

Dark adaptation eye

0.00 1.81

NA 0.01 1.82

NA

XXX exam. 92284............. .............. A

Dark adaptation eye

0.24 1.89

NA 0.02 2.15

NA

XXX exam. 92285............. 26............ A

Eye photography....... 0.20 0.09 0.09 0.01 0.30 0.30

XXX 92285............. TC............ A

Eye photography....... 0.00 0.90

NA 0.01 0.91

NA

XXX 92285............. .............. A

Eye photography....... 0.20 0.99

NA 0.02 1.21

NA

XXX 92286............. 26............ A

Internal eye

0.66 0.29 0.29 0.02 0.97 0.97

XXX photography. 92286............. TC............ A

Internal eye

0.00 2.77

NA 0.02 2.79

NA

XXX photography. 92286............. .............. A

Internal eye

0.66 3.06

NA 0.04 3.76

NA

XXX photography. 92287............. .............. A

Internal eye

0.81 2.39 0.31 0.02 3.22 1.14

XXX photography. 92310............. .............. N

Contact lens fitting.. +1.17 1.12 0.45 0.04 2.33 1.66

XXX 92311............. .............. A

Contact lens fitting.. 1.08 1.09 0.35 0.03 2.20 1.46

XXX 92312............. .............. A

Contact lens fitting.. 1.26 1.08 0.50 0.03 2.37 1.79

XXX 92313............. .............. A

Contact lens fitting.. 0.92 1.06 0.29 0.02 2.00 1.23

XXX 92314............. .............. N

Prescription of

+0.69 0.94 0.27 0.01 1.64 0.97

XXX contact lens. 92315............. .............. A

Prescription of

0.45 0.85 0.16 0.01 1.31 0.62

XXX contact lens. 92316............. .............. A

Prescription of

0.68 0.91 0.29 0.02 1.61 0.99

XXX contact lens. 92317............. .............. A

Prescription of

0.45 0.94 0.15 0.01 1.40 0.61

XXX contact lens. 92325............. .............. A

Modification of

0.00 0.40

NA 0.01 0.41

NA

XXX contact lens. 92326............. .............. A

Replacement of contact 0.00 1.63

NA 0.06 1.69

NA

XXX lens. 92340............. .............. N

Fitting of spectacles. +0.37 0.70 0.14 0.01 1.08 0.52

XXX 92341............. .............. N

Fitting of spectacles. +0.47 0.74 0.18 0.01 1.22 0.66

XXX 92342............. .............. N

Fitting of spectacles. +0.53 0.76 0.21 0.01 1.30 0.75

XXX 92352............. .............. B

Special spectacles

+0.37 0.68 0.14 0.01 1.06 0.52

XXX fitting. 92353............. .............. B

Special spectacles

+0.50 0.73 0.19 0.02 1.25 0.71

XXX fitting. 92354............. .............. B

Special spectacles

+0.00 8.89

NA 0.10 8.99

NA

XXX fitting. 92355............. .............. B

Special spectacles

+0.00 4.34

NA 0.01 4.35

NA

XXX fitting. 92358............. .............. B

Eye prosthesis service +0.00 0.97

NA 0.05 1.02

NA

XXX 92370............. .............. N

Repair & adjust

+0.32 0.55 0.13 0.02 0.89 0.47

XXX spectacles. 92371............. .............. B

Repair & adjust

+0.00 0.62

NA 0.02 0.64

NA

XXX spectacles. 92499............. 26............ C

Eye service or

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure.

[[Page 70445]]

92499............. TC............ C

Eye service or

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 92499............. .............. C

Eye service or

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 92502............. .............. A

Ear and throat

1.51

NA 1.11 0.05

NA 2.67

000 examination. 92504............. .............. A

Ear microscopy

0.18 0.50 0.09 0.01 0.69 0.28

XXX examination. 92506............. .............. A

Speech/hearing

0.86 2.60 0.40 0.03 3.49 1.29

XXX evaluation. 92507............. .............. A

Speech/hearing therapy 0.52 1.11 0.23 0.02 1.65 0.77

XXX 92508............. .............. A

Speech/hearing therapy 0.26 0.51 0.12 0.01 0.78 0.39

XXX 92511............. .............. A

Nasopharyngoscopy..... 0.84 3.32 0.78 0.03 4.19 1.65

000 92512............. .............. A

Nasal function studies 0.55 1.14 0.18 0.02 1.71 0.75

XXX 92516............. .............. A

Facial nerve function

0.43 1.20 0.22 0.01 1.64 0.66

XXX test. 92520............. .............. A

Laryngeal function

0.75 0.51 0.39 0.03 1.29 1.17

XXX studies. 92526............. .............. A

Oral function therapy. 0.55 1.64 0.20 0.02 2.21 0.77

XXX 92531............. .............. B

Spontaneous nystagmus

0.00 0.00 0.00 0.00 0.00 0.00

XXX study. 92532............. .............. B

Positional nystagmus

0.00 0.00 0.00 0.00 0.00 0.00

XXX test. 92533............. .............. B

Caloric vestibular

0.00 0.00 0.00 0.00 0.00 0.00

XXX test. 92534............. .............. B

Optokinetic nystagmus

0.00 0.00 0.00 0.00 0.00 0.00

XXX test. 92541............. 26............ A

Spontaneous nystagmus

0.40 0.19 0.19 0.02 0.61 0.61

XXX test. 92541............. TC............ A

Spontaneous nystagmus

0.00 0.84

NA 0.02 0.86

NA

XXX test. 92541............. .............. A

Spontaneous nystagmus

0.40 1.03

NA 0.04 1.47

NA

XXX test. 92542............. 26............ A

Positional nystagmus

0.33 0.16 0.16 0.01 0.50 0.50

XXX test. 92542............. TC............ A

Positional nystagmus

0.00 0.98

NA 0.02 1.00

NA

XXX test. 92542............. .............. A

Positional nystagmus

0.33 1.14

NA 0.03 1.50

NA

XXX test. 92543............. 26............ A

Caloric vestibular

0.10 0.05 0.05 0.01 0.16 0.16

XXX test. 92543............. TC............ A

Caloric vestibular

0.00 0.52

NA 0.01 0.53

NA

XXX test. 92543............. .............. A

Caloric vestibular

0.10 0.57

NA 0.02 0.69

NA

XXX test. 92544............. 26............ A

Optokinetic nystagmus

0.26 0.12 0.12 0.01 0.39 0.39

XXX test. 92544............. TC............ A

Optokinetic nystagmus

0.00 0.78

NA 0.02 0.80

NA

XXX test. 92544............. .............. A

Optokinetic nystagmus

0.26 0.90

NA 0.03 1.19

NA

XXX test. 92545............. 26............ A

Oscillating tracking

0.23 0.11 0.11 0.01 0.35 0.35

XXX test. 92545............. TC............ A

Oscillating tracking

0.00 0.69

NA 0.02 0.71

NA

XXX test. 92545............. .............. A

Oscillating tracking

0.23 0.80

NA 0.03 1.06

NA

XXX test. 92546............. 26............ A

Sinusoidal rotational

0.29 0.13 0.13 0.01 0.43 0.43

XXX test. 92546............. TC............ A

Sinusoidal rotational

0.00 1.86

NA 0.02 1.88

NA

XXX test. 92546............. .............. A

Sinusoidal rotational

0.29 1.99

NA 0.03 2.31

NA

XXX test. 92547............. .............. A

Supplemental

0.00 0.08

NA 0.06 0.14

NA

ZZZ electrical test. 92548............. 26............ A

Posturography......... 0.50 0.26 0.26 0.02 0.78 0.78

XXX 92548............. TC............ A

Posturography......... 0.00 2.00

NA 0.13 2.13

NA

XXX 92548............. .............. A

Posturography......... 0.50 2.26

NA 0.15 2.91

NA

XXX 92551............. .............. N

Pure tone hearing

0.00 0.00 0.00 0.00 0.00 0.00

XXX test, air. 92552............. .............. A

Pure tone audiometry,

0.00 0.44

NA 0.04 0.48

NA

XXX air. 92553............. .............. A

Audiometry, air & bone 0.00 0.66

NA 0.06 0.72

NA

XXX 92555............. .............. A

Speech threshold

0.00 0.38

NA 0.04 0.42

NA

XXX audiometry. 92556............. .............. A

Speech audiometry,

0.00 0.57

NA 0.06 0.63

NA

XXX complete. 92557............. .............. A

Comprehensive hearing

0.00 1.19

NA 0.12 1.31

NA

XXX test. 92559............. .............. N

Group audiometric

0.00 0.00 0.00 0.00 0.00 0.00

XXX testing. 92560............. .............. N

Bekesy audiometry,

0.00 0.00 0.00 0.00 0.00 0.00

XXX screen. 92561............. .............. A

Bekesy audiometry,

0.00 0.72

NA 0.06 0.78

NA

XXX diagnosis. 92562............. .............. A

Loudness balance test. 0.00 0.41

NA 0.04 0.45

NA

XXX 92563............. .............. A

Tone decay hearing

0.00 0.38

NA 0.04 0.42

NA

XXX test. 92564............. .............. A

Sisi hearing test..... 0.00 0.47

NA 0.05 0.52

NA

XXX 92565............. .............. A

Stenger test, pure

0.00 0.40

NA 0.04 0.44

NA

XXX tone. 92567............. .............. A

Tympanometry.......... 0.00 0.52

NA 0.06 0.58

NA

XXX 92568............. .............. A

Acoustic refl

0.00 0.38

NA 0.04 0.42

NA

XXX threshold tst. 92569............. .............. A

Acoustic reflex decay

0.00 0.41

NA 0.04 0.45

NA

XXX test. 92571............. .............. A

Filtered speech

0.00 0.39

NA 0.04 0.43

NA

XXX hearing test. 92572............. .............. A

Staggered spondaic

0.00 0.09

NA 0.01 0.10

NA

XXX word test. 92573............. .............. A

Lombard test.......... 0.00 0.35

NA 0.04 0.39

NA

XXX 92575............. .............. A

Sensorineural acuity

0.00 0.30

NA 0.02 0.32

NA

XXX test. 92576............. .............. A

Synthetic sentence

0.00 0.44

NA 0.05 0.49

NA

XXX test. 92577............. .............. A

Stenger test, speech.. 0.00 0.72

NA 0.07 0.79

NA

XXX 92579............. .............. A

Visual audiometry

0.00 0.73

NA 0.06 0.79

NA

XXX (vra). 92582............. .............. A

Conditioning play

0.00 0.73

NA 0.06 0.79

NA

XXX audiometry. 92583............. .............. A

Select picture

0.00 0.89

NA 0.08 0.97

NA

XXX audiometry. 92584............. .............. A

Electrocochleography.. 0.00 2.48

NA 0.21 2.69

NA

XXX 92585............. 26............ A

Auditor evoke potent,

0.50 0.21 0.21 0.03 0.74 0.74

XXX compre. 92585............. TC............ A

Auditor evoke potent,

0.00 1.86

NA 0.14 2.00

NA

XXX compre. 92585............. .............. A

Auditor evoke potent,

0.50 2.07

NA 0.17 2.74

NA

XXX compre. 92586............. .............. A

Auditor evoke potent,

0.00 1.86

NA 0.14 2.00

NA

XXX limit. 92587............. 26............ A

Evoked auditory test.. 0.13 0.06 0.06 0.01 0.20 0.20

XXX 92587............. TC............ A

Evoked auditory test.. 0.00 1.31

NA 0.11 1.42

NA

XXX 92587............. .............. A

Evoked auditory test.. 0.13 1.37

NA 0.12 1.62

NA

XXX 92588............. 26............ A

Evoked auditory test.. 0.36 0.16 0.16 0.01 0.53 0.53

XXX 92588............. TC............ A

Evoked auditory test.. 0.00 1.47

NA 0.13 1.60

NA

XXX 92588............. .............. A

Evoked auditory test.. 0.36 1.63

NA 0.14 2.13

NA

XXX 92590............. .............. N

Hearing aid exam, one

0.00 0.00 0.00 0.00 0.00 0.00

XXX ear.

[[Page 70446]]

92591............. .............. N

Hearing aid exam, both 0.00 0.00 0.00 0.00 0.00 0.00

XXX ears. 92592............. .............. N

Hearing aid check, one 0.00 0.00 0.00 0.00 0.00 0.00

XXX ear. 92593............. .............. N

Hearing aid check,

0.00 0.00 0.00 0.00 0.00 0.00

XXX both ears. 92594............. .............. N

Electro hearng aid

0.00 0.00 0.00 0.00 0.00 0.00

XXX test, one. 92595............. .............. N

Electro hearng aid

0.00 0.00 0.00 0.00 0.00 0.00

XXX tst, both. 92596............. .............. A

Ear protector

0.00 0.59

NA 0.06 0.65

NA

XXX evaluation. 92597............. .............. A

Oral speech device

0.86 1.69 0.45 0.03 2.58 1.34

XXX eval. 92601............. .............. A

Cochlear implt f/up

0.00 3.51

NA 0.07 3.58

NA

XXX exam . 92604............. .............. A

Reprogram cochlear

0.00 1.35

NA 0.07 1.42

NA

XXX implt 7 >. 92605............. .............. B

Eval for nonspeech

0.00 0.00 0.00 0.00 0.00 0.00

XXX device rx. 92606............. .............. B

Non-speech device

0.00 0.00 0.00 0.00 0.00 0.00

XXX service. 92607............. .............. A

Ex for speech device

0.00 3.09

NA 0.05 3.14

NA

XXX rx, 1hr. 92608............. .............. A

Ex for speech device

0.00 0.55

NA 0.05 0.60

NA

XXX rx addl. 92609............. .............. A

Use of speech device

0.00 1.59

NA 0.04 1.63

NA

XXX service. 92610............. .............. A

Evaluate swallowing

0.00 3.44

NA 0.08 3.52

NA

XXX function. 92611............. .............. A

Motion fluoroscopy/

0.00 3.44

NA 0.08 3.52

NA

XXX swallow. 92612............. .............. A

Endoscopy swallow tst

1.27 2.75 0.66 0.04 4.06 1.97

XXX (fees). 92613............. .............. A

Endoscopy swallow tst

0.71 0.40 0.39 0.05 1.16 1.15

XXX (fees). 92614............. .............. A

Laryngoscopic sensory

1.27 2.51 0.66 0.04 3.82 1.97

XXX test. 92615............. .............. A

Eval laryngoscopy

0.63 0.35 0.35 0.05 1.03 1.03

XXX sense tst. 92616............. .............. A

Fees w/laryngeal sense 1.88 3.40 0.99 0.06 5.34 2.93

XXX test. 92617............. .............. A

Interprt fees/

0.79 0.44 0.44 0.05 1.28 1.28

XXX laryngeal test. 92620............. .............. A

Auditory function, 60

0.00 1.14

NA 0.06 1.20

NA

XXX min. 92621............. .............. A

Auditory function, +

0.00 0.25

NA 0.06 0.31

NA

ZZZ 15 min. 92625............. .............. A

Tinnitus assessment... 0.00 1.12

NA 0.06 1.18

NA

XXX 92626............. .............. A

Eval aud rehab status. 0.00 0.55

NA 0.06 0.61

NA

XXX 92627............. .............. A

Eval aud status rehab

0.00 0.55

NA 0.06 0.61

NA

XXX add-on. 92630............. .............. I

Aud rehab pre-ling

0.00 0.00 0.00 0.00 0.00 0.00

XXX hear loss. 92633............. .............. I

Aud rehab postling

0.00 0.00 0.00 0.00 0.00 0.00

XXX hear loss. 92700............. .............. C

Ent procedure/service. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 92950............. .............. A

Heart/lung

3.79 4.21 0.97 0.28 8.28 5.04

000 resuscitation cpr. 92953............. .............. A

Temporary external

0.23

NA 0.07 0.02

NA 0.32

000 pacing. 92960............. .............. A

Cardioversion

2.25 6.33 1.17 0.07 8.65 3.49

000 electric, ext. 92961............. .............. A

Cardioversion,

4.59

NA 2.09 0.29

NA 6.97

000 electric, int. 92970............. .............. A

Cardioassist, internal 3.51

NA 1.06 0.16

NA 4.73

000 92971............. .............. A

Cardioassist, external 1.77

NA 0.85 0.06

NA 2.68

000 92973............. .............. A

Percut coronary

3.28

NA 1.29 0.23

NA 4.80

ZZZ thrombectomy. 92974............. .............. A

Cath place, cardio

3.00

NA 1.18 0.21

NA 4.39

ZZZ brachytx. 92975............. .............. A

Dissolve clot, heart

7.24

NA 2.82 0.50

NA 10.56

000 vessel. 92977............. .............. A

Dissolve clot, heart

0.00 8.07

NA 0.46 8.53

NA

XXX vessel. 92978............. 26............ A

Intravasc us, heart

1.80 0.71 0.71 0.06 2.57 2.57

ZZZ add-on. 92978............. TC............ A

Intravasc us, heart

0.00 4.57

NA 0.24 4.81

NA

ZZZ add-on. 92978............. .............. A

Intravasc us, heart

1.80 5.28

NA 0.30 7.38

NA

ZZZ add-on. 92979............. 26............ A

Intravasc us, heart

1.44 0.56 0.56 0.06 2.06 2.06

ZZZ add-on. 92979............. TC............ A

Intravasc us, heart

0.00 2.30

NA 0.13 2.43

NA

ZZZ add-on. 92979............. .............. A

Intravasc us, heart

1.44 2.86

NA 0.19 4.49

NA

ZZZ add-on. 92980............. .............. A

Insert intracoronary

14.82

NA 6.07 1.03

NA 21.92

000 stent. 92981............. .............. A

Insert intracoronary

4.16

NA 1.63 0.29

NA 6.08

ZZZ stent. 92982............. .............. A

Coronary artery

10.96

NA 4.54 0.76

NA 16.26

000 dilation. 92984............. .............. A

Coronary artery

2.97

NA 1.16 0.21

NA 4.34

ZZZ dilation. 92986............. .............. A

Revision of aortic

21.77

NA 11.86 1.51

NA 35.14

090 valve. 92987............. .............. A

Revision of mitral

22.67

NA 12.25 1.59

NA 36.51

090 valve. 92990............. .............. A

Revision of pulmonary 17.31

NA 9.82 1.20

NA 28.33

090 valve. 92992............. .............. C

Revision of heart

0.00 0.00 0.00 0.00 0.00 0.00

090 chamber. 92993............. .............. C

Revision of heart

0.00 0.00 0.00 0.00 0.00 0.00

090 chamber. 92995............. .............. A

Coronary atherectomy.. 12.07

NA 4.97 0.84

NA 17.88

000 92996............. .............. A

Coronary atherectomy

3.26

NA 1.27 0.10

NA 4.63

ZZZ add-on. 92997............. .............. A

Pul art balloon repr, 11.98

NA 4.83 0.40

NA 17.21

000 percut. 92998............. .............. A

Pul art balloon repr,

5.99

NA 2.21 0.28

NA 8.48

ZZZ percut. 93000............. .............. A

Electrocardiogram,

0.17 0.51

NA 0.03 0.71

NA

XXX complete. 93005............. .............. A

Electrocardiogram,

0.00 0.45

NA 0.02 0.47

NA

XXX tracing. 93010............. .............. A

Electrocardiogram

0.17 0.06 0.06 0.01 0.24 0.24

XXX report. 93012............. .............. A

Transmission of ecg... 0.00 6.03

NA 0.18 6.21

NA

XXX 93014............. .............. A

Report on transmitted

0.52 0.19 0.19 0.02 0.73 0.73

XXX ecg. 93015............. .............. A

Cardiovascular stress

0.75 1.96

NA 0.14 2.85

NA

XXX test. 93016............. .............. A

Cardiovascular stress

0.45 0.17 0.17 0.02 0.64 0.64

XXX test. 93017............. .............. A

Cardiovascular stress

0.00 1.68

NA 0.11 1.79

NA

XXX test. 93018............. .............. A

Cardiovascular stress

0.30 0.11 0.11 0.01 0.42 0.42

XXX test. 93024............. 26............ A

Cardiac drug stress

1.17 0.45 0.45 0.04 1.66 1.66

XXX test. 93024............. TC............ A

Cardiac drug stress

0.00 1.12

NA 0.08 1.20

NA

XXX test. 93024............. .............. A

Cardiac drug stress

1.17 1.57

NA 0.12 2.86

NA

XXX test. 93025............. 26............ A

Microvolt t-wave

0.75 0.29 0.29 0.03 1.07 1.07

XXX assess. 93025............. TC............ A

Microvolt t-wave

0.00 7.32

NA 0.11 7.43

NA

XXX assess.

[[Page 70447]]

93025............. .............. A

Microvolt t-wave

0.75 7.61

NA 0.14 8.50

NA

XXX assess. 93040............. .............. A

Rhythm ECG with report 0.16 0.20

NA 0.02 0.38

NA

XXX 93041............. .............. A

Rhythm ECG, tracing... 0.00 0.15

NA 0.01 0.16

NA

XXX 93042............. .............. A

Rhythm ECG, report.... 0.16 0.05 0.05 0.01 0.22 0.22

XXX 93224............. .............. A

ECG monitor/report, 24 0.52 3.62

NA 0.24 4.38

NA

XXX hrs. 93225............. .............. A

ECG monitor/record, 24 0.00 1.24

NA 0.08 1.32

NA

XXX hrs. 93226............. .............. A

ECG monitor/report, 24 0.00 2.19

NA 0.14 2.33

NA

XXX hrs. 93227............. .............. A

ECG monitor/review, 24 0.52 0.19 0.19 0.02 0.73 0.73

XXX hrs. 93230............. .............. A

ECG monitor/report, 24 0.52 3.90

NA 0.26 4.68

NA

XXX hrs. 93231............. .............. A

Ecg monitor/record, 24 0.00 1.52

NA 0.11 1.63

NA

XXX hrs. 93232............. .............. A

ECG monitor/report, 24 0.00 2.19

NA 0.13 2.32

NA

XXX hrs. 93233............. .............. A

ECG monitor/review, 24 0.52 0.19 0.19 0.02 0.73 0.73

XXX hrs. 93235............. .............. A

ECG monitor/report, 24 0.45 2.79

NA 0.16 3.40

NA

XXX hrs. 93236............. .............. A

ECG monitor/report, 24 0.00 2.63

NA 0.14 2.77

NA

XXX hrs. 93237............. .............. A

ECG monitor/review, 24 0.45 0.16 0.16 0.02 0.63 0.63

XXX hrs. 93268............. .............. A

ECG record/review..... 0.52 7.46

NA 0.28 8.26

NA

XXX 93270............. .............. A

ECG recording......... 0.00 1.24

NA 0.08 1.32

NA

XXX 93271............. .............. A

Ecg/monitoring and

0.00 6.03

NA 0.18 6.21

NA

XXX analysis. 93272............. .............. A

Ecg/review, interpret

0.52 0.19 0.19 0.02 0.73 0.73

XXX only. 93278............. 26............ A

ECG/signal-averaged... 0.25 0.10 0.10 0.01 0.36 0.36

XXX 93278............. TC............ A

ECG/signal-averaged... 0.00 1.15

NA 0.11 1.26

NA

XXX 93278............. .............. A

ECG/signal-averaged... 0.25 1.25

NA 0.12 1.62

NA

XXX 93303............. 26............ A

Echo transthoracic.... 1.30 0.48 0.48 0.04 1.82 1.82

XXX 93303............. TC............ A

Echo transthoracic.... 0.00 3.87

NA 0.23 4.10

NA

XXX 93303............. .............. A

Echo transthoracic.... 1.30 4.35

NA 0.27 5.92

NA

XXX 93304............. 26............ A

Echo transthoracic.... 0.75 0.28 0.28 0.02 1.05 1.05

XXX 93304............. TC............ A

Echo transthoracic.... 0.00 1.95

NA 0.13 2.08

NA

XXX 93304............. .............. A

Echo transthoracic.... 0.75 2.23

NA 0.15 3.13

NA

XXX 93307............. 26............ A

Echo exam of heart.... 0.92 0.35 0.35 0.03 1.30 1.30

XXX 93307............. TC............ A

Echo exam of heart.... 0.00 3.87

NA 0.23 4.10

NA

XXX 93307............. .............. A

Echo exam of heart.... 0.92 4.22

NA 0.26 5.40

NA

XXX 93308............. 26............ A

Echo exam of heart.... 0.53 0.20 0.20 0.02 0.75 0.75

XXX 93308............. TC............ A

Echo exam of heart.... 0.00 1.95

NA 0.13 2.08

NA

XXX 93308............. .............. A

Echo exam of heart.... 0.53 2.15

NA 0.15 2.83

NA

XXX 93312............. 26............ A

Echo transesophageal.. 2.20 0.79 0.79 0.08 3.07 3.07

XXX 93312............. TC............ A

Echo transesophageal.. 0.00 3.79

NA 0.29 4.08

NA

XXX 93312............. .............. A

Echo transesophageal.. 2.20 4.58

NA 0.37 7.15

NA

XXX 93313............. .............. A

Echo transesophageal.. 0.95

NA 0.21 0.06

NA 1.22

XXX 93314............. 26............ A

Echo transesophageal.. 1.25 0.47 0.47 0.04 1.76 1.76

XXX 93314............. TC............ A

Echo transesophageal.. 0.00 3.79

NA 0.29 4.08

NA

XXX 93314............. .............. A

Echo transesophageal.. 1.25 4.26

NA 0.33 5.84

NA

XXX 93315............. 26............ A

Echo transesophageal.. 2.78 1.01 1.01 0.09 3.88 3.88

XXX 93315............. TC............ C

Echo transesophageal.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 93315............. .............. C

Echo transesophageal.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 93316............. .............. A

Echo transesophageal.. 0.95

NA 0.24 0.05

NA 1.24

XXX 93317............. 26............ A

Echo transesophageal.. 1.83 0.67 0.67 0.08 2.58 2.58

XXX 93317............. TC............ C

Echo transesophageal.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 93317............. .............. C

Echo transesophageal.. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 93318............. 26............ A

Echo transesophageal

2.20 0.48 0.48 0.14 2.82 2.82

XXX intraop. 93318............. TC............ C

Echo transesophageal

0.00 0.00 0.00 0.00 0.00 0.00

XXX intraop. 93318............. .............. C

Echo transesophageal

0.00 0.00 0.00 0.00 0.00 0.00

XXX intraop. 93320............. 26............ A

Doppler echo exam,

0.38 0.15 0.15 0.01 0.54 0.54

ZZZ heart. 93320............. TC............ A

Doppler echo exam,

0.00 1.71

NA 0.12 1.83

NA

ZZZ heart. 93320............. .............. A

Doppler echo exam,

0.38 1.86

NA 0.13 2.37

NA

ZZZ heart. 93321............. 26............ A

Doppler echo exam,

0.15 0.06 0.06 0.01 0.22 0.22

ZZZ heart. 93321............. TC............ A

Doppler echo exam,

0.00 1.11

NA 0.08 1.19

NA

ZZZ heart. 93321............. .............. A

Doppler echo exam,

0.15 1.17

NA 0.09 1.41

NA

ZZZ heart. 93325............. 26............ A

Doppler color flow add- 0.07 0.03 0.03 0.01 0.11 0.11

ZZZ on. 93325............. TC............ A

Doppler color flow add- 0.00 2.91

NA 0.21 3.12

NA

ZZZ on. 93325............. .............. A

Doppler color flow add- 0.07 2.94

NA 0.22 3.23

NA

ZZZ on. 93350............. 26............ A

Echo transthoracic.... 1.48 0.57 0.57 0.05 2.10 2.10

XXX 93350............. TC............ A

Echo transthoracic.... 0.00 1.77

NA 0.13 1.90

NA

XXX 93350............. .............. A

Echo transthoracic.... 1.48 2.34

NA 0.18 4.00

NA

XXX 93501............. 26............ A

Right heart

3.02 1.15 1.15 0.21 4.38 4.38

000 catheterization. 93501............. TC............ A

Right heart

0.00 16.95

NA 1.05 18.00

NA

000 catheterization. 93501............. .............. A

Right heart

3.02 18.10

NA 1.26 22.38

NA

000 catheterization. 93503............. .............. A

Insert/place heart

2.91

NA 0.68 0.20

NA 3.79

000 catheter. 93505............. 26............ A

Biopsy of heart lining 4.37 1.68 1.68 0.30 6.35 6.35

000 93505............. TC............ A

Biopsy of heart lining 0.00 1.99

NA 0.16 2.15

NA

000 93505............. .............. A

Biopsy of heart lining 4.37 3.67

NA 0.46 8.50

NA

000 93508............. 26............ A

Cath placement,

4.09 2.09 2.09 0.28 6.46 6.46

000 angiography. 93508............. TC............ A

Cath placement,

0.00 12.64

NA 0.65 13.29

NA

000 angiography. 93508............. .............. A

Cath placement,

4.09 14.73

NA 0.93 19.75

NA

000 angiography. 93510............. 26............ A

Left heart

4.32 2.18 2.18 0.30 6.80 6.80

000 catheterization. 93510............. TC............ A

Left heart

0.00 37.06

NA 2.31 39.37

NA

000 catheterization.

[[Page 70448]]

93510............. .............. A

Left heart

4.32 39.24

NA 2.61 46.17

NA

000 catheterization. 93511............. 26............ A

Left heart

5.02 2.45 2.45 0.35 7.82 7.82

000 catheterization. 93511............. TC............ A

Left heart

0.00 36.07

NA 2.24 38.31

NA

000 catheterization. 93511............. .............. A

Left heart

5.02 38.52

NA 2.59 46.13

NA

000 catheterization. 93514............. 26............ A

Left heart

7.04 3.13 3.13 0.49 10.66 10.66

000 catheterization. 93514............. TC............ C

Left heart

0.00 0.00 0.00 0.00 0.00 0.00

000 catheterization. 93514............. .............. R

Left heart

7.04 39.09 39.09 2.74 48.87 48.87

000 catheterization. 93524............. 26............ A

Left heart

6.94 3.18 3.18 0.48 10.60 10.60

000 catheterization. 93524............. TC............ A

Left heart

0.00 47.14

NA 2.95 50.09

NA

000 catheterization. 93524............. .............. A

Left heart

6.94 50.32

NA 3.43 60.69

NA

000 catheterization. 93526............. 26............ A

Rt & Lt heart

5.98 2.82 2.82 0.42 9.22 9.22

000 catheters. 93526............. TC............ A

Rt & Lt heart

0.00 48.43

NA 3.04 51.47

NA

000 catheters. 93526............. .............. A

Rt & Lt heart

5.98 51.25

NA 3.46 60.69

NA

000 catheters. 93527............. 26............ A

Rt & Lt heart

7.27 3.32 3.32 0.51 11.10 11.10

000 catheters. 93527............. TC............ A

Rt & Lt heart

0.00 47.14

NA 2.95 50.09

NA

000 catheters. 93527............. .............. A

Rt & Lt heart

7.27 50.46

NA 3.46 61.19

NA

000 catheters. 93528............. 26............ A

Rt & Lt heart

8.99 4.04 4.04 0.62 13.65 13.65

000 catheters. 93528............. TC............ A

Rt & Lt heart

0.00 47.14

NA 2.95 50.09

NA

000 catheters. 93528............. .............. A

Rt & Lt heart

8.99 51.18

NA 3.57 63.74

NA

000 catheters. 93529............. 26............ A

Rt, lt heart

4.79 2.28 2.28 0.33 7.40 7.40

000 catheterization. 93529............. TC............ A

Rt, lt heart

0.00 47.14

NA 2.95 50.09

NA

000 catheterization. 93529............. .............. A

Rt, lt heart

4.79 49.42

NA 3.28 57.49

NA

000 catheterization. 93530............. 26............ A

Rt heart cath,

4.22 1.94 1.94 0.29 6.45 6.45

000 congenital. 93530............. TC............ A

Rt heart cath,

0.00 16.95

NA 1.05 18.00

NA

000 congenital. 93530............. .............. A

Rt heart cath,

4.22 18.89

NA 1.34 24.45

NA

000 congenital. 93531............. 26............ A

R & l heart cath,

8.34 3.59 3.59 0.58 12.51 12.51

000 congenital. 93531............. TC............ A

R & l heart cath,

0.00 48.43

NA 3.04 51.47

NA

000 congenital. 93531............. .............. A

R & l heart cath,

8.34 52.02

NA 3.62 63.98

NA

000 congenital. 93532............. 26............ A

R & l heart cath,

9.99 4.26 4.26 0.69 14.94 14.94

000 congenital. 93532............. TC............ C

R & l heart cath,

0.00 0.00 0.00 0.00 0.00 0.00

000 congenital. 93532............. .............. C

R & l heart cath,

0.00 0.00 0.00 0.00 0.00 0.00

000 congenital. 93533............. 26............ A

R & l heart cath,

6.69 2.80 2.80 0.47 9.96 9.96

000 congenital. 93533............. TC............ C

R & l heart cath,

0.00 0.00 0.00 0.00 0.00 0.00

000 congenital. 93533............. .............. C

R & l heart cath,

0.00 0.00 0.00 0.00 0.00 0.00

000 congenital. 93539............. .............. A

Injection, cardiac

0.40

NA 0.16 0.01

NA 0.57

000 cath. 93540............. .............. A

Injection, cardiac

0.43

NA 0.17 0.01

NA 0.61

000 cath. 93541............. .............. A

Injection for lung

0.29

NA 0.11 0.01

NA 0.41

000 angiogram. 93542............. .............. A

Injection for heart x- 0.29

NA 0.11 0.01

NA 0.41

000 rays. 93543............. .............. A

Injection for heart x- 0.29

NA 0.11 0.01

NA 0.41

000 rays. 93544............. .............. A

Injection for

0.25

NA 0.10 0.01

NA 0.36

000 aortography. 93545............. .............. A

Inject for coronary x- 0.40

NA 0.16 0.01

NA 0.57

000 rays. 93555............. 26............ A

Imaging, cardiac cath. 0.81 0.32 0.32 0.03 1.16 1.16

XXX 93555............. TC............ A

Imaging, cardiac cath. 0.00 6.29

NA 0.34 6.63

NA

XXX 93555............. .............. A

Imaging, cardiac cath. 0.81 6.61

NA 0.37 7.79

NA

XXX 93556............. 26............ A

Imaging, cardiac cath. 0.83 0.32 0.32 0.03 1.18 1.18

XXX 93556............. TC............ A

Imaging, cardiac cath. 0.00 9.92

NA 0.51 10.43

NA

XXX 93556............. .............. A

Imaging, cardiac cath. 0.83 10.24

NA 0.54 11.61

NA

XXX 93561............. 26............ A

Cardiac output

0.50 0.16 0.16 0.02 0.68 0.68

000 measurement. 93561............. TC............ A

Cardiac output

0.00 0.52

NA 0.06 0.58

NA

000 measurement. 93561............. .............. A

Cardiac output

0.50 0.68

NA 0.08 1.26

NA

000 measurement. 93562............. 26............ A

Cardiac output

0.16 0.05 0.05 0.01 0.22 0.22

000 measurement. 93562............. TC............ A

Cardiac output

0.00 0.32

NA 0.04 0.36

NA

000 measurement. 93562............. .............. A

Cardiac output

0.16 0.37

NA 0.05 0.58

NA

000 measurement. 93571............. 26............ A

Heart flow reserve

1.80 0.68 0.68 0.06 2.54 2.54

ZZZ measure. 93571............. TC............ A

Heart flow reserve

0.00 4.57

NA 0.24 4.81

NA

ZZZ measure. 93571............. .............. A

Heart flow reserve

1.80 5.25

NA 0.30 7.35

NA

ZZZ measure. 93572............. 26............ A

Heart flow reserve

1.44 0.50 0.50 0.04 1.98 1.98

ZZZ measure. 93572............. TC............ C

Heart flow reserve

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ measure. 93572............. .............. C

Heart flow reserve

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ measure. 93580............. .............. A

Transcath closure of

17.97

NA 7.40 1.25

NA 26.62

000 asd. 93581............. .............. A

Transcath closure of

24.39

NA 9.42 1.71

NA 35.52

000 vsd. 93600............. 26............ A

Bundle of His

2.12 0.83 0.83 0.16 3.11 3.11

000 recording. 93600............. TC............ A

Bundle of His

0.00 1.96

NA 0.13 2.09

NA

000 recording. 93600............. .............. A

Bundle of His

2.12 2.79

NA 0.29 5.20

NA

000 recording. 93602............. 26............ A

Intra-atrial recording 2.12 0.82 0.82 0.17 3.11 3.11

000 93602............. TC............ A

Intra-atrial recording 0.00 1.11

NA 0.07 1.18

NA

000 93602............. .............. A

Intra-atrial recording 2.12 1.93

NA 0.24 4.29

NA

000 93603............. 26............ A

Right ventricular

2.12 0.81 0.81 0.18 3.11 3.11

000 recording. 93603............. TC............ A

Right ventricular

0.00 1.68

NA 0.11 1.79

NA

000 recording. 93603............. .............. A

Right ventricular

2.12 2.49

NA 0.29 4.90

NA

000 recording. 93609............. 26............ A

Map tachycardia, add-

4.99 1.96 1.96 0.35 7.30 7.30

ZZZ on. 93609............. TC............ A

Map tachycardia, add-

0.00 2.73

NA 0.17 2.90

NA

ZZZ on. 93609............. .............. A

Map tachycardia, add-

4.99 4.69

NA 0.52 10.20

NA

ZZZ on. 93610............. 26............ A

Intra-atrial pacing... 3.02 1.16 1.16 0.24 4.42 4.42

000 93610............. TC............ A

Intra-atrial pacing... 0.00 1.35

NA 0.10 1.45

NA

000

[[Page 70449]]

93610............. .............. A

Intra-atrial pacing... 3.02 2.51

NA 0.34 5.87

NA

000 93612............. 26............ A

Intraventricular

3.02 1.16 1.16 0.25 4.43 4.43

000 pacing. 93612............. TC............ A

Intraventricular

0.00 1.61

NA 0.11 1.72

NA

000 pacing. 93612............. .............. A

Intraventricular

3.02 2.77

NA 0.36 6.15

NA

000 pacing. 93613............. .............. A

Electrophys map 3d,

6.99

NA 2.77 0.49

NA 10.25

ZZZ add-on. 93615............. 26............ A

Esophageal recording.. 0.99 0.27 0.27 0.03 1.29 1.29

000 93615............. TC............ A

Esophageal recording.. 0.00 0.32

NA 0.02 0.34

NA

000 93615............. .............. A

Esophageal recording.. 0.99 0.59

NA 0.05 1.63

NA

000 93616............. 26............ A

Esophageal recording.. 1.49 0.43 0.43 0.09 2.01 2.01

000 93616............. TC............ C

Esophageal recording.. 0.00 0.00 0.00 0.00 0.00 0.00

000 93616............. .............. C

Esophageal recording.. 0.00 0.00 0.00 0.00 0.00 0.00

000 93618............. 26............ A

Heart rhythm pacing... 4.25 1.67 1.67 0.30 6.22 6.22

000 93618............. TC............ A

Heart rhythm pacing... 0.00 3.97

NA 0.24 4.21

NA

000 93618............. .............. A

Heart rhythm pacing... 4.25 5.64

NA 0.54 10.43

NA

000 93619............. 26............ A

Electrophysiology

7.31 3.19 3.19 0.51 11.01 11.01

000 evaluation. 93619............. TC............ A

Electrophysiology

0.00 7.72

NA 0.47 8.19

NA

000 evaluation. 93619............. .............. A

Electrophysiology

7.31 10.91

NA 0.98 19.20

NA

000 evaluation. 93620............. 26............ A

Electrophysiology

11.57 4.85 4.85 0.80 17.22 17.22

000 evaluation. 93620............. TC............ C

Electrophysiology

0.00 0.00 0.00 0.00 0.00 0.00

000 evaluation. 93620............. .............. C

Electrophysiology

0.00 0.00 0.00 0.00 0.00 0.00

000 evaluation. 93621............. 26............ A

Electrophysiology

2.10 0.82 0.82 0.15 3.07 3.07

ZZZ evaluation. 93621............. TC............ C

Electrophysiology

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ evaluation. 93621............. .............. C

Electrophysiology

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ evaluation. 93622............. 26............ A

Electrophysiology

3.10 1.21 1.21 0.22 4.53 4.53

ZZZ evaluation. 93622............. TC............ C

Electrophysiology

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ evaluation. 93622............. .............. C

Electrophysiology

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ evaluation. 93623............. 26............ A

Stimulation, pacing

2.85 1.11 1.11 0.20 4.16 4.16

ZZZ heart. 93623............. TC............ C

Stimulation, pacing

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ heart. 93623............. .............. C

Stimulation, pacing

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ heart. 93624............. 26............ A

Electrophysiologic

4.80 2.20 2.20 0.33 7.33 7.33

000 study. 93624............. TC............ A

Electrophysiologic

0.00 1.99

NA 0.13 2.12

NA

000 study. 93624............. .............. A

Electrophysiologic

4.80 4.19

NA 0.46 9.45

NA

000 study. 93631............. 26............ A

Heart pacing, mapping. 7.59 2.78 2.78 0.97 11.34 11.34

000 93631............. TC............ C

Heart pacing, mapping. 0.00 0.00 0.00 0.00 0.00 0.00

000 93631............. .............. C

Heart pacing, mapping. 0.00 0.00 0.00 0.00 0.00 0.00

000 93640............. 26............ A

Evaluation heart

3.51 1.36 1.36 0.24 5.11 5.11

000 device. 93640............. TC............ A

Evaluation heart

0.00 7.19

NA 0.42 7.61

NA

000 device. 93640............. .............. A

Evaluation heart

3.51 8.55

NA 0.66 12.72

NA

000 device. 93641............. 26............ A

Electrophysiology

5.92 2.32 2.32 0.41 8.65 8.65

000 evaluation. 93641............. TC............ A

Electrophysiology

0.00 7.19

NA 0.42 7.61

NA

000 evaluation. 93641............. .............. A

Electrophysiology

5.92 9.51

NA 0.83 16.26

NA

000 evaluation. 93642............. 26............ A

Electrophysiology

4.88 2.22 2.22 0.15 7.25 7.25

000 evaluation. 93642............. TC............ A

Electrophysiology

0.00 7.19

NA 0.42 7.61

NA

000 evaluation. 93642............. .............. A

Electrophysiology

4.88 9.41

NA 0.57 14.86

NA

000 evaluation. 93650............. .............. A

Ablate heart dysrhythm 10.49

NA 4.44 0.73

NA 15.66

000 focus. 93651............. .............. A

Ablate heart dysrhythm 16.23

NA 6.34 1.13

NA 23.70

000 focus. 93652............. .............. A

Ablate heart dysrhythm 17.65

NA 6.90 1.23

NA 25.78

000 focus. 93660............. 26............ A

Tilt table evaluation. 1.89 0.74 0.74 0.06 2.69 2.69

000 93660............. TC............ A

Tilt table evaluation. 0.00 1.68

NA 0.02 1.70

NA

000 93660............. .............. A

Tilt table evaluation. 1.89 2.42

NA 0.08 4.39

NA

000 93662............. 26............ A

Intracardiac ecg (ice) 2.80 1.11 1.11 0.09 4.00 4.00

ZZZ 93662............. TC............ C

Intracardiac ecg (ice) 0.00 0.00 0.00 0.00 0.00 0.00

ZZZ 93662............. .............. C

Intracardiac ecg (ice) 0.00 0.00 0.00 0.00 0.00 0.00

ZZZ 93668............. .............. N

Peripheral vascular

0.00 0.00 0.00 0.00 0.00 0.00

XXX rehab. 93701............. 26............ A

Bioimpedance, thoracic 0.17 0.07 0.07 0.01 0.25 0.25

XXX 93701............. TC............ A

Bioimpedance, thoracic 0.00 0.91

NA 0.01 0.92

NA

XXX 93701............. .............. A

Bioimpedance, thoracic 0.17 0.98

NA 0.02 1.17

NA

XXX 93720............. .............. A

Total body

0.17 0.76

NA 0.07 1.00

NA

XXX plethysmography. 93721............. .............. A

Plethysmography

0.00 0.71

NA 0.06 0.77

NA

XXX tracing. 93722............. .............. A

Plethysmography report 0.17 0.05 0.05 0.01 0.23 0.23

XXX 93724............. 26............ A

Analyze pacemaker

4.88 1.92 1.92 0.15 6.95 6.95

000 system. 93724............. TC............ A

Analyze pacemaker

0.00 3.97

NA 0.24 4.21

NA

000 system. 93724............. .............. A

Analyze pacemaker

4.88 5.89

NA 0.39 11.16

NA

000 system. 93727............. .............. A

Analyze ilr system.... 0.52 0.20 0.20 0.02 0.74 0.74

XXX 93731............. 26............ A

Analyze pacemaker

0.45 0.17 0.17 0.01 0.63 0.63

XXX system. 93731............. TC............ A

Analyze pacemaker

0.00 0.49

NA 0.04 0.53

NA

XXX system. 93731............. .............. A

Analyze pacemaker

0.45 0.66

NA 0.05 1.16

NA

XXX system. 93732............. 26............ A

Analyze pacemaker

0.92 0.35 0.35 0.03 1.30 1.30

XXX system. 93732............. TC............ A

Analyze pacemaker

0.00 0.51

NA 0.04 0.55

NA

XXX system. 93732............. .............. A

Analyze pacemaker

0.92 0.86

NA 0.07 1.85

NA

XXX system. 93733............. 26............ A

Telephone analy,

0.17 0.07 0.07 0.01 0.25 0.25

XXX pacemaker. 93733............. TC............ A

Telephone analy,

0.00 0.73

NA 0.06 0.79

NA

XXX pacemaker. 93733............. .............. A

Telephone analy,

0.17 0.80

NA 0.07 1.04

NA

XXX pacemaker. 93734............. 26............ A

Analyze pacemaker

0.38 0.15 0.15 0.01 0.54 0.54

XXX system. 93734............. TC............ A

Analyze pacemaker

0.00 0.35

NA 0.02 0.37

NA

XXX system.

[[Page 70450]]

93734............. .............. A

Analyze pacemaker

0.38 0.50

NA 0.03 0.91

NA

XXX system. 93735............. 26............ A

Analyze pacemaker

0.74 0.28 0.28 0.02 1.04 1.04

XXX system. 93735............. TC............ A

Analyze pacemaker

0.00 0.44

NA 0.04 0.48

NA

XXX system. 93735............. .............. A

Analyze pacemaker

0.74 0.72

NA 0.06 1.52

NA

XXX system. 93736............. 26............ A

Telephonic analy,

0.15 0.06 0.06 0.01 0.22 0.22

XXX pacemaker. 93736............. TC............ A

Telephonic analy,

0.00 0.63

NA 0.06 0.69

NA

XXX pacemaker. 93736............. .............. A

Telephonic analy,

0.15 0.69

NA 0.07 0.91

NA

XXX pacemaker. 93740............. 26............ B

Temperature gradient

+0.16 0.04 0.04 0.01 0.21 0.21

XXX studies. 93740............. TC............ B

Temperature gradient

+0.00 0.15

NA 0.01 0.16

NA

XXX studies. 93740............. .............. B

Temperature gradient

+0.16 0.19

NA 0.02 0.37

NA

XXX studies. 93741............. 26............ A

Analyze ht pace device 0.80 0.31 0.31 0.03 1.14 1.14

XXX sngl. 93741............. TC............ A

Analyze ht pace device 0.00 0.67

NA 0.04 0.71

NA

XXX sngl. 93741............. .............. A

Analyze ht pace device 0.80 0.98

NA 0.07 1.85

NA

XXX sngl. 93742............. 26............ A

Analyze ht pace device 0.91 0.36 0.36 0.03 1.30 1.30

XXX sngl. 93742............. TC............ A

Analyze ht pace device 0.00 0.67

NA 0.04 0.71

NA

XXX sngl. 93742............. .............. A

Analyze ht pace device 0.91 1.03

NA 0.07 2.01

NA

XXX sngl. 93743............. 26............ A

Analyze ht pace device 1.03 0.40 0.40 0.03 1.46 1.46

XXX dual. 93743............. TC............ A

Analyze ht pace device 0.00 0.73

NA 0.04 0.77

NA

XXX dual. 93743............. .............. A

Analyze ht pace device 1.03 1.13

NA 0.07 2.23

NA

XXX dual. 93744............. 26............ A

Analyze ht pace device 1.18 0.46 0.46 0.04 1.68 1.68

XXX dual. 93744............. TC............ A

Analyze ht pace device 0.00 0.67

NA 0.04 0.71

NA

XXX dual. 93744............. .............. A

Analyze ht pace device 1.18 1.13

NA 0.08 2.39

NA

XXX dual. 93745............. 26............ C

Set-up cardiovert-

0.00 0.00 0.00 0.00 0.00 0.00

XXX defibrill. 93745............. TC............ C

Set-up cardiovert-

0.00 0.00 0.00 0.00 0.00 0.00

XXX defibrill. 93745............. .............. C

Set-up cardiovert-

0.00 0.00 0.00 0.00 0.00 0.00

XXX defibrill. 93760............. .............. N

Cephalic thermogram... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 93762............. .............. N

Peripheral thermogram. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 93770............. 26............ B

Measure venous

+0.16 0.05 0.05 0.01 0.22 0.22

XXX pressure. 93770............. TC............ B

Measure venous

+0.00 0.03

NA 0.01 0.04

NA

XXX pressure. 93770............. .............. B

Measure venous

+0.16 0.08

NA 0.02 0.26

NA

XXX pressure. 93784............. .............. A

Ambulatory BP

0.38 1.55

NA 0.03 1.96

NA

XXX monitoring. 93786............. .............. A

Ambulatory BP

0.00 0.91

NA 0.01 0.92

NA

XXX recording. 93788............. .............. A

Ambulatory BP analysis 0.00 0.51

NA 0.01 0.52

NA

XXX 93790............. .............. A

Review/report BP

0.38 0.13 0.13 0.01 0.52 0.52

XXX recording. 93797............. .............. A

Cardiac rehab......... 0.18 0.30 0.07 0.01 0.49 0.26

000 93798............. .............. A

Cardiac rehab/monitor. 0.28 0.46 0.11 0.01 0.75 0.40

000 93799............. 26............ C

Cardiovascular

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 93799............. TC............ C

Cardiovascular

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 93799............. .............. C

Cardiovascular

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 93875............. 26............ A

Extracranial study.... 0.22 0.08 0.08 0.01 0.31 0.31

XXX 93875............. TC............ A

Extracranial study.... 0.00 2.26

NA 0.11 2.37

NA

XXX 93875............. .............. A

Extracranial study.... 0.22 2.34

NA 0.12 2.68

NA

XXX 93880............. 26............ A

Extracranial study.... 0.60 0.20 0.20 0.04 0.84 0.84

XXX 93880............. TC............ A

Extracranial study.... 0.00 5.37

NA 0.35 5.72

NA

XXX 93880............. .............. A

Extracranial study.... 0.60 5.57

NA 0.39 6.56

NA

XXX 93882............. 26............ A

Extracranial study.... 0.40 0.14 0.14 0.04 0.58 0.58

XXX 93882............. TC............ A

Extracranial study.... 0.00 3.37

NA 0.22 3.59

NA

XXX 93882............. .............. A

Extracranial study.... 0.40 3.51

NA 0.26 4.17

NA

XXX 93886............. 26............ A

Intracranial study.... 0.94 0.37 0.37 0.06 1.37 1.37

XXX 93886............. TC............ A

Intracranial study.... 0.00 6.39

NA 0.39 6.78

NA

XXX 93886............. .............. A

Intracranial study.... 0.94 6.76

NA 0.45 8.15

NA

XXX 93888............. 26............ A

Intracranial study.... 0.62 0.23 0.23 0.05 0.90 0.90

XXX 93888............. TC............ A

Intracranial study.... 0.00 4.02

NA 0.27 4.29

NA

XXX 93888............. .............. A

Intracranial study.... 0.62 4.25

NA 0.32 5.19

NA

XXX 93890............. 26............ A

Tcd, vasoreactivity

1.00 0.40 0.40 0.06 1.46 1.46

XXX study. 93890............. TC............ A

Tcd, vasoreactivity

0.00 4.51

NA 0.39 4.90

NA

XXX study. 93890............. .............. A

Tcd, vasoreactivity

1.00 4.91

NA 0.45 6.36

NA

XXX study. 93892............. 26............ A

Tcd, emboli detect w/o 1.15 0.46 0.46 0.06 1.67 1.67

XXX inj. 93892............. TC............ A

Tcd, emboli detect w/o 0.00 4.71

NA 0.39 5.10

NA

XXX inj. 93892............. .............. A

Tcd, emboli detect w/o 1.15 5.17

NA 0.45 6.77

NA

XXX inj. 93893............. 26............ A

Tcd, emboli detect w/

1.15 0.46 0.46 0.06 1.67 1.67

XXX inj. 93893............. TC............ A

Tcd, emboli detect w/

0.00 4.58

NA 0.39 4.97

NA

XXX inj. 93893............. .............. A

Tcd, emboli detect w/

1.15 5.04

NA 0.45 6.64

NA

XXX inj. 93922............. 26............ A

Extremity study....... 0.25 0.08 0.08 0.02 0.35 0.35

XXX 93922............. TC............ A

Extremity study....... 0.00 2.61

NA 0.13 2.74

NA

XXX 93922............. .............. A

Extremity study....... 0.25 2.69

NA 0.15 3.09

NA

XXX 93923............. 26............ A

Extremity study....... 0.45 0.15 0.15 0.04 0.64 0.64

XXX 93923............. TC............ A

Extremity study....... 0.00 3.89

NA 0.22 4.11

NA

XXX 93923............. .............. A

Extremity study....... 0.45 4.04

NA 0.26 4.75

NA

XXX 93924............. 26............ A

Extremity study....... 0.50 0.17 0.17 0.05 0.72 0.72

XXX 93924............. TC............ A

Extremity study....... 0.00 4.63

NA 0.25 4.88

NA

XXX 93924............. .............. A

Extremity study....... 0.50 4.80

NA 0.30 5.60

NA

XXX 93925............. 26............ A

Lower extremity study. 0.58 0.20 0.20 0.04 0.82 0.82

XXX 93925............. TC............ A

Lower extremity study. 0.00 6.60

NA 0.35 6.95

NA

XXX 93925............. .............. A

Lower extremity study. 0.58 6.80

NA 0.39 7.77

NA

XXX

[[Page 70451]]

93926............. 26............ A

Lower extremity study. 0.39 0.13 0.13 0.04 0.56 0.56

XXX 93926............. TC............ A

Lower extremity study. 0.00 3.93

NA 0.23 4.16

NA

XXX 93926............. .............. A

Lower extremity study. 0.39 4.06

NA 0.27 4.72

NA

XXX 93930............. 26............ A

Upper extremity study. 0.46 0.16 0.16 0.04 0.66 0.66

XXX 93930............. TC............ A

Upper extremity study. 0.00 5.21

NA 0.37 5.58

NA

XXX 93930............. .............. A

Upper extremity study. 0.46 5.37

NA 0.41 6.24

NA

XXX 93931............. 26............ A

Upper extremity study. 0.31 0.10 0.10 0.03 0.44 0.44

XXX 93931............. TC............ A

Upper extremity study. 0.00 3.39

NA 0.24 3.63

NA

XXX 93931............. .............. A

Upper extremity study. 0.31 3.49

NA 0.27 4.07

NA

XXX 93965............. 26............ A

Extremity study....... 0.35 0.12 0.12 0.02 0.49 0.49

XXX 93965............. TC............ A

Extremity study....... 0.00 2.68

NA 0.12 2.80

NA

XXX 93965............. .............. A

Extremity study....... 0.35 2.80

NA 0.14 3.29

NA

XXX 93970............. 26............ A

Extremity study....... 0.68 0.23 0.23 0.06 0.97 0.97

XXX 93970............. TC............ A

Extremity study....... 0.00 5.03

NA 0.40 5.43

NA

XXX 93970............. .............. A

Extremity study....... 0.68 5.26

NA 0.46 6.40

NA

XXX 93971............. 26............ A

Extremity study....... 0.45 0.15 0.15 0.03 0.63 0.63

XXX 93971............. TC............ A

Extremity study....... 0.00 3.45

NA 0.27 3.72

NA

XXX 93971............. .............. A

Extremity study....... 0.45 3.60

NA 0.30 4.35

NA

XXX 93975............. 26............ A

Vascular study........ 1.80 0.60 0.60 0.13 2.53 2.53

XXX 93975............. TC............ A

Vascular study........ 0.00 7.05

NA 0.43 7.48

NA

XXX 93975............. .............. A

Vascular study........ 1.80 7.65

NA 0.56 10.01

NA

XXX 93976............. 26............ A

Vascular study........ 1.21 0.40 0.40 0.05 1.66 1.66

XXX 93976............. TC............ A

Vascular study........ 0.00 3.94

NA 0.30 4.24

NA

XXX 93976............. .............. A

Vascular study........ 1.21 4.34

NA 0.35 5.90

NA

XXX 93978............. 26............ A

Vascular study........ 0.65 0.22 0.22 0.06 0.93 0.93

XXX 93978............. TC............ A

Vascular study........ 0.00 4.30

NA 0.37 4.67

NA

XXX 93978............. .............. A

Vascular study........ 0.65 4.52

NA 0.43 5.60

NA

XXX 93979............. 26............ A

Vascular study........ 0.44 0.15 0.15 0.03 0.62 0.62

XXX 93979............. TC............ A

Vascular study........ 0.00 3.07

NA 0.24 3.31

NA

XXX 93979............. .............. A

Vascular study........ 0.44 3.22

NA 0.27 3.93

NA

XXX 93980............. 26............ A

Penile vascular study. 1.25 0.41 0.41 0.08 1.74 1.74

XXX 93980............. TC............ A

Penile vascular study. 0.00 2.45

NA 0.34 2.79

NA

XXX 93980............. .............. A

Penile vascular study. 1.25 2.86

NA 0.42 4.53

NA

XXX 93981............. 26............ A

Penile vascular study. 0.44 0.14 0.14 0.02 0.60 0.60

XXX 93981............. TC............ A

Penile vascular study. 0.00 2.74

NA 0.31 3.05

NA

XXX 93981............. .............. A

Penile vascular study. 0.44 2.88

NA 0.33 3.65

NA

XXX 93990............. 26............ A

Doppler flow testing.. 0.25 0.09 0.09 0.03 0.37 0.37

XXX 93990............. TC............ A

Doppler flow testing.. 0.00 3.91

NA 0.23 4.14

NA

XXX 93990............. .............. A

Doppler flow testing.. 0.25 4.00

NA 0.26 4.51

NA

XXX 94010............. 26............ A

Breathing capacity

0.17 0.05 0.05 0.01 0.23 0.23

XXX test. 94010............. TC............ A

Breathing capacity

0.00 0.62

NA 0.02 0.64

NA

XXX test. 94010............. .............. A

Breathing capacity

0.17 0.67

NA 0.03 0.87

NA

XXX test. 94014............. .............. A

Patient recorded

0.52 0.76

NA 0.03 1.31

NA

XXX spirometry. 94015............. .............. A

Patient recorded

0.00 0.59

NA 0.01 0.60

NA

XXX spirometry. 94016............. .............. A

Review patient

0.52 0.17 0.17 0.02 0.71 0.71

XXX spirometry. 94060............. 26............ A

Evaluation of wheezing 0.31 0.09 0.09 0.01 0.41 0.41

XXX 94060............. TC............ A

Evaluation of wheezing 0.00 0.98

NA 0.06 1.04

NA

XXX 94060............. .............. A

Evaluation of wheezing 0.31 1.07

NA 0.07 1.45

NA

XXX 94070............. 26............ A

Evaluation of wheezing 0.60 0.18 0.18 0.03 0.81 0.81

XXX 94070............. TC............ A

Evaluation of wheezing 0.00 0.64

NA 0.10 0.74

NA

XXX 94070............. .............. A

Evaluation of wheezing 0.60 0.82

NA 0.13 1.55

NA

XXX 94150............. 26............ B

Vital capacity test... +0.07 0.03 0.03 0.01 0.11 0.11

XXX 94150............. TC............ B

Vital capacity test... +0.00 0.44

NA 0.01 0.45

NA

XXX 94150............. .............. B

Vital capacity test... +0.07 0.47

NA 0.02 0.56

NA

XXX 94200............. 26............ A

Lung function test

0.11 0.03 0.03 0.01 0.15 0.15

XXX (MBC/MVV). 94200............. TC............ A

Lung function test

0.00 0.41

NA 0.02 0.43

NA

XXX (MBC/MVV). 94200............. .............. A

Lung function test

0.11 0.44

NA 0.03 0.58

NA

XXX (MBC/MVV). 94240............. 26............ A

Residual lung capacity 0.26 0.08 0.08 0.01 0.35 0.35

XXX 94240............. TC............ A

Residual lung capacity 0.00 0.58

NA 0.05 0.63

NA

XXX 94240............. .............. A

Residual lung capacity 0.26 0.66

NA 0.06 0.98

NA

XXX 94250............. 26............ A

Expired gas collection 0.11 0.03 0.03 0.01 0.15 0.15

XXX 94250............. TC............ A

Expired gas collection 0.00 0.61

NA 0.01 0.62

NA

XXX 94250............. .............. A

Expired gas collection 0.11 0.64

NA 0.02 0.77

NA

XXX 94260............. 26............ A

Thoracic gas volume... 0.13 0.04 0.04 0.01 0.18 0.18

XXX 94260............. TC............ A

Thoracic gas volume... 0.00 0.54

NA 0.04 0.58

NA

XXX 94260............. .............. A

Thoracic gas volume... 0.13 0.58

NA 0.05 0.76

NA

XXX 94350............. 26............ A

Lung nitrogen washout

0.26 0.08 0.08 0.01 0.35 0.35

XXX curve. 94350............. TC............ A

Lung nitrogen washout

0.00 0.68

NA 0.04 0.72

NA

XXX curve. 94350............. .............. A

Lung nitrogen washout

0.26 0.76

NA 0.05 1.07

NA

XXX curve. 94360............. 26............ A

Measure airflow

0.26 0.08 0.08 0.01 0.35 0.35

XXX resistance. 94360............. TC............ A

Measure airflow

0.00 0.62

NA 0.06 0.68

NA

XXX resistance. 94360............. .............. A

Measure airflow

0.26 0.70

NA 0.07 1.03

NA

XXX resistance. 94370............. 26............ A

Breath airway closing

0.26 0.08 0.08 0.01 0.35 0.35

XXX volume. 94370............. TC............ A

Breath airway closing

0.00 0.64

NA 0.02 0.66

NA

XXX volume. 94370............. .............. A

Breath airway closing

0.26 0.72

NA 0.03 1.01

NA

XXX volume.

[[Page 70452]]

94375............. 26............ A

Respiratory flow

0.31 0.09 0.09 0.01 0.41 0.41

XXX volume loop. 94375............. TC............ A

Respiratory flow

0.00 0.51

NA 0.02 0.53

NA

XXX volume loop. 94375............. .............. A

Respiratory flow

0.31 0.60

NA 0.03 0.94

NA

XXX volume loop. 94400............. 26............ A

CO2 breathing response 0.40 0.12 0.12 0.03 0.55 0.55

XXX curve. 94400............. TC............ A

CO2 breathing response 0.00 0.72

NA 0.06 0.78

NA

XXX curve. 94400............. .............. A

CO2 breathing response 0.40 0.84

NA 0.09 1.33

NA

XXX curve. 94450............. 26............ A

Hypoxia response curve 0.40 0.12 0.12 0.02 0.54 0.54

XXX 94450............. TC............ A

Hypoxia response curve 0.00 0.73

NA 0.02 0.75

NA

XXX 94450............. .............. A

Hypoxia response curve 0.40 0.85

NA 0.04 1.29

NA

XXX 94452............. 26............ A

Hast w/report......... 0.31 0.09 0.09 0.02 0.42 0.42

XXX 94452............. TC............ A

Hast w/report......... 0.00 0.93

NA 0.02 0.95

NA

XXX 94452............. .............. A

Hast w/report......... 0.31 1.02

NA 0.04 1.37

NA

XXX 94453............. 26............ A

Hast w/oxygen titrate. 0.40 0.12 0.12 0.02 0.54 0.54

XXX 94453............. TC............ A

Hast w/oxygen titrate. 0.00 1.39

NA 0.02 1.41

NA

XXX 94453............. .............. A

Hast w/oxygen titrate. 0.40 1.51

NA 0.04 1.95

NA

XXX 94620............. 26............ A

Pulmonary stress test/ 0.64 0.20 0.20 0.03 0.87 0.87

XXX simple. 94620............. TC............ A

Pulmonary stress test/ 0.00 2.30

NA 0.10 2.40

NA

XXX simple. 94620............. .............. A

Pulmonary stress test/ 0.64 2.50

NA 0.13 3.27

NA

XXX simple. 94621............. 26............ A

Pulm stress test/

1.42 0.44 0.44 0.06 1.92 1.92

XXX complex. 94621............. TC............ A

Pulm stress test/

0.00 1.77

NA 0.10 1.87

NA

XXX complex. 94621............. .............. A

Pulm stress test/

1.42 2.21

NA 0.16 3.79

NA

XXX complex. 94640............. .............. A

Airway inhalation

0.00 0.30

NA 0.02 0.32

NA

XXX treatment. 94642............. .............. C

Aerosol inhalation

0.00 0.00 0.00 0.00 0.00 0.00

XXX treatment. 94656............. .............. A

Initial ventilator

1.22 1.16 0.32 0.06 2.44 1.60

XXX mgmt. 94657............. .............. A

Continued ventilator

0.83 0.98 0.25 0.04 1.85 1.12

XXX mgmt. 94660............. .............. A

Pos airway pressure,

0.76 0.65 0.23 0.04 1.45 1.03

XXX CPAP. 94662............. .............. A

Neg press ventilation, 0.76

NA 0.23 0.03

NA 1.02

XXX cnp. 94664............. .............. A

Evaluate pt use of

0.00 0.31

NA 0.04 0.35

NA

XXX inhaler. 94667............. .............. A

Chest wall

0.00 0.52

NA 0.05 0.57

NA

XXX manipulation. 94668............. .............. A

Chest wall

0.00 0.45

NA 0.02 0.47

NA

XXX manipulation. 94680............. 26............ A

Exhaled air analysis,

0.26 0.08 0.08 0.01 0.35 0.35

XXX o2. 94680............. TC............ A

Exhaled air analysis,

0.00 1.79

NA 0.06 1.85

NA

XXX o2. 94680............. .............. A

Exhaled air analysis,

0.26 1.87

NA 0.07 2.20

NA

XXX o2. 94681............. 26............ A

Exhaled air analysis,

0.20 0.06 0.06 0.01 0.27 0.27

XXX o2/co2. 94681............. TC............ A

Exhaled air analysis,

0.00 2.47

NA 0.12 2.59

NA

XXX o2/co2. 94681............. .............. A

Exhaled air analysis,

0.20 2.53

NA 0.13 2.86

NA

XXX o2/co2. 94690............. 26............ A

Exhaled air analysis.. 0.07 0.02 0.02 0.01 0.10 0.10

XXX 94690............. TC............ A

Exhaled air analysis.. 0.00 1.98

NA 0.04 2.02

NA

XXX 94690............. .............. A

Exhaled air analysis.. 0.07 2.00

NA 0.05 2.12

NA

XXX 94720............. 26............ A

Monoxide diffusing

0.26 0.08 0.08 0.01 0.35 0.35

XXX capacity. 94720............. TC............ A

Monoxide diffusing

0.00 0.92

NA 0.06 0.98

NA

XXX capacity. 94720............. .............. A

Monoxide diffusing

0.26 1.00

NA 0.07 1.33

NA

XXX capacity. 94725............. 26............ A

Membrane diffusion

0.26 0.08 0.08 0.01 0.35 0.35

XXX capacity. 94725............. TC............ A

Membrane diffusion

0.00 2.84

NA 0.12 2.96

NA

XXX capacity. 94725............. .............. A

Membrane diffusion

0.26 2.92

NA 0.13 3.31

NA

XXX capacity. 94750............. 26............ A

Pulmonary compliance

0.23 0.07 0.07 0.01 0.31 0.31

XXX study. 94750............. TC............ A

Pulmonary compliance

0.00 1.27

NA 0.04 1.31

NA

XXX study. 94750............. .............. A

Pulmonary compliance

0.23 1.34

NA 0.05 1.62

NA

XXX study. 94760............. .............. T

Measure blood oxygen

0.00 0.04

NA 0.02 0.06

NA

XXX level. 94761............. .............. T

Measure blood oxygen

0.00 0.07

NA 0.06 0.13

NA

XXX level. 94762............. .............. A

Measure blood oxygen

0.00 0.47

NA 0.10 0.57

NA

XXX level. 94770............. 26............ A

Exhaled carbon dioxide 0.15 0.04 0.04 0.01 0.20 0.20

XXX test. 94770............. TC............ A

Exhaled carbon dioxide 0.00 0.71

NA 0.07 0.78

NA

XXX test. 94770............. .............. A

Exhaled carbon dioxide 0.15 0.75

NA 0.08 0.98

NA

XXX test. 94772............. 26............ C

Breath recording,

0.00 0.00 0.00 0.00 0.00 0.00

XXX infant. 94772............. TC............ C

Breath recording,

0.00 0.00 0.00 0.00 0.00 0.00

XXX infant. 94772............. .............. C

Breath recording,

0.00 0.00 0.00 0.00 0.00 0.00

XXX infant. 94799............. 26............ C

Pulmonary service/

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 94799............. TC............ C

Pulmonary service/

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 94799............. .............. C

Pulmonary service/

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 95004............. .............. A

Percut allergy skin

0.00 0.10

NA 0.01 0.11

NA

XXX tests. 95010............. .............. A

Percut allergy titrate 0.15 0.32 0.06 0.01 0.48 0.22

XXX test. 95015............. .............. A

Id allergy titrate-

0.15 0.14 0.06 0.01 0.30 0.22

XXX drug/bug. 95024............. .............. A

Id allergy test, drug/ 0.00 0.15

NA 0.01 0.16

NA

XXX bug. 95027............. .............. A

Id allergy titrate-

0.00 0.15

NA 0.01 0.16

NA

XXX airborne. 95028............. .............. A

Id allergy test-

0.00 0.23

NA 0.01 0.24

NA

XXX delayed type. 95044............. .............. A

Allergy patch tests... 0.00 0.20

NA 0.01 0.21

NA

XXX 95052............. .............. A

Photo patch test...... 0.00 0.25

NA 0.01 0.26

NA

XXX 95056............. .............. A

Photosensitivity tests 0.00 0.17

NA 0.01 0.18

NA

XXX 95060............. .............. A

Eye allergy tests..... 0.00 0.35

NA 0.02 0.37

NA

XXX 95065............. .............. A

Nose allergy test..... 0.00 0.20

NA 0.01 0.21

NA

XXX 95070............. .............. A

Bronchial allergy

0.00 2.29

NA 0.02 2.31

NA

XXX tests. 95071............. .............. A

Bronchial allergy

0.00 2.93

NA 0.02 2.95

NA

XXX tests. 95075............. .............. A

Ingestion challenge

0.95 0.82 0.38 0.03 1.80 1.36

XXX test. 95078............. .............. A

Provocative testing... 0.00 0.25

NA 0.02 0.27

NA

XXX

[[Page 70453]]

95115............. .............. A

Immunotherapy, one

0.00 0.39

NA 0.02 0.41

NA

XXX injection. 95117............. .............. A

Immunotherapy

0.00 0.50

NA 0.02 0.52

NA

XXX injections. 95120............. .............. I

Immunotherapy, one

0.00 0.00 0.00 0.00 0.00 0.00

XXX injection. 95125............. .............. I

Immunotherapy, many

0.00 0.00 0.00 0.00 0.00 0.00

XXX antigens. 95130............. .............. I

Immunotherapy, insect

0.00 0.00 0.00 0.00 0.00 0.00

XXX venom. 95131............. .............. I

Immunotherapy, insect

0.00 0.00 0.00 0.00 0.00 0.00

XXX venoms. 95132............. .............. I

Immunotherapy, insect

0.00 0.00 0.00 0.00 0.00 0.00

XXX venoms. 95133............. .............. I

Immunotherapy, insect

0.00 0.00 0.00 0.00 0.00 0.00

XXX venoms. 95134............. .............. I

Immunotherapy, insect

0.00 0.00 0.00 0.00 0.00 0.00

XXX venoms. 95144............. .............. A

Antigen therapy

0.06 0.19 0.02 0.01 0.26 0.09

XXX services. 95145............. .............. A

Antigen therapy

0.06 0.32 0.02 0.01 0.39 0.09

XXX services. 95146............. .............. A

Antigen therapy

0.06 0.44 0.03 0.01 0.51 0.10

XXX services. 95147............. .............. A

Antigen therapy

0.06 0.42 0.02 0.01 0.49 0.09

XXX services. 95148............. .............. A

Antigen therapy

0.06 0.58 0.03 0.01 0.65 0.10

XXX services. 95149............. .............. A

Antigen therapy

0.06 0.80 0.03 0.01 0.87 0.10

XXX services. 95165............. .............. A

Antigen therapy

0.06 0.19 0.02 0.01 0.26 0.09

XXX services. 95170............. .............. A

Antigen therapy

0.06 0.13 0.03 0.01 0.20 0.10

XXX services. 95180............. .............. A

Rapid desensitization. 2.01 2.04 0.93 0.04 4.09 2.98

XXX 95199............. .............. C

Allergy immunology

0.00 0.00 0.00 0.00 0.00 0.00

XXX services. 95250............. .............. A

Glucose monitoring,

0.00 4.11

NA 0.01 4.12

NA

XXX cont. 95251............. .............. A

Gluc monitor, cont,

0.52 0.19 0.19 0.02 0.73 0.73

XXX phys i&r. 95805............. 26............ A

Multiple sleep latency 1.88 0.66 0.66 0.09 2.63 2.63

XXX test. 95805............. TC............ A

Multiple sleep latency 0.00 16.65

NA 0.34 16.99

NA

XXX test. 95805............. .............. A

Multiple sleep latency 1.88 17.31

NA 0.43 19.62

NA

XXX test. 95806............. 26............ A

Sleep study,

1.66 0.54 0.54 0.08 2.28 2.28

XXX unattended. 95806............. TC............ A

Sleep study,

0.00 2.80

NA 0.31 3.11

NA

XXX unattended. 95806............. .............. A

Sleep study,

1.66 3.34

NA 0.39 5.39

NA

XXX unattended. 95807............. 26............ A

Sleep study, attended. 1.66 0.53 0.53 0.08 2.27 2.27

XXX 95807............. TC............ A

Sleep study, attended. 0.00 11.35

NA 0.42 11.77

NA

XXX 95807............. .............. A

Sleep study, attended. 1.66 11.88

NA 0.50 14.04

NA

XXX 95808............. 26............ A

Polysomnography, 1-3.. 2.65 0.92 0.92 0.13 3.70 3.70

XXX 95808............. TC............ A

Polysomnography, 1-3.. 0.00 12.31

NA 0.42 12.73

NA

XXX 95808............. .............. A

Polysomnography, 1-3.. 2.65 13.23

NA 0.55 16.43

NA

XXX 95810............. 26............ A

Polysomnography, 4 or

3.52 1.18 1.18 0.17 4.87 4.87

XXX more. 95810............. TC............ A

Polysomnography, 4 or

0.00 16.36

NA 0.42 16.78

NA

XXX more. 95810............. .............. A

Polysomnography, 4 or

3.52 17.54

NA 0.59 21.65

NA

XXX more. 95811............. 26............ A

Polysomnography w/cpap 3.79 1.27 1.27 0.18 5.24 5.24

XXX 95811............. TC............ A

Polysomnography w/cpap 0.00 17.97

NA 0.43 18.40

NA

XXX 95811............. .............. A

Polysomnography w/cpap 3.79 19.24

NA 0.61 23.64

NA

XXX 95812............. 26............ A

Eeg, 41-60 minutes.... 1.08 0.45 0.45 0.06 1.59 1.59

XXX 95812............. TC............ A

Eeg, 41-60 minutes.... 0.00 3.59

NA 0.11 3.70

NA

XXX 95812............. .............. A

Eeg, 41-60 minutes.... 1.08 4.04

NA 0.17 5.29

NA

XXX 95813............. 26............ A

Eeg, over 1 hour...... 1.73 0.70 0.70 0.09 2.52 2.52

XXX 95813............. TC............ A

Eeg, over 1 hour...... 0.00 4.33

NA 0.11 4.44

NA

XXX 95813............. .............. A

Eeg, over 1 hour...... 1.73 5.03

NA 0.20 6.96

NA

XXX 95816............. 26............ A

Eeg, awake and drowsy. 1.08 0.46 0.46 0.06 1.60 1.60

XXX 95816............. TC............ A

Eeg, awake and drowsy. 0.00 3.26

NA 0.10 3.36

NA

XXX 95816............. .............. A

Eeg, awake and drowsy. 1.08 3.72

NA 0.16 4.96

NA

XXX 95819............. 26............ A

Eeg, awake and asleep. 1.08 0.46 0.46 0.06 1.60 1.60

XXX 95819............. TC............ A

Eeg, awake and asleep. 0.00 2.53

NA 0.10 2.63

NA

XXX 95819............. .............. A

Eeg, awake and asleep. 1.08 2.99

NA 0.16 4.23

NA

XXX 95822............. 26............ A

Eeg, coma or sleep

1.08 0.46 0.46 0.06 1.60 1.60

XXX only. 95822............. TC............ A

Eeg, coma or sleep

0.00 4.15

NA 0.13 4.28

NA

XXX only. 95822............. .............. A

Eeg, coma or sleep

1.08 4.61

NA 0.19 5.88

NA

XXX only. 95824............. 26............ A

Eeg, cerebral death

0.74 0.31 0.31 0.04 1.09 1.09

XXX only. 95824............. TC............ C

Eeg, cerebral death

0.00 0.00 0.00 0.00 0.00 0.00

XXX only. 95824............. .............. C

Eeg, cerebral death

0.00 0.00 0.00 0.00 0.00 0.00

XXX only. 95827............. 26............ A

Eeg, all night

1.08 0.41 0.41 0.05 1.54 1.54

XXX recording. 95827............. TC............ A

Eeg, all night

0.00 2.30

NA 0.14 2.44

NA

XXX recording. 95827............. .............. A

Eeg, all night

1.08 2.71

NA 0.19 3.98

NA

XXX recording. 95829............. 26............ A

Surgery

6.20 2.32 2.32 0.48 9.00 9.00

XXX electrocorticogram. 95829............. TC............ A

Surgery

0.00 28.77

NA 0.02 28.79

NA

XXX electrocorticogram. 95829............. .............. A

Surgery

6.20 31.09

NA 0.50 37.79

NA

XXX electrocorticogram. 95830............. .............. A

Insert electrodes for

1.70 3.30 0.73 0.11 5.11 2.54

XXX EEG. 95831............. .............. A

Limb muscle testing,

0.28 0.46 0.13 0.01 0.75 0.42

XXX manual. 95832............. .............. A

Hand muscle testing,

0.29 0.33 0.12 0.02 0.64 0.43

XXX manual. 95833............. .............. A

Body muscle testing,

0.47 0.58 0.23 0.02 1.07 0.72

XXX manual. 95834............. .............. A

Body muscle testing,

0.60 0.63 0.28 0.03 1.26 0.91

XXX manual. 95851............. .............. A

Range of motion

0.16 0.36 0.08 0.01 0.53 0.25

XXX measurements. 95852............. .............. A

Range of motion

0.11 0.26 0.05 0.01 0.38 0.17

XXX measurements. 95857............. .............. A

Tensilon test......... 0.53 0.60 0.23 0.02 1.15 0.78

XXX 95860............. 26............ A

Muscle test, one limb. 0.96 0.42 0.42 0.05 1.43 1.43

XXX 95860............. TC............ A

Muscle test, one limb. 0.00 1.00

NA 0.02 1.02

NA

XXX 95860............. .............. A

Muscle test, one limb. 0.96 1.42

NA 0.07 2.45

NA

XXX 95861............. 26............ A

Muscle test, 2 limbs.. 1.54 0.68 0.68 0.07 2.29 2.29

XXX

[[Page 70454]]

95861............. TC............ A

Muscle test, 2 limbs.. 0.00 0.73

NA 0.06 0.79

NA

XXX 95861............. .............. A

Muscle test, 2 limbs.. 1.54 1.41

NA 0.13 3.08

NA

XXX 95863............. 26............ A

Muscle test, 3 limbs.. 1.87 0.80 0.80 0.09 2.76 2.76

XXX 95863............. TC............ A

Muscle test, 3 limbs.. 0.00 0.94

NA 0.06 1.00

NA

XXX 95863............. .............. A

Muscle test, 3 limbs.. 1.87 1.74

NA 0.15 3.76

NA

XXX 95864............. 26............ A

Muscle test, 4 limbs.. 1.99 0.87 0.87 0.09 2.95 2.95

XXX 95864............. TC............ A

Muscle test, 4 limbs.. 0.00 1.79

NA 0.12 1.91

NA

XXX 95864............. .............. A

Muscle test, 4 limbs.. 1.99 2.66

NA 0.21 4.86

NA

XXX 95865............. 26............ A

Muscle test, larynx... 1.57 0.77 0.77 0.08 2.42 2.42

XXX 95865............. TC............ A

Muscle test, larynx... 0.00 0.68

NA 0.03 0.71

NA

XXX 95865............. .............. A

Muscle test, larynx... 1.57 1.45

NA 0.11 3.13

NA

XXX 95866............. 26............ A

Muscle test,

1.25 0.56 0.56 0.07 1.88 1.88

XXX hemidiaphragm. 95866............. TC............ A

Muscle test,

0.00 0.20

NA 0.03 0.23

NA

XXX hemidiaphragm. 95866............. .............. A

Muscle test,

1.25 0.76

NA 0.10 2.11

NA

XXX hemidiaphragm. 95867............. 26............ A

Muscle test cran nerv

0.79 0.35 0.35 0.03 1.17 1.17

XXX unilat. 95867............. TC............ A

Muscle test cran nerv

0.00 0.58

NA 0.04 0.62

NA

XXX unilat. 95867............. .............. A

Muscle test cran nerv

0.79 0.93

NA 0.07 1.79

NA

XXX unilat. 95868............. 26............ A

Muscle test cran nerve 1.18 0.51 0.51 0.05 1.74 1.74

XXX bilat. 95868............. TC............ A

Muscle test cran nerve 0.00 0.70

NA 0.05 0.75

NA

XXX bilat. 95868............. .............. A

Muscle test cran nerve 1.18 1.21

NA 0.10 2.49

NA

XXX bilat. 95869............. 26............ A

Muscle test, thor

0.37 0.16 0.16 0.02 0.55 0.55

XXX paraspinal. 95869............. TC............ A

Muscle test, thor

0.00 0.21

NA 0.02 0.23

NA

XXX paraspinal. 95869............. .............. A

Muscle test, thor

0.37 0.37

NA 0.04 0.78

NA

XXX paraspinal. 95870............. 26............ A

Muscle test,

0.37 0.16 0.16 0.02 0.55 0.55

XXX nonparaspinal. 95870............. TC............ A

Muscle test,

0.00 0.21

NA 0.02 0.23

NA

XXX nonparaspinal. 95870............. .............. A

Muscle test,

0.37 0.37

NA 0.04 0.78

NA

XXX nonparaspinal. 95872............. 26............ A

Muscle test, one fiber 1.50 0.63 0.63 0.08 2.21 2.21

XXX 95872............. TC............ A

Muscle test, one fiber 0.00 0.60

NA 0.05 0.65

NA

XXX 95872............. .............. A

Muscle test, one fiber 1.50 1.23

NA 0.13 2.86

NA

XXX 95873............. 26............ A

Guide nerv destr, elec 0.37 0.16 0.16 0.02 0.55 0.55

ZZZ stim. 95873............. TC............ A

Guide nerv destr, elec 0.00 0.20

NA 0.02 0.22

NA

ZZZ stim. 95873............. .............. A

Guide nerv destr, elec 0.37 0.36

NA 0.04 0.77

NA

ZZZ stim. 95874............. 26............ A

Guide nerv destr,

0.37 0.17 0.17 0.02 0.56 0.56

ZZZ needle emg. 95874............. TC............ A

Guide nerv destr,

0.00 0.20

NA 0.02 0.22

NA

ZZZ needle emg. 95874............. .............. A

Guide nerv destr,

0.37 0.37

NA 0.04 0.78

NA

ZZZ needle emg. 95875............. 26............ A

Limb exercise test.... 1.10 0.47 0.47 0.05 1.62 1.62

XXX 95875............. TC............ A

Limb exercise test.... 0.00 0.98

NA 0.06 1.04

NA

XXX 95875............. .............. A

Limb exercise test.... 1.10 1.45

NA 0.11 2.66

NA

XXX 95900............. 26............ A

Motor nerve conduction 0.42 0.18 0.18 0.02 0.62 0.62

XXX test. 95900............. TC............ A

Motor nerve conduction 0.00 1.08

NA 0.02 1.10

NA

XXX test. 95900............. .............. A

Motor nerve conduction 0.42 1.26

NA 0.04 1.72

NA

XXX test. 95903............. 26............ A

Motor nerve conduction 0.60 0.26 0.26 0.03 0.89 0.89

XXX test. 95903............. TC............ A

Motor nerve conduction 0.00 0.93

NA 0.02 0.95

NA

XXX test. 95903............. .............. A

Motor nerve conduction 0.60 1.19

NA 0.05 1.84

NA

XXX test. 95904............. 26............ A

Sense nerve conduction 0.34 0.15 0.15 0.02 0.51 0.51

XXX test. 95904............. TC............ A

Sense nerve conduction 0.00 0.94

NA 0.02 0.96

NA

XXX test. 95904............. .............. A

Sense nerve conduction 0.34 1.09

NA 0.04 1.47

NA

XXX test. 95920............. 26............ A

Intraop nerve test add- 2.11 0.93 0.93 0.16 3.20 3.20

ZZZ on. 95920............. TC............ A

Intraop nerve test add- 0.00 1.31

NA 0.07 1.38

NA

ZZZ on. 95920............. .............. A

Intraop nerve test add- 2.11 2.24

NA 0.23 4.58

NA

ZZZ on. 95921............. 26............ A

Autonomic nerv

0.90 0.33 0.33 0.04 1.27 1.27

XXX function test. 95921............. TC............ A

Autonomic nerv

0.00 0.38

NA 0.02 0.40

NA

XXX function test. 95921............. .............. A

Autonomic nerv

0.90 0.71

NA 0.06 1.67

NA

XXX function test. 95922............. 26............ A

Autonomic nerv

0.96 0.40 0.40 0.05 1.41 1.41

XXX function test. 95922............. TC............ A

Autonomic nerv

0.00 0.38

NA 0.02 0.40

NA

XXX function test. 95922............. .............. A

Autonomic nerv

0.96 0.78

NA 0.07 1.81

NA

XXX function test. 95923............. 26............ A

Autonomic nerv

0.90 0.38 0.38 0.05 1.33 1.33

XXX function test. 95923............. TC............ A

Autonomic nerv

0.00 1.56

NA 0.02 1.58

NA

XXX function test. 95923............. .............. A

Autonomic nerv

0.90 1.94

NA 0.07 2.91

NA

XXX function test. 95925............. 26............ A

Somatosensory testing. 0.54 0.22 0.22 0.04 0.80 0.80

XXX 95925............. TC............ A

Somatosensory testing. 0.00 0.91

NA 0.06 0.97

NA

XXX 95925............. .............. A

Somatosensory testing. 0.54 1.13

NA 0.10 1.77

NA

XXX 95926............. 26............ A

Somatosensory testing. 0.54 0.23 0.23 0.03 0.80 0.80

XXX 95926............. TC............ A

Somatosensory testing. 0.00 0.91

NA 0.06 0.97

NA

XXX 95926............. .............. A

Somatosensory testing. 0.54 1.14

NA 0.09 1.77

NA

XXX 95927............. 26............ A

Somatosensory testing. 0.54 0.25 0.25 0.04 0.83 0.83

XXX 95927............. TC............ A

Somatosensory testing. 0.00 0.91

NA 0.06 0.97

NA

XXX 95927............. .............. A

Somatosensory testing. 0.54 1.16

NA 0.10 1.80

NA

XXX 95928............. 26............ A

C motor evoked, uppr

1.50 0.65 0.65 0.06 2.21 2.21

XXX limbs. 95928............. TC............ A

C motor evoked, uppr

0.00 2.38

NA 0.03 2.41

NA

XXX limbs. 95928............. .............. A

C motor evoked, uppr

1.50 3.03

NA 0.09 4.62

NA

XXX limbs. 95929............. 26............ A

C motor evoked, lwr

1.50 0.65 0.65 0.06 2.21 2.21

XXX limbs. 95929............. TC............ A

C motor evoked, lwr

0.00 2.57

NA 0.03 2.60

NA

XXX limbs. 95929............. .............. A

C motor evoked, lwr

1.50 3.22

NA 0.09 4.81

NA

XXX limbs. 95930............. 26............ A

Visual evoked

0.35 0.15 0.15 0.02 0.52 0.52

XXX potential test.

[[Page 70455]]

95930............. TC............ A

Visual evoked

0.00 2.10

NA 0.01 2.11

NA

XXX potential test. 95930............. .............. A

Visual evoked

0.35 2.25

NA 0.03 2.63

NA

XXX potential test. 95933............. 26............ A

Blink reflex test..... 0.59 0.24 0.24 0.04 0.87 0.87

XXX 95933............. TC............ A

Blink reflex test..... 0.00 0.78

NA 0.06 0.84

NA

XXX 95933............. .............. A

Blink reflex test..... 0.59 1.02

NA 0.10 1.71

NA

XXX 95934............. 26............ A

H-reflex test......... 0.51 0.22 0.22 0.02 0.75 0.75

XXX 95934............. TC............ A

H-reflex test......... 0.00 0.21

NA 0.02 0.23

NA

XXX 95934............. .............. A

H-reflex test......... 0.51 0.43

NA 0.04 0.98

NA

XXX 95936............. 26............ A

H-reflex test......... 0.55 0.24 0.24 0.03 0.82 0.82

XXX 95936............. TC............ A

H-reflex test......... 0.00 0.21

NA 0.02 0.23

NA

XXX 95936............. .............. A

H-reflex test......... 0.55 0.45

NA 0.05 1.05

NA

XXX 95937............. 26............ A

Neuromuscular junction 0.65 0.27 0.27 0.08 1.00 1.00

XXX test. 95937............. TC............ A

Neuromuscular junction 0.00 0.34

NA 0.02 0.36

NA

XXX test. 95937............. .............. A

Neuromuscular junction 0.65 0.61

NA 0.10 1.36

NA

XXX test. 95950............. 26............ A

Ambulatory eeg

1.51 0.64 0.64 0.08 2.23 2.23

XXX monitoring. 95950............. TC............ A

Ambulatory eeg

0.00 3.30

NA 0.43 3.73

NA

XXX monitoring. 95950............. .............. A

Ambulatory eeg

1.51 3.94

NA 0.51 5.96

NA

XXX monitoring. 95951............. 26............ A

EEG monitoring/

5.99 2.56 2.56 0.32 8.87 8.87

XXX videorecord. 95951............. TC............ C

EEG monitoring/

0.00 0.00 0.00 0.00 0.00 0.00

XXX videorecord. 95951............. .............. C

EEG monitoring/

0.00 0.00 0.00 0.00 0.00 0.00

XXX videorecord. 95953............. 26............ A

EEG monitoring/

3.08 1.29 1.29 0.17 4.54 4.54

XXX computer. 95953............. TC............ A

EEG monitoring/

0.00 6.35

NA 0.43 6.78

NA

XXX computer. 95953............. .............. A

EEG monitoring/

3.08 7.64

NA 0.60 11.32

NA

XXX computer. 95954............. 26............ A

EEG monitoring/giving

2.45 1.04 1.04 0.13 3.62 3.62

XXX drugs. 95954............. TC............ A

EEG monitoring/giving

0.00 3.19

NA 0.06 3.25

NA

XXX drugs. 95954............. .............. A

EEG monitoring/giving

2.45 4.23

NA 0.19 6.87

NA

XXX drugs. 95955............. 26............ A

EEG during surgery.... 1.01 0.36 0.36 0.05 1.42 1.42

XXX 95955............. TC............ A

EEG during surgery.... 0.00 1.97

NA 0.17 2.14

NA

XXX 95955............. .............. A

EEG during surgery.... 1.01 2.33

NA 0.22 3.56

NA

XXX 95956............. 26............ A

Eeg monitoring, cable/ 3.08 1.30 1.30 0.16 4.54 4.54

XXX radio. 95956............. TC............ A

Eeg monitoring, cable/ 0.00 14.15

NA 0.43 14.58

NA

XXX radio. 95956............. .............. A

Eeg monitoring, cable/ 3.08 15.45

NA 0.59 19.12

NA

XXX radio. 95957............. 26............ A

EEG digital analysis.. 1.98 0.85 0.85 0.11 2.94 2.94

XXX 95957............. TC............ A

EEG digital analysis.. 0.00 1.70

NA 0.12 1.82

NA

XXX 95957............. .............. A

EEG digital analysis.. 1.98 2.55

NA 0.23 4.76

NA

XXX 95958............. 26............ A

EEG monitoring/

4.24 1.75 1.75 0.21 6.20 6.20

XXX function test. 95958............. TC............ A

EEG monitoring/

0.00 1.75

NA 0.13 1.88

NA

XXX function test. 95958............. .............. A

EEG monitoring/

4.24 3.50

NA 0.34 8.08

NA

XXX function test. 95961............. 26............ A

Electrode stimulation, 2.97 1.32 1.32 0.48 4.77 4.77

XXX brain. 95961............. TC............ A

Electrode stimulation, 0.00 1.31

NA 0.07 1.38

NA

XXX brain. 95961............. .............. A

Electrode stimulation, 2.97 2.63

NA 0.55 6.15

NA

XXX brain. 95962............. 26............ A

Electrode stim, brain

3.21 1.39 1.39 0.32 4.92 4.92

ZZZ add-on. 95962............. TC............ A

Electrode stim, brain

0.00 1.31

NA 0.07 1.38

NA

ZZZ add-on. 95962............. .............. A

Electrode stim, brain

3.21 2.70

NA 0.39 6.30

NA

ZZZ add-on. 95965............. 26............ A

Meg, spontaneous...... 7.99 3.43 3.43 0.46 11.88 11.88

XXX 95965............. TC............ C

Meg, spontaneous...... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 95965............. .............. C

Meg, spontaneous...... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 95966............. 26............ A

Meg, evoked, single... 3.99 1.71 1.71 0.19 5.89 5.89

XXX 95966............. TC............ C

Meg, evoked, single... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 95966............. .............. C

Meg, evoked, single... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 95967............. 26............ A

Meg, evoked, each

3.49 1.18 1.18 0.16 4.83 4.83

ZZZ add'l. 95967............. TC............ C

Meg, evoked, each

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ add'l. 95967............. .............. C

Meg, evoked, each

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ add'l. 95970............. .............. A

Analyze neurostim, no

0.45 0.85 0.14 0.03 1.33 0.62

XXX prog. 95971............. .............. A

Analyze neurostim,

0.78 0.68 0.22 0.07 1.53 1.07

XXX simple. 95972............. .............. A

Analyze neurostim,

1.50 1.21 0.49 0.14 2.85 2.13

XXX complex. 95973............. .............. A

Analyze neurostim,

0.92 0.62 0.34 0.07 1.61 1.33

ZZZ complex. 95974............. .............. A

Cranial neurostim,

3.00 1.70 1.30 0.16 4.86 4.46

XXX complex. 95975............. .............. A

Cranial neurostim,

1.70 0.89 0.73 0.12 2.71 2.55

ZZZ complex. 95978............. .............. A

Analyze neurostim

3.50 1.94 1.30 0.18 5.62 4.98

XXX brain/1h. 95979............. .............. A

Analyz neurostim brain 1.64 0.87 0.69 0.08 2.59 2.41

ZZZ addon. 95990............. .............. A

Spin/brain pump refil

0.00 1.50

NA 0.06 1.56

NA

XXX & main. 95991............. .............. A

Spin/brain pump refil

0.77 1.46 0.17 0.06 2.29 1.00

XXX & main. 95999............. .............. C

Neurological procedure 0.00 0.00 0.00 0.00 0.00 0.00

XXX 96000............. .............. A

Motion analysis, video/ 1.80

NA 0.53 0.11

NA 2.44

XXX 3d. 96001............. .............. A

Motion test w/ft press 2.15

NA 0.66 0.10

NA 2.91

XXX meas. 96002............. .............. A

Dynamic surface emg... 0.41

NA 0.15 0.02

NA 0.58

XXX 96003............. .............. A

Dynamic fine wire emg. 0.37

NA 0.12 0.02

NA 0.51

XXX 96004............. .............. A

Phys review of motion

2.14 0.94 0.94 0.11 3.19 3.19

XXX tests. 96101............. .............. A

Psycho testing by

1.86 0.65 0.63 0.05 2.56 2.54

XXX psych/phys. 96102............. .............. A

Psycho testing by

0.50 0.66 0.17 0.01 1.17 0.68

XXX technician. 96103............. .............. A

Psycho testing admin

0.51 0.21 0.17 0.02 0.74 0.70

XXX by comp. 96105............. .............. A

Assessment of aphasia. 0.00 1.77

NA 0.18 1.95

NA

XXX 96110............. .............. A

Developmental test,

0.00 0.18

NA 0.18 0.36

NA

XXX lim. 96111............. .............. A

Developmental test,

2.60 1.05

NA 0.18 3.83

NA

XXX extend.

[[Page 70456]]

96116............. .............. A

Neurobehavioral status 1.86 0.83 0.64 0.18 2.87 2.68

XXX exam. 96118............. .............. A

Neuropsych tst by

1.86 1.39 0.63 0.18 3.43 2.67

XXX psych/phys. 96119............. .............. A

Neuropsych testing by

0.55 1.02 0.19 0.18 1.75 0.92

XXX tech. 96120............. .............. A

Neuropsych tst admin w/ 0.51 0.74 0.17 0.02 1.27 0.70

XXX comp. 96150............. .............. A

Assess hlth/behave,

0.50 0.18 0.18 0.01 0.69 0.69

XXX init. 96151............. .............. A

Assess hlth/behave,

0.48 0.18 0.17 0.01 0.67 0.66

XXX subseq. 96152............. .............. A

Intervene hlth/behave, 0.46 0.17 0.16 0.01 0.64 0.63

XXX indiv. 96153............. .............. A

Intervene hlth/behave, 0.10 0.04 0.03 0.01 0.15 0.14

XXX group. 96154............. .............. A

Interv hlth/behav, fam 0.45 0.17 0.16 0.01 0.63 0.62

XXX w/pt. 96155............. .............. N

Interv hlth/behav fam +0.44 0.18 0.17 0.02 0.64 0.63

XXX no pt. 96401............. .............. A

Chemo, anti-neopl, sq/ 0.21 1.53 1.53 0.01 1.75 1.75

XXX im. 96402............. .............. A

Chemo hormon antineopl 0.19 0.74 0.74 0.01 0.94 0.94

XXX sq/im. 96405............. .............. A

Chemo intralesional,

0.52 2.78 0.24 0.03 3.33 0.79

000 up to 7. 96406............. .............. A

Chemo intralesional

0.80 3.08 0.29 0.03 3.91 1.12

000 over 7. 96409............. .............. A

Chemo, iv push, sngl

0.24 2.93 2.93 0.06 3.23 3.23

XXX drug. 96411............. .............. A

Chemo, iv push, addl

0.20 1.61 1.61 0.06 1.87 1.87

ZZZ drug. 96413............. .............. A

Chemo, iv infusion, 1

0.28 4.20 4.20 0.08 4.56 4.56

XXX hr. 96415............. .............. A

Chemo, iv infusion,

0.19 0.77 0.77 0.07 1.03 1.03

ZZZ addl hr. 96416............. .............. A

Chemo prolong infuse w/ 0.21 4.61 4.61 0.08 4.90 4.90

XXX pump. 96417............. .............. A

Chemo iv infus each

0.21 1.95 1.95 0.07 2.23 2.23

ZZZ addl seq. 96420............. .............. A

Chemo, ia, push

0.17 2.66

NA 0.08 2.91

NA

XXX tecnique. 96422............. .............. A

Chemo ia infusion up

0.17 4.84

NA 0.08 5.09

NA

XXX to 1 hr. 96423............. .............. A

Chemo ia infuse each

0.17 1.89

NA 0.02 2.08

NA

ZZZ addl hr. 96425............. .............. A

Chemotherapy,infusion

0.17 4.48

NA 0.08 4.73

NA

XXX method. 96440............. .............. A

Chemotherapy,

2.37 8.04 1.23 0.17 10.58 3.77

000 intracavitary. 96445............. .............. A

Chemotherapy,

2.20 8.05 1.18 0.14 10.39 3.52

000 intracavitary. 96450............. .............. A

Chemotherapy, into CNS 1.53 6.96 1.29 0.09 8.58 2.91

000 96521............. .............. A

Refill/maint, portable 0.21 3.77 3.77 0.06 4.04 4.04

XXX pump. 96522............. .............. A

Refill/maint pump/

0.21 2.65 2.65 0.06 2.92 2.92

XXX resvr syst. 96523............. .............. T

Irrig drug delivery

0.04 0.69 0.69 0.01 0.74 0.74

XXX device. 96542............. .............. A

Chemotherapy injection 0.75 4.24 0.66 0.07 5.06 1.48

XXX 96549............. .............. C

Chemotherapy,

0.00 0.00 0.00 0.00 0.00 0.00

XXX unspecified. 96567............. .............. A

Photodynamic tx, skin. 0.00 1.96

NA 0.04 2.00

NA

XXX 96570............. .............. A

Photodynamic tx, 30

1.10

NA 0.37 0.11

NA 1.58

ZZZ min. 96571............. .............. A

Photodynamic tx, addl

0.55

NA 0.19 0.03

NA 0.77

ZZZ 15 min. 96900............. .............. A

Ultraviolet light

0.00 0.44

NA 0.02 0.46

NA

XXX therapy. 96902............. .............. B

Trichogram............ +0.41 0.18 0.16 0.01 0.60 0.58

XXX 96910............. .............. A

Photochemotherapy with 0.00 0.99

NA 0.04 1.03

NA

XXX UV-B. 96912............. .............. A

Photochemotherapy with 0.00 1.26

NA 0.05 1.31

NA

XXX UV-A. 96913............. .............. A

Photochemotherapy, UV- 0.00 1.68

NA 0.10 1.78

NA

XXX A or B. 96920............. .............. A

Laser tx, skin 500

2.10 3.49 0.62 0.04 5.63 2.76

000 sq cm. 96999............. .............. C

Dermatological

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 97001............. .............. A

Pt evaluation......... 1.20 0.75 0.45 0.05 2.00 1.70

XXX 97002............. .............. A

Pt re-evaluation...... 0.60 0.44 0.23 0.02 1.06 0.85

XXX 97003............. .............. A

Ot evaluation......... 1.20 0.88 0.40 0.06 2.14 1.66

XXX 97004............. .............. A

Ot re-evaluation...... 0.60 0.67 0.19 0.02 1.29 0.81

XXX 97005............. .............. I

Athletic train eval... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 97006............. .............. I

Athletic train reeval. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 97010............. .............. B

Hot or cold packs

+0.06 0.05

NA 0.01 0.12

NA

XXX therapy. 97012............. .............. A

Mechanical traction

0.25 0.13

NA 0.01 0.39

NA

XXX therapy. 97014............. .............. I

Electric stimulation

+0.18 0.19 0.19 0.01 0.38 0.38

XXX therapy. 97016............. .............. A

Vasopneumatic device

0.18 0.18

NA 0.01 0.37

NA

XXX therapy. 97018............. .............. A

Paraffin bath therapy. 0.06 0.10

NA 0.01 0.17

NA

XXX 97022............. .............. A

Whirlpool therapy..... 0.17 0.21

NA 0.01 0.39

NA

XXX 97024............. .............. A

Diathermy eg,

0.06 0.07

NA 0.01 0.14

NA

XXX microwave. 97026............. .............. A

Infrared therapy...... 0.06 0.06

NA 0.01 0.13

NA

XXX 97028............. .............. A

Ultraviolet therapy... 0.08 0.07

NA 0.01 0.16

NA

XXX 97032............. .............. A

Electrical stimulation 0.25 0.16

NA 0.01 0.42

NA

XXX 97033............. .............. A

Electric current

0.26 0.27

NA 0.01 0.54

NA

XXX therapy. 97034............. .............. A

Contrast bath therapy. 0.21 0.15

NA 0.01 0.37

NA

XXX 97035............. .............. A

Ultrasound therapy.... 0.21 0.10

NA 0.01 0.32

NA

XXX 97036............. .............. A

Hydrotherapy.......... 0.28 0.32

NA 0.01 0.61

NA

XXX 97039............. .............. C

Physical therapy

0.00 0.00 0.00 0.00 0.00 0.00

XXX treatment. 97110............. .............. A

Therapeutic exercises. 0.45 0.27

NA 0.02 0.74

NA

XXX 97112............. .............. A

Neuromuscular

0.45 0.31

NA 0.01 0.77

NA

XXX reeducation. 97113............. .............. A

Aquatic therapy/

0.44 0.39

NA 0.01 0.84

NA

XXX exercises. 97116............. .............. A

Gait training therapy. 0.40 0.24

NA 0.01 0.65

NA

XXX 97124............. .............. A

Massage therapy....... 0.35 0.23

NA 0.01 0.59

NA

XXX 97139............. .............. C

Physical medicine

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 97140............. .............. A

Manual therapy........ 0.43 0.25

NA 0.01 0.69

NA

XXX 97150............. .............. A

Group therapeutic

0.27 0.18

NA 0.01 0.46

NA

XXX procedures. 97530............. .............. A

Therapeutic activities 0.44 0.32

NA 0.01 0.77

NA

XXX 97532............. .............. A

Cognitive skills

0.44 0.20

NA 0.01 0.65

NA

XXX development.

[[Page 70457]]

97533............. .............. A

Sensory integration... 0.44 0.24

NA 0.01 0.69

NA

XXX 97535............. .............. A

Self care mngment

0.45 0.33

NA 0.01 0.79

NA

XXX training. 97537............. .............. A

Community/work

0.45 0.26

NA 0.01 0.72

NA

XXX reintegration. 97542............. .............. A

Wheelchair mngment

0.45 0.28

NA 0.01 0.74

NA

XXX training. 97545............. .............. R

Work hardening........ 0.00 0.00 0.00 0.00 0.00 0.00

XXX 97546............. .............. R

Work hardening add-on. 0.00 0.00 0.00 0.00 0.00 0.00

ZZZ 97597............. .............. A

Active wound care/20

0.58 0.66

NA 0.05 1.29

NA

XXX cm or 20 0.80 0.79

NA 0.05 1.64

NA

XXX cm. 97602............. .............. B

Wound(s) care non-

0.00 0.00 0.00 0.00 0.00 0.00

XXX selective. 97605............. .............. A

Neg press wound tx, 0.60 0.90 0.41 0.03 1.53 1.04

XXX 50 cm. 97750............. .............. A

Physical performance

0.45 0.32

NA 0.02 0.79

NA

XXX test. 97755............. .............. A

Assistive technology

0.62 0.28

NA 0.02 0.92

NA

XXX assess. 97760............. .............. A

Orthotic mgmt and

0.45 0.34 0.20 0.03 0.82 0.68

XXX training. 97761............. .............. A

Prosthetic training... 0.45 0.28 0.19 0.02 0.75 0.66

XXX 97762............. .............. A

C/o for orthotic/

0.25 0.42 0.19 0.02 0.69 0.46

XXX prosth use. 97799............. .............. C

Physical medicine

0.00 0.00 0.00 0.00 0.00 0.00

XXX procedure. 97802............. .............. A

Medical nutrition,

0.00 0.47

NA 0.01 0.48

NA

XXX indiv, in. 97803............. .............. A

Med nutrition, indiv,

0.00 0.47

NA 0.01 0.48

NA

XXX subseq. 97804............. .............. A

Medical nutrition,

0.00 0.18

NA 0.01 0.19

NA

XXX group. 97810............. .............. N

Acupunct w/o stimul 15 +0.60 0.38 0.23 0.03 1.01 0.86

XXX min. 97811............. .............. N

Acupunct w/o stimul

+0.50 0.25 0.19 0.03 0.78 0.72

ZZZ addl 15m. 97813............. .............. N

Acupunct w/stimul 15

+0.65 0.40 0.25 0.03 1.08 0.93

XXX min. 97814............. .............. N

Acupunct w/stimul addl +0.55 0.30 0.21 0.03 0.88 0.79

ZZZ 15m. 98925............. .............. A

Osteopathic

0.45 0.32 0.14 0.02 0.79 0.61

000 manipulation. 98926............. .............. A

Osteopathic

0.65 0.41 0.25 0.03 1.09 0.93

000 manipulation. 98927............. .............. A

Osteopathic

0.87 0.50 0.29 0.03 1.40 1.19

000 manipulation. 98928............. .............. A

Osteopathic

1.03 0.59 0.34 0.04 1.66 1.41

000 manipulation. 98929............. .............. A

Osteopathic

1.19 0.67 0.37 0.05 1.91 1.61

000 manipulation. 98940............. .............. A

Chiropractic

0.45 0.23 0.12 0.01 0.69 0.58

000 manipulation. 98941............. .............. A

Chiropractic

0.65 0.30 0.17 0.01 0.96 0.83

000 manipulation. 98942............. .............. A

Chiropractic

0.87 0.36 0.23 0.02 1.25 1.12

000 manipulation. 98943............. .............. N

Chiropractic

+0.40 0.24 0.16 0.01 0.65 0.57

XXX manipulation. 98960............. .............. N

Self-mgmt educ &

0.00 0.00 0.00 0.00 0.00 0.00

XXX train, 1 pt. 98961............. .............. N

Self-mgmt educ/train,

0.00 0.00 0.00 0.00 0.00 0.00

XXX 2-4 pt. 98962............. .............. N

Self-mgmt educ/train,

0.00 0.00 0.00 0.00 0.00 0.00

XXX 5-8 pt. 99000............. .............. B

Specimen handling..... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 99001............. .............. B

Specimen handling..... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 99002............. .............. B

Device handling....... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 99024............. .............. B

Postop follow-up visit 0.00 0.00 0.00 0.00 0.00 0.00

XXX 99026............. .............. N

In-hospital on call

0.00 0.00 0.00 0.00 0.00 0.00

XXX service. 99027............. .............. N

Out-of-hosp on call

0.00 0.00 0.00 0.00 0.00 0.00

XXX service. 99050............. .............. B

Medical services after 0.00 0.00 0.00 0.00 0.00 0.00

XXX hrs. 99051............. .............. B

Med serv, eve/wkend/

0.00 0.00 0.00 0.00 0.00 0.00

XXX holiday. 99053............. .............. B

Med serv 10pm-8am, 24

0.00 0.00 0.00 0.00 0.00 0.00

XXX hr fac. 99056............. .............. B

Med service out of

0.00 0.00 0.00 0.00 0.00 0.00

XXX office. 99058............. .............. B

Office emergency care. 0.00 0.00 0.00 0.00 0.00 0.00

XXX 99060............. .............. B

Out of office emerg

0.00 0.00 0.00 0.00 0.00 0.00

XXX med serv. 99070............. .............. B

Special supplies...... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 99071............. .............. B

Patient education

0.00 0.00 0.00 0.00 0.00 0.00

XXX materials. 99075............. .............. N

Medical testimony..... 0.00 0.00 0.00 0.00 0.00 0.00

XXX 99078............. .............. B

Group health education 0.00 0.00 0.00 0.00 0.00 0.00

XXX 99080............. .............. B

Special reports or

0.00 0.00 0.00 0.00 0.00 0.00

XXX forms. 99082............. .............. C

Unusual physician

0.00 0.00 0.00 0.00 0.00 0.00

XXX travel. 99090............. .............. B

Computer data analysis 0.00 0.00 0.00 0.00 0.00 0.00

XXX 99091............. .............. B

Collect/review data

0.00 0.00 0.00 0.00 0.00 0.00

XXX from pt. 99100............. .............. B

Special anesthesia

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ service. 99116............. .............. B

Anesthesia with

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ hypothermia. 99135............. .............. B

Special anesthesia

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ procedure. 99140............. .............. B

Emergency anesthesia.. 0.00 0.00 0.00 0.00 0.00 0.00

ZZZ 99143............. .............. C

Mod cs by same phys, 10. G0378............. .............. X

Hospital observation

0.00 0.00 0.00 0.00 0.00 0.00

XXX per hr. G0379............. .............. X

Direct admit hospital

0.00 0.00 0.00 0.00 0.00 0.00

XXX observ. G3001............. .............. X

Admin + supply,

0.00 0.00 0.00 0.00 0.00 0.00

XXX tositumomab. G9001............. .............. X

MCCD, initial rate.... 0.00 0.00 0.00 0.00 0.00 0.00

XXX G9002............. .............. X

MCCD,maintenance rate. 0.00 0.00 0.00 0.00 0.00 0.00

XXX G9003............. .............. X

MCCD, risk adj hi,

0.00 0.00 0.00 0.00 0.00 0.00

XXX initial. G9004............. .............. X

MCCD, risk adj lo,

0.00 0.00 0.00 0.00 0.00 0.00

XXX initial. G9005............. .............. X

MCCD, risk adj,

0.00 0.00 0.00 0.00 0.00 0.00

XXX maintenance. G9006............. .............. X

MCCD, Home monitoring. 0.00 0.00 0.00 0.00 0.00 0.00

XXX G9007............. .............. X

MCCD, sch team conf... 0.00 0.00 0.00 0.00 0.00 0.00

XXX G9008............. .............. X

Mccd,phys coor-care

0.00 0.00 0.00 0.00 0.00 0.00

XXX ovrsght. G9009............. .............. X

MCCD, risk adj, level

0.00 0.00 0.00 0.00 0.00 0.00

XXX 3. G9010............. .............. X

MCCD, risk adj, level

0.00 0.00 0.00 0.00 0.00 0.00

XXX 4. G9011............. .............. X

MCCD, risk adj, level

0.00 0.00 0.00 0.00 0.00 0.00

XXX 5. G9012............. .............. X

Other Specified Case

0.00 0.00 0.00 0.00 0.00 0.00

XXX Mgmt. G9013............. .............. N

ESRD demo bundle level 0.00 0.00 0.00 0.00 0.00 0.00

XXX I. G9014............. .............. N

ESRD demo bundle-level 0.00 0.00 0.00 0.00 0.00 0.00

XXX II. G9016............. .............. N

Demo-smoking cessation 0.00 0.00 0.00 0.00 0.00 0.00

XXX coun. G9017............. .............. X

Amantadine HCL 100mg

0.00 0.00 0.00 0.00 0.00 0.00

XXX oral. G9018............. .............. X

Zanamivir,inhalation

0.00 0.00 0.00 0.00 0.00 0.00

XXX pwd 10m. G9019............. .............. X

Oseltamivir phosphate

0.00 0.00 0.00 0.00 0.00 0.00

XXX 75mg. G9020............. .............. X

Rimantadine HCL 100mg

0.00 0.00 0.00 0.00 0.00 0.00

XXX oral. G9021............. .............. X

Chemo assess nausea

0.00 0.00 0.00 0.00 0.00 0.00

XXX vomit L1. G9022............. .............. X

Chemo assess nausea

0.00 0.00 0.00 0.00 0.00 0.00

XXX vomit L2. G9023............. .............. X

Chemo assess nausea

0.00 0.00 0.00 0.00 0.00 0.00

XXX vomit L3. G9024............. .............. X

Chemo assess nausea

0.00 0.00 0.00 0.00 0.00 0.00

XXX vomit L4. G9025............. .............. X

Chemo assessment pain

0.00 0.00 0.00 0.00 0.00 0.00

XXX level1. G9026............. .............. X

Chemo assessment pain

0.00 0.00 0.00 0.00 0.00 0.00

XXX level2. G9027............. .............. X

Chemo assessment pain

0.00 0.00 0.00 0.00 0.00 0.00

XXX level3. G9028............. .............. X

Chemo assessment pain

0.00 0.00 0.00 0.00 0.00 0.00

XXX level4. G9029............. .............. X

Chemo assess for

0.00 0.00 0.00 0.00 0.00 0.00

XXX fatigue L1. G9030............. .............. X

Chemo assess for

0.00 0.00 0.00 0.00 0.00 0.00

XXX fatigue L2. G9031............. .............. X

Chemo assess for

0.00 0.00 0.00 0.00 0.00 0.00

XXX fatigue L3. G9032............. .............. X

Chemo assess for

0.00 0.00 0.00 0.00 0.00 0.00

XXX fatigue L4. G9033............. .............. X

Amantadine HCL oral

0.00 0.00 0.00 0.00 0.00 0.00

XXX brand. G9034............. .............. X

Zanamivir, inh pwdr,

0.00 0.00 0.00 0.00 0.00 0.00

XXX brand. G9035............. .............. X

Oseltamivir phosp,

0.00 0.00 0.00 0.00 0.00 0.00

XXX brand. G9036............. .............. X

Rimantadine HCL, brand 0.00 0.00 0.00 0.00 0.00 0.00

XXX G9041............. .............. X

Low vision rehab

0.00 0.00 0.00 0.00 0.00 0.00

XXX occupationa. G9042............. .............. X

Low vision rehab

0.00 0.00 0.00 0.00 0.00 0.00

XXX orient/mobi. G9043............. .............. X

Low vision lowvision

0.00 0.00 0.00 0.00 0.00 0.00

XXX therapi. G9044............. .............. X

Low vision rehabilate

0.00 0.00 0.00 0.00 0.00 0.00

XXX teache. M0064............. .............. A

Visit for drug

0.37 0.34 0.12 0.01 0.72 0.50

XXX monitoring. P3001............. .............. A

Screening pap smear by 0.42 0.15 0.15 0.02 0.59 0.59

XXX phys. Q0035............. 26............ A

Cardiokymography...... 0.17 0.06 0.06 0.01 0.24 0.24

XXX Q0035............. TC............ A

Cardiokymography...... 0.00 0.39

NA 0.02 0.41

NA

XXX Q0035............. .............. A

Cardiokymography...... 0.17 0.45

NA 0.03 0.65

NA

XXX Q0091............. .............. A

Obtaining screen pap

0.37 0.67 0.14 0.02 1.06 0.53

XXX smear. Q0092............. .............. A

Set up port xray

0.00 0.32

NA 0.01 0.33

NA

XXX equipment. Q3001............. .............. C

Brachytherapy

0.00 0.00 0.00 0.00 0.00 0.00

XXX Radioelements. Q3014............. .............. X

Telehealth facility

0.00 0.00 0.00 0.00 0.00 0.00

XXX fee. R0070............. .............. C

Transport portable x-

0.00 0.00 0.00 0.00 0.00 0.00

XXX ray. R0075............. .............. C

Transport port x-ray

0.00 0.00 0.00 0.00 0.00 0.00

XXX multipl. R0076............. .............. B

Transport portable EKG 0.00 0.00 0.00 0.00 0.00 0.00

XXX V5299............. .............. R

Hearing service....... 0.00 0.00 0.00 0.00 0.00 0.00 XXX

\1\ CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. \2\ Copyright 2005 American Dental Association. All rights reserved. \3\ +Indicates RVUs are not used for Medicare payment.

\1\ CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

\2\ Copyright 2005 American Dental Association. All rights reserved.

\3\ +Indicates RVUs are not used for Medicare payment.

Addendum C.--Codes With Interim RVUs

Physician Non-

Mal- Non- CPT \1\ HCPCS \2\

Mod

Status

Description

work Facility Facility practice Facility Facility Global RVUs \3\ PE RVUs PE RVUs RVUs Total Total

15040............. .............. A

Harvest cultured skin

2.00 4.57 1.13 0.24 6.81 3.37

000 graft. 15110............. .............. A

Epidrm autogrft trnk/

9.50 10.70 7.02 1.31 21.51 17.83

090 arm/leg. 15111............. .............. A

Epidrm autogrft t/a/l

1.85 1.29 0.79 0.26 3.40 2.90

ZZZ add-on.

[[Page 70464]]

15115............. .............. A

Epidrm a-grft face/nck/ 9.81 9.25 7.37 1.15 20.21 18.33

090 hf/g. 15116............. .............. A

Epidrm a-grft f/n/hf/g 2.50 1.58 1.12 0.33 4.41 3.95

ZZZ addl. 15130............. .............. A

Derm autograft, trnk/

7.00 9.89 6.36 0.97 17.86 14.33

090 arm/leg. 15131............. .............. A

Derm autograft t/a/l

1.50 1.07 0.64 0.21 2.78 2.35

ZZZ add-on. 15135............. .............. A

Derm autograft face/

10.50 9.90 8.15 1.23 21.63 19.88

090 nck/hf/g. 15136............. .............. A

Derm autograft, f/n/hf/ 1.50 0.89 0.67 0.20 2.59 2.37

ZZZ g add. 15150............. .............. A

Cult epiderm grft t/

8.25 8.48 6.46 1.14 17.87 15.85

090 arm/leg. 15151............. .............. A

Cult epiderm grft t/a/ 2.00 1.31 0.85 0.28 3.59 3.13

ZZZ l addl. 15152............. .............. A

Cult epiderm graft t/a/ 2.50 1.56 1.06 0.35 4.41 3.91

ZZZ l +%. 15155............. .............. A

Cult epiderm graft, f/ 9.00 7.84 6.98 1.05 17.89 17.03

090 n/hf/g. 15156............. .............. A

Cult epidrm grft f/n/

2.75 1.56 1.24 0.36 4.67 4.35

ZZZ hfg add. 15157............. .............. A

Cult epiderm grft f/n/ 3.00 1.78 1.35 0.39 5.17 4.74

ZZZ hfg +%. 15170............. .............. A

Acell graft trunk/arms/ 5.00 3.84 2.37 0.55 9.39 7.92

090 legs. 15171............. .............. A

Acell graft t/arm/leg

1.55 0.68 0.62 0.19 2.42 2.36

ZZZ add-on. 15175............. .............. A

Acellular graft, f/n/

7.00 5.44 4.01 0.82 13.26 11.83

090 hf/g. 15176............. .............. A

Acell graft, f/n/hf/g

2.45 1.11 0.99 0.29 3.85 3.73

ZZZ add-on. 15300............. .............. A

Apply skinallogrft, t/ 3.99 3.21 2.24 0.49 7.69 6.72

090 arm/lg. 15301............. .............. A

Apply sknallogrft t/a/ 1.00 0.47 0.40 0.14 1.61 1.54

ZZZ l addl. 15320............. .............. A

Apply skin allogrft f/ 4.70 3.63 2.54 0.58 8.91 7.82

090 n/hf/g. 15321............. .............. A

Aply sknallogrft f/n/

1.50 0.69 0.59 0.21 2.40 2.30

ZZZ hfg add. 15330............. .............. A

Aply acell alogrft t/

3.99 3.20 2.23 0.49 7.68 6.71

090 arm/leg. 15331............. .............. A

Aply acell grft t/a/l

1.00 0.46 0.40 0.14 1.60 1.54

ZZZ add-on. 15335............. .............. A

Apply acell graft, f/n/ 4.50 3.48 2.45 0.55 8.53 7.50

090 hf/g. 15336............. .............. A

Aply acell grft f/n/hf/ 1.43 0.69 0.57 0.20 2.32 2.20

ZZZ g add. 15340............. .............. A

Apply cult skin

3.72 4.01 2.76 0.41 8.14 6.89

010 substitute. 15341............. .............. A

Apply cult skin sub

0.50 0.61 0.20 0.06 1.17 0.76

ZZZ add-on. 15360............. .............. A

Apply cult derm sub, t/ 3.87 4.48 3.09 0.43 8.78 7.39

090 a/l. 15361............. .............. A

Aply cult derm sub t/a/ 1.15 0.58 0.46 0.14 1.87 1.75

ZZZ l add. 15365............. .............. A

Apply cult derm sub f/ 4.15 4.56 3.20 0.46 9.17 7.81

090 n/hf/g. 15366............. .............. A

Apply cult derm f/hf/g 1.45 0.70 0.58 0.17 2.32 2.20

ZZZ add. 15420............. .............. A

Apply skin xgraft, f/n/ 4.50 4.79 3.80 0.52 9.81 8.82

090 hf/g. 15421............. .............. A

Apply skn xgrft f/n/hf/ 1.50 1.32 0.62 0.21 3.03 2.33

ZZZ g add. 15430............. .............. A

Apply acellular

5.75 6.92 6.63 0.66 13.33 13.04

090 xenograft. 15431............. .............. C

Apply acellular xgraft 0.00 0.00 0.00 0.00 0.00 0.00

ZZZ add. 22010............. .............. A

I&d, p-spine, c/t/cerv- 11.05

NA 8.91 1.73

NA 21.69

090 thor. 22015............. .............. A

I&d, p-spine, l/s/ls.. 10.94

NA 8.85 1.71

NA 21.50

090 22523............. .............. A

Percut kyphoplasty,

8.94

NA 5.92 1.43

NA 16.29

010 thor. 22524............. .............. A

Percut kyphoplasty,

8.54

NA 5.71 1.36

NA 15.61

010 lumbar. 22525............. .............. A

Percut kyphoplasty,

4.47

NA 2.28 0.72

NA 7.47

ZZZ add-on. 28890............. .............. A

High energy eswt,

3.30 5.73 2.09 0.41 9.44 5.80

090 plantar f. 32503............. .............. A

Resect apical lung

30.00

NA 15.11 4.37

NA 49.48

090 tumor. 32504............. .............. A

Resect apical lung tum/ 34.80

NA 16.72 5.07

NA 56.59

090 chest. 33507............. .............. A

Repair art, intramural 30.00

NA 13.68 4.05

NA 47.73

090 33548............. .............. A

Restore/remodel,

37.97

NA 19.35 5.51

NA 62.83

090 ventricle. 33768............. .............. A

Cavopulmonary shunting 8.00

NA 2.67 1.19

NA 11.86

ZZZ 33880............. .............. A

Endovasc taa repr incl 33.00

NA 13.51 2.74

NA 49.25

090 subcl. 33881............. .............. A

Endovasc taa repr w/o 28.00

NA 11.99 2.32

NA 42.31

090 subcl. 33883............. .............. A

Insert endovasc

20.00

NA 9.21 2.10

NA 31.31

090 prosth, taa. 33884............. .............. A

Endovasc prosth, taa,

8.20

NA 2.58 0.86

NA 11.64

ZZZ add-on. 33886............. .............. A

Endovasc prosth,

17.00

NA 8.25 1.79

NA 27.04

090 delayed. 33889............. .............. A

Artery transpose/

15.92

NA 5.19 2.17

NA 23.28

000 endovas taa. 33891............. .............. A

Car-car bp grft/

20.00

NA 6.98 2.72

NA 29.70

000 endovas taa. 33925............. .............. A

Rpr pul art unifocal w/ 29.50

NA 14.70 4.60

NA 48.80

090 o cpb. 33926............. .............. A

Repr pul art, unifocal 42.00

NA 17.73 6.20

NA 65.93

090 w/cpb. 36598............. .............. T

Inj w/fluor, eval cv

0.74 2.65 2.65 0.05 3.44 3.44

000 device. 37184............. .............. A

Prim art mech

8.66 71.90 3.36 0.55 81.11 12.57

000 thrombectomy. 37185............. .............. A

Prim art m-thrombect

3.28 22.95 1.11 0.21 26.44 4.60

ZZZ add-on. 37186............. .............. A

Sec art m-thrombect

4.92 49.53 1.66 0.32 54.77 6.90

ZZZ add-on. 37187............. .............. A

Venous mech

8.03 70.38 3.15 0.51 78.92 11.69

000 thrombectomy. 37188............. .............. A

Venous m-thrombectomy

5.71 62.15 2.37 0.37 68.23 8.45

000 add-on. 37718............. .............. A

Ligate/strip short leg 6.76

NA 4.07 0.14

NA 10.97

090 vein. 37722............. .............. A

Ligate/strip long leg

7.79

NA 4.42 0.86

NA 13.07

090 vein. 43770............. .............. A

Lap, place gastr

16.71

NA 7.73 2.18

NA 26.62

090 adjust band. 43771............. .............. A

Lap, revise adjust

19.50

NA 8.61 2.54

NA 30.65

090 gast band. 43772............. .............. A

Lap, remove adjust

15.00

NA 6.44 1.92

NA 23.36

090 gast band. 43773............. .............. A

Lap, change adjust

19.50

NA 8.61 2.55

NA 30.66

090 gast band. 43774............. .............. A

Lap remov adj gast

15.00

NA 6.58 1.84

NA 23.42

090 band/port. 43845............. .............. A

Gastroplasty duodenal 31.00 10.80 10.80 4.05 45.85 45.85

090 switch. 43886............. .............. A

Revise gastric port,

4.00

NA 3.14 0.25

NA 7.39

090 open. 43887............. .............. A

Remove gastric port,

3.95

NA 2.78 0.51

NA 7.24

090 open. 43888............. .............. A

Change gastric port,

5.80

NA 3.77 0.70

NA 10.27

090 open. 44180............. .............. A

Lap, enterolysis...... 14.42

NA 6.25 1.85

NA 22.52

090 44186............. .............. A

Lap, jejunostomy...... 9.77

NA 4.80 1.27

NA 15.84

090 44187............. .............. A

Lap, ileo/jejuno-stomy 15.93

NA 8.29 1.95

NA 26.17

090 44188............. .............. A

Lap, colostomy........ 17.61

NA 8.87 2.23

NA 28.71

090

[[Continued on page 70465]]

From the Federal Register Online via GPO Access [wais.access.gpo.gov] ]

[[pp. 70465-70476]] 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

[[Continued from page 70464]]

[[Page 70465]]

44213............. .............. A

Lap, mobil splenic fl

3.50

NA 1.22 0.44

NA 5.16

ZZZ add-on. 44227............. .............. A

Lap, close enterostomy 26.50

NA 10.65 3.37

NA 40.52

090 45395............. .............. A

Lap, removal of rectum 30.50

NA 13.71 3.62

NA 47.83

090 45397............. .............. A

Lap, remove rectum w/ 34.00

NA 14.30 3.66

NA 51.96

090 pouch. 45400............. .............. A

Laparoscopic

18.06

NA 7.85 2.02

NA 27.93

090 proctopexy. 45402............. .............. A

Lap proctopexy w/sig

25.04

NA 10.01 2.81

NA 37.86

090 resect. 45499............. .............. C

Laparoscope proc,

0.00 0.00 0.00 0.00 0.00 0.00

YYY rectum. 45990............. .............. A

Surg dx exam,

1.80

NA 0.79 0.17

NA 2.76

000 anorectal. 46505............. .............. A

Chemodenervation anal

2.86 3.05 1.97 0.14 6.05 4.97

010 musc. 46710............. .............. A

Repr per/vag pouch

16.00

NA 7.77 1.38

NA 25.15

090 sngl proc. 46712............. .............. A

Repr per/vag pouch dbl 34.00

NA 15.08 3.66

NA 52.74

090 proc. 50250............. .............. A

Cryoablate renal mass 19.97

NA 9.18 1.39

NA 30.54

090 open. 50382............. .............. A

Change ureter stent,

5.50 36.22 1.87 0.34 42.06 7.71

000 percut. 50384............. .............. A

Remove ureter stent,

5.00 35.32 1.71 0.31 40.63 7.02

000 percut. 50387............. .............. A

Change ext/int ureter

2.00 18.26 0.67 0.12 20.38 2.79

000 stent. 50389............. .............. A

Remove renal tube w/

1.10 12.78 0.37 0.07 13.95 1.54

000 fluoro. 50592............. .............. A

Perc rf ablate renal

6.75 149.45 2.99 0.43 156.63 10.17

010 tumor. 51999............. .............. C

Laparoscope proc,

0.00 0.00 0.00 0.00 0.00 0.00

YYY bladder. 57295............. .............. A

Change vaginal graft.. 7.45

NA 4.44 0.91

NA 12.80

090 58110............. .............. A

Bx done w/colposcopy

0.77 0.55 0.31 0.09 1.41 1.17

ZZZ add-on. 61630............. .............. N

Intracranial

0.00 0.00 0.00 0.00 0.00 0.00

090 angioplasty. 61635............. .............. N

Intracran angioplsty w/ 0.00 0.00 0.00 0.00 0.00 0.00

090 stent. 61640............. .............. N

Dilate ic vasospasm,

0.00 0.00 0.00 0.00 0.00 0.00

000 init. 61641............. .............. N

Dilate ic vasospasm

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ add-on. 61642............. .............. N

Dilate ic vasospasm

0.00 0.00 0.00 0.00 0.00 0.00

ZZZ add-on. 64650............. .............. A

Chemodenerv eccrine

0.70 0.87 0.30 0.06 1.63 1.06

000 glands. 64653............. .............. A

Chemodenerv eccrine

0.88 0.92 0.38 0.08 1.88 1.34

000 glands. 67901............. .............. A

Repair eyelid defect.. 7.39

NA 5.42 0.54

NA 13.35

090 67902............. .............. A

Repair eyelid defect.. 9.35

NA 5.48 0.60

NA 15.43

090 75956............. 26............ A

Xray, endovasc thor ao 7.00 2.71 2.71 0.69 10.40 10.40

XXX repr. 75957............. 26............ A

Xray, endovasc thor ao 6.00 2.32 2.32 0.59 8.91 8.91

XXX repr. 75958............. 26............ A

Xray, place prox ext

4.00 1.55 1.55 0.39 5.94 5.94

XXX thor ao. 75959............. 26............ A

Xray, place dist ext

3.50 1.36 1.36 0.34 5.20 5.20

XXX thor ao. 76376............. 26............ A

3d render w/o

0.20 0.07 0.07 0.02 0.29 0.29

XXX postprocess. 76377............. 26............ A

3d rendering w/

0.79 0.27 0.27 0.08 1.14 1.14

XXX postprocess. 77421............. 26............ A

Stereoscopic x-ray

0.39 0.13 0.13 0.02 0.54 0.54

XXX guidance. 77422............. .............. A

Neutron beam tx,

0.00 1.71

NA 0.13 1.84

NA

XXX simple. 77423............. .............. A

Neutron beam tx,

0.00 2.26

NA 0.13 2.39

NA

XXX complex. 88333............. 26............ A

Intraop cyto path

1.20 0.53 0.53 0.04 1.77 1.77

XXX consult, 1. 88334............. 26............ A

Intraop cyto path

0.59 0.26 0.26 0.02 0.87 0.87

XXX consult, 2. 88384............. 26............ C

Eval molecular probes, 0.00 0.00 0.00 0.00 0.00 0.00

XXX 11-50. 88385............. 26............ A

Eval molecul probes,

1.50 0.65 0.65 0.06 2.21 2.21

XXX 51-250. 88386............. 26............ A

Eval molecul probes,

1.88 0.82 0.82 0.08 2.78 2.78

XXX 251-500. 89049............. .............. A

Chct for mal

1.40 3.56 0.27 0.06 5.02 1.73

XXX hyperthermia. 90760............. .............. A

Hydration iv infusion, 0.17 1.43 1.43 0.07 1.67 1.67

XXX init. 90761............. .............. A

Hydrate iv infusion,

0.09 0.40 0.40 0.04 0.53 0.53

ZZZ add-on. 90765............. .............. A

Ther/proph/diag iv

0.21 1.76 1.76 0.07 2.04 2.04

XXX inf, init. 90766............. .............. A

Ther/proph/dg iv inf,

0.18 0.46 0.46 0.04 0.68 0.68

ZZZ add-on. 90767............. .............. A

Tx/proph/dg addl seq

0.19 0.89 0.89 0.04 1.12 1.12

ZZZ iv inf. 90768............. .............. A

Ther/diag concurrent

0.17 0.44 0.44 0.04 0.65 0.65

ZZZ inf. 90772............. .............. A

Ther/proph/diag inj,

0.17 0.31 0.31 0.01 0.49 0.49

XXX sc/im. 90773............. .............. A

Ther/proph/diag inj,

0.17 0.32 0.32 0.02 0.51 0.51

XXX ia. 90774............. .............. A

Ther/proph/diag inj,

0.18 1.30 1.30 0.04 1.52 1.52

XXX iv push. 90775............. .............. A

Ther/proph/diag inj

0.10 0.57 0.57 0.04 0.71 0.71

ZZZ add-on. 90779............. .............. C

Ther/prop/diag inj/inf 0.00 0.00 0.00 0.00 0.00 0.00

XXX proc. 91022............. 26............ A

Duodenal motility

1.44 0.51 0.51 0.07 2.02 2.02

000 study. 92520............. .............. A

Laryngeal function

0.75 0.51 0.39 0.03 1.29 1.17

XXX studies. 92626............. .............. A

Eval aud rehab status. 0.00 0.55

NA 0.06 0.61

NA

XXX 92627............. .............. A

Eval aud status rehab

0.00 0.55

NA 0.06 0.61

NA

XXX add-on. 92630............. .............. I

Aud rehab pre-ling

0.00 0.00 0.00 0.00 0.00 0.00

XXX hear loss. 92633............. .............. I

Aud rehab postling

0.00 0.00 0.00 0.00 0.00 0.00

XXX hear loss. 95251............. .............. A

Gluc monitor, cont,

0.52 0.19 0.19 0.02 0.73 0.73

XXX phys i&r. 95865............. 26............ A

Muscle test, larynx... 1.57 0.77 0.77 0.08 2.42 2.42

XXX 95866............. 26............ A

Muscle test,

1.25 0.56 0.56 0.07 1.88 1.88

XXX hemidiaphragm. 95873............. 26............ A

Guide nerv destr, elec 0.37 0.16 0.16 0.02 0.55 0.55

ZZZ stim. 95874............. 26............ A

Guide nerv destr,

0.37 0.17 0.17 0.02 0.56 0.56

ZZZ needle emg. 96101............. .............. A

Psycho testing by

1.86 0.65 0.63 0.05 2.56 2.54

XXX psych/phys. 96102............. .............. A

Psycho testing by

0.50 0.66 0.17 0.01 1.17 0.68

XXX technician. 96103............. .............. A

Psycho testing admin

0.51 0.21 0.17 0.02 0.74 0.70

XXX by comp. 96116............. .............. A

Neurobehavioral status 1.86 0.83 0.64 0.18 2.87 2.68

XXX exam. 96118............. .............. A

Neuropsych tst by

1.86 1.39 0.63 0.18 3.43 2.67

XXX psych/phys. 96119............. .............. A

Neuropsych testing by

0.55 1.02 0.19 0.18 1.75 0.92

XXX tech. 96120............. .............. A

Neuropsych tst admin w/ 0.51 0.74 0.17 0.02 1.27 0.70

XXX comp. 96401............. .............. A

Chemo, anti-neopl, sq/ 0.21 1.53 1.53 0.01 1.75 1.75

XXX im. 96402............. .............. A

Chemo hormon antineopl 0.19 0.74 0.74 0.01 0.94 0.94

XXX sq/im.

[[Page 70466]]

96409............. .............. A

Chemo, iv push, sngl

0.24 2.93 2.93 0.06 3.23 3.23

XXX drug. 96411............. .............. A

Chemo, iv push, addl

0.20 1.61 1.61 0.06 1.87 1.87

ZZZ drug. 96413............. .............. A

Chemo, iv infusion, 1

0.28 4.20 4.20 0.08 4.56 4.56

XXX hr. 96415............. .............. A

Chemo, iv infusion,

0.19 0.77 0.77 0.07 1.03 1.03

ZZZ addl hr. 96416............. .............. A

Chemo prolong infuse w/ 0.21 4.61 4.61 0.08 4.90 4.90

XXX pump. 96417............. .............. A

Chemo iv infus each

0.21 1.95 1.95 0.07 2.23 2.23

ZZZ addl seq. 96450............. .............. A

Chemotherapy, into CNS 1.53 6.96 1.29 0.09 8.58 2.91

000 96521............. .............. A

Refill/maint, portable 0.21 3.77 3.77 0.06 4.04 4.04

XXX pump. 96522............. .............. A

Refill/maint pump/

0.21 2.65 2.65 0.06 2.92 2.92

XXX resvr syst. 96523............. .............. T

Irrig drug delivery

0.04 0.69 0.69 0.01 0.74 0.74

XXX device. 96542............. .............. A

Chemotherapy injection 0.75 4.24 0.66 0.07 5.06 1.48

XXX 97760............. .............. A

Orthotic mgmt and

0.45 0.34 0.20 0.03 0.82 0.68

XXX training. 97761............. .............. A

Prosthetic training... 0.45 0.28 0.19 0.02 0.75 0.66

XXX 97762............. .............. A

C/o for orthotic/

0.25 0.42 0.19 0.02 0.69 0.46

XXX prosth use. 98960............. .............. N

Self-mgmt educ &

0.00 0.00 0.00 0.00 0.00 0.00

XXX train, 1 pt. 98961............. .............. N

Self-mgmt educ/train,

0.00 0.00 0.00 0.00 0.00 0.00

XXX 2-4 pt. 98962............. .............. N

Self-mgmt educ/train,

0.00 0.00 0.00 0.00 0.00 0.00

XXX 5-8 pt. 99143............. .............. C

Mod cs by same phys, 20cm 97602................................. Wound(s) care nonselective 97605................................. Neg press wound tx, 50 cm 97750................................. Physical performance test 97755................................. Assistive technology assess 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: ............................. 0028T................................. Dexa body composition study 0042T................................. Ct perfusion w/contrast, cbf 0067T................................. Ct colonography;dx 51798................................. Us urine capacity measure 70100................................. X-ray exam of jaw 70110................................. X-ray exam of jaw 70120................................. X-ray exam of mastoids 70130................................. X-ray exam of mastoids 70134................................. X-ray exam of middle ear 70140................................. X-ray exam of facial bones 70150................................. X-ray exam of facial bones 70160................................. X-ray exam of nasal bones 70190................................. X-ray exam of eye sockets 70200................................. X-ray exam of eye sockets 70210................................. X-ray exam of sinuses 70220................................. X-ray exam of sinuses 70240................................. X-ray exam, pituitary saddle 70250................................. X-ray exam of skull 70260................................. X-ray exam of skull 70300................................. X-ray exam of teeth 70310................................. X-ray exam of teeth 70320................................. Full mouth x-ray of teeth 70328................................. X-ray exam of jaw joint 70330................................. X-ray exam of jaw joints 70336................................. Magnetic image, jaw joint 70350................................. X-ray head for orthodontia 70355................................. Panoramic x-ray of jaws 70360................................. X-ray exam of neck 70370................................. Throat x-ray & fluoroscopy 70371................................. Speech evaluation, complex 70380................................. X-ray exam of salivary gland 70450................................. Ct head/brain w/o dye 70460................................. Ct head/brain w/dye 70470................................. Ct head/brain w/o & w/dye 70480................................. Ct orbit/ear/fossa w/o dye 70481................................. Ct orbit/ear/fossa w/dye 70482................................. Ct orbit/ear/fossa w/o&w/dye 70486................................. Ct maxillofacial w/o dye 70487................................. Ct maxillofacial w/dye 70488................................. Ct maxillofacial w/o & w/dye 70490................................. Ct soft tissue neck w/o dye 70491................................. Ct soft tissue neck w/dye 70492................................. Ct sft tsue nck w/o & w/dye 70496................................. Ct angiography, head 70498................................. Ct angiography, neck 70540................................. Mri orbit/face/neck w/o dye 70542................................. Mri orbit/face/neck w/dye 70543................................. Mri orbt/fac/nck w/o & w/dye 70544................................. Mr angiography head w/o dye 70545................................. Mr angiography head w/dye 70546................................. Mr angiograph head w/o&w/dye 70547................................. Mr angiography neck w/o dye 70548................................. Mr angiography neck w/dye 70549................................. Mr angiograph neck w/o&w/dye 70551................................. Mri brain w/o dye 70552................................. Mri brain w/dye 70553................................. Mri brain w/o & w/dye 71010................................. Chest x-ray 71015................................. Chest x-ray 71020................................. Chest x-ray 71021................................. Chest x-ray 71022................................. Chest x-ray

[[Page 70473]]

71023................................. Chest x-ray and fluoroscopy 71030................................. Chest x-ray 71034................................. Chest x-ray and fluoroscopy 71035................................. Chest x-ray 71100................................. X-ray exam of ribs 71101................................. X-ray exam of ribs/chest 71110................................. X-ray exam of ribs 71111................................. X-ray exam of ribs/chest 71120................................. X-ray exam of breastbone 71130................................. X-ray exam of breastbone 71250................................. Ct thorax w/o dye 71260................................. Ct thorax w/dye 71270................................. Ct thorax w/o & w/dye 71275................................. Ct angiography, chest 71550................................. Mri chest w/o dye 71551................................. Mri chest w/dye 71552................................. Mri chest w/o & w/dye 71555................................. Mri angio chest w or w/o dye 72010................................. X-ray exam of spine 72020................................. X-ray exam of spine 72040................................. X-ray exam of neck spine 72050................................. X-ray exam of neck spine 72052................................. X-ray exam of neck spine 72069................................. X-ray exam of trunk spine 72070................................. X-ray exam of thoracic spine 72072................................. X-ray exam of thoracic spine 72074................................. X-ray exam of thoracic spine 72080................................. X-ray exam of trunk spine 72090................................. X-ray exam of trunk spine 72100................................. X-ray exam of lower spine 72110................................. X-ray exam of lower spine 72114................................. X-ray exam of lower spine 72120................................. X-ray exam of lower spine 72125................................. Ct neck spine w/o dye 72126................................. Ct neck spine w/dye 72127................................. Ct neck spine w/o & w/dye 72128................................. Ct chest spine w/o dye 72129................................. Ct chest spine w/dye 72130................................. Ct chest spine w/o & w/dye 72131................................. Ct lumbar spine w/o dye 72132................................. Ct lumbar spine w/dye 72133................................. Ct lumbar spine w/o & w/dye 72141................................. Mri neck spine w/o dye 72142................................. Mri neck spine w/dye 72146................................. Mri chest spine w/o dye 72147................................. Mri chest spine w/dye 72148................................. Mri lumbar spine w/o dye 72149................................. Mri lumbar spine w/dye 72156................................. Mri neck spine w/o & w/dye 72157................................. Mri chest spine w/o & w/dye 72158................................. Mri lumbar spine w/o & w/dye 72170................................. X-ray exam of pelvis 72190................................. X-ray exam of pelvis 72191................................. Ct angiograph pelv w/o&w/dye 72192................................. Ct pelvis w/o dye 72193................................. Ct pelvis w/dye 72194................................. Ct pelvis w/o & w/dye 72195................................. Mri pelvis w/o dye 72196................................. Mri pelvis w/dye 72197................................. Mri pelvis w/o & w/dye 72198................................. Mr angio pelvis w/o & w/dye 72200................................. X-ray exam sacroiliac joints 72202................................. X-ray exam sacroiliac joints 72220................................. X-ray exam of tailbone 73000................................. X-ray exam of collar bone 73010................................. X-ray exam of shoulder blade 73020................................. X-ray exam of shoulder 73030................................. X-ray exam of shoulder 73050................................. X-ray exam of shoulders 73060................................. X-ray exam of humerus 73070................................. X-ray exam of elbow 73080................................. X-ray exam of elbow 73090................................. X-ray exam of forearm 73092................................. X-ray exam of arm, infant 73100................................. X-ray exam of wrist 73110................................. X-ray exam of wrist 73120................................. X-ray exam of hand 73130................................. X-ray exam of hand 73140................................. X-ray exam of finger(s) 73200................................. Ct upper extremity w/o dye 73201................................. Ct upper extremity w/dye 73202................................. Ct uppr extremity w/o&w/dye 73206................................. Ct angio upr extrm w/o&w/dye 73218................................. Mri upper extremity w/o dye 73219................................. Mri upper extremity w/dye 73220................................. Mri uppr extremity w/o&w/dye 73221................................. Mri joint upr extrem w/o dye 73222................................. Mri joint upr extrem w/dye 73223................................. Mri joint upr extr w/o&w/dye 73500................................. X-ray exam of hip 73510................................. X-ray exam of hip 73520................................. X-ray exam of hips 73540................................. X-ray exam of pelvis & hips 73550................................. X-ray exam of thigh 73560................................. X-ray exam of knee, 1 or 2 73562................................. X-ray exam of knee, 3 73564................................. X-ray exam, knee, 4 or more 73565................................. X-ray exam of knees 73590................................. X-ray exam of lower leg 73592................................. X-ray exam of leg, infant 73600................................. X-ray exam of ankle 73610................................. X-ray exam of ankle 73620................................. X-ray exam of foot 73630................................. X-ray exam of foot 73650................................. X-ray exam of heel 73660................................. X-ray exam of toe(s) 73700................................. Ct lower extremity w/o dye 73701................................. Ct lower extremity w/dye 73702................................. Ct lwr extremity w/o&w/dye 73706................................. Ct angio lwr extr w/o&w/dye 73718................................. Mri lower extremity w/o dye 73719................................. Mri lower extremity w/dye 73720................................. Mri lwr extremity w/o&w/dye 73721................................. Mri jnt of lwr extre w/o dye 73722................................. Mri joint of lwr extr w/dye 73723................................. Mri joint lwr extr w/o&w/dye 73725................................. Mr ang lwr ext w or w/o dye 74000................................. X-ray exam of abdomen 74010................................. X-ray exam of abdomen 74020................................. X-ray exam of abdomen 74022................................. X-ray exam series, abdomen 74150................................. Ct abdomen w/o dye 74160................................. Ct abdomen w/dye 74170................................. Ct abdomen w/o & w/dye 74175................................. Ct angio abdom w/o & w/dye 74181................................. Mri abdomen w/o dye 74182................................. Mri abdomen w/dye 74183................................. Mri abdomen w/o & w/dye 74185................................. Mri angio, abdom w orw/o dye 74210................................. Contrst x-ray exam of throat 74220................................. Contrast x-ray, esophagus 74230................................. Cine/vid x-ray, throat/esoph 74240................................. X-ray exam, upper gi tract 74241................................. X-ray exam, upper gi tract 74245................................. X-ray exam, upper gi tract 74246................................. Contrst x-ray uppr gi tract 74247................................. Contrst x-ray uppr gi tract 74249................................. Contrst x-ray uppr gi tract 74250................................. X-ray exam of small bowel 74290................................. Contrast x-ray, gallbladder 74291................................. Contrast x-rays, gallbladder 74710................................. X-ray measurement of pelvis 75552................................. Heart mri for morph w/o dye 75553................................. Heart mri for morph w/dye 75554................................. Cardiac MRI/function 75555................................. Cardiac MRI/limited study 75635................................. Ct angio abdominal arteries 76000................................. Fluoroscope examination 76006................................. X-ray stress view 76010................................. X-ray, nose to rectum 76020................................. X-rays for bone age 76040................................. X-rays, bone evaluation 76061................................. X-rays, bone survey 76062................................. X-rays, bone survey 76065................................. X-rays, bone evaluation 76066................................. Joint survey, single view 76070................................. Ct bone density, axial 76071................................. Ct bone density, peripheral 76075................................. Dxa bone density, axial 76076................................. Dxa bone density/peripheral 76077................................. Dxa bone density/v-fracture 76078................................. Radiographic absorptiometry 76082................................. Computer mammogram add-on 76083................................. Computer mammogram add-on 76090................................. Mammogram, one breast 76091................................. Mammogram, both breasts 76092................................. Mammogram, screening 76093................................. Magnetic image, breast 76094................................. Magnetic image, both breasts 76100................................. X-ray exam of body section 76101................................. Complex body section x-ray 76102................................. Complex body section x-rays 76120................................. Cine/video x-rays 76125................................. Cine/video x-rays add-on 76150................................. X-ray exam, dry process 76370................................. Ct scan for therapy guide 76376................................. 3d render w/o postprocess 76377................................. 3d rendering w/postprocess 76380................................. CAT scan follow-up study 76400................................. Magnetic image, bone marrow 76499................................. Radiographic procedure 76506................................. Echo exam of head 76510................................. Ophth us, b & quant a 76511................................. Ophth us, quant a only 76512................................. Ophth us, b w/non-quant a 76513................................. Echo exam of eye, water bath 76514................................. Echo exam of eye, thickness 76516................................. Echo exam of eye 76519................................. Echo exam of eye 76536................................. Us exam of head and neck 76604................................. Us exam, chest, b-scan 76645................................. Us exam, breast(s) 76700................................. Us exam, abdom, complete 76705................................. Echo exam of abdomen 76770................................. Us exam abdo back wall, comp 76775................................. Us exam abdo back wall, lim 76778................................. Us exam kidney transplant 76800................................. Us exam, spinal canal 76801................................. Ob us /= 14 wks, sngl fetus 76810................................. Ob us >/= 14 wks, addl fetus 76811................................. Ob us, detailed, sngl fetus 76812................................. Ob us, detailed, addl fetus 76815................................. Ob us, limited, fetus(s) 76816................................. Ob us, follow-up, per fetus 76818................................. Fetal biophys profile w/nst 76819................................. Fetal biophys profil w/o nst 76820................................. Umbilical artery echo 76821................................. Middle cerebral artery echo 76825................................. Echo exam of fetal heart 76826................................. Echo exam of fetal heart 76827................................. Echo exam of fetal heart 76828................................. Echo exam of fetal heart 76856................................. Us exam, pelvic, complete 76857................................. Us exam, pelvic, limited

[[Page 70474]]

76870................................. Us exam, scrotum 76880................................. Us exam, extremity 76885................................. Us exam infant hips, dynamic 76886................................. Us exam infant hips, static 76970................................. Ultrasound exam follow-up 76977................................. Us bone density measure 76999................................. Echo examination procedure 78000*................................ Thyroid, single uptake 78001*................................ Thyroid, multiple uptakes 78003*................................ Thyroid suppress/stimul 78006*................................ Thyroid imaging with uptake 78007*................................ Thyroid image, mult uptakes 78010*................................ Thyroid imaging 78011*................................ Thyroid imaging with flow 78015*................................ Thyroid met imaging 78016*................................ Thyroid met imaging/studies 78018*................................ Thyroid met imaging, body 78020*................................ Thyroid met uptake 78070*................................ Parathyroid nuclear imaging 78075*................................ Adrenal nuclear imaging 78099*................................ Endocrine nuclear procedure 78102*................................ Bone marrow imaging, ltd 78103*................................ Bone marrow imaging, mult 78104*................................ Bone marrow imaging, body 78110*................................ Plasma volume, single 78111*................................ Plasma volume, multiple 78120*................................ Red cell mass, single 78121*................................ Red cell mass, multiple 78122*................................ Blood volume 78130*................................ Red cell survival study 78135*................................ Red cell survival kinetics 78140*................................ Red cell sequestration 78185*................................ Spleen imaging 78190*................................ Platelet survival, kinetics 78191*................................ Platelet survival 78195*................................ Lymph system imaging 78199*................................ Blood/lymph nuclear exam 78201*................................ Liver imaging 78202*................................ Liver imaging with flow 78205*................................ Liver imaging (3D) 78206*................................ Liver image (3d) with flow 78215*................................ Liver and spleen imaging 78216*................................ Liver & spleen image/flow 78220*................................ Liver function study 78223*................................ Hepatobiliary imaging 78230*................................ Salivary gland imaging 78231*................................ Serial salivary imaging 78232*................................ Salivary gland function exam 78258*................................ Esophageal motility study 78261*................................ Gastric mucosa imaging 78262*................................ Gastroesophageal reflux exam 78264*................................ Gastric emptying study 78270*................................ Vit B-12 absorption exam 78271*................................ Vit B-12 absrp exam, int fac 78272*................................ Vit B-12 absorp, combined 78278*................................ Acute GI blood loss imaging 78282*................................ GI protein loss exam 78290*................................ Meckel's divert exam 78291*................................ Leveen/shunt patency exam 78299*................................ GI nuclear procedure 78300*................................ Bone imaging, limited area 78305*................................ Bone imaging, multiple areas 78306*................................ Bone imaging, whole body 78315*................................ Bone imaging, 3 phase 78320*................................ Bone imaging (3D) 78350................................. Bone mineral, single photon 78399*................................ Musculoskeletal nuclear exam 78414*................................ Non-imaging heart function 78428*................................ Cardiac shunt imaging 78445*................................ Vascular flow imaging 78456*................................ Acute venous thrombus image 78457*................................ Venous thrombosis imaging 78458*................................ Ven thrombosis images, bilat 78459*................................ Heart muscle imaging (PET) 78460*................................ Heart muscle blood, single 78461*................................ Heart muscle blood, multiple 78464*................................ Heart image (3d), single 78465*................................ Heart image (3d), multiple 78466*................................ Heart infarct image 78468*................................ Heart infarct image (ef) 78469*................................ Heart infarct image (3D) 78472*................................ Gated heart, planar, single 78473*................................ Gated heart, multiple 78478*................................ Heart wall motion add-on 78480*................................ Heart function add-on 78481*................................ Heart first pass, single 78483*................................ Heart first pass, multiple 78491*................................ Heart image (pet), single 78492*................................ Heart image (pet), multiple 78494*................................ Heart image, spect 78496*................................ Heart first pass add-on 78499*................................ Cardiovascular nuclear exam 78580*................................ Lung perfusion imaging 78584*................................ Lung V/Q image single breath 78585*................................ Lung V/Q imaging 78586*................................ Aerosol lung image, single 78587*................................ Aerosol lung image, multiple 78588*................................ Perfusion lung image 78591*................................ Vent image, 1 breath, 1 proj 78593*................................ Vent image, 1 proj, gas 78594*................................ Vent image, mult proj, gas 78596*................................ Lung differential function 78599*................................ Respiratory nuclear exam 78600*................................ Brain imaging, ltd static 78601*................................ Brain imaging, ltd w/flow 78605*................................ Brain imaging, complete 78606*................................ Brain imaging, compl w/flow 78607*................................ Brain imaging (3D) 78608*................................ Brain imaging (PET) 78609*................................ Brain imaging (PET) 78610*................................ Brain flow imaging only 78615*................................ Cerebral vascular flow image 78630*................................ Cerebrospinal fluid scan 78635*................................ CSF ventriculography 78645*................................ CSF shunt evaluation 78647*................................ Cerebrospinal fluid scan 78650*................................ CSF leakage imaging 78660*................................ Nuclear exam of tear flow 78699*................................ Nervous system nuclear exam 78700*................................ Kidney imaging, static 78701*................................ Kidney imaging with flow 78704*................................ Imaging renogram 78707*................................ Kidney flow/function image 78708*................................ Kidney flow/function image 78709*................................ Kidney flow/function image 78710*................................ Kidney imaging (3D) 78715*................................ Renal vascular flow exam 78725*................................ Kidney function study 78730*................................ Urinary bladder retention 78740*................................ Ureteral reflux study 78760*................................ Testicular imaging 78761*................................ Testicular imaging/flow 78799*................................ Genitourinary nuclear exam 78800*................................ Tumor imaging, limited area 78801*................................ Tumor imaging, mult areas 78802*................................ Tumor imaging, whole body 78803*................................ Tumor imaging (3D) 78804*................................ Tumor imaging, whole body 78805*................................ Abscess imaging, ltd area 78806*................................ Abscess imaging, whole body 78807*................................ Nuclear localization/abscess 78811*................................ Tumor imaging (pet), limited 78812*................................ Tumor image (pet)/skul-thigh 78813*................................ Tumor image (pet) full body 78814*................................ Tumor image pet/ct, limited 78815*................................ Tumor image pet/ct skul-thigh 78816*................................ Tumor image pet/ct full body 78890*................................ Nuclear medicine data proc 78891*................................ Nuclear med data proc 78999*................................ Nuclear diagnostic exam 91110................................. Gi tract capsule endoscopy 93303................................. Echo transthoracic 93304................................. Echo transthoracic 93307................................. Echo exam of heart 93308................................. Echo exam of heart 93320................................. Doppler echo exam, heart [if used in conjunction with 93303- 93308] 93321................................. Doppler echo exam, heart [if used in conjunction with 93303- 93308] 93325................................. Doppler color flow add-on [if used in conjunction with 93303- 93308] 93875................................. Extracranial study 93880................................. Extracranial study 93882................................. Extracranial study 93886................................. Intracranial study 93888................................. Intracranial study 93890................................. Tcd, vasoreactivity study 93892................................. Tcd, emboli detect w/o inj 93922................................. Extremity study 93923................................. Extremity study 93924................................. Extremity study 93925................................. Lower extremity study 93926................................. Lower extremity study 93930................................. Upper extremity study 93931................................. Upper extremity study 93965................................. Extremity study 93970................................. Extremity study 93971................................. Extremity study 93975................................. Vascular study 93976................................. Vascular study 93978................................. Vascular study 93979................................. Vascular study 93980................................. Penile vascular study 93981................................. Penile vascular study 93990................................. Doppler flow testing A4641*................................ Diagnostic imaging agent A4642*................................ Satumomab pendetide per dose A9500*................................ Technetium TC 99m sestamibi A9502*................................ Technetium TC99M tetrofosmin A9503*................................ Technetium TC 99m medronate A9504*................................ Technetium tc 99m apcitide A9505*................................ Thallous chloride TL 201/mci A9507*................................ Indium/111 capromab pendetid A9508*................................ Iobenguane sulfate I-131 A9510*................................ Technetium TC99m Disofenin A9511*................................ Technetium TC 99m depreotide A9512*................................ Technetiumtc99mpertechnetate A9513*................................ Technetium tc-99m mebrofenin A9514*................................ Technetiumtc99m pyrophosphate A9515*................................ Technetium tc-99m pentetate A9516*................................ I-123 sodium iodide capsule A9519*................................ Technetiumtc-99mmacroag albu A9520*................................ Technetiumtc-99m sulfur clld A9521*................................ Technetiumtc-99m exametazine A9522*................................ Indium111ibritumomabtiuxetan A9524*................................ Iodinated I-131 serumalbumin A9526*................................ Ammonia N-13, per dose A9528*................................ Dx I131 so iodide cap millic A9529*................................ Dx I131 so iodide sol millic A9531*................................ Dx I131 so iodide microcurie

[[Page 70475]]

A9533*................................ I-131 tositumomab diagnostic A9700*................................ Echocardiography contrast G0130................................. Single energy x-ray study G0202................................. Screeningmammographydigital G0204................................. Diagnosticmammographydigital G0206................................. Diagnosticmammographydigital G0288................................. Recon, CTA for surg plan Q0092................................. Set up port xray equipment Q3000*................................ Rubidium RB-82 Q3002*................................ Gallium ga 67 Q3003*................................ Technetium tc99m bicisate Q3004*................................ Xenon xe 133 Q3005*................................ Technetium tc99m mertiatide Q3006*................................ Technetium tc99m glucepatate Q3007*................................ Sodium phosphate p32 Q3008*................................ Indium 111-in pentetreotide Q3009*................................ Technetium tc99m oxidronate Q3010*................................ Technetium tc99mlabeledrbcs Q3011*................................ Chromic phosphate p32 Q3012*................................ Cyanocobalamin cobalt co57 Q9945*................................ 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 CPT and HCPCS codes: ............................. 0073T................................. Delivery, comp imrt 0082T................................. Stereotactic rad delivery 0083T................................. Stereotactic rad tx mngmt 19296................................. Place po breast cath for rad 19297................................. Place breast cath for rad 19298................................. Place breast rad tube/caths 31643................................. Diag bronchoscope/catheter 55859................................. Percut/needle insert, pros 57155................................. Insert uteri tandems/ovoids 58346................................. Insert heyman uteri capsule 61770................................. Incise skull for treatment 61793................................. Focus radiation beam 77261................................. Radiation therapy planning 77262................................. Radiation therapy planning 77263................................. Radiation therapy planning 77280................................. Set radiation therapy field 77285................................. Set radiation therapy field 77290................................. Set radiation therapy field 77295................................. Set radiation therapy field 77299................................. Radiation therapy planning 77300................................. Radiation therapy dose plan 77301................................. Radiotherapy dose plan, imrt 77305................................. Teletx isodose plan simple 77310................................. Teletx isodose plan intermed 77315................................. Teletx isodose plan complex 77321................................. Special teletx port plan 77326................................. Brachytx isodose calc simp 77327................................. Brachytx isodose calc interm 77328................................. Brachytx isodose plan compl 77331................................. Special radiation dosimetry 77332................................. Radiation treatment aid(s) 77333................................. Radiation treatment aid(s) 77334................................. Radiation treatment aid(s) 77336................................. Radiation physics consult 77370................................. Radiation physics consult 77399................................. External radiation dosimetry 77401................................. Radiation treatment delivery 77402................................. Radiation treatment delivery 77403................................. Radiation treatment delivery 77404................................. Radiation treatment delivery 77406................................. Radiation treatment delivery 77407................................. Radiation treatment delivery 77408................................. Radiation treatment delivery 77409................................. Radiation treatment delivery 77411................................. Radiation treatment delivery 77412................................. Radiation treatment delivery 77413................................. Radiation treatment delivery 77414................................. Radiation treatment delivery 77416................................. Radiation treatment delivery 77417................................. Radiology port film(s) 77418................................. Radiation tx delivery, imrt 77421................................. Stereoscopic x-ray guidance 77422................................. Neutron beam tx, single 77423................................. Neutron beam tx, complex 77427................................. Radiation tx management, x5 77431................................. Radiation therapy management 77432................................. Stereotactic radiation trmt 77470................................. Special radiation treatment 77499................................. Radiation therapy management 77520................................. Proton trmt, simple w/o comp 77522................................. Proton trmt, simple w/comp 77523................................. Proton trmt, intermediate 77525................................. Proton treatment, complex 77600................................. Hyperthermia treatment 77605................................. Hyperthermia treatment 77610................................. Hyperthermia treatment 77615................................. Hyperthermia treatment 77620................................. Hyperthermia treatment 77750................................. Infuse radioactive materials 77761................................. Apply intrcav radiat simple 77762................................. Apply intrcav radiat interm 77763................................. Apply intrcav radiat compl 77776................................. Apply interstit radiat simpl 77777................................. Apply interstit radiat inter 77778................................. Apply interstit radiat compl 77781................................. High intensity brachytherapy 77782................................. High intensity brachytherapy 77783................................. High intensity brachytherapy 77784................................. High intensity brachytherapy 77789................................. Apply surface radiation 77790................................. Radiation handling 77799................................. Radium/radioisotope therapy 79005*................................ Nuclear rx, oral admin 79101*................................ Nuclear rx, iv admin 79200*................................ Nuclear rx, intracav admin 79300*................................ Nuclr rx, interstit colloid 79403*................................ Hematopoietic nuclear tx 79440*................................ Nuclear rx, intra-articular 79445*................................ Nuclear rx, intra-arterial 79999*................................ Nuclear medicine therapy 92974................................. Cath place, cardio brachytx A9517*................................ Th I131 so iodide cap millic A9523*................................ Yttrium90ibritumomabtiuxetan A9530*................................ Th I131 so iodide sol millic A9532*................................ I-125 serum albumin micro A9534*................................ I-131 tositumomab therapeut A9600*................................ Strontium-89 chloride A9605*................................ Samarium sm153 lexidronamm A9699*................................ Noc therapeutic radiopharm G0173................................. Stereo radiosurgery,complete G0243................................. Multisour photon stero treat 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 Sec. 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 Sec. 411.355(h): . 76083................................. Computer mammogram add-on 76092................................. Mammogram, screening 80061................................. Lipid panel [only when billed with one of the following ICD-9- CM 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-9-CM 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-9-CM 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

[[Page 70476]]

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 Sec. 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 http://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

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT