Medicare: Hospital outpatient prospective payment system and 2006 CY payment rates Correction,
[Federal Register: December 23, 2005 (Volume 70, Number 246)]
[Rules and Regulations]
[Page 76176-76196]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr23de05-13]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 419 and 485
[CMS-1501-CN2]
RIN 0938-AN46
Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Correction of final rule with comment period.
SUMMARY: This document corrects technical errors that appeared in the final rule with comment period published in the Federal Register on November 10, 2005 entitled ``Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Final Rule.''
EFFECTIVE DATE: January 1, 2006.
FOR FURTHER INFORMATION CONTACT: Rebecca Kane, (410) 786-0378.
SUPPLEMENTARY INFORMATION:
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Background
In FR Doc. 05-22136 (70 FR 68515), we have identified a number of technical errors that we have described in the ``Summary of Errors'' section and corrected in the ``Correction of Errors'' section below. The provisions in this correction notice are effective as if they had been included in the CY 2006 final rule with comment period. Accordingly, the corrections are effective January 1, 2006.
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Summary of Errors
On November 10, 2005, we published the CY 2006 Hospital Outpatient Prospective Payment System (OPPS) final rule with comment period. Included in that document were several
[[Page 76177]]
technical and typographical errors that we are correcting in section III of this notice.
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Correction of Technical Errors
We are correcting the following technical errors that were included in the CY 2006 OPPS final rule with comment period affecting drug administration code C8596, estimated expenditures, regulation text, hospital coding for sodium hyaluronate products, and Addendum L.
On page 68680, we neglected to remove the first row, referencing HCPCS code C8956, from Table 31 and the accompanying discussion regarding C8956 from the response to the comment included in the third column, third paragraph. We are correcting these errors in this notice.
On page 68726, we referred to the transfer from the Federal government to Medicare providers in billions rather than millions in the accounting table. We are correcting the error in this notice.
On page 68728, we omitted a reference to pass-through devices in the regulation text as stated in the preamble text at 68559. We correct this omission in this notice.
On page 68643 and in Addendum B we erroneously referred to the creation of a code by the National HCPCS Panel, specifically the creation of HCPCS code J7318. This was incorrect as this code was not created by the National HCPCS Panel. Our error was discovered after publication, and we are taking this opportunity to revise Addendum B to reflect the CY 2006 payment for Sodium Hyaluronate products using HCPCS codes J7317 and J7320, as originally included in the CY 2006 OPPS proposed rule.
On pages 68752-68913 we published Addendum B--Payment Status by HCPCS Code and Related Information--CY 2006. We excluded several codes from this table. In section III of this correction notice we correct this error by publishing the omitted codes.
On pages 68964 through 68980, we published Addendum L--Out- Migration Wage Adjustment CY 2006. We excluded several providers from this table. In Section III of this correction notice, we republish Addendum L.
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Other Corrections
We are also correcting typographical, formatting, and other technical errors that were contained in the CY 2006 OPPS final rule with comment period.
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Waiver of Proposed Rulemaking and Delay in Effective Date
We ordinarily publish a notice of proposed rulemaking in the Federal Register to provide a period for public comment before the provisions of a notice such as this takes effect in accordance with section 553(b) of the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). We also ordinarily provide a 30-day delay in the effective date of the provisions of a notice in accordance with section 553(d) of the APA (5 U.S.C. 553(d)). However, we can waive both the notice and comment procedure and the 30-day delay in effective date if the Secretary finds, for good cause, that it is impracticable, unnecessary or contrary to the public interest, and incorporates a statement of the finding and the reasons therefore in the notice.
The policies and payment methodology finalized in the CY 2006 OPPS final rule with comment period have previously been subjected to notice and comment procedures. This correction notice merely provides technical corrections to the CY 2006 OPPS final rule with comment period that was promulgated through notice and comment rulemaking, and does not make substantive changes to the policies or payment methodology that were finalized in the final rule with comment period. For example, this notice corrects typographical errors, makes clarifications to the preamble and regulations text, and revises inaccurate tabular data. Therefore, we find it unnecessary to undertake further notice and comment procedures with respect to this correction notice. We also believe it is in the public interest to waive notice and comment procedures and the 30-day delay in effective date for this notice. This correction notice is intended to ensure that the CY 2006 OPPS final rule with comment period accurately reflects the policies expressed in the final rule, and that the corrected information is made available to the public prior to January 1, 2006, the date on which the final rule becomes effective.
For the reasons stated above, we find that both notice and comment and the 30-day delay in effective date for this correction notice are unnecessary and that it is in the public interest to make this notice effective in conjunction with the final rule to which the corrections apply. Therefore, we find there is good cause to waive notice and comment procedures and the 30-day delay in effective date for this correction notice.
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Correction of Errors
In FR Doc. 05-22136 (70 FR 68515), make the following corrections:
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Corrections to Preamble Text
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On page 68516, in column 3, in the second full paragraph, line 3, the term ``OPPA'' is corrected to read ``OPPS.''
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On page 68517, in column 1, in the 15th paragraph, line 1, the phrase ``(Cost center specific)'' is removed.
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On page 68518, in column 1, in the 11th paragraph, line 2, the phrase ``and0651'' is corrected to read ``and 0651.''
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On page 68537,
a. In column 3, in the first full paragraph, lines 5 to 6, the phrase ``of the proposed rule (76 FR 42690)'' is removed.
b. In column 3, in the first full paragraph, line 6, the word ``contained'' is corrected to read ``contains.''
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On page 68549,
a. In column 2, in the first full paragraph, line 7, the amount ``$246.04'' is corrected to read ``$245.91.''
b. In column 2, in the first full paragraph, line 8, the amount ``$49.21'' is corrected to read ``$49.18.''
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On page 68551, in column 3; in the second full paragraph, line 12, the term ``TEFRA'' is removed.
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On page 68552,
a. In column 1, in the second partial paragraph, line 32, the term ``TEFRA'' is removed.
b. In column 2, in the first partial paragraph carried over from column 1, line 14, the term ``TEFRA'' is removed.
c. In column 2, in the first partial paragraph carried over from column 1, line 15, the line is corrected by inserting the phrase ``paid under the OPPS but not under the IPPS'' between the words ``hospitals'' and ``will.''
d. In column 3, in the first partial paragraph carried over from column 2, line 3, the term ``TEFRA'' is removed.
e. In column 3 in the first partial paragraph carried over from column 2, line 5, the term ``TEFRA'' is corrected to read ``these.''
f. In column 3, in the first partial paragraph carried over from column 2, line 10, the term ``TEFRA'' is corrected to read ``these.''
g. In column 3, in the first partial paragraph carried over from column 2, line 17, the term ``TEFRA'' is removed.
h. In column 3, in the first partial paragraph carried over from column 2, line 18, the line is corrected by inserting the phrase term ``not paid under the IPPS'' between the words ``hospitals'' and ``that''.
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On page 68556, in column 2, in the second full paragraph, in line 20, the
[[Page 76178]]
sentence is corrected by adding the following bolded text ``payments, brachytherapy seeds, and any service''.
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On page 68559,
a. In column 1, below the table footnotes, line 14, following ``biologicals'' the word ``and'' is removed.
b. In column 1, below the table footnotes, line 16 is corrected adding, ``, and brachytherapy seeds.'' after ``payment policy''.
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On page 68561,
a. In column 1, line 7, add a ``,'' after term ``rural hospitals''.
b. In column 1, in the last partial paragraph, line 7, remove the word ``because'' and add ``as'' in its place.
c. In column 2, in the first partial paragraph carried over from column 1, line 11, ``2 percent'' is corrected to read ``-2 percent''.
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On page 68565, column 1, in the fifth full paragraph, line 5, ``2005'' is corrected to read ``2006''.
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On page 68578, column 1, in the last partial paragraph, line 2, the number ``0042'' is corrected to read ``0429.''
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On page 68596, column 2, in the first full paragraph,
a. Line 8, the amount ``$2,662.62'' is corrected to read ``$2,709.14.''
b. Line 12, the amount ``$2,975.50'' is corrected to read ``$3,051.67.''
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On page 68606, in column 1, in the first full paragraph, line 10, the number ``0442'' is corrected to read ``0422.''
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On page 68628,
a. In column 2, in the first partial paragraph carried over from column 1, line 5, the word ``where'' is corrected to read ``when.''
b. In column 2, in the third full paragraph, line 17, the phrase ``November 13, 2000 final rule'' is corrected to read ``November 13, 2000 interim final rule with comment period.''
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On page 68630,
a. In column 1, in the first partial paragraph carried over from page 68629, line 4, the date ``August 3'' is corrected to read ``November 13.''
b. In column 2, in the first full paragraph, line 13, the date ``August 3'' is corrected to read ``November 13.''
c. In column 2, in the first full paragraph, line 13, the line is corrected by inserting ``with comment period'' at the end of the sentence.
d. In column 2, in the first full paragraph, line 33, the date ``August 3'' is corrected to read ``November 13.''
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On page 68637, in Table 22, the footnote is removed from the column one heading.
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On page 68679, in column 1; in the first partial paragraph at the bottom of the page, line 6, the number ``31'' is corrected to read ``30.''
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On page 68680,
a. In column 3, in the third paragraph, line 3, the term ``codes'' is corrected to read ``code.''
b. In column 3, in the third paragraph, lines 3 through 8, the sentence is corrected by removing the phrase ``C8956 (Refilling and maintenance of portable or implantable pump or reservoir for drug delivery for therapy/diagnosis, systemic (e.g., intravenous, intra- arterial)) and.''
c. In Table 31, the table is corrected by removing row 1.
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On page 68717, in column 1, first partial paragraph continued from the previous page, line 24, the line is corrected by inserting the phrase ``brachytherapy seeds,'' after the word ``* * * biologicals,''.
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On page 68719, in column 1, the third partial paragraph, line 9, the sentence is corrected by inserting the phrase ``at least'' between the word ``of'' and the number ``0.2.''
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On page 68720, in column 3, in the second full paragraph, line 30, the number ``3.2'' is corrected to read ``3.0.''
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On page 68726, in table 41, in column 2, row 2, ``$660 Billion.'' is corrected to read ``$660 Million.''
Sec. 419.43 [Amended]
0 24. On page 68728, 0 a. In column 1, in the first partial paragraph carried over from page 68727, line 1, the phrase ``APC and devices of'' is corrected to read ``APC, devices of.'' 0 b. In column 1, in the first partial paragraph carried over from page 68727, line 3, the sentence is corrected by inserting the phrase, ``, and devices paid under Sec. 419.66'' after the phrase ``(including a radioactive source).''
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Corrections to Addendum A
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On page 68736, for APC 0339, row 22, column 3, ``Q'' is corrected to read ``S.''
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On page 68738, for APC 0430, row 27, is removed.
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On page 68743, for APC 1491, row 23, column 6, ``$2.00'' is removed.
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On page 68746, APC 1611 is added in numerical order as follows:
a. Column 2 reads ``Hylan G-F 20 injection,''
b. Column 3 reads ``K,''
c. Column 4 is blank,
d. Column 5 reads ``$199.09,''
e. Column 6 is blank,
f. Column 7 reads ``$39.82.''
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On page 68748,
a. APC 1706, row 18, is removed.
b. For APC 1713, row 25, column 2, ``Inj Fe-based MR contrast, ml'' is corrected to read ``Inj Fe-base MR contrast, 1m1.''
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On page 68749, APC 7316 is added as follows:
a. Column 2 reads ``Sodium hyaluronate injection,''
b. Column 3 reads ``K,''
c. Column 4 is blank,
d. Column 5 reads ``$106.70,''
e. Column 6 is blank,
f. Column 7 reads ``$21.34.''
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On page 68750,
a. For APC 9119, row 19, column 2, ``Pentastarch 10% solution'' is corrected to read ``Injection, pegfilgrastim 6mg.''
b. For APC 9126, row 25, column 2, ``Injection, Natalizumab, 1mg'' is corrected to read ``Natalizumab injection.''
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On page 68751, for APC 9164, row 7, column 2, ``Inj Gad-base MR contrast, ml'' is corrected to read ``Inj Gad-base MR contrast, 1ml.''
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Corrections to Addendum B
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On page 68876,
a. For HCPCS code 95965, row 9,
i. In column 4, ``T'' is corrected to read ``S,''
ii. In column 5, ``0430'' is corrected to read ``1523,''
iii. In column 6, ``10.8452'' is removed,
iv. In column 7, ``$645.41'' is corrected to read ``$2,750.00,''
v. In column 9, ``$129.08'' is corrected to read ``$550.00.''
b. For HCPCS code 95966, row 10,
i. In column 4, ``T'' is corrected to read ``S,''
ii. In column 5, ``0430'' is corrected to read ``1514,''
iii. In column 6, ``10.8452'' is deleted,
iv. In column 7, ``$645.41'' is corrected to read ``$1,250.00,''
v. In column 9, ``$129.08'' is corrected to read ``$250.00.''
c. For HCPCS code 95967, row 11,
i. In column 4, ``T'' is corrected to read ``S,''
ii. In column 5, ``0430'' is corrected to read ``1510,''
iii. In column 6, ``10.8452'' is deleted,
iv. In column 7, ``$645.41'' is corrected to read ``$850.00,''
v. In column 9, ``$129.06'' is corrected to read ``$170.00.''
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On page 68880,
a. For HCPCS code 0001F, row 1, column 4, ``D'' is corrected to read ``E.''
b. For HCPCS code 0005F, row 7, column 4, ``D'' is corrected to read ``E.''
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On page 68888, for HCPCS code C8956, row 14,
a. In column 4, ``T'' is corrected to read ``D,''
b. In column 5, ``0125'' is removed,
c. In column 6, ``1.9021'' is removed,
d. In column 7, ``$113.20'' is removed,
e. In column 9, ``$22.64'' is removed.
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On page 68895,
[[Page 76179]]
a. For HCPCS code G0375, row 36, column 8, ``$2.00'' is removed.
b. For HCPCS code G0376, row 37, column 8, ``$2.00'' is removed.
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On page 68901,
a. For HCPCS code J2505, row 20, column 2, ``Pentastarch 10% solution'' is corrected to read ``Injection, pegfilgrastim 6mg.''
b. For HCPCS code J2510, row 21, column 2, ``Sincalide injection'' is corrected to read ``Penicillin g procaine inj.''
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On page 68902, for HCPCS code J3070, row 26, column 2, ``Pentazocine hcl injection'' is corrected to read ``Pentazocine injection.''
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On page 68904,
a. For HCPCS code J7317, row 12, column 4,
i. ``D'' is corrected to read ``K,''
ii. In column 5, ``7316'' is added,
iii. In column 7, ``$106.70'' is added,
iv. In column 9, ``$21.34'' is added.
b. For HCPCS code J7318, row 13,
i. In column 4, ``K'' is corrected to read ``D,''
ii. In column 5, ``1706'' is removed,
iii. In column 7, ``$7.20'' is removed,
iv. In column 9, ``$1.44'' is removed,
c. For HCPCS code J7320, row 14,
i. In column 4, ``D'' is corrected to read ``K,''
ii. In column 5, ``1611'' is added,
iii. In column 7, ``$199.09'' is added,
iv. In column 9, ``$39.82'' is added.
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On page 68907, for HCPCS code K0105, row 8, column 4, ``D'' is corrected to read ``Y.''
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On page 68912,
a. For HCPCS code Q4079, row 15, column 2, ``Injection, Natalizumab, 1 MG'' is corrected to read ``Natalizumab injection.''
b. For HCPCS code Q9946, row 21, column 2, ``LOCM 140/ NI................... E 90 mmhg. 4003F.............................. Pt ed write/oral, pts NI................... E w/ hf. 4012F.............................. Warfarin therapy rx... NI................... E 4014F.............................. Written discharge NI................... E instr prvd. 4015F.............................. Persist asthma
NI................... E medicine ctrl. 4016F.............................. Anti-inflm/anlgsc NI................... E agent rx. 4017F.............................. Gi prophylaxis for NI................... E nsaid rx. 4018F.............................. Therapy exercise joint NI................... E rx. A0998.............................. Ambulance response/ NI................... E treatment. A4233.............................. Alkalin batt for
NI................... Y glucose mon. A4234.............................. J-cell batt for
NI................... Y glucose mon. A4235.............................. Lithium batt for
NI................... Y glucose mon. A4236.............................. Silvr oxide batt
NI................... Y glucose mon. A4363.............................. Ostomy clamp,
NI................... A replacement. A4411.............................. Ost skn barr extnd =4 NI................... A sq. A4412.............................. Ost pouch drain high NI................... A output. A4604.............................. Tubing with heating NI................... Y element. A5120.............................. Skin barrier, wipe or NI................... A swab. A5512.............................. Multi den insert
NI................... B direct form. A5513.............................. Multi den insert
NI................... B custom mold. A6457.............................. Tubular dressing...... NI................... A A6513.............................. Compress burn mask NI................... B face/neck. A6530.............................. Compression stocking NI................... E BK18-30. A6531.............................. Compression stocking NI................... A BK30-40. A6532.............................. Compression stocking NI................... A BK40-50. A6533.............................. Gc stocking thighlngth NI................... E 18-30. A6534.............................. Gc stocking thighlngth NI................... E 30-40. A6535.............................. Gc stocking thighlngth NI................... E 40-50. A6536.............................. Gc stocking full lngth NI................... E 18-30. A6537.............................. Gc stocking full lngth NI................... E 30-40. A6538.............................. Gc stocking full lngth NI................... E 40-50. A6539.............................. Gc stocking waistlngth NI................... E 18-30. A6540.............................. Gc stocking waistlngth NI................... E 30-40. A6541.............................. Gc stocking waistlngth NI................... E 40-50. A6542.............................. Gc stocking custom NI................... E made. A6543.............................. Gc stocking lymphedema NI................... E A6544.............................. Gc stocking garter NI................... E belt. A6549.............................. G compression stocking NI................... E A9275.............................. Disp home glucose NI................... E monitor. A9281.............................. Reaching/grabbing NI................... E device. A9282.............................. Wig any type.......... NI................... E B4185.............................. Parenteral sol 10 gm NI................... B lipids. E0170.............................. Commode chair electric NI................... Y E0171.............................. Commode chair non- NI................... Y electric.
[[Page 76182]]
E0172.............................. Seat lift mechanism NI................... E toilet. E0485.............................. Oral device/appliance NI................... Y prefab. E0486.............................. Oral device/appliance NI................... Y cusfab. E0641.............................. Multi-position stnd NI................... E fram sys. E0642.............................. Dynamic standing frame NI................... E E0705.............................. Transfer board or NI................... B device. E0762.............................. Trans elec jt stim dev NI................... B sys. E0764.............................. Functional
NI................... Y neuromuscularstim. E0911.............................. HD trapeze bar attach NI................... Y to bed. E0912.............................. HD trapeze bar free NI................... Y standing. E1392.............................. Portable oxygen
NI................... Y concentrator. E1812.............................. Knee ext/flex w act NI................... Y res ctrl. E2207.............................. Crutch and cane holder NI................... Y E2208.............................. Cylinder tank carrier. NI................... Y E2209.............................. Arm trough each....... NI................... Y E2210.............................. Wheelchair bearings... NI................... Y E2211.............................. Pneumatic propulsion NI................... Y tire. E2212.............................. Pneumatic prop tire NI................... Y tube. E2213.............................. Pneumatic prop tire NI................... Y insert. E2214.............................. Pneumatic caster tire NI................... Y each. E2215.............................. Pneumatic caster tire NI................... Y tube. E2216.............................. Foam filled propulsion NI................... Y tire. E2217.............................. Foam filled caster NI................... Y tire each. E2218.............................. Foam propulsion tire NI................... Y each. E2219.............................. Foam caster tire any NI................... Y size ea. E2220.............................. Solid propulsion tire NI................... Y each. E2221.............................. Solid caster tire each NI................... Y E2222.............................. Solid caster
NI................... Y integrated whl. E2223.............................. Valve replacement only NI................... Y each. E2224.............................. Propulsion whl
NI................... Y excludes tire. E2225.............................. Caster wheel excludes NI................... Y tire. E2226.............................. Caster fork
NI................... Y replacement only. E2371.............................. Gr27 sealed leadacid NI................... Y battery. E2372.............................. Gr27 non-sealed
NI................... Y leadacid. G0333.............................. Dispense fee initial NI................... M 30 day. G0372.............................. MD service required NI................... M for PMD. G8006.............................. AMI pt recd aspirin at NI................... M arriv. G8007.............................. AMI pt did not receiv NI................... M aspiri. G8008.............................. AMI pt ineligible for NI................... M aspiri. G8009.............................. AMI pt recd Bblock at NI................... M arr. G8010.............................. AMI pt did not rec NI................... M bblock. G8011.............................. AMI pt inelig Bbloc at NI................... M arriv. G8012.............................. Pneum pt recv
NI................... M antibiotic 4 h. G8013.............................. Pneum pt w/o
NI................... M antibiotic 4 hr. G8014.............................. Pneum pt not elig NI................... M antibiotic. G8015.............................. Diabetic pt w/
NI................... M HBA1c>9%. G8016.............................. Diabetic pt w/ HBA1c NI................... M 100mg/dl. G8020.............................. Diab pt w/LDL 140/80.... NI................... M G8024.............................. Diabetic pt wBP100mg/dl. NI................... M G8040.............................. CAD pt w/LDL65%. G8076.............................. ESRD pt w/ dialy of NI................... M URRor = 33 NI................... M G8079.............................. ESRD pt w/Hct
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