Tuesday, 

November 27, 2007 

Part II 

Department of 

Health and Human 

Services 

Centers for Medicare & Medicaid Services 

42 CFR Parts 409, 410, et al. 

Medicare Program; Revisions to Payment 

Policies Under the Physician Fee 

Schedule, and Other Part B Payment 

Policies for CY 2008; Revisions to the 

Payment Policies of Ambulance Services 

Under the Ambulance Fee Schedule for 

CY 2008; and the Amendment of the 

E-Prescribing Exemption for Computer 

Generated Facsimile Transmissions; Final 

Rule 


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66222 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 409, 410, 411, 413, 414, 

415, 418, 423, 424, 482, 484, and 485 

[CMS–1385–FC] 

RIN 0938–AO65 

Medicare Program; Revisions to 

Payment Policies Under the Physician 

Fee Schedule, and Other Part B 

Payment Policies for CY 2008; 

Revisions to the Payment Policies of 

Ambulance Services Under the 

Ambulance Fee Schedule for CY 2008; 

and the Amendment of the 

E-Prescribing Exemption for Computer 

Generated Facsimile Transmissions 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Final rule with comment period. 

SUMMARY: This final rule with comment 

period addresses certain provisions of 

the Tax Relief and Health Care Act of 

2006, as well as making other proposed 

changes to Medicare Part B payment 

policy. We are making these changes to 

ensure that our payment systems are 

updated to reflect changes in medical 

practice and the relative value of 

services. This final rule with comment 

period also discusses refinements to 

resource-based practice expense (PE) 

relative value units (RVUs); geographic 

practice cost indices (GPCI) changes; 

malpractice RVUs; requests for 

additions to the list of telehealth 

services; several coding issues including 

additional codes from the 5-Year 

Review; payment for covered outpatient 

drugs and biologicals; the competitive 

acquisition program (CAP); clinical lab 

fee schedule issues; payment for renal 

dialysis services; performance standards 

for independent diagnostic testing 

facilities; expiration of the physician 

scarcity area (PSA) bonus payment; 

conforming and clarifying changes for 

comprehensive outpatient rehabilitation 

facilities (CORFs); a process for 

updating the drug compendia; physician 

self referral issues; beneficiary signature 

for ambulance transport services; 

durable medical equipment (DME) 

update; the chiropractic services 

demonstration; a Medicare economic 

index (MEI) data change; technical 

corrections; standards and requirements 

related to therapy services under 

Medicare Parts A and B; revisions to the 

ambulance fee schedule; the ambulance 

inflation factor for CY 2008; and 

amending the e-prescribing exemption 

for computer-generated facsimile 

transmissions. We are also finalizing the 

calendar year (CY) 2007 interim RVUs 

and are issuing interim RVUs for new 

and revised procedure codes for CY 

2008. 

As required by the statute, we are 

announcing that the physician fee 

schedule update for CY 2008 is ¥10.1 

percent, the initial estimate for the 

sustainable growth rate for CY 2008 is 

¥0.1 percent, and the conversion factor 

(CF) for CY 2008 is $34.0682. 

DATES: Effective Date: The provisions of 

this final rule with comment period are 

effective January 1, 2008, except for the 

amendments to § 409.17 and § 409.23 

which are effective July 1, 2008, and the 

amendments to § 423.160 which is 

effective January 1, 2009. 

Comment Date: Comments will be 

considered if we receive them at one of 

the addresses provided below, no later 

than 5 p.m. e.s.t. on December 31, 2007. 

ADDRESSES: In commenting, please refer 

to file code CMS–1385–FC. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

three ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on specific issues 

in this regulation to http:// 

www.cms.hhs.gov/eRulemaking. Click 

on the link ‘‘Submit electronic 

comments on CMS regulations with an 

open comment period.’’ (Attachments 

should be in Microsoft Word, 

WordPerfect, or Excel; however, we 

prefer Microsoft Word.) 

2. By 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–1385–FC, P.O. 

Box 8020, Baltimore, MD 21244–8020. 

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–1385–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 

(HHH) 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 and 

comprehensive outpatient rehabilitation 

facilities. 

Rick Ensor, (410) 786–5617 for issues 

related to practice expense 

methodology. 

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 the DRA imaging cap. 

Catherine Jansto, (410) 786–7762 for 

issues related to payment for covered 

outpatient drugs and biologicals. 

Edmund Kasaitis (410) 786–0477 for 

issues related to the Competitive 

Acquisition Program (CAP) for part B 

drugs. 

Anita Greenberg (410) 786–4601 for 

issues related to the clinical laboratory 

fee schedule. 

Henry Richter, (410) 786–4562 for 

issues related to payments for end-stage 

renal disease facilities. 

August Nemec (410) 786–0612 for 

issues related to independent diagnostic 

testing facilities. 

Kate Tillman (410) 786–9252 or Brijit 

Burton (410) 786–7364 for issues related 

to the drug compendia. 


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David Walczak (410) 786–4475 for 

issues related to reassignment and 

physician self-referral rules for 

diagnostic tests and beneficiary 

signature for ambulance transport. 

Lisa Ohrin (410) 786–4565 or Joanne 

Sinsheimer (410) 786–4620 for issues 

related to physician self-referral rules. 

Bob Kuhl (410) 786–4597 for issues 

related to the DME update. 

Rachel Nelson (410) 786–1175 for 

issues related to the physician quality 

reporting system for CY 2008. 

Maria Ciccanti (410) 786–3107 for 

issues related to the reporting of anemia 

quality indicators. 

James Menas (410) 786–4507 for 

issues related to payment for physician 

pathology services. 

Dorothy Shannon, (410) 786–3396 for 

issues related to the outpatient therapy 

caps. 

Drew Morgan, (410) 786–2543 for 

issues related to the E-Prescribing 

Exemption for Computer Generated 

Facsimile Transmissions. 

Roechel Kujawa (410) 786–9111 or 

Anne Tayloe (410) 786–4546 for issues 

related to the ambulance fee schedule. 

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 Relative Value 

Units (RVUs) for selected codes 

identified in Addendum C and the 

physician self-referral designated health 

services (DHS) procedures listed in 

Addendum I. You can assist us by 

referencing the file code [CMS–1385–

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 

the comment period are available for 

viewing by the public, including any 

personally identifiable or confidential 

business information that is included in 

a comment. We post all comments 

received before the close of the 

comment period on the following Web 

site as soon as possible after they have 

been received: http://www.cms.hhs.gov/ 

eRulemaking. Click on the link 

‘‘Electronic Comments on CMS 

Regulations’’ on that Web site to view 

public comments. 

Comments received timely will also 

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 Government 

Printing Office 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 also be found on the CMS 

homepage. You can access this data by 

using the following directions: 

1. Go to the following Web site: 

http://www.cms.hhs.gov/Physician

FeeSched/. 

2. Select ‘‘PFS Federal Regulation 

Notices.’’

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. Development of the Relative Value 

System 

B. Components of the Fee Schedule 

Payment Amounts 

C. Most Recent Changes to Fee Schedule 

II. Provisions of the Final Rule Related to the 

Physician Fee Schedule 

A. Resource Based Practice Expense (PE) 

Relative Value Units (RVUs) 

1. Current Methodology 

2. PE Proposals for CY 2008 

B. Geographic Practice Cost Indices (GPCIs) 

1. GPCI Update 

2. Payment Localities 

C. Malpractice (MP) RVUs (TC/PC issue) 

D. Medicare Telehealth Services 

E. Specific Coding Issues Related to PFS 

1. Reduction in the Technical Component 

(TC) Payment for Imaging Services 

Under the PFS to the Outpatient 

Department (OPD) Payment Amount 

2. Application of Multiple Procedure 

Payment Reduction for Mohs 

Micrographic Surgery (CPT Codes 17311 

Through 17315) 

3. Payment for Intravenous Immune 

Globulin (IVIG) Add On Code for 

Preadmission Related Services 

4. Reporting of Cardiac Rehabilitation 

Services 

F. Part B Drug Payment 

1. Average Sales Price (ASP) Issues 

2. Competitive Acquisition Program (CAP) 

Issues 

G. Issues Related to the Clinical Lab Fee 

Schedule 

1. Date of Service for the Technical 

Component (TC) of Physician Pathology 

Services (§ 414.510) 

2. New Clinical Diagnostic Laboratory Test 

(§ 414.508) 

H. Revisions Related to Payment for Renal 

Dialysis Services Furnished by EndStage Renal Disease (ESRD) Facilities 

1. Growth Update to the Drug Add-On 

Adjustment to the Composite Rates 

2. Update to the Geographic Adjustment to 

the Composite Rates 

I. Independent Diagnostic Testing Facility 

(IDTF) Issues 

1. Revisions of Existing IDTF Performance 

Standards 

2. New IDTF Standards 

J. Expiration of MMA Section 413 

Provisions for Physician Scarcity Area 

(PSA) 

K. Comprehensive Outpatient 

Rehabilitation Facility (CORF) Issues 

1. Requirements for Coverage of CORF 

Services Plan of Treatment (§ 410.105(c)) 

2. Included Services (§ 410.100) 

3. Physician Services (§ 410.100(a)) 

4. Clarifications of CORF Respiratory 

Therapy Services 

5. Social and Psychological Services 

6. Nursing Care Services 

7. Drugs and Biologicals 

8. Supplies and DME 

9. Clarifications and Payment Updates for 

Other CORF Services 

10. Cost Based Payment (§ 413.1) 

11. Payment for Comprehensive Outpatient 

Rehabilitation Facility (CORF) Services 

12. Vaccines 

L. Compendia for Determination of 

Medically Accepted Indications for Off 

Label Uses of Drugs and Biologicals in an 

Anti-Cancer Chemotherapeutic Regimen 

(§ 414.930) 

1. Background 

2. Process for Determining Changes to the 

Compendia List 

M. Physician Self Referral Issues 

1. General 

2. Changes to Reassignment and Physician 

Self Referral Rules Relating to Diagnostic 

Tests (Anti Markup Provision) 

N. Beneficiary Signature for Ambulance 

Transport Services 

O. Update to Fee Schedules for Class III 

DME for CYs 2007 and 2008 

1. Background 

2. Update to Fee Schedule 

P. Discussion of Chiropractic Services 

Demonstration 

Q. Technical Corrections 

1. Particular Services Excluded From 

Coverage (§ 411.15(a)) 

2. Medical Nutrition Therapy (§ 410.132(a)) 

3. Payment Exception: Pediatric Patient 

Mix (§ 413.184) 

4. Diagnostic X ray Tests, Diagnostic 

Laboratory Tests, and Other Diagnostic 

Tests: Conditions (§ 410.32(a)(1)) 

R. Other Issues 

1. Recalls and Replacement Devices 

2. Therapy Standards and Requirements 

3. Amendment to the Exemption for 

Computer Generated Facsimile 

Transmission from the National Council 

for Prescription Drug Programs (NCPDP) 

SCRIPT Standard for Transmitting 

Prescription and Certain Prescription 

Related Information for Part D Eligible 

Individuals 


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S. Division B of the Tax Relief and Health 

Care Act of 2006—Medicare 

Improvements and Extension Act of 2006 

(Pub. L. 109–432) (MIEA–TRHCA) 

1. Section 101(b)—Physician Quality 

Reporting Initiative (PQRI) 

2. Section 110—Reporting of Hemoglobin 

or Hematocrit for Part B Cancer AntiAnemia Drugs (§ 414.707(b)) 

3. Section 104—Extension of Treatment of 

Certain Physician Pathology Services 

Under Medicare 

4. Section 201—Extension of Therapy Cap 

Exception Process 

5. Section 101(d)—Physician Assistance 

and Quality Initiative (PAQI) Fund 

III. Revisions to the Payment Policies of 

Ambulance Services Under the Fee 

Schedule for Ambulance Services; 

Ambulatory Inflation Factor Update for 

CY 2007 

A. History of Medicare Ambulance 

Services 

1. Statutory Coverage of Ambulance 

Services 

2. Medicare Regulations for Ambulance 

Services 

3. Transition to National Fee Schedule 

B. Ambulance Inflation Factor (AIF) During 

the Transition Period 

C. Ambulance Inflation Factor (AIF) for CY 

2008 

D. Revisions to the Publication of the 

Ambulance Fee Schedule (§ 414.620) 

IV. Refinement of Relative Value Units for 

Calendar Year 2008 and Response to 

Public Comments on Interim Relative 

Value Units for 2007 

A. Summary of Issues Discussed Related to 

the Adjustment of Relative Value Units 

B. Process for Establishing Work Relative 

Value Units for the Physician Fee 

Schedule 

C. 5 Year Review of Work RVUs 

1. Additional Codes from the 5-Year 

Review of Work RVUs 

2. Anesthesia Coding (Part of 5-Year 

Review) 

3. Budget Neutrality Adjustment 

D. Work Relative Value Unit Refinements 

of Interim Relative Value Units (Interim 

2007 Codes) 

E. 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 2008 

(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 2008 CPT Codes’’) 

F. Discussion of Codes and RUC/HCPAC 

Recommendations 

G. Additional Coding Issues 

H. 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 2008 

V. Physician Self-Referral Prohibition: 

Annual Update to the List of CPT/ 

HCPCS Codes 

VI. Physician Fee Schedule Update for CY 

2008 

A. Physician Fee Schedule Update 

B. The Percentage Change in the Medicare 

Economic Index (MEI) 

C. The Update Adjustment Factor (UAF) 

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 

2008 

D. Revised Sustainable Growth Rate for 

2007 

E. Final Sustainable Growth Rate for 2006 

F. Calculation of 2008, 2007, and 2006 

Sustainable Growth Rates 

VIII. Anesthesia and Physician Fee Schedule 

Conversion Factors for CY 2008 

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 and 

Delay in Effective Date 

XII. Collection of Information Requirements 

XIII. Response to Comments 

XIV. Regulatory Impact Analysis 

Regulation Text 

Addendum A—Explanation and Use of 

Addendum B 

Addendum B—2008 Relative Value Units 

and Related Information Used in 

Determining Medicare Payments for 

2007 

Addendum C—Codes With Interim RVUS 

Addendum D—2008 Geographic Adjustment 

Factors (GAFs) 

Addendum E—2008 Geographic Practice 

Cost Indices (GPCIs) by State and 

Medicare Locality 

Addendum F—CPT/HCPCS Imaging Codes 

Defined by Section 5102(b) of the DRA 

Addendum G—FY 2008 Wage Index for 

Urban Areas Based on CBSA Labor 

Market Areas 

Addendum H—FY 2008 Wage Index Based 

on CBSA Labor Market Areas for Rural 

Areas 

Addendum I—Updated List of CPT/HCPCS 

Codes Used To Describe Certain 

Designated Health Services Under the 

Physician Self-Referral Provision 

Acronyms 

In addition, because of the many 

organizations and terms to which we 

refer by acronym in this final rule with 

comment period, we are listing these 

acronyms and their corresponding terms 

in alphabetical order below: 

AAA Abdominal aortic aneurysm 

AAP Average acquisition price 

ACOTE Accreditation Council for 

Occupational Therapy Education 

ACR American College of Radiology 

AFROC Association of Freestanding 

Radiation Oncology Centers 

AHFS–DI American Hospital Formulary 

Service—Drug Information 

AHRQ Agency for Healthcare Research and 

Quality (HHS) 

AIF Ambulance inflation factor 

AMA American Medical Association 

AMA–DE American Medical Association 

Drug Evaluations 

AMP Average manufacturer price 

AOTA American Occupational Therapy 

Association 

APC Ambulatory payment classification 

APTA American Physical Therapy 

Association 

ASA American Society of Anesthesiologists 

ASC Ambulatory surgical center 

ASP Average sales price 

ASTRO American Society for Therapeutic 

Radiology and Oncology 

ATA American Telemedicine Association 

AWP Average wholesale price 

BBA Balanced Budget Act of 1997 (Pub. L. 

105–33) 

BBRA [Medicare, Medicaid and State Child 

Health Insurance Program] Balanced 

Budget Refinement Act of 1999 (Pub. L. 

106–113) 

BIPA Medicare, Medicaid, and SCHIP 

Benefits Improvement Protection Act of 

2000 

BLS Bureau of Labor Statistics 

BMD Bone mineral density 

BMI Body mass index 

BMM Bone mass measurement 

BN Budget neutrality 

BSA Body surface area 

CAD Computer aided detection 

CAH Critical access hospital 

CAP Competitive acquisition program 

CBSA Core-Based Statistical Area 

CEM Cardiac event monitoring 

CF Conversion factor 

CFR Code of Federal Regulations 

CMA California Medical Association 

CMS Centers for Medicare & Medicaid 

Services 

CNS Clinical nurse specialist 

CORF Comprehensive Outpatient 

Rehabilitation Facility 

COTA Certified Occupational Therapy 

Assistant 

CPEP Clinical Practice Expert Panel 

CPI Consumer Price Index 

CPI–U Consumer price index for urban 

customers 

CPT (Physicians’) Current Procedural 

Terminology (4th Edition, 2002, 

copyrighted by the American Medical 

Association) 

CRT–D Cardiac resynchronization therapy 

defibrillator 

CT Computed tomography 

CTA Computed tomographic angiography 

CY Calendar year 

DEXA Dual energy x-ray absorptiometry 

DHS Designated health services 

DME Durable medical equipment 

DMEPOS Durable medical equipment, 

prosthetics, orthotics, and supplies 

DO Doctor of Osteopathy 

DRA Deficit Reduction Act of 2005 (Pub. L. 

109–432) 

E/M Evaluation and management 

ECI Employment cost index 

EHR Electronic health record 

EPC [Duke] Evidence-based Practice 

Centers 

EPO Erythopoeitin 

ESRD End stage renal disease 

F&C Facts and Comparisons 

FAW Furnish as written 


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FAX Facsimile 

FDA Food and Drug Administration (HHS) 

FMR Fair market rents 

FQHC Federally qualified health center 

FR Federal Register 

GAF Geographic adjustment factor 

GAO General Accounting Office 

GII Global Insight, Inc. 

GPO Group purchasing organization 

GPCI Geographic practice cost index 

HCPAC Health Care Professional Advisory 

Committee 

HCPCS Healthcare Common Procedure 

Coding System 

HCRIS Healthcare Cost Report Information 

System 

HIPAA Health Insurance Portability and 

Accountability Act of 1996 (Pub. L. 104–

191) 

HHA Home health agency 

HHS [Department of] Health and Human 

Services 

HIT Health information technology 

HMO Health maintenance organization 

HPSA Health Professional Shortage Area 

HRSA Health Resources Services 

Administration (HHS) 

HUD [Department of] Housing and Urban 

Development 

ICD Implantable cardioverter-defibrillator 

ICF Intermediate care facilities 

IDTF Independent diagnostic testing facility 

IFC Interim final rule with comment period 

IOTED International Occupational Therapy 

Eligibility Determination 

IPPE Initial preventive physical 

examination 

IPPS Inpatient prospective payment system 

IV Intravenous 

IVIG Intravenous immune globulin 

IWPUT Intra-service work per unit of time 

JCAAI Joint Council of Allergy, Asthma, 

and Immunology 

LPN Licensed practical nurse 

MA Medicare Advantage 

MA–PD Medicare Advantage Prescription 

Drug Plans 

MD Medical doctor 

MedCAC Medicare Evidence Development 

and Coverage Advisory Committee 

(formerly the Medicare Coverage Advisory 

Committee (MCAC)) 

MedPAC Medicare Payment Advisory 

Commission 

MEI Medicare Economic Index 

MIEA–TRHCA Medicare Improvements and 

Extension Act of 2006 (That is, Division B 

of the Tax Relief and Health Care Act of 

2006 (TRHCA) 

MMA Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 (Pub. L. 108–173) 

MNT Medical nutrition therapy 

MP Malpractice 

MRA Magnetic resonance angiography 

MRI Magnetic resonance imaging 

MSA Metropolitan statistical area 

MSP Medicare Secondary Payer 

MSVP Multi-specialty visit package 

NBCOT National Board for Certification in 

Occupational Therapy, Inc. 

NCCN National Comprehensive Cancer 

Network 

NCPDP National Council for Prescription 

Drug Programs 

NCQDIS National Coalition of Quality 

Diagnostic Imaging Services 

NDC National drug code 

NEMC New England Medical Center 

NISTA National Institute of Standards and 

Technology Act 

NLA National limitation amount 

NP Nurse practitioner 

NPP Nonphysician practitioners 

NQF National Quality Forum 

NTTAA National Technology Transfer and 

Advancement Act of 1995 (Pub. L. 104–

113) 

OACT [CMS’] Office of the Actuary 

OBRA Omnibus Budget Reconciliation Act 

OIG Office of Inspector General 

OMB Office of Management and Budget 

OPD Outpatient Department 

OPPS Outpatient prospective payment 

system 

OPT Outpatient physical therapy 

OSCAR Online Survey and Certification 

and Reporting 

PA Physician assistant 

PC Professional component 

PCF Patient compensation fund 

PDP Prescription Drug Plan 

PE Practice Expense 

PE/HR Practice expense per hour 

PEAC Practice Expense Advisory 

Committee 

PECOS Provider Enrollment, Chain, and 

Ownership System 

PERC Practice Expense Review Committee 

PET Positron emission tomography 

PFS Physician Fee Schedule 

PLI Professional liability insurance 

PPI Producer price index 

PPS Prospective payment system 

PQRI Physician Quality Reporting Initiative 

PRA Paperwork Reduction Act 

PSA Physician scarcity areas 

PT Physical therapy 

PT/INR Prothrombin time, international 

normalized ratio 

RFA Regulatory Flexibility Act 

RHC Rural health clinic 

RIA Regulatory impact analysis 

RN Registered nurse 

RT Respiratory therapist 

RUC [AMA’s Specialty Society] Relative 

(Value) Update Committee 

RVU Relative value unit 

SBA Small Business Administration 

SGR Sustainable growth rate 

SLP Speech—language pathology 

SLPs Speech—language pathologists 

SMS [AMA’s] Socioeconomic Monitoring 

System 

SNF Skilled nursing facility 

STS Society of Thoracic Surgeons 

TA Technology Assessment 

TC Technical Component 

TENS Transcutaneous electric nerve 

stimulator 

TRHCA Tax Relief and Health Care Act of 

2006 (Pub. L. 109–432) 

USP–DI United States Pharmacopoeia-Drug 

Information 

WAC Wholesale acquisition cost 

WAMP Widely available market price 

Wet AMD Exudative age-related macular 

degeneration 

WFOT World Federation of Occupational 

Therapists 

I. Background 

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. 

Before the establishment of the 

resource-based relative value system, 

Medicare payment for physicians’

services was based on reasonable 

charges. 

A. 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, Pub. L. 101–239, 

and OBRA 1990, (Pub. L. 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 Federal government, and 

obtained input from numerous 

physician specialty groups. 

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 factor 

in determining payment for these 

services. As a result, there is a separate 

formula used to calculate payment 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). 


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2. Practice Expense Relative Value Units 

(PE RVUs) 

Section 121 of the Social Security Act 

Amendments of 1994 (Pub. L. 103–32), 

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 

general categories of expenses (such as 

office rent and wages of personnel, but 

excluding malpractice expenses) 

comprising PEs. 

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 (RNs)) 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. We have since 

refined and revised these inputs based 

on recommendations from the RUC. 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 typically 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. 

Section 212 of the Balanced Budget 

Refinement Act of 1999 (BBRA) (Pub. L. 

106–113) directed the Secretary of 

Health and Human Services (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 a 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 through March 

1, 2005. 

In the CY 2007 PFS final rule with 

comment period (71 FR 69624), we 

revised the methodology for calculating 

PE RVUs beginning in CY 2007 and 

provided for a 4-year transition for the 

new PE RVUs under this new 

methodology. We will continue to 

reexamine this policy and proposed 

necessary revisions through future 

rulemaking. 

3. Resource-Based Malpractice (MP) 

RVUs 

Section 4505(f) of the BBA amended 

section 1848(c) of the Act to require us 

to implement resource-based 

malpractice (MP) RVUs for services 

furnished on or after 2000. The 

resource-based MP RVUs were 

implemented in the PFS final rule 

published November 2, 1999 (64 FR 

59380). The MP RVUs were 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 RVUs no less 

often than every 5 years. The first 5-Year 

Review of the physician work RVUs was 

effective in 1997, published on 

November 22, 1996 (61 FR 59489). The 

second 5-Year Review went into effect 

in 2002, published in the CY 2002 PFS 

final rule (66 FR 55246). The third 5- 

Year Review of physician work RVUs 

went into effect on January 1, 2007 and 

was published in the CY 2007 PFS final 

rule with comment period (71 FR 

69624) (although we note that certain 

additional proposals relating to the third 

5-Year Review are addressed in the CY 

2008 PFS proposed rule and in this final 

rule with comment period). 

In 1999, the AMA’s RUC established 

the Practice Expense Advisory 

Committee (PEAC) for the purpose of 

refining the direct PE inputs. Through 

March 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). As part of the CY 2007 PFS final 

rule with comment period (71 FR 

69624), we implemented a new 

methodology for determining resourcebased PE RVUs and are transitioning 

this over a 4-year period. 

In the CY 2005 PFS final rule with 

comment period (69 FR 66236), 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. 

As explained in the CY 2007 PFS final 

rule with comment period (71 FR 

69624), due to the increase in work 

RVUs resulting from the third 5-Year 

Review of physician work RVUs, we are 

applying a separate budget neutrality 

(BN) adjustor to the work RVUs for 

services furnished during 2007. This 

approach is consistent with the method 

we use to make BN adjustments to the 

PE RVUs to reflect the changes in these 

PE RVUs. 

B. Components of the Fee Schedule 

Payment Amounts 

To calculate the payment for every 

physician service, the components of 

the fee schedule (physician work, PE, 

and MP RVUs) are adjusted by a 

geographic practice cost index (GPCI). 

The GPCIs reflect the relative costs of 

physician work, PE, 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 (OACT) and is updated 

annually for inflation. 

The formula for calculating the 

Medicare fee schedule amount for a 

given service and fee schedule area can 

be expressed as: 


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Payment = [(RVU work × budget 

neutrality adjuster × work GPCI) + (RVU 

PE × PE GPCI) + (MP RVU × MP GPCI)] 

× CF. 

C. Most Recent Changes to the Fee 

Schedule 

The CY 2007 PFS final rule with 

comment period (71 FR 69624) 

addressed certain provisions of the 

Deficit Reduction Act of 2005 (Pub. L. 

109–432) (DRA) and made other 

changes to Medicare Part B payment 

policy to ensure that our payment 

systems are updated to reflect changes 

in medical practice and the relative 

value of services. This final rule with 

comment period also discussed GPCI 

changes; requests for additions to the 

list of telehealth services; payment for 

covered outpatient drugs and 

biologicals; payment for renal dialysis 

services; policies related to private 

contracts and opt-out; policies related to 

bone mass measurement (BMM) 

services, independent diagnostic testing 

facilities (IDTFs), the physician selfreferral prohibition; laboratory billing 

for the technical component (TC) of 

physician pathology services; the 

clinical laboratory fee schedule; 

certification of advanced practice 

nurses; health information technology, 

the health care information 

transparency initiative; updated the list 

of certain services subject to the 

physician self-referral prohibitions, 

finalized ASP reporting requirements, 

and codified Medicare’s longstanding 

policy that payment of bad debts 

associated with services paid under a 

fee schedule/charge-based system is not 

allowable. 

We also finalized the CY 2006 interim 

RVUs and issued interim RVUs for new 

and revised procedure codes for CY 

2007. 

In addition, the CY 2007 PFS final 

rule with comment period included 

revisions to payment policies under the 

fee schedule for ambulance services and 

announced the ambulance inflation 

factor (AIF) update for CY 2007. 

In accordance with section 

1848(d)(1)(E)(i) of the Act, we also 

announced that the PFS update for CY 

2007 is ¥5.0 percent, the initial 

estimate for the sustainable growth rate 

(SGR) for CY 2007 is 1.8 percent and the 

CF for CY 2007 is $35.9848. However, 

subsequent to publication of the CY 

2007 PFS final rule with comment 

period, section 101(a) of Division B, 

Title I of the Tax Relief and Health Care 

Act of 2006 (Pub. L. 109–432) (MIEA–

TRHCA), which was enacted on 

December 20, 2006, amended section 

1848(d) of the Act. [Division B of the 

Tax Relief and Health Care Act of 2006 

is entitled Medicare and Other Health 

Provisions and its short title is the 

Medicare Improvements and Extension 

Act of 2006. Therefore, the law is 

hereinafter referred to as ‘‘MIEA–

TRHCA’’.] As a result of this statutory 

change, the CF of $37.8975 was 

maintained for CY 2007. 

II. Provisions of the Final Rule Related 

to the Physician Fee Schedule 

In response to the CY 2008 PFS 

proposed rule (72 FR 38122), we 

received approximately 27,000 

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 anesthesia coding 

and the 5-Year Review, the physician 

self-referral provisions and the technical 

correction to § 410.32(a)(1) concerning 

an exception to the requirement that 

diagnostic services (including x-rays) 

must be ordered by the treating 

physician. To the extent that comments 

were outside the scope of the proposed 

rule, they are not addressed in this final 

rule with comment period. 

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 CY 2008 PFS 

proposed rule (72 FR 38122). More 

detailed background information for 

each issue can be found in the CY 2008 

PFS proposed rule. 

A. Resource Based Practice Expense 

(PE) Relative Value Units (RVUs) 

Practice expense (PE) is 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 

personnel wages but excluding 

malpractice expenses, as specified in 

section 1848(c)(1)(B) of the Act. 

Section 121 of the Social Security 

Amendments of 1994 (Pub. L. 103–432), 

enacted on October 31, 1994, required 

CMS to develop a methodology for a 

resource-based system for determining 

PE RVUs for each physician’s service. 

Until that time, PE RVUs were based on 

historical allowed charges. This 

legislation required 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 furnishing the 

service. 

The initial implementation of 

resource-based PE RVUs was delayed 

from January 1, 1998, until January 1, 

1999, by section 4505(a) of the BBA. In 

addition, section 4505(b) of the BBA 

required that 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 of 

the statute was to adjust the PE values 

for certain services for CY 1998. Section 

4505(d) of the 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 and actual 

data on equipment utilization. 

• 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 PE. 

In CY 1999, we began the 4-year 

transition to resource-based PE RVUs 

utilizing a ‘‘top-down’’ methodology 

whereby we allocated aggregate 

specialty-specific practice costs to 

individual procedures. The specialtyspecific PEs were derived from the 

American Medical Association’s 

(AMA’s) Socioeconomic Monitoring 

Survey (SMS). In addition, under 

section 212 of the BBRA, we established 

a process extending through March 2005 

to supplement the SMS data with data 

submitted by a specialty. The aggregate 

PEs for a given specialty were then 

allocated to the services furnished by 

that specialty on the basis of the direct 

input data (that is, the staff time, 

equipment, and supplies) and work 

RVUs assigned to each CPT code. 

For CY 2007, we implemented a new 

methodology for calculating PE RVUs. 

Under this new methodology, we use 

the same data sources for calculating PE, 

but instead of using the ‘‘top-down’’

approach to calculate the direct PE 

RVUs, under which the aggregate direct 

and indirect costs for each specialty are 

allocated to each individual service, we 

now utilize a ‘‘bottom-up’’ approach to 


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calculate the direct costs. Under the 

‘‘bottom-up’’ approach, we determine 

the direct PE by adding the costs of the 

resources (that is, the clinical staff, 

equipment, and supplies) typically 

required to furnish each service. The 

costs of the resources are calculated 

using the refined direct PE inputs 

assigned to each CPT code in our PE 

database, which are based on our review 

of recommendations received from the 

AMA’s Relative Value Update 

Committee (RUC). For a more detailed 

explanation of the PE methodology see 

the Five-Year Review of Work RVUs 

Under the PFS and Proposed Changes to 

the PE Methodology proposed notice (71 

FR 37242) and the CY 2007 PFS final 

rule with comment period (71 FR 

69629). 

1. Current Methodology 

a. Data Sources for Calculating Practice 

Expense 

The AMA’s SMS survey data and 

supplemental survey data from the 

specialties of cardio-thoracic surgery, 

vascular surgery, physical and 

occupational therapy, independent 

laboratories, allergy/immunology, 

cardiology, dermatology, 

gastroenterology, radiology, 

independent diagnostic testing facilities 

(IDTFs), radiation oncology, and urology 

are used to develop the PE per hour (PE/ 

HR) for each specialty. For those 

specialties for which we do not have 

PE/HR, the appropriate PE/HR is 

obtained from a crosswalk to a similar 

specialty. 

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 

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 (66 FR 55246, November 1, 

2002) (hereinafter referred to as CY 2002 

PFS final rule).) The SMS PE survey 

data are adjusted to a common year, 

2005. The SMS data provide the 

following six categories of PE costs: 

• Clinical payroll expenses, which 

are payroll expenses (including fringe 

benefits) for nonphysician clinical 

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 expenses depreciation, 

leases, and rent of medical equipment 

used in the diagnosis or treatment of 

patients. 

• All other expenses, which include 

expenses for legal services, accounting, 

office management, professional 

association memberships, and any 

professional expenses not previously 

mentioned in this section. 

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, (65 FR 25664, 

May 3, 2000).) Originally, the deadline 

to submit supplementary survey data 

was through August 1, 2001. In the CY 

2002 PFS final rule (66 FR 55246), the 

deadline was extended through August 

1, 2003. To ensure maximum 

opportunity for specialties to submit 

supplementary survey data, we 

extended the deadline to submit surveys 

until March 1, 2005 in the Revisions to 

Payment Policies Under the Physician 

Fee Schedule for CY 2004 final rule, 

(November 7, 2003; 68 FR 63196) 

(hereinafter referred to as CY 2004 PFS 

final rule). 

The direct cost data for individual 

services were originally developed by 

the Clinical Practice Expert Panels 

(CPEP). The CPEP data include the 

supplies, equipment, and staff times 

specific to each procedure. The CPEPs 

consisted of panels of physicians, 

practice administrators, and 

nonphysicians (for example, RNs) who 

were nominated by physician specialty 

societies and other groups. There were 

15 CPEPs consisting 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’s 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 RUC established 

the Practice Expense Advisory 

Committee (PEAC). From 1999 to 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 

for over 7,600 codes which we have 

reviewed and accepted. As a result, the 

current PE 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 PE to Services 

The aggregate level specialty-specific 

PEs are derived from the AMA’s SMS 

survey and supplementary survey data. 

To establish PE RVUs for specific 

services, it is necessary to establish the 

direct and indirect PE associated with 

each service. 

(i) Direct costs. The direct costs are 

determined by adding the costs of the 

resources (that is, the clinical staff, 

equipment, and supplies) typically 

required to provide the service. The 

costs of these resources are calculated 

from the refined direct PE inputs in our 

PE database. These direct inputs are 

then scaled to the current aggregate pool 

of direct PE RVUs. The aggregate pool 

of direct PE RVUs can be derived using 

the following formula: (PE RVUs * 

physician CF) * (average direct 

percentage from SMS/(Supplemental 

PE/HR data)). 

(ii) Indirect costs. The SMS and 

supplementary survey data are the 

source for the specialty-specific 

aggregate indirect costs used in our PE 

calculations. We then allocate the 

indirect costs to the code level on the 

basis of the direct costs specifically 

associated with a code and the 

maximum of either the clinical labor 

costs or the physician work RVUs. For 

calculation of the 2008 PE RVUs, we are 

using the 2006 procedure-specific 

utilization data crosswalked to 2007 

services. To arrive at the indirect PE 

costs: 

• We apply a specialty-specific 

indirect percentage factor to the direct 

expenses to recognize the varying 

proportion that indirect costs represent 

of total costs by specialty. For a given 

service, the specific indirect percentage 

factor to apply to the direct costs for the 

purpose of the indirect allocation is 

calculated as the weighted average of 

the ratio of the indirect to direct costs 

(based on the survey data) for the 

specialties that furnish the service. For 

example, if a service is furnished by a 

single specialty with indirect PEs that 

were 75 percent of total PEs, the indirect 

percentage factor to apply to the direct 

costs for the purposes of the indirect 


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allocation would be (0.75/0.25) = 3.0. 

The indirect percentage factor is then 

applied to the service level adjusted 

indirect PE allocators. 

• We use the specialty-specific PE/HR 

from the SMS survey data, as well as the 

supplemental surveys for cardiothoracic surgery, vascular surgery, 

physical and occupational therapy, 

independent laboratories, allergy/ 

immunology, cardiology, dermatology, 

radiology, gastroenterology, IDTFs, 

radiation oncology and urology. (Note: 

For radiation oncology, the data 

represent the combined survey data 

from the American Society for 

Therapeutic Radiology and Oncology 

(ASTRO) and the Association of 

Freestanding Radiation Oncology 

Centers (AFROC).) We incorporate this 

PE/HR into the calculation of indirect 

costs using an index which reflects the 

relationship between each specialty’s 

indirect scaling factor and the overall 

indirect scaling factor for the entire PFS. 

For example, if a specialty had an 

indirect practice cost index of 2.00, this 

specialty would have an indirect scaling 

factor that was twice the overall average 

indirect scaling factor. If a specialty had 

an indirect practice cost index of 0.50, 

this specialty would have an indirect 

scaling factor that was half the overall 

average indirect scaling factor. 

• When the clinical labor portion of 

the direct PE RVU is greater than the 

physician work RVU for a particular 

service, the indirect costs are allocated 

based upon the direct costs and the 

clinical labor costs. For example, if a 

service has no physician work and 1.10 

direct PE RVUs, and the clinical labor 

portion of the direct PE RVUs is 0.65 

RVUs, we would use the 1.10 direct PE 

RVUs and the 0.65 clinical labor 

portions of the direct PE RVUs to 

allocate the indirect PE for that service. 

c. Facility/Nonfacility Costs 

Procedures that can be furnished in a 

physician’s office, as well as in a 

hospital or facility setting, 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 surgical centers 

(ASCs), and skilled nursing facilities 

(SNFs). The methodology for calculating 

PE RVUs is the same for both, facility 

and nonfacility RVUs, but is applied 

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 PFS), the PE 

RVUs are generally lower for services 

provided in the facility setting. 

d. Services With Technical Components 

(TCs) and Professional Components 

(PCs) 

Diagnostic services are generally 

comprised of two components; a 

professional component (PC) and a 

technical component (TC), which may 

be furnished independently or by 

different providers. When services have 

TC, PC, and global components that can 

be billed separately, the payment for the 

global component equals the sum of the 

payment for the TC and PCs. This is a 

result of using a weighted average of the 

ratio of indirect to direct costs across all 

the specialties that furnish the global 

components, TCs, and PCs; that is, we 

apply the same weighted average 

indirect percentage factor to allocate 

indirect expenses to the global 

components, PC, and TCs for a service. 

(The direct PE RVUs for the TC and PCs 

sum to the global under the bottom-up 

methodology.) 

e. Transition Period 

As discussed in the CY 2007 PFS final 

rule with comment period (71 FR 

69674), we are implementing the change 

in the methodology for calculating PE 

RVUs over a 4-year period. During this 

transition period, the PE RVUs will be 

calculated on the basis of a blend of 

RVUs calculated using our methodology 

described previously in this section 

(weighted by 25 percent during CY 

2007, 50 percent during CY 2008, 75 

percent during CY 2009, and 100 

percent thereinafter), and the CY 2006 

PE RVUs for each existing code. PE 

RVUs for codes that are new during this 

period will be calculated using only the 

current PE methodology, and will be 

paid at the fully transitioned rate. 

f. PE RVU Methodology 

The following is a description of the 

PE RVU methodology. 

(i) Setup File 

First, we create a setup file for the PE 

methodology. The setup file contains 

the direct cost inputs, the utilization for 

each procedure code at the specialty 

and facility/nonfacility place of service 

level, and the specialty-specific survey 

PE per physician hour data. 

(ii) Calculate the Direct Cost PE RVUs 

Sum the Costs of Each Direct Input 

Step 1: Sum the direct costs of the 

inputs for each service. The direct costs 

consist of the costs of the direct inputs 

for clinical labor, medical supplies, and 

medical equipment. The clinical labor 

cost is the sum of the cost of all the staff 

types associated with the service; it is 

the product of the time for each staff 

type and the wage rate for that staff 

type. The medical supplies cost is the 

sum of the supplies associated with the 

service; it is the product of the quantity 

of each supply and the cost of the 

supply. The medical equipment cost is 

the sum of the cost of the equipment 

associated with the service; it is the 

product of the number of minutes each 

piece of equipment is used in the 

service and the equipment cost per 

minute. The equipment cost per minute 

is calculated as described at the end of 

this section. 

Apply a BN Adjustment to the Direct 

Inputs 

Step 2: Calculate the current aggregate 

pool of direct PE costs. To do this, 

multiply the current aggregate pool of 

total direct and indirect PE costs (that is, 

the current aggregate PE RVUs 

multiplied by the CF) by the average 

direct PE percentage from the SMS and 

supplementary specialty survey data. 

Step 3: Calculate the aggregate pool of 

direct costs. To do this, for all PFS 

services, sum the product of the direct 

costs for each service from Step 1 and 

the utilization data for that service. 

Step 4: Using the results of Step 2 and 

Step 3 calculate a direct PE BN 

adjustment so that the proposed 

aggregate direct cost pool does not 

exceed the current aggregate direct cost 

pool and apply it to the direct costs 

from Step 1 for each service. 

Step 5: Convert the results of Step 4 

to an RVU scale for each service. To do 

this, divide the results of Step 4 by the 

Medicare PFS CF. 

(iii) Create the Indirect PE RVUs 

Create Indirect Allocators 

Step 6: Based on the SMS and 

supplementary specialty survey data, 

calculate direct and indirect PE 

percentages for each physician 

specialty. 

Step 7: Calculate direct and indirect 

PE percentages at the service level by 

taking a weighted average of the results 

of Step 6 for the specialties that furnish 

the service. Note that for services with 

a TC and PCs we are calculating the 

direct and indirect percentages across 

the global components, PCs and TCs. 

That is, the direct and indirect 

percentages for a given service (for 

example, echocardiogram) do not vary 

by the PC, TC and global component. 

Step 8: Calculate the service level 

allocators for the indirect PEs based on 

the percentages calculated in Step 7. 

The indirect PEs are allocated based on 

the three components: the direct PE 


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RVU, the clinical PE RVU and the work 

RVU. 

For most services the indirect 

allocator is: indirect percentage * (direct 

PE RVU/direct percentage) + work RVU. 

There are two situations where this 

formula is modified: 

• If the service is a global service (that 

is, a service with global, professional 

and technical components), then the 

indirect allocator is: indirect percentage 

* (direct PERVU/direct percentage) + 

clinical PE RVU + work RVU. 

• If the clinical labor PE RVU exceeds 

the work RVU (and the service is not a 

global service), then the indirect 

allocator is: indirect percentage * (direct 

PERVU/direct percentage) + clinical PE 

RVU. 

(Note that for global services the 

indirect allocator is based on both the 

work RVU and the clinical labor PE 

RVU. We do this to recognize that, for 

the professional service, indirect PEs 

will be allocated using the work RVUs, 

and for the TC service, indirect PEs will 

be allocated using the direct PE RVU 

and the clinical labor PE RVU. This also 

allows the global component RVUs to 

equal the sum of the PC and TC RVUs.) 

For presentation purposes in the 

examples in Table 1, the formulas were 

divided into two parts for each service. 

The first part does not vary by service 

and is the indirect percentage * (direct 

PE RVU/direct percentage). The second 

part is either the work RVU, clinical PE 

RVU, or both depending on whether the 

service is a global service and whether 

the clinical PE RVU exceeds the work 

RVU (as described earlier in this step.) 

Apply a BN Adjustment to the Indirect 

Allocators 

Step 9: Calculate the current aggregate 

pool of indirect PE RVUs by multiplying 

the current aggregate pool of PE RVUs 

by the average indirect PE percentage 

from the physician specialty survey 

data. This is similar to the Step 2 

calculation for the direct PE RVUs. 

Step 10: Calculate an aggregate pool of 

proposed indirect PE RVUs for all PFS 

services by adding the product of the 

indirect PE allocators for a service from 

Step 8 and the utilization data for that 

service. This is similar to the Step 3 

calculation for the direct PE RVUs. 

Step 11: Using the results of Step 9 

and Step 10, calculate an indirect PE 

adjustment so that the aggregate indirect 

allocation does not exceed the available 

aggregate indirect PE RVUs and apply it 

to indirect allocators calculated in Step 

8. This is similar to the Step 4 

calculation for the direct PE RVUs. 

Calculate the Indirect Practice Cost 

Index 

Step 12: Using the results of Step 11, 

calculate aggregate pools of specialtyspecific adjusted indirect PE allocators 

for all PFS services for a specialty by 

adding the product of the adjusted 

indirect PE allocator for each service 

and the utilization data for that service. 

Step 13: Using the specialty-specific 

indirect PE/HR data, calculate specialtyspecific aggregate pools of indirect PE 

for all PFS services for that specialty by 

adding the product of the indirect PE/ 

HR for the specialty, the physician time 

for the service, and the specialty’s 

utilization for the service. 

Step 14: Using the results of Step 12 

and Step 13, calculate the specialtyspecific indirect PE scaling factors as 

under the current methodology. 

Step 15: Using the results of Step 14, 

calculate an indirect practice cost index 

at the specialty level by dividing each 

specialty-specific indirect scaling factor 

by the average indirect scaling factor for 

the entire PFS. 

Step 16: Calculate the indirect 

practice cost index at the service level 

to ensure the capture of all indirect 

costs. Calculate a weighted average of 

the practice cost index values for the 

specialties that furnish the service. 

Note: For services with TC and PCs, we 

calculate the indirect practice cost index 

across the global components, PCs and 

TCs. Under this method, the indirect 

practice cost index for a given service 

(for example, echocardiogram) does not 

vary by the PC, TC and global 

components. 

Step 17: Apply the service level 

indirect practice cost index calculated 

in Step 16 to the service level adjusted 

indirect allocators calculated in Step 11 

to get the indirect PE RVU. 

(iv) Calculate the Final PE RVUs 

Step 18: Add the direct PE RVUs from 

Step 6 to the indirect PE RVUs from 

Step 17. 

Step 19: Calculate and apply the final 

PE BN adjustment by comparing the 

results of Step 18 to the current pool of 

PE RVUs. This final BN adjustment is 

required primarily because certain 

specialties are excluded from the PE 

RVU calculation for rate-setting 

purposes, but all specialties are 

included for purposes of calculating the 

final BN adjustment. (See ‘‘Specialties 

excluded from rate-setting calculation’’

below in this section.) 

(v) Setup File Information 

• Specialties excluded from ratesetting calculation: For the purposes of 

calculating the PE RVUs, we exclude 

certain specialties such as midlevel 

practitioners paid at a percentage of the 

PFS, audiology, and low volume 

specialties from the calculation. These 

specialties are included for the purposes 

of calculating the BN adjustment. 

• Crosswalk certain low volume 

physician specialties: Crosswalk the 

utilization of certain specialties with 

relatively low PFS utilization to the 

associated specialties. 

• Physical therapy utilization: 

Crosswalk the utilization associated 

with all physical therapy services to the 

specialty of physical therapy. 

• Identify professional and technical 

services not identified under the usual 

TC and 26 modifier: Flag the services 

that are PC and TC services, but do not 

use TC and 26 modifiers (for example, 

electrocardiograms). This flag associates 

the PC and TC with the associated 

global code for use in creating the 

indirect PE RVU. For example, the 

professional service code 93010 is 

associated with the global code 93000. 

• Payment modifiers: Payment 

modifiers are accounted for in the 

creation of the file. For example, 

services billed with the assistant at 

surgery modifier are paid 16 percent of 

the PFS amount for that service; 

therefore, the utilization file is modified 

to only account for 16 percent of any 

service that contains the assistant at 

surgery modifier. 

• Work RVUs: The setup file contains 

the work RVUs from this final rule with 

comment period. 

(vi) Equipment Cost Per Minute = 

The equipment cost per minute is 

calculated as: 

(1/(minutes per year * usage)) * price 

* ((interest rate/(1¥(1/((1 + interest rate) 

* life of equipment)))) + maintenance) 

Where: 

minutes per year = maximum minutes 

per year if usage were continuous 

(that is, usage = 1); 150,000 

minutes. 

usage = equipment utilization 

assumption; 0.5. 

price = price of the particular piece of 

equipment. 

interest rate = 0.11. 

life of equipment = useful life of the 

particular piece of equipment. 

maintenance = factor for maintenance; 

0.05. 


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TABLE 1.—CALCULATION OF PE RVU

S

UNDER

METHODOLOGY FOR

SELECTED

CODES

Step Source Formula 

99213 33533 71020 71020TC 7102026 93000 93005 93010 

Office visit, 

est nonfacility 

CABG, arterial, single facility Chest x- ray non- facility Chest x- ray non- facility Chest x- ray non- facility ECG, com- plete non- facility ECG, trac- ing non- facility ECG, re- port non- facility 

(1) Labor cost (Lab) ........ Step 1 ............................ AMA ............................... ........................................ $13.32 $77.52 $5.74 $5.74 $ $6.12 $6.12 $(2) Supply cost (Sup) ..... Step 1 ............................ AMA ............................... ........................................ $2.98 $7.34 $3.39 $3.39 $ $1.19 $1.19 $(3) Equipment cost (Eqp) Step 1 ............................ AMA ............................... ........................................ $0.19 $0.65 $8.17 $8.17 $ $0.12 $0.12 $(4) Direct cost (Dir) ......... Step 1 ............................ ........................................ =(1)+(2)+(3) ................... $16.50 $85.51 $17.31 $17.31 $ $7.43 $7.60 $(5) Direct adjustment (Dir 

Adj).

Steps 2–4 ...................... See footnote 1 ................ ........................................ 0.592 0.592 0.592 0.592 0.592 0.592 0.592 0.592 

(6) Adjusted labor ........... Steps 2–4 ...................... =Lab * Dir Adj ................ =(1) * (5) ......................... $7.89 $45.89 $3.40 $3.40 $ $3.62 $3.62 $(7) Adjusted supplies ...... Steps 2–4 ...................... =Sup * Dir Adj ................. =(2) * (5) ......................... $1.77 $4.35 $2.01 $2.01 $ $0.71 $0.71 $(8) Adjusted equipment .. Steps 2–4 ...................... =Eqp *Dir Adj ................. =(3) * (5) ......................... $0.12 $0.39 $4.84 $4.84 $ $0.07 $0.07 $(9) Adjusted direct .......... Steps 2–4 ...................... ........................................ =(6)+(7)+(8) ................... $9.77 $50.62 $10.25 $10.25 $ $4.40 $4.40 $(10) Conversion Factor 

(CF).

Step 5 ............................ MFS ............................... ........................................ $34.0682 $34.0682 $34.0682 $34.0682 $34.0682 $34.0682 $34.0682 $34.0682 

(11) Adj. labor cost converted. Step 5 ............................ =(Lab * Dir Adj)/CF ......... =(6)/(10) ......................... 0.23 1.35 0.10 0.10 .................. 0.11 0.11 ..................(12) Adj. supply cost converted. Step 5 ............................ =(Sup * Dir Adj)/CF ........ =(7)/(10) ......................... 0.05 0.13 0.06 0.06 .................. 0.02 0.02 ..................(13) Adj. equip cost converted. Step 5 ............................ =(Eqp * Dir Adj)/CF ........ =(8)/(10) ......................... 0.00 0.01 0.14 0.14 .................. 0.00 0.00 ..................(14) Adj. direct cost converted. Step 5 ............................ ........................................ =(11)+(12)+(13) ............. 0.29 1.49 0.30 0.30 .................. 0.13 0.13 ..................(15) Wrk RVU * Wrk 

Scaler.

Setup File ...................... MFS ............................... 0.8806 ............................ 0.81 29.62 0.19 0.00¥ 0.19 0.15 0.00 0.15 

(16) Dir_pct ..................... Steps 6, 7 ...................... Surveys .......................... ........................................ 33.8% 32.6% 40.7% 40.7% 40.7% 37.7% 37.7% 37.7% (17) Ind_pct ..................... Steps 6, 7 ...................... Surveys .......................... ........................................ 66.2% 67.4% 59.3% 59.3% 59.3% 62.3% 62.3% 62.3% (18) Ind. Alloc. formula 

(1st part).

Step 8 ............................ See Step 8 .................... ........................................ ((14)/ 

(16)) * (17) 

((14)/ 

(16)) * (17) 

((14)/ 

(16)) * (17) 

((14)/ 

(16)) * (17) 

((14)/ 

(16)) * (17) 

((14)/ 

(16)) * (17) 

((14)/ 

(16)) * (17) 

((14)/ 

(16)) * (17) 

(19) Ind. Alloc. (1st part) Step 8 ............................ ........................................ See (18) ......................... 0.56 3.07 0.44 0.44 .................. 0.21 0.21 ..................(20) Ind. Alloc. formulas 

(2nd part).

Step 8 ............................ See Step 8 .................... ........................................ (15) (15) (15)+(11) (11) (15) (15)+(11) (11) (15) 

(21) Ind. Alloc. (2nd part) Step 8 ............................ ........................................ See (20) ......................... 0.81 29.62 0.29 0.10 0.19 0.26 0.11 0.15 (22) Indirect Allocator 

(1st+2nd).

Step 8 ............................ ........................................ =(19)+(21) ...................... 1.37 32.70 0.73 0.54 0.19 0.47 0.32 0.15 

(23) Indirect Adjustment 

(Ind Adj).

Steps 9–11 .................... See footnote 2 ................ ........................................ 0.362 0.362 0.362 0.362 0.362 0.362 0.362 0.362 

(24) Adjusted Indirect Allocator. Steps 9–11 .................... =Ind Alloc * Ind Adj ........ ........................................ 0.50 11.84 0.26 0.19 0.07 0.17 0.12 0.05 (25) Ind. Practice Cost 

Index (PCI).

Steps 12–16 .................. See Steps 12–16 ........... ........................................ 0.968 0.942 1.054 1.054 1.054 1.280 1.280 1.280 

(26) Adjusted Indirect ..... Step 17 .......................... = Adj. Ind Alloc * PCI ..... =(24) * (25) ..................... 0.48 11.15 0.28 0.21 0.07 0.22 0.15 0.07 (27) PE RVU ................... Steps 18–19 .................. =(Adj Dir+Adj Ind) * budn =((14)+(26)) * budn ........ 0.77 12.64 0.58 0.51 0.07 0.35 0.28 0.07 

1The direct adj = [current pe rvus * CF * avg dir pct] / [sum direct inputs] = [Step 2] / [Step 3]. 2The indirect adj = [current pe rvus * avg ind pct] / [sum of ind allocators] = [Step 9] / [Step 10. 


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66232 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

Comments Related to PE Methodology 

Comment: Several commenters 

recommend that the unadjusted work 

RVUs be used in the allocation of the 

indirect PE RVUs. 

Response: The decision to use the 

budget neutralized work RVUs in the 

calculation of indirect PEs appropriately 

maintains the current relationships 

between the work, PE, and professional 

liability payments. We also believe it is 

important to apply the revised, budget 

neutralized work RVUs consistently 

within the PFS framework. It would not 

be consistent to apply one set of work 

RVUs for work payments, but a different 

set for purposes of calculating indirect 

PEs. Therefore, we will base the 

calculation of both the work payments 

and the indirect PE payments on the 

adjusted work RVUs, and maintain the 

current overall relationships between 

work, PE, and professional liability. The 

PE RVUs in Addendum B and 

throughout the rest of this rule reflect 

this policy. 

Comment: Several commenters 

commended CMS on the bottom up 

approach to calculating resource based 

PE RVUs. Commenters expressed 

gratitude for the transparency and 

straight forward nature of the revised 

methodology. 

Response: We appreciate the support 

for the revised bottom up practice 

methodology and agree that the bottom 

up methodology is a more straight 

forward methodology then its 

predecessor. 

Comment: Some commenters contend 

that the approach of basing PE 

calculations on the weighted average of 

all specialties furnishing a service is 

flawed and should be replaced with an 

approach that bases the specialty 

weighted factors upon specialties that 

represent 95 percent of the total 

utilization of each respective service. 

Response: This issue was fully 

addressed in the comment and response 

section of the CY 2007 PFS final rule 

with comment period (71 FR 69641), 

and we did not make any further 

proposals relating to this policy in the 

CY 2008 PFS proposed rule. Thus, these 

comments are outside the scope of the 

CY 2008 PFS proposed rule. 

Comment: One commenter stated that 

the use of direct PEs in the allocation of 

indirect PEs unfairly penalizes PC only 

billers that do not have any direct costs. 

Additionally, this commenter contends 

that the use of only the work RVU in the 

allocation of indirect PEs for this 

situation underestimates the indirect 

PEs for PC only billers. 

Response: The resource-based PE 

methodology uses both the work RVU 

and the direct cost PE RVU in the 

allocation of indirect PEs. For PC only 

billers, which do not have any direct 

costs, indirect costs will only be 

allocated based upon the work RVUs. 

There is no provision within the current 

methodology to allocate the indirect PEs 

differently, and we made no proposals 

in the CY 2008 PFS proposed rule 

regarding this allocation. Additionally, 

we note that a review of comments on 

past regulations confirms that the 

physician community believes that the 

work RVUs ‘‘over allocate’’ the indirect 

PEs. Thus, there appear to be differing 

views regarding the effect of this 

allocation. We will continue to allocate 

the indirect PEs of PC only services on 

the work RVUs. 

Comment: One commenter 

recommended that, for procedures that 

have supply costs in excess of 40 to 50 

percent of total direct costs, all supply 

costs be passed through and exempt 

from the direct adjustment factor. 

Response: The resource-based PE 

methodology converts the direct costs 

for a service, obtained from the direct 

cost database, into PE RVUs by 

comparing the service specific aggregate 

costs to the aggregate pool of costs 

available for expenditure on direct 

costs. Because the aggregate direct costs 

for all services contained in the direct 

cost database exceed the aggregate pool 

of available direct dollars, a direct cost 

adjustment must be applied to scale the 

database to the pool. Irrespective of the 

percentage of total direct costs for a 

specific service represented by supplies, 

this adjustment will still be applied. If 

this adjustment were not applied to 

certain services, the system would 

either not be budget neutral or RVUs for 

all other services would have to be 

reduced to offset these exemptions. We 

did not make any proposals relating to 

this adjustment. Moreover, we see no 

methodological reason to exempt any 

services regardless of the percentage of 

their direct costs represented by 

supplies from the adjustments that 

apply to all direct costs. 

g. Discussion of Equipment Usage 

Percentage 

In the CY 2008 PFS proposed rule (72 

FR 38132), we included a discussion 

about our use of the equipment usage 

assumption of 50 percent, and stated 

that we continue to receive requests that 

we refine this usage percentage. Some 

groups and individuals state that this 

usage percentage should be in the range 

of 70 to 80 percent while others contend 

that the current utilization rate is too 

high at 50 percent and should be refined 

downward to a lower usage percentage. 

If the equipment usage percentage is 

set too high, the result would be 

insufficient allowance at the service 

level for the practice costs associated 

with equipment. If the equipment usage 

percentage is set too low, the result 

would be an excessive allowance for the 

PE costs of equipment at the service 

level. Although we acknowledged the 

50 percent across the board usage rate 

that we currently apply for all 

equipment does not capture the actual 

usage rates for all equipment, we 

indicated we do not believe that we 

have sufficient empirical evidence to 

justify an alternative proposal on this 

issue. Therefore, we requested that 

commenters submit information relating 

to alternative percentages and 

approaches that differentially classify 

equipment into mutually exclusive 

categories with category specific usage 

rate assumptions. In addition, we 

requested any empirical data that would 

assist us in these efforts. 

h. Equipment Interest Rate 

As part of our calculation of the PE 

equipment costs, we consider several 

factors, for example, the useful life of 

each piece of equipment and the typical 

interest that would be incurred in the 

purchase of the equipment. We updated 

the assigned useful life for all the 

equipment in our PE input database in 

the CY 2005 PFS final rule with 

comment period. However, we have 

used the same interest rate of 11 percent 

since the inception of the resource 

based PE methodology in 1999. There 

has been much discussion regarding 

whether this is still the appropriate 

interest rate to utilize in the calculation 

of the equipment costs. The majority of 

comments on the CY 2007 PFS final rule 

with comment period requested an 

interest rate of prime plus 2 percent 

while a small number of commenters 

requested an interest rate significantly 

lower than prime plus 2 percent. 

In the CY 2008 PFS proposed rule (72 

FR 38132), we discussed the basis for 

the current interest rate of 11 percent 

and indicated that, based on our 

analysis of the revised SBA interest rate 

data, we believe 11 percent continues to 

be an appropriate assumption; therefore, 

we stated would retain the interest rate 

used in the calculation of equipment 

costs at 11 percent. 

Comments Concerning Equipment 

Usage and Interest Rate 

Comment: Several commenters, 

including several specialty societies, 

MedPAC, and the AMA RUC offered 

recommendations regarding the 11 

percent interest rate and the 50 percent 

utilization rate used to calculate the 


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price per minute for each piece of 

equipment. The recommendations 

received regarding the proposed 11 

percent interest rate were generally 

favorable with the majority of 

commenters recommending that we 

monitor the interest rate annually to 

ensure that the appropriate percentage 

is utilized in the calculation of the 

equipment costs. 

The commenters’ recommendations 

about making adjustments to the 50 

percent utilization rate varied. Certain 

commenters recommended we do 

nothing until stronger empirical 

evidence is available, while other 

commenters recommended a decrease in 

the utilization assumptions, and some 

commenters recommended an increase 

in the utilization assumption. The 

particular changes recommended in the 

utilization assumptions were, in most 

cases, directly related to a specific code. 

Virtually all comments received support 

an on going process of obtaining reliable 

empirical data to utilize in the 

calculation of equipment costs in the 

future. 

Response: As discussed in detail in 

the CY 2007 PFS final rule with 

comment period (71 FR 69650), we 

agree with commenters that both the 

equipment interest rate and the 

equipment utilization rate should 

continue to be examined for accuracy. 

We are committed to working with all 

interested parties to define the most 

accurate utilization and interest rate 

information for equipment used in the 

provision of physicians’ services. Since 

we did not propose a specific change, 

we will maintain the assumptions of a 

50-percent equipment utilization rate 

and an 11-percent equipment interest 

rate in the calculation of the PE RVUs 

published in Addendum B of this final 

rule with comment period. We will 

continue to monitor the appropriateness 

of these assumptions, and evaluate 

whether changes should be proposed in 

light of the data available. 

Comment: A few commenters 

recommended that the equipment 

utilization rate associated with 

preventive services be reduced since 

much of the equipment associated with 

preventive services is procedure specific 

and thus not utilized at as high a rate 

as other medical equipment. 

Response: Similar to our response 

regarding the equipment utilization rate 

associated with the entire universe of 

medical equipment, we do not believe 

that we have any strong empirical 

evidence to suggest a change in the 

current equipment utilization rate 

associated with preventive services. We 

are committed to continue working with 

all interested parties to identify the most 

accurate utilization rate information for 

equipment used in the provision of 

physicians’ services. 

2. PE Proposals for CY 2008 

a. Radiology Practice Expense Per Hour 

The American College of Radiology 

(ACR) presented CMS with information 

regarding the PE/HR that was used in 

the PE methodology for radiology in the 

CY 2007 PFS final rule with comment 

period. ACR suggested that we change 

our methodology in a way that would 

weight the survey data to provide an 

alternative method of representing large 

and small practices. We agreed to take 

their approach to our contractor, the 

Lewin Group, for further analysis. (We 

note that the Lewin Group, in its initial 

analysis of the ACR survey data, had 

also raised concerns about the 

representation of small high cost entities 

in the ACR survey data.) The Lewin 

Group reviewed ACR’s approach and 

concluded that weighting the ACR 

survey by practice size more 

appropriately accounts for the small 

high cost entities in the final PE/HR. 

After reviewing both the ACR inquiry 

and the Lewin response, we also agreed 

that ACR’s approach more appropriately 

identifies the PE/HR for radiology. 

For these reasons, we proposed to 

revise the PE/HR associated with 

radiology using the survey data 

weighted by practice size and included 

this revised PE/HR in Table 2 of the CY 

2008 PFS proposed rule which 

identified the PE/HR for all specialties. 

Comment: Several commenters, 

including the AMA’s RUC, expressed 

concern over the proposed increase in 

the PE/HR for radiology whereby the 

PE/HR associated with this specialty 

would be developed based upon a 

revised practice size weighting 

methodology. Commenters believed that 

it is inappropriate to refine the current 

weighting methodology because: (1) 

This weighting methodology was not 

done for all specialties; and (2) some 

specialties requested to survey their 

memberships after the deadline to 

submit supplemental survey data and 

were denied this opportunity by CMS. 

Several other commenters commended 

CMS on their ability to review this 

potential problem and offer a timely 

resolution to the affected specialty. 

Response: The American College of 

Radiology approached CMS with 

questions regarding the weighting 

methodology that were used in the 

development of their PE/HR. 

Specifically, ACR believed that small 

high cost practices that primarily 

furnish professional only services were 

severely underrepresented in the 

published PE/HR. Therefore, we 

forwarded ACR’s concerns to our 

contractor for further review. Upon 

review of ACR’s concerns, our 

contractor concluded that their initial 

PE/HR recommendation to CMS was not 

fully representative of these smaller 

high cost practices. For this reason, our 

contractor recommended a revised 

weighting approach that would fairly 

represent these small high cost 

practices. We agree with both the ACR 

and our contractor and will finalize our 

proposal to use the revised PE/HR for 

radiology. 

Additionally, we do not believe that 

these revisions to the PE/HR for 

radiology constitute a submission of 

data after the deadline. No new data 

were submitted. Rather, we view this as 

a revision to the weighting methodology 

in order to address a unique situation. 

Comment: Several commenters 

recommended that all pain management 

services be crosswalked to the 

interventional pain management 

specialty as opposed to using the actual 

data which currently report the 

anesthesiology specialty furnishing a 

significant portion of the pain 

management services. According to the 

comments received, anesthesiology is 

listed as the primary specialty on many 

pain management services and since the 

PE/HR associated with anesthesiology is 

lower than interventional pain 

management, pain management services 

are being inappropriately valued. 

Response: Physicians self-designate 

their respective specialty for purposes of 

Medicare enrollment. If commenters 

believe that physicians are incorrectly 

self-designating their specialty as 

anesthesiology when it would be more 

appropriate for them to designate 

interventional pain management, 

commenters should work with their 

respective specialty organizations to 

ensure physicians appropriately 

designate the correct specialty. If the 

specialty of a certain percentage of the 

physicians furnishing the pain 

management service is actually 

anesthesiology, we believe that 

weighting the various 

PE/HR for all specialties that furnish 

these services, as we currently do, is the 

appropriate methodology to establish 

the final PE/HR for pain management 

services. 

Comment: One commenter 

recommends that only the PE/HR 

associated with ophthalmology be used 

in the establishment of RVUs for CPT 

code 66984, Extracapsular cataract 

removal with insertion of intraocular 

lens prosthesis (one stage procedure), 

manual or mechanical technique (e.g., 

irrigation and aspiration or 


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phacoemulsification). The commenter 

contends that the 14 percent of the 

utilization that is associated with 

optometry is in error as optometrist 

would only be involved in the postoperative care of these patients and not 

the surgical procedure. 

Response: Although we did not make 

any proposals in the CY 2008 PFS 

proposed rule regarding this issue, we 

agree that, generally, optometrists will 

not be involved in the surgical 

procedure. As stated by the commenter, 

and supported by the utilization data, 

there are a significant number of 

services for which optometrists are 

involved in the post-operative care of 

CPT code 66984. The resource-based PE 

methodology appropriately adjusts for 

those services identified with modifier 

55 (post-operative care only). Since 

there are PEs associated with the postoperative care of CPT code 66984, and 

since we adjust the utilization for those 

services that are identified as the postoperative care only of CPT code 66984, 

we believe the current methodology 

appropriately reflects the correct 

weighted specialty mix associated with 

this service. 

Comment: One commenter 

recommended that the PE/HR for CPT 

codes 22862, Revision including 

replacement of total disc arthroplasty 

(artificial disc) anterior approach, 

lumbar, single interspace, and 22865, 

Removal of total disc arthroplasty 

(artificial disc) anterior approach, 

lumbar, single interspace, be 

crosswalked to orthopedic surgery as 

opposed to the all physician PE/HR. The 

commenter contended this is similar to 

the crosswalk change from all 

physicians to orthopedic surgery that 

was reflected in the PE methodology in 

the proposed rule for CPT code 22857, 

Total disc arthroplasty (artificial disc), 

anterior approach, including 

discectomy to prepare interspace (other 

than for decompression), lumbar, single 

interspace. 

Response: CPT codes 22862 and 

22865 were new for CY 2007 and absent 

specific information with respect to the 

specialty performing the services, we 

had crosswalked these codes to the all 

physician PE/HR. We agree with the 

commenter that these codes are of a 

similar nature to CPT code 22857. They 

are part of the same orthopedic family 

of codes and should be treated 

consistently when applying the PE 

methodology. Therefore, we will assign 

the orthopedic surgery PE/HR to CPT 

codes 22862 and 22865 as opposed to 

the all physician PE/HR. 

Comment: Several commenters 

conveyed support for the Physician 

Practice Information Survey which is 

currently being administered 

throughout the nation and encouraged 

CMS to use this practice cost 

information to update the current 

PE/HR data that is being utilized in the 

development of resourced-based PE 

RVUs. 

Response: The Physician Practice 

Information Survey is a practice cost 

survey that is being conducted by the 

AMA with support from various 

specialty societies and CMS. We look 

forward to analyzing the results of the 

AMA data collection efforts for possible 

inclusion in the resource-based PE 

methodology in future rulemaking 

cycles. 

b. RUC Recommendations for Direct PE 

Inputs and Other PE Input Issues 

In the CY 2008 PFS proposed rule (72 

FR 38133), we proposed the following 

concerning direct PE inputs. 

(i) RUC Recommendations 

In 2004, the AMA’s Relative Value 

Update Committee (RUC) established a 

new committee, the Practice Expense 

Review Committee (PERC), to assist the 

RUC in recommending direct PE inputs 

(clinical staff, supplies, and equipment) 

for new and existing CPT codes, a 

process that was previously 

accomplished by the Practice Expense 

Advisory Committee (PEAC). 

The PERC reviewed the PE inputs for 

nearly 300 existing codes at its meetings 

held in February 2007 and April 2007. 

(A list of these reviewed codes can be 

found in Addendum C of the CY 2008 

PFS proposed rule.) 

In the CY 2007 PFS final rule with 

comment period, we addressed several 

issues concerning direct PE inputs and 

encouraged specialty societies to pursue 

further review of these inputs through 

the RUC/PERC process. The following 

discussions summarize the PERC 

recommendations regarding these 

issues: 

Cardiac Catheterization Procedures 

As discussed in the CY 2008 PFS 

proposed rule, the PERC considered 

recommendations for new or updated 

PE inputs for the family of CPT codes 

93501 through 93556 for cardiac 

catheterization. The American College 

of Cardiology (ACC), in cooperation 

with the Society of Cardiac Angiography 

and Interventions (SCA&I) and the 

Cardiovascular Outpatient Center 

Alliance (COCA), developed PE inputs 

for the nonfacility setting for 13 of the 

28 CPT codes in this family. 

We proposed to accept the PERC 

recommendations for the direct PE 

inputs for the nonfacility setting for the 

CPT codes 93501, 93505, 93508, 93510, 

93526, 93539, 93540, 93542, 93543, 

93544, 93545, 93555, and 93556. 

In addition, we proposed that the PE 

for the following CPT codes will not be 

valued or applicable to the nonfacility 

setting: 93503, 93511, 93514, 93524, 

93527, 93528, 93529, 93530, 93531, 

93532, 93533, 93561, 93562, 93571, and 

93572. 

Comment: We received comments 

from the ACC and the SCA&I thanking 

us for our consideration of the PERC 

recommendations for 13 CPT codes for 

cardiac catheterization procedures 

performed in the nonfacility setting and 

for accepting their request not to 

establish nonfacility PE RVUs for the 

remaining 15 procedures in the cardiac 

catheterization family. 

Response: We appreciate the 

commenters’ support and have accepted 

the PERC recommendations for the 13 

cardiac catheterization procedures and 

have changed our PE database to reflect 

the PE inputs. For the 15 remaining 

codes, we will finalize the proposal and 

attach the ‘‘NA’’ indicator to them. 

Comment: We received comments 

from COCA, a national organization 

representing nonfacility medical 

cardiology practices that conducted a 

‘‘Direct Cost Study’’ purporting to 

demonstrate that the major problem 

with the 2006 RUC estimates of direct 

PE costs for nonfacility outpatient 

cardiac catheterization was an 

inadequate list of direct patient care 

activities. In addition, COCA contends 

that the total RUC estimates of clinical 

labor time were so low as to lack 

credibility. The commenter contends 

that a significant amount of the data 

from its Direct Cost Study were not 

incorporated into the PE 

recommendations that were jointly 

prepared and presented at the April 

2007 RUC meeting with ACC and SCA&I 

for the cardiac catheterization 

procedures. In addition to the 

inadequate clinical labor inputs, the 

commenter believes that the RUC 

process does not allow for the inclusion 

of safety devices, such as crash carts, as 

direct PE inputs because these are not 

used in the typical case; rather, these are 

considered indirect PE. COCA has 

requested that we review the data from 

the Direct Cost Study and revise the 

current proposed PE RVUs for these 

procedures to values that reflect more 

appropriately the direct and indirect 

costs of providing these services. As an 

alternative solution, COCA asks that we 

tie reimbursement for these services to 

a reasonable percentage of the hospital 

APC. 

We also heard from many cardiology 

practices that provide cardiac 

catheterizations in the nonfacility 


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setting. They had similar comments and 

indicated their support for COCA’s 

request that we review the cost study 

data and revise the PE RVUs to more 

appropriately value the cardiac 

catheterization procedures when 

performed in the nonfacility setting. 

Response: While we understand 

COCA’s and the other commenters’

concerns about the decrease in the PE 

RVUs for the cardiac catheterization 

procedures, we want to clarify that the 

PE inputs for these procedures were 

fully considered by the RUC process. 

The RUC has identified standard 

descriptions of clinical staff activities 

that the specialty societies follow as 

they prepare their recommendations for 

direct PE inputs believed to be typical 

to a service and the RUC has established 

standard values for some of these 

clinical activities. The RUC does not 

deviate from accepted standard unless 

the specialty society presents 

compelling evidence to substantiate that 

the variance is typical to the practice for 

each procedure. In the past, the RUC has 

recommended, and we agreed, that the 

crash cart would be included as 

equipment necessary to perform the 

services of cardiopulmonary 

resuscitation, CPT 92950, but is not 

necessary to perform other services, 

even though many physicians have 

purchased and maintain crash carts as 

part of their medical practices. Since the 

crash cart is only specified as required 

for use in CPT 92950, it is considered 

as indirect PE for all other procedures. 

We note that COCA’s request in the 

alternative to make payment for these 

procedures based on a percentage of the 

OPPS APC is not feasible. The PFS and 

the OPPS APC payment amounts are 

determined by different payment 

methodologies that are specified in the 

statute. We rely on the RUC process to 

assist us in establishing the typical PE 

inputs that are necessary to provide 

physician services. This is because the 

specialty-developed PE 

recommendations that are presented to 

the RUC are all subject to the same 

multi-specialty scrutiny. We agree with 

the PERC’s direct PE recommendations 

for the 13 cardiac catheterization codes 

in the nonfacility setting and we will 

accept the RUC PE recommendations for 

these 13 procedures. However, we are 

sympathetic to the concerns raised by 

COCA and echoed by other commenters 

about the extent to which the data from 

the Direct Cost Study were considered 

in the RUC process and we ask that the 

RUC provide another opportunity for 

the review of the direct PE inputs for 

these cardiac catheterization procedures 

to ensure that the data from the COCA 

Direct Cost Study is afforded 

appropriate and adequate consideration. 

Obstetric/Gynecologic PE 

As discussed in the CY 2008 PFS 

proposed rule, we agreed with the PERC 

recommendation to add a non-sterile 

sheet (drape) 40 in by 60 in (supply 

code SB006) priced at $0.222 to the 

pelvic exam pack resulting in the new 

price of $1.172. This change affected 

236 CPT codes for obstetric/gynecologic 

services containing the pelvic exam 

pack. We also proposed to accept the 

PERC recommendations to standardize 

the equipment used in post-operative 

visits to include both a power table and 

fiberoptic light in the PE database for 70 

obstetric/gynecologic codes. 

Comment: We received a comment 

from the society representing 

gynecologic oncologists commending us 

for making the above changes to the 

pelvic exam pack and for standardizing 

the equipment used in follow-up visits. 

The society believes these changes 

enable gynecologic oncologists to 

account for the additional costs incurred 

in their practice specialty. 

Response: We appreciate the specialty 

society’s comments and we will adopt 

the PERC recommended inputs as 

proposed. 

Dual Energy X-Ray Absorptiometry 

(DEXA) 

The PERC recommended revisions to 

the direct PE inputs for CPT codes 

77080, 77081, and 77082 to comply 

with established PERC standards, and 

more appropriately reflect the resources 

used to furnish these services. We 

agreed with these PERC 

recommendations. 

Comment: We received several 

comments thanking us for accepting the 

RUC’s PE recommendations for the 

DEXA codes. We also received 

comments from several device 

manufacturers and specialty societies 

representing gynecologists, 

endocrinologists, rheumatologists, and 

radiologists informing us that the PE 

recommendations passed by the RUC, 

which we had proposed to accept in the 

proposed rule, contained a mistake as to 

the correct DEXA equipment that is 

typically used to perform the procedure 

represented by CPT code 77080. The 

RUC’s PE recommendations listed the 

DEXA equipment as that using a ‘‘pencil 

beam’’ technology, priced at $41,000. 

However, the correct DEXA equipment 

used for CPT 77080 uses the ‘‘fan-beam’’

technology and is priced at $85,000. 

Response: We were sympathetic to the 

concerns expressed by the commenters 

about the listing of the incorrect DEXA 

equipment, and we worked with the 

RUC staff to arrange for this equipment 

error to be reconsidered by the RUC at 

its September 2007 meeting. The RUC 

agreed to the specialty society’s 

recommended change in the DXA 

equipment for CPT 77080. We agree 

with the recommendations from the 

specialty societies and the RUC and we 

have corrected our PE database to reflect 

that the fan-beam DEXA equipment is 

typically used for CPT 77080. In 

addition, a price of $3,000, with 

documentation, was presented for the 

spinal phantom used in this procedure. 

We have also accepted this price and 

have changed the PE database 

accordingly. 

Comment: We received many 

comments expressing concerns about 

the cuts to the PE RVUs for these DEXA 

services. These commenters believe the 

cuts are a result of the new PE 

methodology and may result in access 

problems for patients because 

physicians will no longer be able to 

afford to provide these services in the 

office setting. One commenter asked us 

to identify and make available to the 

public the inputs used to derive the 

indirect PE RVUs. 

Response: We are aware that the PE 

RVUs for these DEXA services were 

negatively impacted by the change in 

the PE methodology, as were those for 

many other services in which the 

previous PE RVUs were not based on 

the PE resources used to furnish the 

service. Because the new PE 

methodology now utilizes these 

resources, it is important to make 

certain that the PE direct inputs actually 

reflect the typical resources that are 

used to provide each service. The 

methodology for determining the 

indirect PE RVUs, including a 

description of each step in the 

calculation, is detailed earlier in this 

section. We share the commenters 

concerns about beneficiary access to 

DEXA services and will continue to 

monitor this issue. 

Computer-Aided Detection (CAD) Codes 

The specialty society for radiological 

services reviewed the direct inputs for 

CPT codes 77051 and 77052 and 

recommended that no changes to the PE 

inputs were needed. The PERC 

concurred with this decision and we are 

in agreement. 

Comment: We received a comment 

from the society representing 

radiologists conveying their 

appreciation for accepting the 

unchanged direct PE inputs for CAD 

services. 

Response: We appreciate the 

commenter’s support and will maintain 

the PE inputs as proposed. 


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Nuclear Medicine Services 

The specialty society representing 

nuclear medicine and the PERC 

recommended that the direct PE inputs 

for 2 CPT codes contained CPEP inputs 

and needed to be updated to agree with 

2004 PEAC-approved inputs. However, 

in reviewing the PE database, we 

discovered that there were 4 other 

related codes which also had CPEP 

inputs which should be updated. We 

made the appropriate adjustments to 

substitute the PEAC inputs for the CPEP 

for CPT codes 78600, 78607, 78206, 

78647, 78803 and 78807. 

The specialty society also noted that 

for 7 CPT codes, revision of x-ray 

related supplies was required, including 

the number of x-ray films, developer 

solution, and film jackets. The PERC 

forwarded these recommendations and 

we made the appropriate changes to the 

PE database for the following CPT 

codes: 78600, 78601, 78605, 78606, 

78607, 78610 and 78615. 

Comment: The specialty society 

representing nuclear medicine 

expressed appreciation for acceptance of 

their recommended inputs and 

indicated it will continue to monitor the 

nuclear medicine codes and provide 

inputs and refinements as necessary and 

appropriate. 

Response: We appreciate the specialty 

society’s comments and we will adopt 

the PERC recommended inputs as 

proposed. 

Transcatheter Placement of Stent(s) 

At the request of the specialty 

societies representing radiology and 

interventional radiology, the PERC 

considered and approved direct PE 

inputs for the nonfacility setting for 3 

CPT codes, 37205, 37206, and 75960, for 

transcatheter placement of stent(s). 

Among the supplies, a ‘‘vascular stent 

deployment system’’, valued at $1,645, 

was noted by the society as the typical 

stent used for CPT codes 37205 and 

37206 requiring 2 such stents for the 

placement in the initial vessel and 1 

stent for each subsequent vessel, 

respectively. We reviewed a published 

clinical research study that was 

forwarded by the specialty society. The 

study indicated that 1 stent was typical 

for the procedure of CPT code 37205. As 

discussed in the CY 2008 PFS proposed 

rule (72 FR 38134), absent any further 

verification from the specialty, we 

included only 1 stent in the PE database 

for this code. 

Comment: Commenters, representing 

specialty societies for radiology, 

interventional radiology and vascular 

surgery appreciated the proposal 

assigning direct PE inputs for the 

nonfacility setting for these three CPT 

codes. However, these commenters 

expressed concern that the number of 

stents had been reduced. One 

commenter agreed that two stents may 

not be typical but requested guidance on 

how the cost of the additional stent 

could be billed; another of the 

commenters asked that we reconsider 

this decision or at a minimum include 

the ‘‘average’’ of 1.5 stents. One of the 

commenters also noted that several 

studies clearly establish that these 

peripheral stent services are safely 

performed in the nonfacility 

environment, with nearly all of the 

procedures in the studies resulting in 

short observation stays, typically of less 

than 4 hours. 

Response: Based on a review of the 

literature and other information 

provided by the commenters we will 

revise the PE database for CPT code 

37205 to reflect 1.5 stents. 

Comment: Two commenters, 

representing manufacturers, expressly 

urged us to consider the safety issues 

surrounding the proposal to value these 

procedures in the nonfacility setting and 

believe that this conflicts with the 

decision to exclude these procedures 

from the ambulatory surgical center 

(ASC) list. One of these commenters 

acknowledged that, while we have no 

specific policy to identify which 

procedures can be safely performed in a 

physician’s office, we do have some 

safety standards for ASCs. The 

commenter requested that the ASC 

standards be extended to the physician 

office. This commenter also referenced 

studies that demonstrate complications 

can be associated with these procedures, 

and suggested that these risks need to be 

addressed by appropriate safety or 

quality standards. 

Response: We appreciate the 

commenters’ viewpoint. However, as 

the commenters acknowledged, we have 

no established policy to designate 

procedures that can be ‘‘safely’’

performed in the physician office 

setting. The purpose of the PFS is to 

establish proper payment for procedures 

furnished by physicians and other 

health professionals. Several medical 

specialty societies recommended the 

valuation of these services in the 

nonfacility setting, which suggests to us 

that these procedures are being 

furnished in nonfacility settings on a 

regular basis. These societies provided 

the recommended PE inputs involved in 

furnishing the typical service in a 

nonfacility setting, and these inputs 

were reviewed, accepted and 

recommended by the RUC. We also note 

that, as indicated in the previous 

comment, one commenter provided 

literature from studies to support that 

these services are safely performed in 

the nonfacility environment. Because it 

appears these procedures are being 

furnished regularly in nonfacility 

settings, we believe it is appropriate to 

value them for payment in those 

settings. Therefore, we will value these 

procedures in the nonfacility setting as 

proposed. 

Comment: One commenter noted that 

payment for CPT code 75960, the 

supervision and interpretation service 

associated with the 2 CPT codes 

discussed above for the transcatheter 

placement of stent(s), is still shown as 

carrier-priced in the Addendum of the 

proposed rule. 

Response: We regret the error. The 

Addendum and PFS database have been 

corrected to reflect the appropriate 

RVUs. 

(ii) Remote Cardiac Event Monitoring 

In the CY 2007 PFS final rule with 

comment period, direct PE inputs for 

remote cardiac event monitoring (CEM) 

services represented by CPT codes 

93012, 93225, 93226, 93231, 93232, 

93270, 93271, 93733, and 93736 were 

revised on an interim basis to reflect the 

unique circumstances surrounding the 

provision of these services. Unlike most 

physicians’ services, CEM services are 

furnished primarily by specialized 

IDTFs that, due to the nature of CEM 

services, must operate on a 24/7 basis. 

The specialty group representing 

suppliers that furnish CEM services 

believes that these services require 

additional direct PE inputs, such as 

telephone line charges associated with 

trans-telephonic transmissions and fees 

associated with providing Web access 

for storage and transmission of clinical 

information to the patient’s physician. 

We continue to work with the specialty 

group regarding the specific direct PE 

inputs, as well as the components for 

the indirect PE allocation, based on 

surveys conducted by the specialty 

group. To clarify and further the results 

of our discussions with and information 

provided by, the specialty group, we 

requested comments in the CY 2008 PFS 

proposed rule on the appropriateness of 

the above-mentioned direct PE inputs. 

In addition, we invited comments on 

any additional direct inputs and 

components of the indirect PE 

allocations which would be appropriate 

for these services, along with supporting 

documentation to justify their inclusion 

for PE purposes. 

Comment: We received comments 

from medical societies, provider 

organizations and a device manufacturer 

thanking us for working with these 

organizations to develop direct PE for 


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these services that do not fit the typical 

physician service model. Several 

comments supported the specific PE 

proposals supplied by the specialty 

group representing providers that 

furnish CEM services, and urged us to 

adopt them. A medical society 

representing cardiologists requested to 

work with us and the remote CEM 

provider groups to gather and review 

any additional necessary data prior to 

adoption of additional direct PE inputs. 

The CEM provider group specifically 

proposed that we add telephone 

transmission costs to the direct PE 

inputs for CPT codes for CEM, 93012 

and 93271 and the CPT codes for 

pacemaker monitoring, 93733, and 

93736. The group also identified 

expenses for Web-based storage, 

maintenance and access to clinical 

information to be allocated to the CEM 

and pacemaker monitoring CPT codes, 

as well as the holter monitoring CPT 

codes 93226 and 93232. In addition to 

these supply PE recommendations, the 

CEM provider group proposed 

equipment time-in-use increases for the 

holter monitors, cardiac event monitors 

and for INR monitors (which are 

discussed later in this section). 

Response: We carefully reviewed the 

information supplied by all of the 

commenters and believe that it would 

be valuable for the commenters to work 

together, including the cardiology 

specialty society, before we establish 

further direct PE inputs for these cardiac 

monitoring services. In addition, we 

would like to make the CEM providers 

aware that it appears the assignment we 

made in CY 2007 of 43,200 time-in-use 

minutes for the looping CEM monitor 

used in CPT code 93271 (typically used 

for a 30-day period) pays back the cost 

of this CEM monitor, that is valued at 

$995, in less than 5 months, even 

though the CEM monitor has an 

established 4-year useful life. As we 

discuss later in the Prothrombin Time, 

International Normalized Ratio (PT/INR) 

section, we believe that the time-in-use 

assigned to any one device should not 

exceed its useful life. We will review 

this time-in-use assignment for CEM 

monitors during our CY 2009 

rulemaking. 

(iii) Prothrombin Time, International 

Normalized Ratio (PTI/NR) 

As discussed in the CY 2008 PFS 

proposed rule, based on comments 

received and subsequent discussions 

with entities that furnish these PT/INR 

services, we adjusted the time in use for 

the home monitor equipment for G0249 

Provision of test materials and 

equipment for home INR monitoring to 

patient with mechanical heart valve(s) 

who meets Medicare coverage criteria; 

includes provision of materials for use 

in the home and reporting pwiof 

[prothrombin] test results to physician; 

per four tests to 1440 minutes to reflect 

that the monitor is dedicated for use 24 

hours a day and unavailable for others 

receiving this service. We invited 

comments on this change, as well as 

comments on any additional direct 

inputs which would be appropriate to 

this service, along with supporting 

documentation to justify their inclusion 

for PE purposes. 

Comment: We received comments 

from specialty societies, provider 

groups, and individuals expressing their 

appreciation of our attempt to correct 

the problem concerning the application 

of PE methodology for the PT/INR 

service, but noted their concern that 

changing the INR home monitor time-inuse minutes from 32 to 1440 does not 

have a rational basis nor does it provide 

for an adequate recoupment of the cost 

of the device. These commenters 

requested that we assign a more realistic 

figure to capture the 28-day period that 

the patient is required to use the 

monitor. One commenter noted that 

using the current 1440 minutes, it 

would take 11.7 years to recoup the 

$2000 price of the equipment which has 

an assigned life of 4 years. The 

commenters suggested several 

alternative methodologies to calculate 

the time-in-use for the INR monitor. One 

method suggests multiplying the 1-day 

time, 1440 minutes, by 4, which 

represents the number of tests 

conducted in the 28-day period, to equal 

5,760 minutes. This method would take 

3 years to get back the $2000 value of 

the INR monitor. Another proposal 

suggests multiplying the 1-day 1440 

minutes by 28 days which is the actual 

time the patient has the equipment. This 

method yields 40,300 minutes and the 

commenter admittedly states this 

method greatly overestimates the value 

of the INR monitor because it would 

take just 5 months to recoup the $2000 

price. One commenter suggested that we 

simply amortize the price of the 

equipment, $2,000, over the useful life 

of 4 years. Another commenter’s 

suggestion uses the annual minutes 

figure of 150,000 that we use in our 

formula for deriving per minute 

equipment costs, and divides it by 28 

(days) to arrive at 5,753 minutes. This 

method recoups the INR monitor price 

in 3 years. 

Other commenters voiced concerns 

about the valuation of the INR home 

monitor and offered alternatives to 

capture the cost of the device. One 

commenter suggested that we treat the 

cost of the INR home monitor as a onetime upfront cost and include this price 

in HCPCS code G0248 that is used to 

report the demonstration of the INR 

monitor to the patient, at the initial use. 

Another commenter recommended that 

the INR home monitor be removed from 

the PE for both G0248 and G0249 and 

be considered under the DME benefit. 

Response: We understand the 

concerns expressed by the commenters 

and appreciate their suggested 

alternatives that we could use to more 

appropriately cover the costs of the INR 

home monitor. Further, we agree that 

the 1440 minutes we assigned for CY 

2007 seems too low considering that the 

patient uses the INR home monitor for 

28 days, not just one. After reviewing all 

of the suggested alternatives, we 

eliminated the two proposals asking us 

to change the mechanism of payment for 

the INR home monitor. We, therefore, 

considered the various suggestions for 

establishing a more appropriate time-inuse value for the INR home monitor. We 

believe the proposal that best reflects 

the policy we use to determine the timein-use for equipment items where the 

actual minutes-in-use exceed the 

assigned useful life is the commenter’s 

suggestion to amortize the $2000 INR 

monitor over its 4-year life. Using this 

method, 4,315 minutes is the necessary 

time-in-use figure to recover the 

purchase price of the equipment in 4 

years. We will replace the 1440 minutes 

assigned for CY 2007 with 4,315 

minutes as the time-in-use for the INR 

home monitor and will change the PE 

database accordingly. 

(iv) Positron Emission Tomography 

(PET) Codes Clinical Labor Time 

We received comments from the 

specialty society representing nuclear 

medicine regarding a discrepancy in the 

clinical labor time for CPT codes 78811, 

78812, and 78813 which are PET codes 

for tumor imaging. The specialty noted 

that the clinical labor time indicated in 

the PE database differs by 7 minutes 

from the time that was previously 

recommended by the PERC in April 

2004. We agreed with the specialty 

society that the PE database labor inputs 

for these 3 PET codes are incorrect and 

we made the appropriate adjustments to 

the PE database. 

Comment: The specialty society 

representing nuclear medicine 

expressed appreciation for acceptance of 

its recommended inputs and indicated 

it will continue to monitor the nuclear 

medicine codes and provide inputs and 

refinements as necessary and 

appropriate. 

Response: We thank the specialty 

society for reviewing the direct inputs 

for their related procedures in the PE 


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database that we post as a download 

with each proposed and final rule on 

our Web site (www.cms.hhs.gov/ 

PhysicianFeeSchedule/PFSFRN). We 

will adopt the recommended inputs as 

proposed. 

(v) Nuclear Medicine PE Supplies 

The specialty society representing 

nuclear medicine commented that the 

PE database currently contains supply 

items that are inappropriate for certain 

procedures and provided the 

information to make the corrections. For 

respiratory imaging procedures 

represented by CPT codes 78587, 78591, 

78593, 78594, 78630, 78660, 78291, and 

78195, the specialty society noted 

specific IV supply items to be deleted 

from procedures where they are not 

required. For a thyroid imaging 

procedure represented by CPT code 

78020, x-ray supply items were 

recommended for deletion. In addition, 

the society recommended adding supply 

items for respiratory imaging 

procedures, including nose clips, masks, 

and nebulizer kits, as appropriate, to 

CPT codes 78584, 78585, 78591, 78593, 

78594, 78586, 78587, 78588, and 78596. 

For a kidney function study represented 

by CPT code 78725, injection supply 

items were noted as missing and the 

specialty society requested that these be 

added. We proposed to accept these 

direct PE input corrections and revised 

our PE database accordingly. 

Comment: The specialty society 

voiced its gratitude for the acceptance of 

their recommended inputs. 

Response: We thank the specialty 

society for its interest in assuring the 

accuracy of the PE inputs in the 

procedures provided by their members. 

We will adopt the PERC recommended 

inputs as proposed. 

(vi) Arthroscopic Procedure Nonfacility 

Inputs 

In the CY 2008 PFS proposed rule (72 

FR 38135), we included a discussion 

about the establishment of nonfacility 

direct PE inputs for the arthroscopic 

procedures represented by CPT codes 

29805, 29830, 29840, 29870, and 29900. 

Absent specific recommendations from 

the RUC and because some physicians 

are already performing these procedures 

in the office setting, we specifically 

requested comments regarding the 

appropriateness of establishing 

nonfacility PE inputs for these 

arthroscopic procedures when they are 

provided in the office setting. We also 

invited comments as to the specific 

direct PE inputs, following the RUC 

approved standardized format, that are 

typical in the provision of each above 

listed arthroscopic procedure furnished 

in the physician’s office. We indicated 

we will review these comments to 

determine whether or not it is 

appropriate to propose on an interim 

basis PE inputs for these codes in the 

nonfacility setting in our final rule. 

Comment: We received comments 

from the specialty society representing 

orthopedic surgeons in opposition to the 

establishment of nonfacility PE for the 

arthroscopic procedures because they 

believe these procedures are not safely 

performed in the office setting. The 

specialty society indicated that one of 

these codes, CPT 29900, Arthroscopy, 

metacarpophalangeal joint, diagnostic, 

includes synovial biopsy, was surveyed 

by the RUC in April 2001 and, at that 

time, the RUC recommended this 

service only as a facility-based 

procedure. The RUC supported the 

AAOS concerns and recommended that 

the PE RVUs for the nonfacility setting 

remain designated as ‘‘NA.’’ The 

specialty society believes that if the 

arthroscopic procedures were valued in 

the nonfacility setting, untrained 

physicians may begin to perform them 

and, as a result, patients will face 

significant risks. The specialty society 

believes that only credentialed 

physicians should perform these 

procedures and that this process can 

only be ensured in the facility-based 

setting. The specialty society also 

asserts the facility-based setting is the 

safest setting for these procedures 

because it affords the physician more 

clinical options for dealing with any 

complications that may arise. In 

addition, if the procedure is furnished 

in the nonfacility setting, there would 

be no way to address any treatable 

lesion that is found and a patient would 

need to be seen in the facility setting to 

undergo a second procedure. 

Because the specialty society’s 

position was established by an expert 

panel, the society states that it will 

reconsider its position if evidence is 

presented establishing the safety and 

efficacy of these procedures in the office 

setting and if a method is established to 

ensure that only qualified physicians 

perform these procedures in the office 

setting. 

We also received comments from 

orthopedic practices and individual 

physicians—the majority of which 

indicated they are members of the 

orthopedic specialty society—all stating 

that they are currently performing these 

procedures in the nonfacility setting. 

These comments requested that we 

establish PE inputs for the arthroscopic 

procedures because this would allow 

patients greater access to these services 

in more convenient settings and, 

because it would establish payment that 

would more fairly compensate them for 

the resources they use to provide these 

services in the office location. A product 

manufacturer supported the views of the 

physicians who requested the 

establishment of nonfacility PE for the 

nonfacility setting. 

These physicians note that the safety 

of the in-office procedures is well 

documented in the literature, and 

provided us with citations of articles 

going back to the mid-1990s. We also 

received suggested PE inputs including 

clinical labor, supplies and equipment 

that are typically used when these 

procedures are provided in the 

nonfacility setting. 

Response: We appreciate the concern 

expressed by the commenters opposing 

the establishment of PE for the office 

setting and are sympathetic to those 

supporting the assignment of PE for 

these codes. We are also dismayed that 

the parties involved on each side of this 

issue have not been able to resolve these 

issues to date. We have decided that the 

most prudent course of action is to defer 

proposing nonfacility inputs for these 

arthroscopic procedures in this final 

rule. We are hopeful that the specialty 

society and its physician colleagues 

who provide these services in the 

nonfacility setting will be able to 

discuss the issues of mutual concern 

regarding the safety of performing these 

procedures in the office setting. We are 

hopeful that this issue can be resolved 

and that the physicians performing 

these services in the nonfacility setting 

will be given the opportunity to have a 

multi-specialty review by the RUC. We 

are aware that this decision to refer this 

issue back to the specialty society and 

the RUC postpones the establishment of 

nonfacility PE values for these 

procedures until CY 2009, at the 

soonest, and that a review by the RUC 

process is not guaranteed. However, 

given the apparent level of dissension 

within the specialty, we believe that the 

specialty society, its physician 

colleagues, and the RUC should first be 

given an opportunity to resolve these 

important issues. 

(vii) Nonfacility Inputs for CPT Code 

52327 

As discussed in the CY 2008 PFS 

proposed rule we indicated that the 

society representing urologists 

requested that we remove all of the 

nonfacility PE inputs for CPT code 

52327, Cystourethroscopy (including 

ureteral catheterization); with 

subureteric injection of implant 

material. The specialty society reasoned 

that the nonfacility PE value is 

inappropriate since the procedure is 

never performed in the physician office; 


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it is specific to the pediatric population; 

and, as such, is always performed with 

general anesthesia. We agreed with the 

specialty society that this procedure is 

incorrectly valued for the nonfacility 

setting and proposed to accept its 

recommendation to remove the 

nonfacility direct PE inputs, revising the 

PE database accordingly. 

Comment: The specialty society 

thanked us for accepting its 

recommendation to remove the 

nonfacility PE for this procedure. 

However, the society indicated that a 

review of the PE database on our Web 

site indicated that these inputs were 

still included and suggested that they be 

deleted. 

Response: We appreciate the 

commenter’s attention to detail and 

have removed the PE inputs from the PE 

database. 

(viii) Maxillofacial Prosthetics 

We have been working with the 

society representing maxillofacial 

prosthetists since 2005 to establish 

nonfacility direct inputs for the 

prosthetic services represented by the 

CPT code series, 21076 through 21087. 

The current PE database reflects the 

labor, supplies, and equipment needed 

to perform each procedure. However, 

we do not have pricing information and 

documentation for many supply items. 

The society provided information and 

documentation for equipment prices, 

but because specific time-in-use 

information was not provided, we 

developed time in use in 2006 for each 

equipment item in each procedure. For 

CY 2007, these equipment inputs were 

utilized under the new PE methodology 

to calculate the nonfacility PE RVUs for 

these procedures. Although we have 

asked the specialty society to provide 

the supply pricing information and time 

in use data for each equipment item for 

each procedure, we have not received 

the requested information to date. 

Consequently, unless such information 

is provided, the PE database will 

continue to have no prices associated 

with these supplies. Therefore, in the 

CY 2008 PFS proposed rule, we 

proposed to cap the time in use for each 

equipment item at 25 minutes until 

specific information is received 

regarding the actual time in use. Tables 

listing the needed information for were 

included in the proposed rule. 

Comment: The specialty society 

representing the maxillofacial 

prosthetists supplied us with some of 

the requested information. The society 

provided us with the time-in-use data 

for every piece of equipment for each of 

the procedures in the CPT code series 

21076 through 21087. The specialty also 

provided prices for the supply items 

used in this code series; however, it did 

not provide any documentation to 

support these prices. 

Response: We appreciate the 

information provided by the specialty, 

especially that in relation to the 

equipment time-in-use. The 

recommended equipment times were 

compared with the total clinical labor 

time for each procedure and times that 

were greater were reduced to equal the 

labor time, in accordance with our usual 

allocation policy. Capping the 

equipment time-in-use to match the 

labor time affected 4 pieces of 

equipment in every procedure 

including: the dental chair, ceiling light, 

air compressor, and delivery unit. For 3 

of these codes, the time-in-use for a 5th 

piece of equipment, the washout and 

curing unit, was also capped. We will 

accept the specialty’s equipment timein-use information, with the 

aforementioned variances, and have 

changed the PE database accordingly. 

We regret that documentation for the 

supply prices was not forwarded. We 

did, however, receive a catalog 

documented pricing for articulating 

paper/ribbon that was submitted by a 

different specialty in reference to 

another CPT code, and have entered this 

price in the PE database for 8 of the 10 

codes in this family, as appropriate. The 

specialty is reminded that our policy for 

accepting prices for supplies or 

equipment in the PE database requires 

the submission of acceptable 

documentation, the definition of which 

is specified below the table that 

appeared in the proposed rule listing 

the outstanding prices for supply items 

needing documentation. We will 

continue to work with the specialty as 

it collects and forwards this important 

information. 

(ix) Requests for Increases in Supply 

Prices 

We received a request from the 

specialty society for obstetrics and 

gynecology to increase the price of 

supply item (kit, hysteroscopic tubal 

implant for sterilization) for CPT code 

58565, Hysteroscopy, surgical; with 

bilateral fallopian tube cannulation to 

induce occlusion by placement of 

permanent implants for this code which 

was created for CY 2005. This 

hysteroscopic implant kit is priced at 

$980 and the specialty is now 

requesting a price of $1,245, providing 

an invoice for documentation. The 

specialty reports that the higher price is 

attributed to a manufacturer change in 

design and materials, and submitted the 

manufacturer’s documents supporting 

these changes that were used to secure 

FDA approval. Therefore, we proposed 

to accept the new price of $1,245 for the 

hysteroscopic implant kit due to the 

changes made in the modified model. 

Comment: We did not receive 

comments on this proposal. 

Response: We will finalize our 

proposed price of $1,245 for the 

hysteroscopic implant kit and will 

amend our PE database, as appropriate. 

(x) Supply and Equipment Items 

Needing Specialty Input 

We have identified certain supply and 

equipment items for which we were 

unable to verify the pricing information 

(see Table 2: Supply Items Needing 

Specialty Input for Pricing and Table 3: 

Equipment Items Needing Specialty 

Input for Pricing). In our CY 2008 PFS 

proposed rule, we listed both supply 

and equipment items for which pricing 

documentation was needed from the 

medical specialty societies and, for 

many of these items, we received 

sufficient documentation containing 

specific descriptors and pricing 

information in the form of catalog 

listings, vendor Web pages, invoices, 

and manufacturer quotes. We have 

accepted the documented prices for 

many of these items and these prices are 

reflected in the PE RVUs in Addendum 

B of this final rule with comment 

period. For the items listed in Tables 2 

and 3, we are requesting that 

commenters provide pricing 

information on items in these tables 

along with acceptable documentation, 

as noted in the footnote to each table, to 

support recommended prices. For 

supplies or equipment that have 

previously appeared on this list, and for 

which we received no or inadequate 

documentation, we proposed to delete 

these items unless we receive adequate 

information to support current pricing 

by the conclusion of the comment 

period for this proposed rule. 

In Tables 4 and 5, we have listed new 

supplies and equipment from the new 

CPT codes for CY 2008 that are 

discussed elsewhere in this final rule 

with comment period. These items have 

been added to the PE database and, 

where priced, are reflected in the PE 

RVUs in Addendum B. 


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TABLE 2.—SUPPLY ITEMS NEEDING SPECIALTY INPUT FOR PRICING

Code 2006/7 Description Unit Unit price Primary associated 

specialties 

Associated 

*CPT code(s) 

Prior item 

status on 

table 

Commenter response 

and CMS action 

2008 

item 

status 

refer to 

note(s) 

SC088 .. Fistula needle, dialysis, 17g.Item ... ................ Dermatology .............. 36522 ............ Yes .......... Documentation received. Revised description per specialty’s comments. 

Price accepted at 

$1.62.

C 

Gas, argon, 

cryoablation.

............ ................ Urology, Radiology, 

Interventional Radiology.

50395 ............ No ............ New Item ................... A, E 

Gas, helium, 

cryoablation.

............ ................ Urology, Radiology, 

Interventional Radiology.

50395 ............ No ............ New Item ................... A, E 

SD140 .. Pressure bag ............. item .... 8.925 Cardiology ................. 93501, 93508, 

93510, 

93526.

Yes .......... Documentation received. Price accepted at $19.00.C 

SL119 .. Sealant spray ............ oz ....... ................ Radiation Oncology ... 77333 ............ Yes .......... No comments received.B 

SD213 .. Tubing, sterile, nonvented (fluid administration).item .... 1.99 Cardiology ................. 93501, 93508, 

93510, 

93526.

Yes .......... Documentation received. Price accepted at $0.949.C 

Stent, vascular, deployment system.Kit ...... $1,645 Radiology, Interventional Radiology.37205, 37206 Yes .......... Documentation received. Price retained at $1,645.C 

Catheter, Kumpe ....... Item ... ................ Radiology, Interventional Radiology.50385, 50386 No ............ New item ................... A, E 

Disposable aspirating 

syringe.

............ ................ Oral and Maxillofacial 

Surgery.

21073 ............ No ............ New item ................... A, E 

Guidewire, angle tip 

(Terumo), 180 cm1.

............ ................ Radiology, Interventional Radiology.50385, 50386 No ............ New item ................... A, E 

Snare, Nitinol 

(Amplatz).

Item ... ................ Radiology, Interventional Radiology.50385, 50386 No ............ New item ................... A, E 

* CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 

Note: Acceptable documentation includes—Detailed description (including system components), source, and current pricing information, such 

as copies of catalog pages, hard copy from specific Web pages, invoices, and quotes (letter format okay) from manufacturer, vendors or distributors. Unacceptable documentation includes—phone numbers and addresses of manufacturer, vendors or distributors, Web site links without pricing information, etc. 

Note A: Additional documentation required. Need detailed description (including kit contents), source, and current pricing information (including 

pricing per specified unit of measure in database). Accept copies of catalog pages or hard copy from specific Web pages. Phone numbers or addresses of manufacturer, vendors or distributors are not acceptable documentation. 

Note B: No/Insufficient received. Retained price in database on an interim basis. Forward acceptable documentation promptly. 

Note C: Submitted price accepted. 

Note D: Deleted per comment or CMS. 

Note E: 2007/8 price retained on an interim basis. Forward acceptable documentation promptly. 

TABLE 3.—EQUIPMENT ITEMS NEEDING SPECIALTY INPUT FOR PRICING AND PROPOSED DELETIONS

Code 2006/7 Description 2007/8 

Price 

Primary specialties associated with item 

*CPT code(s) 

associated 

with item 

Prior status on 

table 

Commenter response 

and CMS action 

2008 Item 

status refer 

to note(s) 

EQ269 ... Ambulatory blood 

pressure monitor.

3000 Cardiology .................. 93784, 93786, 

93788.

Yes .......... Documentation provided. Price accepted is $1525 (Did not 

accept $395 warranty cost.).

C 

Camera mount—floor 2300 Dermatology ............... 96904 ............. Yes .......... Specialty to submit, 

asap.

A, E 

Cross slide attachment.500 Dermatology ............... 96904 ............. Yes .......... Specialty to submit, 

asap.

A, E 

Dermal imaging software.4500 Dermatology ............... 96904 ............. Yes .......... Documentation provided. Price accepted at $4500.C 

Dermoscopy attachments.650 Dermatology ............... 96904 ............. Yes .......... Documentation provided. Price accepted at $650 ( average of the cost of 

the two items provided).

C 


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TABLE 3.—EQUIPMENT ITEMS NEEDING SPECIALTY INPUT FOR PRICING AND PROPOSED DELETIONS—Continued 

Code 2006/7 Description 2007/8 

Price 

Primary specialties associated with item 

*CPT code(s) 

associated 

with item 

Prior status on 

table 

Commenter response 

and CMS action 

2008 Item 

status refer 

to note(s) 

EQ008 ... ECG signal averaging 

system w-P waves 

and late potentials 

software.

8,250 Cardiology, IM ............ 93278 ............. Yes .......... Documentation provided. Revised description to better 

describe system. 

Price accepted at 

17,900.

A, E 

Instrument, microdissection................... Pathology ................... 88380 ............. No ............ New Item .................... A, E 

Lens, macro, 35–

70mm.

.................. Dermatology ............... 96904 ............. Yes .......... Deleted item as price 

is less than $500 

per documentation 

received.

D 

Plasma pheresis machine.37,900 Radiology, Dermatology.36481, G0341 Yes .......... Revised description 

based on comments 

received that light 

source was not part 

of item. Documentation requested.

B 

ED039 ... Psychology Testing 

Equipment.

.................. Psychology ................. 96101, 96102 Yes .......... Specialty to submit, 

asap.

B 

ER070 ... Portal imaging system 

(w/PC work station 

and software).

377,319 Radiation oncology .... 77421 ............. Yes .......... Documentation provided. Price accepted at $489,940 ( average of the cost of 

the two items provided).

C 

Strobe, 400 watts 

(Studio) (2).

1500 Dermatology ............... 96904 ............. Yes .......... Documentation requested.B 

Cryosurgery system 

(for tumor ablation)1.

.................. Urology, Radiology, 

Interventional Radiology.

50593 ............. No ............ New item .................... A, E 

* CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 

Note: Acceptable documentation includes—Detailed description (including system components), source, and current pricing information, such 

as copies of catalog pages, hard copy from specific Web pages, invoices, and quotes (letter format okay) from manufacturer, vendors or distributors. Unacceptable documentation includes—phone numbers and addresses of manufacturer, vendors or distributors, Web site links without pricing information, etc. 

Note A: Additional documentation required. Need detailed description (including kit contents), source, and current pricing information (including 

pricing per specified unit of measure in database). Accept copies of catalog pages or hard copy from specific Web pages. Phone numbers or addresses of manufacturer, vendors or distributors are not acceptable documentation. 

Note B: No/Insufficient received. Retained price in database on an interim basis. Forward acceptable documentation promptly. 

Note C: Submitted price accepted. 

Note D: Deleted per comment or CMS. 

Note E: 2007/8 price, where specified, retained on an interim basis. Forward acceptable documentation promptly. 

TABLE 4.—PRACTICE EXPENSE SUPPLY ITEM ADDITIONS FOR CY 2008 

Equip 

code Supply description Unit Unit price *CPT code(s) associated with item Supply category 

NA ........ Blade, sharp pointed surgical ................................................. item ...... 0 .73 88381 ...................... Cutters, closures. 

NA ........ Buffer, lysis .............................................................................. ml ......... 0 .46 88381 ...................... Lab. 

NA ........ Caps, Capsure Macro LCM .................................................... ml ......... 4 .54 88380 ...................... Lab. 

NA ........ Catheter, balloon, lacrimal ...................................................... item ...... 306 68816 ...................... Accessory. 

NA ........ Catheter, Kumpe 1 ................................................................... item ...... ...................... 50385, 50386 .......... Accessory. 

NA ........ Disposable aspirating syringe 1 ............................................... .............. ...................... 21073 ......................

NA ........ Ethanol, 95% ........................................................................... ml ......... 0 .0033 88380, 88381 .......... Lab. 

NA ........ Fee, image analysis ................................................................ item ...... 18 99174 ...................... Office supply. 

NA ........ Gas, argon, cryoablation ......................................................... .............. ...................... 50593 ...................... Accessory. 

Gas, helium, cryoablation ....................................................... .............. ...................... 50593 ...................... Accessory. 

NA ........ Gastrostomy. Low profile replacement button (Mic-Key) ....... item ...... 5 43760 ...................... Accessory. 

NA ........ Gastrostomy. Stoma measuring device (Mic-Key) ................. item ...... 10 43760 ...................... Accessory. 

NA ........ Glycerol, 3% ............................................................................ ml ......... 0 .001 88380, 88381 .......... Lab. 

NA ........ Guidewire, angle tip (Terumo), 180 cm 1 ................................ item ...... ...................... 50385, 50386 .......... Accessory. 

NA ........ IV infusion set, Sof-set (Minimed) ........................................... item ...... 11 .50 90769, 90771 .......... Hypodermic, IV. 

NA ........ Methylene blue stain ............................................................... ml ......... 0 .178 88380 ...................... Lab. 

NA ........ Probe, cryoablation, renal ....................................................... item ...... 1175 50593 ...................... Accessory. 

NA ........ Rnase-free water ..................................................................... ml ......... 0 .85 88381 ...................... Lab. 

NA ........ Slide, microscope, sterile ........................................................ item ...... 1 88380, 88381 .......... Lab. 

NA ........ Snare, Nitinol (Amplatz) 1 ........................................................ item ...... ...................... 50385, 50386 .......... Accessory. 

NA ........ Swab, patient prep, 1.5 ml (chloraprep) ................................. item ...... 1 .04 36592 ...................... Pharmacy, NonRx. 


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TABLE 4.—PRACTICE EXPENSE SUPPLY ITEM ADDITIONS FOR CY 2008—Continued 

Equip 

code Supply description Unit Unit price *CPT code(s) associated with item Supply category 

NA ........ Tube, jejunsostomy ................................................................. item ...... 195 49441, 49446, 

49451 and 49452.

Accessory. 

* CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 1Price verification needed. Item(s) added to table of supplies requiring specialty input. 

TABLE 5.—PRACTICE EXPENSE EQUIPMENT ITEM ADDITIONS FOR CY 2008 

Equip 

code Equipment description Life Unit price *CPT code(s) associated with item 

Equipment 

category 

NA ......... Cryosurgery system (for tumor ablation) 1 ........................... 10 .................... 50593 ..................... Other Equipment. 

NA ......... Cardiac coil, 1.5T 8-channel (MR) ....................................... 5 35400 7557, 7558 and 

75559.

Imaging Equipment. 

Instrument, Microdissection .................................................. 7 .................... 88381 ..................... Laboratory. 

NA ......... Pressure sensor, wireless (for implanted AAA sac sensor) 5 25000 93982 ..................... Documentation. 

NA ......... Camera, ocular photoscreening, w-laptop and software ..... 5 7000 99174 ..................... Documentation. 

* CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 1Price verification needed. Item(s) added to table of equipment requiring specialty input. 

(xi) Additional PE Issues Raised By 

Commenters 

Comment: One commenter 

recommends that the direct inputs 

associated with all fee schedule services 

be made available to the public. 

Response: Since the inception of 

resource based PEs, all direct input data 

has been made available to the public 

on the CMS Web page. The direct inputs 

associated with this final rule with 

comment period are also available to the 

public at the following Web site under 

CMS–1385–IFC: http:// 

www.cms.hhs.gov/PhysicianFeeSched/ 

PFSFRN/list.asp#TopOfPage. 

Comment: Several commenters 

recommend that we reprice supply 

items over $200 in the PE direct input 

database annually. Additionally, 

commenters also requested that we 

establish individual J codes for these 

high cost supplies. Alternatively, 

several other commenters expressed 

concerns over this recommendation 

stating that utilization guidelines must 

be set up that would trigger repricing or 

an undue burden would be placed upon 

those specialties using these high cost 

supplies. 

Response: Using an individual HCPCS 

code for each of these supplies would be 

difficult as there are multiple 

manufacturers, with multiple prices, 

associated with the majority of these 

codes. Having multiple manufacturers, 

and thus multiple prices, also makes it 

difficult to reprice these supplies within 

the PE methodology, which is why we 

continue to work with the AMA RUC to 

establish direct cost input data. 

Additionally, all direct inputs need to 

be budget neutralized within the PE 

methodology. Removing these high cost 

supplies from the standard PE 

methodology would unfairly advantage 

procedures that contain these supplies 

as they would not be subject to the same 

budget neutrality adjustments as would 

other supplies. Finally, we agree with 

those commenters that state that any 

annual repricing of these supplies 

would place undue burden on specific 

physician groups. For these reasons, we 

will continue to price these high cost 

supplies within the standard PE 

methodology. 

Comment: A few comments were 

received that recommended that 

desktop computers be included as a 

direct PE cost. 

Response: The direct PE database 

includes desktop computers with 

monitor when this computer is 

identified as being dedicated to a 

specific procedure. The costs associated 

with computers that are used for nonclinical purposes assigned to a specific 

procedure, for example, used for 

administrative procedures, are more 

appropriately captured in the indirect 

cost category. 

Comment: One commenter 

representing home care physicians 

requested that travel time and other 

inherent costs related to mobile medical 

services such as vehicle operation and 

mobile communication should be 

accounted for in the PE calculation. 

Response: To the extent that travel 

time is necessary to furnish physician 

services outside of the office setting, 

these expenses are not considered direct 

costs under the PE methodology. 

Although the mobile communication 

devices are not specifically included as 

direct PE inputs, 12 minutes of clinical 

labor time is assigned for each of the 

home visit E/M services, 6 minutes in 

the pre-time period and 6 minutes in the 

post time period. Phone calls are 

standardized at 3 minutes each for 

purposes of the direct PE inputs and 

would be included as part of this 

clinical labor time. 

Comment: One commenter stated that 

adjustments need to be made to the PE 

database for certain dialysis codes and 

requested that for G0393 and G0392 an 

angioplasty balloon be added to the PE 

database and that for CPT code 36870 

the PE database should be revised to 

include an angiographic room and a 

power table. 

Response: The balloon catheters are 

reflected in the PE database, as supply 

number SD152, and the angiographic 

room and an exam table are included in 

the equipment for CPT code 36870. 

Comment: Commenters expressed 

concern about the level of 

reimbursement for intrathecal pump 

management services for chronic pain 

patients and believe that the refill kit is 

not accounted for in the PE. In addition, 

commenters expressed concern that 

reimbursement did not cover the leasing 

costs for the equipment. 

Response: We reviewed the PE 

database and have verified that a refill 

kit, priced at $28, is included as a 

supply in CPT codes 95990 and 95991. 

In our PE database, equipment costs are 

assigned based on the purchase price for 

each piece of equipment, regardless of 

whether the equipment is owned, rented 

or leased. 

Comment: A manufacturer expressed 

concern that the PE RVUs for intranasal 

administration of vaccines (CPT codes 

90467/8 and 90473/4) are 

inappropriately low and should be 

equalized to the injectable 

immunization administration PE RVUs. 


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The commenter stated that when the 

codes were reevaluated in 2004 there 

was not enough experience in the office 

to fully understand the time associated 

with providing an intranasal vaccine. 

The commenter stated that specialty 

organizations have indicated that this 

issue is worth reexamining and 

indicated that they had been encouraged 

to communicate with the RUC in 

support of equalizing payment for the 

codes. 

Response: We appreciate the 

commenter’s concerns about the 

disparity in the PE RVUs for the 

intranasal and injectable immunization 

administration procedures. To the 

extent that these concerns relate to the 

direct PE inputs, we would encourage 

the commenter to work with the 

specialty organizations to determine if it 

is appropriate to bring these codes 

forward for further RUC review. 

Comment: One commenter requested 

that we publish the RUC approved 

RVUs for all noncovered and carrier 

priced services, particularly for the 

positron emission tomography (PET) 

and PET/CT procedures. 

Response: We have made it our policy 

to publish work and PE RVUs for 

services in instances where the 

information has been forwarded to us, 

with a few exceptions. One exception to 

this policy is for carrier priced codes. 

Our rationale for this policy is simply 

that any published values for carrierpriced codes would be in direct 

contradiction of our intentions with 

respect to this designation. As we state 

in Addendum A, a ‘‘C’’ status indicator 

means that carriers price this code 

establishing RVUs and payment 

amounts without direct guidance from 

CMS. Because the commenter did not 

provide us with information about 

specific noncovered services that do not 

have published RVUs, we are not able 

to address this particular aspect of the 

comment. 

Comment: Commenters representing 

radiation oncologists expressed concern 

about the significant PE reductions in 

CPT code 77336 for continuing medical 

physics consults. The commenters 

noted this code was last reviewed by the 

PEAC in 2002 and the practice standard 

has changed significantly. Commenters 

recommended that the direct PE inputs 

for this code be reviewed and refined so 

that accurate PE data is reflected for this 

code. 

Response: While we appreciate that 

the commenters expressed their 

concerns to us regarding a change in the 

practice standards for the services of 

CPT code 77336 which they believe 

results in the need to change the direct 

PE inputs, we believe that the 

appropriate course of action for the 

commenters is to work together with the 

RUC affiliated specialty society in order 

to determine if these concerns can be 

appropriately addressed by the RUC. 

Comment: We received comments 

from individuals and associations with 

concerns about the new bottom-up PE 

methodology and the resulting effect of 

decreases in the PE RVUs for various 

services including, but not limited to 

the following: chemotherapy 

administration, endovenous ablation 

procedures, brachytherapy treatments, 

3-D imaging services, and procedures 

for photopheresis and plasma pheresis. 

Response: As we noted earlier in this 

section, we are aware that the PE RVUs 

for some services were negatively 

impacted by the change in our PE 

methodology. However, we will 

reiterate here that it is our policy to 

make certain, to the maximum extent 

possible, that the direct PE inputs used 

in the PE RVU calculation actually 

reflect the typical resources used to 

provide each service. To the extent that 

the current PE RVUs are lower than 

those determined under our previous 

methodology, the difference is likely 

attributable to a previous PE RVU that 

was based on charges that overvalued 

the service. Because the current 

methodology uses the direct PE inputs 

that are inherent and typical to each 

procedure, the resulting PE RVUs more 

accurately reflect the resources that are 

used to provide the service. 

Comment: One commenter explained 

that, in the CY 2004 PFS final rule, we 

decided to set the values for the 

monthly ESRD-related services for home 

dialysis patients (for example, G0323) at 

the same rate as the monthly ESRD 

related services with 2 or 3 visits per 

month (for example, HCPCS code 

G0318) to provide an incentive for the 

increase use of home dialysis (as 

authorized under 1881(b)(3)(B) of the 

Act). The commenter notes that the 

current payment rate for ESRD related 

services, with 2 or 3 face-to-face visits 

per month is higher than ESRD related 

services for home dialysis patients, (due 

to a difference in PE). As such, the 

commenter is concerned that the 

differential in payment rates mitigates 

the incentives that we previously 

attempted to establish. The commenter 

suggested that incentives for using home 

dialysis should be strengthened by 

using a consistent PE value for MCP 

codes G0323 and G0318. However, the 

commenter prefers that we establish a 

new payment rate for the monthly 

management of home dialysis patients 

based on the weighted average of the 

MCP for patients who dialyze in a 

dialysis center or other outpatient 

facility. 

Response: We appreciate the 

suggestions regarding our payment 

policy for the monthly management of 

home dialysis patients. We intend to 

consider the commenters suggestions as 

we continue to evaluate payment rates 

for the monthly management of patients 

on home dialysis. 

Note: We received comments regarding 

certain items and services that are not 

germane to the PE RVUs or other components 

of the PFS. These issues include comments 

regarding: revisions to the definition of preservice work and time for certain global 

services; inadequate pricing of HCPCS code 

A4562 for pessaries, requests for payment 

adjustments for certain services under PFS to 

approximate payment amounts for these 

services established under OPPS and ASCs, 

inadequate payment for pharmacy costs and 

nursing services for drug administration 

codes, and concerns about the reduction of 

PE RVUs in the nonfacility setting due to the 

changes in the PE methodology along with 

requests to freeze payment amounts at the 

level of the CY 2006 transitional PE RVUs. 

Because these comments are outside the 

scope of the issues raised in the CY 2008 PFS 

proposed rule, we will not respond to these 

issues in this final rule with comment period. 

B. Geographic Practice Cost Indices 

(GPCIs) 

We are required by section 

1848(e)(1)(A) and (C) of the Act to 

develop separate Geographic Practice 

Cost Indices (GPCIs) to measure 

resource cost differences among 

localities; and to review and, if 

necessary, adjust the GPCIs at least 

every 3 years. In the CY 2008 PFS 

proposed rule, we published the 

proposed GPCIs for CY 2008 in 

Addendum E, noting that the proposed 

GPCIs do not reflect the 1.000 floor that 

was in place during CY 2006 and CY 

2007. This floor expires as of January 1, 

2008 in accordance with section 102 of 

the MIEA–TRHCA. 

In developing a GPCI, section 

1848(e)(1)(A)(i) and (ii) of the Act 

require that the PE and malpractice 

(MP) GPCIs reflect the full relative cost 

difference while section 

1848(e)(1)(A)(iii) of the Act requires that 

the physician work GPCIs reflect only 

one quarter of the relative cost 

differences. Section 1848(e)(1)(C) of the 

Act also specifies that if more than 1 

year has elapsed since the last GPCI 

revision, we must phase in the 

adjustment over 2 years, applying only 

one half of any adjustment in each year. 

All GPCIs are developed through a 

comparison to a national average for 

each component, and the RVUs for 

different services uniformly weight each 

component. 


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1. GPCI Update 

A detailed description of the 

methodology used to develop and 

update the GPCIs can be found in the 

CY 2004 PFS proposed rule (68 FR 

49039, August 15, 2003). There are three 

components of the GPCIs (physician 

work, PE, and MP) and each relies on its 

own data source. 

a. Physician Work 

The physician work GPCI is 

developed using the median hourly 

earnings from the 2000 Census of 

workers in six professional specialty 

occupation categories which we use as 

a proxy for physician wages and 

calculate to reflect one quarter of the 

relative cost differences. Physician 

wages are not included in the 

occupation categories because Medicare 

payments are a key determinant of 

physicians’ earnings; therefore, 

including physician wages in the 

physician work GPCI would, in effect, 

make the index dependent upon 

Medicare payments. The physician 

work GPCI was updated in 2001, 2003, 

and 2005 using data from the 2000 

Census; the proposed CY 2008 

physician work GPCI is also based on 

the 2000 Census data. Because all 

updates since 2001 have relied on the 

2000 Census data, the changes observed 

in the physician work GPCI in the 

update years are due to minor changes 

in utilization and budget neutrality 

factors; for CY 2008, Addendum E 

shows that there have been small 

changes in the physician work GPCI. 

Section 102 of the MIEA–TRHCA 

required application of a 1.000 floor on 

the work GPCI in payment localities 

where the work GPCI was less than 

1.000. This provision expires on 

December 31, 2007. The CY 2008 

proposed physician work GPCI reflects 

the removal of this floor. 

b. Practice Expense 

The PE GPCI is developed from three 

data sources: 

(i) Employee Wages: We use 2000 

Census median hourly earnings of four 

occupation categories. The physician 

work GPCI was updated in 2001, 2003, 

and 2005 using data from the 2000 

Census. 

(ii) Office Rents: We use residential 

apartment rental data produced 

annually by the Department of Housing 

and Urban Development (HUD) as a 

proxy for physician office rents. In 2001, 

2003, and 2005, we used rents in the 

HUD 40th percentile. For CY 2008, we 

have calculated the GPCI using rents in 

the 50th percentile for the physician 

office rent proxy. We proposed to use 

the 50th percentile because although 

HUD generally allows payment for 

subsidized housing up to the 40th 

percentile, in some areas it allows 

payment up to the 50th percentile. We 

made this change to reflect the trend 

toward higher rents across the country. 

Fair Market Rents (FMRs) are gross 

rent estimates including rent and 

utilities. HUD calculates the FMRs 

annually using: (1) Decennial Census 

data; (2) American Housing Surveys 

conducted by the Census Bureau for 

HUD to enable HUD to develop 

revisions between Census years; and (3) 

random digit dial surveys to enable 

HUD to develop gross rent change 

factors. The American Housing Surveys 

cover 11 areas annually, rotating among 

the 44 largest metropolitan areas. The 

random digit dial component surveys 60 

FMR areas annually. 

The FMR is set as a percentile point 

in the distribution of rents for standard 

housing occupied by people who moved 

within the previous 15 months. The 

current FMR definition is the 40th 

percentile rent (the amount below 

which 40 percent of units are rented). 

Each year, the 50th percentile rent is 

also calculated by HUD and available 

through the HUDUSER Web site. 

In 2000, HUD changed its FMR policy 

to increase access to housing for 

families receiving Section 8 rent subsidy 

vouchers (65 FR 58870). To do so, HUD 

increased FMRs from the 40th 

percentile to the 50th percentile in areas 

where subsidized families were highly 

concentrated in certain census tracts, 

given evidence that affordable housing 

was not well distributed. Only 

metropolitan areas with more than 100 

census tracts are considered for possible 

increase to the 50th percentile rent. 

FMRs can be moved from 40th to 50th 

percentile or back from 50th to 40th 

percentile. 

In the case of the office rent index for 

the PE GPCI, FMRs have been used to 

capture geographic differences in rental 

costs, in the absence of a consistent 

commercial rent index that covers all 

metropolitan and nonmetropolitan areas 

in the U.S. It has been used as a measure 

of the ‘‘average rent’’ in a market. 

However, since 2000, the FMRs have 

been a mixture of the 40th percentile 

and 50th percentile rents. FMR areas 

move between the two cutoffs. For 

example, in California, 9 counties had 

FMRs set at the 50th percentile in 2004. 

In 2007, only 2 of these 9 counties were 

still at the 50th percentile level for the 

FMR, out of 4 total counties at the 50th 

percentile level. 

As described above in this section 

(and as detailed in 65 FR 58870), the 

criteria for setting the FMR at the 40th 

or 50th percentile are based on 

concentrations of subsidized 

households. There is no reason to 

assume that commercial rents would 

follow the same patterns. 

Therefore, we believe the 50th 

percentile, or median, rents calculated 

by HUD will be a more consistent, fair 

measure of geographic differences for 

the purpose of proxying for commercial 

rents. 

Rent data produce the most 

significant changes because they are 

based on annual changes in HUD rents, 

and therefore, are more volatile than the 

wage (Census) data. While it has been 

suggested that we explore sources of 

commercial rental data for use in the 

GPCI, we do not believe there is a 

national data source better than the 

HUD data. 

(iii) Equipment and Supplies: We 

assume that items such as medical 

equipment and supplies have a national 

market and that input prices do not vary 

among geographic areas. As mentioned 

in previous updates, some price 

differences may exist, but we believe 

these differences are more likely to be 

based on volume discounts rather than 

on geographic market differences. 

Equipment and supplies are factored 

into the GPCIs with a component index 

of 1.000. 

c. Malpractice 

The MP GPCI is calculated based on 

insurer rate filings of premium data for 

a $1 million to $3 million mature 

‘‘claims made’’ policy along with 

premium or surcharge data for 

mandatory patient compensation funds 

(PCFs). The MP GPCI is the most 

volatile of the GPCIs. This GPCI was 

updated in 2001 and 2003 as scheduled 

with the physician work and PE GPCIs; 

but, there was an unscheduled update of 

the MP GPCI in 2004 (68 FR 49043) to 

reflect increases in MP premiums 

nationwide. The proposed CY 2008 MP 

update reflects the most recent premium 

data available. The physician work and 

PE GPCIs are being updated at the same 

time. 

We received the following comments 

about our proposed GPCIs: 

Comment: We received several 

comments expressing the concern that 

San Benito County in California was 

placed in the wrong payment locality. 

Response: In 2003, the U.S. Census 

Bureau moved San Benito County from 

the Rest of State Census category and 

placed it in the San Jose MSA. Our data 

and methodology do not accommodate 

mid-decennial changes in Census data, 

and therefore, our 2008 update reflects 

that San Benito County remains in the 

Rest of California payment locality. 


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Comment: We received several 

comments about the PE GPCI for Santa 

Clara County, California. In the 

proposed rule, the PE GPCI was lower 

for Santa Clara than it has been in 

previous years and commenters were 

concerned about why this happened. 

Response: We recognize that there 

was a decrease in the proposed Santa 

Clara County PE GPCI. We have studied 

this issue including examining both the 

source data and the methodology for 

obtaining the PE GPCI in case there was 

a mistake in the proposed values. 

However, a close examination of the 

data showed that the GPCI is accurate 

and reflects a decrease in the value of 

HUD rentals in Santa Clara County. 

Comment: One commenter suggested 

that a GPCI adjustment should not be 

applied to physician work, or that the 

physician work GPCI should be 1.000 

for all localities. 

Response: We are required to apply a 

GPCI adjustment to physician work in 

accordance with section 1848(e) of the 

Act. Therefore, we will continue to 

apply the physician work GPCI. 

Comment: We received several 

comments suggesting that the PE GPCI 

is inaccurate due to our continued use 

of HUD rental data as a proxy for 

medical office space. 

Response: Because Medicare is a 

national program, we believe it is 

important to use the best data that is 

available on a nationwide basis. We 

believe the HUD rental data is the most 

comprehensive and valid indicator of 

the national real estate rental market 

that is available. Additionally, as we 

stated most recently in the CY 2007 PFS 

final rule with comment period (71 FR 

69656), we believe the HUD rental data 

remains the best data source to fulfill 

our requirements that the data be 

available for all areas, be updated 

annually, and retain consistency area-toarea and year-to-year. In the past, we 

have had both the GAO and the 

Research Triangle Institute examine 

available data sources for use in the PE 

GPCI, and both have found that 

available commercial data sets either 

have insufficient coverage nationally or 

are developed by suspect methodology. 

Therefore, we continue to believe the 

HUD rental data is the best nationally 

available data source to use as a proxy 

for physician office rents. 

Comment: We received several 

comments suggesting that the GPCIs of 

Hawaii/Guam and Alaska need to be 

adjusted to accommodate the higher 

costs of transportation of supplies and 

equipment to these localities. 

Response: The GPCIs are a proxy for 

costs associated with providing services 

to beneficiaries, not costs associated 

with living in a particular place. 

However, we will consider these 

comments as we evaluate possible 

changes to our methodology. 

Comment: We received comments 

from the Medicare Payment Advisory 

Commission (MedPAC) suggesting an 

alternative method for calculating the 

PE GPCI. This alternative PE GPCI 

method excludes cost measures for 

equipment and supplies. 

Response: We appreciate MedPAC 

suggesting an alternative method. We 

intend to evaluate the suggested change 

to the PE GPCI methodology and will 

propose any changes in future 

rulemaking. 

We will finalize the GPCIs shown in 

Addendum E. The GPCI values shown 

represent the first year of the two-year 

GPCI update transition and have been 

budget neutralized to ensure that 

nationwide total RVUs are not impacted 

by changes in locality GPCIs. 

Specifically, this is done by applying a 

weight that is derived from the 

difference between payments using the 

‘‘old’’ GPCIs and the ‘‘new’’ GPCIs to the 

proposed GPCIs that insures that total 

payments would not be different. As we 

indicated above in this section, there is 

no 1.000 floor on the physician work 

GPCI in 2008. The GAFs are shown in 

Addendum D. 

2. Payment Localities 

a. Background 

The Medicare statute requires that 

PFS payments be adjusted for certain 

differences in the relative costs among 

areas. The statute requires an 

adjustment which reflects differences 

among areas for the relative costs of the 

mix of goods and services comprising 

PEs (other than Malpractice expenses) 

compared to the national average. The 

statute also requires adjustment for the 

relative costs of MP expenses among 

areas compared to the national average. 

Finally, the statute requires adjustment 

for one quarter of the difference between 

the relative value of physicians’ work 

effort among areas and the national 

average of such work effort. 

The physician work component 

represents 52.466 percent of the 

national average fee schedule payment 

amount. Thus, the statutory requirement 

for geographic adjustment of only onequarter of the differences in the 

physician work component means that, 

on average, only 13.117 percentage 

points of physician work are 

geographically-adjusted, and, on average 

39.349 percentage points of the 

physician work component are not 

adjusted and represent a national fee 

schedule amount. 

In addition, the PE component 

represents 43.669 percent of the 

national average fee schedule payment 

amount. PEs are comprised of 

nonphysician employee compensation, 

office expenses (including rent), 

medical equipment, drugs and supplies, 

and other expenses. As explained above 

in this section, we do not make a 

geographic adjustment relating to 

medical equipment, drugs, and supplies 

because there is a national market for 

these items. Thus, only the categories of 

nonphysician employee compensation 

and rents are geographically adjusted. 

These categories represent, on average, 

30.862 percentage points of the total PE, 

and 12.807 percentage points of PEs are 

not geographically-adjusted. 

In total, more than half (52.156 

percent) of the average PFS amount is a 

national payment that is the same in all 

areas of the country; that is, 52.156 

percent of the average fee is not 

geographically-adjusted. 

There are two additional points about 

the geographic indices that are 

important to note. First, as described 

above in this section, the data used to 

measure cost differences among 

localities are proxies for physician 

work, employee compensation and 

office rents. That is, wage data for 

various categories of employees are used 

to proxy the actual wages of physician 

employees. Second, the data used for 

such proxies are based on actual Census 

data only for a limited number of 

counties. The geographic adjustment 

factors (GAFs) for more than 90 percent 

of counties are developed using proxies 

based on larger geographic areas (for 

example, data for all rural areas in a 

State are combined and used to proxy 

the values for each rural county in a 

State). This aggregation is necessary for 

areas where country level data are not 

available. Thus, the underlying data are 

proxies for actual costs, and the 

resulting GPCIs do not measure 

perfectly the cost differences among 

localities. 

Currently, there are 89 Medicare 

physician payment localities to which 

GPCIs are applied. The payment locality 

structure under the PFS was established 

in 1996 and took effect January 1, 1997. 

The development of this structure is 

described in detail in both the CY 1997 

PFS proposed (61 FR 34615) and final 

rules (61 FR 59494). 

b. Revision of Payment Localities 

Over time, changing demographics 

and local economic conditions may lead 

to increased variations in practice costs 

within payment locality boundaries. We 

are concerned about the potential 

impact of these variations and have 


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been studying this issue and potential 

alternatives for a number of years. 

However, because changes to the GPCIs 

must be applied in a budget neutral 

manner (and under the current locality 

system, budget neutrality results in 

aggregate payments within each State 

remaining the same), there are 

significant redistributive effects to any 

change. Therefore, we are also 

concerned about the potential impact of 

locality revisions. 

For the past several years, we have 

been involved in discussions with 

California physicians and their 

representatives about recent shifts in 

relative demographics and economic 

conditions among a number of counties 

within the current California payment 

locality structure. 

The California Medical Association 

(CMA) suggested that we use our 

demonstration authority to adopt an 

alternative locality configuration and 

avoid certain redistributive effects, but 

such an approach was not feasible (as 

discussed in the CY 2005 PFS final rule 

with comment period (70 FR 70151)). In 

the CY 2006 PFS proposed rule (70 FR 

45784), we proposed to remove two 

counties from the ‘‘Rest of California’’

payment locality and create a new 

payment locality for each county. These 

two counties were the ones with the 

largest difference between the county 

and locality GAFs. However, there was 

much more opposition than support for 

this proposal, in large part because of its 

negative effect on payments for the 

counties that would have remained in 

the ‘‘Rest of California’’ locality. For 

example, the CMA commented on this 

proposal stating, ‘‘a nationwide 

legislative solution that would provide 

additional funding * * * is the only 

solution we are supporting at this time.’’

We did not finalize the proposal and 

described our reasons in the CY 2006 

PFS final rule with comment period (70 

FR 70151). 

As indicated previously, we recognize 

that changing demographics and local 

economic conditions may lead to 

increased variations in practice costs 

within payment locality boundaries. We 

are concerned about the potential 

impact of these variations. 

In considering potential changes in 

payment localities, we believe it is 

important to evaluate both the potential 

impact of intralocality practice cost 

variations and the redistributive impacts 

that would result from any revisions to 

the localities. We also indicated that we 

are concerned about the considerable 

administrative issues in making locality 

changes, particularly if such changes 

involve a transition, and if they occur 

when new GPCI data are being phasedin. As we noted in the response to the 

June 2007 General Accountability Office 

report on localities (GAO–07–466), 

changing localities requires 

reprogramming systems and extensive 

provider education, both of which are 

expensive and burdensome 

administrative activities that can last for 

a significant period of time. We receive 

claims for payment that cross calendar 

years and carriers must maintain 

payment files for the 2 different years. 

In the proposed rule we solicited 

comments on three possible locality 

reconfigurations. We indicated that 

because of the importance of striking an 

appropriate balance between 

intralocality variations and 

redistributive impacts with any such 

locality revisions, we wanted to be 

cautious and evaluate the impacts in 

California before considering applying 

the policy more broadly in the future. 

The three options from the proposed 

rule are described as follows: 

Option 1: Using the existing locality 

structure, apply a rule whereby if a 

county GAF is more than 5 percent 

greater than the GAF for the locality in 

which the county resides it would be 

removed from the current locality. A 

separate locality would be established 

for each county that is removed. Based 

on the new fully phased-in GPCI data 

(that is, for CY 2009), application of this 

approach in California would remove 

three counties (Santa Cruz, Monterey, 

and Sonoma) from the Rest of California 

payment locality and Marin county from 

the Marin/Napa/Solano payment 

locality and create separate payment 

localities for each of these four counties. 

This approach focuses on counties for 

which there is the biggest difference 

between the county GAF and the 

locality GAF. 

This proposal is similar to the policy 

we previously proposed in the CY 2006 

PFS proposed rule (70 FR 45784) but 

did not adopt to address the counties 

with GAFs that are most different from 

their current locality designation. 

Implementation of this option would 

lead to an increase in payment of 7.6 

percent for Santa Cruz County (and 

average increase of 5 percent for the 

other counties involved) and a decrease 

in payment of 4.3 percent for Napa and 

Solano Counties. 

Option 2: This approach is similar to 

option 1, but the new localities would 

be structured differently. We would use 

the same 5 percent threshold 

methodology but instead of creating four 

new localities in which each county 

becomes its own new locality, the three 

counties that are removed from the Rest 

of California locality would become one 

new locality. Marin County would still 

be removed from the Marin/Napa/ 

Solano locality to become its own 

locality. Application of this approach 

would remove three counties (Santa 

Cruz, Sonoma, and Monterey) from the 

Rest of California payment locality, and 

Marin County from the existing Marin/ 

Napa/Solano payment locality. This 

approach groups together counties from 

the Rest of California locality that have 

the greatest difference between the 

county and locality GAF. (This option 

would lead to an increase of 6 percent 

for the new 3-county payment locality.) 

These counties have similar cost 

structures and grouping them together 

into one new locality is consistent with 

our goal of homogeneous resource costs 

within a locality. 

Option 3: Apply a methodology 

similar to that used in the 1997 locality 

revisions (61 FR 59495), but applied at 

the county level rather than the 

‘‘existing locality’’ level. That is, we 

sorted the counties by descending GAFs 

and compared the highest county to the 

second highest. If the difference is less 

than 5 percent, the counties were 

included in the same locality. The third 

highest is then compared to the highest 

county GAF. This process continues 

until a county has a GAF difference that 

is more than 5 percent. When this 

occurs, that county becomes the highest 

county in a new payment locality and 

the process is repeated for all counties 

in the State. This approach would group 

counties within a State into localities 

based on similarity of GAFs even if the 

counties were not geographically 

contiguous. 

This organizes payment localities 

based on costs, which would reduce the 

number of payment localities in 

California from 9 to 6 localities. This 

option alleviates the greatest variations 

in cost between counties in California. 

This proposal is unique in that the new 

localities are not contiguous. Currently, 

all localities encompass adjacent 

geographic areas. 

The impacts associated with this 

option are significant. Depending on the 

tier, changes could reflect increases of 

as much as 7.6 percent or decreases of 

as much as 7.3 percent. 

We received numerous comments on 

these options as discussed below: 

We received similar comments from a 

number of individuals, State and local 

medical societies, and organizations, 

including the California Medical 

Association, on several significant 

issues and are addressing these together: 

Comment: Santa Cruz County should 

be removed from the Rest of California 

payment locality due to its higher costs. 

Response: We recognize that Santa 

Cruz County has higher costs than other 


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counties within the Rest of California 

locality, and the methodologies we 

presented in each of the options would 

result in Santa Cruz County being 

removed from the Rest of California 

payment locality. 

Comment: Many commenters were 

concerned about the description of the 

methodology used for Options 1 and 2. 

Specifically, these comments directed 

us to adopt a methodology suggested by 

the California Medical Association. The 

methodology compares the highest GAF 

county to the weighted average (GAF) of 

the remaining counties of the locality. 

Response: To clarify, the methodology 

we used identified counties where the 

county GAF was at least 5 percent 

higher than the GAF of the locality and 

then we either left that county as a 

payment locality itself or joined it with 

other counties into a payment locality. 

In Option 1, each of these counties 

became a separate locality; in Option 2, 

we combined several of these counties 

into a single payment locality. This 

approach is not the ‘‘iterative 

methodology’’ that some commenters 

suggested we should follow. We 

recognize that there are alternative 

methodologies that can be used to 

consider reconfigurations to locality 

structures. We will consider the 

suggestions of the commenters in the 

future. 

Comment: There were concerns that 

combining several counties into a single 

payment locality in Option 2 was 

arbitrary and led to lower payments for 

these counties. 

Response: As we stated in the 

proposed rule, there are trade-offs 

involved in making any changes to 

localities, and we recognize the 

importance of trying to achieve a 

reasonable balance among competing 

priorities. One of our goals was to keep 

the number of payment localities 

manageable. Although we recognize that 

there are effects on each of the 

individual counties, combining counties 

with very similar costs was a reasonable 

way to meet this goal. 

Comment: Numerous commenters 

from California recommended that we 

implement Option 3 but suggested that 

we erred in describing the methodology 

used in the development of Table 9 of 

the proposed rule and recommended 

that if we implement it, we should use 

their suggested methodology. 

Commenters suggested that we really 

meant to insert a hierarchical approach 

and discussed how these are both 

acceptable ways to accomplish the 

restructuring of the counties. Other 

State societies expressed interest in this 

option as long as we use the alternative 

methodology suggested by the California 

commenters. 

Response: In Option 3 in the proposed 

rule, we ranked the counties by GAF 

from highest to lowest. We then 

combined into a new payment locality 

the county with the highest GAF and 

the other counties that have a GAF 

within 5 percent of the highest GAF 

county. Then, we found the county with 

the highest GAF among the remaining 

counties. We combined that county and 

all the counties that have a GAF within 

5 percent of the new highest GAF 

county into a payment locality. We 

continued this method until all counties 

were included in a locality. As 

previously mentioned, there are 

multiple approaches to reconfiguring 

the localities that result in similar 

outcomes. We will further study the 

suggestions provided by the 

commenters. 

Comment: We received a number of 

comments requesting that we provide a 

wide variety of data, at the county level, 

from numerous sources covering the 

years 1999 through 2006. 

Response: We believe we provided 

commenters sufficient information to 

fairly evaluate our proposals. We note 

that many of these requests involved 

county level data. There is very little 

county level data available nationwide. 

Most of our data sources are collected at 

the MSA or Consolidated MSA, or NonMetropolitan Area level, and our 

methodology was designed to be used to 

develop GPCIs within a payment 

locality analysis, not a county level 

analysis. We do our best to provide 

requestors with sources for publicly 

available data and to provide any other 

data that is requested of CMS. However, 

we often simply do not have data 

available at other than the locality level. 

Comment: Several commenters are 

concerned that the data used to develop 

the latest GPCI update are out of date or 

inaccurate. 

Response: We used the most up-todate data available for the GPCIs used in 

the calculation of the proposed options. 

Descriptions of the data sources we use 

can be found in previous regulations (69 

FR 66261) but we will reiterate them 

here. For the physician work GPCI, we 

use data files from the latest decennial 

census (currently 2000) supplied to 

CMS by the Census Bureau. These data 

are available to any individual or group 

interested in obtaining them from the 

Census Bureau. Data for the rental 

portion of the PE GPCI update come 

from HUD rental files, and these data 

are available online to anyone wishing 

to obtain them. Wage data for the PE 

GPCI come from the 2000 Census files 

which are available from the Census 

Bureau. Data for the malpractice GPCI 

come from premium data that are filed 

by companies writing Professional 

Liability Insurance in each state. These 

filings are provided, upon request by 

our contractor, to CMS by each State 

Department of Insurance. Our latest 

update covers premium data for 2004, 

2005 and 2006. 

Comment: We received comments 

from certain physicians in Ohio 

requesting that we examine Ohio for a 

possible change in the current Statewide 

payment locality. 

Response: We are currently examining 

alternatives to the current locality 

structure. As a part of our study we will 

revisit Statewide localities to determine 

if revisions are appropriate. 

Comment: We received a number of 

comments from ambulance suppliers 

throughout the mid-West requesting that 

we make no changes that would have a 

negative impact on the GPCIs in rural 

areas. Other commenters expressed 

similar concerns about the impact of 

locality changes on rural physicians and 

beneficiaries. 

Response: The vulnerability of rural 

areas to decreases in relative payments 

as a result of locality revisions is an 

issue that is of considerable concern to 

us and something we take very 

seriously. However, as previously noted 

we must find an acceptable balance 

between the multiple competing 

concerns when making changes in 

localities in order to best meet the needs 

of the entire program and this generally 

cannot be done without having any 

impact on rural areas. 

Comment: MedPAC provided 

comments outlining two possible 

mechanisms for developing changes in 

the payment localities of the States. 

These methods are similar but differ in 

that one method begins at the locality 

level and the other starts with MSA 

level data. MedPAC also suggests that 

we determine whether those States that 

are currently single payment localities 

wish to remain single payment 

localities. 

Response: As always, we value the 

input of MedPAC and we intend to 

analyze their suggested methods 

carefully as we discuss possible national 

policy changes. 

Comment: Comments regarding 

changes in the payment localities in 

California were universally 

accompanied with a belief that we 

should implement these changes, 

without decreasing payments to any 

counties. 

Response: We understand the desire 

to avoid the negative impact 

implementing any of these options 

might have on certain areas. However, 


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the statute requires that geographic 

adjustments be established based upon 

an index of costs that is tied to national 

averages. As a result, when the average 

increases in one locality because of the 

addition of a higher cost county, the 

average in the locality that previously 

contained the higher cost county will 

necessarily decrease. Any changes in 

localities will necessarily produce 

changes in the underlying GPCIs, and 

we have no authority to assign or retain 

GPCIs that do not represent the actual 

values for a locality. 

Comment: Many commenters 

suggested that we consider a national 

solution to payment locality structure 

problems, not focus on a single state. 

Response: Our proposals attempted to 

address locality issues in an area of the 

country where the incongruity of certain 

GAFs within localities is particularly 

evident. In addition, these issues have 

been brought to our attention regularly 

over the past several years, and the 

California Medical Association has 

demonstrated its desire and willingness 

to work with us to develop ideas for 

resolving them. We viewed these 

proposals relating only to California as 

a starting point and, as we indicated in 

the proposed rule, we would consider 

applying any changes to additional 

States in the future. 

Decision: We appreciate the 

thoughtful comments we received in 

response to the three options we 

included in the proposed rule. As 

mentioned above, we recognize that 

changing the locality structure is a 

complex undertaking and there are 

competing concerns, including budget 

neutrality that results in payments in 

certain areas decreasing whenever 

payments in other areas are increased, 

that must be carefully balanced to 

achieve the most appropriate results. 

Historically, to help us find the best 

balance in a particular state, we have 

looked to State medical societies to 

work with us to provide leadership and 

support on preferred approaches to 

locality reconfiguration in that 

particular State. 

The comments we received from 

California physicians, including the 

California Medical Association’s 

indication that it does not support any 

of the options, and interested parties 

from other States have convinced us 

that this issue requires further study and 

analysis. Therefore, we will not be 

finalizing any of the three proposed 

options in this rule. Commenters have 

suggested some other methodologies 

that we find worthy of further 

exploration, including the use of 

Metropolitan Statistical Areas (MSAs). 

We do not necessarily believe that the 

county is the appropriate geographic 

unit on which we should be focusing for 

locality revisions. Commenters also 

made strong arguments for why any 

locality reconfiguration should be done 

on a nationwide basis and not just one 

State at a time. Therefore, we intend to 

conduct a thorough analysis of 

approaches to reconfiguring localities 

and will address this issue again in 

future rulemaking. 

C. Malpractice RVUs (TC/PC Issue) 

In the CY 2008 PFS proposed rule (72 

FR 38142), we included a discussion 

about the radiology codes for which the 

technical component malpractice RVUs 

are higher than the professional 

component malpractice RVUs. In the 

past, several organizations have 

requested that we examine these codes 

and make changes to this assignment of 

malpractice RVUs. We asked for 

information about how we could 

address this issue and obtain data on 

malpractice costs associated with these 

radiology codes. 

We received the following comments 

on this issue. 

Comment: The Professional Liability 

Insurance (PLI) workgroup of the AMA/ 

Specialty Society RVU update 

committee (RUC) supported by several 

other organizations recommended that 

we reduce the PLI technical component 

for these codes to zero. They suggest 

that there are no identifiable separate 

costs for professional liability for 

technical components. They also 

recommend that the PLI RVUs be 

redistributed across all physicians’

services. The RUC is concerned that the 

Deficit Reduction Act of 2005 (Pub. L. 

109–171) (DRA) cap on the TC payment 

for imaging services will remove an 

estimated $200 million from the Part B 

pool (as a result of the exemption of the 

reduced expenditures from the budget 

neutrality requirement at section 

1848(c)(2)(B)(v)). The RUC believes that 

making the recommended changes will 

keep money that would be lost due to 

the DRA cap in the Part B pool. The 

RUC wants CMS to implement this 

change immediately and consider other 

changes to the PLI RVU assignment 

later. 

Response: In the CY 2008 PFS 

proposed rule, we explained that these 

codes had not been reviewed due to a 

lack of suitable data on the cost of PLI 

for technical staff or imaging centers. 

The RUC believes that no such data are 

available because there are no 

identifiable separate costs. At this point 

in time, we are not able to evaluate 

whether sufficient data exists or to make 

a judgment on the RUC’s assertion that 

such data are not available because 

there are no identifiable costs. We will 

continue to explore possible sources of 

information about these costs. We made 

no proposal regarding malpractice RVU 

assignment and we are still considering 

possible changes. If we identify in the 

future what we believe is a more 

appropriate way to pay for these 

services, we will propose changes 

through notice and comment 

rulemaking. 

Comment: Some commenters stated 

that the malpractice RVUs in the 

technical component should not be 

zero. These commenters suggested that 

we either ‘‘flip’’ the malpractice RVU 

assignment between the professional 

and technical components or make them 

equal. 

Response: As we stated in the CY 

2008 PFS proposed rule, we do not 

believe it would be appropriate to ‘‘flip’’

the PC and TC RVU values because the 

professional part of the MP RVUs has 

undergone a resource based review, is 

derived from actual data, and is 

consistent with the resource based 

methodology for PFS payments. Further, 

we will not simply equalize the PC and 

TC RVU values because at this time we 

have no data to demonstrate that the 

malpractice costs for the technical 

portion of these services are the same as 

the professional portion. We will 

continue to study this issue and will 

propose any changes in future 

rulemaking. 

Comment: We received several 

comments recommending that we make 

the PLI RVUs resource based for all 

codes and that we should continue to 

collect and analyze appropriate 

malpractice premium data before 

making changes to the RVU assignment. 

Response: We will continue to solicit, 

collect, and analyze appropriate data on 

this subject. Once we have sufficient 

information, we will be better able to 

make a determination as to what, if any, 

changes should be made, and we will 

propose any changes in future 

rulemaking. 

D. Medicare Telehealth Services 

1. Requests for Adding Services to the 

List of Medicare Telehealth Services 

As discussed in the CY 2008 PFS 

proposed rule (72 FR 38143), section 

1834(m)(4)(F) of the Act defines 

telehealth services as professional 

consultations, office visits, and office 

psychiatry services, and any additional 

service specified by the Secretary. In 

addition, the statute required us to 

establish a process for adding services to 

or deleting services from the list of 

telehealth services on an annual basis. 


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In the CY 2003 PFS final rule with 

comment period (67 FR 79988), we 

established a process for adding services 

to or deleting services from 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, consultation, 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 following to the list of 

Medicare telehealth services: 

psychiatric diagnostic interview 

examination; ESRD services furnished 

under the monthly capitation payment 

(MCP) with two to three visits per 

month and four or more visits per 

month (although we require at least one 

visit a month, in person ‘‘hands on’’, by 

a physician, Certified Nurse Specialist, 

NP, or PA to examine the vascular 

access site); and individual medical 

nutrition therapy. 

Requests to add services to the list of 

Medicare telehealth services must be 

submitted and received no later than 

December 31 of each calendar year to be 

considered for the next rulemaking 

cycle. For example, requests submitted 

before the end of CY 2006 are 

considered for the CY 2008 proposed 

rule. For more information on 

submitting a request for an addition to 

the list of Medicare telehealth services, 

visit our Web site at www.cms.hhs.gov/ 

telehealth/. 

We received the following requests for 

additional approved services in CY 

2006: (1) Subsequent hospital care (as 

represented by HCPCS codes 99231 

through 99233); (2) neurobehavioral 

status exam (HCPCS code 96116); and 

(3) neuropsychological testing (HCPCS 

codes 96118 through 96120). 

After reviewing the public requests, 

we proposed to add neurobehavioral 

status exam as described by HCPCS 

code 96116 to the list of Medicare 

telehealth services in the CY 2008 PFS 

proposed rule. We also proposed to 

revise § 410.78 and § 414.65 to include 

neurobehavioral status exam as a 

Medicare telehealth service. We did not 

propose to add subsequent hospital care 

or neuropsychological testing but 

requested comments as to how we could 

determine when subsequent hospital 

care is actually a follow-up inpatient 

consultation and specific information 

on neuropsychological testing. For 

further information on our proposals, 

see the CY 2008 PFS proposed rule (72 

FR 38143). 

Subsequent Hospital Care 

The following is a summary of the 

comments we received regarding 

subsequent hospital care. 

Comment: We received two comments 

regarding the conditions (or 

requirements) we could apply to 

subsequent hospital care so that 

subsequent hospital care reflects a 

follow-up inpatient consultation. One 

commenter suggested that follow-up 

inpatient consultation should be 

approved as a telehealth service only if 

the initial inpatient consultation was 

performed via telehealth. The 

commenter does not believe we should 

approve a follow-up inpatient 

consultation for telehealth if the initial 

inpatient consultation was furnished inperson (because it might lead to a 

reduction in follow-up consultations 

furnished face-to-face). The commenter 

also agreed with our proposal not to 

approve subsequent hospital care for 

telehealth. Another commenter noted 

that follow-up inpatient consultation 

was previously on the list of Medicare 

telehealth services and asserts that the 

AMA’s deletion of follow-up inpatient 

consultation (as described by CPT codes 

99261 through 99263) created the need 

to approve the addition of subsequent 

hospital care to the list of Medicare 

telehealth services when used for 

follow-up inpatient consultation care. 

The commenter suggested that we create 

a special modifier to report follow-up 

inpatient consultation via telehealth. 

Response: We appreciate the 

comments on the conditions (or 

requirements) we could apply to 

subsequent hospital care so that 

subsequent hospital care reflects a 

follow-up inpatient consultation. We 

intend to consider the suggestions 

raised by the commenters as we 

continue to evaluate whether 

subsequent hospital care should be 

approved for telehealth when it is used 

to furnish a follow-up inpatient 

consultation. With regard to the 

commenter who suggested the creation 

of a special modifier, we will assess 

whether it would be appropriate to use 

a modifier(s) to identify when a 

subsequent hospital care service is 

actually a follow-up inpatient 

consultation. 

Comment: One commenter who 

supports approving subsequent hospital 

care for telehealth explained that 

recruiting specialists to North and South 

Dakota is difficult and that telehealth 

has helped hospital inpatients in these 

States to obtain access to various types 

of specialty care including 

pulmonology, endocrinology, pediatric 

gastroenterology, pediatric cardiology, 

and infectious disease specialties. The 

commenter also mentioned that 

inpatient consultations are frequently 

provided by infectious disease 

specialists for patients in the intensive 

care unit (ICU) and explained that once 

the patient has made progress and is 

moved from the ICU, the infectious 

disease specialist at the distant site 

continues to ‘‘follow’’ the patient until 

the patient is discharged from the 

hospital. The commenter recognized 

that access to on-going specialty care for 

outpatients is important but believes 

that obtaining access to specialty 

subsequent inpatient ‘‘follow-up’’ care 

is even more critical. Commenters 

submitted a comparative study between 

subsequent hospital care furnished as a 

telehealth service and furnished inperson. 

Response: As discussed in the CY 

2008 PFS proposed rule, given the 

potential acuity level of the patient in 

the hospital setting, we believe that 

many services furnished within the 

scope of the subsequent hospital service 

codes are not similar to the current 

telehealth services. As such, we 

indicated that subsequent hospital care 

is a category 2 service (which requires 

sufficient comparative analyses before 

approving it for telehealth). The 

commenters did submit one 

comparative analysis between 

subsequent hospital care furnished as a 

telehealth service and subsequent 

hospital care furnished in-person. 

However, the study submitted involved 

only continuing specialist care (for one 

specialty), not continuing inpatient care 

by the primary attending physician. In 


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addition, the sample size was extremely 

small. Thus, the study findings are not 

generalizable. 

As such, we continue to have 

concerns about using a 

telecommunications system as a 

substitute for the on-going, day-to-day 

(in-person) evaluation and management 

of a hospital inpatient and believe 

further study is necessary. In the 

absence of sufficient, well-designed 

comparison studies showing that the 

use of a telecommunications system is 

an adequate substitute for the in-person 

delivery of subsequent hospital care, we 

are not adding subsequent hospital care 

to the list of Medicare telehealth 

services. As discussed above in this 

response, we will work with the 

industry organizations and groups to 

learn more about hospital care as a 

telehealth service when it is used for 

follow-up inpatient consultations. 

Comment: One commenter (who 

submitted the request to approve 

subsequent hospital care for telehealth) 

stated that the original request to add 

subsequent hospital care to the list of 

Medicare telehealth services was a 

request to ‘‘re-establish’’ subsequent 

inpatient visits (as a Medicare telehealth 

service). The commenter described two 

scenarios in which subsequent hospital 

care could be furnished as a telehealth 

service. The first scenario would 

involve a specialty physician who 

furnishes an inpatient consultation as a 

telehealth service (as requested by the 

attending physician). The second 

scenario involves an attending or 

admitting physician who furnishes 

initial hospital care in-person (not as 

telehealth) and provides subsequent 

hospital care as a telehealth service. The 

commenter believes that access to 

telehealth care is better than not having 

access to any care and that studies have 

shown that telehealth care provides 

better clinical outcomes than no care at 

all. Additionally, the commenter asserts 

that tertiary care trauma surgeons, 

neurologists (for initial and follow-up 

stroke evaluation), psychiatrists (for 

initial assessment and prescriptive 

safety orders), infectious disease 

physicians, and cardiologists can be 

made available through telehealth when 

these specialties are not available onsite. The commenter believes that not 

approving subsequent hospital care for 

telehealth will severely hinder access to 

specialty care in the inpatient hospital 

setting and will lead to grave 

consequences for patients when no 

specialists are available on-site (at the 

hospital). 

Response: We agree that telehealth 

services may help provide greater access 

to specialty care, and therefore, better 

clinical outcomes where a shortage of 

medical professionals exist (or in 

situations when no care is available). As 

discussed in the CY 2008 PFS proposed 

rule, we are considering approving 

subsequent hospital care for telehealth 

when it is used for follow-up inpatient 

consultation. We believe that permitting 

follow-up inpatient consultations via 

telehealth will help provide greater 

access to specialty care in the inpatient 

hospital setting. 

Additionally, we note that, contrary to 

the commenter’s assertion, subsequent 

inpatient hospital visits were not 

previously on the list of Medicare 

telehealth services. As mentioned by a 

previous commenter, the AMA deleted 

the codes for follow-up inpatient 

consultation (as described by CPT codes 

99261 through 99263). Effective January 

1, 2006, these CPT codes no longer exist 

and were removed from the PFS, and a 

conforming change was made to the list 

of Medicare telehealth services. Prior to 

January 1, 2006, the physician (or 

practitioner) at the distant site could 

have used these CPT codes to bill for 

follow-up inpatient consultations as a 

telehealth service. However, subsequent 

inpatient hospital visits were not on the 

list of Medicare telehealth services. 

Comment: One commenter cited the 

concerns we raised in the proposed rule 

regarding the acuity level of a hospital 

inpatient and the use of a 

telecommunications system to furnish 

on going evaluation and management 

services in the inpatient hospital setting. 

The commenter believes that patients in 

the emergency department typically 

have a higher acuity level, are in a more 

precarious physical state (as compared 

to a hospital inpatient) and may not 

have a diagnosis. The commenter 

explains that hospitalized patients have 

already been seen and admitted by a 

physician on site and have at least a 

preliminary diagnosis. Despite the 

higher acuity level of a patient in the 

emergency department, the commenter 

asserts that we reimburse for telehealth 

care in the emergency department (but 

not for inpatients). 

Additionally, the commenter 

discussed various scenarios involving 

the examination of acute stroke patients 

via telehealth in the emergency room 

and ICU. For example, the commenter 

provided a summary of a study that 

tested whether the use of an audio and 

video multimedia telecommunications 

system is a feasible and reliable means 

for delivering emergency stroke care 

(using the National Institute of Health 

Stroke Scale). This study concluded that 

‘‘remote examination of acute stroke 

patients with a computer based 

telesupport system is feasible and 

reliable when applied in the emergency 

room’’. The commenter also explained 

how telehealth is being used to provide 

24 hour access to acute stroke care 

expertise for a number of hospitals in 

Massachusetts and that similar 

programs are being established 

throughout the United States, Canada, 

the United Kingdom, Scandinavia, and 

other parts of the world. The commenter 

also provided a discussion of a study 

that examined the fiscal impact of 

providing telehealth consultation (for 

acutely ill and injured children in the 

ICU) on rural hospitals. The study found 

that as a result of greater access to 

pediatric consultations, savings are 

realized from a reduction in patient 

transfers (to larger hospitals) and 

increased revenue for rural hospitals. 

Response: We appreciate the 

information the commenter has 

submitted on the remote evaluation of 

stroke patients and pediatric telehealth 

consultations in the emergency 

department or ICU. We intend to 

consider this information as we evaluate 

whether to approve subsequent hospital 

care for telehealth when it is used for 

follow up inpatient consultation. We 

would also mention that the nature of 

the comment indicates a misconception 

that we pay for emergency department 

services as a telehealth service. We note 

that only outpatient consultations (not 

visits) are approved as a Medicare 

telehealth service for a patient in the 

emergency department. If guidance or 

advice is needed in the emergency 

department (for example, for acute 

stroke care), an outpatient consultation 

may be requested from an appropriate 

source and may be furnished as a 

telehealth service. However, emergency 

department services (as described by 

CPT codes 99281 through 99285) are not 

on the list of Medicare telehealth 

services. 

Comment: One commenter mentioned 

that we previously approved the 

psychiatric diagnostic interview 

examination and subsequent ESRD 

related visits furnished under the 

monthly capitation payment (MCP) for 

telehealth without comparative analyses 

and data showing patient satisfaction 

(which implies that subsequent hospital 

care could be approved for telehealth on 

the same basis). The commenter also 

cited the proposed regulatory impact 

analysis for telehealth stating that 

previous additions to the list of 

Medicare telehealth services have not 

resulted in a significant increase in 

Medicare program expenditures. 

Response: In approving the 

psychiatric diagnostic interview 

examination for telehealth, we 

considered this service to be comparable 


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to an initial office visit, or consultation 

service, which are currently Medicare 

telehealth services. Likewise, we 

considered the outpatient dialysis visits 

furnished under the MCP (except for 

one visit to examine the vascular access 

site) to be comparable to office and 

other outpatient visits currently on the 

list of Medicare telehealth services. 

Therefore, we considered these services 

to be category 1, and therefore, we were 

able to review and approve them for 

telehealth without reviewing additional 

research studies to support their 

approval. However, as discussed above 

in this section, because of the potential 

acuity of a hospital inpatient, we were 

not able to conclude that the entire 

scope of services described by the 

subsequent hospital care codes is 

similar to the existing list of telehealth 

services (for example, an office visit, 

office psychology service, or 

consultation). Therefore, we considered 

subsequent hospital care to be a 

category 2 service (which requires 

sufficient comparative analyses before 

approving for telehealth). 

For more information on the addition 

of the psychiatric diagnostic interview 

examination see the CY 2003 PFS 

proposed rule (67 FR 43863). For more 

information on the addition of ESRDrelated visits furnished under the MCP, 

see the CY 2005 PFS proposed rule (69 

FR 47511). 

Neurobehavioral Status Exam 

Comment: Several commenters 

expressed support for our proposal to 

add the neurobehavioral status exam to 

the list of Medicare telehealth services. 

Commenters agreed that because the 

neurobehavioral status exam is 

primarily a clinical interview (similar to 

the psychiatric diagnostic interview 

which is currently a Medicare telehealth 

service), it is logical and consistent to 

approve this service for telehealth. 

Response: We agree with the 

commenters. As discussed in the 

proposed rule, the neurobehavioral 

status exam is furnished by a physician 

or psychologist and includes an initial 

assessment and evaluation of mental 

status for a psychiatric patient. In this 

regard, we believe the neurobehavioral 

status exam is similar to psychiatric 

diagnostic interview examination 

(which is currently approved as a 

Medicare telehealth service). 

Comment: One commenter who 

supported our proposal to approve the 

neurobehavioral status exam for 

telehealth, stated that HCPCS code 

96116 is a new code that replaced 

HCPCS code 96115 (the predecessor to 

HCPCS code 96116) in the 2006 CPT 

compendia. The commenter believes 

that neurobehavioral status exam (as 

described by HCPCS code 96115) was 

previously on the list of Medicare 

telehealth services and considers our 

proposal to add neurobehavioral status 

exam (as described by CPT code 96116) 

to be a restoration of the 

neurobehavioral status exam as a 

telehealth service. 

Response: The commenter’s assertion 

that our proposal to add the 

neurobehavioral status exam to the list 

of Medicare telehealth services is a 

restoration of the neurobehavioral status 

exam as a telehealth service is not 

correct. The neurobehavioral status 

exam (as previously described by CPT 

code 96115) was not on the list of 

Medicare telehealth services. The 

proposed addition of neurobehavioral 

status exam is a new proposal. 

Comment: One commenter stated that 

the neurobehavioral status exam 

appears to require that the service be 

provided face to face (in person). 

Therefore, the commenter requested us 

to clarify that face to face services may 

qualify as telehealth services. 

Response: As discussed in the CY 

2005 PFS final rule with comment 

period, only services that traditionally 

require a face-to-face (in-person) 

physician or practitioner encounter are 

candidates for the list of Medicare 

telehealth services. Services not 

requiring a face-to-face encounter with 

the patient that may be furnished 

through the use of a 

telecommunications system are already 

covered under Medicare. For more 

information see the CY 2005 PFS final 

rule (69 FR 66278). 

Neuropsychological Testing 

Comment: We received conflicting 

comments regarding neuropsychological 

testing. For example, one commenter 

agreed with the requestor that 

neuropsychological testing furnished 

via telehealth is not significantly 

different from being furnished in-person 

(especially when administered by a 

computer). Additionally, the commenter 

stated that existing telehealth services 

for psychiatric patients include office 

visits, consultation, and office 

psychiatry. The commenter believes that 

the patient-provider dynamics of these 

services would not appear to be so 

significantly different from those for 

neuropsychological testing as to justify 

not approving the services for 

telehealth. The commenter also believes 

that testing dynamics, such as the 

patient being blindfolded or having 

numbers assigned to his or her fingers, 

could be easily reproduced with the 

help of someone at the originating site. 

The same commenter also provided a 

discussion of the importance of early 

detection of dementia through 

neuropsychological testing. The 

commenter included a letter from the 

Armed Forces Epidemiological Board 

about brain injury in military service 

members with recommendations on 

handling these injuries. The commenter 

stated that although the Epidemiological 

Board addressed military patients, the 

principles of its findings apply to 

civilian assessment and treatment of 

brain injuries; that is, appropriate 

testing at earlier stages of brain injury or 

disease is likely to elicit a more accurate 

patient profile, leading to more targeted 

interventions and better patient 

outcomes. 

In addition, the commenter stated that 

the administration of neuropsychological testing may be more difficult for 

some patients than others; however, this 

is true in both the in-person and 

telehealth setting. The commenter 

believes that if the patient requires 

immediate in-person assistance, a 

telepresenter could be used to facilitate 

the testing and that the determination of 

patient suitability for testing should be 

up to the physician or practitioner at the 

distant site. Two commenters agreed 

that a telepresenter could assist the 

physician or psychologist at the distant 

site with the testing and that the 

physician or psychologist should 

determine which patients (and tests) are 

appropriate for telehealth. 

Another commenter who provides 

neuropsychological testing via 

telehealth explained that many 

standardized neuropsychological tests 

are available (literally hundreds) to the 

physician or psychologist (or 

technician) and that tests vary widely in 

terms of administrative procedure and 

the level of interaction between the 

patient and practitioner responsible for 

administering the test. The commenter 

believes that many tests could be 

effectively administered via telehealth 

and that it is not appropriate for us to 

issue a ‘‘global denial’’ of 

neuropsychological testing. For 

example, the commenter believes that 

neuropsychological testing administered 

via a computer should be approved for 

telehealth and that testing administered 

by a physician, psychologist, or 

qualified technician should be reevaluated. The commenter also 

explained that an RN is often used as a 

telepresenter to assist the 

neuropsychologist or technician with 

testing. When testing cannot be 

administered in a ‘‘standardized 

fashion’’ via telehealth, a qualified 

technician could be present on-site with 

the patient to assist a psychologist who 


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furnishes the test at the distant site. 

However, the commenter believes that 

some testing measures may not be 

appropriate for telehealth. The 

commenter estimated that ‘‘fewer than 

35 percent of the hundreds of available 

measures do not lend themselves to 

standardized administration via 

telehealth’’. The commenter also cited 

the American Psychological 

Association’s Ethical Principles of 

Psychologists and Code of Conduct and 

stated these guidelines would prohibit 

administration of certain individual 

tests via telehealth. 

Other commenters believe that further 

study is necessary. The commenters 

urged us to seek additional information 

concerning the provision of 

neuropsychological testing before 

making a determination about these 

services for telehealth. One commenter 

believes that neuropsychological testing 

should be considered for telehealth 

approval stating, ‘‘however it is unclear 

whether the technology has advanced 

far enough to allow all 

neuropsychological testing to be 

provided via telehealth without 

compromising the quality of care’’. 

Additionally, the commenter stated that 

more time is needed to assess how 

neuropsychological testing could be 

provided via telehealth and listed the 

following issues that need further 

consideration: 

• The variety of disorders and 

diagnoses appropriate via telehealth; 

• The physical assistance that 

patients may need to complete tests; and 

• The impact of face-to-face 

interactions with a psychologist or 

trained psychological technician during 

testing on the interpretation of test 

results. 

Response: We appreciate the 

comments regarding the use of an 

interactive audio and video 

telecommunications system in 

furnishing neuropsychological testing 

services. Based on the comments 

received, we believe that further study 

is necessary before making a 

determination about neuropsychological 

testing for telehealth. As discussed 

above in this section, we received 

conflicting comments as to whether the 

administration of a neuropsychological 

test could be furnished adequately when 

the practitioner who is responsible for 

administering the test is not physically 

present with the patient. 

For example, some commenters 

believe that neuropsychological testing 

furnished via telehealth is not 

significantly different than when 

furnished in-person and that a 

telepresenter could be used to assist the 

physician or psychologist at the distant 

site if necessary. Other commenters 

believed that further study is necessary 

before approving neuropsychological 

testing for telehealth. One commenter 

believed that it is unclear whether the 

use of a telecommunications system for 

administering neuropsychological 

testing would compromise quality of 

care and listed specific issues that need 

greater exploration. Even a commenter 

who supports approving 

neuropsychological testing for 

telehealth indicated that many 

neuropsychological testing measures 

would not be appropriate for telehealth. 

As such, we continue to have concerns 

about using an interactive audio and 

video telecommunications system as a 

substitute for the face-to-face (in-person) 

requirements of neuropsychological 

testing. 

Comment: Two commenters believe 

that sufficient empirical evidence exists 

to support the approval of 

neuropsychological testing for 

telehealth. The commenters submitted 

summaries of two comparative analyses 

between neuropsychological testing 

furnished via an interactive audio and 

video telecommunications system and 

neuropsychological testing furnished inperson. 

Response: As discussed above in this 

section, we believe that further study is 

necessary before approving 

neuropsychological testing for 

telehealth. Although the commenters 

did submit comparative analyses, in one 

of the studies cited, the same 

psychologist furnished 

neuropsychological testing in both 

conditions (face-to-face and via 

telehealth). In another study cited, study 

participants without neuropsychological 

or psychiatric disturbance were tested. 

Additionally, the studies cited had 

extremely small samples. As such, we 

believe it would be difficult to 

generalize any findings to a broader 

population. 

Comment: One commenter questioned 

whether the regulatory impact analysis 

for telehealth was intended to provide a 

rationale to make reductions in 

Medicare payment for telehealth 

services in the future. The commenter 

urged us to continue to fund a wide 

variety of telehealth services. 

Response: The regulatory impact 

analysis was not intended to be used as 

a rationale for making reductions in 

Medicare payment for telehealth 

services. The intent of the regulatory 

impact analysis on telehealth was to 

illustrate that the proposed addition of 

neurobehavioral status exam to the list 

of Medicare telehealth services should 

not have a significant budgetary impact 

on the Medicare program. For more 

information on our regulatory impact 

analysis for the proposed addition of 

neurobehavioral status exam to the list 

of Medicare telehealth services, see the 

CY 2008 PFS proposed rule (72 FR 

38216). 

Comment: One commenter stated that 

neuropsychological testing is ancillary 

to a neurobehavioral status exam and 

that neuropsychological testing would 

have little additional budgetary impact 

(beyond the impact of adding 

neurobehavioral status exam). To 

support this assertion, the commenter 

cited our proposed regulatory impact 

analysis on the addition of 

neurobehavioral status exam (as 

described by CPT code 96116). 

Response: As discussed above in this 

section, we believe that further study is 

necessary before approving 

neuropsychological testing for 

telehealth. 

Comment: A few commenters 

requested that we approve additional 

services for telehealth (for example, 

standardized performance testing as 

described by CPT code 96125). 

Response: Requests for additions 

(including any supporting data 

analyses) should be submitted through 

our process for adding services and 

must be received by December 31 of 

each calendar year to be considered for 

the next proposed rule. For more 

information on how to submit a request 

for addition, please visit our Web site at 

http://www.cms.hhs.gov/telehealth. 

Results of Evaluation of Comments 

We are adding the neurobehavioral 

status exam as represented by HCPCS 

code 96116 to the list of Medicare 

telehealth services. Additionally, we are 

revising § 410.78 and § 414.65 to 

include neurobehavioral status exam as 

a Medicare telehealth service. 

As discussed above, only services that 

traditionally require a face-to-face (in 

person) physician or practitioner 

encounter are candidates for the list of 

Medicare telehealth services. Services 

not requiring a face-to-face encounter 

with the patient that may be furnished 

through the use of a 

telecommunications system are already 

covered under Medicare. As discussed 

in chapter 15, section 30 of the 

Medicare Benefit Policy Manual, 

payment may be made for physicians’

services delivered via a 

telecommunications system for services 

that do not require a face-to-face patient 

encounter. The interpretation of an xray, electrocardiogram, 

electroencephalogram and tissue 

samples are listed as examples of these 

services. 


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After further review of the requested 

services for addition, 

neuropsychological testing administered 

by a computer (as described by HCPCS 

code 96120) is not a candidate for the 

list of Medicare telehealth services. 

Neuropsychological testing 

administered by a computer (HCPCS 

code 96120) does not require a face-toface (in person) encounter between the 

patient and the physician or 

psychologist (or qualified technician) 

responsible for the administration and 

interpretation of the test results (for 

example, the patient is interfacing with 

the computer, not a physician or 

psychologist). As such, a 

telecommunications system may be 

used to facilitate neuropsychological 

testing administered by a computer (as 

described by HCPCS code 96120); for 

example, Web-based computer 

neuropsychological testing, and/or 

transmission of neuropsychological test 

results to an interpreting physician or 

psychologist via telecommunications 

system. 

E. Specific Coding Issues Related to the 

PFS 

1. Reduction in the Technical 

Component (TC) for Imaging Services 

Under the PFS to the Outpatient 

Department (OPD) 

Effective January 1, 2007, section 

5102(b)(1) of the Deficit Reduction Act 

of 2005 (Pub. L. 109–171) (DRA) 

amended section 1848 of the Act to 

require that, for imaging services, if—

‘‘(i) The technical component (including 

the technical component portion of a 

global fee) of the service established for 

a year under the fee schedule* * * 

without application of the geographic 

adjustment factor * * *, exceeds (ii) 

The Medicare OPD fee schedule amount 

established under the prospective 

payment system for hospital outpatient 

department services* * * for such 

service for such year, determined 

without regard to geographic adjustment 

* * *, the Secretary shall substitute the 

amount described in clause (ii), adjusted 

by the geographic adjustment factor 

[under the PFS], for the fee schedule 

amount for such technical component 

for such year.’’

As required by the statute, for imaging 

services (described in this section) 

furnished on or after January 1, 2007, 

we cap the TC of the PFS payment 

amount for the year (prior to geographic 

adjustment) by the Outpatient 

Prospective Payment System (OPPS) 

payment amount for the service (prior to 

geographic adjustment). We then apply 

the PFS geographic adjustment to the 

capped payment amount. 

Section 5102(b)(1) of the DRA defines 

imaging services as ‘‘imaging and 

computer-assisted imaging services, 

including X-ray, ultrasound (including 

echocardiography), nuclear medicine 

(including PET), magnetic resonance 

imaging (MRI),computed tomography 

(CT), and fluoroscopy, but excluding 

diagnostic and screening 

mammography.’’

To apply section 5102(b) of the DRA, 

we needed to determine the CPT and 

alpha-numeric HCPCS codes that fall 

within the scope of ‘‘imaging services’’

defined by the DRA provision. In the CY 

2008 PFS proposed rule, we explain in 

detail the process we used for 

establishing the list of codes that fall 

within the scope of this DRA provision. 

We also stated that upon further review, 

we have determined that certain 

ophthalmologic procedures meet the 

DRA definition of imaging procedures, 

but were not included in the original list 

of imaging services subject to the OPPS 

cap. Therefore, we proposed to add the 

following procedures to the list of 

procedures subject to the OPPS cap, 

effective January 1, 2008: 

• 92135, Scanning computerized 

ophthalmic diagnostic imaging (e.g., 

scanning laser) with interpretation and 

report. 

• 92235, Fluorscein angioscopy 

(includes multiframe imaging) with 

interpretation and report. 

• 92240, Indocyanine-green 

angiography (includes multiframe 

imaging) with interpretation and report. 

• 92250, Fundus photography with 

interpretation and report. 

• 92285, External ocular photography 

with interpretation and report for 

documentation of medical progress (e.g., 

close-up photography, slit lamp 

photography, goniophotography, stereophotography). 

• 92286, Special anterior segment 

photography with interpretation and 

report; with specular endothelial 

microscopy and cell count. 

A complete list of CPT codes that 

identify imaging services as defined by 

the DRA OPPS cap provision, amended 

to include these ophthalmologic 

procedures, was also published in 

Addendum F of the CY 2008 PFS 

proposed rule (72 FR 38369 through 

38372). Payment for an individual 

service on this list will only be capped 

if the PFS TC payment amount exceeds 

the OPPS payment amount. 

Comment: Several commenters 

indicated that none of the six 

ophthalmologic CPT codes proposed for 

addition to the list of procedures subject 

to the OPPS cap meet the statutory 

definition of imaging under the DRA, 

that is, none of the procedures codes fall 

under the categories of x-rays, 

ultrasound, MRI, PET, CT or 

fluoroscopy. Specifically, they noted 

that CPT code 92250 utilizes a wide 

angle camera used primarily for 

detecting retinopathy in diabetics. 

Likewise, CPT codes 92235, 92240, and 

92285 are all photos, using 

photographic equipment, or an 

angioscope. The commenters concluded 

that the Congress did not intend for any 

service that uses a camera or 

microscope, takes photographs, and 

produces negatives to be included in the 

DRA definition of imaging services. 

Another commenter indicated that 

CPT codes 92250 and 92285 do not meet 

our criterion for including a procedure 

under the DRA provision, that is, 

services that provide visual information 

regarding areas of the body that are not 

normally visible, thereby assisting in the 

diagnosis or treatment of injury. The 

commenter noted that the subject 

procedures take traditional pictures of 

parts of the eye that are normally 

visualized with the naked eye. One 

commenter noted that the six CPT codes 

have not experienced dramatic increases 

in utilization, but rather, utilization has 

remained stable or decreased. 

Response: The DRA provision 

describes imaging services broadly as 

‘‘imaging and computer-assisted 

imaging services,’’ and does not provide 

for the type of distinctions the 

commenters suggested. While it 

specifically includes certain imaging 

modalities (x-ray, ultrasound, MRI, PET, 

CT, and fluoroscopy), it does not 

exclude other imaging modalities. In 

fact, the DRA provision excludes only 

one imaging service, that is, diagnostic 

and screening mammography. 

Concerning CPT codes 92250 and 

92285, we believe the images generated 

by these services may include 

information that requires the use of 

photographic or imaging equipment and 

is not normally visible by the unaided 

human eye. Finally, the description of 

imaging services to which the DRA 

provision applies is not limited to 

procedures that have experienced 

dramatic increases in utilization. We 

believe the six procedures meet the DRA 

definition of imagining services and are 

similar to other procedures already 

subject to the DRA provision. Therefore, 

we will include these CPT codes on the 

list of procedures subject to the OPPS 

cap. (Note: This list of procedures is 

published in Addendum F of this final 

rule with comment period.) 

Comment: Many comments requested 

clarification of the application of the 

OPPS cap when there is no OPPS 

payment for comparison; where the 

code is bundled under OPPS; or where 


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the OPPS payment includes items (for 

example, contrast agents or 

radiopharmaceuticals) that are paid 

separately under the PFS. 

Response: Where there is no OPPS 

payment for a procedure or where the 

OPPS for a procedure is bundled, there 

is no OPPS amount for the comparison 

with the PFS payment. Therefore, it is 

infeasible to apply an OPPS cap. The 

codes will remain on the list of codes 

subject to the OPPS cap, but will not be 

affected by the cap. Where the OPPS 

payment includes packaged services or 

items that are paid separately under the 

PFS, we can and do apply an OPPS cap. 

The physician can continue to bill 

separately for such services or items 

when furnished in a place of service, for 

example, a physician’s office, where the 

item is paid separately. 

2. Application of Multiple Procedure 

Reduction for Mohs Micrographic 

Surgery (CPT Codes 17311 Through 

17315) 

Under the multiple procedure 

payment reduction policy, 

reimbursement for subsequent surgical 

procedures performed during the same 

operative session by the same physician 

is reduced by 50 percent. The Mohs 

surgery codes have been exempt from 

the multiple procedure payment 

reduction rules since the inception of 

the PFS (56 FR 59602, November 25, 

1991). 

The CPT Editorial Panel reviewed all 

of the codes on the list of codes exempt 

from the multiple procedure payment 

reduction (the ‘‘¥51 modifier exempt 

list’’) to identify which codes should be 

exempt from the multiple procedure 

payment reduction rules. Based on the 

revisions to the code descriptors and a 

clearer understanding regarding the 

technical elements of the procedure, in 

CY 2007, the CPT Editorial Panel 

removed the Mohs procedure from the 

¥51 modifier exempt list. The codes for 

Mohs surgery were revised to take into 

account the different level of physician 

work intensity involved based on 

anatomic site. The RVUs associated 

with the codes for each anatomic 

location were recommended by the 

RUC, as they are for other procedures, 

after a thorough discussion by the RUC 

of all aspects of the service. Work RVUs 

were developed for each Mohs surgery 

base code based on an assumption that 

each code is performed separately. 

Because the work RVUs for these 

services do not take into account the 

efficiencies that occur when multiple 

procedures are performed in one 

session, we do not believe that these 

codes should continue to be exempt 

from the multiple procedure payment 

reduction. Therefore, we proposed to 

eliminate the modifier 51 exemption 

and apply the multiple procedure 

payment reduction rules to these codes. 

Comment: We received comments 

supporting our proposal and expressing 

the belief that our proposal is fair and 

consistent with our multiple procedure 

payment policies already affecting a 

wide range of procedures with codes in 

the Surgery/Integumentary System of 

CPT. Many commenters opposed our 

proposal to eliminate the modifier ¥51 

exemption and apply the multiple 

procedure payment reduction to these 

codes. These commenters believed that 

eliminating these codes from the 

modifier ¥51 exempt list would 

negatively impact Medicare 

beneficiaries’’ access to timely and 

quality care, and could lead to increases 

in pathology charges and increase the 

amount spent on multiple facility fees, 

thereby raising the overall cost of 

treating an individual with skin cancer. 

In addition to these concerns, many of 

the commenters do not believe we have 

sufficient justification to make the 

change, and suggest that this is an 

arbitrary decision. Further, the 

commenters asserted that the AMA–

RUC and CPT decisions were in error 

and should not be followed. 

Response: We verified with the CPT 

Editorial Panel that the application of 

the modifier ¥51 exempt status 

indicator, and subsequently, the 

inclusion of this series of codes (CPT 

codes 17311 through 17315) in 

Appendix E, Summary of CPT Codes 

Exempt from Modifier ¥51, of the 2008 

CPT codebook would not be carried 

forward with the new series of codes 

created in 2007. The CPT panel 

confirmed with us that the exclusion of 

these codes from Appendix E was not 

an error. The AMA RUC reviewed and 

valued the new and existing codes for 

Mohs surgery. Upon completion of a 

thorough review and discussion of the 

Mohs codes, the RUC valued these 

codes with the full understanding these 

codes were removed from the modifier 

¥51 exempt list and would be subject 

to the multiple procedure payment 

reduction as well. 

We believe the CPT Editorial Panel 

and the Mohs workgroup on the CPT 

Editorial Panel gave considerable time, 

effort and discussion in the creation of 

the new and existing codes for Mohs 

surgery. We also believe the AMA-RUC 

carefully reviewed the rationale and 

deliberations which lead to the creation 

of new Mohs surgery codes. In addition, 

we believe the specialty society had 

ample time and opportunity to express 

its point of view to both the CPT Panel 

and the AMA-RUC. As a result of the 

revisions to these codes and their 

respective valuation, we do not believe 

they should continue to be treated 

differently from other codes in the 

Surgery/Integumentary System section 

of the CPT book and see no reason not 

to accept the recommendations 

provided by the CPT Panel and AMARUC. Therefore, we are finalizing our 

proposal to eliminate the modifier –51 

exemption and apply the multiple 

surgery procedure payment reduction 

rules to these codes. 

3. Payment for Intravenous Immune 

Globulin (IVIG) Add-On Code for 

Preadmission Related Services 

Intravenous immune globulin (IVIG) 

is a unique product derived from blood 

plasma. This drug is paid for under the 

ASP methodology and the 

administration of this drug is reported 

using the first hour and second hour 

infusion codes for therapeutic, 

prophylactic and diagnostic services 

under CPT. 

We recognize the importance of IVIG 

to patients who require it and are 

concerned about reports of problems 

with IVIG access and availability. We 

have initiated several actions in 

response to concerns about the supply 

of IVIG. 

In July 2007, we implemented new 

codes for reporting IVIG for liquid nonlyophilized IVIG. 

In CY 2006 and 2007, we established 

payment, through the creation of a 

special G-code, G0332, for 

preadministration services furnished in 

connection with the procurement of 

IVIG in the physician’s office. This code 

is designed to compensate physicians 

for the extra resources required to be 

expended due to market conditions to 

locate and obtain the appropriate IVIG 

products and to schedule patient 

infusions. 

Comment: We received several 

comments regarding our proposal to 

continue in CY 2008 the 

preadministration payment under the 

PFS for patients treated with IVIG in a 

physician’s office. 

The majority commenters supported 

our proposal and recommended that it 

be finalized, and recommended that this 

policy be made permanent. Commenters 

stated that if this code and payment are 

not made permanent, we would need to 

present a convincing evidence to 

terminate this payment. Commenters 

indicated that without continuation of 

the add on payment, access problems 

for Medicare beneficiaries in need of 

IVIG would be more severe. 

Many commenters indicated problems 

with the ASP payment methodology for 

IVIG stating that IVIG is a unique 


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product for which market conditions are 

unlike all other drugs paid under ASP. 

Other commenters remarked that the 

addition of the four new billing codes 

for liquid IVIG adopted in July 2007 

should improve market conditions and 

beneficiary access to IVIG. Some 

commenters asked that we consider 

making the liquid IVIG codes permanent 

J-codes. A few commenters asked that 

CMS consider establishing an add on 

payment for IVIG similar to the add on 

payment for clotting factor. 

Two commenters indicated that 

Addendum B did not include the Gcode for preadministration services and 

recommended that the code be included 

in Addendum B for the final rule. 

Response: Comments regarding the 

ASP pricing methodology for IVIG, the 

adoption of new drug codes for liquid 

IVIG in CY 2007, and the consideration 

of an add-on payment for IVIG similar 

to the add-on payment for blood clotting 

factor are beyond the scope of our 

proposal which focuses on payment for 

a service under the PFS. We will 

consider these comments in context of 

any proposed policies for drug 

payments made as part of the CY 2009 

PFS proposed rule. 

In terms of the preadministration 

service for IVIG, we will continue the 

CY 2007 payment policy for code G0332 

through CY 2008. We will carefully 

consider all relevant information 

including the conditions of the IVIG 

drug market during CY 2008 when we 

address whether it would be appropriate 

to continue the payment policy as part 

of the CY 2009 PFS. 

We appreciate the commenters 

alerting us that G0332 was omitted from 

Addendum B in the proposed rule and 

we will ensure that this code is listed in 

Addendum B of this final rule with 

comment period. 

Therefore, we are finalizing the 

proposal to continue to recognize 

payment for preadministration services 

for IVIG furnished to patients in a 

physician’s office in CY 2008. Payment 

for this service will be made based on 

the PE RVUs previously established for 

this service in CY 2007. Payment for 

preadminstration services for IVIG 

furnished to hospital outpatients is paid 

under the outpatient PPS (OPPS) and is 

addressed as part of that final rule. 

4. Reporting of Cardiac Rehabilitation 

Services 

For CY 2008, we proposed to assign 

a status indicator of ‘‘I’’ (invalid for 

Medicare purposes, Medicare recognizes 

another code for the billing of this 

service) to the current CPT codes for 

cardiac rehabilitation services, CPT 

codes 93797, Physician services for 

outpatient cardiac rehabilitation; 

without continuous ECG monitoring (per 

session), and 93798, Physician services 

for outpatient cardiac rehabilitation; 

with continuous ECG monitoring (per 

session) and proposed to establish two 

new Level II HCPCS codes that we 

believe are more appropriate for 

specifically reporting cardiac 

rehabilitation services under the PFS. 

The proposed HCPCS codes are: 

GXXX1, Physician services for 

outpatient cardiac rehabilitation; 

without continuous ECG monitoring (per 

hour), and GXXX2, Physician services 

for outpatient cardiac rehabilitation; 

with continuous ECG monitoring (per 

hour). We also proposed to crosswalk 

the current RVUs associated with CPT 

codes 93797 and 93798 to HCPCS Codes 

Gxxx1 and Gxxx1. 

Comment: Many commenters, 

including physicians and providers of 

cardiac rehabilitation services, were 

generally supportive of the proposal for 

the specific G-codes. Commenters 

believed that this proposed coding 

change would allow for more 

appropriate coding and payment for 

cardiac rehabilitation services in those 

cases where intensive programs provide 

multiple sessions each day. In addition, 

commenters requested that we explicitly 

state that multiple sessions of cardiac 

rehabilitation can be paid for the same 

date of service when modifier 59 is 

reported. They also requested that we 

crosswalk the payments for both of the 

proposed G-codes to the higher cost CPT 

code 93798 to ensure that the full range 

of modalities provided in certain 

intensive cardiac rehabilitation 

programs are available. 

Several of these commenters also 

requested that we provide additional 

guidance related to reporting of the 

cardiac rehabilitation G-codes, such as: 

(1) Explaining that it is likely to be 

reasonable and necessary to cover 72 

cardiac rehab sessions when multiple 

sessions are provided in one day; (2) 

encouraging contractors to factor the 

‘‘proven results’’ of a program into 

coverage decisions and that 72 sessions 

should be ‘‘presumptively covered’’

when they are furnished by a certain 

intensive cardiac rehabilitation 

program; and (3) providing further 

clarification and expansion of 

nutritional counseling by registered 

dieticians, indicating that they could 

independently bill for nutritional 

counseling within cardiac rehabilitation 

programs using the medical nutrition 

therapy codes because the NCD does not 

specifically mention these services. 

Alternatively, a few commenters, 

including physician specialty groups, 

questioned the need for the proposed Gcodes, indicating that no new data 

would be gained by a coding shift that 

changes a unit from a session to an 

hour. Commenters also suggested that 

we work with the AMA to address the 

issue of whether it would be appropriate 

to modify the CPT definition for this 

code from a per session to per hour 

basis. 

Many commenters also expressed 

concern that the use of the term 

‘‘physician services’’ and ‘‘MD services’’

in the G-code descriptors could be 

misinterpreted by Medicare contractors 

as requiring a physician to directly 

deliver the care or be in attendance 

during each service episode and 

requested that the code descriptor be 

revised. 

Response: We are aware of several 

intensive cardiac rehabilitation 

programs that provide multiple sessions 

in a day, lasting several hours total. The 

NCD for cardiac rehabilitation currently 

states that cardiac rehabilitation 

programs are covered for certain 

categories of patients and that the 

programs must be comprehensive. To be 

comprehensive the programs must 

include a medical evaluation, a program 

to modify cardiac risk factors (for 

example, nutritional counseling), 

prescribed exercise, education, and 

counseling. The NCD does not 

distinguish between different 

approaches to the delivery of cardiac 

rehabilitation services, whether the 

more common practice of two sessions 

per week or the more intensive 

programs of several sessions per day. In 

order to allow for flexibility and 

tailoring of cardiac rehabilitation 

programs based on patient needs, we 

have not been prescriptive regarding the 

precise amount of time that must be 

spent on each component of the 

program. Regarding intensity, we expect 

the intensity of cardiac rehabilitation 

programs to vary by patient and by 

program. 

We believe it is important that our 

payment policy provides appropriate 

payment for cardiac rehabilitation 

services. In order to minimize the 

administrative burden to physicians and 

providers, but permit accurate reporting 

and payment for cardiac rehabilitation 

programs that provide more than one 

session per day, we believe that 

continuing the use of CPT codes 93797 

and 93798 and allowing physicians and 

providers to bill more than one session 

per day under some circumstances 

would be the most appropriate course. 

Therefore, based upon the comments 

received and upon further review of this 

issue, for CY 2008, we will allow 

physicians and providers to report more 

than one unit for a date of service if 


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more than one cardiac rehabilitation 

session lasting at least 1 hour each is 

provided on the same day. 

With respect to commenters’ concerns 

about the use of the term ‘‘physician 

services’’ in the proposed G-code 

descriptors, we note that the descriptors 

for these codes were proposed to be 

parallel to the descriptors of the CPT 

codes for cardiac rehabilitation sessions 

which contain the term ‘‘physician 

services’’ in their descriptors. We are 

not aware that physicians and providers 

have problems with Medicare 

contractors’’ interpretation of the CPT 

code descriptors. 

After consideration of all public 

comments received, we are not 

finalizing our proposal to establish two 

new G-codes for reporting cardiac 

rehabilitation services. Instead, we will 

continue to use the CPT codes 93797 

and 93798 to report cardiac 

rehabilitation services under the CY 

2008 PFS. 

We will provide further guidance on 

coding and payment instructions for the 

cardiac rehabilitation services codes 

through program instructions. 

We will not provide the additional 

coverage-related guidance requested by 

some commenters, such as the 

presumptive coverage and independent 

billing for registered dieticians. These 

recommendations effectively request 

changes to the NCD, and therefore, are 

outside of the scope of this final rule 

with comment period. 

F. Part B Drug Payment 

1. Average Sales Price (ASP) Issues 

Medicare Part B covers a limited 

number of prescription drugs and 

biologicals. For the purposes of this 

proposed rule, the term ‘‘drugs’’ will 

hereafter refer to both drugs and 

biologicals, unless otherwise specified. 

Medicare Part B covered drugs not paid 

on a cost or prospective payment basis 

generally fall into the following three 

categories: 

• Drugs furnished incident to a 

physician’s service. 

• DME drugs. 

• Drugs specifically covered by 

statute (certain 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 furnishing fee for blood 

clotting factors, a dispensing fee for 

inhalation drugs, and a supplying fee to 

pharmacies for certain Part B drugs. 

In January 2006, the drug coverage 

available to Medicare beneficiaries 

expanded with the implementation of 

Medicare Part D. The Medicare Part D 

program does not change Medicare Part 

B drug coverage. 

In this section, we discuss changes 

and issues related to the determination 

of the payment amounts for covered Part 

B drugs and furnishing blood clotting 

factor. This section also discusses 

changes to how manufacturers calculate 

and report ASP data to us. 

a. ASP Payment 

Section 303(c) of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (Pub. L. 108–

173) (MMA) amended Title XVIII of the 

Act by adding section 1847A. This 

section revised the payment 

methodology for the vast majority of 

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 by 

11-digit National Drug Code (NDC) 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 42 

CFR, part 414, subpart K. We update the 

Part B drug payment amounts quarterly 

based on the data we receive. In this 

section of the preamble, we discuss 

certain aspects of the calculation of 

manufacturers’ ASP data, issues related 

to bundled price concessions, and other 

Part B drug payment issues. 

Further information on 

manufacturers’ submission of ASP data 

for Medicare Part B drugs and 

biologicals is contained in prior 

rulemaking documents and other 

guidance accessible on the CMS Web 

page at (http://www.cms.hhs.gov/ 

McrPartBDrugAvgSalesPrice/). 

Specifically refer to the April 6, 2004 

ASP interim final rule with comment 

period (IFC) (69 FR 17935) and the CY 

2007 PFS final rule with comment 

period (71 FR 69624), which finalized 

the ASP calculation and reporting 

requirements of the April 6, 2004 IFC, 

and the Frequently Asked Questions 

available on the CMS Web page. 

b. Bundled Price Concessions 

In the CY 2007 PFS proposed rule and 

final rule with comment period, we 

solicited and responded to comments 

regarding the issue of how to allocate 

price concessions across drugs that are 

sold under bundling arrangements for 

purposes of calculating the ASP. We did 

not establish a specific methodology 

that manufacturers must use for the 

treatment of bundled price concessions 

for purposes of the ASP calculation in 

the CY 2007 PFS final rule with 

comment period. In the absence of 

specific guidance, we maintained 

existing guidance that manufacturers 

may make reasonable assumptions in 

their calculation of ASP, consistent with 

the general requirements and the intent 

of the Act, Federal regulations, and their 

customary business practices. We also 

indicated that we would be closely 

monitoring this issue and may provide 

more specific guidance in the future if 

we determine it is warranted. 

As stated in the CY 2008 PFS 

proposed rule (72 FR 38150), in its 

January 2007 Report to Congress, 

‘‘Impact of Changes in Medicare 

Payments for Part B Drugs,’’ the 

MedPAC discussed the issue of 

allocation of bundled price concessions 

for purposes of calculating the ASP, 

noting that ‘‘some manufacturers offer 

provider discounts for one of their 

products contingent on purchases of one 

or more other products.’’ This report 

discusses two approaches for allocating 

bundled price concessions. 

According to MedPAC, one option 

would be to require manufacturers to 

allocate bundled discounts in 

proportion to the sales of each drug sold 

under the bundled arrangement. For 

example, Drug A and Drug B are sold 

under a bundled arrangement and have 

a combined bundled discount equal to 

$200,000 on total sales of $1 million. If 

Drug A has sales of $600,000, the 

manufacturer would allocate 60 percent 

of the bundled discount to that drug 

when calculating ASP. Forty percent of 

the bundled discount would be 

allocated to Drug B. MedPAC states that 

this approach would parallel bundling 

requirements under Medicaid and 

would be simpler to administer. 

However, MedPAC notes that this 

method might not capture contingent 

discounts. 

The other approach discussed by 

MedPAC would be to require 

manufacturers to allocate bundled 

discounts to reflect the contingencies in 

the contract. That is, manufacturers 

would allocate any additional (or 

increased) discount to the sales of the 

drug (or drugs) that the discount is 

meant to increase. This approach would 

result in an ASP that more accurately 

reflects the transaction price of drugs 

when a discount for one drug or drugs 

is contingent in whole or in part on the 

purchase of another drug. For example, 

if a greater discount on the purchase 

price of Drug A is contingent on the 


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purchase (or purchases) of Drug B, this 

additional discount would be allocated 

to sales of Drug B in the calculation of 

ASP. 

In its discussion of bundling, 

MedPAC states that the goal should be 

to ensure that ASP reflects the average 

transaction price for drugs. To that end, 

MedPAC recommends that the Secretary 

clarify the ASP reporting requirements 

for bundled products to ensure that ASP 

calculations allocate discounts to reflect 

the transaction price for each drug. 

Further, MedPAC states that we should 

ensure that the reporting requirements 

for allocating discounts are clear and 

that they can be implemented by 

manufacturers in a timely fashion. 

In the CY 2008 PFS proposed rule (71 

FR 77176), we also discussed the 

Medicaid Program: Prescription Drugs 

proposed rule published in the 

December 22, 2006 Federal Register 

(hereinafter referred to as the December 

22, 2006 proposed rule) concerning the 

calculation of manufacturers’ average 

manufacturer price (AMP). In the 

December 22, 2006 proposed rule, we 

proposed that discounts associated with 

a bundled sale would be allocated 

proportionately according to the dollar 

value of the units of each drug sold 

under the bundled arrangement. For 

bundled sales where multiple drugs are 

discounted, the aggregate value of all 

the discounts would be proportionately 

allocated across all of the drugs in the 

bundle. For AMP purposes, a bundled 

sale would mean an arrangement 

regardless of physical packaging under 

which the rebate, discount, or other 

price concession is conditioned upon 

the purchase of the same drug or drugs 

of different types (that is, at the ninedigit NDC level) or some other 

performance requirement (for example, 

the achievement of market share, 

inclusion or tier placement on a 

formulary), or where the resulting 

discounts or other price concessions are 

greater than those which would have 

been available had the bundled drugs 

been purchased separately or outside of 

the bundled arrangement. In the 

December 22, 2006 proposed rule, we 

further proposed that the AMP should 

be adjusted for bundled sales by 

determining the total value of all the 

discounts on all drugs in the bundle and 

allocating those discounts 

proportionately to the respective AMP 

calculations. The aggregate discount is 

allocated proportionately to the dollar 

value of the units of each drug sold 

under the bundled arrangement. Where 

discounts are offered on multiple 

products in a bundle, the aggregated 

value of all of the discounts should be 

proportionately allocated across all of 

the drugs in the bundle. We received 

many comments on the many aspects of 

the December 22, 2006 proposed rule. 

However, the review of those comments 

and development of the final AMP 

calculation policies and rule were not 

complete at the time the CY 2008 PFS 

proposed rule was developed. 

In light of MedPAC’s recommendation 

that we clarify the ASP reporting 

requirements for bundled products and 

our discussion of bundled price 

concessions in the CY 2007 PFS 

rulemaking, we stated in the CY 2008 

PFS proposed rule that we believe 

specific guidance in the ASP context is 

warranted to provide for greater 

consistency in ASP reporting across 

manufacturers and to enhance the 

accuracy of the ASP payment system. 

We stated that we found MedPAC’s 

suggestion not to defer further guidance 

in this area compelling with respect to 

the potential that manufacturers may 

make differing assumptions in the 

absence of specific guidance on how to 

allocate bundled price concessions in 

the context of ASP. In addition, we 

stated that we believe it is appropriate 

at this time to establish a specified 

method for treating bundled price 

concessions in the calculation of ASP 

that is consistent with the treatment of 

such discounts for purposes of the AMP 

calculation, and that appropriate 

consistencies across the calculations of 

ASP and AMP will result in a lower 

potential for error and more accurate 

calculations of both prices. 

As we noted in the CY 2008 PFS 

proposed rule, although ASP and AMP 

serve similar, but not identical, 

purposes, differences between these 

calculations provide a rationale for, and 

in some instances may require, minor 

differences between the final policies 

adopted in Medicaid and Medicare 

regulations. We believe any differences 

would be necessary to clarify certain 

aspects of a consistent approach for 

treatment of bundling, and would not 

result in significant policy differences 

on how bundling is addressed in the 

context of AMP and in the context of 

ASP. 

Therefore, for purposes of calculating 

the ASP (beginning with the reporting 

period for the first calendar quarter of 

2008 and thereafter), we proposed that 

the manufacturer must allocate the total 

value of all price concessions 

proportionately according to the dollar 

value of the units of each drug sold 

under a bundled arrangement to ensure 

that the ASP is adjusted for bundled 

arrangements as defined at proposed 

§ 414.802. For a bundled arrangement, 

where multiple drugs are discounted, 

the aggregate value of all the discounts 

would be proportionately allocated 

across all of the drugs sold under the 

bundled arrangement. We proposed that 

a bundled arrangement, for ASP 

purposes, would mean an arrangement, 

regardless of physical packaging under 

which the rebate, discount, or other 

price concession is conditioned upon 

the purchase of the same drug or 

biological or other drugs or biologicals 

or some other performance requirement 

(for example, the achievement of market 

share, inclusion or tier placement on a 

formulary, purchasing patterns, prior 

purchases), or where the resulting 

discounts or other price concessions are 

greater than those that would have been 

available had the drugs or biologicals 

sold under the bundled arrangement 

been purchased separately or outside of 

the bundled arrangement. We proposed 

to specify at proposed 

§ 414.804(a)(2)(iii) that all price 

concessions on drugs sold under a 

bundled arrangement must be allocated 

proportionately to the dollar value of 

the units of each drug sold under the 

bundled arrangement. 

In the CY 2008 PFS proposed rule, we 

also stated our intention to remain 

consistent, as appropriate, with the final 

policy adopted in the Medicaid 

Program: Prescription Drugs final rule 

with comment period published in the 

July 17, 2007 Federal Register (72 FR 

39142) (hereinafter referred to as the 

July 17, 2007 final rule with comment 

period), which was still under 

development at that time. We stated that 

the Medicaid policies on bundled sales 

may ultimately differ from our 

discussion of the topic in the CY 2008 

PFS proposed rule as a result of the final 

policy adopted in the July 17, 2007 final 

rule with comment period and that our 

policies for ASP in this final rule with 

comment period may reflect the final 

Medicaid policy on bundled sales, but 

only to the extent that it is appropriate 

for ASP and the public has had the 

opportunity to comment on how the 

final Medicaid policy for bundled sales, 

if appropriately adopted for ASP 

purposes, would effect the calculation 

of ASP. The final Medicaid policy on 

bundled sales adopted in the July 17, 

2007 final rule with comment period 

was consistent with the discussion of 

this issue in the December 22, 2006 

proposed rule with certain 

clarifications. 

Comment: We received many 

comments on this issue. Most of these 

commenters noted that our proposal for 

the treatment of bundled price 

concessions in the ASP context was 

similar to the language finalized in the 

July 17, 2007 final rule with comment 

period. In general, most of the 


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commenters supported an appropriately 

consistent approach for the treatment of 

bundled price concessions within both 

the AMP and ASP calculations. 

However, several commenters indicated 

that they were still reviewing the July 

17, 2007 final rule with comment period 

and believe additional time may be 

needed to better understand how the 

proposed Medicare bundled 

arrangement definition is to be applied. 

Several commenters had questions 

about how the proposed bundling 

policies may apply to certain 

contracting arrangements, and because 

of these questions, recommended that 

we cease or delay implementation of our 

proposed method for treatment of 

bundled price concessions for purposes 

of ASP. 

Response: Based on comments 

recommending a delay and to better 

understand the concerns stated by the 

commenters, we are not finalizing the 

regulatory language changes we 

proposed in the CY 2008 PFS proposed 

rule at this time. Although we are not 

establishing a specific methodology that 

manufacturers must use for the 

treatment of bundled price concessions 

for purposes of calculating ASP at this 

time, we are clarifying that, in the 

absence of specific guidance, 

manufacturers may make reasonable 

assumptions in their calculation of ASP, 

consistent with the general 

requirements and the intent of the Act, 

Federal regulations, and their customary 

business practices. In making reasonable 

assumptions for purposes of calculating 

ASP, one method manufacturers could 

use is to reallocate price concessions 

that are conditioned upon other 

purchases or a performance requirement 

(for example, the achievement of market 

share, inclusion or tier placement on a 

formulary) so that the total value of all 

such price concessions are allocated 

proportionately according to the dollar 

value of the units of each drug sold. 

However, manufacturers may have other 

methods they could use to report 

bundled price concessions, so long as 

manufacturers apply reasonable 

assumptions consistent with the general 

requirements and the intent of the Act, 

Federal regulations, and their customary 

business practices. Manufacturers’

reasonable assumptions consistent with 

our requirements, guidance and 

manufacturer’s customary business 

practices remain an important aspect of 

ASP reporting. These assumptions 

should be submitted along with the ASP 

data and the signed certification form. 

Recognizing that the treatment of 

bundled price concessions in the ASP 

calculation has implications for the 

integrity of the ASP payment 

methodology, we will continue to 

monitor this issue, will consider the 

comments on this issue, and may 

provide more specific guidance in the 

future through rulemaking or through 

program instruction or other guidance 

(consistent with our authority under 

section 1847A(c)(5)(C) of the Act) if we 

determine it is warranted. As we 

continue to review these issues, we 

want to be sure we are aware of 

concerns from all stakeholders, and thus 

we encourage the public to provide 

additional information or concerns to us 

on this issue as they may arise. 

c. 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. 

Section 1842(o)(5)(C) of the Act 

specifies that the furnishing fee for 

clotting factor for CY 2006 and 

subsequent years 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 furnishing fee for CY 2007 is 

$0.152 per unit clotting factor. The 

percent increase in the CPI for medical 

care for the 12-month period ending in 

June 2007 is 4.0 percent. Consequently, 

the furnishing fee will be $0.158 per 

unit of clotting factor for CY 2008. 

While the furnishing fee payment rate is 

calculated at 3 digits, the actual amount 

paid to providers and suppliers is 

rounded to 2 digits. 

In the CY 2008 PFS proposed rule, we 

proposed to announce the annual 

update of the blood clotting factor 

furnishing fee, as specified in section 

1842(o)(5)(C) of the Act, by issuing 

program instructions and postings on 

the CMS Web site in lieu of including 

a discussion of this issue in PFS 

rulemaking for CY 2009, and thereafter, 

until such time as the update 

methodology may be modified. We 

made our proposal because the update 

is statutorily determined, is based on an 

index not affected by administrative 

discretion or public comment, is based 

on the percentage increase in the CPI for 

medical care for the 12-month period 

ending with June of the previous year, 

and is not released by the Bureau of 

Labor Statistics until after our proposed 

rule is published. 

As stated in the CY 2008 proposed 

rule, we believe that including a 

discussion of the furnishing fee update 

in annual rulemaking does not provide 

an advantage over other means of 

announcing this information, so long as 

the current statutory update 

methodology continues in effect. We 

believe that the public’s need for 

information and adequate notice 

regarding the updated furnishing fee can 

be better met by issuing program 

instructions which will eliminate the 

discussion of the furnishing fee update 

annually in rulemaking. In addition, by 

communicating the updated furnishing 

fee in program instruction, the actual 

figure for the percent change in the 

applicable CPI and the updated 

furnishing fee calculated based on that 

figure can be announced more timely 

than when included as part of the PFS 

final rulemaking process. 

Comment: We received comments in 

support of our proposal to announce the 

update furnishing fee via program 

instructions beginning in CY 2009, and 

to continue updating the furnishing fee 

according to the consumer price index 

for medical care. Comments supported 

the continued use of our proposed 

approach until such time as the 

methodology is changed. 

Response: After consideration of the 

public comments, beginning for CY 

2009, we will announce the updated 

blood clotting factor furnishing fee via 

program instructions and via a Web 

posting. In addition, we may include the 

updated blood clotting factor furnishing 

fee in the annual PFS final rules to 

promote broader dissemination of the 

announcement. 

d. Widely Available Market Prices 

(WAMP) and AMP Threshold 

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 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 


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the AMP for such drug or biological by 

the applicable threshold percentage (as 

defined in subparagraph (B)).’’ The 

applicable threshold is specified in the 

statute 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.’’ In 

CY 2006 and CY 2007, we specified an 

applicable threshold percentage of 5 

percent for both the WAMP and AMP. 

We based this decision on the limited 

data available to support a change in the 

current threshold percentage. 

For CY 2008, we proposed to specify 

an applicable threshold percentage of 5 

percent for the WAMP and the AMP. At 

present, the OIG is continuing its 

comparison of both the WAMP and the 

AMP. Furthermore, information on how 

recent changes to the calculation of the 

AMP may affect the comparison of AMP 

to ASP is not available at this time. 

Since we do not have data that suggest 

another level is more appropriate at this 

time, we believe that continuing the 5 

percent applicable threshold percentage 

for both the WAMP and AMP is 

appropriate for CY 2008. 

As we noted in the CY 2007 PFS final 

rule with comment period (71 FR 

69680), we understand that there are 

complicated operational issues 

associated with potential payment 

substitutions and will continue to 

proceed cautiously in this area and 

provide stakeholders, particularly 

manufacturers of drugs impacted by 

potential price substitutions, with 

adequate notice of our intentions 

regarding such, including the 

opportunity to provide input with 

regard to the processes for substituting 

the WAMP or the AMP for the ASP. As 

part of our approach, we intend to 

develop a better understanding of the 

issues that may be related to certain 

drugs for which the WAMP and AMP 

may be lower than the ASP over time. 

Comment: We received several 

comments regarding our proposal to 

maintain the threshold at 5 percent. 

Most commenters supported 

maintaining this threshold. One 

commenter suggested increasing the 

threshold but did not specify a 

percentage to which it should be 

increased. Another commenter 

suggested increasing the threshold for 

AMP to 10 percent while maintaining 

the 5 percent threshold for WAMP. 

Response: We recognize the public’s 

concern regarding the establishment of 

an appropriate threshold for making 

price substitutions. We disagree with 

the commenter who recommended 

different thresholds for WAMP 

comparisons and for AMP comparisons 

because of current operational 

difficulties associated with maintaining 

and communicating different 

thresholds. At the current time, we also 

believe that maintaining two thresholds 

lessens stakeholders’ ability to 

accurately predict the potential risk for 

price adjustments. After considering 

public comments on this issue, and as 

required by statute, we are finalizing our 

proposal to establish the WAMP/AMP 

threshold at 5 percent for CY 2008. 

Comment: We received many 

comments suggesting that caution be 

exercised in the determination of price 

substitutions and that we develop a 

formal process and criteria to be used to 

determine when substitutions are 

necessary. Commenters also 

recommended that we assure adequate 

notice is provided prior to making a 

price substitution. Several commenters 

indicated recent policy changes made to 

the Medicaid AMP calculation could 

impact the accuracy of the comparisons 

between AMP and ASP and stated that 

these changes should be carefully 

studied and considered before 

implementing any pricing changes. 

Additionally, several commenters 

opposed any price substitutions for 

certain classes of providers or for certain 

specific drugs. The commenters noted 

that certain classes of providers may be 

subject to different cost structures 

making wholesale substitution of prices 

impractical. Some commenters asserted 

that certain drugs experience unique 

market forces that may be adversely 

affected by pricing substitutions. 

Response: We understand that 

complex operational issues, both within 

CMS and externally could impact 

potential payment rate substitutions. We 

acknowledge the recent changes to the 

AMP regulations and are studying such 

changes carefully. Furthermore, we 

recognize the variety of providers and 

the marketplace forces that impact drug 

pricing decisions under ASP. Therefore, 

we will proceed cautiously and provide 

stakeholders, particularly manufacturers 

of drugs impacted by potential price 

substitutions, with adequate notice of 

our intentions regarding such, including 

the opportunity to provide input with 

regard to the processes for substitution. 

e. Other Issues 

Comment: A few commenters noted 

that we did not discuss the payment for 

separately billable ESRD drugs in the 

CY 2008 PFS proposed rule. These 

commenters supported continuation of 

the current policy of basing the payment 

on the ASP+6 percent. 

Response: We did not propose any 

policy changes to the approach that we 

currently use to pay for separately billed 

ESRD drugs. Therefore, for CY 2008 

payment for separately billable drugs 

furnished by ESRD facilities will 

continue at ASP+6 percent in 

accordance with section 1847A of the 

Act. 

Comment: Several commenters noted 

that the billing and payment codes 

recently established for liquid IVIG to 

implement separate payment under 

section 1847A(b)(4) of the Act should 

improve beneficiary access to these 

products. 

Response: We thank the commenters 

for communicating their support. 

Comment: We received a few 

comments expressing concern that, 

because ASP based payment limit 

updates lag time by at least 2 calendar 

quarters, increases in market prices may 

not be reflected in a drug’s payment 

limit for at least 6 months after a pricing 

adjustment. One commenter suggested 

that current technology should enable 

CMS to decrease the lag time from 6 

months to 2 to 3 months. 

Response: By statute, the ASP based 

payment allowances are determined on 

a quarterly basis and are based on ASPs 

reported by manufacturers quarterly. 

Manufacturers must report to us no later 

than 30 days after the close of the 

calendar quarter. 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. We implement these new 

payment limits through program 

instructions or otherwise at the first 

opportunity after we received the data, 

which is the calendar quarter after 

receipt. 

Comment: One commenter suggested 

that we modify the formula we use to 

calculate the payment amounts based on 

manufacturers’ ASP data so that the 

formula is volume weighted as 

suggested by the OIG. 

Response: We discussed our formula 

for determining the payment amounts 

based on manufacturers’ ASP data in the 

CY 2006 PFS final rule (70 FR 70217). 

As we stated in the CY 2006 PFS final 

rule, in establishing the formula used to 

calculate the payment amounts based on 

manufacturers’ ASP data, we considered 

various approaches, including the 

alternative suggested by this 

commenter. If appropriate, we may 

consider revising the methodology in 

the future. We did not propose to 

change our current formula, and are not 


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implementing changes to our formula at 

this time. 

Comment: We received a few requests 

to increase the pharmacy supplying fee 

for immunosuppressive, oral anticancer, 

and oral anti-emetic drugs for CY 2008 

to reflect actual supplying costs. We 

also received comments expressing 

concerns that primarily because of the 

labor intensive Medicare Part B claims 

processing services provided by 

specialty transplant pharmacies, the 

current supplying fee payment for 

immunosuppressive drugs is 

substantially lower than reported actual 

supplying costs. One commenter 

requested that we eliminate the twotiered pharmacy supplying fee for 

prescriptions filled within a 30-day 

period. 

Response: We are committed to 

assuring that our claims systems process 

claims as timely and accurately as 

possible and that their payment 

methodologies result in the 

determination of accurate payment 

amounts. We recognize the operational 

complexities under which certain 

providers operate and strive to develop 

systems and processes to minimize such 

complexities. We appreciate the 

comments that were provided and may 

consider the issue in future rulemaking 

if appropriate. Since we did not propose 

a change to these rates for CY 2008, they 

will continue to be in effect in CY 2008. 

We received several other comments on 

the use and potential impacts of the 

ASP payment methodology and other 

issues related to Part B drugs that are 

also outside the scope of this 

rulemaking and will not be addressed in 

this final rule with comment. These 

topics include the following: 

• Requests for billing codes for 

specific products; 

• Whether alternative payment 

methodologies or exceptions to the ASP 

based payment should be considered; 

• Variation in local coverage and 

payment policies, including use of least 

costly alternative policies and invoice 

pricing for compounded drugs; 

• Excluding prompt pay discounts 

from the calculation of ASP; and 

• Whether coverage under Part B 

should be expanded to include certain 

vaccines. 

2. Competitive Acquisition Program 

(CAP) Issues 

Section 303(d) of the MMA required 

the implementation of a CAP for certain 

Medicare Part B drugs and biologicals 

not paid on a cost or PPS basis. The 

provisions for acquiring and billing 

drugs under the CAP were described in 

the Competitive Acquisition of 

Outpatient Drugs and Biologicals Under 

Part B proposed rule (published in the 

March 4, 2005 Federal Register; 

hereinafter referred to as the March 4, 

2005 proposed rule) and interim final 

rule with comment period (published in 

the July 6, 2005 Federal Register; 

hereinafter referred to as the July 6, 

2005 IFC) (70 FR 10746 and 70 FR 

39022, respectively). Certain provisions 

were finalized in the CY 2006 PFS final 

rule with comment period (70 FR 

70116). We specified a single CAP drug 

category to include a defined list of 

drugs furnished incident to a 

physician’s service. 

In this final rule with comment 

period, we discuss the impact of 

provisions in section 108 of the MIEA–

TRHCA on administrative and 

operational aspects of the CAP. Topics 

include the implementation of a postpayment review process and the 

corresponding changes to claims 

processing procedures, and changes to 

other operational aspects of the CAP. 

This final rule with comment period 

implements conforming changes to the 

CAP regulations to reflect these 

provisions that made changes to the 

payment process of the CAP for Part B 

Drugs. 

When the CAP program began on July 

1, 2006, physicians were given a choice 

between obtaining these drugs from 

vendors selected through a competitive 

bidding process and approved by CMS, 

or directly purchasing these drugs and 

being paid under the ASP system. In 

this final rule with comment period, we 

discuss areas related to transporting 

CAP drugs and the administrative 

burden of the CAP submitted in 

response to the July 6, 2005 IFC. In 

addition, we are finalizing portions of 

the July 6, 2005 IFC that were not 

finalized in the CY 2006 PFS final rule 

with comment period and responding to 

the other timely comments we received 

on the July 6, 2005 IFC that we have not 

responded to previously. 

a. MMA Operational Provisions 

Prior to the enactment of the MIEA–

TRHCA, section 1847B(a)(3)(A) of the 

Act set forth specific requirements that 

have a direct impact on the 

administrative and operational 

parameters for instituting a CAP. This 

section of the statute required the 

following: 

(1) Approved CAP vendors bill the 

Medicare program for the drug or 

biological supplied, and collect any 

applicable deductibles and coinsurance 

from the Medicare beneficiary. (For 

purposes of the preamble, the term 

‘‘approved CAP vendor’’ means the term 

‘‘contractor’’ as referred to in the 

statute.) 

(2) Any applicable deductible and 

coinsurance may not be collected unless 

the drug was administered to the 

beneficiary. (For purposes of the 

preamble, the term ‘‘drug’’ refers to 

drugs and biologicals furnished under 

the CAP, unless the context specifies 

otherwise.) 

(3) Medicare can make payments only 

to the approved CAP vendor, and these 

payments are conditioned upon the 

administration of the drug. 

Section 108 of the MIEA–TRHCA 

amended this third element. 

b. MIEA–TRHCA 

Section 108 of the MIEA–TRHCA 

made changes to the CAP payment 

methodology. Section 108(a)(1) of the 

MIEA–TRHCA amended section 

1847B(a)(3)(A)(iii) of the Act by adding 

new language that requires that payment 

for drugs and biologicals be made upon 

receipt of a claim for a drug or biological 

supplied for administration to a 

beneficiary. This statutory change took 

effect on April 1, 2007. 

Section 108(a)(2) of the MIEA–

TRHCA requires the Secretary to 

establish (by program instruction or 

otherwise) a post-payment review 

process (which may include the use of 

statistical sampling) to assure that 

payment is made for a drug or biological 

only if the drug or biological has been 

administered to a beneficiary. The 

Secretary shall recoup, offset, or collect 

any overpayments determined by the 

Secretary under this process. 

Section 108(b) of the MIEA–TRHCA 

states that nothing in this section shall 

be construed as requiring the conduct of 

any additional competition under 

section 1847B(b)(1) of the Act; or 

requiring an additional physician 

election process. 

Section 108(c) of the MIEA–TRHCA 

states that the amendments of this 

section apply to payments for drugs and 

biologicals supplied: (1) On or after 

April 1, 2007; and (2) on or after July 1, 

2006 and before April 1, 2007, for 

claims that are unpaid as of April 1, 

2007. 

Comment: Some commenters 

suggested that any changes to the CAP 

be made only after the expiration of the 

current vendor contract. The 

commenters stated that implementation 

of changes before the next vendor 

contract would be unfair to bidders who 

chose not to participate in the CAP 

because of previously issued guidance. 

The commenters cited the CAP statutory 

reference about waiving the FAR in 

order to promote competition. The 

commenters believe that such changes 

would inappropriately favor the single 


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existing vendor, and therefore, hurt 

competition. 

Response: We do not have the 

authority to delay implementing the 

claims processing changes required by 

the MIEA–TRHCA, which were effective 

April 1, 2007. Although some of our 

changes were not expressly required by 

the statute, we believe these conforming 

changes are necessary to allow the 

program to function in a manner that is 

consistent with, and required by, the 

statutory changes. Further, because the 

CAP is a new payment program, change 

that is consistent with operational 

experience and improves efficiency for 

participants is to be expected. Finally, 

we disagree that the FAR affects our 

ability to make changes in the program 

while the current contract is in force. 

Because these changes do not modify an 

approved CAP vendor’s responsibilities 

under its contract with us, we do not 

believe the FAR is implicated. 

Further, as we have discussed in prior 

rulemaking, the CAP statute authorizes 

the waiver of provisions of the FAR 

(other than provisions relating to 

confidentiality of information and such 

other provisions as the Secretary 

determines appropriate) as necessary for 

the efficient implementation of Section 

1847B of the Act, in order to promote 

competition. 

We have discussed our approach to 

conforming to the confidentiality 

provisions in the July 6, 2005 IFC (70 FR 

39077), and we intend to comply with 

this approach during future vendor 

bidding periods. In implementing the 

CAP, we have waived all of the FAR 

except for the confidentiality and the 

conflict of interest provisions to 

promote competition and the efficient 

implementation of the program. We 

made the decision to waive the FAR 

(other than the provisions on 

confidentiality and conflict of interest) 

in order to increase the pool of qualified 

vendors available to participate in the 

program. It is our understanding that 

compliance with the FAR is not 

normally required of the companies that 

make up the pool of potential CAP 

vendors. It is also not required of other 

Medicare suppliers. We waived these 

provisions in order to structure CAP 

bidding in a manner consistent with 

established vendor bidding practices. 

The FAR’s confidentiality provisions, 

as well as the conflict of interest 

standards and requirements found in 

FAR subsection 9.5, apply to approved 

CAP vendors and applicants. All other 

provisions of the FAR have been waived 

for purposes of the CAP. However, we 

have used certain provisions of the FAR 

for guidance in implementing the CAP, 

and we may from time to time used 

other FAR provisions as a guide, even 

though they have been waived. For 

example, as we discussed in the July 6, 

2005 IFC (70 FR 39063), we look to the 

provisions of the FAR to guide our 

assessment of bidder’s financial 

solvency. 

However, even if the FAR were 

implicated, we believe these changes 

promote competition because they make 

the program a more attractive option for 

physicians, which will provide 

physicians who compete among one 

another a more meaningful choice 

between the CAP and the ASP 

methodology. We further believe the 

changes we are implementing here are 

designed to improve the flexibility and 

administrative ease of the CAP. 

Therefore, we will proceed with 

implementing the provisions we are 

finalizing as indicated in this final rule 

with comment period. 

c. CAP Claims Processing 

In the July 6, 2005 IFC (70 FR 39042), 

we initially implemented a claims 

processing system that enables selected 

approved CAP vendors to bill the 

Medicare program directly, and to bill 

the Medicare beneficiary and his or her 

third party payer after verification that 

the physician has administered the 

drug. When a participating CAP 

physician elects to join the program, he 

or she must agree to obtain all drugs on 

the CAP drug list from the approved 

CAP vendor, with only a few 

exceptions. For example in furnish as 

written (FAW) situations (that is, where 

a beneficiary needs a particular 

formulation of a drug not available from 

the approved CAP vendor) the 

participating CAP physician would be 

allowed to obtain that drug outside of 

the CAP. In the case of Medicare 

Secondary Payer (MSP) (that is, where 

a Medicare beneficiary may have 

another payer primary to Medicare), the 

participating CAP physicians must 

obtain physician administered drugs 

from entities approved by the primary 

plan and bill the primary payer. 

Detailed MSP instructions have been 

issued by CMS that allow the physician 

to bill under the ASP methodology for 

the portion of the drug not covered by 

the primary payer in this situation. 

Prior to the MIEA–TRHCA, the claims 

processing procedures for the approved 

CAP vendor and the participating CAP 

physician were as follows: 

• Once a shipment is received from 

the approved CAP vendor, the 

participating CAP physician stores the 

drug until the date of drug 

administration. 

• When the drug is administered to 

the beneficiary, the participating CAP 

physician places the prescription order 

number for each drug administered on 

the claim form submitted to his or her 

regular Part B carrier. 

Similarly, when the approved CAP 

vendor bills Medicare for the drug it 

shipped to the participating CAP 

physician, it places the relevant 

prescription order number on the claim 

form submitted to the designated 

carrier. The use of the prescription order 

number on both the participating CAP 

physician’s claim and the approved 

CAP vendor’s claim is intended to 

indicate drug administration to the 

beneficiary. The participating CAP 

physician’s claim and the approved 

CAP vendor’s claim are matched in the 

Medicare claims processing system so 

that drug administration can be verified 

and payment to the approved CAP 

vendor can be made. 

d. Required Changes to CAP Claims 

Processing 

As originally implemented, the claims 

matching process described above in 

this section was completed before 

payment was made. However, as of 

April 1, 2007, section 108 of the MIEA–

TRHCA requires payment to be made to 

the CAP vendor for claims upon receipt. 

The statute also requires us to establish 

a post-payment review process to assure 

that payment is made for a drug only if 

the drug has been administered to a 

beneficiary. We are authorized under 

the statute to recoup, offset, or collect 

any overpayments by the Secretary. We 

are also authorized to conduct postpayment review using statistical 

sampling and to implement the postpayment review process by program 

instruction or otherwise. We 

implemented the necessary changes to 

our claims processing system and 

initiated the post-payment review 

process on April 1, 2007 via instructions 

to the CAP-designated claims processing 

contractor and Questions and Answers 

posted on the CMS competitive bidding 

Web site at http://www.cms.hhs.gov/ 

CompetitiveAcquisforBios/ 

15_Approved_Vendor.asp#TopOfPage. 

Under the post-payment review 

process, the CAP-designated carrier will 

use the CMS claims processing system 

to look for a match between the CAP 

prescription order number on the 

participating CAP physician’s claim and 

the same prescription order number on 

the approved CAP vendor’s claim to 

track drug administration on a dose by 

dose basis. If the CAP-designated carrier 

is able to find a match between the two 

claims, the carrier makes a 

determination that the beneficiary did 

receive the drug being billed for by the 

CAP physician. The participating CAP 


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physician claim may also contain 

information on any determination of 

medical necessity and coverage made by 

the local carrier. 

We will also use statistical sampling 

under the post-payment review process 

to determine whether drugs were 

medically necessary. All Medicare 

claims are subject to medical necessity 

determinations; however, under the 

changes required by the MIEA–TRHCA, 

CAP claims may not all have a chance 

to be reviewed for medical necessity 

before they are paid. Therefore, the postpayment review includes both 

verification of drug administration and 

a medical necessity review of a 

statistically valid sample of CAP claims. 

In conducting the post-payment review, 

we will continue to monitor for fraud, 

waste, and abuse. All CAP claims will 

remain eligible for review for medical 

necessity and verification of drug 

administration. We anticipate that the 

post-payment review process will 

provide us with additional 

opportunities to monitor for the 

appropriate payment of drugs furnished 

under this program. 

To conduct post-payment review of 

claims, we may also ask for 

documentation of administration from 

the approved CAP vendor and for 

medical records from the participating 

CAP physician for any claim that is 

identified for review. While it is 

standard practice for CMS to require 

Medicare providers to submit medical 

records as part of claims review, we 

reserve the right to also specifically 

request any other records that verify the 

administration of a CAP drug. 

Furthermore, we want to make it very 

clear to the participating CAP physician 

that when electing to join the program 

that the physician may be asked to 

supply medical records for postpayment review. Therefore, in the CY 

2008 PFS proposed rule (72 FR 38153), 

we proposed to revise § 414.908(a)(3)(xi) 

and the physician election agreement 

form to clarify that medical records and 

certain other information may be 

requested from the CAP physician 

during the post-payment review 

process. 

The procedures used to verify valid 

claims and ensure proper payment for 

drugs supplied under the CAP are based 

on established post-payment review 

processes used in other parts of the 

Medicare program. The request for 

medical records as part of the claims 

payment process during CAP postpayment review is intended to work in 

conjunction with Item 12 on the Health 

Insurance Claim Form CMS–1500 

which, when signed by a beneficiary, 

authorizes the release of ‘‘any medical 

information necessary to process a 

claim.’’

When a claim is selected for review 

we notify the approved CAP vendor and 

request its records to verify 

administration. We also notify the 

approved CAP vendor that we will be 

requesting medical records from the 

participating CAP physician. If the 

medical record is not received within 30 

days, the claim is denied because we 

will not have sufficient information to 

verify drug administration and medical 

necessity. 

This review process is similar to those 

used elsewhere in the Medicare program 

such as clinical laboratory payment 

review or payment of radiology services. 

As we specified in the July 6, 2005 

IFC (70 FR 39038), the local carrier’s 

medical review policies and coverage 

determinations will continue to apply in 

the CAP. Under our previous claims 

processing methodology, the local 

carrier made the coverage determination 

on the drug ordered by the participating 

CAP physician and furnished by the 

approved CAP vendor as part of the 

claim matching process prior to 

payment of the approved CAP vendor’s 

claim. Under the new methodology, the 

drug claim will be paid upon receipt 

unless the local carrier has already 

made a coverage or medical necessity 

determination on the drug, and the 

match has already occurred showing 

that the drug claim should be denied. 

As part of the post-payment review 

process, the CAP-designated carrier 

checks the CMS central claims 

processing system to determine whether 

the local carrier has made a coverage or 

medical necessity determination on the 

CAP drug indicated on the participating 

CAP physician’s drug administration 

claim. If a coverage determination has 

been made, the CAP-designated carrier 

reflects the local carrier’s decision in its 

post-payment review of the claim. If the 

local carrier has not reviewed the drug 

administration portion of the 

participating CAP physician’s claim as 

of the date that the designated carrier 

processes the approved CAP vendor’s 

drug claim, the CAP-designated carrier 

uses the local carrier’s coverage 

determination policies when conducting 

medical review of the claim. 

Comment: One commenter stated that 

we had exceeded the scope of the 

statute because we were planning to 

conduct a medical necessity review on 

CAP drug claims that were selected for 

review as part of the statistical sample. 

Another commenter recommended 

that we make detailed description of the 

claims sampling process available for 

public comment and asked that we 

design the process consistent with the 

Medicare Program Integrity Manual. The 

commenter also asked for more detail on 

the information necessary to include in 

the medical record to ensure that the 

participating CAP physician has 

appropriately documented the medical 

necessity of the drug administered. 

One commenter questioned whether 

we needed to obtain additional 

information from the CAP participating 

physician on claims selected for post 

pay review based on the statistical 

sample and stated that the information 

contained on the claim form should be 

sufficient to verify administration. 

Another commenter questioned why 

we were changing the CAP claims 

processing methodology to pay most 

claims upon receipt and to verify 

administration on a post pay basis. The 

commenter asked whether we would 

allow for extenuating circumstances if 

the medical record was not supplied by 

the participating CAP physician within 

the 30-day time period for situations 

such as bankruptcy, litigation, or 

closure of the practice. 

Response: As stated in the CY 2008 

PFS proposed rule (72 FR 38153), we 

were required to make changes to the 

CAP claims processing methodology 

because section 108 of the MIEA–

TRHCA amended section 

1847B(a)(3)(A)(iii) of the Act by adding 

new language that requires the payment 

for drugs and biologicals upon receipt of 

a claim for a drug or biological supplied 

for administration to a beneficiary. This 

change in the law was effective on April 

1, 2007. Section 108(a)(2) of the MIEA–

TRHCA requires the Secretary to 

establish (by program instruction or 

otherwise) a post-payment review 

process (which may include the use of 

statistical sampling) to assure that 

payment is made for a drug or biological 

only if the drug or biological has been 

administered to a beneficiary. The 

Secretary is required to recoup, offset, or 

collect any overpayment determined by 

the Secretary under this process. We 

implemented the necessary changes to 

our claims processing system and 

initiated the post-payment review 

process on April 1, 2007, via 

instructions to the CAP-designated 

claims processing contractor and 

Questions and Answers posted the CMS 

competitive bidding Web site at http:// 

www.cmsm.hhs.gov/ 

CompetitiveAcquisforBios/ 

15_Approved_Vendor.asp#TopOfPage. 

In the CY 2008 PFS proposed rule, we 

described the changes we had made to 

our claims processing system and 

proposed conforming changes to our 

regulations for additional items not 

covered by the MIEA–TRHCA. Because 

the MIEA–TRHCA gave us authority to 


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implement its provisions by program 

instructions or otherwise by April 1, 

2007, the necessary changes have 

already been made to our claims 

processing system and the post-pay 

review process had been implemented. 

The post-payment review process 

includes verification of drug 

administration and a medical necessity 

review of a statistically-valid sample of 

CAP claims. This process was designed 

in conformance with the Medicare 

Program Integrity Manual and in 

consultation with CMS statistical 

sampling experts, consistent with our 

authority to establish these procedures 

by program instruction or otherwise. For 

additional information on the 

requirements of the Program Integrity 

Manual see http://www.cms.hhs.gov/ 

manuals/downloads/pim83co2pdf. 

All Medicare claims are subject to 

medical necessity determinations; 

however, under the changes required by 

the MIEA–TRHCA, there may not be 

sufficient time for all CAP claims to be 

reviewed for medical necessity before 

they are paid. Prior to paying the 

approved CAP vendor’s claim, the 

designated carrier will check the claims 

processing system to determine whether 

the participating CAP physician has 

submitted the claim for the 

administration of the drug. If the 

physician has submitted the claim and 

the local carrier has made a 

determination that the drug is not 

payable because of a coverage or 

medical necessity denial, the drug claim 

will be denied by the designated carrier. 

However, if no determination has been 

made on the physician’s claim, the 

designated carrier will pay the approved 

CAP vendor’s claims for the drug under 

the MIEA–TRHCA, and the claim will 

be subject to statistical sampling on a 

post-pay basis. If the claim is selected 

for review, verification of drug 

administration and a medical necessity 

review will be conducted. As part of 

this process, the designated carrier will 

check the system to see whether the 

local carrier had denied the claim as not 

medically necessary. If a denial has 

been made, the designated carrier will 

deny the approved CAP vendor’s claim 

on medical necessity grounds. The 

designated carrier will use the local 

carrier’s policies when conducting the 

review. 

Medical necessity review is always 

conducted based on medical records 

obtained from the physician and will be 

conducted in an effort to look behind 

the information on the claim form. As 

specified in chapter 3 of the Medicare 

Program Integrity Manual, standard data 

elements for post-pay medical review 

include signature requirements, 

diagnosis requirements, and 

documentation of orders for testing. The 

carrier may also specify additional 

information it will review to document 

that coverage and medical necessity 

requirements have been met. Under the 

current CAP post-pay review process, 

the designated carrier requests that all 

records be supplied by the physician 

within 30 days but allows for a limited 

amount of time beyond that period 

before the service will be considered not 

to have been administered. Participating 

CAP physicians are encouraged to send 

any information they can provide to the 

designated carrier within the timeframes 

provided. If the physician is unable to 

provide all of the requested information 

in a timely manner to the carrier, he or 

she may contact the carrier to determine 

if the contractor will grant an extension. 

There is also a provision in the 

Medicare Program Integrity Manual that 

allows contractors to grant additional 

time in the event of a natural disaster. 

As we indicated in the CY 2008 PFS 

proposed rule, it is standard practice for 

Medicare providers to be required to 

submit medical records to assist in 

claims review. Therefore, we are 

finalizing our proposal to revise 

§ 414.908(a)(3)(xi) and the physician 

election agreement to make it very clear 

to the CAP participating physician that 

they may be asked to provide medical 

records for post-payment review in the 

CAP. 

e. Provisions for Collection of 

Beneficiary Coinsurance 

In the CY 2006 PFS final rule with 

comment period, we specified at 

§ 414.914(h)(1) that 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. If a balance remains after the 

supplemental insurer pays its share of 

the bill, or if there is no supplemental 

insurance, the approved CAP vendor 

may bill the beneficiary for the balance. 

In prior practice, a match in the claims 

system between the participating CAP 

physician’s drug administration claim 

and the approved CAP vendor’s drug 

claim and the subsequent payment by 

Medicare was used to indicate that the 

beneficiary received the drug. We also 

allowed voluntary information 

exchanges between the approved CAP 

vendor and the participating CAP 

physician’s office to verify CAP drug 

administration. Additionally, we note 

that under the CAP regulations, the 

participating CAP physician has a 

responsibility to notify the approved 

CAP vendor when a drug is not 

administered or a smaller amount was 

administered than was originally 

ordered. 

Because section 108 of the MIEA–

TRHCA requires the payment of CAP 

claims upon receipt, payment of a claim 

by Medicare may occur before 

administration of the drug has been 

verified. However, section 

1847B(a)(3)(A)(ii) of the Act, which 

states that deductible and coinsurance 

shall not be collected unless the drug or 

biological is administered, remains 

unchanged. Thus, because we have 

interpreted this provision as requiring 

verification of administration prior to 

the collection of applicable cost sharing 

amounts, the requirement for 

verification of administration similarly 

remains unchanged. However, because 

of the statutory change of section 

108(a)(1) of the MIEA–TRHCA and its 

resulting impact on our claims 

processing methodology, the claims 

processing system no longer provides a 

way for CMS to verify administration on 

the approved CAP vendor’s behalf 

before the approved CAP vendor 

collects coinsurance from the 

beneficiary or the supplemental insurer. 

Verification of CAP drug administration 

is also conducted in the post-payment 

review process. The approved CAP 

vendor is expected to make information 

available to verify administration for 

post-payment review as necessary. 

We believe that an approved CAP 

vendor can verify whether a CAP drug 

was administered in a variety of ways. 

For example, an approved CAP vendor 

may enter into a voluntary agreement 

with a participating CAP physician to 

exchange such information as described 

in the CY 2006 PFS final rule with 

comment period (70 FR 70251). 

However, if a participating CAP 

physician is unwilling to enter into a 

voluntary agreement to verify 

administration, the approved CAP 

vendor may verify that the drug was 

administered by contacting the 

participating CAP physician’s office to 

request verbal confirmation. In such an 

instance, the approved CAP vendor is 

expected to document the verbal 

confirmation of CAP drug 

administration, the identities of 

individuals who exchanged the 

information, and the date and time that 

the information was obtained. In 

addition to verifying administration 

through contact with the physician’s 

office, we also suggest that the approved 

CAP vendor place a statement on 

beneficiaries’ bills informing the 

individual of the statutory requirement 

and suggesting that the beneficiary 

contact the participating CAP physician 

to verify that he or she received the dose 


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of the drug for which he or she are being 

billed prior to paying any cost sharing 

amount. 

For the reasons described above in 

this section, we believe that the 

verification of CAP drug administration 

remains a required element of the CAP; 

therefore, in the CY 2008 PFS proposed 

rule (72 FR 38155), we proposed to add 

§ 414.906(a)(6) by specifying that all of 

the following elements are required to 

document the verification of CAP drug 

administration: 

• Beneficiary’s name. 

• Health insurance number. 

• Expected date of administration. 

• Actual date of administration. 

• Identity of the participating CAP 

physician. 

• Prescription order number. 

• Identity of the individuals who 

supply and receive the information. 

• Dosage supplied. 

• Dosage administered. 

In the CY 2008 PFS proposed rule, 

these data elements were actually 

proposed in § 414.914 (72 FR 38226). 

We believe that the drug administration 

verification requirements best fit in 

§ 414.914 since CAP vendors must 

collect this information as part of their 

terms of contract. Therefore, we are 

finalizing § 414.914 to include these 

provisions. 

Also, as a result of changes mandated 

by section 108(a)(1) of the MIEA–

TRHCA, we proposed to revise new 

§ 414.914(i)(1) to remove the reference 

to ‘‘final payment by Medicare’’ and 

revise this language to state, ‘‘payment 

by Medicare.’’ The original language 

was written to indicate that an approved 

CAP vendor could not bill a 

beneficiary’s supplemental insurer for 

applicable amounts of cost sharing until 

the CAP drug claim had matched the 

corresponding physician’s drug 

administration claim. Under the postpayment review process, the final 

payment would not occur until a 

statistical review of the claims was 

complete, a process that may take 

several months. Removing the word 

final from this section of the regulation 

will clarify that the approved CAP 

vendor may bill the supplemental 

insurer immediately after the designated 

CAP carrier makes the initial payment 

on a CAP drug claim. Under our current 

regulations, the approved CAP vendor 

may also bill the beneficiary if drug 

administration is verified by the 

participating CAP physician. This 

provision remains unchanged. 

Under the revised CAP claims 

payment process, the approved CAP 

vendor will bill Medicare for the CAP 

drug that has been provided. In most 

cases Medicare will pay the claim upon 

receipt. If the beneficiary has a 

supplemental insurance policy, and the 

supplemental insurer has a crossover 

agreement with Medicare, the claim 

automatically will cross over to the 

supplemental insurer for payment. The 

supplemental insurer will pay its share. 

Upon receipt of payment from the 

supplemental insurer, the approved 

CAP vendor may bill the beneficiary for 

any residual amount. For beneficiaries 

who do not have a supplemental 

insurance policy, the approved CAP 

vendor may bill the beneficiary after 

payment by Medicare. 

However, in either case, the approved 

CAP vendor may not collect any 

coinsurance owed from the beneficiary 

or his or her supplemental insurer 

unless it has verified that the drug was 

administered. If the approved CAP 

vendor believes that the drug was 

administered but later learns that it was 

not, the approved CAP vendor must 

refund any coinsurance collected to the 

beneficiary and his or her supplemental 

insurer, as applicable. In addition, in 

§ 414.914(i)(2), we proposed that the 

approved CAP vendor must promptly 

refund any payment made by CMS if the 

vendor has been paid for drugs that 

were not administered. We also 

proposed to interpret the word 

‘‘promptly’’ to mean 2 weeks. Thus, the 

approved CAP vendor would have 2 

weeks from the date it was notified that 

it had been paid for a drug that had not 

been administered to refund to the 

designated carrier any payment for the 

claim and refund any cost sharing 

collected to the beneficiary or his or her 

supplemental insurer. 

Comment: We received few comments 

on our proposal for provisions for 

collection of beneficiary coinsurance. 

One commenter was concerned about 

the administrative burden placed on the 

participating CAP physician if the 

approved CAP vendor calls the 

physician’s office to verify that a drug 

was administered. Another commenter 

agreed with our proposal to require that 

the approved CAP vendor refund any 

cost sharing collected in error promptly 

to the beneficiary and or his or her 

supplemental insurance provider. The 

commenter also suggested that we 

require the approved CAP vendor to pay 

a penalty above the amount owed if it 

does not refund the cost sharing amount 

within the 2 week time frame. 

Response: Physicians and their staff 

are the best source of information for 

drug verification since they have direct 

contact with the beneficiary. We have 

structured the process for verification of 

CAP drug administration in the least 

burdensome way possible for the 

participating CAP physician that would 

still provide us with information to 

comply with the statutory mandate to 

assure that payment is made for a CAP 

drug only if it has been administered to 

a beneficiary. 

Physicians have flexibility in how 

verification for drug administration 

occurs. The physician is free to enter 

into a voluntary agreement with the 

approved CAP vendor to verify drug 

administration and to specify the 

manner in which he or she would like 

the verification to occur. Alternatively, 

if the physician chooses not to enter 

into such an agreement and does not 

notify the vendor that a dose of a CAP 

drug has been administered, the 

approved CAP vendor will contact the 

physician to verify administration 

before collecting coinsurance from the 

beneficiary. 

We believe that the degree of 

flexibility built into this procedure for 

drug administration verification 

minimizes the burden for participating 

CAP physicians within the confines of 

our statutory obligation to assure that 

payment is made for a CAP drug only 

if it has been administered to a 

beneficiary. Therefore, we are finalizing 

our proposal to add new § 414.914(h)(1) 

as described above in this section. 

We are also finalizing our proposal to 

revise new § 414.914(i)(1) to remove the 

reference to ‘‘final payment by 

Medicare’’ and revise this language to 

state, ‘‘payment by Medicare.’’ Under 

the post-payment review process, the 

final payment will not occur until a 

statistical review of the claims was 

complete, a process that may take 

several months. Removing the word 

final from this section of the regulation 

will clarify that the approved CAP 

vendor may bill the supplemental 

insurer immediately after the designated 

CAP carrier makes the initial payment 

on a CAP drug claim. Under our current 

regulations, the approved CAP vendor 

may also bill the beneficiary if drug 

administration is verified by the 

participating CAP physician. This 

provision remains unchanged. 

Under the revised CAP claims 

payment process, the approved CAP 

vendor will bill Medicare for the CAP 

drug that has been provided. In most 

cases Medicare will pay the claim upon 

receipt. If the beneficiary has a 

supplemental insurance policy, and the 

supplemental insurer has a crossover 

agreement with Medicare, the claim 

automatically will cross over to the 

supplemental insurer for payment. The 

supplemental insurer will pay its share. 

Upon receipt of payment from the 

supplemental insurer the approved CAP 

vendor may bill the beneficiary for any 

residual amount. For beneficiaries who 


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do not have a supplemental insurance 

policy, the approved CAP vendor may 

bill the beneficiary after payment by 

Medicare. 

However, in either case, the approved 

CAP vendor may not collect any 

coinsurance owed from the beneficiary 

or his or her supplemental insurer 

unless it has verified that the drug was 

administered. If the approved CAP 

vendor believes that the drug was 

administered but later learns that it was 

not, the approved CAP vendor must 

refund any coinsurance collected to the 

beneficiary and his or her supplemental 

insurer, as applicable. 

In addition, we are finalizing 

§ 414.914(i)(2), so that the approved 

CAP vendor must promptly refund any 

payment made my CMS if the vendor 

has been paid for drugs that were not 

administered. We are implementing our 

proposal to interpret the term 

‘‘promptly’’ to mean 2 weeks so that the 

approved CAP vendor would have 2 

weeks from the date that they were 

notified that they had been paid for a 

drug that had not been administered to 

the beneficiary to refund any payment 

for the claim made to the designated 

carrier and refund any cost sharing 

collected to the beneficiary and his or 

her supplemental insurer. We are not 

implementing a penalty if the refund of 

any cost sharing collected in error 

exceeds the two week time frame 

because section 1847B of the Act does 

not provide for such a remedy. 

f. Approved CAP Vendor Appeals for 

Denied Drug Claims 

In the March 4, 2005 proposed rule 

(70 FR 10757 through 10758) and the 

July 6, 2005 IFC (70 FR 39054 through 

39057), we discussed the development 

of the CAP dispute resolution process 

and the limited applicability of the 

traditional Medicare fee for service 

appeals process to an approved CAP 

vendor’s dispute of CAP drugs claims 

that are denied by the CAP-designated 

carrier. We stated that the approved 

CAP vendor could file appeals as a 

Medicare supplier consistent with the 

rules at 42 CFR part 405, subpart I. For 

the purposes of the appeals regulations 

at Part 405, Subpart I, we indicated that 

a local carrier’s initial determination of 

the participating CAP physician’s drug 

administration claim was an initial 

determination regarding payment of the 

approved CAP vendor’s drug claim. 

Thus, the approved CAP vendor was to 

be considered a party to any 

redetermination of the drug 

administration claim by the local 

carrier. In addition, the approved CAP 

vendor would be considered a party to 

an initial determination on the claim for 

payment for the drug product that the 

approved CAP vendor filed with the 

CAP-designated carrier. 

We also specified that appeals of 

either initial determination would be 

filed with the local carrier. We stated 

that the local carrier, rather than the 

designated carrier, possessed all 

information necessary to adjudicate an 

appeal in this situation. Such 

information included local coverage 

decisions, medical necessity 

determinations, and information 

regarding payment of drug 

administration claims. A dispute 

resolution process was set forth in 

§ 414.916. 

Under our initial implementation of 

the provision that authorized CAP, this 

alternative approach provided party 

status to the approved CAP vendor on 

the participating CAP physician’s drug 

administration claim. This was 

necessary because an approved CAP 

vendor was not permitted to receive 

payment for a CAP drug until the 

corresponding drug administration 

claim was submitted by a participating 

CAP physician. Payment for the 

approved CAP vendor’s claim was 

authorized when the participating CAP 

physician’s claim and the approved 

CAP vendor’s claim were matched in 

the system. 

However, changes to the claims 

processing requirements and the 

addition of a post-payment review 

process required by section 108(a)(2) of 

the MIEA–TRHCA (discussed above in 

this section) eliminate the approved 

CAP vendor’s dependency on a 

participating CAP physician’s filing of a 

drug administration claim in order to 

receive payment for a CAP drug. 

Accordingly, the approved CAP vendor 

no longer needs party status on the drug 

administration claim submitted by the 

participating CAP physician. Instead, 

under the MIEA–TRHCA, the approved 

CAP vendor’s drug claim may be paid 

by the CAP-designated carrier once it is 

received. This determination made on 

the claim constitutes an initial 

determination as defined in § 405.924. 

The approved CAP vendor is considered 

a party to this initial determination and 

may request a redetermination and 

subsequent appeals consistent with the 

process established under 42 CFR part 

405, subpart I. 

The changes to CAP claims processing 

in this final rule with comment period 

that conform to the MIEA–TRHCA 

result in two scenarios that create 

appeals rights for the approved CAP 

vendor with respect to their drug 

product claim: (1) Prepayment denials 

of the approved CAP vendor’s claim 

made by the CAP-designated carrier 

(based on information from the local 

carrier that the payment for the drug 

should be denied as excluded or noncovered); and (2) post-payment denials 

by the CAP-designated carrier based on 

the post-payment review process 

established under the MIEA–TRHCA. 

Therefore, as proposed in the CY 2008 

PFS proposed rule (72 FR 38156), we 

are making the following clarifications 

regarding the CAP appeals process for 

an approved CAP vendor’s denied drug 

claims: 

• For prepayment denials, the 

approved CAP vendor, as a supplier, has 

a direct right to appeal the initial 

determination made by the designated 

carrier on its drug product claim. The 

local carrier will conduct the 

redetermination on prepayment denials. 

It is the most appropriate entity to 

review prepayment denials since it is 

most familiar with the relevant coverage 

policies for that jurisdiction. We 

acknowledge that this process differs 

from a traditional fee-for-service appeal 

since the redetermination will not be 

conducted by the contractor that issued 

the initial determination. 

• For the post-payment review 

process, an initial determination will be 

considered re-opened if the CAPdesignated carrier selects the drug claim 

for review. If the CAP-designated carrier 

cannot verify administration or cannot 

determine that the drug is covered or 

medically reasonable and necessary, the 

CAP-designated carrier will issue a 

revised determination to deny coverage 

of the drug product claim. The CAPdesignated carrier will then determine 

whether an overpayment exists, and if 

so, will recover the overpayment. As a 

supplier, the approved CAP vendor 

would then have the right to request a 

redetermination of the revised coverage 

determination, and the overpayment 

assessment. The CAP-designated carrier 

will process the redetermination. 

We received no comments on this 

topic; therefore, we are finalizing the 

proposed conforming changes to the 

CAP appeals process as described 

herein. 

g. Definition of Exigent Circumstances 

Sections 1847B(a)(1)(A)(ii) and 

1847B(a)(5)(A)(ii) of the Act require that 

each physician be given the opportunity 

annually to elect to obtain drugs and 

biologicals through the CAP and to 

select an approved CAP vendor. Section 

1847B(a)(5)(A)(i) of the Act allows for 

selection of another approved CAP 

vendor more frequently than annually 

in exigent circumstances as defined by 

CMS. 

In the CY 2005 PFS final rule with 

comment period (70 FR 70258), we 


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stated that participating CAP physicians 

would have the option of changing 

approved CAP vendors or opting out of 

the CAP program on an annual basis. 

We also provided the circumstances, as 

specified in § 414.908(a)(2), under 

which a participating CAP physician 

may choose a different approved CAP 

vendor 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 (if 

multiple CAP competitive areas are 

developed) or, (4) for other exigent 

circumstances defined by CMS. 

We also identified a separate exigent 

circumstance relating to instances in 

which an approved CAP vendor 

declines to ship CAP drugs (when the 

conditions of new § 414.914(i) are met) 

in § 414.908(a)(5). We noted that in 

these cases, a physician may opt-out of 

his or her drug category, and because 

there is currently only one drug category 

for the CAP, then the participating CAP 

physician would be allowed to opt-out 

of the CAP altogether (70 FR 39081). 

The CAP became operational on July 

1, 2006. At that time, we believed that 

most issues raised by participating CAP 

physicians would relate to quality and 

service, which could be resolved 

through the approved CAP vendor’s 

grievance process and the dispute 

resolution process conducted by the 

designated carrier. However, since then, 

we have been contacted by a few 

participating CAP physicians who have 

requested termination of their election 

agreement because they misunderstood 

the CAP program or determined that it 

was not a viable option for their 

practice. 

These instances demonstrate that a 

practice might wish to leave the 

program for other business reasons that 

are unrelated to the approved CAP 

vendor’s performance. However, we 

continue to believe that opportunities 

for leaving the CAP outside the annual 

election process should be limited 

because the CAP was designed as a 

program in which physicians would 

make an annual decision to participate, 

as consistent with sections 

1847B(a)(1)(A)(ii) and 1847B(a)(5)(A) of 

the Act. 

Therefore, in the CY 2008 PFS 

proposed rule (72 FR 38156), we 

proposed to define an additional exigent 

circumstance for opting out of the CAP. 

We proposed that within 30 days of the 

effective date of the election agreement, 

the participating CAP physician may 

submit a written request to terminate his 

or her participation in the CAP. The 

request would be sent to the designated 

carrier under the dispute resolution 

process, and the designated carrier 

would determine within 1 business day 

whether the request was related to the 

service provided by the approved CAP 

vendor. If so, the designated carrier 

would refer the participating CAP 

physician to his or her approved CAP 

vendor’s grievance process to further 

determine whether any appropriate and 

reasonable steps could be taken to 

resolve the identified issue. 

We proposed that the approved CAP 

vendor would have 2 business days to 

respond to the participating CAP 

physician’s concern, consistent with 

§ 414.914(f)(5). If the approved CAP 

vendor is unable to identify a solution 

for resolving the issue that is consistent 

with the CAP statute, regulations, 

contracts and guidance, and that is 

acceptable to the physician, then the 

participating CAP physician would be 

referred back to the designated carrier 

for assistance under the dispute 

resolution process. We also proposed 

that the participating CAP physician’s 

request would be handled under the 

dispute resolution process because 

protocols and defined time frames have 

already been developed for handling 

participating CAP physician and 

approved CAP vendor complaints in 

this set of procedures. 

We proposed that if the designated 

carrier does not believe that the 

participating CAP physician’s request is 

related to an issue that could be 

resolved by the approved CAP vendor, 

then the designated carrier would 

conduct an investigation and attempt to 

resolve any issues identified in the 

physician’s request to terminate his or 

her CAP election agreement. If the 

designated carrier is unable to resolve 

the situation to the physician’s 

satisfaction within 2 business days, then 

it can either make a recommendation to 

CMS that the physician be permitted to 

terminate his or her CAP election 

agreement, or request a 2-day extension 

to continue examining the issue. We 

stated that we believed that 4 business 

days would be sufficient to conclude 

this process because it would give the 

designated carrier time to gather 

information from other affected parties, 

such as the participating CAP 

physician’s local carrier, but still 

prepare a speedy summary of the issues 

involved in the physician’s request. 

Under our proposal, after the 2-day or 

4-day period, as applicable, the 

designated carrier would forward its 

recommendation and the physician’s 

request to CMS. We would then review 

the recommendation and make a final 

decision within 2 business days from 

the date that we received the request. 

We proposed that if the participating 

CAP physician demonstrated that 

remaining in the CAP was a significant 

burden, then we would allow that 

physician to terminate his or her 

participation in the program. We would 

inform the designated carrier of our 

decision, which the designated carrier 

would then communicate to the 

participating CAP physician in writing. 

As part of this process, the physician’s 

termination date for his or her CAP 

election agreement would be 

determined and communicated to all 

parties involved, including the 

physician’s local carrier. 

Conversely, if we did not believe that 

the physician demonstrated that CAP 

participation constituted a significant 

burden, then we would not allow the 

physician to terminate his or her CAP 

contract. Subsequently, we would 

inform the physician of our decision in 

writing via the designated carrier. We 

would also include a recommendation 

for corrective action. 

In the CY 2008 PFS proposed rule, we 

also proposed that, even if we agreed to 

terminate the participating CAP 

physician’s CAP election agreement, the 

physician would still be required to 

continue to cooperate in any postpayment review and appeal of claims 

for drugs that the approved CAP vendor 

had already provided and been paid for. 

The physician would also have to make 

arrangements with the approved CAP 

vendor for the return of any unused 

drugs that had not been administered to 

the beneficiary prior to the effective date 

of the physician’s termination from the 

CAP. If the approved CAP vendor had 

billed CMS for drugs that had not yet 

been administered to a beneficiary, then 

the vendor would be required to correct 

the claim and return any overpayment. 

Comment: We received several 

comments that supported defining an 

additional exigent circumstance for 

leaving the CAP because of a burden on 

the practice. Several commenters 

addressed the timeframe for leaving the 

CAP. Of these comments, all supported 

a 30-day timeframe, though several 

encouraged a longer window. 

Commenters who encouraged a longer 

time period believe that 30 days was 

insufficient time to determine the 

suitability of the CAP for their practice. 

While most commenters agreed that a 

demonstration of burden should be 

required, one commenter stated that 

allowing physicians to opt-out for any 

reason would be desirable. One 

commenter suggested that physicians 

should be allowed to opt-out of the CAP 


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at any time for any reason. Several 

commenters asked that the opt-out 

process be simplified. Another 

commenter requested that the process 

for determining whether to grant a 

physician’s request to leave the CAP be 

outlined. 

Response: Based on the comments, we 

are revising our proposal to make it 

more flexible. While we recognize the 

concerns raised by commenters who 

recommended that we allow physicians 

to leave the CAP for any reason at any 

time, we continue to believe that there 

should be limits on a participating CAP 

physician’s ability to leave the CAP. The 

CAP statute contemplates an annual 

election process. Our proposal to allow 

a 30-day period for opting out because 

of a burden is based on our authority to 

specify ‘‘exigent circumstances,’’ and 

we do not believe it would be 

appropriate to allow physicians to optout under this process without some 

exigency that makes termination of CAP 

participation necessary. However, in 

recognition of these comments, and 

because we agree that participating CAP 

physicians should have a sufficient 

opportunity to assess the suitability of 

the CAP for their practice, we are 

making the following changes to the 

opt-out process. 

First, we note that we intend to take 

a broad view of what would constitute 

a burden to the practice resulting in an 

‘‘exigent circumstance.’’ We believe that 

a broad view is appropriate because 

there may be many reasons why a 

participating CAP physician may find 

CAP participation more burdensome 

than he or she expected, and we do not 

wish at this time to place a limit on 

what those reasons may be. As we gain 

experience with this process, we may in 

a future rulemaking specify a list of 

‘‘exigent circumstances’’ or prescribe 

more specific standards for what 

constitutes an ‘‘exigent circumstance’’

for purposes of the opt-out process; 

however, for now we will assess 

requests on a case-by-case basis under 

the process described in this preamble 

and set forth in the regulations at 

§ 414.908. 

In response to comments seeking 

greater flexibility in the process and a 

longer window in which to assess the 

CAP’s suitability for the physician’s 

practice, we are implementing a twotiered process that would both expand 

the initial time frame for requesting to 

opt-out of the CAP and would allow for 

requests to opt-out at any time based on 

a change in circumstances that was not 

previously known to the participating 

CAP physician. We believe that such a 

process, which we outline below, strikes 

a balance between providing 

participating CAP physicians with 

flexibility to opt-out of the CAP when 

participation is burdensome, while still 

placing appropriate limits on a 

physician’s ability to leave the CAP 

outside the annual election process. 

Thus, under the two-tiered process we 

are finalizing in this rule, we are 

changing to 60 days the initial period 

during which a physician can request 

termination of his or her CAP 

participation agreement as a result of 

exigent circumstances. We agree with 

commenters that allowing physicians 

more time to determine whether the 

CAP is suitable for their practices is 

advisable. We believe that an initial 60- 

day period will allow the participating 

CAP physician time to make a more 

complete assessment of the CAP’s 

suitability. Although certain burdens 

will be likely to be apparent 

immediately, the first 30 days may be a 

period with a steep learning curve for 

the practice as it adapts to the CAP drug 

ordering process, and the first 30 days 

may involve working out any ‘‘start up’’

issues within the practice or with the 

approved CAP vendor. For this reason, 

the first 30 days may not be a fully 

representative time period during which 

to assess ongoing CAP participation. We 

believe an additional 30 days of CAP 

participation would be sufficient to 

identify, in the vast majority of cases, 

whether participation will constitute a 

burden to the practice. 

Under this process, therefore, if a 

participating CAP physician’s election 

agreement was effective on January 1, 

2008, then he or she would have until 

March 1, 2008, to request to terminate 

participation in the program if CAP 

participation results in a burden to the 

practice. In addition, based on the 

concerns raised by commenters, we will 

allow physicians to leave the CAP at 

any time after the first 60 days if they 

can show that a change in 

circumstances that was not known to 

the practice previously results in a 

burden to the practice. As noted above, 

we believe that in the vast majority of 

cases participating CAP physicians will 

be able to identify a burden, if any, 

within the first 60 days. However, we 

also recognize that issues may arise 

during the course of the year that would 

result in an ‘‘exigent circumstance,’’ but 

that were not known to the participating 

CAP physician during the first 60 days 

of CAP participation. In such instances, 

we agree with commenters that 

physicians should have a longer 

window to request an opt-out. 

For purposes of the two-tiered 

process, then, examples of burdens that 

we would expect a practice could 

identify within the first 60 days may 

include difficulties with CAP billing or 

drug ordering requirements, or 

documentation that the practice’s initial 

understanding of these requirements 

was based on inaccurate information 

provided by a third party. Examples of 

burdens that might arise after the initial 

60 days could include a change in 

practice personnel, patient population, 

computer systems, or vendor behavior 

that makes it harder to participate in the 

program. Where an opt-out request is 

submitted after the initial 60 days, we 

will require the participating CAP 

physician to demonstrate the request is 

based on information that he or she did 

not have within the first 60 days. 

All requests to terminate 

participation, whether within the first 

60 days or thereafter, would be 

submitted to the CAP-designated carrier 

and processed under the dispute 

resolution process. The request would 

need to document the physician’s 

burden. Upon completion of the process 

outlined in proposed § 414.917, we 

would make the decision about whether 

the participating CAP physician’s 

participation in the CAP will be 

terminated. 

If the physician has not demonstrated 

that CAP participation represents a 

burden for his or her practice—either 

during the first 60 days or, if thereafter, 

as a result of a change in circumstances 

that was not known to the practice 

previously, then we would not allow the 

physician to terminate his or her 

participation in CAP because, as noted 

above, we continue to believe that a 

participating CAP physician’s ability to 

opt-out of the CAP under this process 

should be limited to ‘‘exigent 

circumstances,’’ as contemplated by the 

statute and our regulations. 

We would inform the physician of our 

decision in writing via the designated 

carrier. We would also include a 

recommendation for corrective action, if 

appropriate. For example, if the reason 

that the CAP participating physician 

wanted to leave the program was that 

the approved CAP vendor was not 

delivering drugs timely, the designated 

carrier would investigate the situation. 

If it found that the approved CAP 

vendor was complying with our 

regulations on drug delivery at 

§ 414.914(f) and § 414.902 but that the 

participating CAP physician was not 

ordering drugs consistent with the 

vendor’s procedures, then the CAPdesignated carrier could educate the 

physician about the proper drug 

ordering procedures and facilitate a 

discussion between the approved CAP 

vendor and the participating CAP 

physician about how the physician 

could order drugs in a way that met the 


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needs of his or her practice and the drug 

ordering requirements of the CAP 

vendor. The CAP-designated carrier 

would document the result of that 

discussion in writing. The participating 

CAP physician would have the right to 

request a reconsideration of our 

decision as specified in § 414.916(c). We 

are revising § 414.916(c) to clarify that 

the physician reconsideration process 

would apply to reconsiderations of our 

decision on whether the participating 

CAP physician may opt-out of the CAP. 

Based on our experience with the 

program, we continue to believe that 

handling all requests to terminate CAP 

election under the dispute resolution 

process is reasonable and 

straightforward. We further believe the 

use of our pre-existing process will not 

create unnecessary delays in processing 

opt-out requests, particularly in light of 

the short time frames we have specified 

for responding to opt-out requests. 

Moreover, we believe the dispute 

resolution process is sufficiently 

detailed that it provides an ample 

description of how a physician’s request 

to terminate CAP participation will be 

assessed. 

Physicians will still be required to 

return unused CAP drugs and to 

complete any required CAP claims 

processing activities as described in 

proposed § 414.917. The notification to 

a physician will also include the end 

date of CAP participation in order to 

facilitate an orderly and efficient 

changeover between the CAP and ASP 

payment systems. 

Therefore, we are finalizing § 414.908 

and § 414.917 as proposed, subject to 

the changes described in this section. 

(We are making an additional technical 

change to § 414.908 to consolidate the 

‘‘additional opt-out’’ provision, 

currently set forth at § 414.908(a)(5), 

with the other opt-out provisions at 

§ 414.908(a)(2). We believe this 

nonsubstantive change will improve the 

clarity of the regulations.) Finally, we 

also are finalizing § 414.916(c) as 

amended as described in this section. 

h. Transporting CAP Drugs 

Although section 1847B((b)(4)(E) of 

the Act provides for the shipment of 

CAP drugs to settings other than a 

participating CAP physician’s office 

under certain conditions, we did not 

propose to implement the CAP in 

alternative settings. In the July 6, 2005 

IFC (70 FR 39047), we described both 

comments that supported the idea of 

allowing participating CAP physicians 

to transport drugs to multiple office 

locations, and comments that raised 

concerns about the risk of damaging a 

drug that has not been kept under 

appropriate conditions while being 

transported. 

As stated in § 414.906(a)(4), we 

implemented the CAP with a restriction 

that CAP drugs be shipped directly to 

the location where they will be 

administered. However, we were aware 

that physicians may desire to administer 

drugs in alternative settings, especially 

in a home. We sought comment on how 

this could be accommodated under the 

CAP in a way that addresses the 

concerns about product integrity and 

damage to the approved CAP vendors’

property expressed by the potential 

vendors. 

Several comments submitted in 

response to the July 6, 2005 IFC 

suggested either narrowing or removing 

the restriction on transporting drugs to 

other locations. Commenters believed 

that physicians, particularly those who 

specialize in oncology, and their staff 

are knowledgeable about drug stability 

and handling, and therefore, were 

capable of assuming this responsibility. 

Other commenters indicated that 

transporting the drug to another office 

location may allow for flexibility in 

scheduling patient visits. It would allow 

practices with satellite operations that 

are not open every business day to 

receive shipments of CAP drugs at 

another practice location and then to 

administer the drugs in the satellite 

office. 

We also received several comments 

discussing the impact of CAP-delivery 

times on rural clinics and offices with 

satellite locations. Many of these 

responses discussed how easing the 

restriction on transporting CAP drugs 

between locations would be welcome in 

rural areas and for satellite offices with 

limited hours. 

These comments and our experience 

with the CAP thus far have caused us to 

consider revising our policy. Therefore, 

in the CY 2008 PFS proposed rule (72 

FR 38157), we requested comments on 

the potential feasibility of narrowing the 

restriction on transporting CAP drugs 

where this is permitted by State law and 

other applicable laws and regulations. 

We asked commenters to consider how 

such a policy could be constructed so 

that the approved CAP vendor could 

retain control over how the drugs that 

it owns are handled. We also requested 

comments on other issues that we 

should take into account concerning 

transportation of CAP drugs between 

practice locations listed on a physician’s 

CAP election agreement form. 

Additionally, we also solicited 

comments on the following areas that 

we could use in the development of 

future proposals: 

• How to structure requirements so 

that drugs are not subjected to 

conditions that will jeopardize their 

integrity, stability or sterility while 

being transported and steps to keep 

transportation activities consistent with 

all applicable laws and regulations; 

• Whether any agreement allowing 

participating CAP physicians to 

transport CAP drugs to alternate 

practice locations should be voluntary. 

This means that approved CAP vendors 

would not be required to offer such an 

agreement and physicians who 

participate in the CAP would not be 

required to accept such an offer; and 

• Whether the agreement should be 

documented in writing, and whether it 

is necessary to create any restrictions on 

which CAP drugs could be transported. 

We stated that we were not making a 

specific proposal at this time but that 

we would use any information received 

to structure a future proposal in the 

event we made one. 

Comment: Several commenters 

supported the concept of easing the 

restriction on transporting CAP drugs if 

this could be done safely, and if changes 

were consistent with applicable rules, 

regulations, and within the limitations 

of product stability and integrity. The 

restriction on transporting CAP drugs 

was perceived as a barrier to physician 

participation in the program. One 

commenter stated that elimination of 

the restriction would result in the same 

flexibility as the ASP (buy and bill) 

method of acquiring drugs. Another 

commenter expressed a strong desire to 

implement these changes promptly. 

A few commenters also cautioned us 

to be certain that appropriate safeguards 

would be in place if we chose to ease 

the transportation restriction. One 

commenter asked that the safeguards be 

available for public scrutiny before they 

are implemented. Conversely, other 

commenters stated that a physician’s 

certification or discretion were 

satisfactory. 

Response: We are sympathetic to the 

concerns expressed by the commenters 

and expect to issue a proposal in the CY 

2009 PFS proposed rule that would 

allow the transportation of CAP drugs 

from one physician practice location in 

certain circumstances. We further 

expect that our proposal would propose 

to permit transport of CAP subject to 

voluntary agreements between the 

approved CAP vendor and the 

participating CAP physician that 

complied with all applicable State and 

Federal laws and regulations and 

product liability requirements. We 

welcome comments on how to structure 

such a proposal. 


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i. Alternatives to the CAP Prescription 

Order Number 

In the July 6, 2005 IFC (70 FR 39043 

and 39049), we responded to several 

comments regarding the administrative 

burden that the CAP ordering and 

claims payment process imposes upon 

participating CAP physicians; 

specifically, activities associated with 

using and tracking the prescription 

order number were mentioned. We 

received additional comments on this 

issue in response to the IFC as well. 

After the close of the comment period, 

we also received an inquiry from the 

current approved CAP vendor about the 

potential length of the CAP prescription 

order number and whether it could 

present a burden to participating CAP 

physicians. A 30-byte field is currently 

available on the electronic claim form 

for prescription numbers; however, it is 

not necessary for the prescription order 

number to be 30 bytes long. Typically, 

15 or fewer total characters have been 

used by the approved CAP vendor. 

The requirements for developing the 

CAP prescription order number are as 

follows: The first 9 characters are the 

approved CAP vendor’s ID and the 

HCPCS code of the drug that is being 

billed; the approved CAP vendor sets 

the remaining characters. The assigned 

CAP prescription order number is 

captured in Loop 2410, REF02 

(REF01=XZ) of the ANSI 4010A1 

electronic claims transaction. This 

segment of the electronic claims 

transaction is part of a specific data 

format that Medicare claims must 

adhere to in order to meet national 

electronic standards for the automated 

transfer of certain health care data as 

mandated by the Health Insurance 

Portability and Accountability Act of 

1996 (Pub. L. 104–191) (HIPAA). 

Each prescription order number is 

unique to a dose of a CAP drug that is 

being shipped for administration to a 

particular beneficiary. The prescription 

order number is generated by the 

approved CAP vendor and, as stated in 

the July 6, 2005 IFC (70 FR 39042), each 

dose of a CAP drug is required to have 

a separate prescription order number. 

After the drug is administered, the 

participating CAP physician’s drug 

administration claim is submitted with 

a no-pay line containing the 

prescription order number. The 

approved CAP vendor’s claim for the 

CAP drug also contains the prescription 

order number. 

When the CAP was implemented, the 

prescription order number was used in 

the claims matching process to facilitate 

accurate payment of the approved CAP 

vendor. Prior to payment, this system 

paired an approved CAP vendor’s drug 

claim to a participating CAP physician’s 

drug administration claim using the 

prescription order number. A matching 

prescription order number between 

these two claims indicated that the drug 

had been administered. 

Since the CAP began, the claims 

process has changed because of 

statutory changes. Section 108(a)(2) of 

the MIEA–TRHCA requires us to make 

payment upon receipt of an approved 

CAP vendor’s drug claim and then to 

conduct a post-payment review of 

claims. As stated in the MIEA–TRHCA, 

the post-payment review process is 

intended to ‘‘assure that payment is 

made only for a drug or biological * * * 

if the drug or biological has been 

administered to a beneficiary.’’

Under this new process, the 

prescription order number still plays a 

pivotal role. Prior to the payment of the 

approved CAP vendor’s drug claim, the 

CAP-designated carrier uses the 

prescription order number to check the 

claims processing system to ascertain 

whether the local carrier has 

adjudicated the drug administration 

claim. If the local carrier has done so, 

then the CAP-designated carrier will 

look to see whether the local carrier has 

determined that the CAP drug 

administered by the participating CAP 

physician is covered and is medically 

necessary. The local carrier’s decision 

determines whether the CAP-designated 

carrier will pay the approved CAP 

vendor’s drug claim. If the participating 

CAP physician’s local carrier has not 

made a determination on the 

physician’s claim and the CAP drug 

claim, then the designated carrier will 

pay the approved CAP vendor’s claim 

upon receipt and use the CAP 

prescription order number to help verify 

drug administration on a post-payment 

basis. 

The prescription order number is also 

still used in other CAP processes. Each 

dose of a CAP drug that is shipped by 

the approved CAP vendor is tracked 

using the prescription order number. 

Moreover, the prescription order 

number is particularly useful in certain 

situations such as those that involve 

recurring cyclic drug treatment 

regimens. In these cases, the 

prescription order number minimizes 

the possibility of confusion by serving 

as a unique differentiating factor 

between highly similar drug claims. 

Also, the prescription order number is 

valuable during instances in which the 

anticipated day of service submitted by 

the participating CAP physician differs 

from the actual date of drug 

administration. In these situations, the 

prescription order number would clarify 

confusion stemming from discrepancies 

in dates. Overall, we believe that the 

prescription order number remains an 

appropriate and necessary tool to track 

the administration of a specific dose of 

a drug and for the accurate execution of 

the post-payment review process. 

Although we believe that the use of 

the prescription order number is 

necessary to facilitate accurate review of 

CAP claims, we are aware that it may be 

considered an inconvenience by some 

potential participating CAP physicians 

and approved CAP vendors. Therefore, 

in the CY 2008 PFS proposed rule (72 

FR 38158), we requested comments on 

alternative methods to accurately track 

the administration of specific doses of 

drugs in order to meet the requirements 

stated in section 108(a)(2) of the MIEA–

TRHCA. These comments could then be 

used in the development of a proposal 

for future rulemaking. 

Comment: We received a few 

comments on this issue. One commenter 

suggested that the CAP-designated 

carrier should simply match vendor and 

physician claims but did not provide 

any details about how that could be 

accomplished without the prescription 

order number. Another commenter 

stated that the CAP prescription order 

number was no longer needed to verify 

drug administration and should be 

eliminated. Instead they recommended 

that we should rely on the approved 

e-CAP vendor’s verification of drug 

administration and the physician’s 

records of drug administrations. 

Response: While the records of 

participating CAP physicians and the 

CAP vendor are currently used in the 

post pay review process, the CAP 

prescription order number plays an 

important role in that it enables the 

designated carrier to identify the exact 

doses of a drug that was administered 

and provides a link between the 

approved CAP vendor’s claim and the 

participating CAP physician’s claim that 

is not available otherwise. 

We do not believe the suggestions that 

we have received thus far would allow 

us to discontinue the use of the 

prescription order number. The 

prescription order number allows us to 

better ‘‘assure that payment is made 

only for a drug or biological * * * if the 

drug or biological has been 

administered to a beneficiary’’ since it 

tracks the administration of a specific 

dose of a drug, which allows CMS to 

match the vendor and the physician 

claim in the post pay review process. 

However, we would appreciate 

receiving other suggestions that would 

allow drug administration verification 

on a dose specific basis. Since we did 

not make a specific proposal about this 


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issue, we will not make any changes at 

this time to the requirement that the 

CAP prescription order number be 

supplied by the approved CAP vendor 

and included on claims from both the 

participating CAP physician and the 

approved CAP vendor. 

j. Prefilled Syringes 

In the July 6, 2005 IFC (70 FR 39061), 

we described public comments which 

stated that participating CAP physicians 

could not vouch for the quality of 

products that were opened by an 

approved CAP vendor for repackaging, 

for mixing the drug with other drugs or 

injectable fluids (admixture), or for 

removing a part of the contents to 

supply the exact dose for a beneficiary. 

Several commenters recommended that 

approved CAP vendors deliver their 

products in the same form in which 

they are received from the 

manufacturer, without opening 

packaging or containers, mixing or 

reconstituting vials, or repackaging. 

Specifically, the commenters were 

concerned about the capabilities of 

individuals who mix the drug, as well 

as shipping conditions, storage, and 

stability. 

We responded by stating that the CAP 

is not intended to require approved CAP 

vendors to perform pharmacy admixture 

services (for example, to furnish 

reconstituted or otherwise mixed drugs 

repackaged in IV bags, syringes, or other 

containers that are ready to be 

administered to a patient) when 

furnishing CAP drugs. Admixture 

services for injectable drugs require 

specialized staff, training, and 

equipment, and these services are 

subject to standards such as United 

States Pharmacopoeia Chapter 797, 

Pharmaceutical Compounding—Sterile 

Preparations. These requirements have 

significant impact on drug shipping, 

storage, and stability requirements, as 

well as system cost and complexity. As 

stated in § 414.906(a)(4), the approved 

CAP vendor must deliver ‘‘CAP drugs 

directly to the participating CAP 

physician in unopened vials or other 

original containers as supplied by the 

manufacturer or from a distributor that 

has acquired the products directly from 

the manufacturer.’’

Since issuing the July 6, 2005 IFC, we 

have become aware that bevacizumab 

(Avastin) is being used for the 

treatment of exudative age-related 

macular degeneration (wet AMD) in 

very small doses. Although this is an off 

label use, it is gaining acceptance among 

ophthalmologists who treat wet AMD, 

and this use has been the subject of 

several carriers’ local coverage 

determinations. Bevacizumab is 

considerably less expensive than certain 

other drugs used in the treatment of wet 

AMD. 

The smallest commercially-available 

package of bevacizumab is a 100mg 

single use vial, while a dose used to 

treat wet AMD is approximately 1mg. 

Some local carriers who have issued 

coverage instructions for the use of 

bevacizumab in the treatment of wet 

AMD allow physicians to obtain these 

small doses of drug from a pharmacy 

that is capable of preparing sterile 

products. We expect to issue 

instructions that will allow participating 

CAP physicians to use the furnish as 

written option, as appropriate, and to 

obtain small doses of bevacizumab 

outside of the CAP in prefilled syringes 

if their local carrier’s coverage 

determinations allow such a practice 

and if it is consistent with applicable 

laws and regulations. We believe that 

this approach will minimize the waste 

associated with using a 100mg single 

use vial for the treatment of wet AMD 

and will increase the flexibility for 

participating CAP physicians by making 

an alternative quantity of this drug 

available to participating CAP 

physicians whose carriers have 

applicable policies. 

However, this option is not available 

in all areas. Therefore, we stated that we 

are considering reassessing our policy 

on the use of prefilled syringes to 

determine whether it would be feasible 

to make the option of using prefilled 

syringes supplied by an approved CAP 

vendor available to all physicians who 

participate in the CAP, rather than 

requiring physicians to go outside the 

CAP in order to obtain CAP drugs in 

prefilled syringes. In the CY 2008 PFS 

proposed rule (72 FR 38159), we 

requested comments on whether 

allowing approved CAP vendors to 

repackage CAP drugs in certain 

situations may be beneficial to 

beneficiaries, the program, and to the 

physicians who participate in it. 

In considering whether to propose a 

change to our regulations in the future, 

we also solicited comments on: 

• Whether approved CAP vendors are 

likely to be pharmacies or have access 

to pharmacy services with trained 

personnel and facilities for the small 

scale preparation of sterile drug 

products in response to a specific 

prescription order for a specific patient; 

• Whether an approved CAP vendor 

should be given an opportunity to 

supply bevacizumab under the CAP if it 

is repackaged in a patient-specific dose 

consistent with applicable state laws 

and regulations upon request from a 

participating CAP physician; 

• Whether this sort of activity should 

be restricted to bevacizumab, or 

possibly phased-in for other CAP drugs. 

If we were to apply this sort of policy 

to other CAP drugs, we would also have 

to determine how phasing-in might 

occur, which drugs it should apply to 

and whether the preparation of 

admixtures (including the preparation 

of sterile syringes, minibags, and mixing 

of drugs and solutions intended for 

intravenous administration) should be 

allowed as well; 

• How this sort of service could be 

limited to participating CAP physicians 

who voluntarily agree to use it, and 

whether such an agreement should be 

made in writing between the approved 

CAP vendor and the participating CAP 

physician; 

• How such a program could be 

structured so that the service and staff 

engaged in providing the service would 

be required to meet all applicable laws 

(including Stark, Anti-kickback, and 

State pharmacy laws), as well as 

regulations for the preparation of sterile 

products, (including standards for 

product integrity and sterility); 

• Whether the cost of preparing such 

product would be included in the CAP 

vendor’s bid price; and 

• Whether any other important 

elements should be evaluated if we 

consider changing CAP policy on 

prefilled syringes in the future. 

Comment: We received several 

comments on these issues. Overall, 

responses were generally equally 

divided among those who supported 

prefilled syringes, those who advocated 

a cautious approach, and those who 

opposed the practice. 

Those who opposed making prefilled 

syringes available through the CAP cited 

stability and sterility concerns. Those 

commenters also raised concerns about 

whether the CAP vendor’s preparation 

of a particular drug product for an offlabel use by participating CAP 

physicians would violate existing drug 

law because of the potential scale of an 

approved CAP vendor’s activities and 

because the drug was being prepared for 

use in a manner other than as described 

in its FDA-approved labeling. Several 

commenters urged that caution be used 

in developing changes to the aspects of 

the CAP that are discussed above in this 

section, but many of these commenters 

were not completely opposed to the 

preparation of prefilled syringes by 

approved CAP vendors. 

Several commenters were quite 

supportive of using prefilled syringes. 

One commenter stated that pharmacy 

preparation of prefilled syringes was 

regarded as a ‘‘convenient and safe 

practice’’ and would avoid both waste 


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and some of the risk associated with 

transferring sterile products. Another 

commenter also recommended that a 

mechanism to pay for the preparation 

and waste associated with the process 

be established. 

There was a general point of 

agreement between commenters who 

urged a cautious approach and those 

who agreed with the concept of prefilled 

syringes. These commenters agreed that 

that additional flexibility or 

enhancements to the CAP would be 

welcome provided that they did not 

affect beneficiary safety and were 

consistent with applicable laws, 

regulations, product stability, and 

product integrity requirements. 

Response: We appreciate the 

comments on prefilled syringes and we 

will consider whether to develop a 

proposal that is consistent with 

applicable laws, regulations, product 

stability, and product integrity concerns 

in future rulemaking. Because we did 

not propose a change to our current 

regulations on the use of prefilled 

syringes in the CAP, they remain 

unchanged for the present time. We may 

make a proposal in the future. 

k. Contractual Provisions 

Section 1847B of the Act is generally 

silent on the subject of disputes 

surrounding the delivery of drugs and 

the denial of drug claims. However, 

section 1847B(b)(2)(A)(ii)(II) of the Act 

states that a grievance process is a 

quality and service requirement 

expected of approved CAP vendors. In 

the July 6, 2005 IFC (70 FR 39055 

through 39058), we described the 

process for the resolution of approved 

CAP vendors’ claims denials and the 

resolution of participating CAP 

physicians’ drug quality and service 

complaints. We encouraged 

participating CAP physicians, 

beneficiaries, approved CAP vendors, 

and the designated carrier to use 

informal communication as a first step 

to resolve service-related administration 

issues. However, we recognized that 

certain disputes would require a more 

structured approach, and therefore, we 

established processes under § 414.916 

and § 414.917. 

Suspension and termination from the 

CAP were the only remedies described 

under the CAP dispute resolution 

processes. Having gained some 

experience with the CAP, we believe 

that having an intermediate level of 

remedy for less serious but persistent 

problems is desirable in order to bridge 

the gap between taking no action and 

suspension or termination of an 

approved CAP vendor. 

We believe that additional contractual 

obligations, such as additional reporting 

requirements, could be useful, 

particularly if they provide an 

opportunity for the approved CAP 

vendor to come into compliance using 

objective goals and a set timeline. 

Therefore, in the CY 2008 PFS proposed 

rule (72 FR 38160), we requested 

comments on what types of potential 

contractual provisions could be used to 

encourage approved CAP vendors to 

comply with CAP requirements for less 

serious violations, such as missing 

reporting deadlines, or participation in 

inappropriate promotional strategies. 

We also requested comments on the 

following: 

• The type of contractual provisions 

that would be suitable. For example, 

requests for specific or targeted 

reporting and monitoring activities in 

response to specific violations. 

• Whether an approved CAP vendor’s 

code of conduct could be used to 

address these types of less serious 

situations and how that could be 

accomplished; and 

• Whether the CAP physician 

election agreement should be revised to 

include provisions to address 

participating CAP physicians’

noncompliance with CAP rules or the 

CAP election agreement. 

Comment: One commenter agreed 

with the use of contractual provisions, 

including additional reporting 

requirements, as an intermediate form of 

remedy in response to a CAP vendor’s 

noncompliance with CAP requirements. 

The commenter also noted that a vendor 

code of conduct would be useful. 

Response: We plan to develop a 

proposal for additional provisions that 

could be added to the CAP contract. 

These provisions would be used to 

encourage approved CAP vendors to 

comply with CAP requirements. We will 

propose such provisions in a future 

rulemaking period. 

l. Finalizing Remaining Provisions of 

the July 6, 2005 Interim Final Rule with 

Comment Period 

In this PFS final rule with comment, 

we are finalizing the portions of the July 

6, 2005 IFC that were not finalized in 

previous rulemaking. We are also 

responding to other timely comments 

we received on the July 6, 2005 IFC that 

we have not responded to previously. 

Comments that we will be addressing 

in this rule include the following: 

• The use of e-prescribing in CAP. 

• Updating CAP prices and data 

reporting. 

• The application of Comprehensive 

Error Rate Testing (CERT) to CAP 

claims. 

• The 14-day participating CAP 

physician billing requirement. 

• The impact of CAP participation on 

clinical research. 

• Licensure requirements for CAP 

pharmacies and distributors. 

• Community mental health centers 

and participation in the CAP. 

• Administrative and financial 

burden of CAP participation for 

physicians. 

We have addressed drug 

transportation previously in this section 

of this final rule with comment period. 

Basis and Scope (§ 414.900) 

These provisions provide that the 

regulations in this subpart implement 

sections 1847A and 1847B of the Act. 

We received no comments on these 

provisions and we are finalizing the 

corresponding regulatory text at 

§ 414.900 in its entirety. 

Definitions (§ 414.902) 

Section 414.902 lists the definitions 

used in 42 CFR Subpart K. We did not 

receive any comments about the 

revisions to this section that we made in 

the July 6, 2005 IFC (70 FR 39093). At 

this time, we are finalizing the 

regulatory text at § 414.902 as it 

currently reads. 

Competitive Acquisition Program as the 

Basis for Payment (§ 414.906) 

Section 414.906 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. 

i. 2005 Comments 

In the July 6, 2005 IFC (70 FR 39074), 

we discussed the methodology used to 

update CAP drug prices during the 

bidding process. We responded to 

comments that suggested that single 

price updates for CAP drugs should be 

tied to changes in ASP prices. We stated 

that we did not believe that there had 

been enough experience with the ASP 

payment methodology to update the 

bids based on growth in the ASP. We 

also solicited comments on this method 

of updating single drug prices to the 

payment year in order to develop and 

refine the CAP in the future. 

(a) Updating CAP Prices and Data 

Submission 

Comment: We received comments 

about updating CAP drug prices more 

frequently than annually. One 

commenter suggested that we should 

consider quarterly data submissions and 


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pricing updates even during the phase 

in period in order to produce greater 

savings in instances where vendors’

overall costs for CAP drugs were 

declining, while providing greater 

protection for vendors in instances 

where vendors were experiencing cost 

increases. Another commenter 

encouraged us to compare CAP prices to 

ASP prices using the most recent data 

available and to account for 

manufacturer price adjustments in a 

timely manner. 

Response: In the July 6, 2005 IFC (70 

FR 39076), we stated, ‘‘when the 

administrative mechanisms of the CAP 

are operational and vendors have more 

experience under the program, we will 

consider whether more frequent 

reporting (of reasonable net acquisition 

costs) would be appropriate.’’ Section 

414.914 requires that the CAP contract 

must provide for the disclosure of the 

approved CAP vendor’s reasonable, net 

acquisition costs for a specified period 

of time, not to exceed quarterly and 

provide for appropriate adjustments as 

described in § 414.906(c)(1). This 

section describes the computation of an 

annual update to the payment amount 

and allows updates more often than 

annually but no more often than 

quarterly in any of the following cases: 

introduction of new drugs; expiration of 

a drug patent or availability of a generic 

drug; material shortages that result in a 

significant price increase for the drug; 

and withdrawal of a drug from the 

market. Also, the CAP payment amount 

is limited by the weighted payment 

amount established under section 

1847A of the Act across all drugs for 

which a composite bid is required in the 

category, and limited by the payment 

amount established under section 

1847A of the Act for each other drug for 

which the approved CAP vendor 

submits a bid. It is not clear how the 

commenter is proposing that we account 

for changes in manufacturer’s price 

adjustments in a more timely manner. 

Because the CAP has been operational 

for 15 months, we are still gaining 

experience with the reporting and 

update mechanisms already in place. At 

present, we believe these processes are 

sufficient to address the needs of the 

CAP; however, as the program grows, 

we may consider other options, 

including more frequent price updates. 

(b) Impact of CAP on Clinical Research 

Comment: Some commenters stated 

that they were concerned that CAP 

participation would conflict with the 

Medicare National Coverage Decision 

(NCD) on Clinical Trials. Since the NCD 

enables Medicare to reimburse 

physicians for the current standard of 

care drugs that are administered to 

beneficiaries in the control group of 

clinical trial protocols, commenters 

were concerned that physicians would 

not be able to enroll Medicare 

beneficiaries in clinical trials if drugs 

required in the protocol were not on the 

CAP drug list. In addition, some 

commenters expressed their concern 

that there was a lack of built in 

oversight in CAP to ensure that vendors 

would buy drugs directly from a 

manufacturer or wholesaler. The 

commenters were concerned that this 

could result in the acquisition of 

counterfeit product, and that as a result, 

such products could infiltrate clinical 

trials and compromise the results of 

cancer clinical research that a CAP 

physician might be participating in. 

Response: As a result of an executive 

memorandum issued by the President of 

the United States in June 2000, we 

instituted the NCD in September 2000 

as explained in our ‘‘September 2000 

Program Memorandum’’ on clinical 

trials available at http:// 

www.cms.hhs.gov/ClinicalTrialPolicies/. 

The NCD stipulates that Medicare will 

provide payment for routine costs 

associated with qualifying clinical trials 

and for items or services needed to treat 

complications arising from participation 

in such trials. The NCD was revised in 

July 2007 as outlined in CAG–00071R, 

the ‘‘Decision Memorandum for the 

Clinical Trial Policy,’’ which may be 

found at https://www.cms.hhs.gov/mcd. 

More information about the National 

Coverage Decision on Clinical Trials can 

be found on the CMS Web site at 

http://www.cms.hhs.gov/ 

ClinicalTrialPolicies/ and through a 

Medicare Learning Network article at 

http://www.cms.hhs.gov/ 

MLNMattersArticles/. 

We are very aware of the importance 

of clinical trial research in the treatment 

of cancer, and we do not believe that 

CAP participation has imposed any 

undue hardships on participating CAP 

physicians or their Medicare patients 

who engage in such activities. 

Participating CAP physicians do not 

have to buy and bill for the medications 

they receive from the approved CAP 

vendor. The vendor is responsible for 

billing the designated carrier and the 

beneficiary. Thus, if the standard of care 

drug needed for the control group of a 

research protocol is on the CAP drug 

list, the participating CAP physician 

may order the medication from the 

approved CAP vendor. This should not 

affect the participating CAP physician’s 

ability to enroll Medicare patients in 

clinical trials. Moreover, participating 

CAP physicians may still purchase and 

bill for medications that are not on the 

CAP drug list through the ASP system, 

which would allow them to obtain the 

non-CAP drugs required in a research 

protocol. If a particular NDC for a drug 

is not on the CAP drug list but is part 

of the research protocol, a participating 

CAP physician may buy the medication 

on their own and bill for it via the 

‘‘furnish as written’’ provision, which 

allows the physician to bill for the drug 

under the ASP methodology in that 

instance, even though it is on the CAP 

drug list. 

Though we have had no reports that 

CAP physicians have been prevented 

from engaging in clinical trial research 

because of their CAP participation, we 

are mindful that this could be an issue 

because of the way some studies are 

structured. In the event that we receive 

comments that demonstrate that this has 

become a problem in the future, we will 

address the issues accordingly and 

possibly propose mechanisms to 

facilitate participation in clinical trial 

research and the CAP. 

We would also like to reemphasize 

that CAP is a voluntary program. If 

physicians do not believe that the 

‘‘furnish as written’’ option and the CAP 

drug list are sufficient to meet their 

clinical research needs, then they may 

decline to join the CAP and continue to 

purchase and bill for medication under 

the ASP system. 

We also are cognizant of the 

importance of preserving drug quality 

and integrity in the CAP and have 

structured the program accordingly. The 

importance of drug quality and 

oversight are recognized in both the 

vendor bidding process and in the CAP 

dispute resolution process administered 

by the designated carrier. We have 

discussed our concern for maintaining 

CAP drug quality in the program as a 

whole on several occasions, most 

recently in the CY 2006 PFS final rule 

with comment period (70 FR 70244). 

Section 1847B of the Act and 

§ 414.908(b) delineate several 

requirements that vendors must meet in 

order to be selected to participate in the 

CAP, including an ability to ensure 

product integrity, at least 3 years 

experience in furnishing Part B 

Injectable drugs, and acquisition of all 

CAP drugs directly from the 

manufacturer or from the distributor 

that has acquired the products directly 

from the manufacturers. After an entity 

has been awarded a contract, we work 

closely with the CAP-designated carrier 

and the approved CAP vendor to 

monitor and respond to any concerns 

that are raised by participating CAP 

physicians under the dispute resolution 

process. 


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We have not received any complaints 

regarding CAP drug quality and 

integrity. If such an event were to occur, 

it would be investigated and resolved 

promptly so that patient health and 

safety would not be jeopardized. In light 

of all of these requirements and 

protections, we do not believe that 

research and CAP participation are 

incompatible. 

At this time, we are finalizing the 

remaining provisions of this section. 

Competitive Acquisition Program 

(§ 414.908) 

This section specifies the process for 

a physician to select an approved CAP 

vendor. It also details the 

responsibilities of a participating CAP 

physician, such as including the 

specific information required on the 

prescription order, notifying the CAP 

vendor about changes in drug 

administration, and adhering to the 

timeframe for submission of claims. 

Moreover, § 414.908 delineates the 

process for selecting approved CAP 

vendors. It also outlines additional 

factors that are considered both during 

and after the vendor selection process 

such as exclusion of entities from 

participation in Medicare or other 

Federal health care programs under 

section 1128 of the Act. 

i. 2005 Comments 

(a) Physician Administrative and 

Financial Burden 

Comment: We received several 

comments from individual physicians 

and physician groups expressing their 

concern that CAP could place a 

significant burden on physicians. Some 

commenters stated that the requirement 

to maintain a separate inventory of CAP 

drugs will increase physicians’

administrative burden and costs. Others 

indicated that physicians would have 

no incentive to participate in the CAP 

unless these extra administrative costs 

could be reimbursed. One commenter 

indicated that the program was 

impractical and economically 

unfeasible. 

Response: In the July 6, 2005 IFC (70 

FR 39049), we discussed the issue of 

administrative burden. Although we 

agree that a physician may have to make 

some adjustments in his or her practice 

in order to comply with the 

requirements of the CAP, we believe 

that the relief from the financial burden 

of purchasing drugs and billing 

Medicare for them will be a substantial 

benefit for many physicians. We do not 

believe that the clerical and inventory 

resources associated with participation 

in the CAP exceed the clerical and 

inventory resources associated with 

buying and billing drugs under the ASP 

system. A physician is free to design his 

or her practice in a way that minimizes 

the extent of changes necessary to 

comply with the CAP requirements. For 

example, an electronic inventory of CAP 

drugs is required, but separate drug 

storage is not; it is a suggested option if 

such a procedure makes it easier on the 

physician’s practice to track the CAP 

drugs. We recognize that although a 

physician’s staff or their software 

vendor may need to make system 

changes to bill using the CAP format 

and to accommodate the CAP modifiers 

and prescription numbers, these initial 

changes would be a one-time 

occurrence. 

In the ASP system, the payment for 

clerical and inventory resources 

associated with buying and billing for 

drugs is bundled into the drug 

administration payment under the 

physician fee schedule. We have 

adopted this same logic in the CAP and 

believe that the drug administration 

payment is sufficient to cover any 

associated expenses of participating in 

the CAP. 

If a physician perceives that CAP 

participation would be more 

burdensome than the ASP system, then 

he or she is under no obligation to join 

the CAP because it is a voluntary 

program. Additionally, as described in 

other parts of this rule, participating 

CAP physicians may also petition to 

terminate their CAP election due to 

exigent circumstances through the 

dispute resolution process in the event 

that they find the participation in the 

program becomes a burden. 

Comment: One commenter expressed 

disappointment that community mental 

health centers (CMHCs) cannot elect to 

participate in the CAP. 

Response: As noted in the July 6, 2005 

IFC (70 FR 39030), CMHCs can not elect 

to participate in the CAP for provision 

of Part B drugs. The CAP statute is clear 

that only physicians may elect to have 

section 1847B of the Act apply in lieu 

of the ASP payment methodology. 

(b) E-Prescribing 

Comment: One commenter 

recommended that CAP vendors should 

be capable of accepting and submitting 

e-prescribing transactions in accordance 

with the final e-prescribing standards 

issued for Medicare Part D. The 

commenter reasoned that vendor 

compliance would not be an undue 

hardship because vendors already will 

have a fairly rigorous technical 

infrastructure in place. 

Response: Section 101 of the MMA 

amended title XVIII of the Act to 

establish a voluntary prescription drug 

benefit program. The MMA electronic 

prescription program provisions found 

in section 1860D–4(e) of the Act apply 

to the electronic transmission of 

prescription and certain prescriptionrelated information for Medicare Part D 

drugs for Part D eligible individuals. 

The Part D e-prescribing requirements 

do not apply to the electronic 

transmission of prescriptions and 

prescription related information for Part 

B drugs unless those prescriptions are 

written for Part D eligible persons and 

the prescribed drug is a Part D drug. 

Prescription Drug Plan (PDP) sponsors 

Medicare Advantage (MA) organizations 

offering Medicare AdvantagePrescription Drug Plans (MA–PD) are 

required to establish electronic 

prescription drug programs to provide 

for electronic transmittal of certain 

information to the prescribing provider 

and dispensing pharmacy and 

pharmacist. Prescribers and dispensers 

of Part D drugs are not required to write 

prescriptions electronically, but those 

that do so would be required to comply 

with any applicable final e-prescribing 

standards that are in effect when they 

conduct electronic prescription 

transactions, or seek or transmit 

prescription information or certain other 

related information electronically. 

We responded to a comment on 

whether participating physicians would 

be required to incorporate e-prescribing 

technologies into the CAP in the July 6, 

2005 IFC (70 FR 39039). At that time, 

we stated that we would monitor the 

development of the program to see if 

some aspects of it could be adapted to 

the CAP. Since publication of the IFC, 

we have adopted three foundation 

standards (70 FR 67568), recognized six 

initial standards in a Request for 

Applications (RFA) (Available through 

http://www.grants.nih.gov/grants/guide/ 

rfa-files/FRA-HS-06-001.htm), and 

conducted a pilot program in 2006 to 

test the six initial standards and their 

ability to interoperate with the 

foundation standards. More information 

about the MMA e-prescribing program 

and the outcome of the pilots can be 

found on the CMS Web site at http:// 

www.cms.hhs.gov/EPrescribing/. The 

MMA requires the adoption of 

additional standards by the Secretary by 

April 1, 2008. We will continue to track 

the development of the e-prescribing 

program to see whether it would be 

appropriate to incorporate some of the 

program’s elements into the CAP at a 

later date. 


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(c) The Comprehensive Error Rate 

Testing (CERT) Program and CAP 

Claims 

The purpose of the CERT program is 

to monitor and report the accuracy of 

Medicare fee for service payments. In 

the July 6, 2005 IFC (70 FR 39038), we 

discussed CERT and how it would 

apply to CAP claims. While we 

anticipated that CERT would apply to 

CAP, the process had not been 

determined at that point. We received 

no additional comments on this issue 

and have implemented CERT review of 

CAP claims since publication of the July 

6, 2005 IFC. CAP claims paid by the 

designated carrier may be selected for 

review in a manner consistent with 

other claims the carrier processes. 

(d) 14-Day Billing Requirement 

In the July 6, 2006 IFC (70 FR 39050), 

we summarized and responded to 

comments about the 14-day requirement 

for physicians to file claims for CAP 

drug administration. Although a number 

of commenters considered the time 

period to be too brief and were opposed 

to it, we decided to implement the 14- 

day requirement at § 414.908(a)(3)(x) 

because the approved CAP vendor’s 

payment for drugs furnished under the 

CAP depended on a match between the 

vendor’s drug claim and the physician’s 

drug administration claim. 

Implementation of the post-payment 

review as mandated by section 108 of 

the MIEA–TRHCA has superseded our 

original implementation of CAP claims 

processing procedures, which had 

required a pre-payment claims matching 

process for CAP drug claims, and the 

14-day billing requirement was not 

finalized in previous rules (70 FR 

70260). 

Comment: In 2006 several 

commenters asked us to allow at least 

30 days or more for physicians to 

submit CAP drug administration claims. 

During this comment period, we also 

received several comments stating that 

the 14-day requirement be withdrawn 

because changes to the claims 

processing system made it unnecessary 

and such an action would encourage 

physician participation in the CAP. 

Response: Our 14-day standard was 

based on a review of Medicare claims 

that showed approximately 75 percent 

of part B drug and drug administration 

claims were submitted within 14 days of 

the date of service. It was initially 

implemented as a means of facilitating 

the CAP claims matching process that 

was in effect prior to the 

implementation of the post-payment 

review process as mandated by section 

108 of the MIEA TRHCA. As the 

commenters indicated, a 14-day 

requirement is less than is allowed 

under claim submission requirements 

used in other parts of the program. 

We agree that the claims processing 

changes required by Section 108 of 

MIEA–TRHCA have altered the role of 

the claims submission standard. 

However, we do not believe that it has 

eliminated the need for a claimsmatching process under the CAP. Under 

the new payment process that resulted 

from the MIEA–TRHCA, the CAPdesignated carrier also conducts a prepayment review in which it checks for 

any local carrier decisions about 

medical necessity prior to paying for 

drug claims submitted by the approved 

CAP vendor. Retaining a claims 

submission requirement for 

participating CAP physician drug 

administration claims may prevent the 

agency from paying for drugs that have 

been denied on a medical necessity 

basis by the local carrier because when 

the local carrier reviews the physician’s 

claim it makes a determination on 

whether the CAP drug that was 

administered was medically necessary. 

We are not eliminating the requirement 

for prompt billing altogether, as 

requested by commenters, because it 

will continue to facilitate a quicker 

determination that the drug can be 

administered. 

However, we acknowledge that a 

somewhat longer claims submission 

standard would not adversely affect the 

post-payment review process because it 

still would allow for a relatively quick 

match between the claim for a particular 

dose of a CAP drug and the claim for its 

administration. Also, separate analyses 

of previous claims submission data and 

CAP drug claims lead us to conclude 

that the overwhelming majority of 

participating CAP drug administration 

claims are submitted within 30 days of 

the date of service. We further believe 

that, in light of the comments, 

increasing the 14-day claims submission 

requirement would make the CAP more 

appealing to physicians and provide 

them with greater claims submission 

flexibility. 

Therefore, we are increasing the 

requirement for timely CAP drug 

administration claim submission from 

14 days to 30 days. We are finalizing the 

requirements at § 414.908 to include 

this revision. 

ii. Regulatory Text 

At this time, we are finalizing 

§ 414.908 as amended to reflect the 

changes discussed in this final rule with 

comment period. 

The Bidding Process (§ 414.910) 

This section outlines the specific 

criteria for the submission of a bidding 

price for a CAP drug, and specifies what 

costs should be included in the bid 

price. We received no comments on this 

provision and are now finalizing the 

regulatory text for § 414.910. 

Conflicts of Interest (§ 414.912) 

Section 414.912 states conflict of 

interest requirements and standards that 

vendor applicants and approved CAP 

vendors must meet in order to 

participate in CAP. We received no 

comments on this provision, and 

therefore, are finalizing § 414.912. 

Terms of Contract (§ 414.914) 

Section 414.914 outlines the contract 

provisions between CMS and the 

approved CAP vendor such as contract 

length and termination, and specific 

requirements that the approved CAP 

vendor must comply with. 

i. 2005 Comments 

(a) Licensure Requirements for Cap 

Pharmacies and Distributors 

Comment: Some commenters 

requested clarification on the types of 

licenses that are required of CAP 

vendors. A few commenters also asked 

us to specify whether a CAP vendor will 

be operating as a pharmacy or as a 

wholesale distributor since licensing 

requirements and regulatory laws for 

these two types of entities can vary by 

state, and since pharmacies and 

distributors are two different models. 

Response: As specified in § 414.914, 

approved CAP vendors and their 

subcontractors must meet applicable 

licensure requirements in each State in 

which it supplies drugs under the CAP. 

This includes appropriate licensure in 

States that the CAP vendor ships drug 

to even though the vendor does not 

maintain a physical establishment in 

these States. In the July 6, 2005 IFC (70 

FR 39066), we stated that a vendor, its 

subcontractor, or both must be licensed 

appropriately by each State to conduct 

its operations under the CAP. Therefore, 

a vendor under the CAP would be 

required to be licensed as a pharmacy, 

as well as a distributor if a State requires 

it. It is the CAP vendor’s responsibility 

to determine which State and national 

requirements it must adhere to. Based 

on our experience with the CAP, we are 

not persuaded by the comments that any 

changes to this policy are necessary at 

this time. 

ii. Regulatory Text 

We finalized portions of § 414.914 in 

the CY 2006 PFS final rule with 


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comment period (70 FR 70333) and are 

now finalizing the remainder of the 

regulatory text. 

Dispute Resolution for Vendors and 

Beneficiaries (§ 414.916) 

This section discusses the steps, 

timeframes, and requirements of the 

dispute resolution process that are 

available to an approved CAP vendor 

and beneficiaries to address the issue of 

denied CAP drug claims. It also 

describes the protocol that physicians 

would utilize to appeal the suspension 

of their CAP contract. 

We did not receive any comment on 

this comments on this provision in 

response to the CY 2006 PFS proposed 

rule. However, a revision to this section 

will be made in light of the exigent 

circumstance discussion in section (g) of 

this section of the preamble. We are 

revising § 414.916(c) to clarify that the 

physician reconsideration process 

would apply to reconsiderations of our 

decision on whether the participating 

CAP physician may opt out of the CAP. 

We are finalizing § 414.916 at this time. 

Dispute Resolution and Process for 

Suspension or Termination of Approved 

CAP Contract (§ 414.917) 

This section discusses the steps and 

timeframes of the process available to 

participating CAP physicians for the 

resolution of quality or service issues 

concerning an approved CAP vendor. 

We did not receive any comments on 

this section during the comment period 

for the July 6, 2005 IFC. Comments that 

we received on this section during the 

comment period for the CY 2008 PFS 

proposed rule are discussed above in 

this section. We are now finalizing the 

regulatory text for this section as 

described in this final rule with 

comment period. 

Assignment (§ 414.918) 

Section 414.918 specifies that 

payment for a competitively biddable 

drug may be made only on an 

assignment related basis. We received 

no comments on this provision and are 

now finalizing § 414.918. 

Judicial Review (§ 414.920) 

Section 414.920 outlines the areas 

under the CAP that are not subject to 

administrative or judicial review. We 

received no comments on this provision 

and are now finalizing this section. 

m. Brief Summary of Comments We Are 

Not Addressing 

In response to the FY 2007 IPPS final 

rule with comment period (71 FR 

47870), we received a comment related 

to the payment rate for intravenous 

immunoglobulin (IVIG) therapy in 

Medicare. We will not be addressing 

this comment since it is outside the 

scope of both the CY 2008 PFS proposed 

rule and the FY 2007 IPPS final rule 

with comment period. In addition, in 

response to the CY 2007 PFS proposed 

rule, one commenter recommended that 

we implement continuous open 

enrollment in the CAP and eliminate the 

requirement for annual physician 

election, and specify who are the 

appropriate people to sign the CAP 

election form. We are not addressing 

these comments because it is outside the 

scope of the proposed rule. 

G. Issues Related to the Clinical 

Laboratory Fee Schedule 

1. Date of Service for the Technical 

Component of Physician Pathology 

Services (§ 414.510) 

In the CY 2007 PFS final rule with 

comment period (72 FR 69787), we 

added § 414.510 for the date of service 

of a clinical diagnostic laboratory test 

that uses a stored specimen. 

When we added § 414.510, we 

indicated the provision applies to 

clinical diagnostic laboratory tests. For 

outpatients, clinical diagnostic 

laboratory tests are paid under the 

Medicare Part B clinical laboratory fee 

schedule. Upon further review, we 

believe the provision should also apply 

to the technical component (TC) of 

physician pathology services. In 

practice, the collection date for both 

clinical laboratory services and the TC 

of physician pathology services is 

similar. Therefore, we believe § 414.510 

should apply to both types of services. 

This will improve claims processing 

and adjudication in relation to the 

clarity of dates of service, accuracy of 

payment, and detection of duplicate 

services. For outpatients, the TC of 

physician pathology services can be 

paid under the Physician Fee Schedule 

(PFS) or the hospital Outpatient 

prospective payment system (OPPS). As 

a result, for § 414.510, in the CY 2008 

PFS proposed rule (72 FR 38160), we 

proposed to revise the section heading 

and introductory sentence to specify 

that the provision applies to both 

clinical laboratory and pathology 

specimens. We also proposed revising 

§ 415.130(d) to include a reference to 

§ 414.510. 

Comment: Some commenters 

supported our proposal to revise the 

section heading and introductory 

sentence for § 414.510 to specify that the 

provision applies to both clinical 

laboratory and pathology specimens. 

(We also proposed revising § 415.130(d) 

to include a reference to § 414.510.) One 

commenter asked that we clarify 

whether the provision applies to 

pathology tests where the technical 

component and the professional 

component (PC) are performed by the 

same lab and billed globally. 

Response: Concerning one line global 

billing, we would like to point out that 

the TC and the PC of a laboratory test 

should be on separate line items on the 

same claim when two different dates of 

service are involved, even when both 

services are performed by the same 

independent laboratory. One line global 

billing is not appropriate in this 

instance. Program instructions on this 

issue will be forthcoming. 

Comment: One commenter requested 

revisions to our regulations to specify 

that if the clinical laboratory test 

specimen is collected outside the 

hospital by nonhospital personnel, the 

beneficiary qualifies as a nonhospital 

patient. 

Response: We do recognize that the 

determination of whether the 

beneficiary qualifies as an inpatient, 

outpatient, or nonpatient is important 

for payment purposes. However, we do 

not agree that the laboratory date of 

service regulation should be amended to 

address the employment arrangements 

of the personnel performing the 

specimen collection. Furthermore, this 

comment is outside the scope of our 

proposal to broaden the clinical 

laboratory date of service rules we 

adopted last year. 

We continue to believe the date of 

service should relate to clear calendar 

dates for the specimen collection and 

day of discharge from the hospital if the 

specimen was collected while the 

patient was undergoing a hospital 

procedure. 

We are implementing our proposed 

regulation at § 414.510 on the date of 

service of the TC of the physician 

pathology service. 

2. New Clinical Diagnostic Laboratory 

Test (§ 414.508) 

a. Background 

In the CY 2007 PFS final rule with 

comment period (71 FR 69701), we 

adopted a new subpart G under part 414 

that implemented section 942(b) of the 

MMA requiring that we establish 

procedures for determining the basis for, 

and amount of payment for any clinical 

diagnostic laboratory test for which a 

new or substantially revised HCPCS 

code is assigned on or after January 1, 

2005 (‘‘new tests’’). 

Under § 414.508, we use one of two 

bases for payment to establish a 

payment amount for a new test. Under 

§ 414.508(a), the first basis, called 


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‘‘crosswalking,’’ is used if a new test is 

determined to be comparable to an 

existing test, multiple existing test 

codes, or a portion of an existing test 

code. If we use crosswalking, we assign 

to the new test code the local fee 

schedule amount and national 

limitation amount (NLA) of the existing 

test code or codes. If we crosswalk to 

multiple existing test codes, we 

determine the local fee schedule amount 

and NLA based on a blend of payment 

amounts for the existing test codes. The 

second basis for payment is 

‘‘gapfilling.’’ Under § 414.508(b), we use 

gapfilling when no comparable existing 

test is available. We instruct each 

Medicare carrier or MAC to determine a 

carrier-specific amount for use in the 1st 

year that the new code is effective. The 

sources of information that these 

carriers or MACs examine in 

determining carrier-specific amounts 

include: 

• Charges for the test and routine 

discounts to charges; 

• Resources required to perform the 

test; 

• Payment amounts determined by 

other payers; and 

• Charges, payment amounts, and 

resources required for other tests that 

may be comparable (although not 

similar enough to justify crosswalking) 

or otherwise relevant. 

After the first year, the carrier-specific 

amounts are used to calculate the NLA 

for subsequent years. Under 

§ 414.508(b)(2), the test code is paid at 

the NLA, rather than the lesser of the 

NLA and the carrier-specific amounts. 

We instruct our carriers or MACs to 

use the gapfill method through program 

instruction, which lists the specific new 

test code and the timeframes to establish 

carrier-specific amounts. During the first 

year a new test code is paid using the 

gapfill method, contractors are required 

to establish carrier-specific amounts on 

or before March 31. Contractors may 

revise their payment amounts, if 

necessary, on or before September 1. In 

this manner, a carrier or MAC may 

revise its carrier-specific amount based 

on additional information during the 1st 

year. 

In the CY 2007 PFS final rule with 

comment period (71 FR 69702), we also 

described the timeframes for 

determining the amount of and basis for 

payment for new tests. The codes to be 

included in the upcoming year’s fee 

schedule (effective January 1) are 

available as early as May. We then list 

the new clinical laboratory test codes on 

our Web site, usually in June, along 

with registration information for the 

public meeting. 

The public meeting is held no sooner 

than 30 days after we announce the 

meeting in the Federal Register. The 

public meeting is typically held in July. 

In September, we post our proposed 

determination of the basis for payment 

for each new code and seek public 

comment on these proposed 

determinations of the basis for payment. 

The updated clinical laboratory fee 

schedule is prepared in October for 

release to our contractors during the 

first week in November so that the 

updated clinical laboratory fee schedule 

is ready to pay claims effective January 

1 of the following calendar year. 

We received comments in response to 

the CY 2007 PFS proposed rule 

concerning information to be presented 

during the public meeting process. In 

responding to these comments in the CY 

2007 PFS final rule, we stated that we 

did not believe that opportunities for 

information gathering on new tests have 

been fully utilized within the public 

meeting process. Payment 

recommendations from the public have 

sometimes lacked charge, cost, and 

clinically-detailed information for the 

new clinical laboratory tests. We also 

stated that when soliciting public input 

for the meeting we would recommend 

that all participants in the public 

meeting consultation process strive for 

transparency and try to provide as much 

supporting information as possible to 

assist us in evaluating their 

recommendations. 

In addition, in the CY 2007 PFS final 

rule with comment period, in response 

to comments suggesting that the method 

used by contractors to determine their 

price for gapfilled tests should be more 

specific, we indicated that we would 

engage in discussions with our carrier 

contractors and laboratory industry 

representatives to explore their 

experiences with the gapfill process. We 

also agreed to host a forum to listen to 

suggestions from the public and said 

that we expected to solicit comments on 

a potential reconsideration process in a 

future rulemaking. 

As explained in the CY 2008 PFS 

proposed rule, we discussed these 

issues with our contractors. We also 

solicited comments on the gapfill 

process in the July 16, 2007 clinical 

laboratory public meeting. 

Discussions with our contractors and 

other interested parties revealed that the 

length of time we allow for a contractor 

to establish a carrier-specific amount 

may sometimes be insufficient for 

obtaining additional sources and data 

on a new test. However, our contractors 

and other interested parties were also 

concerned that if procedures and 

determinations were permitted to 

extend over too long a time frame, the 

uncertainty of the final payment amount 

would be detrimental for laboratories, 

practitioners, and patients for 

incorporating new technology tests and 

improving patient care. In the CY 2008 

PFS proposed rule, we also encouraged 

the public to submit written comments 

on gapfilling and said that we would 

respond to them to the extent they 

related to a proposal in the rule. 

In the CY 2008 PFS proposed rule, we 

proposed a reconsideration process for 

determining the basis for and amount of 

payment for any new test for which a 

new or substantially revised HCPCS 

code is assigned on or after January 1, 

2008. This proposed change attempted 

to balance additional opportunities for 

public input against the necessity for 

establishing final fees for new clinical 

laboratory test codes. 

Section 1833(h)(8)(A) of the Act 

provides broad authority to develop 

through regulation procedures for the 

method for determining the basis for 

and amount of payment for new tests. 

We believe that we have authority under 

section 1833(h)(8)(A) of the Act to 

establish procedures under which we 

may reconsider the basis for and amount 

of payment for a new test. Furthermore, 

under section 1833(h)(8)(D) of the Act, 

the Secretary may convene such other 

public meetings to receive public 

comments on payment amounts for new 

tests as the Secretary deems appropriate. 

We note that, under both section 

1833(h)(8)(B)(v) of the Act and 

§ 414.506(d)(2), the Secretary must make 

available to the public a list of ‘‘final 

determinations.’’ We do not believe that 

these provisions preclude us from 

reconsidering our final determinations. 

It is not unusual for us to provide for 

discretionary reopening or 

reconsideration of final agency action. It 

is not unusual for us to provide for 

discretionary reopening or 

reconsideration of final agency action. 

For example, under § 405.1885, we may 

reopen a final agency determination 

regarding payment to a provider of 

services. 

Comment: Commenters were 

supportive of our proposal to add 

§ 414.509 concerning a reconsideration 

process for new lab test payment 

determinations. Generally, commenters 

believed that in contrast to several other 

payment systems, which have been 

significantly revised in the last several 

years, the procedures for operating the 

clinical laboratory fee schedule have 

remained relatively static. They further 

commented that the implementation of 

a reconsideration process would be a 

significant step in helping assure 

reasonable pricing decisions for new 


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tests, and they commended us for our 

actions in this regard. 

Response: We appreciate the support 

for our proposal for a reconsideration 

process for new lab test payment 

determinations. We believe this 

additional opportunity to revisit 

payment determinations for clinical 

laboratory test codes will foster accurate 

payment levels for new tests. We will 

discuss specific suggestions for 

revisions to § 414.509 below in this 

section. 

b. Basis for Payment 

Under our existing procedures for 

determining the basis for payment of a 

new test, either to crosswalk or gapfill, 

we receive comments on the appropriate 

basis for payment for a new test both at 

the public meeting in July and after we 

announce our proposed determinations 

in September. In November, we post our 

determination on the basis for payment 

for the new test on the CMS Web site. 

This determination of the basis for 

payment is final, except in the case of 

a gapfilled test for which we later 

determine that gapfilling is not 

appropriate under § 414.508(b)(3). 

In the CY 2008 PFS proposed rule, we 

proposed to create a reconsideration 

process for determinations of the basis, 

either crosswalking or gapfilling, for 

payment of a new clinical diagnostic 

laboratory test. Consistent with our 

existing process, we would make a 

determination using the information 

gathered from the public meeting 

process and post a determination of the 

basis for payment, either to crosswalk or 

gapfill, on the CMS Web site, likely in 

September. We would accept written 

comments asking for a reconsideration 

on this basis determination for 30 days 

after we posted the determination on the 

CMS Web site. If a commenter 

recommended that we switch from 

gapfilling to crosswalking for a new 

code, the commenter would also have 

the opportunity to recommend the code 

or codes to which to crosswalk the new 

test code. Under § 414.508, claims 

would be paid using this basis to 

calculate fees beginning January 1. 

After considering the comments 

received and the information from the 

public meeting, we would post our 

decision on our Web site as to whether 

we elect to reconsider our determination 

of the basis for payment. If we elect to 

reconsider the basis for payment (that is, 

whether to crosswalk or gapfill a test), 

we would post our determination as to 

whether we would change the basis for 

payment on the CMS Web site. Our 

decision regarding the basis for payment 

would be final and not subject to further 

reconsideration. 

If we change our prior determination 

of the basis for payment, the new 

determination would be effective on 

January 1. We would not reopen or 

otherwise reprocess claims with dates of 

service prior to the effective date of the 

revised determination. 

We note that, under our proposed 

reconsideration processes (for both the 

basis for payment and amount of 

payment) we would make two separate 

decisions. First, we would decide 

whether to reconsider our prior 

determination. If we elect to reconsider 

our prior determination, we would then 

determine whether we should change 

our prior determination. 

Comment: One commenter suggested 

that the agenda for the public meeting 

should announce a list of requests 

received by CMS to reconsider the basis 

for and amount of payment for a new 

clinical laboratory test, and the agenda 

should invite comment, either written 

or orally, on the requests. The 

commenter stated that in this way, we 

will receive views on the validity of the 

requests for reconsideration. Another 

commenter indicated that more than 

one public meeting per year should be 

hosted by CMS to discuss comments 

under the reconsideration process, as 

well as the payment determination 

process. 

Response: We are receptive to 

suggestions on providing information 

about the public meeting agenda. We do 

not believe a revision to the regulatory 

text at subpart of § 414.509(a) is 

required in order to disseminate 

information on our meetings. We 

publish a public meeting notice in the 

Federal Register to announce the 

meeting. The notice includes many 

details about the purpose and 

registration process for the meeting and 

also refers to additional Web site 

information for the meeting. If we 

receive a request to reconsider the basis 

of payment for a new test within the 60- 

day window after we post our basis of 

payment on the CMS Web site, the 

requestor could also request to present 

his or her comment orally at the next 

clinical laboratory public meeting. We 

can include this information in the 

meeting agenda that will be posted on 

the CMS Web site. Members of the 

public who are interested in addressing 

a particular reconsideration request at 

the laboratory public meeting can let us 

know of their interest in doing so after 

they review the reconsideration requests 

that will be addressed at the laboratory 

public meeting. In addition, we will 

accept written comments on the 

reconsideration request after the public 

meeting. We will accept written 

comments during the same time period 

we set for accepting other comments 

after the clinical laboratory public 

meeting—usually 2 weeks. We note that, 

if the party that submitted the 

reconsideration request does not choose 

to present at the public meeting, 

members of the public may not 

comment on the reconsideration request 

and we will not accept written 

comments. 

However, hosting more than one 

public meeting per year is a timing issue 

which is limited by the constraints of 

the process. Currently, there is a limited 

amount of time between the receipt of 

the new test codes for the upcoming 

year and the deadline to issue them via 

CMS instruction; therefore, we cannot 

accommodate two public meetings in a 

year. As a result, we are finalizing 

§ 414.509(a) with revisions to specify 

that other commenters may speak about 

reconsideration requests on the 

laboratory public meeting agenda and 

that we will accept written comments 

on reconsideration requests addressed at 

the public meeting. 

c. Amount of Payment 

i. Crosswalking 

Under our existing procedures, 

commenters recommend the code or 

codes to which to crosswalk a new 

clinical laboratory test both at the public 

meeting in July and during the comment 

period after we issue our proposed 

determination in September. We 

consider the appropriate basis for 

payment and the amount of payment at 

the same time. Therefore, commenters 

that recommend crosswalking as the 

basis for payment for a new test also 

make recommendations concerning the 

code or codes to which to crosswalk the 

new test. In November, we post the code 

or codes to which we will crosswalk the 

test and the payment amount for the test 

on the CMS Web site. This 

determination is final. 

In the CY 2008 PFS proposed rule (72 

FR 38162), we proposed to create a 

reconsideration process under which we 

may reevaluate the code or codes and 

their corresponding fees to which we 

crosswalk a new test’s fees. We would 

accept reconsideration requests and 

written comments on the crosswalked 

code or codes and the resulting amount 

of payment for the new code for 60 days 

after we posted the determination on the 

CMS Web site, sometime in November. 

In addition, we proposed that a 

commenter who had submitted a 

written comment within the 60-day 

comment period would also be given 

the opportunity to present its comment 

at the public meeting. After considering 

the comments received and the 


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information of the public meeting, we 

would post our decision as to whether 

we had elected to reconsider our 

determination of the crosswalked code 

or codes and the resulting amount of 

payment on the CMS Web site. If we 

elect to reconsider the amount of 

payment and had determined that we 

should revise the amount of payment, 

we would post a new determination of 

the code or codes to which we would 

crosswalk the test on the CMS Web site. 

We proposed that, after we posted our 

determination of the code or codes to 

which the test would be crosswalked on 

the CMS Web site, we would pay claims 

on the basis of this determination 

beginning January 1. Our decision 

regarding the amount of payment would 

be final and not subject to further 

reconsideration. 

If we change our prior determination 

of the amount of payment, the new 

determination would be effective 

January 1. We would not reopen or 

otherwise reprocess claims with dates of 

service prior to the effective date of the 

revised determination. 

As discussed in section II.G.2.b., we 

may also change the basis for payment 

for a new test as the result of 

reconsideration. If we change the basis 

for payment from gapfilling to 

crosswalking, we would also determine 

the code or codes to which we would 

crosswalk the test. Because we believe 

it is important to establish final 

payment amounts within a reasonable 

amount of time, we also proposed that 

these determinations of crosswalked 

payment amounts would not be subject 

to reconsideration. 

Comment: Some commenters 

indicated that § 414.509(b)(1) should 

establish payment amounts at the 

national limitation amount (NLA) of the 

tests to which the new tests are 

crosswalked. The NLA should replace 

carrier-specific amounts below the NLA 

for new tests. The commenters believe 

that if the amount of payment is lower 

than the NLA in a carrier’s geographic 

area, patient access to a new test will be 

limited in the geographic area. 

Response: In the CY 2008 PFS 

proposed rule, we did not make policy 

proposals regarding the level of 

payment for crosswalked tests. Rather, 

our policy proposals were limited to the 

reconsideration process. Accordingly, 

we believe that this comment is outside 

of the scope of this rulemaking 

Comment: One commenter suggested 

that a similar reconsideration process 

should also be available for existing 

laboratory tests. The commenter pointed 

out that the payment amounts 

determined for certain laboratory tests 

by one or another Medicare carrier or 

MAC now differ from the payment 

amounts determined for these same tests 

by other Medicare contractors and from 

the corresponding NLA. 

Response: Section 1833(h)(1) of the 

Act sets forth the calculation of the 

payment amounts for test codes 

included on the clinical laboratory fee 

schedule to be the lower of the charge 

submitted, the carrier-specific amount, 

or the NLA. We believe changes to 

payment amounts for tests that are not 

‘‘new tests’’ under section 1833(h)(8)(A) 

of the Act would require a statutory 

change. 

Comment: One commenter 

recommended that CMS clarify how fee 

schedule amounts below the NLA will 

be adjusted as carriers are phased out 

and their functions are moved to MACs. 

Response: This comment is outside 

the scope of our proposal. If necessary 

we may address this comment in a 

future program memorandum. 

We are finalizing § 414.509(b)(1). 

Consistent with the revisions we made 

to § 414.509(a), we are revising 

§ 414.509(b)(1) to provide that other 

commenters may speak about 

reconsideration requests on the lab 

public meeting agenda and that we will 

accept written comments on 

reconsideration requests addressed at 

the public meeting. 

ii. Gapfilling 

As discussed in this preamble and in 

accordance with § 414.508(b), after we 

determine that gapfilling will be the 

basis for payment for a new clinical 

diagnostic laboratory test, we instruct 

our carriers or MACs to determine 

carrier-specific gapfill amounts by April 

1 and finalize carrier-specific amounts 

by September 30. We include the 

determinations of carrier-specific 

amounts and the NLA for the new test 

code in the clinical laboratory fee 

schedule the following November when 

we post our payment determinations on 

the CMS Web site. Except in the case of 

a gapfilled test for which we determine 

that gapfilling was not appropriate 

under § 414.508(b)(3), these 

determinations are final. 

We proposed to provide for a 

reconsideration process for gapfilled 

payment amounts. Under this process, 

by April 30, we would post the carrierspecific amounts on the CMS Web site 

at http://www.cms.hhs.gov/ 

ClinicalLabFeeSched/02_clinlab.asp. 

Interested parties would submit 

written comments to CMS (which we 

would provide to the carriers for their 

consideration) on the carrier-specific 

amounts within 60 days from the date 

of posting the carrier-specific amounts. 

In the CY 2008 PFS proposed rule, we 

stated that carriers or MACs would 

finalize carrier-specific amounts by 

September 30 and that we would set the 

NLA at the median of the carrierspecific amounts, and we would post 

the carrier-specific amounts and the 

NLA on our Web site. In addition, we 

stated that the public would have 60 

days to submit a reconsideration 

request. 

We also proposed that if we elect to 

act on the reconsideration request to 

reconsider the carrier-specific amounts 

and decide to revise our prior 

determination, we would adjust the 

NLA based on comments received. We 

would post the revised NLA on the CMS 

Web site and payment for the test would 

be made at the NLA beginning January 

1. This determination would be final 

and not subject to further 

reconsideration. 

In addition we proposed that, if we 

change the basis of payment from 

crosswalking to gapfilling as the result 

of a reconsideration, the new gapfilled 

payment amount would be subject to 

reconsideration under proposed 

§ 414.509(b)(2). Unlike a crosswalked 

test, the payment amount for a gapfilled 

test is not established when we 

determine the basis for payment because 

it takes approximately 9 months for our 

contractors to establish carrier-specific 

amounts. Thus providing for 

reconsideration of gapfilled payment 

amounts would not lengthen the period 

of time it would take to determine a 

final payment amount. 

We proposed to amend § 414.508(b)(3) 

to provide that § 414.508(b)(3) applies to 

new tests for which a new or 

substantially revised HCPCS code 

assigned on or before December 31, 

2007. We proposed that the more 

comprehensive reconsideration 

procedures would apply to new or 

substantially revised HCPCS codes 

assigned after December 31, 2007. 

Comment: One commenter suggested 

that we should accept comments after 

the carrier-specific amounts become 

final, which is currently on September 

30. 

Response: We appreciate this 

commenter’s input. We have decided to 

revise the reconsideration process that 

we proposed. Under the final policy we 

are adopting in this final rule with 

comment period, we will post interim 

determinations of carrier-specific 

amounts on the CMS Web site in April 

and, for 60 days, we will accept written 

comments that we will share with our 

carriers and MACs. However, we will 

not accept reconsideration requests on 

the interim carrier-specific amounts. In 

September, we will post final carrierVerDate Aug<31>2005 16:01 Nov 26, 2007 Jkt 214001 PO 00000 Frm 00058 Fmt 4701 Sfmt 4700 E:\FR\FM\27NOR2.SGM 27NOR2

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specific amounts on the CMS Web site. 

Interested parties may request 

reconsideration of the final carrierspecific amounts within 30 days of 

when we post the final carrier-specific 

amounts on the CMS Web site. Based on 

the written reconsideration requests 

received, we would evaluate whether 

we should reconsider the carrierspecific amounts and NLA. 

If we elect to reconsider the carrierspecific amounts and the NLA, we will 

process the request for reconsideration 

between the end of the 30-day comment 

period and the deadline for 

dissemination of the information to the 

Medicare carriers or MACs via CMS 

instruction so that we can finalize our 

determinations prior to January 1. A 

request for reconsideration can be 

denied or reconsidered for a different 

payment amount. 

If we elect not to reconsider the 

carrier-specific amounts and the NLA, 

we will post the carrier-specific 

amounts and NLA on the CMS Web site 

on or before January 1. These amounts 

would be based on the carrier-specific 

amounts and NLA we had posted in 

September. Payment for the test would 

be made at the NLA on January 1. This 

determination would be final and not 

subject to further reconsideration. 

In addition, after the final test codes 

and payment amounts are effective on 

January 1, there is no reconsideration 

process that occurs after that date. 

Comment: One commenter suggested 

that CMS provide a rationale for either 

accepting or declining a reconsideration 

after it is received and for deciding 

whether to change a prior 

determination. 

Response: We do not plan to post a 

rationale for our decision to accept or 

decline a reconsideration request. This 

is consistent with our policy in other 

areas of the Medicare program when we 

make a decision about whether to 

reopen a previous decision. 

Comment: One commenter suggested 

that we should convene an expert 

advisory committee, broadly 

representative of the laboratory 

industry, to advise CMS on pricing 

along with standardizing the sources 

and quality of charge and cost data. 

Response: The purpose of the Clinical 

Laboratory public meeting is to convene 

industry experts and entertain 

comments, both orally and in writing, as 

well as any charge and cost data that is 

available from the industry. In fact, we 

specifically asked, via public notice, 

those in the clinical laboratory industry 

to provide charge and cost data related 

to the agenda items at the annual public 

meeting. We welcome any related 

information that industry 

representatives would like to provide 

via the public meeting forum and during 

the associated comment period. 

Comment: There were specific 

concerns raised by commenters 

regarding varying payment amounts set 

by carriers when the gapfilling basis is 

utilized to determine payment amounts 

for a new test code. These commenters 

recommended that we establish formal 

procedures for carriers or MACs to 

apply when establishing payment 

amounts, including a formal appeals 

process. The commenters stated the 

payment amounts should be calculated 

using information on the following 

factors, resources needed to perform the 

test, staff expertise, time needed to 

perform the test and the test’s potential 

value. In addition, the commenters 

suggested we should publish the gapfill 

payment amounts determined by 

carriers or MACs and an explanation of 

the payment amounts. 

Response: Although we appreciate the 

comments on the establishment of 

payment amounts for new clinical 

laboratory test codes using the gapfill 

basis and the suggested improvements 

to the way we set rates, these comments 

are outside the scope of this rulemaking. 

In the CY 2008 PFS proposed rule, we 

proposed policies and requested 

comment regarding our proposed 

reconsideration process. We made no 

policy proposals with respect to the 

methodology our contractors use to 

establish gapfilled payment amounts. 

However, in the interest of transparency 

we will instruct carriers or MACs to 

provide a rationale for their final carrierspecific amounts, which we will post on 

our Web site. 

Comment: One commenter suggested 

that we should establish a temporary 

NLA based on the carrier-specific 

amounts posted on April 30 within the 

first year of the gapfill process. 

Response: We appreciate the 

commenter’s suggestion; however, we 

are concerned that establishing a 

temporary NLA within a 3 month time 

period is not possible due to our 

substantial program requirements each 

year. Currently, clinical laboratory fee 

schedule payment rates are established 

on a calendar year basis. During the year 

preceding each January 1, an extensive 

multi-step process is in place in order 

to bring those payment rates to fruition. 

Currently, that process does not allow 

for additional ratesetting procedures. 

d. Jurisdiction for Reconsideration 

Decisions 

In the CY 2008 PFS proposed rule (72 

FR 38163), we proposed that 

jurisdiction for reconsideration would 

rest exclusively with the Secretary. A 

decision whether to reconsider a 

determination would be committed to 

the discretion of the Secretary. 

Accordingly, a refusal to reconsider an 

initial determination would not be 

subject to administrative or judicial 

review. We recognize that parties 

dissatisfied with an initial 

determination as to the amount of 

payment for a particular claim for 

laboratory services may appeal the 

initial determination under part 405, 

subpart I of our regulations. Under our 

proposal, a party could challenge under 

part 405, subpart I a determination 

regarding the amount of payment for a 

new test—regardless of whether the 

amount of payment was established as 

the result of a reconsideration—but a 

party could not challenge a decision not 

to reconsider. 

Comment: One commenter stated that 

comments should be allowed on the 

final payment determination amounts. 

Response: This comment appears to 

request an extension of the 

reconsideration process or a change in 

the jurisdiction as proposed in 

§ 414.509. The commenter did not 

provide additional information on the 

circumstances that would warrant an 

extension of the reconsideration 

process. Also, the comment did not 

specify the length of time for an 

extension or procedures for an 

extension or change of jurisdiction. We 

believe § 414.506 through § 414.509 

permit adequate opportunities for 

public participation in the process of 

establishing a payment amount and 

requesting a reconsideration. More than 

2 years can elapse if all steps of these 

reconsideration procedures are 

necessary for the establishment of the 

basis and payment for a new test code. 

We do not agree that revisions to 

§ 414.509(d) are warranted. 

3. Technical Revisions 

We also proposed technical revisions 

to § 414.502, § 414.506, and § 414.508. 

Under section 1833(h)(8)(A) of the Act, 

the term ‘‘new tests’’ is defined as any 

clinical diagnostic laboratory test for 

which a new or substantially revised 

HCPCS code is assigned on or after 

January 1, 2005. However, our 

regulations do not define the term ‘‘new 

test.’’ Therefore, we proposed to define 

the term ‘‘new test’’ under § 414.502 

using the statutory definition. In 

addition, under § 414.506 and § 414.508, 

we proposed to replace references to 

‘‘new clinical diagnostic laboratory test 

that is assigned a new or substantially 

revised code on or after January 1, 

2005’’ with references to ‘‘new test.’’

Response: We received one 

supportive comment on this subpart, 


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and we appreciate the positive input 

received on our technical revisions. 

Therefore, we are finalizing the 

technical revisions as proposed. 

H. Revisions Related to Payment for 

Renal Dialysis Services Furnished by 

End-Stage Renal Disease (ESRD) 

Facilities 

In the CY 2008 PFS proposed rule (72 

FR 38163), we outlined the proposed 

updates to the case mix adjusted 

composite rate payment system 

established under section 1881(b)(12) of 

the Act, added by section 623 of the 

MMA. These included updates to the 

drug add-on component of the 

composite rate system, as well as the 

wage index values used to adjust the 

labor component of the composite rate. 

Specifically, we proposed the 

following provisions which are 

described in more detail below in this 

section. 

• A growth update to the drug add-on 

adjustment to the composite rates for 

2008 required by section 1881(b)(12)(F) 

of the Act. 

• An update to the wage index 

adjustments to reflect the latest hospital 

wage data, including a reduction to the 

wage index floor and a revised budget 

neutrality adjustment to the wage index 

for 2008. 

We received approximately 7 

comments on these proposed changes 

which are discussed in detail below in 

this section. 

1. Growth Update to the Drug Add-On 

Adjustment to the Composite Rates 

Section 623(d) of the MMA added 

section 1881(b)(12)(B)(ii) of the Act 

which required the establishment of an 

add-on to the composite rate to account 

for changes in the drug payment 

methodology stemming from enactment 

of the MMA. Section 1881(b)(12)(C) of 

the Act provides that the drug add-on 

must reflect the difference in aggregate 

payments between the revised drug 

payment methodology for separately 

billable ESRD drugs and the AWP 

payment methodology. In 2005, we 

generally paid for ESRD drugs based on 

average acquisition costs. Thus the 

difference from AWP pricing was 

calculated using acquisition costs. 

However, in 2006 when we moved to 

ASP pricing for ESRD drugs, we 

recalculated the difference from AWP 

pricing using ASP prices. 

Comment: Two commenters 

supported our continued use of ASP+6 

percent to pay for separately billable 

ESRD drugs. 

Response: Although these comments 

are outside the scope of the proposed 

rule, we appreciate the support of our 

previous decision to pay for separately 

billable ESRD drugs at ASP+6 percent. 

In addition, section 1881(b)(12)(F) of 

the Act requires that beginning in CY 

2006, we establish an annual update to 

the drug add-on to reflect the estimated 

growth in expenditures for separately 

billable drugs and biologicals furnished 

by ESRD facilities. This growth update 

applies only to the drug add-on portion 

of the case-mix adjusted payment 

system. 

The CY 2007 drug add-on adjustment 

to the composite rate is 14.9 percent. 

The drug add-on adjustment for 2007 

incorporates an inflation adjustment of 

0.5 percent. This computation is 

explained in detail in the CY 2007 PFS 

final rule with comment period (71 FR 

69682 through 69684). We note that the 

drug add-on adjustment of 15.1 percent 

that was published in the CY 2007 PFS 

final rule with comment period did not 

account for the 1.6 percent update to the 

composite rate portion of the basic casemix adjustment payment system that 

was subsequently enacted by the MIEA–

TRHCA, effective April 1, 2007. Since 

we compute the drug add-on adjustment 

as a percentage of the weighted average 

base composite rate, the drug add-on 

percentage was decreased to account for 

the higher composite payment rate 

resulting in a 14.9 percent add-on 

adjustment beginning April 1, 2007. 

This adjustment was necessary to 

ensure that the total drug add-on dollars 

remain constant. 

(a) Estimating Growth in Expenditures 

for Drugs and Biologicals for CY 2008 

In the CY 2007 PFS final rule with 

comment period (71 FR 69682), we 

established a methodology for annually 

estimating the growth in ESRD drugs 

and biological expenditures that uses 

the Producer Price Index (PPI) for 

pharmaceuticals as a proxy for pricing 

growth in conjunction with 2 years of 

ESRD drug data to estimate per patient 

utilization growth. 

For CY 2008, we proposed to continue 

using this methodology to update the 

drug add-on adjustment, using 

expenditure data from CY 2005 and CY 

2006 to estimate the growth in per 

patient utilization of drugs. However, 

we also proposed using only drug 

expenditure data from independent 

ESRD facilities because we were unable 

to determine utilization change in 

hospital-based dialysis facilities due to 

the changes in payment methodology 

for these types of dialysis facilities from 

CY 2005 to CY 2006. In 2005, payments 

to hospital-based facilities were based 

on cost (or a percentage of charges), 

whereas payments to those facilities in 

2006 were based on ASP pricing. 

Because of the cost payment 

methodology, the ‘‘drug unit’’ fields on 

the 2005 hospital-based ESRD facility 

bills were not used for payment 

purposes, and therefore, the data may 

not have been accurately reported on 

those bills. As such, we were unable to 

accurately isolate the per unit payment 

differential for hospital-based ESRD 

facility drug expenditures between 2005 

(cost payments) and 2006 (ASP 

payments) for purposes of estimating 

the residual utilization change between 

years. We proposed imputing the same 

utilization growth for hospital-based 

ESRD facilities as estimated for 

independent ESRD facilities. 

Comment: One comment urged us to 

reevaluate the data and methodology 

used to estimate utilization changes. 

The comment was specifically 

concerned about the timeliness of the 

data and that the exclusion of hospitalbased drug data may significantly skew 

the accuracy of the utilization growth 

calculation. However, the comment did 

not suggest an alternative methodology. 

Response: The data from CY 2005 and 

CY 2006 represent the most up to date 

and latest full years of data available. 

Contrary to the commenter’s suggestion, 

as we indicated in the CY 2008 PFS 

proposed rule, including hospital-based 

data in the computation would have 

resulted in a negative utilization growth. 

Therefore, we opted to exclude those 

data to avoid penalizing ESRD facilities 

because of the problems with the 

hospital-based ESRD facility drug data. 

We believe our approach provides the 

most reasonable result given the 

available data. 

Comment: One comment suggested 

that we adopt an index that would 

account for both price and utilization 

such as the National Health 

Expenditures (NHE) index. This would 

avoid the data issues associated with 

estimating utilization growth. 

Response: We do not believe that the 

NHE projections would be the best 

proxy for growth in ESRD drug 

expenditures. The NHE projections are 

based on the economic, demographic 

and Medicare spending projections 

contained in the Medicare Trustees 

Report as opposed to an independent 

forecast of economic assumptions, such 

as the Global Insights projections of the 

PPI for prescription drugs that are used 

in our Medicare market basket forecasts 

to update many of our payment systems. 

The NHE projection modeling approach 

is at an aggregate level and does not 

capture the nuances of both labor and 

economic markets as accurately as does 

the specific PPI forecast. We believe 

that, despite some of the limitations in 

the data, estimating utilization growth 


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from reported ESRD claims data 

provides the most accurate measure of 

actual ESRD facility drug utilization. 

Comment: One comment suggested 

that the PPI may not result in an 

accurate assessment of prices for ESRD 

drugs and that there are other available 

indices that would provide more 

accurate data on ESRD drugs. In 

addition, they stated that should we 

choose to move forward with the PPI, 

the most up to date PPI forecast should 

be used. 

Response: We do not know of any 

better price index than the PPI for 

measuring price growth for ESRD drugs. 

However, we welcome any suggestion 

the industry may have on an alternative 

price index suitable for measuring price 

growth of ESRD drugs. Global Insight, 

Inc. is a nationally recognized economic 

and financial forecasting firm that 

contracts with CMS to forecast the 

components of our market baskets. The 

current projection of the PPI for 

prescription drugs is based on the 2007 

second quarter forecast using historical 

data through the first quarter of 2007, 

the most current data available at this 

time. 

Comment: One comment 

recommended that a mechanism be 

established to provide for a forecasting 

error adjustment of prior estimates. 

Response: While we appreciate the 

concern related to the accuracy of an 

update based on proxy measures for 

price and the proposed utilization 

computations, the very nature of 

estimating future expenditures under a 

prospective payment system requires 

that those estimates are based on the 

best historical data available. As such, 

we believe we have met our obligation 

under the statute in estimating growth 

in ESRD drug expenditures for CY 2008. 

Moreover, forecast error adjustments are 

rarely made in our prospective payment 

systems. 

(b) Estimating Growth in Per Patient 

Drug Utilization 

To isolate and project the growth in 

per patient utilization of ESRD drugs for 

CY 2008, we removed the enrollment 

and price growth components from the 

historical data and considered the 

residual to be utilization growth. As 

discussed previously, we proposed to 

use independent ESRD facility drug 

expenditure data from CY 2005 and CY 

2006 to estimate per patient utilization 

growth for CY 2008. 

We first estimated total drug 

expenditures. For the CY 2008 PFS 

proposed rule (72 FR 38165), we used 

the final CY 2005 ESRD facility claims 

data and the latest available CY 2006 

ESRD facility claims data, updated 

through December 31, 2006. That is, for 

CY 2006 we used claims that were 

received, processed, paid, and passed to 

the National Claims History File as of 

December 31, 2006. For this final rule 

with comment period, we are using 

more updated CY 2006 claims with 

dates of service for the same time 

period. This updated CY 2006 data file 

includes all claims that were received, 

processed, paid, and passed to the 

National Claims History File as of June 

30, 2007 for CY 2006. 

For the CY 2008 PFS proposed rule, 

we adjusted the December 2006 file to 

reflect our estimate of what total drug 

expenditures would be using the final 

June 30, 2007 bill file for CY 2006. The 

net adjustment we applied to the CY 

2006 claims data was an increase of 12 

percent to the December 2006 claims 

file. For this final rule with comment 

period, we are using the CY 2006 claims 

file as of June 30, 2007, which 

represents the final claims file for that 

year. To calculate the proposed per 

patient utilization growth, we removed 

the enrollment component by using the 

growth in enrollment data between 2005 

and 2006. This was approximately 3 

percent. To remove the price effect, we 

calculated the weighted difference 

between 2005 average acquisition price 

(AAP) and 2006 ASP pricing for the 

original top ten drugs for which we had 

average acquisition prices. We weighted 

the differences by the 2006 independent 

ESRD facility drug expenditure data. 

This process led to an overall 3 percent 

reduction in price between 2005 and 

2006 (72 FR 38165 through 38166). 

After removing the enrollment and 

price effects from the expenditure data, 

the residual growth would reflect the 

per patient utilization growth. To do 

this, we divided the product of the 

enrollment growth of 3 percent (1.03) 

and the price reduction of 3 percent 

(1.00 ¥ 0.03 = 0.97) into the total drug 

expenditure change between 2005 and 

2006 of ¥0.2 percent (1.00 ¥0.00 = 

1.00). The result is a proposed 

utilization growth factor equal to 1.00 

(1.00/1.03 * 0.97) = 1.00. 

Since we observed no growth in per 

patient utilization of drugs between 

2005 and 2006, we proposed no 

projected growth in per patient 

utilization for all ESRD facilities for CY 

2008. 

c. Applying the Proposed Growth 

Update to the Drug Add-On Adjustment 

In the CY 2007 PFS final rule with 

comment period (71 FR 69684), we 

revised our update methodology by 

applying the growth update to the per 

treatment drug add-on amount. That is, 

for CY 2007, we applied the growth 

update factor of 4.03 percent to the 

$18.88 per treatment drug add-on 

amount for an updated amount of 

$19.64 per treatment. 

For CY 2008, we proposed to update 

the per treatment drug add-on amount 

of $19.64 established in CY 2007 by 

converting the update into an 

adjustment factor as specified in section 

1881(b)(12)(F) of the Act. 

(i) Update to the Drug Add-On 

Adjustment 

In the CY 2008 PFS proposed rule (72 

FR 38166), we estimated no growth in 

per patient utilization of ESRD drugs for 

CY 2008. Using the projected growth of 

the CY 2008 PPI for prescription drugs 

of 3.66 percent, we projected that the 

combined growth in per patient 

utilization and pricing for CY 2008 

would result in an update equal to the 

PPI growth, or 3.66 percent (1.0 * 1.0366 

= 1.0366). This proposed update factor 

was applied to the CY 2007 per 

treatment drug add-on amount of $19.64 

(reflecting a 14.9 percent adjustment in 

CY 2007), resulting in a proposed 

weighted average increase to the 

composite rate of $0.72 for CY 2008 or 

a 0.5 percent increase in the drug addon percentage. Thus, the total proposed 

drug add-on adjustment to the 

composite rate for CY 2008, including 

the growth update was 15.5 percent 

(1.149 * 1.005 = 1.155). 

In addition, we proposed to continue 

to use this method to estimate the 

growth update to the drug add-on 

component of the case mix adjusted 

payment system until we have at least 

3 years worth of ASP-based historical 

drug expenditure data that could be 

used to conduct a trend analysis to 

estimate the growth in drug 

expenditures. Given the time lag in the 

availability of ASP drug expenditure 

data, we expect that the earliest we 

could consider using trend analysis to 

update the drug add-on adjustment 

would be 2010. We intend to reevaluate 

our methodology for estimating the 

growth update at that time. 

Comment: One comment suggested 

that we should work with the kidney 

care community as we consider a CY 

2010 transition to trend analysis using 

ASP-based historical data. The comment 

expressed concern that using actual 

historical ESRD drug expenditure data 

reflecting ASP pricing could adversely 

affect ESRD facilities due to changes in 

ASP pricing for EPO and Procrit. 

Response: Once we begin using trend 

analysis to update the drug add-on 

adjustment, we will provide details of 

that methodology in future rulemaking. 


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66282 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

(ii) Final Growth Update to the Drug 

Add-On Adjustment for 2008 

Similar to the proposed rule, we 

estimated no growth in per patient 

utilization of ESRD drugs for CY 2008. 

To remove the price effect, we used 

2006 weights for each of the top ten 

ESRD drugs billed by independent 

ESRD facilities. These weights are 

shown in Table 6. 

TABLE 6.—CY 2006 DRUG WEIGHTS

FOR INDEPENDENT FACILITIES

Independent drugs 

2006 

weights 

(percent) 

EPO .......................................... 75.2 

Paricalcitol ................................ 11.6 

Sodium_ferric_glut .................... 2.9 

Iron_sucrose ............................. 5.7 

Levocarnitine ............................ 0.3 

Doxercalciferol .......................... 3.1 

Calcitriol .................................... 0.1 

Iron_dextran .............................. 0.0 

Vancomycin .............................. 0.1 

Alteplase ................................... 0.9 

We removed the enrollment and price 

effects from the independent ESRD 

facility expenditure data to determine 

the per patient utilization growth. To do 

this we divided the product of the 

enrollment growth of 3 percent (1.03) 

and the price reduction of 3 percent 

(1.00¥0.03 = 0.97) into the total drug 

expenditure change between 2005 and 

2006 of ¥0.1 percent (1.00¥0.00 = 

1.00). The result is a utilization growth 

factor equal to 1.00 (1.00/1.03 * 0.97) = 

1.00. 

Using the latest projected growth of 

the CY 2008 PPI for prescription drugs 

of 3.5 percent, we project that the 

combined growth in per patient 

utilization and pricing of ESRD drugs 

for CY 2008 would result in an update 

equal to the PPI growth or 3.5 percent 

(1.00 * 1.035 = 1.035). This update 

factor was applied to the CY 2007 

average per treatment drug add-on 

amount of $19.64 (reflecting a 14.9 

percent adjustment for CY 2007), 

resulting in a weighted average increase 

to the composite rate of $0.69 for CY 

2008 or a 0.5 percent increase in the 

drug add-on percentage for CY 2008. 

Thus, the total drug add-on adjustment 

to the composite rate for CY 2008, 

including the growth update is 15.5 

percent (1.149 * 1.005 = 1.155). 

2. Update to the Geographic Adjustment 

to the Composite Rates 

Section 1881(b)(12)(D) of the Act, as 

added by section 623(d) of the MMA, 

gives the Secretary the authority to 

revise the wage indexes previously 

applied to the ESRD composite rates. 

The wage index values are calculated 

for each urban and rural area. The 

purpose of the wage index is to adjust 

the composite rates for differing wage 

levels covering the areas in which ESRD 

facilities are located. 

(a) Updates to Core-Based Statistical 

Area (CBSA) Definitions 

In the CY 2008 PFS proposed rule (72 

FR 38166), we clarified that this and all 

subsequent ESRD rules and notices are 

considered to incorporate the CBSA 

changes published in the most recent 

OMB bulletin that applies to the 

hospital wage data used to determine 

the current ESRD wage index. The OMB 

bulletins may be accessed online at 

http://www.whitehouse.gov/omb/ 

bulletins/index.html. 

(b) Updated Wage Index Values 

In the CY 2006 PFS final rule with 

comment period (70 FR 70167), we 

described that methodology for 

calculating the CY 2006 wage index 

values and stated that we intend to 

update the ESRD wage index values 

annually. Current wage index values for 

CY 2007 were developed from FY 2003 

wage and employment data obtained 

from the Medicare hospital cost reports. 

The ESRD wage index values are 

calculated without regard to geographic 

reclassifications authorized under 

sections 1886(d)(8) and (d)(10) of the 

Act and utilize pre-floor hospital data 

that is unadjusted for occupational mix. 

We proposed to use the same 

methodology for CY 2008 (72 FR 38167), 

with the exception that FY 2004 

hospital data will be used to develop the 

CY 2008 ESRD wage index values. For 

a detailed description of the 

development of the CY 2008 wage index 

values based on FY 2004 hospital data, 

see the FY 2008 IPPS final rule entitled 

‘‘Changes to the Hospital Inpatient 

Prospective Payment Systems and Fiscal 

Year 2008 Rates’’ (72 FR 47320). Section 

G of the preamble to that final rule 

describes the cost report schedules, line 

items, data elements, adjustments, and 

wage index computations. The wage 

index data affecting ESRD composite 

rates for each urban and rural locale 

may also be accessed on the CMS Web 

site at http://www.cms.hhs.gov/ 

AcuteInpatientPPS/WIFN/list.asp. The 

wage data are located in the section 

entitled ‘‘FY 2008 Final Rule 

Occupational Mix Adjusted and 

Unadjusted Average Hourly Wage and 

Pre-Reclassified Wage Index by CBSA.’’

Comment: One commenter expressed 

concern in regard to our use of acute 

care hospital wage data in the 

calculation of the wage index stating 

that the cost for hospital based facilities 

and ambulatory centers varies greatly. 

The commenter urged us to locate an 

alternative data source that reflects 

information directly tied to ESRD 

facilities. 

Response: At the present time, data 

that is specific to independent dialysis 

facilities is not available upon which to 

base the wage index. As described in the 

CY 2007 PFS final rule with comment 

period (71 FR 69685), given the 

similarity of the labor market for 

professional, technical, and nursing staff 

between hospitals and ESRD facilities, 

we believe our use of hospital wage and 

employment data obtained from the 

Medicare cost reports to develop the 

ESRD wage index is appropriate. In 

addition, several of our major 

prospective payment systems (PPS) 

utilize the same wage index (for 

example, Skilled Nursing Home PPS, 

Inpatient Psychiatric Facility PPS, 

Inpatient Rehabilitation Facility PPS, 

Home Health PPS, and Hospice PPS.) 

(i) Third Year of the Transition 

In the CY 2006 PFS final rule with 

comment period (70 FR 70169), we 

indicated that we would apply a 4-year 

transition period to mitigate the impact 

on composite rates resulting from our 

adoption of CBSA-based geographic 

designations. Beginning January 1, 2006, 

during each year of the transition, an 

ESRD facility’s wage-adjusted composite 

rate (that is, without regard to any casemix adjustments) will be a blend of its 

old MSA-based wage-adjusted payment 

rate and its new CBSA-based wageadjusted payment rate for the transition 

year involved. In addition, beginning in 

CY 2006 we provided a gradual 

reduction in the wage index floor. We 

indicated that we would reassess the 

need for a wage index floor for CY 2008. 

In the CY 2008 PFS proposed rule (72 

FR 38167), we proposed a further 

reduction in the wage index floor. For 

each transition year, the share of the 

blended wage-adjusted base payment 

rate that is derived from the MSA-based 

and CBSA-based wage index values and 

the applicable wage index floor is as 

follows: 

• In CY 2006, the first year of the 

transition, we implemented a 75/25 

blend. The wage index floor was 

reduced from 0.9000 to 0.8500. 

• In CY 2007, the second year of the 

transition, we implemented a 50/50 

blend. The wage index floor was 

reduced from 0.8500 to 0.8000. 

• For CY 2008, consistent with the 

transition blends announced in the CY 

2006 PFS final rule with comment 

period (70 FR 70170), we are 

implementing a 25/75 blend between an 

ESRD facility’s MSA based composite 


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rate, and its CY 2008 CBSA-based rate 

reflecting its revised wage index values. 

In addition, we proposed to continue 

the wage index floor, but to further 

reduce it from 0.8000 to 0.7500. 

An example of how the wage-adjusted 

composite rates would be blended 

during CY 2008 and the additional 

subsequent transition year follows. 

Example: An ESRD facility has a 

wage-adjusted composite rate (without 

regard to any case-mix adjustments) of 

$135.00 per treatment in CY 2007. Using 

CBSA-based geographic area 

designations, the facility’s CY 2008 

wage-adjusted composite rate, reflecting 

its wage index value would be $145.00. 

During the remaining 2 years of the 4- 

year transition period to the new CBSAbased wage index values, this facility’s 

blended rate through 2009 would be 

calculated as follows: 

CY 2008 = 0.25 × $135.00 + 0.75 × 

$145.00 = $142.50 

CY 2009 = 0 × $135.00 + 1.0 × $145.00 

= $145.00 

We note that this hypothetical 

example assumes that the calculated 

wage-adjusted composite rate of $145.00 

for CY 2008 does not change in CY 

2009. In actuality, the wage-adjusted 

composite rate for CY 2009 would 

change because of annual revisions to 

the wage index. However, the example 

serves only to demonstrate the effect on 

the composite rate of the CBSA-based 

wage index values which will be phased 

in during the remaining 2 years of the 

transition period. As noted above in this 

section, the 4-year transition period will 

expire and in CY 2009 and forward, we 

will be using CBSA-based wage index 

values. 

Comment: Several commenters 

expressed concern in regard to our 

proposal to decrease the wage index 

floor from 0.80 to 0.75. In addition, one 

commenter indicated that a defunct 

licensing board in Puerto Rico has 

inhibited licensing of dialysis 

technicians for a long period of time. As 

a result, registered nurses are the only 

group of licensed professional qualified 

to furnish dialysis within this area. 

In addition, a commenter believes that 

decreasing the floor will make it 

difficult to recruit and retain qualified 

personnel in areas affected by the 

removal of the floor. The commenter 

also identified the recent transition to 

the ASP drug pricing methodology and 

increases in operating expense as factors 

that have compounded the impact of 

any further drop in the wage index 

floor. 

Response: As described in the CY 

2007 PFS final rule with comment 

period (71 FR 69686 through 69687), the 

proposed wage index floor was 

substantially higher than the actual 

wage index values for urban locales in 

Puerto Rico, without application of any 

floor and prior to the application of the 

BN adjustment. Specifically, the 

proposed wage index floor was 0.80 

whereas the actual wage index values 

ranged from 0.3241 to 0.4893. Similarly, 

the proposed wage index floor for CY 

2008 is 0.75 whereas the actual wage 

index values for urban locales in Puerto 

Rico range from 0.3064 to 0.4729. 

Therefore, we believe that the CY 2008 

wage index floor of 0.75 compared to 

actual wage levels is an appropriate 

level and the new floor would not 

impede the ability of ESRD facilities to 

recruit and retain staff. 

(ii) Wage Index Values for Areas With 

No Hospital Data 

In CY 2006, while adopting the CBSA 

designations, we identified a small 

number of ESRD facilities in both urban 

and rural geographic areas where there 

is no hospital wage data from which to 

calculate ESRD wage index values. The 

affected areas were rural Massachusetts, 

rural Puerto Rico and the urban area of 

Hinesville, GA (CBSA 25980). For both 

CY 2006 and CY 2007, we calculated the 

ESRD wage index values for those areas 

as follows: 

• For rural Massachusetts, because 

we had not determined a reasonable 

proxy for rural data in Massachusetts, 

we used the FY 2005 wage index value 

for rural Massachusetts. 

• For rural Puerto Rico, the situation 

is similar to rural Massachusetts. 

However, since all geographic areas in 

Puerto Rico were subject to the wage 

index floor in CY 2006 and CY 2007, we 

applied the ESRD wage index floor to 

rural Puerto Rico as well. 

• For the urban area of Hinesville, 

GA, we calculated the CY 2006 and CY 

2007 wage index value for Hinesville, 

GA (CBSA 25980) based on the average 

wage index value for all urban areas 

within the State of Georgia. 

In the CY 2008 PFS proposed rule (72 

FR 38168), we proposed an alternative 

methodology for establishing a wage 

index value for rural Massachusetts. 

Since we have used the same wage 

index value for two years with no 

updates, we believed it was appropriate 

to establish a methodology that uses 

reasonable proxy data for rural areas 

(including rural Massachusetts) and also 

permits annual updates to the wage 

index value based on that proxy data. 

Therefore, in cases where there is a rural 

area without hospital wage data, we 

proposed to use the average wage index 

values from all contiguous CBSAs to 

represent a reasonable proxy for that 

rural area. 

In determining the imputed rural 

wage index, we interpret the term 

‘‘contiguous’’ to mean sharing a border. 

In the case of Massachusetts, the entire 

rural area consists of Dukes and 

Nantucket Counties. We determined 

that the borders of Dukes and Nantucket 

counties are ‘‘contiguous’’ with 

Barnstable and Bristol counties. Under 

the proposed methodology, the wage 

index values for the counties of 

Barnstable (CBSA 12700, Barnstable 

Town, MA—(1.2539)) and Bristol (CBSA 

39300, Providence-New Bedford-Fall 

River, RI-MA—(1.0783)) are averaged, 

resulting in a proposed imputed wage 

index value of 1.1665 for rural 

Massachusetts for CY 2008. 

For rural Puerto Rico, we proposed to 

continue to apply the wage index floor 

in CY 2008. Since all areas in Puerto 

Rico that have a wage index are eligible 

for the proposed CY 2008 ESRD wage 

index floor of 0.7500, we proposed to 

also apply the floor to ESRD facilities 

located in rural Puerto Rico. 

For Hinesville, GA (CBSA 25980) 

which is an urban area without specific 

hospital wage data, we proposed to 

continue using the same methodology 

used to impute a wage index value for 

that area as we used in CY 2006 and CY 

2007. Specifically, we used the average 

wage index value for all urban areas 

within the State of Georgia for purposes 

of calculating the wage index value for 

Hinesville. Therefore, for CY 2008 we 

proposed that the wage index value for 

urban CBSA (25980) Hinesville-Fort 

Stewart, GA is calculated as the average 

of the wage index values of all urban 

areas in Georgia. 

We solicited comments on these 

proposed approaches to calculate the 

wage index values for areas without 

hospital wage data for CY 2008 and 

subsequent years. We indicated that we 

would continue to evaluate existing 

hospital wage data and, possibly, wage 

data from other sources, such as the 

Bureau of Labor Statistics, to determine 

if other methodologies of imputing a 

wage index value for these areas may be 

feasible. We received one comment on 

this issue. 

Comment: One commenter was 

supportive of our methodology used in 

calculating wage index values for areas 

with no hospital wage data including 

rural Massachusetts, Puerto Rico, and an 

urban area in Georgia. However, the 

commenter requested that we carefully 

evaluate the extent to which these 

methodologies would be appropriate in 

other situations nationwide. 

Response: We agree with the 

commenter. As additional areas are 


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identified for which hospital wage data 

does not exist, we will reevaluate the 

extent to which the methodologies used 

for Massachusetts, Puerto Rico, and 

Georgia would be appropriate and 

consider alternative methodologies on 

an as needed basis. 

We are finalizing the ESRD wage 

index and associated policies as 

proposed for CY 2008. In addition, we 

note that we plan to evaluate any 

policies adopted in the FY 2008 IPPS 

final rule (72 FR 47130, 47337 through 

47338) that affect the wage index, 

including how we treat certain New 

England hospitals under section 601(g) 

of the Social Security Amendments of 

1983 (Pub. L. 98–21). 

(iii) Budget Neutrality (BN) Adjustment 

Section 1881(b)(12)(E)(i) of the Act, as 

added by section 623(d) of the MMA, 

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 2007 should be the same 

as aggregate payments that would have 

been made if we had not made any 

changes to the geographic adjusters. We 

note that this BN adjustment only 

addresses the impact of changes in the 

geographic adjustments. A separate BN 

adjustment was developed for the casemix adjustments, currently in effect. 

Since we are not proposing any changes 

to the case-mix measures for CY 2008, 

the current case-mix budget neutrality 

will remain in effect for CY 2008. For 

CY 2008, we again proposed to apply 

the BN adjustment directly to the ESRD 

wage index values, as we did in CY 

2007. As we explained in the CY 2007 

PFS final rule with comment period (71 

FR 69687 through 69688), we believe 

this is the simplest approach because it 

allows us to maintain our base 

composite rates during the transition 

from the current wage adjustments to 

the revised wage adjustments described 

previously in this section. Because the 

ESRD wage index is only applied to the 

labor related portion of the composite 

rate, we computed the BN adjustment 

based on that proportion (53.711 

percent). 

To compute the proposed CY 2008 

wage index BN adjustment, we used the 

proposed wage index values, 2006 

outpatient claims (paid and processed 

as of December 31, 2006), and 

geographic location information for each 

facility. 

Using the treatment counts from the 

2006 claims and facility-specific CY 

2007 composite rates, we computed the 

estimated total dollar amount each 

ESRD provider would have received in 

CY 2007 (the 2nd year of the 4-year 

transition). The total of these payments 

became the target amount of 

expenditures for all ESRD facilities for 

CY 2008. Next, we computed the 

estimated dollar amount that would 

have been paid to the same ESRD 

facilities using the proposed ESRD wage 

index for CY 2008 (the 3rd year of the 

4-year transition). The total of these 

payments became the third year amount 

of wage-adjusted composite rate 

expenditures for all ESRD facilities. 

After comparing these two dollar 

amounts (target amount divided by 3rd 

year new amount), we calculated an 

adjustment factor that, when multiplied 

by the applicable CY 2008 ESRD 

proposed wage index value would result 

in payments to each facility that remain 

within the target amount of composite 

rate expenditures when totaled for all 

ESRD facilities. The proposed BN 

adjustment for the CY 2008 wage index 

was 1.054955. 

We also must apply the BN 

adjustment to the proposed wage index 

floor of 0.7500 which resulted in a 

proposed adjusted wage index floor of 

0.7912 (0.7500 × 1.054955) for CY 2008. 

Comment: One commenter expressed 

concern in regard to the calculation of 

the BN adjustment for the geographic 

wage index stating that the methodology 

included in the proposed rule lacked 

transparency. The commenter urged us 

to provide the data and methodology 

used in calculating the BN adjustment. 

Response: The commenter did not 

identify where transparency was lacking 

or any missing elements that would 

enable the community to assess the 

impact of the proposed changes. 

However, we received a similar request 

for clarification during last year’s 

rulemaking process and provided an 

extensive description of the manner in 

which budget neutrality is applied to 

the wage index in the CY 2007 PFS final 

rule with comment period (71 FR 69687 

through 69688). While claims data have 

been updated since publication of that 

final rule with comment period, the 

methodology has not changed. 

During the CY 2008 PFS proposed 

rule comment period, we made 

available an ESRD Composite Rate 

Payment System File. This file 

contained select claims level data from 

the 2006 ESRD facility outpatient 

claims, updated through December 31, 

2006. For more information on this file, 

see the following page on the CMS Web 

site at http://www.cms.hhs.gov/ 

LimitedDataSets/06.asp#TopOfPage. 

After publication of this final rule 

with comment period, we intend to 

provide the updated version of the CY 

2006 outpatient claims (paid and 

processed as of June 30, 2007) that were 

used to compute the BN adjustment. 

To compute the final CY 2008 ESRD 

wage index BN adjustment, we used FY 

2004 pre-floor, pre-reclassified, nonoccupational mix-adjusted hospital 

wage data to compute the wage index 

values, 2006 outpatient claims (paid and 

processed as of June 30, 2007), and 

geographic location information for each 

ESRD facility which may be found 

through Dialysis Facility Compare. The 

FY 2004 hospital wage index data for 

each urban and rural locale by CBSA 

may also be accessed on the CMS Web 

site at: http://www.cms.hhs.gov/ 

AcuteInpatientPPS/WIFN/list.asp. The 

wage index data are located in the 

section entitled ‘‘FY 2008 Final Rule 

Occupational Mix Adjusted and 

Unadjusted Average Hourly Wage and 

Pre-Reclassified Wage Index by CBSA.’’

Dialysis Facility Compare Information 

can be found on the CMS Web site at 

http://www.cms.hhs.gov/ 

DialysisFacilityCompare/. 

Using treatment data from the latest 

2006 claims file and facility-specific CY 

2007 composite rates, we computed the 

estimated total dollar amount each 

ESRD provider would have received in 

CY 2007 (the 2nd year of the 4-year 

transition). The total of these payments 

became the target amount of 

expenditures for all ESRD facilities for 

CY 2008. Next, we computed the 

estimated dollar amount that would 

have been paid to the same ESRD 

facilities using the ESRD wage index for 

CY 2008 (the 3rd year of the 4-year 

transition). The total of these payments 

became the 3rd year new amount of 

wage adjusted composite rate 

expenditures for all ESRD facilities. 

After comparing these dollar amounts 

(target amount divided by 3rd year new 

amount), we calculated an adjustment 

factor that when multiplied by the 

applicable CY 2008 wage index value, 

will result in aggregate payments to 

ESRD facilities that will remain within 

the target amount of composite rate 

expenditures. When making this 

calculation, the ESRD wage index floor 

value of 0.7500 is used whenever 

appropriate. 

The final BN adjustment for the CY 

2008 wage index is 1.055473. 

To ensure budget neutrality, we also 

must apply the BN adjustment to all 

index values, including the wage index 

floor of 0.7500, which results in an 

adjusted wage index floor of 0.7916 for 

CY 2008. 

(iv) ESRD Wage Index Tables 

The final CY 2008 wage index tables 

applicable to ESRD facilities are located 


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in Addenda G and H of this final rule 

with comment period. 

I. Independent Diagnostic Testing 

Facility (IDTF) Issues 

In the CY 2008 PFS proposed rule (72 

FR 38169 through 38171), we clarified 

our interpretation of several of the 

existing performance standards at 

§ 410.33(b), and § 410.33(g), proposed a 

new IDTF performance standard at 

§ 410.33(g)(15), and a new proposed 

IDTF provision at § 410.33(i). 

We received numerous comments 

concerning the revisions to existing 

performance standards and new 

provisions affecting IDTFs and have 

revised our proposed changes, where 

applicable, to reflect the issues brought 

forth by the commenters. We are 

adopting the provisions contained in the 

proposed rule as final with the 

following changes. 

1. Revisions of Existing IDTF 

Performance Standards 

a. § 410.33(g)(6) 

In § 410.33(g)(6), we had proposed to 

revise this existing performance 

standard to include the requirement that 

an IDTF must list our designated 

contractor as a Certificate Holder on the 

comprehensive liability insurance 

policy by revising § 410.33(g)(6) to state, 

‘‘Has a comprehensive liability 

insurance policy in the amount of at 

least $300,000 per location that covers 

both the supplier’s place of business 

and all customers and employees of the 

supplier and ensures that this insurance 

policy must remain in force at all times. 

The policy must be carried by a 

nonrelative owned company. Failure to 

maintain required insurance at all times 

will result in revocation of the IDTF’s 

billing privileges retroactive to the date 

the insurance lapsed. IDTF suppliers are 

responsible for providing the contact 

information for the issuing insurance 

agent and the underwriter. In addition, 

we proposed that the IDTF must: ensure 

that the insurance policy must remain 

in force at all times and provide 

coverage of at least $300,000 per 

incident; notify the CMS-designated 

contractor in writing of any policy 

changes or cancellations; and list the 

CMS-designated contractor as a 

Certificate Holder on the policy.’’

Comment: One commenter suggested 

that we amend the § 410.33(g)(6) 

provision on the comprehensive 

liability insurance policy to state that 

IDTFs should have a comprehensive 

liability insurance policy of at least 

$100,000 per incident, $300,000 

aggregate and that CMS should require 

the IDTF to list Medicare contractors as 

certificate holders for notification 

purposes only. 

Response: After receiving numerous 

comments supporting the proposed 

figures, we are adopting the proposed 

figure of $300,000 per incident. 

Comment: Several commenters 

recommended that we revise the 

proposed performance standard found 

at § 410.33(g)(6) to remove the 

requirement that our designated 

contractor be listed as a Certificate 

Holder on the liability insurance policy. 

One commenter supported the proposed 

changes to the performance standard at 

§ 410.33(g)(6), but expressed concerned 

about whether underwriters were 

willing to list the government as a 

certificate holder on an insurance 

policy. 

Another commenter questioned 

whether insurance underwriters will be 

open to the idea of adding the 

government as a certificate holder on an 

insurance policy and suggested that 

CMS survey several insurance carriers 

which provide this type of coverage to 

determine if this performance standard 

is achievable. One commenter stated 

that the comprehensive liability 

insurance policy provision 

(§ 410.33(g)(6)) which requires the IDTF 

to list the Medicare contractor as the 

certificate holder on the policy is too 

burdensome and obtrusive on small 

business entities. They recommended 

using a comparable approach to the one 

required by DMEPOS supplier, and have 

the IDTF provide a copy of the annual 

renewal of the insurance coverage for 

the IDTF to the Medicare contractor (the 

renewal package would include 

information on the coverage levels, as 

well as the premiums paid). 

One commenter suggested removing 

the contractor as the certificate holder 

for the comprehensive liability 

insurance policy, but if they are named 

as a certificate holder for the 

comprehensive liability insurance 

policy that it be only for notification 

purposes. 

Response: Given the concerns raised 

about the increased administrative 

burden, we agree that our designated 

contractor should not be included as a 

Certificate Holder on the IDTF’s 

comprehensive liability insurance 

policy. We have revised the 

performance standard found at 

§ 410.33(g)(6) to remove the requirement 

that our designated contractor be listed 

as a Certificate Holder on the IDTF’s 

comprehensive liability insurance 

policy. However, we believe that it is 

essential that a Medicare fee for service 

(FFS) contractor be allowed to verify 

information contained in the 

comprehensive liability insurance 

policy. We believe that a Medicare 

contractor (that is, carrier or Part A/Part 

B Medicare Administrator Contractor) 

should be able to verify the issuance of 

a comprehensive liability insurance 

policy with an insurance agent or, as 

necessary, an underwriter. This 

approach will allow a Medicare FFS 

contractor to review and verify that a 

comprehensive liability insurance 

policy has been issued and is in effect 

at the time of enrollment and 

throughout the enrollment period. We 

have revised § 410.33(g)(6) to read, ‘‘Has 

a comprehensive liability insurance 

policy in the amount of at least 

$300,000 per location that covers both 

the supplier’s place of business and all 

customers and employees of the IDTF. 

The policy must be carried by a 

nonrelative-owned company. Failure to 

maintain required insurance at all times 

will result in revocation of the IDTF’s 

billing privileges retroactive to the date 

the insurance lapsed. IDTF suppliers are 

responsible for providing the contact 

information for the issuing insurance 

agent and the underwriter. In addition, 

the IDTF must—

• Ensure that the insurance policy 

must remain in force at all times and 

provide coverage of at least $300,000 

per incident; and 

• Notify the CMS designated 

contractor in writing of any policy 

changes or cancellations.’’

b. § 410.33(g)(2) 

In § 410.33(g)(2), we proposed to 

establish a 30-day reporting period for 

certain reportable events and a 90-day 

reporting period for all other reportable 

events. 

Comment: One commenter asked that 

we define the term ‘‘nonrelative owned’’

while another commenter asked that we 

remove this term altogether because we 

are not precluding self insurance. 

Response: While we do not believe 

that it is necessary to define the term 

‘‘nonrelative owned’’ in this rulemaking 

effort, a non-relative owned company 

applies to insurance policies obtained 

through a familial relationship, not a 

related organization or business partner. 

Therefore, we are not removing this 

term from the performance standard. 

Comment: Several commenters 

supported our proposal to revise the 

reporting requirements found in the 

performance standard found at 

§ 410.33(g)(2). One commenter 

supported the CMS proposal to revise 

the reporting requirements found in 

performance standard at § 410.33(g)(2) 

to establish separate reporting periods 

for different reportable events. The 

proposed changes will provide the 

information desired by CMS in a timely 


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manner while minimizing the 

administrative burdens on both IDTFs 

and the Medicare contractors caused by 

the current notification standard. 

Response: We appreciate these 

comments and agree that revising this 

standard will reduce the administrative 

burden on both IDTFs and our 

contractors. 

Comment: One commenter 

recommended that we revise the CMS–

855B to list the specific changes that 

must be reported within 30 calendar 

days of the change. However, one 

commenter stated that requiring the 

reporting of changes depending on the 

type change in 30 or 90 days puts an 

unfair burden on IDTFs. 

Response: We agree that the CMS–

855B should be revised and should list 

the specific changes that must be 

reported within 30 calendar days of the 

change. Currently, IDTFs are required to 

report all changes in 30 days. Our 

proposal would limit the number of 

reportable events that would need to be 

reported within 30 days of the change. 

We intend to revise the CMS–855B to 

clarify which reportable events must be 

reported within 30 and 90 days. We will 

use the Paperwork Reduction Act 

process to seek specific comments in 

seeking revisions to the CMS–855B. 

Comment: One commenter 

recommended that we allow IDTFs to 

make changes online. 

Response: We are developing the 

Provider Enrollment, Chain, and 

Ownership System (PECOS) Web, 

which will allow all providers and 

suppliers, including IDTFs, to enroll or 

report enrollment changes via the 

Internet. We are hoping to implement 

PECOS Web in most parts of the country 

by March 2008. 

Comment: One commenter suggested 

that all changes should be reported to 

CMS within 90 days or in the 

alternative. This commenter also 

recommended that IDTFs report any 

changes that have occurred in the 

preceding quarter on a quarterly basis. 

Another commenter suggested that we 

should allow at least 90 days for 

reporting changes in contact 

information with the contractor. This 

commenter also suggested that we 

further define what the policy and 

coverage requirements for self insurance 

and the term ‘‘independent 

underwriter.’’

Response: Section 410.33(g)(2) 

requires IDTFs to report all changes in 

30 days. By adopting our proposal, we 

limit the number of reportable events 

that would need to be reported within 

30 days of the change. As stated above, 

we intend to revise the CMS–855B to 

clarify what items must be reported 

within 30 and 90 days. Since many 

IDTFs operate on different schedules, it 

would not be practical to implement a 

quarterly reporting requirement. 

As a result of the issues raised by the 

commenters, we are revising 

§ 410.33(g)(2) to read, ‘‘Provides 

complete and accurate information on 

its enrollment application. Changes in 

ownership, changes of location, changes 

in general supervision, and adverse 

legal actions must be reported to the 

Medicare FFS contractor on the 

Medicare enrollment application within 

30 calendar days of the change. All 

other changes to the enrollment 

application must be reported within 90 

days.’’

c. § 410.33(g)(8) 

We received the following comments 

in response to our proposal at 

§ 410.33(g)(8). 

Comment: Several commenters 

recommended that we consider limiting 

the types of beneficiary complaints that 

are subject to the performance standard 

found in § 410.33(g)(8). Another 

commenter recommended that the 

standard found in § 410.33(g)(8) apply 

only when a beneficiary formalizes their 

complaint in writing. Other commenters 

stated that the proposed change in 

§ 410.33(g)(8) is unnecessary, not to 

mention ambiguous and labor intensive 

to implement. 

One commenter recommended that 

we model the IDTF documentation 

requirement after standards established 

by the Food and Drug Administration. 

Specifically, this commenter 

recommends that IDTFs maintain a 

record for each serious complaint 

received by the facility for at least 3 

years from the date the complaint was 

received. 

Another commenter recommended 

that we clarify that IDTFs are required 

to monitor only those beneficiary 

complaints that relate to the quality of 

care the patient receives. 

One commenter stated that the 

standard at § 410.33(g)(8) be clarified to 

eliminate the documentation of routine 

billing questions so there is no 

unnecessary burden on small business 

entities. 

One commenter suggested that 

instead of adopting § 410.33(g)(8) as 

written for documenting a beneficiary’s 

questions or complaints, IDTFs should 

be required to develop and adhere to a 

complaint policy that includes 

documentation of material medical or 

billing complaints, and that if CMS 

adopts the current provision, the word 

questions should be changed to 

complaints. The commenter also 

maintains that IDTFs should be allowed 

to keep documents that are older than 

30 days at a site other than the IDTF’s 

physical location and CMS should 

clarify how long the IDTFs are required 

to keep each complaint and whether an 

IDTF will be required to record the 

insurance claim number for each 

complaint. 

Other commenters recommended that 

we clarify § 410.33(g)(8) to specifically 

state that this standard relates to 

complaints regarding the provision of 

service, because as written, it will 

impose a sweeping new recordkeeping 

requirement that drastically affects 

small business entities. 

Response: Based upon the comments 

received, we have revised this provision 

to clarify and limit the amount of 

documentation that is necessary when a 

clinical complaint is received in 

writing. We also are clarifying and 

limiting the amount of documentation 

that is necessary when a clinical 

complaint is received in writing. We 

believe that complaints should be 

readily available for examination and 

we will establish a time frame for 

maintaining this documentation. 

Therefore, we have revised 

§ 410.33(g)(8) accordingly. 

Comment: One commenter 

recommended that we develop a 

standardized complaint form and an 

electronic Web-based platform for 

submitting complaints regarding an 

IDTF. 

Response: We believe that an IDTF 

can document any formal complaints it 

receives in the most convenient way 

possible for that IDTF. 

After reviewing public comments 

regarding our proposed change to 

§ 410.33(g)(8), we are adopting this 

proposed change with modifications. By 

revising this language, we believe that 

we are reducing the paperwork burden 

on IDTFs to maintain and respond to 

written clinical complaints, rather than 

all questions and complaints it receives 

from beneficiaries. Section 410.33(g)(8) 

is revised to read, ‘‘Answer, document, 

and maintain documentation of a 

beneficiary’s written clinical complaint 

at the physical site of the IDTF (for 

mobile IDTFs, this documentation 

would be stored at their home office.) 

This includes, but is not limited to, the 

following: 

• The name, address, telephone 

number, and health insurance claim 

number of the beneficiary. 

• The date the complaint was 

received; the name of the person 

receiving the complaint; and a summary 

of actions taken to resolve the 

complaint. 

• If an investigation was not 

conducted, the name of the person 


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making the decision and the reason for 

the decision.’’

By making this change, we believe 

that we are reducing the paperwork 

burden on IDTFs by asking them to 

maintain and respond to written clinical 

complaints, rather than address all 

questions and complaints it receives 

from beneficiaries. 

d. § 410.33(b)(1) 

We received the following comments 

in response to our proposal at 

§ 410.33(b)(1). 

Comment: Several commenters agreed 

with our proposal to delete the 

requirement that the supervising 

physician is responsible for the overall 

operation and administration of an 

IDTF. 

Response: We appreciate these 

comments and are adopting this change 

in the final regulation. 

Comment: One commenter 

recommended that we delay the 

implementation of our clarification that 

a physician providing general 

supervision can oversee a maximum of 

three IDTF sites by noting that term, 

‘‘sites’’ includes fixed, as well as mobile 

sites. 

Response: We believe that a physician 

providing general supervision can 

oversee a maximum of three IDTF sites 

which includes fixed as well as mobile 

sites. 

Comment: One commenter 

recommended that we clarify that the 

three site limitation only relates to the 

provision of general supervision. In 

addition, one commenter recommended 

that we clarify that while a physician 

may only provide general supervision to 

three IDTF sites, this provision does not 

apply to the number of interpreting 

physicians at an IDTF site. 

Response: We agree with this 

comment and will clarify that the 

supervision limitation only applies to 

general supervision. 

Comment: One commenter stated that 

our proposal to consider each mobile 

IDTF unit as one IDTF site was 

unreasonable. 

Response: We disagree and we believe 

that a physician providing general 

supervision can oversee a maximum of 

three IDTF sites. We maintain that fixed 

and mobile IDTFs essentially are 

furnishing the same services. We note 

that the term, ‘‘sites’’ includes fixed as 

well as mobile sites because there are 

three concurrent locations where testing 

may occur at a given time. 

Comment: One commenter stated 

individual locations should be counted 

only if they have separate Medicare 

PINs. 

Response: With Medicare’s 

implementation of the National Provider 

Identifier (NPI) on or before May 23, 

2008, Medicare contractors will no 

longer issue billing numbers to the 

public. Providers and suppliers will use 

their assigned NPI to submit claims to 

Medicare. As such, organizations may 

obtain one or many NPIs. Accordingly, 

we are not able to adopt this suggestion. 

Comment: One commenter suggested 

that it would be inappropriate to require 

that a mobile IDTF have a different 

supervising physician for every three 

office locations that it visits, therefore 

this provision should apply only to 

those IDTFs in a fixed location. 

Response: We believe that a physician 

providing general supervision can 

oversee a maximum of three IDTF sites 

and note that the term, ‘‘sites’’ includes 

fixed, as well as mobile sites, because 

there are three concurrent locations 

where testing may occur at a given time. 

A mobile IDTF may visit multiple 

locations and it would still be 

considered one mobile unit. The 

number of places a mobile IDTF visits 

does not change the fact that this is a 

single unit and up to three fixed base or 

mobile units may be under the general 

supervision of one physician. 

Comment: One commenter stated that 

the mobile unit described at 

§ 410.33(b)(1) should be consistent with 

the language used on the CMS-855B 

enrollment application. 

Response: We will consider revising 

the CMS-855B to incorporate this 

recommendation. 

Comment: One commenter 

recommended treating fixed base sites 

and portable units on a comparable 

basis in that a supervising physician not 

be limited to supervising three portable 

units, but also could supervise three 

sites from which portable units are 

dispatched. 

Response: A mobile IDTF may visit 

multiple locations, and it would still be 

considered one mobile unit. The 

number of places a mobile IDTF visits 

does not change the fact that this is a 

single unit and up to three fixed base or 

mobile units may be under the general 

supervision of one physician. Under the 

commenter’s scenario, any number of 

mobile units could be in use and a 

physician would not be able to provide 

general supervision to an infinite 

number of mobile units. 

Comment: One commenter 

recommended that we revise § 410.33(b) 

to move to a diagnostic equipment 

threshold limit instead of an IDTF site 

limit since, as proposed, the provision 

allowing fixed based IDTFs to run 

limitless testing procedures at the IDTF 

is equated with a mobile unit running 

one test at a time. Therefore the number 

of supervising physicians should be 

determined through testing volume and 

not location. 

Another commenter recommended 

that a maximum threshold of 15 units 

per supervising physician would be 

advisable and that is should be made 

clear that this section applies to general 

supervision and not direct or personal 

supervision. 

Response: Due to the varied and ever 

changing equipment used by IDTFs, it 

would be impractical to establish such 

limits. 

Comment: One commenter 

recommended that we conduct 

additional audits, monitoring, and 

enforcement actions, where warranted, 

to address existing compliance 

problems. 

Response: We agree with the 

commenters that audits, monitoring, 

and enforcement efforts are effective 

ways to identify individual compliance 

issues. We already require that Medicare 

contractors conduct an onsite visit to 

verify the performance standards found 

in this section prior to initial 

enrollment. We will consider adding 

and/or redirecting existing resources to 

ensure that an IDTF remains in 

compliance with these standards. 

Comment: One commenter requested 

clarification to differentiate between 

fixed and mobile IDTFs business models 

and the differences by which IDTFs 

using these models provide services. 

Response: A fixed base IDTF performs 

all of its diagnostic testing at the 

practice location found on the Medicare 

enrollment application (CMS–855), 

whereas a mobile IDTF travels and 

performs its diagnostic tests at locations 

other than a single practice location. 

Comment: One commenter requested 

that we clarify the definition of ‘‘site’’

versus ‘‘testing locations’’ distinction. 

Response: We consider sites and 

testing locations to be a practice 

location for both fixed base and mobile 

IDTFs. 

Comment: One commenter suggested 

that the language at § 410.33(i)(3) is in 

error and was meant to be a definition, 

because it explains the first two parts of 

the effective date provision. The 

commenter stated that they believe that 

the date which a signed enrollment 

application is submitted should be 

considered the date of filing and that 

any time lag in contractor decisions 

should be excluded when determining 

the date of filing. 

Response: We agree with the 

commenter and are revising 

§ 410.33(b)(1) accordingly. 

After reviewing the public comments, 

we are amending the provision to 


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remove the following sentence from 

§ 410.33(b)(1), ‘‘The IDTF supervising 

physician is responsible for the overall 

operation and administration of the 

IDTFs, including the employment of 

personnel who are competent to 

perform test procedures, record and 

report test results promptly, accurately 

and proficiently, and for assuring 

compliance with the applicable 

regulations’’. 

We are adopting the provision at 

§ 410.33(b)(1) which clarifies the 

meaning of what constitutes three IDTF 

sites to include both fixed sites and 

mobile units. This includes moving 

portable diagnostic equipment to 

another location and used it to provide 

IDTF services. Accordingly, we believe 

that a physician providing general 

supervision as defined in 

§ 410.32(b)(3)(i) can oversee a maximum 

of three sites (that is, fixed or mobile) 

where concurrent operations can be 

performed. In addition, we are clarifying 

that that this provision applies only to 

general supervision within an IDTF 

setting. Section 410.33(b)(1) is revised to 

read, ‘‘Each supervising physician must 

be limited to providing general 

supervision to no more than three IDTF 

sites. This provision applies to both 

fixed sites and mobile units where three 

concurrent operations are capable of 

performing tests.’’

2. New IDTF Standards 

a. § 410.33(i) 

In § 410.33(i), we proposed to 

establish an initial enrollment date for 

IDTFs and to limit the retrospective 

period for which an IDTF can obtain 

payment for services after enrolling into 

the Medicare program. 

Comment: One commenter 

recommended that we adopt an 

accelerated rollout plan of the PECOS 

Web to facilitate the enrollment process 

for IDTFs. 

Response: We expect to implement 

PECOS Web in most parts of the country 

by March 2008. 

Comment: One commenter 

recommended that we ensure that 

Medicare contractors process 

enrollment applications in a timely 

manner so that beneficiaries will have 

access to quality and convenient 

healthcare delivery at an IDTF. 

Response: We will continue to work 

with all Medicare contractors to ensure 

that applications are processed in a 

timely and accurate manner. With the 

implementation of PECOS Web, we 

believe that many of the processing 

delays that have occurred within the 

last year will be corrected. Specifically, 

PECOS Web will facilitate the 

submission of a complete application 

and allow applicants to make any 

necessary changes to their enrollment 

application in a timely manner. 

Comment: Several commenters 

recommended that we revise our 

proposals to allow an IDTF to begin 

billing Medicare for claims with dates of 

service on or after the day on which the 

IDTF submits a ‘‘substantially correct’’

or ‘‘substantially complete’’ enrollment 

application or the date the IDTF first 

furnishes services at its location, 

whichever is later. 

Response: We disagree with the 

recommendation to permit an IDTF to 

submit claims with dates of service on 

or after the day which the IDTF submits 

a ‘‘substantially correct’’ enrollment 

application or the date the IDTF first 

furnishes services at its location, 

whichever is later. We believe that it is 

essential that all providers and 

suppliers, including IDTFs, submit a 

complete application at the time of 

filing or perfect the submission of their 

enrollment application in response to a 

contractor’s request for information. 

Accordingly, an applicant who submits 

a complete application or responds in a 

timely manner to a request for 

additional information is not 

disadvantaged by this proposal. 

However, it is important to note that if 

an application is rejected in accordance 

with the provisions found at § 424.525, 

the applicant will need to submit a new 

application to enroll in the Medicare 

program. In this case, the applicant only 

will be able to seek payments for those 

services furnished on or after the date of 

filing or when the Medicare contractor 

has approved the second application 

request. 

Comment: One commenter 

recommended that retroactive billing 

(once approval has been determined) be 

allowed back to the time of the initial 

application (even if the first submission 

is rejected). 

Response: As stated above in this 

section, we disagree with this 

recommendation. We believe that an 

IDTF should be allowed to bill for 

services furnished on or after the date of 

filing or the date the practice location 

became operational. However, we do 

not believe that it is appropriate to 

allow an IDTF to bill for services back 

to the filing date of the initial 

application if the initial application was 

rejected due to the nonsubmission of 

information or denied because the 

applicant did not meet the program 

requirements to enroll as an IDTF. 

Comment: One commenter 

recommended that a 60-day period be 

allowed for retroactive billing before an 

IDTF is enrolled. 

Response: While we believe that an 

IDTF should be allowed to bill for 

services furnished on or after the date of 

filing or the date the practice location 

became operational, we do not believe 

that it is appropriate to allow an IDTF 

to bill for services prior to the filing date 

associated with when the application 

was submitted. 

Comment: One commenter 

recommended that Medicare contractors 

follow a protocol that outlines the items 

that will require a contractor to reject or 

deny an enrollment application. 

Response: Medicare contractors are 

bound by applicable enrollment 

regulations and CMS manual 

instructions. Specifically, all Medicare 

contractors are required to follow 

regulations found at § 424.525 and 

manual instructions found in 

publication 100–8, Chapter 10 of the 

Program Integrity Manual (PIM) when 

rejecting an enrollment application for 

insufficient information. In addition, 

Medicare contractors are required to 

follow regulations found at § 424.530 

and manual instructions found in 

publication 100–8, Chapter 10 of the 

PIM when denying an enrollment 

application. 

Comment: One commenter 

recommended that we not implement 

our proposal to preclude an IDTF from 

being allowed to bill Medicare 

retroactively for services that are 

rendered prior to the provider being 

formally approved by the applicable 

Medicare contractor to participate in the 

Medicare program. 

Response: Since our proposal 

specifically allows an IDTF to receive 

reimbursement for services furnished on 

or after the filing or the date the IDTF 

opened a new practice location, 

whichever was later, we believe that we 

are allowing IDTFs a limited amount for 

retroactive billing. As stated in the 

preamble to the proposed rule, the 

purpose of this rulemaking effort is to 

establish a date of enrollment for IDTFs 

where we believe that the enrolling 

IDTF meets all of the program 

requirements to participate in the 

Medicare program. 

Comment: One commenter 

recommended that we clarify that our 

proposed change in billing be applied 

only to new or initial enrollment 

applications and would not affect 

existing operations when changes or 

additions are made to an enrollment 

application, such as the addition of a 

new physician or piece of equipment. 

Response: In general, we agree with 

this commenter in that the proposed 

change only will apply to new or initial 

enrollment applications. Since the 

provision is designed to limit 


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retrospective billing prior to enrollment 

in the Medicare program, we do not 

believe this change will impact existing 

IDTFs who are making a change to an 

existing enrollment record for a fixed or 

mobile practice location. However, it is 

important to note that the limitations on 

retroactive billing will apply to existing 

IDTFs who are adding a new fixed or 

mobile practice location to their existing 

enrollment record. Moreover, a 

limitation on retroactive billing may 

apply when there is change of 

ownership. 

Comment: One commenter stated that 

they had no issues with the effective 

date of the billing privileges provision. 

However, this commenter suggested that 

this provision be tied to a requirement 

that the CMS designated contractor 

process the application in a timely 

fashion. 

Response: We are also concerned 

about delays associated with the 

enrollment process. However, we 

recognize that many of the delays are 

the result of IDTF suppliers not 

submitting a complete application at the 

time of filing or failing to submit 

complete and timely responses to a 

contractor’s request for information. 

In addition, we believe that it is 

appropriate to expect meaningful 

Medicare contractor processing 

timeliness standards. As necessary, the 

agency can update or revise processing 

standards through the manual 

instructions and through contracts with 

Medicare Administrative Contractors. 

We fully expect that most enrollment 

applications will be processed in 

accordance with CMS processing 

requirements found in Publication 100–

8, Chapter 10 of the PIM. The PIM 

establishes processing standards for 

initial applications, changes of 

information, and reassignments that all 

Medicare contractors must adhere to. 

Specifically, we currently require 

Medicare contractors to process 80 

percent of initial applications within 60 

days, 90 percent of initial applications 

within 120 days, and 99 percent of 

initial applications within 180 days. We 

also require Medicare contractors to 

process 80 percent of changes of 

information and reassignments within 

45 days, 90 percent of changes of 

information and reassignments within 

60 days, and 99 percent within 90 days. 

With the implementation of PECOS 

Web, an internet version of the 

Medicare enrollment process, in FY 

2008, we expect to establish more 

stringent contractor processing 

timeliness standards for applications 

submitted via PECOS Web. 

Comment: One commenter stated that 

the effective date of the billing 

privileges provision may economically 

affect small and medium sized business 

in that the IDTF must list the 

credentialed employees on the 

application itself in order for the 

application to be processed, and that 

these businesses cannot use or bill for 

their services during the time periods 

that they are not enrolled. Further, the 

commenter states that it would be 

impractical to hire these technicians if 

they cannot use them to perform the 

tests for the time it takes to get 

approved. 

Response: We disagree with the 

commenter because all IDTFs should 

have proper staffing, including 

credentialed technicians, at the time the 

IDTF practice location is applying to 

participate in the Medicare program or 

when the IDTF is operational. 

Comment: One commenter suggested 

that an IDTF that is enrolled and in 

good standing in the Medicare program 

at one location be able to enroll new 

sites retroactively to the first date of 

service at the new location. 

Response: We disagree with this 

recommendation because the approval 

of one practice location does not 

necessarily mean that a second practice 

location meets the requirements for 

approval. 

Comment: One commenter 

recommended that we require that 

applicants be notified of their 

enrollment status within 60 days of 

submitting their applications. 

Response: We believe that this 

comment is outside the scope of this 

final rule. However, given certain 

resource limitations, contractors are 

unable to respond to such status 

inquiries. With the implementation of 

PECOS Web, providers and suppliers, 

except DMEPOS suppliers, will be able 

to check the status of their applications 

via the Internet. 

After reviewing the public comments 

we are finalizing the provision at 

§ 410.33(i) to state that we will establish 

an initial enrollment date for an IDTF 

that would be the later of: (1) the date 

of filing of a Medicare enrollment 

application that was subsequently 

approved by Medicare FFS contractor; 

or (2) the date an IDTF first started 

furnishing services at its new practice 

location. We also adopted the ‘‘date of 

filing’’ as the date that the Medicare FFS 

contractor receives a signed provider 

enrollment application that the 

Medicare FFS contractor is able to 

process for approval. If the Medicare 

FFS contractor rejects or denies an 

enrollment application that is not later 

overturned during the appeals process, 

the new date of filing would be 

established when an IDTF submits a 

new enrollment application that the 

contractor is able to process to approval. 

With the implementation of an 

Internet enrollment process referred to 

as the PECOS Web in 2008, the date of 

filing for applications submitted 

through PECOS Web will be the date the 

Medicare contractor receives all of the 

following: (1) A signed Certification 

Statement; (2) an electronic version of 

the enrollment application; and (3) a 

signature page that the Medicare 

contractor processes to approval. 

While this change limits the 

retrospective payments that an IDTF 

may obtain from the Medicare program, 

we believe that this approach will 

ensure that a Medicare contractor is able 

to verify that an IDTF meets all program 

requirements at the time of filing, 

including the performance standards 

outlined in § 410.33(g) before payment 

for service occurs. 

b. § 410.33(g)(3) 

We received the following comments 

regarding our proposal at § 410.33(g)(3) 

to expressly preclude hotels and motels 

from being considered an appropriate 

site for an IDTF setting. 

Comment: One commenter stated that 

many IDTFs have contracts directly 

with a hotel or motel where they rent 

space for studies and that they disagreed 

with the rules’ provision to ban such a 

situation. 

Response: We disagree with this 

comment because we believe that space 

located within a hotel or motel can 

easily be transferred to other uses other 

than providing sleep studies. 

Comment: Several commenters stated 

that a hotel or motel room is not 

appropriate places for diagnostic testing 

to take place. 

Response: We agree with these 

comments and have revised 

§ 410.33(g)(3) accordingly. 

Comment: One commenter suggested 

that the provision at § 410.33(g)(3) be 

changed to state that the requirements 

for hand washing and patient privacy 

only apply to IDTFs that see patients 

and to clarify that being able to access 

records electronically fulfills the 

requirement of storing business and 

medical records. 

Response: We have amended 

§ 410.33(g)(3) to state that the 

requirements for hand washing and 

patient privacy only apply to IDTFs that 

see patients and to clarify that being 

able to access records electronically 

fulfills the requirement of storing 

business and medical records. 

We are adopting a revision to 

§ 410.33(g)(3) to expressly preclude 

hotels and motels from being considered 

an appropriate site for an IDTF setting. 


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Based on public comments, we believe 

that a hotel or motel is not an 

appropriate place for diagnostic testing 

to take occur. Accordingly, we have 

revised § 410.33(g)(3) to read, ‘‘Maintain 

a physical facility on an appropriate 

site. For the purposes of this standard, 

a post office box, commercial mailbox, 

motel, or hotel are not considered an 

appropriate site. The physical facility, 

including mobile units, must contain 

space for equipment appropriate to the 

services designated on the enrollment 

application, facilities for hand washing, 

adequate patient privacy 

accommodations, and the storage of 

both business records and current 

medical records within the office setting 

of the IDTF, or IDTF home office, not 

within the actual mobile unit.’’

Additionally, we have added an 

exception at § 410.33(g)(3)(ii), where 

IDTFs that do not see beneficiaries at 

their locations are exempt from 

providing hand washing and patient 

privacy accommodations. 

c. § 410.33(g)(15) 

At § 410.33(g)(15), we proposed a new 

performance standard which stated, 

‘‘Does not share space, equipment, or 

staff or sublease its operations to 

another individual or organization.’’

Comment: One commenter stated that 

they were concerned about the 

emergence of arrangements in which a 

physician practice leases a block of time 

from an imaging provider (such as an 

IDTF) or agrees to pay the provider a per 

service fee to use its facility. The group 

practice then refers its patients to the 

imaging provider for imaging tests and 

bills the insurer for the services, usually 

profiting from the difference between 

the insurer’s payment rates and the fees 

the practice pays to the imaging 

provider. 

Response: We agree with the 

commenter and reiterate that our 

proposals are designed to prohibit such 

practices. 

Comment: Several commenters 

supported our proposal to prohibit 

IDTFs from sharing space, equipment, 

or staff, or subleasing their operations to 

another individual or organization. 

Response: We appreciate these 

comments and agree that there has been 

a proliferation of share use agreements 

between IDTFs and physicians and/or 

other organizations that have allowed 

the sharing of space and equipment. 

Comment: One commenter stated that 

they applauded our efforts to address an 

alarming proliferation of referring 

physicians entering into ‘‘lease’’ or 

similar purchased test arrangements 

with imaging centers for the primary 

purpose of enabling physicians to profit 

from their own referrals. 

Response: We appreciate these 

comments as our proposals are designed 

to prohibit such practices. 

Comment: Several commenters 

recommended that CMS not finalize 

§ 410.33(g)(15) because it severely 

restricts the use of an IDTF’s property 

and places unnecessary limitations on 

the entity. 

Response: We disagree with this 

comment. With the revisions we are 

making to § 410.33(g)(15), we believe 

that an IDTF’s property is fully available 

for use solely by the IDTF. The adopted 

provision at § 410.33(g)(15) will allow 

an IDTF to conduct all of its approved 

diagnostic testing procedures. 

Comment: One commenter stated that 

the proposed rule would prohibit an 

IDTF from participating in any type of 

leasing arrangement. 

Response: In this final rule with 

comment period, we are prohibiting the 

leasing or subleasing of an IDTF practice 

location, as well as diagnostic 

equipment that are used in taking the 

initial diagnostic test. In addition, we 

are prohibiting leasing and subleasing to 

a third party. 

Comment: One commenter requested 

that we clarify whether the proposed 

performance standard found at 

§ 433.10(g)(15) would permit a multispecialty clinic and an IDTF to be 

enrolled as a clinic and an IDTF, and for 

portions of space and staff to be used for 

both clinic and IDTF activities. 

Response: While we understand the 

commenter’s concern, we do not believe 

that it is appropriate to co-locate a 

multi-specialty clinic in the same 

practice location as an IDTF. 

Specifically, while we are not 

prohibiting the sharing common of 

hallways, parking, or common areas, we 

believe that a multi-specialty clinic 

cannot occupy or be co-located within 

the same practice location. For example, 

a multi-specialty clinic and an IDTF 

could not enroll or remain enrolled 

using the same suite number within the 

same office building. 

Comment: Some commenters 

recommended that we define the term, 

‘‘individual or organization’’ to exclude 

hospitals and nonreferring radiologists, 

because hospitals and nonreferring 

radiologists are not in a position to selfrefer. 

Response: We disagree that the terms 

‘‘individual and organization’’ needs to 

be defined. For the purposes of this rule, 

an individual is a person, and an 

organization is any entity other than an 

individual. 

Comment: One commenter 

recommended that we permit an 

adjoining physician practice or a 

radiology group that is the owner of an 

IDTF to share space, equipment, and 

staff. 

Response: While we agree that it is 

common for IDTFs to share common 

areas (that is, waiting rooms) with the 

adjoining physician practice or 

radiology group that is an owner of the 

IDTF, we do not believe that it is 

appropriate for IDTFs to share common 

practice locations or diagnostic testing 

equipment. 

Comment: Several commenters 

recommended that we not extend the 

prohibition of sharing space, equipment, 

and staff to the mobile IDTF setting. 

Another commenter recommended 

that the proposed restriction on sharing 

space, equipment, and staff should not 

apply to mobile IDTFs, as this would 

add both physical and financial burdens 

that mobile units simply could not 

meet. 

Response: We agree with these 

commenters that requiring mobile IDTFs 

to adhere to limitations regarding space, 

equipment, and staffing may limit 

beneficiary access to necessary mobile 

services and increase the costs of 

providing necessary diagnostic care. 

Accordingly, we are excluding mobile 

IDTFs from the provisions found at 

§ 410.33(g)(15). 

Comment: One commenter 

recommended that we revise our 

proposals to account for certain 

practical implications concerning the 

imaging industry, including common 

and legitimate sharing practices 

between multiple IDTFs, between IDTFs 

and hospitals, and between IDTFs and 

radiologist. 

Response: While we agree that it 

reasonable for IDTFs located within a 

hospital to share practice locations and 

diagnostic testing equipment, we 

continue to have significant concerns 

regarding the sharing of space by IDTFs 

in a nonhospital setting. 

Comment: One commenter 

recommended that we revise the 

performance standard found at 

§ 410.33(g)(15) to state, ‘‘Does not share 

space, equipment or staff or sublease its 

operations to another individual, 

organization, employee or contractor of 

such organizations, that refers Medicare 

patients to the IDTF for designated 

health services.’’

Response: We have considered this 

comment in revising the performance 

standard at § 410.33(g)(15). 

Comment: One commenter believed 

that the performance standard found in 

§ 410.33(g)(15) applies to hospitals. 

Response: Upon review of the 

comments, we have revised 

§ 410.33(g)(15) to exclude hospitals. 


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Comment: Several commenters 

recommended that we clarify that the 

proposed performance standard found 

in § 410.33(g)(15) would apply only to 

newly enrolling IDTFs and not IDTFs 

already enrolled in the Medicare 

program. Specifically, these commenters 

requested that we clarify that this new 

standard would allow an IDTF to 

continue to lease personnel and 

equipment from third parties provided 

that the IDTF uses the personnel, space, 

and equipment exclusively throughout 

the lease term. 

Response: We maintain that the 

provision found in § 410.33(g)(15) 

applies to both newly enrolling IDTFs, 

as well as those IDTFs currently 

enrolled in the Medicare program. This 

provision does not prohibit an IDTF 

from leasing space or equipment that is 

used solely by that IDTF-party, such as 

a building management company or an 

equipment manufacturer. This does not 

preclude an IDTF from leasing any part 

of its practice location or equipment 

used in conducting the initial diagnostic 

procedure to another Medicare-enrolled 

individual or group to conduct 

diagnostic testing activities. 

Comment: One commenter 

recommended that we clarify that 

employees of affiliated employers under 

the Fair Labor Standards Act are not 

considered ‘‘shared staff’’ under this 

new standard. In addition, several 

commenters recommended that the 

prohibition on sharing ‘‘staff’’ be limited 

to sharing nonphysician personnel. 

Response: The new sharing provision 

has been modified to exclude the 

prohibition on the sharing of staff. 

Comment: One commenter 

recommended that if we adopt the 

proposed performance standard found 

in § 410.33(g)(15) that the 

implementation date be delayed for at 

least 12 months to provide IDTFs and 

physician practices with sufficient time 

to find new office space, recruit 

additional staff, notify their patients and 

generally restructure their existing 

relationships. Another commenter 

recommended that we clarify our 

proposed performance standard found 

in § 410.33(g)(15). 

Response: We agree with commenters 

and we are adopting a 1-year delay in 

implementation (effective January 1, 

2009) of the space-sharing provision for 

IDTFs that are currently occupying a 

practice location with another 

Medicare-enrolled individual or 

organization that is found at 

§ 410.33(g)(15)(i). 

Comment: One commenter 

recommended that we clarify whether 

the proposed prohibition on sharing 

space, equipment, and staff is intended 

to apply when the IDTF leases or 

subleases space from a hospital on a 

full-time, exclusive basis. Other 

commenters recommended that we 

exclude mobile IDTFs from the 

prohibition to share space because it is 

impractical in complying with this 

provision. One commenter stated that 

the sharing of staff standard is 

impractical to comply with and should 

not be extended to mobile IDTFs, 

because accredited and trained 

contracted personnel are sometimes 

necessary to contract with on a 

temporary basis. 

Another commenter suggested that we 

not apply this provision to mobile 

IDTFs and instead, permit an IDTF to 

share space, equipment and staff with 

an entity that is related to the IDTF, 

such as through common control or 

ownership. Also, this commenter 

recommended that we should clarify in 

what situation an IDTF could not share 

staff, such as; supervising physician and 

nonphysician personnel. 

Response: This provision is not 

intended to restrict an IDTF from 

entering into a rental agreement for 

space or equipment, excluding 

hospitals, as long as that IDTF, or the 

owner of the IDTF are exclusively using 

that space or equipment. We are 

excluding mobile IDTFs from the 

prohibition on sharing space and staff. 

Comment: One commenter stated that 

the sharing of space provision should 

not apply to a Medicare-certified IDTF 

that leases or subleases space and/or 

qualified technical staff from a hospital 

on a full time, exclusive basis (they are 

not ‘‘shared’’ with the hospital). 

Response: We agree with the 

comment and the standard has been 

revised to reflect this concern. 

Comment: One commenter wanted 

clarification on whether we will permit 

an IDTF to utilize a common area in a 

building where an IDTF enters into a 

lease or sublease with a hospital for the 

full-time, exclusive use of the operation 

of the IDTF. 

Response: We will permit an IDTF to 

utilize a common area in a building 

where an IDTF enters into a lease or 

sublease with a hospital for the full-time 

exclusive use of the operation of the 

IDTF. However, the IDTF must have its 

own practice location that is only used 

by that IDTF. 

Comment: One commenter requested 

clarification on whether we intend to 

prohibit only new space, equipment, or 

staff sharing arrangements from the 

effective date of the rule or if it will 

apply to existing arrangements. If it 

applies to existing arrangements, then 

the commenter requests that the 

implementation be delayed by 1 year. 

Response: While we intend to 

prohibit the sharing of space at a 

practice location from the effective date 

of the rule for newly-enrolling IDTFs 

(including those with applications that 

are still pending as of January 1, 2008), 

we are adopting a 1-year delay in 

implementation (effective January 1, 

2009) of the space-sharing provision for 

IDTFs that are currently occupying a 

practice location with another 

Medicare-enrolled individual or 

organization that is found at 

§ 410.33(g)(15)(i). 

Comment: One commenter requested 

clarification as to whether we will 

permit an IDTF that leases or subleases 

space and/or staff from a hospital to 

purchase back-office services from the 

hospital. (These types of service may 

include, but are not limited to, 

transcription, billing, collection, 

recordkeeping, and computer access 

services, based upon a flat fee or at cost 

plus to the hospital). 

Response: We will permit an IDTF to 

lease or sublease space from a hospital 

and to purchase services from the 

hospital which may include, but are not 

limited to, transcription, billing, 

collection, recordkeeping, and computer 

access services, based upon a flat fee or 

at cost plus to the hospital. 

Comment: One commenter 

recommended that there should be an 

exception made at § 410.33(g)(15) for 

companies operating both an IDTF and 

portable x ray supplier, since both are 

surveyed and subject to multiple 

standards under the Medicare program. 

Response: While we understand this 

concern, we believe that an IDTF must 

have a practice location where only one 

Medicare-enrolled IDTF is furnishing 

services. If another Medicare-enrolled 

entity is using the same practice 

location space as an IDTF, especially for 

shortened periods of time, our 

designated contractor is not able to 

determine which entity is responsible 

for meeting performance standards at a 

given time. 

Comment: One commenter urged us 

to address the sharing of space, staff, 

and equipment provision by specifically 

excluding radiologists and radiology 

groups, who are not self-referring, from 

the sharing arrangements in IDTFs due 

to the increased costs and possible 

detriment to the beneficiary (numerous 

visits to different locations and 

increased stress) that may occur in this 

situation. 

Response: We believe that the practice 

location and equipment that an IDTF 

uses for its initial diagnostic testing 

cannot be used by another Medicare 

provider or supplier, and therefore, we 


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are not excluding radiologists and 

radiology groups. 

Comment: One commenter agreed that 

it would be inappropriate to commingle 

the clinical staff listed on the CMS–855 

enrollment application during the times 

that the IDTF is open; however, the 

commenter maintains that non-clinical 

space and staff (such as waiting rooms, 

receptionists, and schedulers) should be 

shared with other entities. 

Response: We agree with this 

comment and have amended the 

provision to reflect these concerns. 

Comment: One commenter 

recommends that the sharing of 

nonclinical space, equipment and 

personnel be allowed between an IDTF 

and an adjacent facility, because it does 

not offer the same potential for abuse as 

situations where the clinical operations 

of the IDTF would be commingled. 

Response: We have amended the 

provision found at § 410.33(g)(15) to 

address these concerns. 

Comment: One commenter 

recommends that the sharing of space 

between a group or a physician practice 

and its own IDTF should not be 

prohibited. Another commenter 

recommends changing the proposed 

§ 410.33(g)(15) because they believe it 

would prohibit wholly-owned corporate 

subsidiaries and affiliated under 

common control from sharing space, 

equipment, and staff in a cost efficient 

manner. 

Response: We disagree with this 

recommendation since it is not feasible 

to distinguish between two different 

practices that are co-located at the same 

practice location. Also, this provision 

would not prohibit wholly-owned 

corporate subsidiaries and affiliated 

entities under common control from 

sharing equipment, as long as the 

change in equipment location is timely 

reported. In addition, the IDTF’s 

practice location must be separately 

distinguishable and not commingled 

with another Medicare provider or 

supplier. 

Comment: One commenter 

recommends changing the proposed 

§ 410.33(g)(15) to read as follows: ‘‘Does 

not share space, equipment, or staff or 

sublease it operations to another 

individual or organization, except for a 

subsidiary or affiliated IDTF that is 

wholly owned by, and under the 

complete control of, the IDTF.’’

Response: We understand the 

commenter’s recommendation and we 

have amended § 410.33(g)(15) to address 

the commenter’s concern. 

Comment: One commenter 

recommends that CMS specifically 

exempt IDTFs that have common 

ownership and common control from 

the definition of ‘‘individual or 

organization,’’ if CMS implements 

§ 410.33(g)(15) as written. 

Response: We disagree with the 

commenter’s recommendation. While 

IDTFs may have common ownership, 

each practice location is enrolled 

separately. 

Comment: One commenter offered 

support for our provision to prohibit 

fixed site IDTFs from sharing space, 

equipment, and staff or subleasing their 

operations to another individual or 

organization. 

Response: We appreciate the 

commenters support on the proposed 

provisions. 

Comment: One commenter suggested 

excluding radiologist and radiology 

groups from the definition of individual 

or organization in the regulatory 

language at § 410.33(g)(15) so that 

imaging IDTFs can share space, 

equipment, and staff with radiologists 

and radiology groups. 

Response: We disagree with this 

recommendation because IDTFs enroll 

each practice location separately. 

Comment: One commenter suggested 

that we clarify in the preamble that the 

prohibition does not preclude affiliated 

companies (which do not have any 

referring nonradiologist physicians as 

owners) that provide services integrally 

related to the operations of an imaging 

IDTF (such as interoperable information 

system, centralized credentialing, staff 

and billing) from sharing space, 

equipment and staff. 

Response: We modified 

§ 410.33(g)(15) to reflect concerns about 

the sharing of space and equipment. 

Since Medicare enrolls each IDTF at a 

separate location, we believe that it is 

not necessary to address how affiliated 

companies interact with an IDTF as long 

as each IDTF is in compliance with the 

provisions of this final rule with 

comment period. 

Comment: One commenter suggested 

that CMS clarify that an ownership or 

investment interest held by radiologists 

and radiology groups in an imaging 

IDTF does not constitute sharing under 

§ 410.33(g)(15). 

Response: We agree that an ownership 

or investment interest held by 

radiologists and radiology groups in an 

imaging IDTF does not constitute 

sharing under § 410.33(g)(15). 

Comment: One commenter suggested 

that we revise this provision to specify 

that an IDTF cannot share its space, 

equipment or staff with another 

individual or organization that has 

Medicare billing privileges, and that it 

is okay for another non-Medicare 

enrolled entity to use the IDTF’s space, 

equipment, and staff. 

Response: We agree with the 

commenter. The IDTF may not share 

clinical space or the diagnostic 

equipment involved in the original 

diagnostic test with a Medicare-enrolled 

provider or supplier. 

Based on public comments, we have 

removed the sharing of staff aspect of 

this provision, and we are revising 

§ 410.33(g)(15) to read, ‘‘With the 

exception of hospital-based and mobile 

IDTFs, a fixed-base IDTF does not—

• Share a practice location with 

another Medicare-enrolled individual or 

organization; 

• Lease or sublease its operations or 

its practice location to another 

Medicare-enrolled individual or 

organization; or 

• Share diagnostic testing equipment 

used in the initial diagnostic test with 

another Medicare-enrolled individual or 

organization.’’

We believe that it is inappropriate for 

a fixed-base (physical site) IDTF to 

commingle its practice location or the 

equipment used in conducting the 

initial diagnostic test with another 

individual or organization enrolled in 

the Medicare program. By sharing space 

and/or equipment, Medicare contractors 

are not able to determine if an IDTF 

meets all of enrollment requirements at 

§ 424.500 through § 424.555 or whether 

each IDTF meets and maintains all 

performance standards and other 

requirements under § 410.33 and other 

applicable requirements. 

After examining public comments, we 

believe that it is appropriate to establish 

two exceptions to the prohibition 

associated with sharing space and 

clinical equipment. These exceptions 

apply to mobile IDTFs or IDTFs that are 

co-located within a hospital. 

A mobile IDTF, by its very nature, 

may share space with other Medicareenrolled entities. As such, we believe 

that it would be detrimental to the IDTF 

industry to apply this new performance 

standard to mobile IDTFs, because this 

may limit beneficiary access to 

necessary mobile IDTF services and 

increase the costs of providing 

necessary diagnostic care. In addition, 

we believe that hospital-based IDTFs are 

inherently located within a larger 

facility type and based on the need of 

the hospital, may appropriately share 

space or clinical equipment to gain 

operating efficiencies with little 

additional risk to the Medicare program 

or its beneficiaries. 

Finally, while all IDTF provisions are 

effective on the implementation date of 

this final rule with comment period, we 

believe that additional time may be 

needed for some IDTFs to change their 

business model if they are sharing a 


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practice location with another 

Medicare-enrolled individual or 

organization. Accordingly, we are 

adopting a 1-year transition period for 

IDTFs that are currently enrolled and 

are sharing a practice location with 

another Medicare individual or 

organization. While this 1-year 

transition period applies to the 

provision found at § 410.33(g)(15)(i) 

related to the sharing of space, it does 

not apply to the provisions found at 

§ 410.33(g)(15)(ii) or § 410.33(g)(15)(iii). 

Accordingly, IDTFs are prohibited from 

maintaining or establishing leasing or 

subleasing agreements or the sharing of 

diagnostic testing equipment used in 

taking the initial diagnostic test, after 

the effective date of this rule. 

3. Additional Comments and 

Responses 

Comment: One commenter 

recommended that our proposal to 

prohibit the sharing of space, 

equipment, and staff be applied 

consistently in all imaging centers, 

whether enrolled as an IDTF or as a 

physician-directed clinic. 

Another commenter recommended 

that any policy initiative intended to 

eliminate certain suspect leasing or 

space sharing arrangements should be 

applied to all imaging providers, not 

just IDTF providers. 

One commenter supported the 

proposed prohibition on shared 

equipment but urged us to apply this 

prohibition to all entities (including 

physician practices, mobile units, and 

hospitals) that provide imaging services. 

Some commenters believe an 

exception should be made to include 

cardiologists that are certified for the 

interpretation of nuclear cardiology 

studies in an IDTF as well as allow 

interpretation of nuclear cardiology 

studies for an IDTF. 

One commenter stated that since selfinsurance is permitted, the requirement 

that the insurance be purchased from a 

‘‘non-relative owned company’’ should 

be removed, or replaced with a 

provision that permits an alternate 

method of meeting the requirement by 

maintaining insurance through a 

relative-owned company that has been 

approved by a state department of 

insurance or comparable state agency or 

that can be validated by a placing 

broker. 

Another commenter recommended 

that CMS should end payments to 

independent contractor physicians who 

are not board-certified in Sleep 

Disorders Medicine. 

One commenter recommended that 

CMS require interpreting physicians to 

have board certification in Sleep 

Medicine in metropolitan areas. 

One commenter recommended that 

we edit the location of service language 

at § 410.33(e)(2) to redefine the location 

from which a service is billed. 

Another commenter recommended 

requiring a hospital licensed entity and 

actual radiology group to be the owners 

of entities that do not have to register as 

IDTFs and allow related entities of the 

hospital and radiology group to also 

own the imaging center. 

Response: We appreciate these 

comments and we will consider these 

recommendations in a future 

rulemaking effort. 

J. Expiration of MMA Section 413 

Provisions for Physician Scarcity Area 

(PSA) 

Section 413(a) of the MMA added a 

new section 1833(u) to the Act. That 

section provided a 5 percent incentive 

payment to physicians furnishing 

services in physician scarcity areas 

(PSAs) for physicians’ services 

furnished on or after January 1, 2005, 

and before January 1, 2008. Specifically, 

section 1833(u) of the Act provided for 

payment of an additional 5 percent of 

the payment amount for services 

furnished by primary care physicians in 

a primary care scarcity area and by nonprimary care physicians in a specialist 

care scarcity area. 

Because the provisions of section 

1833(u) of the Act do not apply to 

services furnished after December 31, 

2007, in the CY 2008 PFS proposed rule, 

we provided notification that these 5 

percent incentive payments will no 

longer be made for services furnished on 

or after January 1, 2008. 

The list of zip codes for both primary 

care and specialty PSAs can be found on 

the CMS Web site at http:// 

www.cms.hhs.gov/ 

hpsapsaphysicianbonuses/ 

01_overview.asp. 

Comment: We received comments 

expressing concern over the expiration 

of this provision. Commenters stated 

that the expiration of this provision may 

exacerbate the problems beneficiaries in 

rural areas experience in accessing 

medical services. 

Response: We acknowledge the 

commenters’ concerns regarding access 

to care, especially in rural areas. We 

provided notification of the pending 

expiration of this provision in the CY 

2008 PFS proposed rule. We note that 

the Congress specifically established the 

PSA incentive program to apply only to 

claims for services furnished between 

January 1, 2005, and January 1, 2008. 

We do not have authority under the 

current statute to extend PSA bonus 

payments beyond this time frame. 

K. Comprehensive Outpatient 

Rehabilitation Facility (CORF) Issues 

In the CY 2008 PFS proposed rule (72 

FR 38171), we discussed Medicare 

payment for comprehensive outpatient 

rehabilitation facility (CORF) services, 

including nursing services delivered 

within a CORF, which are defined by 

HCPCS code (G0128) for such services. 

We also explained that we use the 

payment amount established by an 

existing fee schedule other than the PFS 

when the PFS does not establish a 

payment amount for the CORF service. 

Specifically, we use the existing fee 

schedules for prosthetic and orthotic 

devices, DME and supplies, and drugs 

and biologicals for prosthetics and 

orthotics devices, durable medical 

equipment (DME) and supplies, and 

drugs and biologicals, respectively, 

provided by CORFs that are considered 

CORF services. Covered DME, orthotic 

and prosthetic devices, and supplies 

provided by a CORF are paid under the 

DMEPOS fee schedule. 

Drugs and biologicals that are not 

considered to be self-administered are 

specified as CORF services at section 

1861(cc)(1)(F) of the Act. However, as 

discussed in the proposed rule, we 

believe that drugs and biologicals 

provided to CORF patients are not 

appropriately provided as part of a 

rehabilitation plan of treatment and, as 

such, we proposed to remove drugs and 

biologicals from the scope of CORF 

services as defined at § 410.100. After 

reviewing comments, we have decided 

to retain within the definition of CORF 

services drugs and biologicals that are 

not self-administered, as discussed 

below in section II.K.7. However, as we 

are not aware of any non-selfadministered drugs and biologicals that 

appropriately may be included as part of 

a rehabilitation plan of treatment, we 

intend to closely track the provision of 

drugs and biologicals in the CORF 

setting and do not expect CORFs to bill 

for such drugs and biologicals. In 

addition, because we believe it is 

appropriate for pneumococcal, 

influenza, and hepatitis B vaccines to be 

administered to CORF patients in the 

CORF setting, even though such 

vaccines fall outside the scope of CORF 

services, we also proposed to revise the 

conditions of participation at § 485.51(a) 

to permit CORFs to provide to their 

patients pneumococcal, influenza, and 

hepatitis B vaccines in addition to 

CORF services. 

Because the regulations under 42 CFR 

parts 410 and 413 were never updated 

to reflect the change in CORF payment 

methodology from a ‘‘reasonable cost’’

basis to 80 percent of the lesser of a 


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payment amount under an existing fee 

schedule or the CORF’s actual charge, 

we proposed to add a new subpart M to 

42 CFR part 414 to reflect the change in 

CORF payment methodology. 

In addition, we proposed revisions to 

the definitions of certain CORF services 

under § 410.100, in order to limit the 

scope of such services and items to 

those appropriately provided by 

qualified CORF personnel and related to 

the rehabilitation goals of the plan of 

treatment established under 

§ 410.105(c). Specifically, we proposed 

to clarify the definition of physician 

services; respiratory therapy services; 

psychological and social services; 

nursing services; drugs and biologicals; 

supplies, appliances, and equipment; 

and the home environment evaluation. 

We also proposed to add clarifying 

language to § 410.105(b)(3) to make clear 

that physical therapy, occupational 

therapy, and speech-language pathology 

services can be provided offsite in the 

patient’s home. In § 410.105(c), we 

proposed to clarify that CORF services, 

that are not skilled rehabilitation 

services, must directly relate to the 

physical therapy or other rehabilitation 

plan of treatment and its associated 

goals. 

1. Requirements for Coverage of CORF 

Services Plan of Treatment 

(§ 410.105(c)) 

In accordance with section 

1861(cc)(1) of the Act, requiring that 

CORF services be furnished ‘‘under a 

plan (for furnishing such items and 

services to such individual) established 

and periodically reviewed by a 

physician,’’ § 410.105(c) provides that 

CORF services as defined under 

§ 410.100 are covered only if furnished 

under a written plan of treatment. 

Specifically, the plan of treatment must: 

(1) Be established and signed by a 

physician prior to the commencement of 

treatment in the CORF setting; and (2) 

indicate the diagnosis and anticipated 

rehabilitation goals, and prescribe the 

type, amount, frequency, and duration 

of the services to be furnished. We 

interpret these provisions as requiring 

that the services furnished under the 

rehabilitation plan of treatment must 

relate directly to the rehabilitation of 

injured, disabled, or sick patients. 

Services provided in the CORF setting 

that do not relate directly to such 

rehabilitation goals and treatment plan 

are not covered as CORF services. 

Therefore, we proposed to revise 

§ 410.105(c) to clarify our policy that 

CORF services are covered only if they 

relate directly to the rehabilitation of 

injured, disabled, or sick patients. We 

believe our policy is consistent with the 

statutory requirements under section 

1861(cc) of the Act. Section 1861(cc)(1) 

of the Act specifies that CORF services 

must be furnished under a plan of 

treatment. Section 1861(cc)(1)(H) of the 

Act further states that ‘‘other items and 

services’’ are considered CORF services 

only if ‘‘medically necessary for the 

rehabilitation of the patient.’’ We 

believe the implication of this limitation 

for ‘‘other items of services’’ is that all 

other CORF services (that is, those listed 

under sections 1861(cc)(1)(A) through 

(G) of the Act) also must be necessary 

for the rehabilitation of the patient. In 

addition, we noted that section 

1861(cc)(2)(A) of the Act specifies that 

a CORF facility is a facility ‘‘primarily 

engaged in providing * * * diagnostic, 

therapeutic, and restorative services to 

outpatients for the rehabilitation of 

injured, disabled, or sick persons’’

(emphasis added). We believe this 

requirement further signals the 

Congress’s intent that the services 

provided in a CORF setting be covered 

as CORF services only if such services 

relate directly to the rehabilitation of the 

patient. 

Comment: One commenter supported 

the proposal to clarify that all services 

provided in a CORF must be directly 

related to the rehabilitation treatment 

plan. The commenter noted that this 

proposal is directly aligned with the 

goals and purpose of physical therapy. 

Response: We appreciate the 

commenter’s support of this 

clarification. Because the CORF is 

defined as a facility that is primarily 

engaged in providing diagnostic, 

therapeutic and restorative services to 

outpatients for the rehabilitation of 

injured, disabled or sick persons, we 

believe the intent of the statute is that 

all services rendered in a CORF must 

relate to the patient’s rehabilitation 

needs which are stated in the patient’s 

plan of treatment established by the 

physician. Section 1861(cc)(1) of the Act 

and § 410.100 clarify that physician 

services, and services of other qualified 

professionals, can be provided in a 

CORF; but, a physician must first certify 

that the patient requires skilled 

rehabilitation services, including 

physical therapy, occupational therapy, 

speech-language pathology, and 

respiratory therapy, and then establish 

the CORF patient’s rehabilitation plan of 

treatment. 

Therefore, we are finalizing 

§ 410.105(c) as proposed with the 

exception that we have added language 

to clarify our policy that the 

rehabilitation plan of treatment, along 

with its goals, is specific to the skilled 

rehabilitation services for physical 

therapy, occupational therapy, speechlanguage pathology, or respiratory 

therapy and that these services are 

distinct from all other CORF services 

which, when provided, must directly 

relate to the goals of the rehabilitation 

treatment plan. 

2. Included Services (§ 410.100) 

Section 410.100 establishes the 

services that are covered under the 

CORF services benefit, consistent with 

section 1861(cc)(1) of the Act. Because 

of the change in payment methodology 

from that based on cost to payment 

under the PFS and other existing fee 

schedules beginning in CY 1999, this 

section does not reflect our current 

payment policies. Therefore, we 

proposed to clarify our payment policy 

in the introductory paragraph of this 

section by including a cross reference to 

proposed § 414.1101, which sets forth 

the payment methodology for CORF 

services, including identifying the 

applicable fee schedule for each CORF 

service. In addition, we proposed to 

revise: 

• The definition of physician services 

to reflect the change in payment 

methodology for CORF services; 

• The definitions of physician 

services, respiratory therapy services, 

social and psychological services, and 

nursing services to ensure that these 

definitions include only those services 

appropriately provided by qualified 

nonphysician and physician personnel 

and related to the rehabilitation plan of 

treatment established under 

§ 410.105(c); and 

• The definition of supplies, 

equipment, and appliances to conform 

to the statutory provision at section 

1861(cc)(1)(G) of the Act. 

We also proposed to remove the 

provision for drugs and biologicals. 

Although vaccines are not included in 

the definition of CORF services at 

section 1861(cc)(1) and § 410.100, we 

proposed to make revisions to the CORF 

conditions of participation at § 485.51 to 

reflect current coverage and payment 

policy for vaccines provided in the 

CORF setting. 

3. Physician Services (§ 410.100(a)) 

Section 410.100(a) defines the 

physician services included within the 

scope of CORF services. Specifically, 

those services of a CORF physician 

described as administrative in nature 

are considered CORF services, to the 

exclusion of diagnostic and therapeutic 

services, which are physician services 

under section 1861(q) of the Act and 

separately billable as physician services 

under 42 CFR part 414, subpart B. 

Section 1861(cc)(1) of the Act excludes 

from the definition of CORF services 


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any item or service that, if furnished to 

an inpatient of a hospital, would be 

excluded under section 1861(b) of the 

Act. Section 1861(b)(4) of the Act 

excludes from the definition of 

‘‘inpatient hospital services’’ the 

‘‘medical or surgical services provided 

by a physician,’’ which would include 

the diagnostic and therapeutic services 

of a physician. Consequently, diagnostic 

and therapeutic services provided in the 

CORF setting by a physician are not 

considered CORF services. In contrast, 

because those services of a CORF 

physician that are of an administrative 

nature are not ‘‘medical’’ services, such 

services are included in the definition of 

CORF services. 

In accordance with section 

1861(cc)(2)(B)(i) of the Act and 

§ 485.70(a)(1), the CORF physician must 

be either a medical doctor (MD) or a 

Doctor of Osteopathy (DO). The 

conditions of participation at 

§ 485.70(a)(2) and (3) further require 

that the physician have training or 

experience in the medical management 

of patients requiring rehabilitation 

services. The conditions of participation 

at § 485.58(a)(1)(i) also require the CORF 

facility physician to provide, in 

accordance with accepted principles of 

medical practice, medical direction, 

medical supervision, medical care 

services and consultation. In the CY 

2008 PFS proposed rule, we proposed to 

revise § 410.100(a) to clarify that only 

those physician services required and 

provided by the CORF facility physician 

that are administrative in nature are 

considered CORF services, whereas 

diagnostic and therapeutic services 

provided by a physician to CORF 

patients are considered physician 

services under section 1861(q) of that 

Act. Specifically, we proposed to define 

CORF physician services as those 

services provided by a CORF facility 

physician that are administrative in 

nature, such as consultation with and 

medical supervision of nonphysician 

staff, patient case review conferences, 

utilization review, and the review of the 

therapy plan of treatment, as 

appropriate. 

Services provided to a CORF patient 

by the CORF facility physician or other 

physician that are not administrative in 

nature but that are diagnostic or 

therapeutic services are considered 

physician services under section 

1861(q) of the Act. Where these services 

are covered, they are separately payable 

to the physician as physician services 

under the PFS at the nonfacility 

payment amount. 

In addition, § 410.100(a) currently 

provides that physician services 

included within the definition of CORF 

services are reimbursed on a reasonable 

cost basis under part 413, and that 

physician services to CORF patients not 

included within the definition of CORF 

services but billed as physician services 

are paid by the carrier on a reasonable 

charge basis subject to the provisions of 

subpart E of part 405 of this chapter. 

This description of the payment 

methodology for physician services 

provided in the CORF setting under 

§ 410.100(a) is inconsistent with the 

payment methodology set forth under 

section 1834(k)(1) of the Act for CORF 

services and section 1848 of the Act for 

physician services, as well as the 

preamble discussion in the CY 1999 PFS 

final rule (63 FR 58860). In the CY 1999 

PFS final rule, we stated that we would 

base payment for diagnostic and 

therapeutic physician services provided 

to individuals in the CORF setting on 

the PFS amount for the services. 

Therefore, we proposed to revise 

§ 410.100(a) to remove the reference to 

reasonable cost based payments for 

CORF physician services and the 

reference to reasonable charge based 

payments for non CORF physician 

services. In place of these references, we 

proposed to revise § 410.100(a) to add a 

reference to 42 CFR part 414, subpart B, 

setting forth the payment methodology 

for non CORF physician services. 

Comment: One commenter stated that 

the nonfacility fee schedule amounts for 

CORF services fail to fairly compensate 

the CORF for services provided by a 

CORF physician that are administrative 

in nature. The commenter stated that 

the PFS nonfacility amounts, containing 

higher PE RVUs (than those for the 

facility setting) for CORFs, are 

inappropriately low to cover these costs 

for the CORF setting. The commenter 

believes that the required level of 

physician activity in a CORF is greater 

than that in a physician office. Since 

there is no separate facility payment to 

the CORF, the commenter requests that 

we develop a new set of codes with 

associated fees to pay for the required 

CORF administrative physician services 

in a manner similar to that we employed 

to establish G0128 in the CY 1999 PFS 

final rule to pay for CORF nursing 

services. 

Response: The 1997 BBA required 

CMS to establish prospectively 

determined payments for all outpatient 

physical therapy, occupational therapy 

and speech-language pathology services 

regardless of the site-of-service and 

additionally required that all other 

CORF services also be based on existing 

fee schedules. When we implemented 

these BBA requirements during the CY 

1999 rulemaking process, we 

specifically addressed the issue of a siteof-service differential payment to 

institutional providers of outpatient 

therapy services, including CORFs. In 

the CY 1999 PFS final rule, we reasoned 

that a site-of-service differential 

payment to a facility provider would 

create payment incentives that favor one 

setting over another. In addition, we 

believe that the law intended the 

creation of a ‘‘level playing field’’ for 

these services and that we accomplished 

this with the selection of the PFS 

nonfacility rate to pay for all 

rehabilitation and CORF services. 

Therefore, we will continue to make 

payment at the PFS nonfacility rate for 

CORF services and will not change this 

policy to allow a separate site-of-service 

differential payment to the CORF. 

Accordingly, we are finalizing 

§ 410.100(a) as proposed. 

4. Clarifications of CORF Respiratory 

Therapy Services 

Section 1861(cc)(1)(B) of the Act 

states that CORF services include 

respiratory therapy services along with 

physical therapy, occupational therapy, 

and speech-language pathology services. 

Because respiratory therapists (RTs) are 

not recognized as independent 

practitioners in the Act or regulations, 

and respiratory therapy services are not 

specifically identified in a statutory 

benefit category except as specified in 

the CORF services benefit at section 

1861(cc)(1)(B) of the Act, separate 

payment, except that made to the CORF 

provider, is not made for services 

provided by RTs. 

The description of CORF respiratory 

therapy services currently includes 

some services that we believe are more 

appropriately provided by a physician 

rather than a RT. As discussed above in 

section II.K.3., diagnostic and other 

medical services provided in the CORF 

setting by a physician are not 

considered CORF services, and therefore 

may not be included in a respiratory 

therapy plan of treatment. In addition, 

the description of respiratory therapy 

services under § 410.100(e) currently 

includes services that in accordance 

with § 410.105(c) must be performed by 

a physician, and not a RT. For example, 

only the physician may indicate the 

clinical diagnosis and rehabilitation 

goals, and prescribe the type, amount, 

frequency, and duration of the services 

to be furnished under the rehabilitation 

plan of treatment. 

Therefore, we proposed to amend 

§ 410.100(e) to revise the definition of 

respiratory therapy services to include 

only those services that can be 

appropriately provided to CORF 

patients by RTs under a physicianestablished respiratory therapy plan of 


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treatment in accordance with current 

medical and clinical standards and the 

requirements of § 410.105(c). 

Specifically, we proposed to remove 

from the definition of CORF respiratory 

therapy services at § 410.100(e)(1) the 

terms ‘‘diagnostic evaluation’’, 

‘‘management’’, and ‘‘assessment’’

because these services are performed by 

the physician to establish the medical 

and therapy-related diagnosis and the 

respiratory therapy plan of treatment. 

These services, referred to in the 

proposed rule as ‘‘evaluation and 

management (E/M)’’ services, may be 

provided by either the CORF facility 

physician, as CORF physician services 

or as non-CORF physician services, or 

by the patient’s referring physician, as 

appropriate. We also proposed to 

remove diagnostic tests and periodic 

assessment at § 410.100(e)(2)(v) and (vi), 

respectively, from the description of 

CORF respiratory therapy services. As 

discussed above, we believe that under 

current medical standards, diagnostic 

tests that are or become necessary for 

patients receiving rehabilitation services 

should be provided by physicians. In 

addition, we believe that under current 

medical standards, periodic assessment 

of chronically ill patients in order to 

determine their need for respiratory 

services should be within the purview 

of the physician. We note that these 

services are covered under the 

physician services benefit category at 

section 1861(s)(2)(C) of the Act when 

provided by the physician to a CORF 

patient, and therefore, may be separately 

billable by the physician under the PFS. 

In addition to RTs, we noted that the 

conditions of participation also 

recognize respiratory therapy 

technicians as CORF personnel; 

however, during the CY 1999 PFS 

rulemaking to recognize the 1997 BBA 

payment requirements, we did not 

include services performed by 

respiratory therapy technicians because 

we believed that current medical 

standards for skilled respiratory therapy 

services provided to patients in the 

CORF setting required the educational 

requirements possessed by RTs. This 

determination to only recognize the 

services of RTs, and not those provided 

by respiratory therapy technicians in 

carrying out the therapy plan of 

treatment was further supported in the 

CY 2002 and CY 2003 rulemaking (66 

FR 55311 and 67 FR 79999), when we 

developed and discussed G codes for 

certain CORF respiratory therapy 

services and specifically recognized the 

RT as the appropriate level of personnel 

to provide these CORF services. The 

three HCPCS codes G0237, G0238, and 

G0239 are specific to services provided 

under the respiratory therapy treatment 

plan and, as such, are not designated as 

subject to the therapy caps. Therefore, 

in the CY 2008 PFS proposed rule, we 

proposed to revise the description of 

respiratory therapy services to include 

only those services that are 

appropriately provided under a 

respiratory therapy treatment plan. In so 

doing, we sought to clarify those 

services that we believe the physician 

should provide, such as E/M services, 

diagnostic tests, and establishing the 

rehabilitation plan of treatment. In 

addition, we stated that a condition of 

coverage for the respiratory therapy 

service is that it be provided by an 

individual meeting the educational and 

training level of the RT, rather than the 

RT technician. For these reasons, we 

indicated we would accept comments 

on the service description at 

§ 410.100(e), and the personnel 

qualifications at § 485.70(j) and (k) for a 

respiratory therapist and a respiratory 

therapy technician, respectively. 

Comment: One commenter opposed 

the proposed revisions to the definition 

of CORF respiratory therapy services 

which removes diagnostic E/M services 

from the list of services at 

§ 410.100(e)(1) and diagnostic tests from 

§ 410.100(e)(2)(v). The commenter 

suggested that respiratory therapists, by 

virtue of their training and competency 

testing, can and do provide such 

services as part of their scope of work 

and asks us to add at § 410.100(e)(2) 

certain tests, specifically ‘‘pulmonary 

function tests, spirometry and blood gas 

analyses’’, as well as services for 

‘‘assessment, evaluation and monitoring 

of the patient’s responses to the 

respiratory treatment plan.’’ The 

commenter also requested that we 

reinsert the term ‘‘assessment’’ in the 

definition of respiratory therapy 

services at § 410.100(e)(1) in order to 

bring consistency to the definitions of 

all other CORF therapy services, such as 

physical therapy, occupational therapy, 

and speech-language pathology. Lastly, 

the commenter objected to the CORF 

requirement that the respiratory therapy 

treatment plan be entirely established 

by the physician. 

Response: Section 1861(cc)(1) of the 

Act states that respiratory therapy can 

be provided in a CORF, by qualified 

professional personnel, only under a 

treatment plan established and reviewed 

by a physician. In order to determine 

the need for and to construct an 

appropriate CORF respiratory therapy 

plan of treatment, a physician provides 

E/M services and often uses diagnostic 

tests, such as pulmonary function and 

spirometry tests, in order to establish 

the patient’s medical and therapy 

related diagnoses. These findings are 

then detailed in the patient’s 

rehabilitation treatment plan which, in 

the CORF, the physician must wholly 

establish. 

The plan of treatment is described at 

§ 410.105(c) and must include services 

furnished under a written plan of 

treatment that: (1) Is established and 

signed by a physician before the 

treatment is begun; (2) prescribes the 

type, amount, frequency, and duration 

of the services to be furnished, and 

indicates the diagnosis and anticipated 

rehabilitation goals. The respiratory 

treatment plan must be reviewed at least 

every 60 days by the physician who 

must certify that the patient is making 

reasonable progress in attaining the 

treatment goals and that the treatment is 

having no harmful effects. Therefore, we 

believe that the E/M services and 

diagnostic services associated with 

establishing, periodically reviewing, 

and overseeing the respiratory therapy 

treatment plan are appropriately 

furnished by the physician. As 

discussed above, physician services, 

including E/M services and diagnostic 

services performed by the physician, are 

separate Medicare benefits, defined at 

sections 1861(q) and 1861(s)(3) of the 

Act, respectively. These therapeutic and 

diagnostic services are covered and 

separately paid to the physician, not the 

CORF, when they are furnished to a 

CORF patient in the CORF setting by the 

physician, as discussed previously in 

this section at II.K.3. 

We agree with the commenter’s 

request to reinsert the word 

‘‘assessment’’ in the definition of 

respiratory therapy services at 

§ 410.100(e)(1). Because assessments are 

conducted as an integral part of any 

service, we agree that revising the 

definition more accurately describes the 

services provided by RTs, as well as 

other qualified and recognized CORF 

personnel. As illustrated below, 

assessments can be made by the RT 

using the physiologic data gathered 

from the monitoring services that are 

inherent to CORF respiratory therapy 

services. 

Also, we would like to clarify the 

term ‘‘monitoring’’ as used in 

§ 410.100(e)(1) specifically as it relates 

to the provision of CORF respiratory 

therapy services. As we stated in the CY 

2003 PFS final rule with comment 

period (when we created 3 G-codes—

G0237, G0238, and G0239—to better 

describe CORF respiratory therapy 

activities), we incorporated the term 

‘‘monitoring’’ in to each of the 3 G-code 

descriptors. We further described this 

‘‘monitoring’’ to include physiologic or 


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other data about the patient during the 

period before, during, and after the 

activities. It can represent, for example, 

pulse oximetry readings, 

electrocardiography data, pulmonary 

testing measurements of strength or 

endurance performed to assess the 

status of the patient before, during and 

after the activities. In order to further 

illustrate and clarify our intention, we 

provided an example in which pursed 

lip breathing, used to create positive 

pressure in the upper respiratory tract 

and to improve respiratory muscle 

action and described as G0237, was 

identified as an included service in the 

patient’s respiratory therapy treatment 

plan. 

Before providing this service, the RT 

assesses the patient to determine the 

appropriateness of providing this 

pursed lip breathing activity and may 

check the patient’s oxygen saturation 

level (via pulse oximetry). If 

appropriate, the RT then provides the 

initial training and necessary retraining 

in order to ensure that the patient can 

accurately perform this activity. After 

this session, the RT may again check the 

patient’s oxygen saturation level, or 

perform peak respiratory flow, or other 

respiratory parameters. These services 

are considered ‘‘monitoring’’ and are 

bundled into the payment for G0237 (as 

well as HCPCS codes G0238 and 

G0239). 

Another example of monitoring 

includes the provision of a 6-minute 

walk test that is typically conducted 

before the start of the patient’s 

respiratory therapy activities. When this 

‘‘test’’ is conducted, the RT uses this 

information to form an assessment of 

the patient’s condition and uses it to 

guide and monitor the activities that are 

furnished as specified in the treatment 

plan. This assessment, determined by 

data from monitoring activities is 

included as part of the activities 

inherent to G0237. The time spent by 

the RT, face-to-face and one-on-one, 

with the patient to conduct these 

respiratory measures is counted as part 

of each of the respiratory therapy 15- 

minute G-codes. When provided as part 

of a CORF respiratory therapy treatment 

plan, payment for these monitoring 

activities is bundled into the payment 

for other services provided by the RT, 

including the three respiratory therapy 

specific G-codes. The bundling of these 

monitoring activities into each CORF 

respiratory therapy service is to 

acknowledge that these activities are 

inherent to the services we envisioned 

RTs would provide in the CORF setting. 

Similarly, assessment, including the use 

of monitoring data, is included as part 

of services provided by other 

rehabilitation therapists. The G-codes 

were specifically created to better 

describe the services provided as part of 

a respiratory therapy plan of care under 

the CORF benefit. 

Comment: One commenter indicated 

that the personnel qualifications in the 

regulations for RTs and RT technicians 

are out of date and that for over a 

decade the term respiratory therapist 

has been used to describe both 

respiratory therapy care professional 

categories currently defined in the 

CORF regulations. Rather, the 

commenter states that the certified 

respiratory therapist (CRT) and the 

registered respiratory therapist (RRT) 

have replaced the older terms, RT techs 

and RTs, respectively. The commenter 

explained that the CRT designation is 

awarded after successfully passing the 

entry-level examination, while 

qualifications to sit for the RRT 

examination include graduation from 

advanced levels of respiratory therapy 

educational programs and obtaining the 

CRT credential. Based on the newer 

terminology for respiratory therapists, 

along with information provided 

regarding the CRT and RRT 

credentialing processes, the commenter 

requested that we change the CORF 

conditions of participation to reflect the 

newer qualifications. In addition, the 

commenter requested that we change 

the coverage provisions to recognize 

both the CRT and RRT as qualified 

personnel to provide CORF respiratory 

therapy services. 

Response: Based on the information 

provided by the commenter, we will 

work within CMS to develop and 

update the personnel qualifications for 

RTs and RT technicians at § 485.70(j) 

and (k), respectively. This request 

involves changes to longstanding 

provisions for CORF personnel 

qualifications, and we believe that other 

organizations, individuals, and medical 

specialties should have the opportunity 

to comment on such changes. We will 

propose updated qualifications for the 

CRT and RRT in future rulemaking to 

seek and review comments from other 

interested parties, before finalizing any 

changes to these personnel 

qualifications. In that rulemaking, we 

will revisit the issue of the respiratory 

therapy professional(s) best qualified to 

provide services under the CORF 

respiratory therapy plan of treatment. 

Until such time, we expect that the RT, 

and not the RT technician, will provide 

the services of the respiratory therapy 

treatment plan as previously discussed 

in CY 2002 and CY 2003 rulemaking 

and, again, reinforced in this final rule. 

We are finalizing our proposal to 

revise § 410.100(e)(1), with the 

exception that we will not remove the 

term ‘‘assessment’’ for the reasons 

discussed above. We will also adopt the 

revisions to § 410.100(e)(2), as proposed. 

5. Social and Psychological Services 

In accordance with section 

1861(cc)(1)(D) of the Act, social and 

psychological services are included 

within the definition of CORF services 

under § 410.100(h) and (i), respectively. 

In addition, § 485.58 specifies that the 

CORF must provide a coordinated 

rehabilitation program that includes, at 

a minimum, social or psychological 

services, along with physical therapy 

services and physician services, and 

that these services must be consistent 

with the therapy plan of treatment. 

As discussed in the CY 2008 PFS 

proposed rule, the current description of 

social work services considered CORF 

services under § 410.100(h) includes: (1) 

Assessment of the social and emotional 

factors related to the individual’s 

illness, need for care, response to 

treatment, and adjustment to care 

furnished by the facility; (2) casework 

services to assist in resolving social and 

emotional problems that may have an 

adverse effect on the beneficiary’s 

ability to respond to treatment; and (3) 

assessment of the relationship of the 

individual’s medical and nursing 

requirements to his or her home 

situation, financial resources, and the 

community resources available upon 

discharge from facility care. The current 

description of CORF psychological 

services under § 410.100(h) includes: 

(1) Assessment diagnosis and 

treatment of an individual’s mental and 

emotional functioning as it relates to the 

individual’s rehabilitation; (2) 

psychological evaluations of the 

individual’s response to and rate of 

progression under the treatment plan; 

and (3) assessment of those aspects of an 

individual’s family and home situation 

that affect the individual’s rehabilitation 

treatment. We believe these current 

definitions of CORF social and 

psychological services are too broad. As 

discussed above in this section, we 

proposed to revise § 410.105 to clarify 

our policy that CORF services are 

covered only if they are provided under 

the rehabilitation plan of treatment and 

relate directly to the rehabilitation of the 

patient. As such, we are concerned that 

the current descriptions of CORF social 

and psychological services may be 

misconstrued to include social and 

psychological services for the treatment 

of mental illness, which we believe is 

outside the scope of coverage for CORF 

social and psychological services 

because these services do not relate 

directly to a rehabilitation plan of 


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treatment and the associated 

rehabilitation goals. 

In addition, we believe it unnecessary 

to distinguish between CORF social 

services and CORF psychological 

services given their similarities, and 

therefore, we proposed to merge the two 

definitions into a single definition of 

CORF social and psychological services. 

As noted at section 1861(cc)(2)(B) of the 

Act, we believe that CORFs are required 

to provide either social services or 

psychological services, and not both 

types of services. We believe that 

merging the § 410.100(h) and (i) into a 

single definition of CORF social and 

psychological services is warranted to 

clarify the similarities between them. 

Therefore, we proposed to clarify the 

description of social and psychological 

services at § 410.100(h) to include only 

those services that address the patient’s 

response and adjustment to the 

treatment plan; rate of improvement and 

progress towards the rehabilitation 

goals, or other services as they directly 

relate to the physical therapy, 

occupational therapy, speech-language 

pathology, or respiratory therapy plan of 

treatment. In addition, we proposed to 

change the heading at § 410.100(h) from 

‘‘social services’’ to ‘‘social and 

psychological services,’’ and to 

eliminate the separate definition for 

psychological services under 

§ 410.100(i). 

Because we proposed to revise the 

description of social and psychological 

services in § 410.100(h), we also 

solicited comments concerning the 

CORF personnel qualifications in the 

conditions of participation at § 485.70(g) 

and (l) for psychologists and social 

workers, respectively, and comments 

relating to the appropriate CPT codes to 

represent these CORF services. 

Due to the specificity of the purpose 

of CORF social and psychological 

services requiring that these covered 

services directly relate to the patient’s 

rehabilitation treatment plan, we also 

invited comments on which CPT codes 

would be appropriate for CORF social 

and psychological services. We believe 

that the procedure codes for health and 

behavior assessment and treatment, 

represented by CPT codes 96150 

through 96154, specific to the patient’s 

physical health problems, best describe 

the social and psychological services 

required in the CORF setting. 

Comment: A commenter suggested 

that the proposed definition of social 

and psychological services is too 

restrictive. The commenter recommends 

including social work, biopsychosocial 

functioning, and discharge plans in the 

new proposed definition of social and 

psychological services. 

One commenter is concerned that 

clarifying that CORFs are not intended 

to be used to treat mental illness may 

result in denial of the CORF benefit to 

persons who need CORF services, but 

who also suffer from a mental illness 

(for example, patient with 

schizophrenia suffers a stroke). A CORF 

patient’s mental illness may need to be 

accounted for in developing a 

rehabilitation plan of treatment. The 

commenter urges us to avoid causing a 

‘‘chilling effect’’ on those individuals 

providing social and psychological 

services in CORFs at the expense of 

allowing a patient to recover as fully as 

possible. 

A CORF provider cautioned that by 

not treating social and psychological 

services as a stand-alone CORF service 

(like physical therapy or occupational 

therapy) may have an adverse effect on 

the patient’s ability to make progress 

toward rehabilitation goals. They also 

state that social and psychological 

services may be needed even beyond the 

conclusion of other CORF services. 

Response: We believe that our 

proposal to combine the descriptions of 

social services and psychological 

services into one definition best 

describes the services that CORFs are 

required to provide to their patients, as 

an adjunct to the rehabilitation plan of 

treatment. A broader definition of these 

services could be interpreted to include 

treatment of mental illness which the 

CORF statute and regulations do not 

permit, thereby causing Medicare to pay 

for services that fall outside the clearly 

defined scope of the CORF benefit. 

We proposed to combine the 

definitions of social services and 

psychological services to clarify and 

simplify the associated regulatory 

provisions. We believe that our proposal 

does not result in any actual change to 

either the social or psychological 

services, or the rehabilitation services, 

provided to CORF patients that relate 

directly to their rehabilitation plan of 

treatment and the associated 

rehabilitation goals. 

Therefore, we will finalize our 

proposal to combine the descriptions of 

social services at § 410.100(h) and 

psychological services at § 410.100(i) 

into one definition for social and 

psychological services at new 

§ 410.100(h) to make clear that these 

CORF services are the same, regardless 

of whether provided by a qualified 

social worker or a psychologist. 

Comment: One commenter stated that 

because there are several levels of social 

work education and licensure for social 

workers, a recommendation as to the 

qualifications for CORF social workers 

depends on whether we change our 

proposal to include the treatment of 

mental illness. As proposed, the 

commenter supports the Bachelor of 

Social Work (BSW) as the appropriate 

qualification educational level. 

However, if the scope of services is 

expanded to include the treatment of 

mental illnesses, then the commenter 

believes that the educational level of the 

Masters of Social Work (MSW) would be 

the appropriate qualification. 

A CORF provider stated that the 

personnel qualifications to perform 

CORF social and psychological services 

should be either a licensed psychologist 

at a Masters or PhD level, or a licensed 

social worker. 

A medical society representing 

psychiatrists suggested we use an 

existing set of qualifications for CORF 

psychologists and social workers, such 

as those established by the Office of 

Personnel Management. 

Response: We believe that the 

appropriate qualification for individuals 

providing social and psychological 

services in the CORF setting is a BSW 

for social workers and a Masters-level 

degree for psychologists. In response to 

the comment, the combination of social 

and psychological services into one 

definition was made for clarification 

and simplification, and does not result 

in any change to the scope of social and 

psychological services provided to 

CORF patients. Therefore, we believe it 

is appropriate to maintain the existing 

personnel qualifications for individuals 

providing these unique services in the 

CORF setting. 

Comment: In terms of what CPT codes 

might best describe the proposed CORF 

social and psychological services, one 

commenter suggested that CPT code 

96155 should be added to the suggested 

list of CPT codes 96150 through 96154 

in order to allow CORFs to bill for social 

and psychological services provided to 

a patient’s family without the patient 

presence. 

Another commenter suggested that 

limiting the services to those described 

by CPT codes 96150 through 96154 is 

potentially too restrictive because it may 

not describe all of the services provided 

by CORFs. The commenter believes that 

this restriction would not permit CORFs 

to code the social or psychological 

services provided to the highest 

specificity, although no specific CPT 

codes were offered for consideration. 

In addition, one commenter believes 

that using a full range of CPT codes to 

describe CORF social and psychological 

services is inappropriate because these 

codes were not intended to be used for 

providing non-clinical CORF services. 

This commenter specifically objects to 

the use of CPT codes 96150 through 


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96154 because these services are 

specifically used by PhD level 

psychologists to provide clinical 

services. The commenter notes that 

other CPT codes are inappropriate to 

CORF use, including the CPT code 

range 90801 through 90899 that is used 

to treat mental illnesses, and the E/M 

CPT code series (CPT codes 99XXX), 

because all of these CPT codes represent 

clinical services. Rather, they believe 

that the social and psychological 

services provided in CORFs have 

‘‘strong case management and patient 

assessment components’’ as they relate 

to the rehabilitation treatment plan. 

Instead of using existing CPT code(s), 

the commenter suggested we develop 

HCPCS code(s) specifically for CORF 

social and psychological services in 

order to keep case management services 

clearly distinguished from patient 

treatment. 

Response: In an effort to address the 

coding issues, at this time we believe 

that only CPT code 96152, Health and 

behavior intervention, each 15 minutes, 

face to-face; individual, best describes 

these unique CORF social and 

psychological services and should be 

used to bill for all social and 

psychological services provided in 

CORFs. 

We are sensitive to the concerns 

expressed by the commenter that CPT 

codes 96150 through 96154 do not 

accurately represent the descriptions of 

CORF social and psychological services, 

and that there may be a need to develop 

a HCPCS code designed specifically for 

use in the CORF setting. However, in 

this final rule, we do not believe it is 

appropriate to create a HCPCS code to 

reflect the nonclinical nature of the 

CORF social and psychological services 

when we did not propose doing so in 

the proposed rule. However, we will 

consider the commenter’s views in 

making the determination regarding the 

necessity to create a new HCPCS code 

to describe CORF social and 

psychological services in the future. 

6. Nursing Care Services 

Because the PFS does not contain a 

CPT code for nursing services, we 

established in the CY 1999 PFS final 

rule a new HCPCS code (G0128) for 

direct face to face skilled nursing 

services delivered to a CORF patient by 

an RN as part of a rehabilitation therapy 

plan of treatment. In the CORF 

conditions of participation at § 485.70(b) 

and (h), qualified personnel for nursing 

services include an LPN or vocational 

nurse and an RN, respectively. 

However, when the HCPCS code G0128 

was created for CORF nursing services 

we determined that a condition for 

coverage is that the nursing service be 

provided by an individual meeting the 

qualifications of an RN, rather than the 

LPN, for CORF clinical nursing services 

as they relate, or are part of, the therapy 

plan of treatment. Because we 

established coverage for CORF nursing 

services only when provided by an RN, 

in the CY 2008 PFS proposed rule, we 

proposed to revise new § 410.100(i) (that 

is, the current § 410.100(j) is 

redesignated as § 410.100(i)) to 

specifically reflect this coverage 

decision. We also requested comments 

on the appropriateness of the personnel 

qualification standards at § 485.79(b) 

and (h) for the LPN and for the RN, 

respectively. 

Comment: We received a comment 

that opposed the proposed revisions 

that would allow skilled nursing 

services to be performed only by 

registered nurses. The commenter 

suggested that the CORF nursing 

services provided by either a registered 

nurse or the licensed practice nurse 

should be determined by the legal scope 

of practice as outlined in State law by 

a State board of nursing. 

Response: During the CY 1999 final 

rule, we defined HCPCS code G0128 as 

a face-to-face nursing service delivered 

to a CORF patient that is directly related 

to a rehabilitation plan of treatment. We 

believe that the level of skill needed to 

render clinical nursing services as they 

relate to, or are supportive of the 

rehabilitation plan of treatment is more 

appropriately performed by registered 

nurses. 

Comment: One commenter asked us 

to provide an example of nursing 

services that would be appropriately 

furnished and separately payable as 

such in a CORF that also meets the 

criteria of directly relating to the 

rehabilitation treatment plan. This 

commenter also requests clarification as 

to whether an RN can provide services 

as part of the respiratory therapy 

treatment plan and if one of the HCPCS 

G-codes for respiratory therapy services, 

G0237, G0238, and G0239 can be used 

to bill for these services. 

Response: In the CY 1999 PFS final 

rule, we established coverage for CORF 

nursing services only when provided by 

an RN. HCPCS code G0128 is used to 

bill for services that are not included in 

the work or PEs of other therapy or 

physician services. Because of the 

advances in medical science since the 

inception of the CORF benefit in 1982, 

the need for nursing services necessary 

to be provided as an adjunct to the 

rehabilitation treatment plan has 

decreased significantly. In the CY 1999 

PFS final rule, we used the example of 

a RN who instructs a patient in the 

proper procedure of ‘‘in and out’’

urethral catheterization to illustrate one 

such nursing service directly related to 

the rehabilitation treatment plan. At that 

time, nursing services might have been 

provided to patients receiving 

respiratory therapy services relating to 

tracheostomy tube suctioning. Another 

nursing service might be related to the 

cleaning instructions for ileostomy or 

colostomy bags for a patient receiving 

physical therapy services where the care 

is imminent to the start or completion 

of a therapy session. 

Comment: Another commenter noted 

that CORFs are required to provide the 

3 core services, including physician 

services, physical therapy services, and 

social or psychological services, and 

asked that we clarify the amount that 

these other non-core services—

specifically nursing services and 

respiratory therapy services—can 

comprise of the total CORF services. 

The commenter cites examples of 

CORFs where non-core services 

comprise the majority of services, 

sometimes as much as 90 percent or 

more, including wound care services 

where RNs are used to provide the 

majority of these services and other 

CORFs specializing predominantly in 

respiratory therapy services. 

Specifically, the commenter requested 

that we unambiguously address our 

intent as it relates to the provision of 

non-core services. 

Response: The CORF statutory 

provision at section 1861(cc)(2)(B) of the 

Act and § 485.58 require that the CORF, 

as a minimum condition of 

participation, provide three core 

services— physician services, physical 

therapy services, and social or 

psychological services. When a CORF 

provides only the three required core 

services, we expect that physical 

therapy services would comprise a clear 

majority of the total CORF services, 

since social and psychological services 

are provided only as an adjunct to the 

rehabilitation services and CORF 

physician services are administrative in 

nature and not easily identified. 

However, when a CORF provides 

physical therapy services and other 

skilled rehabilitation services, we 

expect that physical therapy services 

will be the predominant rehabilitation 

service provided. The case noted by the 

commenter where CORFs specialize in 

providing a preponderance of 

respiratory therapy services is counter 

to our expectations. 

The example cited by the commenter 

where the CORF is using RNs to provide 

wound care services, which together 

with other non-core services constitute 

the majority of services provided to a 


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patient, exemplifies a situation in which 

the CORF is providing nursing services 

that are not in support of a 

rehabilitation plan of treatment. In this 

situation, the services provided by the 

RNs do not conform to the requirement 

that nursing services must directly 

relate to or further a rehabilitation 

treatment plan and its goals, and 

therefore, are noncovered. As we 

discussed previously in section II.K.6 of 

this final rule with comment period, we 

specifically define and require CORF 

nursing services to relate to the 

rehabilitation plan of treatment, with 

such nursing services necessary for the 

attainment of the rehabilitation goals of 

the physical therapy, occupational 

therapy, speech language pathology, or 

respiratory therapy plan of treatment. 

We believe only professional therapists/ 

pathologists, such as PTs, OTs, SLPs, 

and RTs, may appropriately provide 

these rehabilitation services and that it 

is inappropriate for an RN to provide 

these services. Nursing services may not 

substitute for or supplant the services of 

these therapists/pathologists, but 

instead should lend support to or 

further the services provided by 

professional therapists/pathologists 

under the rehabilitation plan of 

treatment. Therefore, CORF nursing 

services are covered as CORF services 

only when provided by a RN and only 

to the extent that they support or are an 

adjunct to the rehabilitation services 

provided by professional therapists/ 

pathologists under the rehabilitation 

plan of treatment. 

In addition to above clarification 

regarding the coverage and provision of 

the listed CORF services, we would also 

like to clarify that CORFs cannot 

provide services that are not included in 

the definition of CORF services at 

§ 410.100 (other than vaccines) and that 

those services included in the definition 

of CORF services are covered only to the 

extent that they support or further the 

rehabilitation plan of treatment. For 

example, we believe that CORF services 

do not include the provision of 

hyperbaric oxygen services, infusion 

therapy services, or diagnostic sleep 

studies because they do not meet the 

definition of CORF services at § 410.100 

or they do not relate to the rehabilitation 

plan of treatment. We believe that these 

services and other services not 

specifically listed as CORF services may 

be covered under other categories of 

Medicare benefits, such as physician 

services and diagnostic services. 

Comment: One commenter asked us 

to clarify if a RN could perform 

respiratory therapy services in a CORF. 

Response: As we have discussed, we 

believe only professional therapists/ 

pathologists, such as PTs, OTs, SLPs, 

and RTs, may appropriately provide 

rehabilitation services, such as 

respiratory therapy services, and that it 

is inappropriate for an RN to provide 

these services. Therefore, respiratory 

therapy services provided by an RN are 

not considered CORF services under 

§ 410.100. Services performed by an RN 

may not substitute for or supplant the 

services of these therapists, but instead 

are covered as CORF services only to the 

extent that they support or are an 

adjunct to the rehabilitation services 

provided by professional therapists/ 

pathologists under the rehabilitation 

plan of treatment. 

We would like to clarify that any 

CORF nursing service must be provided 

by a RN and coded as G0128 indicating 

that CORF ‘‘nursing services’’ were 

provided. Services provided by an RN 

may only be billed as CORF nursing 

services, provided they meet the 

definition of CORF nursing services at 

§ 410.100(i). We are aware that some 

CORFs have billed RN services 

inappropriately as E/M services, such as 

CPT code 99211. In addition, we believe 

some physicians have inappropriately 

billed the services of CORF RNs as 

incident to physician services. Because 

CORF services are a distinct benefit 

category, and because any therapeutic 

and diagnostic services (as opposed to 

administrative and supervisory services) 

furnished by physicians are not CORF 

services, any service furnished by CORF 

personnel, including RNs, PTs, OTs, 

SLPs, and RTs, are not considered to be 

furnished incident to physicians’’

services, and thus cannot be billed as 

services incident to physician services. 

Therefore, the CORF nursing services of 

RNs may only be billed using G0128, 

provided that such services meet the 

definition of CORF nursing services at 

§ 410.100(i). 

Therefore, we are finalizing 

§ 410.100(i) as proposed. 

7. Drugs and Biologicals 

Section 410.100(k) currently provides 

that drugs and biologicals included 

within the definition of CORF services 

includes drugs and biologicals that are 

prescribed by a physician and 

administered by a physician or a CORF 

RN and not otherwise excluded from 

Medicare Part B payment under § 410.29 

(relating to self-administered drugs). In 

addition, in accordance with 

§ 410.105(c), drugs and biologicals 

administered to a CORF patient will be 

covered as CORF services only if 

included as part of the rehabilitation 

plan of treatment. However, we are 

unable to identify any physician 

prescribed drugs or biologicals that are 

not self administered that would be 

appropriately provided under a patient’s 

rehabilitation plan of treatment. We also 

expressed our concerns about the 

potential for duplicative billing for 

drugs and biologicals provided in the 

CORF setting because they could be 

billed by the CORF or the physician 

furnishing such drugs and biologicals. 

Therefore, we proposed to remove 

§ 410.100(k) and invited comments on 

this proposed revision, particularly on 

the appropriateness of including drugs 

and biologicals under a CORF patient’s 

rehabilitation plan of treatment. 

Comment: One commenter objected to 

the proposed removal of the provision 

for drugs and biologicals from the CORF 

benefit and believes there is an inherent 

risk that neither the CORF nor the 

physician would be paid for drugs and 

biologicals provided to CORF patients 

when they are purchased by the CORF. 

The commenter explained that, under 

our proposal, the CORF would no longer 

be permitted to submit claims for the 

drugs and biologicals they purchase, 

and further stated that, under this 

scenario, the physician also could not 

be compensated because the drug or 

biological provided in this manner 

would not satisfy the CMS incident to 

rules. The commenter questioned our 

concerns about the possibility of 

duplicative billing permitted under the 

current payment methodologies 

although they believe that we might be 

justified in our proposal should we have 

proof that both the CORF and physician 

are being paid for the same drug and 

biological. Until such time, the 

commenter requested we continue to 

permit both the CORF and the physician 

to submit claims for the drugs and 

biologicals provided to CORF patients. 

Another commenter also disagreed 

with our proposal to remove drugs and 

biologicals as a CORF service claiming 

that when the Congress created the 

CORF benefit, it ‘‘intended to create a 

new type of facility that could provide 

all of the services required by a patient 

in a coordinated fashion.’’ They also 

challenged our authority to remove this 

provision and believe that duplicative 

billing possibilities by the CORF and the 

physician administering the drug or 

biological is not cause for us to rewrite 

the statute. 

Response: The purpose of our 

proposal was not intended to deny 

patients access to or to avoid making 

payment for medically necessary drugs 

and biologicals. Because we proposed to 

make payment directly to physicians for 

the drugs and biologicals provided in 

the CORF setting, CORFs opting to 

continue purchasing these drugs and 

biologicals would not also be paid. 


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Nevertheless, we are persuaded by the 

commenter challenging our legal 

authority to remove drugs and 

biologicals from our regulatory 

definition of CORF services § 410.100 in 

light of their inclusion in the statutory 

definition of CORF services under 

section 1861(cc)(1) of the Act. As 

explained in the legislative history of 

the CORF statute, the intent of this 

benefit was to simplify coordination of, 

and access to, ‘‘a broad array of 

rehabilitation services’’ (H.R. Rep. No. 

96–1167, 96th Cong., 2nd Sess., at 375 

(1980). Although as discussed in the 

proposed rule, we have been unable to 

identify among currently available drugs 

or biologicals that are not selfadministered any such drugs or 

biologicals that appropriately may be 

included in as part of a rehabilitation 

plan of treatment, we cannot rule out 

the possibility that others will alert us 

to such drugs or biologicals or that 

future non self-administered drugs or 

biologicals appropriately may be 

included under a rehabilitation plan of 

treatment. Therefore, in order to ensure 

that, should we learn of any non selfadministered drugs or biologicals that 

appropriately may be included in a 

rehabilitation plan of treatment, we may 

give effect to Congressional intent that 

CORFs be able to provide any such 

drugs or biologicals in coordination 

with other CORF rehabilitation services, 

we will not remove the reference to 

drugs and biologicals from the 

definition of CORF services under 

§ 410.100 as proposed. 

Instead, we will retain the existing 

definition of CORF-covered drugs and 

biologicals provided at new § 410.100(j) 

(that is, the current § 410.100(k) is 

redesignated as § 410.100(j)) with the 

exception of adding the word ‘‘by’’ to 

the new § 410.100(j)(1) to clarify our 

policy that, in accordance with existing 

professional standards, the 

administration of the drug can by 

provided by a RN but not by others 

under the supervision of an RN. As we 

are not aware of any non-selfadministered drugs and biologicals that 

appropriately may be included in a 

rehabilitation plan of treatment, we 

intend to closely track the provision of 

drugs in the CORF setting. If in the 

future we learn that the administration 

of drugs or biologicals in the CORF 

setting is an appropriate service to 

include in the rehabilitation treatment 

plan, the regulatory framework will 

allow for coverage of such drugs or 

biologicals. In the mean time, we do not 

expect to see CORFs submitting claims 

for drugs and biologicals for the reasons 

noted above. 

8. Supplies and DME 

Payment for supplies and DME as part 

of CORF services is specified at 

§ 410.100(l) as ‘‘[s]upplies, appliances 

and equipment’’ and includes 

nonreusable supplies, medical 

equipment and appliances, and DME as 

defined in § 410.38 (except for renal 

dialysis systems). These are CORF 

covered services when provided for the 

patient’s use outside the CORF whether 

purchased or rented, and is paid under 

the DMEPOS fee schedule. We believe 

that the provision at § 410.100(l) is too 

broad, out of date, and inconsistent with 

current terminology used for covered 

services or items. The CORF provision 

at section 1861(cc)(1)(G) of the Act 

applies only to supplies and DME, yet 

the regulatory provision also 

encompasses medical equipment and 

appliances. Because we believe the 

requirements of § 410.100(l) are 

inconsistent with those of section 

1861(cc)(1)(G) of the Act, we proposed 

to revise both the title and description 

at new § 410.100(k) (that is, the current 

§ 410.100(l) is redesignated as 

§ 410.100(k)) by deleting reference to 

medical equipment and appliances to 

reflect the CORF statutory provision by 

including only the items specified 

under section 1861(cc)(1)(G) of the Act. 

[Note: The preamble discussion 

incorrectly noted this new section as 

§ 410.100(k) instead of § 410.100(j). 

Section 410.100(k) is correct in this final 

rule with comment period.] We also 

noted that DME, as well as prosthetics, 

orthotics, and supplies, provided in the 

CORF setting requires the CORF’s 

participation in the competitive bidding 

process, where applicable, in 

accordance with 42 CFR part 414 

subpart F. In this final rule with 

comment period, we have added 

language at § 414.1105(c)(2) to clarify 

that payment for DME, prosthetics, 

orthotics, and supplies determined 

under the DMEPOS competitive bidding 

program is a single payment amount, 

rather than an amount determined 

under a fee schedule. While a payment 

amount determined under a competitive 

bidding program is not generally 

thought of as a ‘‘fee schedule’’ for 

purposes of section 1834(k)(3) of the Act 

we believe the term refers to a single 

payment amount determined through an 

existing prospective payment system. 

The Congress amended the Act to 

replace reasonable cost-based payment 

for CORF services with prospective 

payments. Therefore, we believe the 

reference to ‘‘fee schedule’’ at section 

1834(k)(3) of the Act is meant to broadly 

refer to existing prospective payment 

systems for the CORF-covered services 

or items, including amounts determined 

prospectively under a competitive 

bidding program, and should not be 

referring only to ‘‘fee schedules’’ in the 

narrow sense. We did not receive 

comments, in support of or in 

opposition to, our proposal to specify 

the new § 410.100(k) to include only 

supplies and durable medical 

equipment as specified at section 

1861(cc)(G) of the Act in the CORF 

benefit provision. 

Therefore, we are finalizing 

§ 410.100(k) as proposed with the 

exception that we will add the revision, 

discussed above, regarding the single 

payment amount determined under the 

DMEPOS competitive bidding program. 

9. Clarifications and Payment Updates 

for Other CORF Services 

Section 4078 in the Omnibus Budget 

Reconciliation Act of 1987 (Pub. L. 100- 

203) (OBRA) amended section 

1861(cc)(1) of the Act to provide that 

there is no requirement that any item or 

service furnished by a CORF in 

connection with physical therapy, 

occupational therapy, and speech 

pathology services under the plan of 

treatment be furnished at a single fixed 

location; however, such items and 

services are covered as CORF services 

only if payment is not otherwise made 

under Medicare. In the CY 2008 PFS 

proposed rule, we noted that such items 

and services may be covered under the 

Medicare home health benefit 

established under sections 1861(g), (m), 

and (p) of the Act. Accordingly, 

physical therapy, occupational therapy, 

and speech-language pathology services 

provided in the home are not covered as 

CORF services if such services and 

related items are covered under the 

Medicare home health benefit. Because 

the CORF regulations were not revised 

to reflect these changes in coverage and 

payment methodology, we proposed to 

clarify the regulations at new 

§ 410.100(l) (that is, the current 

§ 410.100(m) which is redesignated as 

§ 410.100(l)) and § 410.105(b)(3) to 

reflect these requirements. 

In § 410.105(b)(3), we proposed to 

clarify that physical therapy, 

occupational therapy, and speechlanguage pathology services can be 

furnished in the patient’s home when 

payment for these therapy services is 

not otherwise made under the Medicare 

home health benefit. 

In addition, we proposed to revise 

§ 410.100(l) to clarify that the patient 

must be present during the home 

environment evaluation that is 

performed by the PT, OT or SLP, as 

appropriate, because we believe that the 

patient’s presence is necessary to fully 


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evaluate the potential impact of the 

home situation on the patient’s 

rehabilitation goals. 

Comment: Some commenters 

supported our proposal to clarify the 

CORF therapy services that can be 

provided in the home and who can 

provide these services. One of these 

commenters expressed concern about 

the requirement that the patient be 

present for the home environment 

evaluation and requested that we further 

clarify this proposal. 

Response: Section 1861(cc)(1)(H) of 

the Act states that there is no 

requirement for physical therapy, 

occupational therapy, or speechlanguage pathology services to be 

provided at a fixed location such as at 

the CORF’s physical location. This 

provision was further clarified in 

section 4078 of OBRA 1987 to clearly 

permit that, so long as the physical 

therapy, occupational therapy, or 

speech language pathology services are 

not otherwise covered under the 

Medicare home health benefit, these 

therapy services can be provided in the 

patient’s home. Section 410.105(b)(3) 

also provides that only physical 

therapy, occupational therapy, or 

speech-language pathology services can 

be provided offsite, in the patient’s 

home, and that all other CORF services 

must be provided in the CORF facility. 

We also proposed to clarify the 

provision at the new § 410.100(l) (that 

is, the current § 410.100(m) is 

redesignated as § 410.100(l)) regarding 

the provision of a single home 

environment evaluation, to include the 

presence of the patient, which can be 

performed by a PT, OT, or SLP, as 

appropriate. [Note: The preamble 

discussion incorrectly noted this new 

section as § 410.100(l) instead of section 

§ 410.100(k). Section 410.100(l) is 

correct in this final rule with comment 

period.] 

Therefore, we are finalizing the new 

§ 410.100(l) (that is, the current 

§ 410.100(m) is redesignated as 

§ 410.100(l)), as proposed. 

10. Cost Based Payment (§ 413.1) 

Section 413.1(a)(2)(iv) currently 

provides for cost-based payment for 

CORF services, which reflects the 

payment methodology provided for 

under section 1833(a) of the Act, 

requiring payment on the basis of the 

lesser of the provider’s reasonable costs 

or customary charges. As discussed 

above, this payment methodology is 

inconsistent with section 1834(k) of the 

Act, requiring that the payment basis for 

outpatient physical therapy services 

(including outpatient speech-language 

pathology services), outpatient 

occupational therapy services, and all 

other CORF services provided on or 

after January 1, 1999 be 80 percent of 

the lesser of: (1) The actual charge for 

the services; or (2) the applicable fee 

schedule amount. Therefore, we 

proposed to remove § 413.1(a)(2)(iv) to 

clarify that cost based payment is not 

applicable to CORF services. We also 

proposed to remove § 413.1(a)(2)(vi) for 

OPTs or rehabilitation agencies as 

referenced at section 1861(p) of the Act, 

because these providers were also 

affected by the same payment changes 

required by the 1997 BBA for physical 

therapy, occupational therapy, and 

speech-language pathology services 

effective for CY 1999. 

We did not receive comments to these 

technical corrections regarding the 

change in payment methodology for 

CORFs and OPTs that was effective CY 

1999. Therefore, we are finalizing the 

technical corrections to remove 

references to cost-based payment for 

CORFs and OPTs at § 413.1(a)(2)(iv) and 

(vi). 

11. Payment for Comprehensive 

Outpatient Rehabilitation Facility 

(CORF) Services 

In the CY 2008 PFS proposed rule, we 

proposed to establish a new regulatory 

subpart M at 42 CFR part 414 to specify 

the payment methodology for 

comprehensive outpatient rehabilitation 

services covered under Part B of Title 

XVIII of the Act that are described at 

section 1861(cc)(1) of the Act. 

Specifically, this proposed subpart 

would identify and describe how 

payment is determined for services 

included as CORF services under 

§ 410.100. 

Proposed § 414.1100 sets forth the 

basis and scope for payment for CORF 

services. Proposed § 414.1105 sets forth 

the payment methodology for CORF 

services, including identifying the 

applicable fee schedule for each type of 

CORF service identified in § 410.100. 

Section 1834(k)(1)(B) of the Act 

provides that the payment basis for 

CORF services is 80 percent of the lesser 

of: (1) the actual charge for the services; 

or (2) the applicable fee schedule 

amount. The term ‘‘applicable fee 

schedule amount’’ is defined under 

section 1834(k)(3) of the Act to mean, 

for services furnished in a year, the 

payment amount determined under the 

PFS established under section 1848 of 

the Act for such services for the year 

‘‘or, if there is no such fee schedule 

established for such services, the 

amount determined under the fee 

schedule established for such 

comparable services as the Secretary 

specifies.’’ Accordingly, we proposed at 

new § 414.1105(a) to base payment for a 

CORF service on 80 percent of the lesser 

of the actual charge or the PFS amount 

for the service when the PFS establishes 

a payment amount for such service. 

Payment for CORF services under the 

PFS is made for physical therapy, 

occupational therapy, speech-language 

pathology, and respiratory therapy 

services, as well as the related nursing 

and social and psychological services. 

In the CY 1999 PFS final rule (63 FR 

58860), we explained that we interpret 

section 1834(k)(3) of the Act, defining 

the term ‘‘applicable fee schedule 

amount,’’ as requiring us to use the 

payment amount established by an 

existing fee schedule other than the PFS 

when the PFS does not establish a 

payment amount for the CORF service. 

Therefore, in the CY 2008 PFS proposed 

rule we proposed at new § 414.1105(c) 

that payment for covered DME, orthotic 

and prosthetic devices and supplies 

provided by a CORF be based on the 

lesser of 80 percent of actual charges or 

the payment amount established under 

the DMEPOS fee schedule under 

sections 1834 and 1847 of the Act and 

in 42 CFR part 414, subparts D and F. 

Finally, we proposed at new 

§ 414.1105(d) that if there is no fee 

schedule amount established for a CORF 

service, payment shall be based on the 

lesser of 80 percent of actual charges or 

the amount determined under the fee 

schedule established for a comparable 

service, as specified by the Secretary. 

As discussed in section II.K.3., 

physician services included within the 

definition of CORF services under 

§ 410.100(a) are limited to those services 

of a CORF physician described as 

administrative in nature, to the 

exclusion of diagnostic and therapeutic 

services which are considered 

separately billable physician services. 

Medicare generally does not permit 

providers to separately bill for their 

administrative costs; rather, such costs 

typically are subsumed in the payment 

amounts for covered medical services 

and items furnished to Medicare 

beneficiaries. Under the PFS these costs 

are included in the payment amount as 

part of the indirect PEs that are reflected 

in the PE RVUs for each service and also 

captured as part of the post-visit work 

RVU component. Similarly, we believe 

payment to CORFs for the 

administrative duties of a CORF 

physician, required as a condition of 

participation at § 485.58(a), such as 

participating in patient case review 

conferences is subsumed within PFS 

payments to CORFs for physical 

therapy, occupational therapy, speechlanguage pathology, and respiratory 


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therapy services, and the related 

nursing, and social and psychological 

services. Generally, administrative costs 

associated with the provision of such 

services is incorporated into payment 

amounts established under the PFS 

through the PE RVUs representing the 

resources necessary to perform each 

service in the physician office or 

nonfacility setting. Therefore, we 

believe it unnecessary to separately 

compensate CORFs for CORF physician 

services given that such services are 

administrative in nature, and proposed 

at § 414.1105(b) not to separately pay 

CORFs for CORF physician services. 

To ensure that CORFs are not paid 

twice for CORF services, we proposed at 

new § 414.1105 to base payment for a 

CORF service on the applicable fee 

schedule amount only to the extent that 

payment for such service is not 

included in the payment amount for 

other CORF services. Accordingly, 

under proposed § 414.1105(c) a CORF 

could not bill separately for supplies 

included in the PE RVU component of 

the payment amount established for a 

service under the PFS. However, we 

noted that CORFs could bill separately 

for certain splint and cast supplies for 

the application of casts and strapping 

because these supplies have been 

removed from the payment amounts 

established under the PFS. We also 

noted that Medicare makes separate 

payment for surgical dressings, which 

are also referenced at section 1861(s)(5) 

of the Act, only when used by the 

beneficiary in his or her home. No 

separate payment is made when these 

surgical dressings are used in the CORF 

setting; rather the dressings’ costs are 

bundled into the payment amount 

established under the PFS for the 

provided services. 

For CORF services based on the 

payment amount determined under the 

PFS, we proposed at new 

§ 414.1105(a)(2) to use the PFS amount 

applicable to services furnished in a 

nonfacility setting, with no separate 

payment made for facility costs. We 

proposed to use the PFS nonfacility 

amount for CORF services in order to 

offset any costs of providing such 

services in the CORF setting. [Note: in 

the proposed rule we incorrectly 

referenced the codification of the 

regulation text under proposed subpart 

M as § 414.1001 or § 414.1101 rather 

than § 414.1105. However, the proposed 

regulation text was presented accurately 

as § 414.1105 in the ‘‘List of Subjects’’

under the proposed subpart.] 

Other than the objection discussed 

above in section II.K.7 regarding the 

proposed removal of the CORF 

provision for drugs and biologicals, we 

did not receive other comments about 

our proposal to create a regulatory 

provision to specify the payment 

methodologies for the CORF services 

identified at section 1861(cc)(1) of the 

Act. Therefore, we are finalizing our 

proposal to add a new regulatory 

provision defining the payment 

methodologies used to pay for CORF 

services except that we also include a 

section for payment of drugs and 

biologicals included within the 

definition of CORF services under the 

new § 410.100(j), as explained in section 

II.K.7. We will implement this proposal, 

including the addition of the payment 

provision for drugs and biologicals 

included within the definition of CORF 

services under the new § 410.100(j), and 

revise, by adding a new subpart M to 

part 414. The basis and scope for 

payment for CORF services is set forth 

at § 414.1100 and § 414.1105 sets forth 

the payment methodology for CORF 

services, including identifying the 

applicable fee schedule for each type of 

CORF service identified in § 410.100. 

12. Vaccines 

Section 485.51(a) defines a CORF as a 

nonresidential facility that ‘‘is 

established and operated exclusively for 

the purpose of providing’’ rehabilitation 

services by or under the supervision of 

a physician. Because vaccines 

administered in the CORF setting are 

not rehabilitation services furnished 

under a plan of treatment relating 

directly to the rehabilitation of the 

patient (or, presumably, even medically 

necessary for the rehabilitation of the 

patient), in accordance with § 485.51(a), 

a CORF may not administer vaccines to 

its patients. However, in the CY 2008 

PFS proposed rule we noted that 

nothing in the Medicare statute would 

prohibit a CORF from providing 

pneumococcal, influenza, and hepatitis 

B vaccines to its patients provided the 

facility is ‘‘primarily engaged in 

providing * * * diagnostic, therapeutic, 

and restorative services to outpatients 

for the rehabilitation of injured, 

disabled, or sick persons’’ (section 

1861(cc)(2)(A) of the Act). Accordingly, 

under the statute, such vaccines may be 

covered separately from the CORF 

services benefit under section 

1861(s)(10) of the Act—defining the 

term ‘‘medical and other health 

services’’ to include the pneumococcal, 

influenza, and hepatitis B vaccines—

provided the applicable conditions of 

coverage under § 410.58 and § 410.63 

are met. In order to include coverage 

and payment for these vaccines when 

provided to CORF patients in the CORF 

setting, we proposed to amend the 

CORF conditions of participation at 

§ 485.51 to permit CORFs to provide 

vaccines to their patients in addition to 

rehabilitation services. Such vaccines 

would be covered in the CORF setting 

provided the conditions of coverage 

under § 410.58 and § 410.63 are met. In 

accordance with sections 1833(a)(1) and 

1842(o)(1) of the Act, payment for 

covered pneumococcal, influenza, and 

hepatitis B vaccines provided in the 

CORF setting is based on 95 percent of 

the average wholesale price (AWP). 

Comment: We received a few 

comments strongly supporting the 

proposal to permit vaccines to be 

provided in the CORF setting in 

addition to the CORF services. These 

commenters also strongly supported our 

proposal to clarify our policy regarding 

the administration of vaccines to CORF 

patients by revising the CORF 

conditions of participation to permit the 

provision of vaccines, in addition to 

CORF services. These commenters 

believe that increasing the number and 

types of providers where vaccinations 

can be furnished will not only help to 

ensure increased access to these 

vaccinations but will result in improved 

health outcomes and lower costs. 

Response: We agree with the 

commenters and will implement our 

proposal to revise the CORF conditions 

of participation, accordingly. 

L. Compendia for Determination of 

Medically-Accepted Indications for OffLabel Uses of Drugs and Biologicals in 

an Anti-Cancer Chemotherapeutic 

Regimen (§ 414.930) 

1. Background 

a. Statutory Requirements 

Section 1861(t)(2)(B)(ii)(I) of the Act 

lists three drug compendia that may be 

used in determining the medicallyaccepted indications of drugs and 

biologicals used in an anti-cancer 

chemotherapeutic regimen. The three 

drug compendia listed are: 

• American Hospital Formulary 

Service-Drug Information (AHFS– DI) 

• American Medical Association Drug 

Evaluations (AMA–DE) 

• United States Pharmacopoeia Drug 

Information (USP–DI) 

Section 1861(t)(2) of the Act provides 

the Secretary the authority to revise the 

list of compendia for determining 

medically-accepted indications for 

drugs. Due to changes in the 

pharmaceutical reference industry, 

fewer of the statutorily named 

compendia are available for our 

reference. (That is, AMA–DE is no 

longer in publication; USP–DI has been 

purchased by Thomson Micromedex 

and it is our understanding that the 


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name ‘‘USP–DI’’ may not be used after 

2007.) 

Section 6001(f)(1) of the Deficit 

Reduction Act of 2005 (Pub. L. 109–171) 

(DRA) amends both ‘‘sections 

1927(g)(1)(B)(i)(II) and 1861(t)(2)(B)(ii)(I) 

of the Act by inserting ‘‘(or its successor 

publications)’’ after ‘United States 

Pharmacopeia Drug Information’.’’ We 

interpret this DRA provision as 

explicitly authorizing the Secretary to 

continue recognition of the 

compendium currently known as USP–

DI after its name change if the Secretary 

determines that it is in fact a successor 

publication rather than a substitute 

publication. 

b. Requests To Amend the Compendia 

Listings 

We received requests from the 

stakeholder community for recognition 

of additional compendia under the 

following authorities: 

• Section 1861(t)(2)(B) of the Act 

which allows the Secretary to identify 

additional authoritative compendia; and 

• Section 1873 of the Act which 

allows the Secretary to recognize a 

successor publication if one of the 

statutorily-named compendia changes 

its name. 

In contrast, others suggested that the 

Secretary consider elimination of 

certain listed compendia. However, as 

we stated in the CY 2008 PFS proposed 

rule (72 FR 38177), there was no 

established regulatory process by which 

we could accept and act definitively on 

such requests. In addition, we saw the 

need to increase transparency of 

decision making criteria. 

c. Technology Assessment of Drug 

Compendia Used To Determine 

Medically-Accepted Uses of Drugs and 

Biologicals in an Anti-Cancer 

Chemotherapeutic Regimen 

We commissioned a technology 

assessment (TA) from the Agency for 

Healthcare Research and Quality 

(AHRQ) on the currently listed 

compendia (AHFS and USP–DI), as well 

as other compendia (that is, National 

Comprehensive Cancer Network 

(NCCN), ClinPharm, DrugDex, Facts & 

Comparisons (F&C)) which might 

provide comparable information. AHRQ 

contracted the TA to the New England 

Medical Center (NEMC) and Duke 

Evidence-based Practice Centers (EPCs) 

and found little agreement in the 

evidence cited among drug compendia. 

In addition, the TA found little 

agreement between the EPCs’

independent identification of evidence 

on 14 example off-label indications and 

evidence cited in the drug compendia. 

The TA can be found at http:// 

www.cms.hhs.gov/ mcd/ 

viewtechassess.asp? 

where=index&tid=46. 

d. Medicare Evidence Development and 

Coverage Advisory Committee 

(MedCAC) 

On March 30, 2006, the MedCAC 

(formerly the Medicare Coverage 

Advisory Committee (MCAC)) met in 

public session to advise CMS on the 

evidence about the desirable 

characteristics of compendia to 

determine medically-accepted 

indications of drugs and biologicals in 

anti-cancer therapy and the degree to 

which the currently listed and other 

available compendia display those 

characteristics. All information on this 

MedCAC meeting can be found on the 

CMS Web site at http:// 

www.cms.hhs.gov/mcd/ 

viewmcac.asp?where=index&mid=33. 

The agenda included a presentation of 

the TA performed for AHRQ by staff of 

the NEMC and Duke EPCs, scheduled 

stakeholder presentations, as well as an 

opportunity to hear testimony from 

members of the audience. As is 

customary, the MedCAC panelists 

elicited additional information from the 

presenters and discussed the evidence 

in preparation for a formal vote. 

The MedCAC identified the following 

desirable characteristics: 

• Extensive breadth of listings. 

• Quick processing from application 

for inclusion to listing. 

• Detailed description of the evidence 

reviewed for every individual listing. 

• Use of pre specified published 

criteria for weighing evidence. 

• Use of prescribed published process 

for making recommendations. 

• Publicly transparent process for 

evaluating therapies. 

• Explicit ‘‘Not recommended’’ listing 

when validated evidence is appropriate. 

• Explicit listing and 

recommendations regarding therapies, 

including sequential use or combination 

in relation to other therapies. 

• Explicit ‘‘Equivocal’’ listing when 

validated evidence is equivocal. 

• Process for public identification 

and notification of potential conflicts of 

interest of the compendia’s parent and 

sibling organizations, reviewers, and 

committee members, with an 

established procedure to manage 

recognized conflicts. 

The MedCAC concluded that none of 

the compendia fully display the 

desirable characteristics. The voting 

results can be viewed at the same Web 

site provided previously for the 

MedCAC meeting. In addition the 

MedCAC noted significant variability 

among the compendia. There was no 

agreement among the panel members 

that any particular predetermined 

number of compendia was desirable. 

Participants in the meeting also 

discussed the clinical usefulness of drug 

compendia in the treatment of cancer. It 

was reported that oncologists do not 

rely on compendia when making 

treatment decisions, relying instead on 

published treatment guidelines, clinical 

trial protocols, or consultation with 

peers. 

Prior to the CY 2008 PFS proposed 

rule, we received, and reviewed, 

unsolicited comments from professional 

societies regarding additions and 

deletions to the listing of compendia for 

purposes of section 1861(t) of the Act. 

We received 46 public comments 

regarding these provisions on the CY 

2008 PFS proposed rule. 

2. Process for Determining Changes to 

the Compendia List 

A compendium for the purpose of this 

section is defined as a comprehensive 

listing of FDA-approved drugs and 

biologicals or a comprehensive listing of 

a specific subset of drugs and 

biologicals in a specialty compendium, 

for example, a compendium of anticancer treatment. A compendium: (1) 

Includes a summary of the 

pharmacologic characteristics of each 

drug or biological and may include 

information on dosage, as well as 

recommended or endorsed uses in 

specific diseases; (2) is indexed by drug 

or biological; (3) differs from a disease 

treatment guideline, which is indexed 

by disease. We believe that the use of 

compendia to determine medicallyaccepted indications of drugs and 

biologicals in the manner specified in 

section 1861(t)(2)(B)(ii)(I) of the Act is 

more efficiently accomplished if the 

information contained is organized by 

the drug or biological and if the listings 

are comprehensive. 

We proposed an annual process, 

incorporating public notice and 

comment, to receive and make 

determinations regarding requests for 

changes to the list of compendia used to 

determine medically-accepted 

indications for drugs and biologicals 

used in anti-cancer treatment as 

described in section 1861(t)(2)(B)(ii)(I) 

of the Act. The specific details of the 

proposed process were outlined in PFS 

CY 2008 proposed rule (72 FR 38118). 

We received the following comments on 

our proposed process. 

Comment: Several commenters 

remarked that we should correlate Part 

B and Part D compendia for consistency 

within the Medicare program. 

Response: The Social Security Act 

separately determines the Agency’s use 


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of authoritative compendia for specific 

programs. The use of any compendium 

for Part D or for Medicaid is beyond the 

scope of this regulation. 

Comment: Many commenters voiced 

concerns about the time line proposed 

by CMS to address requests for changes 

to the list of compendia. 

Response: We are striving to achieve 

a more expedient and predictable time 

line that will better serve the needs of 

those who care for Medicare 

beneficiaries. We have carefully 

considered the comments and made the 

following revisions: 

(1) In order to shorten the proposed 

timeline, CMS will not publish an 

annual notice for formal requests. 

(2) We expect to receive requests 

annually during a 30-day window 

starting January 15th. 

(3) We expect to post these complete 

requests received by March 15th for 

public notice and comment on the CMS 

Web site. 

(4) We will accept public comments 

for a 30 day period beginning on the day 

that the request is posted by CMS on the 

Web site. 

Comment: Some commenters 

suggested alternative review cycles 

including changing the annual review 

to: a rolling review process; an every 3- 

year review process; or an every 5-year 

review process. 

Response: We appreciate the 

commenters’ suggestions regarding 

alternative review cycles; however, at 

this time, we believe that an annual 

review cycle is the best balance of these 

suggestions to promote a publicly 

responsive review process. Due to the 

general stability of the compendium 

publishing market, an annual review 

process is sufficient. However, if we 

determine that the public interest would 

be served by an immediate compendia 

review, we reserve the right to internally 

generate a request at any time. 

Comment: Several commenters 

suggested specific additions to the list of 

compendia. 

Response: The addition or deletion of 

specific compendia is beyond the scope 

of this regulation. Formal requests for 

additions and deletions may be 

submitted during the annual open 

request period established in this final 

rule with comment period. 

Comment: The comments received 

from several associations and 

manufacturers stated that the language 

used for the individual desirable 

characteristics was not clear and that we 

did not give the appropriate 

consideration to quality concerns and 

the potential conflicts of interest. 

Response: We appreciate the 

commenters’ concerns and strive to 

provide clarity on the MedCAC 

desirable characteristics that we will 

utilize in the compendia review process. 

The characteristics presented here 

represent an evidence-based consensus 

from the MedCAC panel on the 

desirability and priority of those 

characteristics. We recognize that 

different compendia might attempt to 

achieve these characteristics in 

individualized ways. CMS plans to use 

the desirable characteristics as 

framework and guidance in the review 

process. However, we believe that the 

public interest is best served by CMS 

attention to the quality and the integrity 

of each compendium’s evidence 

evaluation process. 

Comment: A few commenters made 

the general suggestion for CMS to 

prioritize the desirable characteristics 

identified at the MedCAC meeting, 

March 2006. 

Response: We wish to clarify that the 

desirable characteristics recommended 

by the MedCAC will serve as guidance 

and a framework which will aid in the 

CMS review process. As stated in the 

CY 2008 PFS proposed rule, we ‘‘may 

consider additional reasonable factors in 

making a determination’’ as deemed 

appropriate. While we have decided not 

to rank the MedCAC desirable 

characteristics, we do consider the 

characteristics referencing transparency 

and conflict of interest to be of high 

priority to preserve the integrity and 

minimize bias during the review 

process. 

Comment: Some commenters stated 

that a deletion from the list of 

compendia could cause a beneficiary to 

lose coverage of an off-label treatment 

regimen already begun. 

Response: We understand the concern 

expressed by the commenters on a 

beneficiary’s loss of coverage during the 

continuance of off-label treatment in the 

absence of compendium support; 

however local contractors have 

additional authority to make 

determinations regarding medically 

accepted indications. While we require 

local contractors to use the compendia 

as a reference in the determination of 

‘‘medically-accepted’’ off-label 

treatment regimens, the compendia are 

not the sole reference for these 

determinations. Section 

1861(t)(2)(B)(ii)(II) of the Act provides 

that local contractors use ‘‘supportive 

clinical evidence in peer-reviewed 

medical literature’’ to aid in making 

determinations of ‘‘medically-accepted’’

off-label treatment regimens when 

appropriate. 

Comment: Commenters asked that we 

recognize compendia indexed by 

disease. 

Response: In order to meet our 

criteria, a compendium should: (1) 

Include a summary of the 

pharmacologic characteristics of each 

drug or biological and may include 

information on dosage, as well as 

recommended or endorsed uses in 

specific diseases; (2) be indexed by drug 

or biological; (3) differ from a disease 

treatment guideline, which is indexed 

by disease. We believe that the use of 

compendia to determine medicallyaccepted indications of drugs and 

biologicals in the manner specified in 

section 1861(t)(2)(B)(ii)(I) of the Act is 

more efficiently accomplished if the 

information contained is organized by 

the drug or biological and if the listings 

are comprehensive. 

Comment: Several commenters 

suggested that we should regulate a time 

frame for compendia to update their 

recommendations. 

Response: We believe that the public 

interest is served if compendia generally 

update their recommendations in a 

timely manner when new evidence 

regarding the use of drugs warrants an 

update. We also believe that this is 

consistent with spirit of the MedCAC’s 

recommendations. However, medical 

evidence on a particular use of a 

specific drug may at times be complex 

and inconsistent, and thus, merit a 

prolonged rather than an expedited 

analysis. We do not believe that we 

should establish in regulation a specific 

broad time line requirement at this time. 

However, we will consider public input 

regarding a compendium’s timely 

updating of its recommendations as an 

additional criterion in our compendium 

review process. 

Comment: We received comments 

suggesting that a compendium’s use of 

grades of evidence may add a confusing 

factor in determining whether a 

compendium citation supports a 

particular drug use. Commenters stated 

that it is desirable for a compendium to 

clarify in a summary recommendation 

whether it regards each drug use as 

medically-accepted. 

Response: We recognize and support 

the desirability of an explicit summary 

recommendation for each drug or 

biological cited in each compendium. 

This will facilitate the consistent 

interpretation of off-label 

recommendations by Medicare 

contractors. 

Comment: One commenter suggested 

that a recognized compendium should 

include and identify a well designed 

clinical trial that is pending FDA 

approval. 

Response: We do not believe that we 

can specify how a compendium 


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references materials regarding clinical 

trials for a drug not yet FDA-approved. 

Comment: Two commenters claimed 

that section 1861(t)(2) of the Act 

mandates separate processes for adding 

and removing compendia. 

Response: While we appreciate the 

thoughtful interpretation of the 

language, we do not agree separate 

processes are required by the statute. 

Comment: One commenter suggested 

that the identity of the members of the 

compendium’s advisory board and 

scientific review committee should 

become public record. The commenter 

also requested that we to establish a 

formal process to facilitate stakeholder/ 

compendia communication. 

Response: Public identification of 

members of the compendium’s advisory 

board and the scientific review 

committees and establishing a formal 

process for stakeholders/compendia 

communication is beyond our authority 

and scope of this regulation. 

Based on the public comments 

received, we have made revisions to the 

proposed compendia review process. 

We appreciate the need for a more 

expedient process to provide a useful 

compendia list for Medicare providers 

and have made the necessary changes. 

Requests may be submitted in two 

ways (no duplicates please). Electronic 

submissions are encouraged to facilitate 

administrative efficiency. We will 

identify the electronic address to be 

used for submissions. Hard copy 

requests can be sent to the Centers for 

Medicare & Medicaid Services, Coverage 

and Analysis Group, Mailstop C1–09–

06, 7500 Security Boulevard, Baltimore, 

MD, 21244. Please allow sufficient time 

for hard copies to be received prior to 

the close of the receipt period. 

We may consider additional 

reasonable factors in making a 

determination. (For example, we may 

consider factors that are likely to impact 

the compendium’s suitability for this 

use, such as but not restricted to a 

change in ownership or affiliation, 

suspension of publication, the standards 

applicable to the evidence considered 

by the compendium, and any relevant 

conflicts of interest. We may consider 

that broad accessibility by the general 

public to the information contained in 

the compendium may assist 

beneficiaries, their treating physicians, 

or both, in choosing among treatment 

options.) 

• We will also consider a 

compendium’s grading of evidence used 

in making recommendations regarding 

off-label uses and the process by which 

the compendium grades the evidence. 

• We may, at our discretion, combine 

and consider multiple requests that refer 

to the same compendium, even if those 

requests are for different actions. This 

facilitates administrative efficiency in 

our review of requests. 

• We will notify the public of 

additions or deletions to the list of 

compendia on the CMS Web site. 

• In keeping with our desire to 

shorten the compendia review time line, 

we will publish our decision no later 

than 90 days following the close of the 

public comment period. 

M. Physician Self-Referral Issues 

1. General 

In the CY 2008 PFS proposed rule (72 

FR 38122), we proposed several 

revisions to the physician self-referral 

regulations. We also solicited comments 

regarding potential changes to or 

limitations on the use of the in-office 

ancillary services exception in 

§ 411.355(b). We received 

approximately 1100 pieces of timely 

correspondence in response to these 

proposals. 

We received the following comments 

regarding finalizing our proposals: 

Comment: Many commenters were 

concerned about the perceived 

complexity and breadth of the physician 

self-referral proposals. Several 

commenters questioned our ability to 

analyze sufficiently, and give adequate 

consideration to, the public comments 

due to the brief time period between 

issuance of the CY 2008 PFS proposed 

rule (72 FR 38122) and the statutory 

deadline for publication of this final 

rule with comment period. Some 

commenters suggested that we not 

finalize any of the proposals at this 

time. Many of those commenters 

asserted that we should further 

contemplate the issues and propose 

revised regulatory provisions in the CY 

2009 PFS proposed rule if we continue 

to believe that such revisions are 

necessary. 

Response: We are not inclined to 

follow the commenters’ suggestion 

regarding reproposal of the physician 

self-referral provisions in the CY 2009 

PFS proposed rule. However, given the 

number of physician self-referral 

proposals, the significance of the 

provisions both individually and in 

concert with each other, and the volume 

of public comments, we do not believe 

it is prudent to finalize any of the 

proposals in this rule (except for the 

proposal for anti-markup provisions for 

diagnostic tests, as discussed below in 

this section). Although we are not 

finalizing the proposed revisions to the 

other physician self-referral regulations 

in this final rule with comment period, 

we are confident that we have sufficient 

information, both from the commenters 

and our independent research, to 

finalize revisions to the physician selfreferral regulations without the need for 

new proposals and additional public 

comment. We intend to publish a final 

rule that addresses the following 

proposals: 

• Burden of proof; 

• Obstetrical malpractice insurance 

subsidies; 

• Unit-of-service (per-click) payments 

in lease arrangements; 

• The period of disallowance for 

noncompliant financial relationships; 

• Ownership or investment interests 

in retirement plans; 

• ‘‘Set in advance’’ and percentagebased compensation arrangements; 

• ‘‘Stand in the shoes’’ provisions; 

• Alternative criteria for satisfying 

certain exceptions; and 

• Services furnished ‘‘under 

arrangements.’’ Because we did not 

make a specific proposal regarding the 

in-office ancillary services exception, 

but rather merely solicited comments 

regarding its scope and application, any 

revisions to the exception in 

§ 411.355(b) will be accomplished 

through a future notice of proposed 

rulemaking with provisions for public 

comment. 

A measured, thoughtful approach to 

the final physician self-referral rules is 

critical. We believe that the future 

rulemaking will address the public 

comments and present a coordinated, 

comprehensive approach to 

accomplishing the goals described in 

the proposed rule, namely, minimizing 

the threat of program and patient abuse 

while providing sufficient flexibility to 

enable those who are parties to financial 

arrangements to satisfy the requirements 

of, and remain in compliance with, the 

physician self-referral law and the 

exceptions thereto. 

2. Changes to Reassignment and 

Physician Self-Referral Rules Relating to 

Diagnostic Tests (Anti-Markup 

Provisions) 

Medicare regulations currently 

prohibit the markup of the technical 

component (TC) of certain diagnostic 

tests that are performed by outside 

suppliers and billed to Medicare by a 

different individual or entity (§ 414.50). 

In addition, Medicare program 

instructions restrict who may bill for the 

professional component (PC) (the 

interpretation) of diagnostic tests 

(Section 30.2.9.1 of the CMS InternetOnly Manual, Publication 100–04, 

Medicare Claims Processing Manual, 

Chapter 1, general billing requirements, 

as amended or replaced from time to 

time). 


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1We note that, in our proposals, we used the term 

‘‘billing entity’’ to refer to a billing physician or 

medical group. In this final rule with comment 

period, the anti-markup provisions potentially 

apply to TCs and PCs billed by any supplier; 

therefore, we use the terms ‘‘billing physician or 

other supplier’’ and ‘‘billing supplier.’’ These terms 

are used interchangeably. 

In the CY 2007 PFS proposed rule (71 

FR 48982), we stated that recent changes 

to our rules on reassignment concerning 

the right to receive Medicare payment 

may have led to some confusion as to 

whether the anti-markup and purchased 

interpretation requirements apply in 

certain situations where a reassignment 

has occurred pursuant to a contractual 

arrangement. In addition, we expressed 

concern about the existence of certain 

arrangements that we believe are not 

within the intended purpose of the 

physician self-referral exception for inoffice ancillary services, which permits 

physician group practices to bill for 

certain services referred by group 

physicians and furnished by a 

contractor physician in a ‘‘centralized 

building.’’ We also expressed concern 

that allowing physician group practices 

or other suppliers to purchase or 

otherwise contract for the provision of 

diagnostic testing services and to then 

realize a profit when billing Medicare 

may: (1) Lead to program and patient 

abuse in the form of overutilization of 

services; and (2) result in higher costs to 

the Medicare program (71 FR 49054). In 

the CY 2007 PFS proposed rule, we 

proposed to amend § 424.80 to provide 

that, if the TC of a diagnostic test (other 

than a clinical diagnostic laboratory test 

paid under section 1833(a)(2)(D) of the 

Act, which is subject to the special rules 

set forth in section 1833(h)(5)(A) of the 

Act) is billed by a physician or medical 

group (the ‘‘billing entity’’) under a 

reassignment involving a contractual 

arrangement with a physician or other 

supplier who performs the service, the 

amount billed to Medicare by the billing 

entity would be limited. We also 

proposed that, to bill for the TC, the 

billing entity would be required to 

perform the interpretation. In addition, 

we considered imposing certain 

conditions on when a physician or 

medical group can bill for the 

reassigned PC of a diagnostic test. For 

our physician self-referral rules, we 

proposed to modify the definition of 

‘‘centralized building’’ at § 411.351. 

Finally, we solicited comments on the 

specific application of our proposals. 

(See the CY 2007 and CY 2008 PFS 

proposed rules for more information on 

these proposals (71 FR 49054 through 

49057 and 72 FR 38179 through 38180, 

respectively).) 

We received numerous comments on 

the proposals in the CY 2007 PFS 

proposed rule. Because we decided to 

study the issues further, we did not 

finalize our proposals in the CY 2007 

PFS final rule with comment period. 

Rather, based on the comments received 

and other information that we 

considered, in the CY 2008 PFS 

proposed rule, we proposed to impose 

an anti-markup limitation on the TC and 

PC of diagnostic tests. We stated that we 

would apply the anti-markup provision 

irrespective of whether: (1) The billing 

entity outright purchases the TC or the 

PC; or (2) the physician or other 

supplier performing the TC or PC 

reassigns his or her right to bill the 

Medicare program to the billing entity 

(unless the performing supplier is a fulltime employee of the billing entity). 

That is, we proposed to limit the 

payment to the billing entity to the 

lowest of: (1) The performing 

physician’s or other supplier’s net 

charge to the billing entity; (2) the 

billing entity’s actual charge; or (3) the 

fee schedule amount for the service that 

would be allowed if the physician or 

other supplier performing the service 

billed directly. To prevent gaming, 

whereby the performing physician’s or 

other supplier’s net charge to the billing 

entity is inflated to cover the cost of 

equipment or space that is leased by the 

billing entity to the performing 

physician or other supplier, we stated 

that we would define ‘‘net charge’’ as 

exclusive of any amount that takes into 

consideration such charges. 

We also stated that we were 

concerned that overutilization of 

diagnostic tests could continue despite 

our proposal to apply an anti-markup 

provision to TCs that are reassigned to, 

or outright purchased by, group 

practices. That is, we intended to 

address the situation in which the TC is 

performed by a part-time or leased 

employee of the group practice in a 

‘‘centralized building,’’ and the group 

neither receives a reassignment from the 

employee technician (if the technician 

is not able to bill for the TC in his or 

her own right), nor purchases the TC 

outright from the technician. Therefore, 

we proposed to apply an anti-markup 

provision to TCs that are performed in 

a centralized building, and sought 

comments on whether we should have 

such a provision and, if so, how we 

should effect such a provision (for 

example, by amending the definition of 

‘‘centralized building’’ or through some 

other means). We stated that we would 

except from the anti-markup provision 

PCs performed by a physician pursuant 

to an arrangement with an independent 

laboratory as we do not believe that 

such PCs ordered by an independent 

laboratory pose a significant risk of 

program abuse because the independent 

laboratory does not order the diagnostic 

test. We proposed revisions to § 424.80 

(reassignments) and § 414.50 (purchased 

diagnostic tests). (We did not propose 

regulatory text revisions for our 

proposals to apply an anti-markup 

provision to TCs that are performed in 

a centralized building, and not apply 

the anti-markup provision to PCs billed 

by independent laboratories whose 

personnel do not order the diagnostic 

test.) 

Many commenters supported our 

proposals to prohibit the markup of the 

TC and PC of diagnostic tests in order 

to prevent physicians, physician group 

practices, and medical groups from 

profiting through the ordering of such 

tests. Commenters that supported our 

proposals often cited a concern about 

overutilization. Many commenters were 

opposed to our proposals. These 

commenters stated that the Medicare 

program and its beneficiaries are better 

served by physicians who refer tests to 

specialists (such as pathologists who 

contract directly with group practices), 

instead of physicians who use large 

reference laboratories. These 

commenters asserted that, because 

physicians develop a working 

relationship with particular 

pathologists, and because the 

pathologists ‘‘specialize’’ in a particular 

type of biopsy (for example, prostate 

biopsies), results are obtained more 

quickly and quality is enhanced. 

Finally, most commenters who 

responded to our proposal to apply an 

anti-markup to reassignments from parttime employees, irrespective of whether 

they were in support generally of our 

proposals, opposed this specific 

proposal. 

After careful consideration of all of 

the comments, we are adopting our 

proposals, with modification. We are 

imposing an anti-markup provision on 

TCs of diagnostic tests that are ordered 

by the billing physician or other 

supplier (or ordered by a party related 

by common ownership or control to 

such billing supplier), if the TC is 

outright purchased or if the TC is 

performed at a site other than the office 

of the billing physician or other 

supplier.1 (For purposes of the antimarkup provisions, the ‘‘office of the 

billing physician or other supplier’’ has 

its common meaning. The term is 

defined at revised § 414.50(a)(2)(iii) as 

space where the physician or other 

supplier regularly furnishes patient 

care. With respect to a billing physician 

or other supplier that is a physician 


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organization (as defined at § 411.351 of 

this chapter), the ‘‘office of the billing 

physician or other supplier’’ is space in 

which the physician organization 

provides substantially the full range of 

patient care services that the physician 

organization provides generally.) We are 

also imposing an anti-markup provision 

on PCs of diagnostic tests that are 

ordered by the billing physician or other 

supplier (or ordered by a party related 

by common ownership or control to 

such billing supplier), if the PC is 

outright purchased or if the PC is not 

performed in the office of the billing 

physician or other supplier. Also, parttime employees are treated no 

differently than full-time employees or 

contractors who reassign benefits. 

We are primarily revising § 414.50, 

although we have also revised § 424.80 

by adding (d)(3) to alert the reader that, 

in the case of the reassignment of the TC 

or PC of a diagnostic test, the reader 

should consult § 414.50 to investigate 

whether the anti-markup provisions 

apply to the TC or PC. We are also 

revising our definition of ‘‘entity’’ at 

§ 411.351, which is relevant to our rules 

on physician self-referral. Currently, the 

definition of ‘‘entity’’ provides an 

exception for a physician’s practice 

when it bills Medicare for a diagnostic 

test in accordance with § 414.50. We are 

revising the definition of ‘‘entity’’ at 

§ 411.351 to exclude a physician’s 

practice when it bills Medicare for the 

TC or PC of a diagnostic test in 

accordance with § 414.50. 

Examples of the application of the 

final provisions to particular facts 

appear immediately below, followed by 

a discussion of the specific comments 

we received on our proposals. We note 

that the following examples are 

intended only to illustrate the 

application of the anti-markup 

provisions of this final rule with 

comment period; they are not intended 

to address whether the physician selfreferral rules would prohibit payment 

due to financial relationships that may 

exist between the billing supplier and 

any physician ordering a test or 

performing the TC or PC of a test. 

Example 1. A urology group practice 

contracts with a leasing company that 

supplies a technician and a pathologist to 

perform testing on prostate samples. The 

technician performs the tissue sampling and 

the pathologist reads the slides. All work is 

done outside of the office of the billing group 

practice, and instead is performed in space 

that is rented exclusively ‘‘24/7’’ by the 

group practice (thus meeting the definition of 

a ‘‘centralized building’’ at § 411.351) for the 

sole purpose of providing pathology services 

for the group’s patients. Because the 

centralized building does not qualify as ‘‘the 

office of the billing physician or other 

supplier,’’ the anti-markup provisions apply 

to both the TC and the PC, and the group may 

bill Medicare the lowest of the following: (1) 

The leasing company’s net charge to the 

group; (2) the group’s actual charge; or (3) the 

fee schedule amounts for the TC and 

interpretation that would be allowed if the 

leasing company were enrolled in and billed 

Medicare directly. 

Example 2. Same as Example 1, except that 

the TC and PC are performed by the group 

practice’s employee technician and a 

pathologist who is an independent contractor 

of the group practice, respectively. Here, the 

anti-markup provisions again apply to both 

the TC and the PC because the work was not 

done in the ‘‘office of the billing physician 

or other supplier’’ (that is, the office of the 

group practice). It does not matter that the 

technician is an employee and the 

pathologist is an independent contractor 

because the work was not performed in the 

office of the billing group practice. 

Example 3. A physician in a group practice 

orders a diagnostic test and a technician who 

is a part-time employee of the group performs 

the test in the group’s office. A physician 

who is an independent contractor of the 

group performs the PC in the group’s office 

and reassigns his or her right to payment to 

the group. The anti-markup provisions do not 

apply to the group’s billing of the TC or the 

PC. 

Example 4. Same as Example 3, except that 

the independent contractor physician 

performs the PC in his or her home and 

reassigns his or her right to payment to the 

group. The group’s billing of the TC is not 

subject to the anti-markup provision, but the 

group’s billing of the PC is subject to the antimarkup provision because the work was not 

performed in the office of the billing 

supplier. 

Example 5. A group practice purchases 

both a diagnostic test and its interpretation 

from a laboratory and bills the TC and PC to 

Medicare. The anti-markup provisions apply 

to both the TC and the PC. Because the TC 

and the PC were purchased, the location(s) at 

which the TC and the PC were performed 

does not matter. 

Example 6. A group practice orders a 

diagnostic test from an independent 

laboratory. The laboratory performs the test 

and contracts with a physician to perform the 

PC. The laboratory bills Medicare for both the 

TC and the PC. The laboratory is not subject 

to the anti-markup provision for the PC, 

because the laboratory did not order the test. 

Example 7. Same as Example 6, except that 

a physician orders a diagnostic test from an 

independent diagnostic testing facility 

(IDTF). The IDTF bills Medicare for both the 

TC and the PC of the test. The anti-markup 

provisions do not apply because the IDTF did 

not order the test. 

a. Authority 

Comment: Several commenters 

questioned whether we have the 

authority pursuant to section 1842(n) of 

the Act to impose an anti-markup 

provision as described in the CY 2008 

PFS proposed rule. The commenters 

specifically noted that, in section 

1842(n) of the Act, the Congress 

directed the Secretary to impose an antimarkup on the TC of diagnostic tests, 

yet our proposal applied to the TC and 

the PC of diagnostic tests. Commenters 

stated that the interpretation of a 

diagnostic test is a physician service, 

and that section 1848 of the Act 

mandates that physician services be 

paid the lesser of the billing physician’s 

actual charge or the fee schedule 

amount, and therefore, we have no 

authority to extend the anti-markup rule 

to physician services. 

Response: We believe that several 

provisions of the Medicare statute 

provide us with the requisite authority 

to impose anti-markup provisions on 

the TC and PC of certain diagnostic 

tests. Section 1842(n)(1)(A) of the Act, 

which was enacted as part of the 

Omnibus Budget Reconciliation Act of 

1987, provides that, if the diagnostic test 

was not performed or supervised by the 

billing physician and also was not 

performed or supervised by a physician 

with whom the billing physician shares 

a practice, the Medicare payment is the 

lower of the costs (net of any discount) 

charged by the performing supplier to 

the billing physician, or the performing 

supplier’s reasonable charge (or other 

applicable limit). This is commonly 

known as the anti-markup provision. 

Although, to date, this statutory 

provision has been implemented 

through the regulation in § 414.50 that 

imposes an anti-markup provision on 

the TC only of a diagnostic test, nothing 

in this section limits our authority to 

apply this section to the PC of a 

diagnostic test. 

Moreover, we believe that we can 

interpret the language ‘‘shares a 

practice’’ as giving us the authority to 

impose an anti-markup provision on the 

TC of tests that are outright purchased 

by a billing physician or group, as well 

as on the TC of tests for which payment 

is reassigned to the billing physician or 

group. Although we previously 

implemented this statutory provision 

through regulation in § 414.50 by 

enacting an anti-markup provision on 

the TC of ‘‘purchased’’ diagnostic tests 

from an outside supplier, the statutory 

provision does not speak in terms of 

‘‘purchased’’ tests. In the intervening 

time since CMS promulgated the 

regulation in § 414.50, other changes to 

the Medicare program, in particular, the 

changes made by section 952 of the 

MMA to the reassignment exceptions 

authority, have created incentives for 

conduct that we believe increases the 

risk of overutilization and abuse of the 

Medicare program. We believe that the 

language ‘‘shares a practice’’ in section 

1842(n)(1) of the Act can cover not just 


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tests that are outright purchased, but 

also tests for which payment is 

reassigned to the billing supplier. We 

are amending § 414.50 in this final rule 

to provide that TCs and PCs that are not 

performed in the office of the billing 

physician or other supplier are subject 

to the anti-markup provision. We 

believe that, if the TC or PC is not 

purchased and is performed in the office 

of the billing supplier by an employee 

(whether full-time or part-time) or an 

independent contractor who reassigns 

benefits, a sufficient nexus with the 

practice of the billing supplier (that is, 

the billing physician or group) is 

established such that the employee or 

independent contractor may be viewed 

as ‘‘sharing a practice’’ with the billing 

supplier for purposes of section 

1842(n)(1) of the Act. In addition, we 

believe that we have authority under 

sections 1102(a) and 1871(a) of the Act 

(our general rulemaking authority) to 

impose anti-markup provisions on the 

TC and PC of diagnostic tests in order 

to fully effectuate the Congress’ intent in 

enacting section 1842(n)(1) of the Act. 

We find additional authority in 

section 1842(b)(6) of the Act. This 

section generally prohibits Medicare 

payment to anyone other than the 

Medicare beneficiary or the physician or 

other person who furnished the item or 

service to the beneficiary. We allow a 

physician or other supplier to bill for 

tests and test interpretations that are 

purchased from an outside supplier 

because we have deemed the test or 

interpretation to be performed by the 

billing supplier; however, we are not 

required to deem the test or 

interpretation as having been performed 

by the billing supplier, nor are we 

required to do so without placing limits 

on the amount the purchasing supplier 

may bill. Likewise, whereas section 

1842(b)(6) of the Act also provides 

exceptions (known as the reassignment 

exceptions) to the general rule that 

payment may be made only to the 

beneficiary or the physician or other 

person who furnished the item or 

service, such exceptions allow us 

(‘‘payment may be made’’), but do not 

require us, to make payment to an 

individual or an entity other than the 

beneficiary or the physician or other 

person who furnished the item or 

service to the beneficiary. (We note that 

the Congress specifically provided for 

CMS to implement safeguards in the 

context of reassignments pursuant to a 

contractual arrangement. Section 952 of 

the MMA permitted Medicare to pay a 

physician or entity billing for an item or 

service as a result of a reassignment 

created pursuant to a contractual 

arrangement, regardless of the site of 

service. However, in section 952 of the 

MMA, the Congress specifically 

authorized the Secretary to subject such 

arrangements to ‘‘such program integrity 

and other safeguards as the Secretary 

may determine to be appropriate.’’) 

Therefore, we believe that we have 

ample authority under section 

1842(b)(6) of the Act to place 

restrictions on the billing of tests and 

interpretations when the tests or 

interpretations were performed by 

someone other than the billing supplier, 

particularly with respect to situations in 

which there is the potential for 

overutilization. 

We do not view the application of the 

anti-markup provision to the PC of 

diagnostic tests as representing a 

conflict with section 1848 of the Act as 

stated by the commenters. Although 

section 1848 of the Act does outline 

how physician services will be paid in 

the typical situation, section 1848 of the 

Act does not preclude us from setting 

conditions on physician payment or 

from deviating from the payment 

methodology outlined in section 1848 of 

the Act where a physician or other 

supplier is seeking to take advantage of 

a special situation made available to 

physicians or other suppliers by CMS. 

Payment pursuant to the terms of 

section 1848 of the Act is available for 

all the diagnostic tests in question. 

Physicians and other suppliers are free 

not to take advantage of the purchased 

test option or the reassignment option, 

and bill and receive payment only for 

tests they have personally performed. 

Where physicians and other suppliers 

choose to take advantage of these 

options, for purposes of convenience or 

for other reasons, we have the authority 

under our general rulemaking authority 

in sections 1102(a) and 1871(a) of the 

Act, as well as under our authority to set 

conditions for the payment of purchased 

and reassigned tests in section 

1842(b)(6) of the Act, to promulgate 

rules to ensure that these options do not 

increase the likelihood of Medicare 

program abuse. 

b. Scope of Application of the AntiMarkup Provisions 

Comment: One commenter offered 

alternatives to our proposals. The 

commenter stated that, at least initially, 

the anti-markup provisions should 

apply exclusively to gastroenterology, 

dermatology, and urology physician 

group practices because those 

specialties order a significant number of 

pathology tests. The commenter 

suggested that we could subsequently 

broaden application of the anti-markup 

provisions to the extent that ‘‘new 

abusive’’ arrangements develop. 

Alternatively, according to the 

commenter, CMS could define the 

specialties to which the anti-markup 

provisions would apply on the basis of 

objective criteria. For example, the antimarkup provisions could apply to group 

practices billing for pathology services 

where at least 75 percent of the 

members are from a single nonpathology 

specialty and where at least 75 percent 

of the pathology services billed by the 

group practice were ordered by 

members of the group. The commenter 

asserted that such a definition should 

cover most of the abusive arrangements 

that have developed in recent years. The 

commenter urged us to impose a broad 

prohibition on profiting from pathology 

tests, which would apply without regard 

to whether the histotechnologists are 

full-time employees or independent 

contractors of the group practice. 

According to the commenter, a 

prohibition on profiting could be 

accomplished by prohibiting any 

markup over the direct costs incurred by 

the group practice in providing such 

services, and direct costs should be 

limited to the compensation paid to the 

persons providing the services and the 

cost of the equipment and supplies 

utilized in performing the services. 

Finally, the commenter suggested the 

alternative of amending the 

requirements for ‘‘group practices’’ in 

§ 411.352 to prohibit gastroenterology, 

dermatology and urology group 

practices from profiting from Medicare 

payments for pathology services 

performed within the group practice. 

Response: We decline to adopt any of 

the approaches suggested by the 

commenter. The anti-markup provisions 

in this final rule with comment period 

apply to group practices (as well as all 

other suppliers) regardless of specialty. 

We believe that making the rule 

applicable to all suppliers ensures fair 

and equitable treatment among types of 

suppliers and also ensures that the 

potential for overutilization is addressed 

regardless of the particular type of 

supplier involved. As we discuss in 

greater detail below, we agree with the 

commenter that it should not matter 

whether the person performing the TC 

is a full-time employee, part-time 

employee or independent contractor. If 

the TC (or PC) is purchased, or if it is 

performed in a place other than the 

office of the billing supplier, the antimarkup provision will apply, 

irrespective of the employment status of 

the person performing the TC (or PC). 

We are not revising the requirements for 

‘‘group practices’’ at § 411.352 at this 

time. We did not propose to amend 


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these provisions and believe that such a 

change would be outside the scope of 

the proposed rulemaking. 

Comment: A commenter suggested 

that we consider an anti-markup 

provision that would apply to any group 

practice where at least 90 percent of the 

practice is comprised of a single 

specialty other than pathology that 

orders the pathology tests billed by the 

group. The anti-markup rule should 

prohibit the markup of the direct costs 

incurred by the group (such as 

compensation paid to the 

histotechnologists and pathologists, and 

equipment and supplies utilized). 

Response: We believe that the 

commenter’s suggestion would be 

cumbersome and difficult to administer, 

and therefore, we are not persuaded to 

adopt it. We believe that the antimarkup rules that we have finalized are 

much more practical and will be an 

effective deterrent to the ordering of 

medically unnecessary tests. 

Comment: One commenter stated that 

the anti-markup provisions should 

apply equally to all physicians, 

including pathologists. The commenter 

noted that, in some cases, a pathologist 

performing the PC purchases the TC 

from a hospital or another pathology 

laboratory and bills globally. In 

addition, the commenter asserted that it 

is a myth to say that pathologists do not 

order tests and, therefore, should be 

exempt from the proposed anti-markup 

provision applicable to the PC of a 

diagnostic test. Another commenter 

stated that there is no more likelihood 

of abuse in specialty physician-owned 

pathology laboratories than with 

pathology groups ordering expensive 

and unneeded special tests and stains 

on specimens that they then interpret in 

the pathology group-owned histology 

laboratory. 

Response: The revisions to § 414.50 

and § 424.80 concerning the antimarkup requirements apply equally to 

all physicians, including pathologists. 

We recognize that, in some situations, a 

pathologist may order additional tests to 

be performed by an outside pathologist. 

Where a pathologist orders and bills for 

a test that he or she did not personally 

perform, the anti-markup provisions 

may apply to the TC or PC, or both 

(depending on whether the TC or PC 

was purchased or, if not, whether the 

TC or PC was performed in the 

pathologist’s office). If the pathologist 

did not order the test, the anti-markup 

rules do not apply. 

Comment: One commenter requested 

clarification that § 414.50 applies only 

to physicians and medical groups, and 

not to suppliers, such as medical 

foundations, that, under State laws 

governing the corporate practice of 

medicine, are required to enroll in Part 

B as a clinic or group practice. The 

commenter asserted that, in States 

prohibiting the corporate practice of 

medicine, many suppliers enrolled as a 

clinic or group practice are unable to 

directly employ the radiologist or other 

physician who performs a test 

interpretation. 

Response: In this final rule with 

comment period, we are revising 

§ 414.50 to apply to all suppliers. 

However, the anti-markup provisions do 

not apply to TCs and PCs that are not 

purchased and that are performed in the 

office of the billing physician or other 

supplier. Therefore, in the commenter’s 

example, if clinic personnel order, for 

example, the TC and PC, and the TC and 

PC are performed in the clinic’s office, 

neither the TC nor the PC will be subject 

to the anti-markup provisions. 

Comment: Two commenters asserted 

that IDTFs operate similarly to 

independent laboratories in that the 

tests are ordered by a financially 

independent physician. The 

commenters also said that the physician 

performing the interpretation sees the 

patient. Therefore, the commenters 

recommended that we provide an 

exception to the proposed anti-markup 

rules for purchased interpretations for 

imaging suppliers, such as IDTFs, if the 

current purchased interpretation rules 

are met. 

Response: We are not persuaded to 

provide an exception to the final antimarkup provisions for purchased 

interpretations for imaging suppliers if 

the current purchased interpretation 

rules are met. We note that, if the 

interpreting physician sees the patient, 

the purchased interpretation rules are 

not fully met. Therefore, the imaging 

supplier is not satisfying all of the 

purchased interpretation rules, and the 

imaging supplier should only bill for the 

TC portion of the test. 

Comment: One commenter requested 

clarification that the anti-markup 

proposals do not apply to radiologists 

who have contractual arrangements 

with IDTFs. The commenter asserted 

that radiologists and IDTFs are not in a 

position to refer to each other or to 

themselves because both are dependent 

upon referrals from other physicians in 

the community. Another commenter 

asked us to clarify that the anti-markup 

for the PC will not apply to an IDTF that 

purchases the PC from the interpreting 

physician, particularly in States in 

which the corporate practice of 

medicine doctrine applies. Another 

commenter stated that the anti-markup 

provision for the PC should not be 

applied to physicians or group practices 

that bill for the professional services 

performed by an independent contractor 

or part-time employee if those services 

were performed pursuant to the order of 

another practitioner who is independent 

of the group, and thus would not profit 

from his or her referral. 

Response: As finalized, the antimarkup provisions are applicable to all 

types of suppliers. However, in the 

situation in which an IDTF, radiology 

practice, or other supplier does not 

order the diagnostic test, the anti 

markup provisions do not apply. 

Comment: A few commenters 

questioned whether the proposed antimarkup provision, for the PC of 

diagnostic tests, would apply to IDTFs 

that purchase the PC from an 

interpreting physician, particularly in 

States where the corporate practice of 

medicine prohibits an IDTF from hiring 

the physician as an employee. 

Response: The anti-markup rules will 

not apply to entities that are enrolled as 

an IDTF where the IDTF does not order 

the test. If the IDTF orders the test, the 

anti markup provisions will apply to the 

same extent that they apply to other 

suppliers. 

Comment: A few commenters urged 

us to clarify in § 424.80 that the antimarkup provisions apply to 

reassignments under both the 

contractual arrangement exception as 

well as the employee reassignment 

exception. The commenters also 

suggested that § 424.80 and § 414.50 

should state that the anti-markup 

provisions are limited to claims 

submitted by physicians and medical 

groups and do not apply to claims 

submitted by independent laboratories. 

The commenters were concerned that 

the preamble language on the 

applicability of the anti-markup 

provisions to independent laboratories 

was not carried over and included in the 

regulatory text in § 424.80 and § 414.50. 

Response: We have determined to 

revise § 414.50, with a cross reference in 

new § 424.80(d)(3). As finalized, the 

anti-markup provisions apply to 

reassignments under both the employee 

exception and the contractual 

arrangements exception, to the extent 

that the services for which payment is 

reassigned are not performed in the 

office of the billing physician or other 

supplier. The anti-markup provisions 

apply to a billing supplier only if the 

billing supplier orders the TC. 

Therefore, if an independent laboratory 

does not order the TC, the anti-markup 

provisions will not apply to the 

laboratory billing of the TC or the PC. 

Comment: Two commenters urged us 

to create an exception for entities that 

are located off-campus from a hospital 


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which are jointly owned by radiologists 

and the hospital and which have an 

exclusive contract for the provision of 

professional interpretations to the 

hospital. According to the commenters, 

it is important to allow such joint 

ventures to exist, because the profits 

generated by the ventures give financial 

stability to community hospitals that 

otherwise would be financially 

impaired as outpatient imaging 

continues to migrate away from the 

hospital. In States in which the 

corporate practice of medicine doctrine 

exists, the joint ventures do not directly 

employ the physicians, but rather 

typically contract with the professional 

radiology practice to provide the PC. 

The commenter stated that the 

radiologists providing the professional 

reads are neither full-time employees 

nor exclusively employed by the joint 

venture imaging center to which they 

reassign their right to Medicare 

payment. 

Response: We do not believe that it is 

necessary to create such an exception. 

The comment is unclear as to which 

entity, the joint venture imaging center 

or the hospital, is billing for the service; 

however, if the imaging center is billing 

for the PC, the anti-markup provision 

will not apply if the physician performs 

the PC in the imaging center’s office. If 

the imaging center, or an entity related 

to it by common ownership or control, 

orders the TC, and the physician does 

not perform the PC in the imaging 

center’s office, the anti-markup 

provision will apply. 

Comment: Some commenters believed 

that the anti markup provisions should 

not apply to imaging suppliers that meet 

the purchased test rules in CMS 

manuals. 

Response: In the CY 2007 PFS 

proposed rule, we stated that we were 

considering placing restrictions on the 

ordering of PCs that would be similar to 

the purchased interpretation rules in 

our manuals. After giving the matter 

considerable thought, we believe that an 

anti-markup billing provision is 

necessary to guard against potential 

overutilization and that it would not be 

sufficient simply to require that billing 

entities meet the purchased 

interpretation rules in our manuals. 

Comment: In the proposed rule, we 

proposed to add new § 424.80(d)(3) to 

require that, in order to bill for the TC, 

the billing entity must directly perform 

the PC of the service. Two commenters 

asked that we clarify what we meant by 

‘‘directly perform.’’ Other commenters 

recommended that we clarify in 

§ 424.80 the requirement to bill for the 

TC of a diagnostic test, and clarify in 

§ 414.50 the requirement that a billing 

entity must directly perform the PC of 

the service. 

Response: We are not finalizing the 

proposed change to § 424.80(d)(3). We 

note that the requirement continues to 

appear in our manuals at CMS InternetOnly Manual, Pub. 100–04, Chapter 1, 

section 30.2.9. Currently, we are 

considering whether to retain this 

requirement in the manuals or to 

withdraw it. 

Comment: One commenter supported 

generally the establishment of an antimarkup provision on purchased 

interpretations, but voiced concerns that 

our proposal to incorporate the billing 

rules for purchased diagnostic testing 

services to all reassigned services 

(unless performed by a full-time 

employee of the group) could adversely 

affect the billing practices of 

pathologists and pathology groups who 

often depend upon the reassignment 

rules to bill for services performed by 

independent contractor and part-time 

pathologists. Therefore, the commenter 

requested an exception from our 

proposed rules for independent 

laboratories and single-specialty 

pathology physician groups. 

The commenter also asserted that 

reassignment arrangements between 

pathology groups do not raise the same 

threat of abuse because the vast majority 

of pathology services are initiated by a 

request for a consultation from a 

referring physician of another specialty, 

and the pathologist is not in a position 

to influence the referrals from ordering 

physicians. The commenter further 

stated that a broader exception for 

single-specialty pathology physician 

groups and independent laboratories 

that covers both the TC and PC of a 

pathology service is supported by the 

existing physician self-referral law and 

regulations. The commenter stated that, 

the ‘‘Congress recognized that certain 

physicians, specifically pathologists, 

diagnostic radiologists and radiation 

oncologists, who order certain services 

pursuant to a consultation with another 

physician do not have the same risk of 

abuse and, consequently, will not be 

treated as having made a restricted 

referral to an entity with which they 

have a financial interest.’’ The 

commenter urged us, for this same 

policy reason, to recognize an exception 

for single-specialty pathology physician 

groups and independent laboratories 

that bill for pathology services 

performed or supervised by another 

pathologist, whether an independent 

contractor or full-time or part-time 

employee. 

Response: In order to be fair and to 

avoid the appearance of giving 

preferential treatment to one physician 

specialty group over another, the antimarkup provisions on the TC and PC of 

diagnostic tests are potentially 

applicable to all physician specialty 

groups that order tests and wish to bill 

for the TC or PC, or both, performed by 

another person or group and billed as a 

purchased test or billed through a 

reassignment. (Whether the anti-markup 

provision for the TC or the anti-markup 

provision for the PC will, in fact, apply 

depends on whether the TC or the PC 

was purchased, or, if not purchased, 

whether the TC or the PC was 

performed in the office of the billing 

physician or other supplier.) Therefore, 

we are not recognizing an exception for 

single-specialty pathology physician 

groups that bill for pathology services 

performed or supervised by another 

pathologist, unless the single-specialty 

pathology physician group does not 

order the test. If a pathologist in the 

single-specialty pathology physician 

group orders and bills for the test 

performed by another supplier, the antimarkup rules apply. If the pathologist 

does not order the test and wishes to bill 

for the test, which is performed by 

another supplier, the anti-markup rules 

will not apply. Finally, we note that 

clinical diagnostic laboratory tests 

performed by independent laboratories 

and paid under section 1833(a)(2)(D) of 

the Act are not subject to the antimarkup provisions pertaining to 

diagnostic tests. 

c. Overutilization 

Comment: Many commenters in favor 

of the proposed rulemaking cited 

overutilization as a concern in the 

existing billing and payment 

environment. Commenters opposed to 

our proposals denied that contractual 

arrangements for pathology services 

lead to overutilization. 

In support of their contention that 

current arrangements facilitate 

overutilization, some commenters cited 

various studies for the proposition that 

physician self-referral leads to increased 

utilization. For example, one 

commenter cited 1989 studies from the 

OIG and GAO that found that 

physicians who had an ownership or 

investment interest in a laboratory 

ordered more tests than those 

physicians who did not have such an 

interest. This commenter also noted that 

an analysis by the Florida Cost 

Containment Board in 1998 found that 

physician-owned clinical laboratories, 

diagnostic imaging centers, physical 

therapy centers, and rehabilitation 

centers performed more procedures on a 

per-patient basis than those facilities 

that were not physician-owned. The 

commenter also cited the 2007 study by 


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the McKinsey Global Institute that 

found that the United States spends 

more of its wealth on health care than 

any other developed country, and that 

one reason for the difference in 

spending is due to profit incentives in 

physician ownership of medical 

facilities. Other commenters mentioned 

the 2007 OIG studies of three urology 

practices, which the commenters 

described as finding that all three 

practices substantially increased the 

number of biopsies ordered per patient 

after entering into an arrangement for 

contracted pathology services, and that, 

after entering into such an arrangement, 

all three practices billed significantly 

more biopsies than what their respective 

carriers paid on average to other 

suppliers. One commenter cited a study 

by the Center for Health Policy Studies 

that examined the effects of State 

‘‘direct billing’’ laws. Under such laws, 

the pathologist or entity performing the 

ordered pathology services is required 

to bill for the services. This study found 

that laboratory charges per enrollee 

under private health insurance 

programs were 41 percent higher in 

non-direct billing States than in direct 

billing States. Another commenter 

stated that a study in the American 

Journal of Roentgenology in 2002 

confirmed that physician self-referral 

may be contributing to the uncontrolled 

growth in imaging services. According 

to the commenter, that study reported 

that, when a managed care organization 

prohibited certain non-radiologist 

specialties from billing for imaging 

services, total billings for imaging 

declined 20 to 25 percent from the 

amount of billings that were expected 

based on the previous trend in imaging 

growth. 

One commenter stated that it is 

unaware of any evidence of 

overutilization by gastroenterologists 

who have entered into contractual 

arrangements for pathology services. 

Another commenter stated that its 

managed ‘‘pod labs’’ are vital to the 

accurate detection and treatment of 

prostate cancer and do not expose 

Medicare to an undue risk of program 

abuse. The commenter asserted that no 

data supports the accusation that its 

managed laboratories facilitate the 

generation of medically unnecessary 

biopsies, and in any event, clinical 

indications for prostate biopsy are not 

subject to manipulation. 

Another commenter stated that 

urological pathology volume is based 

upon objectively demonstrated medical 

necessity, and is not affected by profit 

margin or who is billing for services. 

This commenter suggested that specific 

requirements could be placed on 

contractual arrangements to address 

overutilization concerns, while 

preserving the benefits of these types of 

arrangements. The commenter stated 

that the best way to ensure that 

contractual arrangements are 

maximizing their potential for 

improving care and outcomes, while 

discouraging overutilization, is to 

prohibit arrangements that are merely 

passive investments of the treating 

physicians. The commenter asserted 

that physicians who own off-site 

pathology laboratories should be 

actively involved in their direction and 

supervision, and responsible for the 

services provided by the laboratory. The 

commenter offered several specific 

recommendations, including: (1) If a 

group practice intends to bill for the TC, 

it must also perform the PC; (2) 

consistent with CLIA regulations, a 

pathologist may not be the medical 

director of more than five laboratories; 

and (3) refined credentialing criteria for 

pathologists. In its comments to the CY 

2008 PFS proposed rule, MedPAC stated 

that it agrees that allowing physicians to 

purchase or contract for the provision of 

diagnostic tests and to realize a profit 

when billing Medicare could lead to 

overuse of services and higher program 

costs. 

One commenter discussed available 

types of diagnostic tests for prostate 

cancer and stated that there does not 

appear to be any added benefit to the 

patient from receiving a 12-part biopsy 

series instead of a smaller number. 

According to the commenter, this 

method of biopsy results only in 

increased diagnosis of minimal prostate 

disease or atypical small acinar 

proliferations, which leads only to 

further biopsies and increased medical 

costs. The commenter stated that the 

argument of urologists, that 12 biopsies 

is the standard of care, is shown to be 

fallacious by the fact that, when 

members of a particular urology group 

perform prostate biopsies in local 

hospitals, they are doing only two-part 

biopsies. However, another commenter 

stated that he knows of more than one 

urologist who routinely submitted two 

core biopsies for review, but after 

employing a pathologist, switched to 12 

core biopsies. Another commenter 

stated that patient care improves with 

contractual arrangements because the 

test results are timelier and are of higher 

quality. Faster results, together with the 

opportunity to collaborate with 

pathologists, permit urologists to better 

manage their patients’ care. According 

to the commenter, the number of cores 

taken for each prostate biopsy is a direct 

result of the evolving understanding of 

the nature of prostate cancer, rather 

than, as some state, the formation of 

urology specialty laboratory 

arrangements between urologists and 

pathologists. One commenter stated 

that, whereas it understood our concern 

of overutilization, the current 

malpractice system creates far more 

incentive to perform unnecessary tests. 

Two commenters stated that the 

incessant complaints of profits being 

made at the expense of the Medicare 

program do not serve any purpose. The 

commenters claimed that, unless a 

profit can be achieved, no one will 

perform services needed by Medicare or 

any other program. The commenters 

suggested that, regardless of who 

collects the fees for pathology and 

laboratory services and makes a profit, 

whether an individual pathologist, a 

commercial laboratory, or a physician 

specialty practice, this should not be a 

focus of CMS. Rather, CMS should 

review the standards of care and hold 

suppliers to those standards. The 

commenters pointed out that the 

National Comprehensive Cancer 

Network developed standards for a 

patient with early prostate cancer. At 

first, the standard was only two cores. 

In the mid 1990s, the standard was 

increased to six cores, then, with 

additional research, the standard was 

increased to ten cores, and, recently, the 

recommendation was further increased 

to 12 cores. The research has shown a 

dramatic increase in prostate cancer 

detection with increased core sampling. 

The commenters stated that it is 

hypocritical that pathologists are 

claiming overutilization of services by 

physician specialty groups, when these 

same pathologists accepted 12 core 

biopsies without a whisper of 

discontent. These commenters asserted 

that overutilization would cease to be an 

issue if CMS actively pursued those 

practitioners, including pathologists, 

who do not follow the accepted and 

published standards of care. 

Response: It is difficult to determine 

whether and the extent to which 

overutilization is due to, or facilitated 

by, arrangements that allow the referring 

physician or group practice to bill for 

the TC and the PC of diagnostic tests. 

Our proposals were not predicated upon 

a belief that there was a correlation 

between the size of the group practice 

and the volume of diagnostic tests and 

the risk of program abuse. We 

appreciate that, for a particular practice 

specialty, an increase in biopsies 

ordered may be due to a change in 

business arrangements that produces 

profits for the referring physician or 

group practice, or it may be due to a 

change in the standard protocols (or in 


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the referring physician’s or group’s 

perception of the appropriate standard 

of care). Nevertheless, studies have 

shown that, in the aggregate, utilization 

of diagnostic tests increases in the case 

of physician self-referral. We believe it 

is appropriate to guard against the 

potential for overutilization through an 

anti-markup provision on the TC and PC 

of diagnostic tests. We decline to use a 

specific number of prostate biopsies as 

a trigger point for application of the 

anti-markup provisions, as we believe 

the appropriate number of biopsies is 

largely patient-specific. 

Comment: Several commenters stated 

that contractual arrangements for 

anatomic pathology testing pose no risk 

of overutilization because Medicare 

patients would not be subjected to 

unnecessary testing due to the invasive 

nature of test procedures such as colon 

or prostate biopsies. 

Response: We are skeptical that the 

risk of overutilization for biopsies is 

appreciably less than that of other types 

of diagnostic tests. In any event, in 

enacting the anti-markup provision in 

section 1842(n)(1) of the Act, the 

Congress made no exception for 

biopsies or other minimally invasive 

tests, and in order to effectuate 

Congressional intent we are not 

providing for such an exception. 

d. Quality and Patient Access 

Comment: Many commenters, both in 

favor of and against the proposed 

rulemaking, focused on the issue of the 

quality of the diagnostic testing, 

particularly pathology services. 

Two commenters stated that the 

financial incentive inherent in some 

arrangements can result in physicians 

selecting laboratories not on the basis of 

quality but on the potential for profit 

from these arrangements. One 

commenter believes that ‘‘by reducing 

pathologists to the status of indentured 

servants of clinicians who ‘own’ the 

patients and their biopsies, the 

autonomy and quality of the pathology 

services provided is fatally eroded.’’

According to one commenter, aspects of 

pathology practice, such as the 

adequacy of the biopsy, the sampling 

procedure, the need for deeper or 

additional sections, the severity of a 

process, the adequacy of margins, the 

need for re-excision, the 

appropriateness of special studies, and 

the need for outside expert consultation 

despite increased expense, ultimately 

are decided based on what provides the 

maximum economic benefit to the 

ordering and billing physician. The 

other commenter stated that a 

gastroenterology group practice that had 

been sending its pathology work to his 

pathology practice ended the 

relationship because it entered into an 

arrangement with another pathology 

group under which the gastroenterology 

group practice could bill for the TC. The 

commenter stated that the 

gastroenterology group said that there 

was no dissatisfaction with quality or 

the service of the commenter’s work, but 

rather it was purely a business decision 

that enabled the gastroenterology group 

practice to capture additional revenue 

in an environment of shrinking 

reimbursement. Another commenter 

stated that he received a biopsy for 

review that was performed on a 

urologist who routinely sent his (the 

urologist’s) patients’ biopsies to his (the 

urologist’s) employed pathologist. The 

commenter stated that what was good 

enough for the urologist’s patients was 

not good enough for the urologist. 

One commenter stated that captive 

pathology arrangements are detrimental 

to patient care. The commenter stated 

that a local gastroenterology group was 

able to locate a pathologist who was 

desperate for work and who reads the 

biopsies only once a week. The 

commenter called the turn-around time 

of once per week ‘‘atrocious.’’ The 

commenter claimed that pathologists 

who are not willing to work for less than 

fair market value are being put out of 

work by physicians who are ignorant of 

the value of quality pathology services 

and who hire anyone willing to read 

slides for any price under any 

condition. Another commenter asserted 

that, although gastroenterologists claim 

they get better service from pathologists 

who allow the gastroenterologists to bill 

for the pathology services, the ‘‘better 

service’’ is, in reality, more money for 

the gastroenterologists. 

One commenter stated that surgeons 

and surgical pathologists need to work 

in close contact with each other, and 

that the pathologist in a ‘‘pod lab’’ has 

little or no interaction with surgeons 

and other clinicians. Hospital-based 

pathologists meet on a regular basis 

with surgeons and other clinicians to 

share insights and perspectives on 

cases, sometimes with immeasurable 

patient benefit. The ‘‘pod lab’’

arrangement impacts negatively upon 

the ‘‘pod’’ pathologist’s professional 

growth. Another commenter suggested 

that we should be aware that the 

‘‘current campaign’’ against so-called 

‘‘pod labs’’ is led by a few self-interested 

private pathologists, some in leadership 

positions in their national organizations, 

who wish to monopolize the outpatient 

biopsy market. The commenter stated 

that these pathologists are using scare 

tactics to paint with the same brush any 

nontraditional pathology arrangement, 

without regard to any real 

demonstration of quality problems. The 

commenter suggested that, instead of 

focusing on the ‘‘straw man’’ of ‘‘pod 

labs,’’ we should require all suppliers of 

pathology services to demonstrate 

quality of service and appropriateness of 

utilization in order to end the ongoing 

abusive pathology practices that are 

occurring in traditional pathology 

groups, independent laboratories and 

academic medical centers. 

One commenter asserted that the use 

of contractual arrangements allows 

specialization by pathologists that 

otherwise would be seen only in the 

largest medical centers or reference 

laboratories. Moreover, the commenter 

stated that pathologists who work 

together in contractual arrangements 

with various groups have the unique 

opportunity to consult with each other 

on a regular basis. An entity that 

manages ‘‘pod labs’’ stated that internal 

data generated by group practices that 

refer to their own managed laboratories 

show a higher positive incidence of 

prostate cancer now than before they 

contracted with the commenter. One 

commenter contended that most 

gastroenterologists who enter into 

contractual arrangements with 

pathology laboratories do so in order to 

achieve a higher quality of patient care 

through timely diagnoses and the use of 

pathology personnel who are experts in 

gastrointestinal and liver pathology. The 

commenter expressed certainty that our 

proposal would have an adverse effect 

on practice efficiency and the quality of 

patient care. 

A commenter stated that large 

corporate laboratories do not always 

provide the highest level of care 

available. According to the commenter, 

large laboratories have an incentive to 

hire the cheapest physician labor in 

order to ‘‘churn out’’ a high volume of 

services. The commenter argued that the 

interaction between the urologists in a 

group practice and a dedicated 

pathologist in that practice will lead to 

better outcomes. Another commenter 

stated that some gastrointestinal group 

practices have opened their own 

pathology laboratories because they 

believed that the pathology reports they 

received from general laboratory 

companies were in some ways lacking. 

A commenter echoed that sentiment, 

and added that the fact that the 

pathologist was practicing in its office 

meant that the group can easily discuss 

the pathologist’s findings with him and 

even review slides together. 

One commenter contended that, based 

on her experience gained from working 

for large, national laboratories, sections 

are poorly processed there and, often, 


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much of the tissue is lost. According to 

the commenter, extra ribbons are not 

collected at these laboratories and 

immunostains often do not contain the 

area suspicious for carcinoma. There is 

no communication with the physician’s 

office and usually no clinical 

information is exchanged. She further 

asserted that group practices that send 

tissue samples to large laboratories run 

the risk that an inexperienced 

pathologist could be performing the 

work. The commenter related a personal 

experience in which biopsies were read 

at a large national laboratory as showing 

HGPIN, a precursor to adenocarcinoma. 

The commenter stated that the slides 

she reviewed on re-biopsy showed no 

HGPIN, and, not only was the patient 

made to worry unnecessarily, but the 

mistaken biopsy review led to the 

expense of a re-biopsy and another 

reading. Another commenter stated that 

its clients say that it provides better 

quality services and in a timelier 

manner than do the national 

commercial laboratories. According to 

the commenter, this is because 

physician practices that send anatomic 

pathology specimens to large 

commercial laboratories do not choose 

the pathologists who interpret the slides 

and thus do not know the qualifications 

of the pathologist. 

Response: We believe that, everything 

else being equal, there can be some 

advantages to a physician or group 

practice referring to the same 

pathologist, if the referring physician or 

group practice chooses the pathologist 

on the basis of his or her qualifications 

and experience, and the service that he 

or she provides. However, we also 

believe that, where there is a financial 

reward for choosing a pathologist or 

other diagnostic specialist based on 

financial self-interest, there is the 

potential to disregard, or at least 

subordinate, quality considerations. 

This final rule with comment period 

eliminates the profit incentive in 

choosing a pathologist or other 

specialist while preserving the referring 

physician or group practice’s right to 

continue to use the pathologist or other 

specialist of its choosing. That is, if a 

billing group practice currently has a 

contractual arrangement with a 

particular histotechnologist and 

particular pathologist because it 

believes that the histotechnologist and 

the pathologist provide superior quality 

and service, it may continue to refer to 

them; it only will be prevented from 

marking up the TC and PC (unless the 

TC and PC are not purchased and are 

provided in the office of the group 

practice). 

Comment: Many commenters asserted 

that there would be no adverse effect on 

patient access if the proposal was 

adopted. Other commenters stated that 

patient care would be significantly 

disrupted if the proposal was adopted. 

Specifically, commenters stated that the 

proposed changes would limit access to 

multiple urologic services in a local 

area, namely, radiation therapy, 

lithotripsy, and many in-office 

procedures such as thermal ablative 

procedures for prostate obstruction. 

These commenters contended that many 

in-office procedures are never 

performed in hospitals, and that, if the 

proposed changes to the reassignment 

and purchased diagnostic test rules 

become effective, it would be difficult, 

if not impossible, to provide these 

services to Medicare beneficiaries. 

Response: We are skeptical that our 

proposal would cause any patient access 

problem. There appear to be adequate 

choices throughout the country for 

physicians and group practices to obtain 

timely access to diagnostic testing. No 

evidence was brought to our attention 

that a patient access problem previously 

existed and was somehow alleviated 

when physicians and group practices 

began entering into contractual 

arrangements for the provision of 

pathology and other diagnostic services. 

In any event, as noted above, our 

proposal as finalized does not prohibit 

physicians and group practices from 

continuing to use the same diagnostic 

services that they have been using to 

date. 

e. Purchased Tests as They Relate to 

Reassigned Tests 

Comment: We received comments 

stating that physician contractual 

arrangements with pathologists 

constitute an attempt to evade the 

restrictions of the physician self-referral 

law. Several commenters stated that 

there is no practical distinction between 

a purchased service and a reassigned 

service. One commenter stated that the 

proposal effectively eliminates the 

reassignment rules. The commenter 

argued that, although CMS states that, 

under section 952 of the Act, it is 

required to recognize contractual 

reassignments only to the extent they 

meet program integrity and other 

standards determined by the Secretary, 

the commenter asserts that the Congress 

surely did not mean that this statutory 

provision could be administratively 

repealed by merging it into the already 

existing purchased diagnostic test rules. 

Another commenter stated that our 

proposal appears to be mixing the 

purchased diagnostic test policies with 

contractual reassignments, which could 

result in confusion for the imaging 

industry. 

Response: We are concerned that 

some current arrangements are not in 

accord with the spirit or the letter of the 

anti-markup provision in section 

1842(n)(1) of the Act. Section 

1842(n)(1)(A) of the Act, which was 

enacted as part of the Omnibus Budget 

Reconciliation Act of 1987 (Pub. L. 100–

203), provides that, if a diagnostic test 

described in section 1861(s)(3) of the 

Act (other than a clinical diagnostic 

laboratory test) was not performed or 

supervised by the billing physician and 

also was not performed or supervised by 

a physician with whom the billing 

physician ‘‘shares a practice,’’ Medicare 

payment is the lower of the costs (net of 

any discount) charged by the performing 

supplier to the billing physician, or the 

performing supplier’s reasonable charge 

(or other applicable limit). We 

implemented the anti-markup provision 

of section 1842(n)(1) of the Act by 

promulgating current § 414.50, 

‘‘Physician billing for purchased 

diagnostic tests.’’ The current version of 

§ 414.50 applies to TCs performed by an 

‘‘outside supplier,’’ but that term is 

undefined. We acknowledge that some 

have understood § 414.50 as applying 

only to TCs that are outright purchased, 

instead of reassigned, but as we 

indicated in the CY 2007 PFS proposed 

rule (71 FR 49056), and as some 

commenters have noted, reassigned tests 

are functionally the equivalent of 

purchased tests. When section 

1842(n)(1) of the Act was enacted, there 

was perhaps more of a difference 

between purchased tests and reassigned 

tests, but subsequent events have 

blurred the distinction between tests 

that are outright purchased and tests for 

which payment is reassigned. 

At the time section 1842(n)(1) of the 

Act was enacted, reassignments under 

the contractual arrangement 

reassignment exception in section 

1842(b)(6)(A)(ii) of the Act were 

permitted only to the extent the work 

was performed on the premises of the 

billing supplier. Therefore, at that time, 

a physician reassigning benefits to 

another physician was either an 

employee of the billing supplier or a 

contractor who was furnishing the 

services on the premises of the billing 

supplier. However, in our January 4, 

2001 (Phase I) final rule with comment 

period, we provided that, for purposes 

of our rules on physician self-referral, 

an independent contractor physician is 

a ‘‘physician in the group practice,’’ as 

defined at § 411.351, during the time the 

physician is providing care to the group 

practice’s patients ‘‘in the group 

practice’s facilities’’ (66 FR 885 through 


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886, 955). Further, in that same 

rulemaking, we provided that a group 

practice’s facilities (again, for purposes 

of our rules on physician self-referral) 

can include a ‘‘centralized building’’ (66 

FR 888 through 889). As defined at 

§ 411.351, space qualifies as a group 

practice’s ‘‘centralized building’’ if it is 

leased ‘‘24/7’’ by the group practice, 

irrespective of the amount of square 

footage of the space and irrespective of 

the proximity (or lack thereof) to the 

group’s facilities. Following that 

rulemaking, a group practice could, in 

compliance with our rules on physician 

self-referral, refer patients for designated 

health services (DHS) (such as 

diagnostic testing) to an independent 

contractor physician, and such 

physician could perform or supervise 

the performance of diagnostic tests in a 

centralized building, provided that all 

requirements of an exception were 

satisfied. Further, the independent 

contractor physician arguably satisfied 

the ‘‘on the premises’’ requirement of 

section 1842(b)(6)(A)(ii) of the Act and, 

thus, was permitted to reassign benefits 

to the group practice for the work 

performed in the centralized building, 

because we considered a centralized 

building to be the group practice’s 

facilities. In any event, in section 952 of 

the MMA of 2003, the Congress 

amended section 1842(b)(6)(A)(ii) of the 

Act to remove the requirement that the 

services must be performed on the 

premises of the billing supplier in order 

to utilize the contractual arrangement 

exception. Therefore, following the 

MMA amendment, it is clear that 

independent contractor physicians who 

perform or supervise the performance of 

diagnostic tests in a centralized building 

may reassign payment for such tests to 

the group practice that owns or leases 

the centralized building. 

Being mindful of the Congress’ intent 

to impose an anti-markup on the TC of 

diagnostic tests that are not performed 

or supervised by a physician who 

‘‘shares a practice’’ with the billing 

physician, we are amending § 414.50 in 

this final rule with comment period to 

provide that TCs that are not performed 

in the office of the billing physician or 

other supplier are subject to the antimarkup provision. With respect to a 

physician organization (such as a group 

practice), we consider the ‘‘office of the 

billing physician or other supplier’’ to 

be medical office space in which the 

physician organization provides 

substantially the full range of patient 

care services that the physician 

organization provides generally. 

Therefore, with respect to group 

practices, we do not consider space to 

be the ‘‘office of the physician or other 

supplier’’ if that space does not meet the 

requirement regarding patient care 

services in revised § 414.50(a)(2)(iii) (for 

example, space that is utilized as a 

‘‘centralized building’’ for purposes of 

the exceptions for physician services 

and in-office ancillary services in 

§ 411.355(a) and (b), respectively, but in 

which the group practice provides 

diagnostic testing services only). 

We believe that, if the TC is 

performed by an employee (full-time or 

part-time), or by an independent 

contractor who reassigns benefits, in the 

office of the billing physician or other 

supplier, a sufficient nexus with the 

practice of the billing supplier is 

established. (In this regard, we note that, 

if the TC is performed by someone other 

than an employee or a contractor who 

reassigns benefits, that is, someone who 

sells the test to the billing physician or 

other supplier, the anti-markup 

provision will apply regardless of where 

the service is performed.) Further, we 

see no reason to distinguish between the 

TC and the PC of diagnostic tests for 

purposes of the anti-markup provisions. 

Although the Congress did not establish 

an anti-markup provision in section 

1842(n)(1) of the Act or elsewhere for 

the PC of diagnostic tests, the omission 

may have been inadvertent. That is, it is 

not immediately clear why the 

Congress, if it wished to prevent 

overutilization of diagnostic testing, 

would not have desired an anti-markup 

on the PC, because without such a 

provision, the incentive to order 

unnecessary tests (and profit on the PC) 

remains. We believe that, in order to 

fully effectuate the Congress’ intent to 

prevent or limit the ordering of 

unnecessary diagnostic tests, it is 

necessary to impose an anti-markup 

provision on the PC of diagnostic tests. 

Accordingly, our revisions to § 414.50 

apply to PCs to the same extent as they 

apply to TCs. 

We see no reason to distinguish 

between physicians and physician 

group practices on the one hand, and 

other types of suppliers on the other 

hand, that bill for diagnostic tests. In the 

proposed rule, we used the terminology 

‘‘physician or medical group,’’ which 

we borrowed from the existing manual 

provisions on purchased tests and 

purchased test interpretations. However, 

the term ‘‘medical group’’ is not defined 

and is not commonly used elsewhere. 

We are amending § 414.50 so that it 

applies to a billing ‘‘physician or other 

supplier.’’ Any enrolled supplier that 

bills for a diagnostic test or its 

interpretation is potentially subject to 

the anti-markup provisions in § 414.50. 

f. Definition of ‘‘Entity’’

Comment: One commenter stated that, 

although we proposed to expand the 

purchased diagnostic test rule in 

§ 414.50 to apply also to the purchased 

PC of a diagnostic test, it was not 

entirely clear whether we proposed to 

expand the scope of the exception in the 

definition of ‘‘entity’’ at § 411.351 for 

purposes of our rules on physician selfreferral. The commenter noted that the 

definition of ‘‘entity’’ at § 411.351 

provides that a physician’s practice is 

not acting as an ‘‘entity’’ when it bills 

Medicare for ‘‘a diagnostic test in 

accordance with § 414.50.’’ The 

commenter contended that the phrase 

‘‘diagnostic test’’ is currently interpreted 

to mean only the TC, in part because 

§ 414.50 currently applies only to the 

TC. The commenter also stated that if 

the scope of § 414.50 is expanded to 

cover both the TC and the PC, one could 

interpret the phrase in § 411.351, 

‘‘diagnostic test in accordance with 

§ 414.50,’’ to mean that a physician 

practice is not an entity when it bills 

Medicare for either the TC or the PC in 

accordance with § 414.50. The 

commenter suggested that, if we finalize 

our proposal to apply an anti-markup 

provision to purchased TCs and PCs, we 

should revise the definition of ‘‘entity’’

at § 411.351 to clarify that the exception 

for purchased diagnostic tests applies to 

both the TC and the PC. Another 

commenter also supported changing the 

definition of ‘‘entity’’ at § 411.351 to 

except from that definition a supplier 

that is billing for the PC in accordance 

with the anti-markup provisions of 

§ 414.50. 

Response: Under our physician selfreferral rules in part 411, subpart J of 

this chapter, a physician may not refer 

a patient for certain designated health 

services (DHS) to an entity with which 

the physician (or an immediate family 

member) has a financial relationship, 

and the entity may not bill Medicare for 

such DHS, unless an exception applies. 

The definition of ‘‘entity’’ at § 411.351 

‘‘does not include a physician’s practice 

when it bills Medicare for a diagnostic 

test in accordance with § 414.50.’’ The 

rationale for excluding from the 

definition of ‘‘entity,’’ and hence from 

the application of our physician selfreferral rules, a physician practice that 

is billing for a TC that is subject to the 

anti-markup provision, is that there is 

no risk of overutilization arising from a 

financial relationship between the 

referring physician and the physician’s 

practice billing for the service. We 

believe the same rationale should apply 

to PCs made subject to an anti-markup 

provision under this final rule with 


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comment period. We are amending 

slightly the definition of ‘‘entity’’ at 

§ 411.351 to make clear that the 

exclusion applies to both TCs and PCs. 

As amended, the pertinent language 

reads ‘‘does not include a physician’s 

practice when it bills Medicare for the 

TC or the PC of a diagnostic test for 

which the anti-markup provision is 

applicable in accordance with 

§ 414.50.’’

We note that, under our physician 

self-referral rules, an independent 

contractor physician is a ‘‘physician in 

the group’’ for purposes of the physician 

services exception in § 411.355(a) and 

the in-office ancillary services exception 

in § 411.355(b), only with respect to 

services performed on the group’s 

premises (including a ‘‘centralized 

building’’ as defined at § 411.351). 

Therefore, one practical effect of the 

change in the definition of ‘‘entity’’ is 

that a group practice that currently may 

not bill for a PC performed by an 

independent contractor physician, 

because the independent contractor 

physician is not performing the PC on 

the group’s premises, will be able to do 

so without running afoul of the 

physician self-referral rules if the PC is 

billed in accordance with the antimarkup provisions of this final rule 

with comment period. 

g. Employment Status 

Comment: A commenter that 

supported our proposed changes to the 

reassignment rules pertaining to 

diagnostic tests stated that it was 

appropriate for CMS to focus on the 

billing of diagnostic tests performed by 

someone other than a full-time 

employee. The vast majority of 

commenters that addressed the 

employment status issue, however, 

opposed applying the anti-markup 

provisions to part-time employees and 

independent contractors based simply 

on their employment status. Three 

commenters asserted that the proposed 

changes are unnecessary and would 

negatively impact the way physicians 

provide care to patients, possibly 

resulting in the termination of part-time 

physicians or a prohibition on part-time 

physicians furnishing diagnostic tests. 

Many commenters claimed that, if the 

proposed changes to the purchased 

diagnostic test rules are implemented, 

physicians and group practices would 

not be able to provide certain routine 

medical procedures if limited to using 

full-time employees. One commenter 

requested that we exempt part-time 

employees and independent contractors 

from the anti-markup rules provided 

that the billing supplier satisfies a 

physician self-referral exception and the 

services are furnished in the billing 

supplier’s office. A few commenters 

proposed that CMS not apply the antimarkup requirements to technicians 

who work on-site at the medical group 

and who work at least half-time for that 

specific group. 

One commenter stated that limiting 

reimbursement for the PC of diagnostic 

tests performed by outside suppliers 

would create an incentive to hire fulltime staff and then overutilize pathology 

services in an attempt to recoup the 

costs of such personnel. The commenter 

urged us not to penalize physician 

groups by having the anti-markup rules 

apply when using part-time employees 

or independent contractors who furnish 

services on less than a full-time basis. 

Two commenters considered our 

proposal to be premised on the 

unsupported belief that group practices 

that perform a lower volume of 

diagnostic tests and, therefore, need 

only employ pathologists on a part-time 

basis, present more risk of program 

abuse. Another commenter stated that 

forcing suppliers and their staff into 

full-time relationships will impose 

needless costs and will require forgoing 

efficiencies that are available through 

more flexible supplier-staff 

relationships. Several commenters 

believed that applying an anti-markup 

provision based upon the employment 

status of the technician or physician 

would unfairly disadvantage 

individuals who want to work only parttime (for example, mothers of young 

children). One of these commenters 

stated that we essentially placed a 

hurdle in front of group practices that 

wish to accommodate the professional 

and personal needs of its employees, 

and that, given the shortage of qualified 

health professionals in many areas, we 

should be making it easier, and not 

more difficult, for professionals to 

provide care. 

Response: We agree that it is not 

necessary or advisable to premise the 

application of the anti-markup 

provisions on the employment status of 

the person performing the TC or PC. We 

are revising the language in § 414.50 to 

clarify that an outside supplier is 

someone who is not an employee of the 

billing physician or other supplier and 

who does not furnish the test or 

interpretation to the billing supplier 

under a reassignment that meets the 

requirements of § 424.80. Therefore, 

diagnostic testing services furnished by 

part-time employees and independent 

contractors in the office of the billing 

supplier will not be subject to the antimarkup rules, unless the services of the 

independent contractor are billed as a 

purchased diagnostic test. 

Comment: One commenter stated that 

the anti-markup provisions should 

apply only when the diagnostic service 

is provided in a centralized building 

outside of the physician’s primary office 

site where he or she provides his or her 

professional services, and should not 

apply based on the employment status 

of the individual performing the TC. 

Response: We agree generally and 

have revised § 414.50 and § 424.80 to 

specify that the anti-markup rules apply 

to purchased tests and interpretations 

(regardless of site of service) and to TCs 

and PCs performed at a site other than 

the office of the billing supplier. With 

respect to physician group practices, the 

group’s ‘‘office’’ is the medical office 

space in which the physician 

organization provides substantially the 

full range of patient care services that 

the physician organization provides 

generally. The group’s office does not 

include space utilized by the group as 

a ‘‘centralized building’’ (or other space) 

where only (or primarily) diagnostic 

testing is performed by radiologists or 

pathologists. 

Comment: One commenter found the 

proposed definition of an outside 

supplier as someone other than a fulltime employee of the billing physician 

or medical group to be confusing and 

inconsistent with the definitions at 

§ 411.351. Thus, the commenter 

recommended replacing the term ‘‘fulltime employee of the billing physician 

or medical group’’ with the defined term 

‘‘member of the group or member of a 

group practice.’’

Response: In the CY 2007 PFS 

proposed rule (71 FR 49054), we 

proposed that TCs and PCs that are 

reassigned under the contractual 

arrangements exception in section 

1842(b)(6)(A)(ii) of the Act would be 

subject to an anti-markup provision. We 

received comments expressing concern 

that our proposals would be ineffective 

to the extent that contractors who 

performed TCs and PCs for multiple 

group practices would now become 

part-time employees of the same group 

practices. In response, in the CY 2008 

PFS proposed rule, we proposed that 

the anti-markup provisions would apply 

to reassigned TCs and PCs that are not 

performed by full-time employees. 

However, we believe we can guard 

adequately against potential 

overutilization by imposing an antimarkup provision on purchased PCs 

and TCs, and, with respect to nonpurchased TCs and PCs, imposing an 

anti-markup provision on the TCs and 

PCs that are performed outside of the 

office of the billing physician or other 

supplier, without regard to the 

employment status of the person 


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performing the TC or PC, thus leaving 

intact the part-time employment 

arrangements that have traditionally 

existed. Therefore, we believe it is 

unnecessary and inadvisable to adopt 

the commenter’s suggestion. 

Comment: Several commenters 

requested that we clarify what is meant 

by a ‘‘full-time employee.’’ They urged 

us to use the Department of Labor’s 

Bureau of Labor Statistics standard, 

which is 35 hours per week. 

Response: For the reasons stated 

above, we do not believe it is necessary 

to define ‘‘full-time employee.’’

Comment: Several commenters 

suggested that we exempt TCs and PCs 

furnished by part-time employees of the 

billing supplier from the anti-markup 

provisions, provided that the employees 

are working exclusively for one billing 

supplier, such as a single health care 

organization. Other commenters 

suggested that, instead of providing that 

the anti-markup provisions would apply 

to the TCs and PCs performed by parttime employees, we apply an antimarkup provision to work performed by 

employees who work for more than a 

certain number of physician practices. 

Response: We considered creating an 

exception from the anti-markup 

provisions for services provided by parttime employees who work exclusively 

for one billing supplier. We also 

considered restricting the application of 

the anti-markup provision to work 

performed by employees who work for 

more than a certain number of 

physicians’ practices. We rejected both 

approaches as unnecessary given our 

decision to base the application of the 

anti-markup primarily on the site of 

service, as well as because we believe 

that each approach would add undue 

complexity to the rule and would be 

difficult for both billing suppliers and 

for us to administer. We will monitor 

the effectiveness of our site-of-service 

approach in addressing our concerns 

regarding potential overutilization. If 

arrangements that currently are taking 

place at a site other than the office of the 

billing physician or other supplier 

simply migrate to the ‘‘office of the 

billing physician or other supplier’’ in 

order to escape the application of the 

anti-markup provisions, we may revisit 

the idea of imposing an anti-markup 

provision for services performed by a 

technician or physician who works for 

more than a certain number of physician 

practices. 

h. Deductibles and Coinsurance 

Comment: Several commenters 

observed that there appeared to be a 

drafting error regarding the application 

of deductibles and coinsurance to the 

anti-markup limits in proposed § 414.50 

and § 424.80. In both sections, the 

maximum payment is set as an amount 

that is net of deductibles and 

coinsurance, that is, ‘‘less the applicable 

deductibles and coinsurance.’’ The 

commenters noted that the price 

limitation should represent the 

Medicare allowable amount, which 

should include any coinsurance or 

deductibles to be paid by the Medicare 

beneficiary. One of the commenters 

stated that the current language could be 

interpreted such that the combined 

Medicare and beneficiary payment to 

the physician could exceed the amount 

that a physician paid an outside 

supplier of a TC or PC by 20 percent, the 

applicable coinsurance for PFS services. 

The commenter recommended that the 

language be revised to read ‘‘the 

payment to the billing physician or 

medical group, including applicable 

deductibles and coinsurance, may not 

exceed the lowest of the following 

amounts.’’

Response: Proposed § 414.50 and 

proposed § 424.80 stated that, payment 

to the billing supplier, ‘‘less the 

applicable deductibles and 

coinsurance’’ may not exceed the lowest 

of the following amounts: (1) The 

supplier’s net charge to the physician; 

(2) the physician’s actual charge; or (3) 

the fee schedule amount for the test that 

would be allowed if the supplier billed 

directly. The quoted language 

referenced above is identical to that in 

current § 414.50 and is virtually 

identical to that in section 1842(n)(1) of 

the Act. We read the statute and 

regulations as saying that the 

contractor’s payment to the billing 

supplier, in the situation in which the 

anti-markup provision applies, is the 

lowest of the performing supplier’s net 

charge, or the billing supplier’s actual 

charge, or the applicable fee schedule 

amount, less any applicable deductible 

and coinsurance amounts. 

We agree with the commenters that 

the total payment (that is, by the 

contractor and the beneficiary or third 

party payor on behalf of the beneficiary) 

is limited to the lowest of the three 

amounts specified above. This 

interpretation represents historical 

Medicare policy, and we believe that 

this policy has been implemented 

correctly by the carriers. However, we 

are refining the language of the 

regulation as suggested by the 

commenter for greater clarity. We do not 

consider this a substantive change. We 

are revising § 414.50 to read ‘‘the 

payment to the billing physician or 

other supplier (including applicable 

deductibles and coinsurance paid by the 

beneficiary or on behalf of the 

beneficiary) for the technical or 

professional component of the test may 

not exceed the lowest of the following 

amounts * * *’’

i. Net Charge 

Comment: Several commenters 

addressed the question of how to 

determine the net charge for purposes of 

applying the anti-markup provisions. 

Commenters asserted that most 

physicians are paid an aggregate 

monthly or annual amount for their 

services and therefore there is no 

‘‘charge’’ to report on a claim. One 

commenter stated that independent 

contractors are frequently paid based on 

time spent furnishing the services, as 

opposed to a per-interpretation price. 

Alternatively, payment may be made at 

a fixed rate per month or year. Yet 

another model is a per-service price 

reflecting a blended rate of different 

payor pricing, not just the Medicare 

allowable amount. Employees, 

including part-time employees, are often 

salaried. Consequently, according to the 

commenter, there is no cost or charge 

per professional interpretation, and it 

would be impossible for a group 

practice to determine the unit price for 

purposes of the anti-markup provision. 

The commenter contended that all of 

the various types of employment 

relationships would have to be 

restructured, at great cost and 

administrative burden, to practices. 

One commenter stated that it would 

not be administratively feasible to 

determine the net charge per test in 

order to apply the anti-markup 

provisions to part-time employees or 

independent contractors who are paid 

on an hourly basis or a per-diem rate. 

Other commenters complained that the 

proposed rules do not address how the 

billing entity is supposed to determine 

the net charge per service on the claim. 

According to these commenters, it 

causes confusion as well as the risk of 

false claims liability to require 

physician practices to include a charge 

for all diagnostic test services. Another 

commenter pointed to what it saw as 

difficulties in allocating charges 

between the TC and the PC when a 

billing supplier purchases both the TC 

and the PC. 

A few commenters urged us to 

provide guidance on how to determine 

the ‘‘net charge’’ for a service. One 

commenter requested that we clearly 

state that the billing entity must 

calculate its net unit price, which may 

reflect payments divided by the number 

of slides referred; for example, if the 

billing entity pays a supplier a set 

amount per month or per year to 

prepare and read all the slides that were 


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referred. One commenter stated that it 

agreed with the proposed approach of 

not allowing the net charge to reflect the 

cost incurred by the performing supplier 

of leasing equipment or space from the 

billing supplier. The commenter 

expressed concern, however, that 

participants in some joint venture 

laboratories may inappropriately 

attempt to inflate the acquisition cost of 

the service, and suggested that we not 

permit other related costs, such as 

separately purchased or leased 

equipment, supplies, insurance, etc., to 

be included when determining the 

amount charged by the person 

performing the TC or PC. If these costs 

were included, it would have the effect 

of raising the net charge, and permit the 

billing suppliers to charge Medicare a 

higher price. 

Response: We are leaving the 

responsibility for determining the net 

charge for a test with the billing 

supplier. The anti-markup provision 

imposed on the PC through this final 

rule with comment period is similar to 

the longstanding provision for 

prohibiting a markup on the TC. Thus, 

we do not believe most suppliers will 

experience significant difficulty in 

calculating the net charge, despite the 

fact that some physicians are paid an 

aggregate monthly or annual amount for 

their services. Suppliers that incur 

difficulty in calculating the net charge 

may structure arrangements so that the 

anti-markup provisions do not apply 

(for example, by ensuring that tests and 

interpretations are not purchased and 

are performed in the office of the billing 

physician or other supplier), may allow 

the performing supplier to bill for the 

TC or PC, or may use a payment method 

(such as per-procedure) that yields an 

easily ascertainable net charge. 

Suppliers must calculate the net charge 

in a reasonable manner. This final rule 

with comment period does not prevent 

suppliers from using any particular 

method that yields an accurate net 

charge. For example, in some situations, 

it may be appropriate to divide a 

technician’s weekly compensation by 

the number of procedures performed to 

arrive at the net charge for each 

procedure performed during that week. 

Because suppliers would have the 

burden of establishing that the charge 

billed was the net charge, suppliers 

should retain contemporaneous 

documentation of the methodology and 

information used to calculate the net 

charge. 

We are not adopting at this time the 

commenter’s suggestion that, to guard 

against parties artificially inflating the 

cost of the TC or PC, we specifically 

prohibit the performing supplier to take 

into account, when calculating its net 

charge, the costs of equipment or 

services (such as insurance), obtained 

from the billing supplier. However, we 

note that, to the extent that a billing 

supplier would sell goods or services at 

an inflated price so as to game the 

application of the anti-markup 

provisions, such excess compensation 

may constitute a violation of our rules 

on physician self-referral and may also 

be a violation of the anti-kickback 

statute (section 1128B(b) of the Act). We 

will monitor financial relationships 

between billing and performing 

suppliers and, if it appears that parties 

are attempting to evade application of 

the anti-markup provisions through the 

sale of goods and services, we may 

modify the provisions. 

Comment: One commenter expressed 

concern about expanding the antimarkup provision to cover the PC, 

noting that, because a per-interpretation 

price is not the most efficient method of 

compensation for purchased PCs, 

practices would likely develop a system 

of compensation that would pay the 

reading physician differently depending 

on the patient’s payor. For example, 

practices might pay the reading 

physician on a salary basis for reads for 

patients of private and non-Medicare 

payors and on a per-read basis for 

Medicare patients. According to the 

commenter, this could result in lower 

costs associated with non-Medicare 

patients than with Medicare patients, 

depending on the way in which the 

physician and the practice negotiate 

payment for the different groups of 

patients. The commenter questioned 

whether it is appropriate to charge 

Medicare more on a per-procedure basis 

than other payors. 

Response: Nothing in this final rule 

with comment period requires practices 

to pay for professional services for 

Medicare patients on a per-procedure 

basis or using any particular payment 

method. What is important is that the 

practice calculates an accurate net 

charge for purposes of these regulations. 

In reviewing the accuracy of the net 

charges of a practice that pays 

differently for professional services 

based on the payor status of the 

patients, we would look to see whether 

the use of different payment structures 

results in inappropriate shifting of costs 

to Medicare (that is, by paying 

physicians more for Medicare reads 

than non-Medicare reads, the practice is 

able to collect more reimbursement 

under the anti-markup provisions). 

Moreover, we note that section 

1128(b)(6)(A) of the Act provides for the 

permissive exclusion of providers or 

suppliers that submit bills or requests 

for payment based on charges or costs 

to Medicare that are substantially in 

excess of the party’s usual charges or 

costs, absent a finding of good cause for 

the differential. Responsibility for that 

statute is delegated to the OIG. 

Comment: One commenter questioned 

whether the anti-markup provisions 

would apply to diagnostic tests 

performed through block lease 

arrangements. This commenter (and 

another commenter) also stated that it 

would be difficult to calculate the pertest charge on tests performed in block 

lease arrangements. 

Response: The anti-markup rules do 

apply to diagnostic tests performed 

through block lease arrangements, and 

the burden is on the billing entity to 

determine how to calculate its net 

charge per test. 

Comment: Several commenters urged 

us to ensure that the calculation of the 

payment level under the anti-markup 

rules will not impose new 

administrative burdens on the billing 

supplier. A few commenters stated that 

the billing supplier should be able to 

mark up the PC between 7 and 10 

percent to cover the costs of billing. A 

few commenters asserted that the 

proposed anti-markup provisions will 

adversely affect group practices that 

wish to bill globally for interpretations 

performed by teleradiologists located 

outside of the billing group practice’s 

office. The commenters were concerned 

that billing physicians or other 

suppliers would not be able to include 

administrative expenses in the price 

paid for the interpretation. One 

commenter stated that, by limiting 

reimbursement to a practice’s actual 

acquisition cost, we are ignoring the role 

of the RBRVS system to appropriately 

establish a proper payment amount for 

services. 

Response: Where the anti-markup 

provisions are applicable, the billing 

supplier will be responsible for 

calculating the net charge. Suppliers 

that do not wish to contend with 

calculating the net charge will have to 

structure arrangements so that the antimarkup provisions do not apply (for 

example, by requiring the suppliers 

performing the TC and PC to bill for 

them, or by ensuring that the TC and PC 

are performed in the office of the billing 

physician or other supplier), or utilize a 

per-procedure method of payment or 

other method that yields an easily 

ascertainable net charge. Similarly, 

suppliers that do not wish to incur the 

cost of billing without being able to 

mark up the TC or PC, should structure 

arrangements so that the anti-markup 

provisions do not apply. 


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Comment: One commenter contended 

that, in a medical foundation context, 

there is no way to determine the net 

charge to the foundation for the services 

of the interpreting physician. The 

commenter stated that the anti-markup 

proposal would result in the need to 

generate artificial invoices, greatly 

complicating and needlessly burdening 

medical foundations. 

Response: A medical foundation, or 

any other medical group practice, 

billing for the TC or PC of a diagnostic 

test that it did not perform will need to 

calculate its own net charge per test. We 

perceive no need to generate artificial 

invoices. The purpose of this 

requirement is to address potential 

program abuse where physicians and 

other suppliers order tests and bill for 

tests that they did not perform at a 

markup from the price paid for the test. 

Comment: Several commenters 

inquired how we would be able to verify 

the true cost of purchasing a TC or PC 

of a diagnostic test. The commenters 

questioned our rationale for this 

proposal and asserted that the proposal 

would be detrimental because it would 

have the effect of precluding suppliers 

from recouping overhead costs. The 

commenters voiced concerns that we are 

trying to eliminate purchased diagnostic 

tests entirely. 

Response: We can verify the true cost 

of a purchased TC or PC by requesting 

supporting documentation from the 

provider or supplier. The burden of 

proof in substantiating the validity of a 

claim rests with the billing provider or 

supplier. The anti-markup provisions 

finalized in this rule are not designed to 

prevent the billing supplier from 

recovering overhead expenses or to 

eliminate purchased diagnostic tests 

entirely, but rather to minimize program 

and patient abuse. Where the TC or PC 

is performed in the office of the billing 

physician or other supplier, the billing 

supplier will be able to recoup some or 

all of the overhead it incurs in the 

performance of the TC or PC by billing 

at the fee schedule amount (or at the 

Medicare limiting charge amount). If, 

however, the billing supplier has 

incurred overhead expenses for a TC or 

PC that was performed at a site other 

than the office of the billing supplier 

(such as in space leased by a billing 

group practice and utilized by the group 

practice as a ‘‘centralized building’’ that 

does not meet the definition of ‘‘office 

of the billing physician or other 

supplier’’ at § 414.50(a)(2)(iii)), the 

billing supplier will not be able to 

recoup the overhead, but rather will be 

limited to the lowest of the performing 

supplier’s net charge, the billing 

supplier’s actual charge, or the 

applicable fee schedule amount. (In the 

unlikely event that the lowest of the 

three amounts is either the billing 

supplier’s actual charge or the 

applicable fee schedule amount, the 

billing supplier may be able to recoup 

its overhead but nevertheless would be 

receiving less payment than the 

performing supplier’s net charge.) We 

believe that this result is appropriate. If 

billing suppliers were able to recoup 

overhead incurred for TCs and PCs that 

are performed at sites other than their 

offices, the effectiveness of the antimarkup provisions would be 

undermined, because there would be an 

incentive to overutilize to recover the 

overhead incurred for purchasing or 

leasing space. 

Comment: One commenter 

recommended that we require, as a 

condition for reassignment of a 

purchased interpretation, that the 

parties to the arrangement calculate a 

net charge for the service. The 

commenter stated that, if this condition 

applied, per-diem or other time-based 

arrangements, which are more 

susceptible to markups, would not be 

permitted. 

Response: We realize that, in most 

circumstances, a group practice would 

not want to pay an independent 

contractor more for a service than the 

payment it receives from an insurer for 

furnishing the service. However, we are 

under the impression that some 

physician group practices that have 

exclusive contracts with hospitals under 

which the group practice furnishes all 

PCs of inpatient and outpatient 

radiology services often hire 

independent contractors to provide PCs 

that are needed at night or on weekends. 

We have been informed that, in some of 

these cases, the group practice willingly 

pays its independent contractors more 

for their services than the group practice 

receives in reimbursement so that the 

group practice physicians do not have to 

provide services late at night. There may 

also be other reasons (for example, as an 

improper inducement for referrals) why 

parties could agree to an amount that 

does not accurately reflect the true net 

charge. 

As explained above, we believe that a 

group practice may pay an independent 

contractor on a per-diem or hourly 

basis, and also arrive at an appropriate 

amount to bill Medicare for each service 

based on the number and differing work 

intensities of the services provided. 

Comment: One commenter 

recommended that we prohibit any 

mark-up over the direct costs incurred 

by the group practice in providing 

diagnostic testing services. Direct costs 

would be defined as limited to the 

compensation paid to the persons 

providing the services and the cost of 

equipment and supplies utilized in 

performing the services. One commenter 

asserted that the proposed restrictions 

would not allow a billing practice to be 

paid for its legitimate overhead costs. 

Two commenters requested that we 

permit employers to include in the 

calculation of a supplier’s net charge the 

lower of the following: (1) A reasonable 

practice expense (PE) derived from its 

own relative value cost; or (2) the actual 

overhead costs attributable to the 

supplier. The commenters suggested 

that this would permit a group to utilize 

part-time diagnostic physicians without 

financially penalizing the employer, and 

at the same time safeguard against 

artificially inflated overhead costs. 

Response: In effect, the commenters 

requested that we adopt a ‘‘net charge 

plus’’ approach. In order for the antimarkup provisions to have real effect, it 

is necessary that payment by Medicare 

be limited to the lowest of: (1) The 

physician’s or other supplier’s net 

charge to the billing supplier; (2) the 

billing supplier’s actual charge; or (3) 

the fee schedule amount for the service 

that would be allowed if the physician 

or other supplier billed directly. If we 

were to allow billing suppliers to 

include costs in addition to the 

performing supplier’s net charge, we 

would defeat the purpose of the antimarkup provisions. 

Comment: A few commenters 

requested that we ensure consistency in 

the language in § 414.50 and § 424.80. 

For example, proposed § 414.50(a)(3)(i) 

states that net charge does not include 

‘‘any charge that is intended to reflect 

the cost of equipment or space leased to 

the outside supplier,’’ whereas § 424.80 

states that it does not include ‘‘any 

charge that is intended to cover or 

address the cost of this equipment.’’

Response: As noted above, we have 

effectuated the anti-markup provisions 

by revising § 414.50, and by placing a 

cross reference to that section in new 

§ 424.80(d)(3). The language of proposed 

§ 414.50(a)(3)(i), ‘‘reflect the cost of 

equipment or space leased’’ survives. 

Comment: One commenter 

recommended that we include in the net 

charge the costs incurred by the 

purchasing supplier to facilitate test 

interpretations, specifically, the cost of 

teleradiography to transmit images to 

the interpreting physician and the cost 

of producing a written report of the 

interpretation. 

Response: To the extent that costs 

such as those noted by the commenter 

are incurred by the billing supplier, as 

opposed to the performing supplier, we 

are not persuaded to permit the inflation 


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of the net charge to include such costs. 

As discussed above with respect to the 

recoupment of overhead costs, we 

believe that allowing billing suppliers to 

recoup the costs suggested by the 

commenter would defeat the purpose of 

the anti-markup provisions. 

i. Miscellaneous 

Comment: One commenter suggested 

that, as an alternative to an anti-markup 

provision, we prescribe a fixed dollar 

amount (for example, based on a 

percentage of what Medicare would pay 

for the PC if billed directly), as a ceiling 

for Medicare payment. The ceiling 

would be adjusted for certain PEs such 

as bona fide collection costs and bad 

debt. 

Response: We believe that setting a 

fixed dollar amount for diagnostic tests 

and interpretations performed under 

particular circumstances is problematic. 

There would be difficulties in 

determining what the fixed dollar 

amount should be, and what, if any, PEs 

should be taken into consideration to 

augment the fixed dollar amount. In 

addition, we did not propose such an 

approach, and believe it may be outside 

the logical outgrowth test for issuing 

final rules to adopt the commenter’s 

approach in this final rule with 

comment period. Moreover, even if we 

were able to adopt such an approach 

without first specifically proposing one, 

it would take us considerable time to 

study the feasibility of prescribing a 

payment ceiling for TCs and PCs under 

particular circumstances, and we 

believe that it is important to issue a 

final rulemaking on this subject without 

further delay in order to address our 

current concerns with potential 

overutilization. 

Comment: Two commenters stated 

that, in addition to restrictions 

contained in the proposed rule, we 

should also require that: (1) A 

pathologist not be allowed to work for 

more than one physician group practice; 

(2) a pathologist not be allowed to work 

for, or have any arrangement with, 

independent reference laboratories; and 

(3) medical liability insurance for the 

pathologist should be paid by the 

physician group practice billing for the 

pathologist’s services. (The commenters 

explained that the purpose of the 

second proposed requirement is to 

eliminate the possibility that a reference 

laboratory could provide a pathologist 

to a physician group practice in return 

for receiving the right to bill for the TC.) 

One of the commenters was also 

concerned that, if a single pathologist is 

performing work for the billing 

physician practice, appropriate or 

optimal quality assurance will not take 

place. The commenter stated that, in her 

pathology group practice, all 

malignancies are reviewed by at least 

two pathologists. 

Response: With respect to the 

commenters’’ first suggested 

requirement, we proposed that an antimarkup provision would apply to PCs 

that are reassigned by someone who is 

not a full-time employee of the supplier 

billing for the PC, because we were 

concerned with the potential for 

overutilization where a single physician 

performs interpretations for more than 

one group practice in contiguous 

centralized buildings (such as in ‘‘pod’’

or ‘‘condo’’ laboratories). Specifically, 

we were concerned that a physician 

who formerly reassigned benefits under 

the contractual arrangements 

reassignment exception could simply be 

made a part-time employee of a number 

of group practices. As noted above, in 

response to public comments, we are 

not imposing an anti-markup on the PC 

of a diagnostic test simply because the 

PC was performed by someone other 

than a full-time employee of the billing 

supplier. Rather, we are addressing our 

concerns regarding potential 

overutilization by imposing an antimarkup on the PC of a diagnostic test if 

it is purchased or if it is not performed 

in the office of the billing physician or 

other supplier. We believe our decision 

to impose an anti-markup provision on 

PCs that are ordered by the billing 

supplier and performed at a site other 

than the office of the billing supplier 

(for example, in space that the billing 

supplier utilizes as a ‘‘centralized 

building’’ but that does not meet the 

definition of ‘‘office of the billing 

physician or other supplier’’ in revised 

§ 414.50(a)(2)(iii)), regardless of the 

employment status of the physician, 

will adequately address our concerns 

with overutilization. As for the other 

two proposed requirements and the 

second commenter’s implied proposed 

requirement, we do not believe it is 

within the scope of this rule to attempt 

to restrict a pathologist from working for 

more than one supplier, or to require a 

group practice to pay for a pathologist’s 

malpractice premiums, or to impose 

quality standards for pathologist 

performed PCs. 

Comment: A commenter 

recommended that we revise the 

definition of ‘‘centralized building’’ at 

§ 411.351 to include the following 

language: ‘‘In the case of a space used 

for the performance of the [TC] of a 

diagnostic test, which is billed by a 

group practice, such space can qualify 

as a centralized building only if the 

group complies with the requirements 

of § 414.50 or § 424.80(d)(3) when 

billing for the [TC].’’ The commenter 

also suggested that, by changing the 

definition of ‘‘centralized building,’’ a 

physician or medical group would be 

prohibited from marking up what it paid 

for the TC of a test that was performed 

in a centralized building, unless it was 

performed by a full-time employee. 

Response: We are not revising the 

definition of ‘‘centralized building’’ in 

this rule. Because the anti-markup 

provisions will apply to all TCs and PCs 

that are both: (1) Ordered by a group 

practice (or an entity related to the 

group practice by common ownership or 

control; see § 413.17 regarding 

‘‘common ownership or control’’); and 

(2) performed at a site other than the 

office of the physician or other supplier, 

it is not necessary at this time to narrow 

the definition of a ‘‘centralized 

building’’ in order to guard against 

potential overutilization. 

Comment: One commenter expressed 

concern regarding physicians who have 

invested heavily in in-office equipment 

and have followed CMS guidelines 

established for the in-office ancillary 

services exception in § 411.355(b) for 

purposes of the physician self-referral 

rules. The commenter recommended 

that we regulate the usage of ancillary 

services through medical necessity 

guidelines and by requiring that the 

services be provided at fair market 

value, rather than by the proposed 

changes to the reassignment and 

purchased test rules. 

Response: As finalized, the antimarkup provisions do not apply to nonpurchased TCs and PCs performed in 

the office of the billing physician or 

other supplier. We note that in the CY 

2008 PFS proposed rule, we sought 

comments as to whether we should 

narrow the in-office ancillary services 

exception, including whether we should 

exclude certain types of services from 

the protection of the exception. We 

received many comments on this issue, 

and if we are inclined to make any 

changes to the in-office ancillary 

services exception we will first propose 

such changes in a notice of proposed 

rulemaking. 

Comment: One commenter urged us 

to require that imaging technology be 

provided only by physicians trained in 

modality-specific interpretation of 

imaging procedures who follow the 

guidelines of specialty organizations 

such as the American College of 

Cardiology and the American Society of 

Echocardiography. In addition, the 

commenter supported the accreditation 

of facilities that provide such imaging 

services, provided that we allow 

adequate time for practices to become 

accredited by relevant organizations that 


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2We are making a technical change in the final 

rule. The references in the proposed rule to 

§ 424.36(b)(5) were in error, as individuals are 

specified only in § 424.36(b)(1) through (b)(4). 

are dedicated to improving the quality 

of imaging services. 

Response: The comment is outside the 

scope of the proposed rule. Moreover, 

currently we do not have the statutory 

authority to restrict payment for these 

procedures to physicians who possess 

the training and accreditation 

recommended by the commenter. 

Comment: One commenter urged us 

to enforce the anti-markup requirements 

on purchased diagnostic tests by 

auditing pathology practices and 

laboratories. The commenter contended 

that there is widespread ordering of 

unnecessary tests by pathologists with 

no regulatory oversight by CMS. The 

commenter suggested that effective 

enforcement and application of current 

anti-markup rules to the pathology 

community would obviate the need to 

add new regulations that would limit 

physician practices from providing 

quality pathology services to their 

Medicare patients. The commenter also 

suggested that we adopt reasonable 

protocols and standards for the review 

of Pap smears, among other tests, which, 

according to the commenter, would 

significantly reduce unnecessary testing 

by pathologists and result in 

tremendous cost savings to the Medicare 

program. 

Response: Our contractors perform 

pre-pay and post-pay reviews of 

services, including reviews to determine 

if the services were reasonable and 

necessary. However, the extremely large 

number of claims that contractors must 

handle each year, as well as the 

difficulty in sometimes knowing 

whether services were reasonable and 

necessary, underscores the need to 

adopt rules to address the potential for 

overutilization in other ways, rather 

than relying solely on reviews for 

medical necessity. The proposed antimarkup provisions would apply equally 

to all physicians, including pathologists. 

However, section 1842(n)(1) of the Act 

does not authorize the anti-markup on 

diagnostic tests to apply to clinical 

laboratory tests, and we did not propose 

to extend the anti-markup provisions to 

such tests. We are concerned with 

preventing the billing supplier from 

ordering unnecessary tests for profit. 

Laboratories typically do not order tests, 

and therefore, there has not been a 

concern about abuse by laboratories in 

purchasing diagnostic tests. The 

comment that we should adopt 

protocols or standards for the review of 

Pap smears and other tests is outside the 

scope of the proposed rule. 

Comment: One commenter urged us 

to prohibit any markup of the TC of 

surgical pathology specimens and let 

each physician decide where the TC is 

performed in addition to where the PC 

is performed. 

Response: Section 414.50 and section 

30.2.9 of Pub. 100–04, Chapter 1, CMS 

Internet-Only Manual, currently 

prohibit markups of the TC of a 

diagnostic test if the TC is performed by 

an outside supplier. As finalized, our 

revisions to § 414.50 will prohibit the 

markup of a TC if the TC is ordered by 

the billing supplier and is either 

purchased or performed somewhere 

other than the office of the billing 

supplier. Physicians are permitted to 

determine where the TC and PC are 

performed, provided that the 

arrangement is in compliance with the 

purchased test rules and physician selfreferral rules. 

Comment: One commenter stated that 

the proposed anti-markup provisions 

are unfair and would interfere with 

existing business relationships. The 

commenter asserted that medical 

practices should have the freedom to 

hire in-house professionals or contract 

with other practices to perform services 

without fear of financial penalty. 

Response: We are not persuaded that 

our anti-markup proposals, as finalized 

in this final rule with comment, are 

unfair. The proposals as finalized are 

designed to reduce overutilization of 

diagnostic tests, so that tests are ordered 

because they are medically necessary 

and are not ordered because a profit can 

be made on each test. Practices can 

maintain relationships with other 

professionals on a part-time or 

contractual basis. If the services are 

furnished in the office of the billing 

supplier, the anti-markup rules will not 

apply, unless the services of an 

independent contractor are billed as a 

purchased test. 

N. Beneficiary Signature for Ambulance 

Transport Services 

Section 424.36 requires that a 

beneficiary’s signature must appear on 

all claims submitted for Medicare 

services, unless the beneficiary has 

died, or another exception applies. 

However, ambulance suppliers and 

providers have stated that, in emergency 

situations, it is often impossible or 

impractical for ambulance providers or 

suppliers to obtain a beneficiary’s or 

other authorized person’s signature on a 

claim to properly bill Medicare for 

ambulance transport services because: 

(1) Many beneficiaries are incapable of 

signing claims due to their medical 

condition at the time of transport; (2) 

another person authorized to sign the 

claim under § 424.36(b) is not available, 

or is unwilling to sign the claim at the 

time of transport; and (3) if an 

individual listed in § 424.36(b) is not 

available or is unwilling to sign a claim 

on behalf of the beneficiary at the time 

of transport, it is impractical later to 

locate the beneficiary (or the 

beneficiary’s authorized representative) 

to obtain a signature on the claim form 

before submitting it to Medicare for 

payment. 

As stated in the CY 2008 PFS 

proposed rule (72 FR 38187), we are 

sympathetic to the concerns of 

ambulance providers and suppliers 

insofar as emergency transport services 

are involved. Therefore, we proposed to 

revise § 424.36 to provide that, for 

emergency ambulance transport 

services, where the ambulance provider 

or supplier documents that the 

beneficiary was physically or mentally 

incapable of signing a claim form at the 

time the service was provided and that 

none of the individuals listed in 

§ 424.36(b)(1) through (b)(5) 2 was 

available or willing to sign a claim on 

behalf of the beneficiary, the ambulance 

provider or supplier could submit the 

claim without a beneficiary signature. 

Under our proposal, such claim 

submission would be permitted only if: 

(1) The beneficiary was physically or 

mentally incapable of signing the claim 

form at the time the service was 

provided; (2) none of the individuals 

listed in § 424.36(b)(1) through (b)(4) 

was available or willing to sign the 

claim form on behalf of the beneficiary 

at the time the service was provided; 

and (3) the ambulance provider or 

supplier maintains in its files for a 

period of at least 4 years from the date 

of service certain documentation. 

Required documentation would include: 

(1) A signed contemporaneous 

statement, made by an ambulance 

employee present during the trip to the 

receiving facility, that the beneficiary 

was physically or mentally incapable of 

signing a claim form and that none of 

the individuals listed in § 424.36(b)(1) 

through (b)(4) was available or willing 

to sign the claim form on behalf of the 

beneficiary at the time the service was 

provided; (2) the date and time the 

beneficiary was transported, and the 

name and location of the facility where 

the beneficiary was received; and (3) a 

signed contemporaneous statement from 

a representative of the facility that 

received the beneficiary, which 

documents the name of the beneficiary 

and the time and date that the 

beneficiary was received by that facility. 

For non-emergency ambulance 

transport services, the ambulance 


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provider or supplier would continue to 

be required to obtain a beneficiary’s 

signature on a claim form (or the 

signature of someone who is authorized 

to sign on behalf of the beneficiary 

under § 424.36(b)(1) through (b)(4)) 

prior to submitting claims to Medicare. 

We received comments from two 

national associations that represent 

providers and suppliers of ambulance 

services and hospitals. The remainder of 

the comments came from ambulance 

owners and employees. The 

commenters generally agreed that we 

should eliminate the beneficiary 

signature requirement entirely when a 

beneficiary is mentally or physically 

incapable of signing a claim and no 

other person authorized to sign a claim 

on behalf of the beneficiary is available 

or willing to sign at the time of 

transport. In addition, the commenters 

argued that the proposed documentation 

requirements would be costly and 

burdensome to ambulance providers 

and suppliers. 

We are adopting our proposal, with 

modification. Specifically, we are 

allowing a secondary form of 

verification to be used in lieu of the 

proposed signed contemporaneous 

statement from a representative of the 

facility that received the beneficiary 

(which remains an alternative). We are 

also amending § 424.32(a) to clarify that 

the beneficiary signature requirement is 

satisfied if one of the exceptions in 

§ 424.36 is satisfied. Finally, we are 

making a technical change to our 

proposal. In the proposed rule, we 

stated that ambulance providers and 

suppliers could utilize proposed 

§ 424.36(b)(6) if none of the individuals 

listed in § 424.36(b)(1) through (b)(5) 

were available or willing to sign the 

claim on behalf of the beneficiary at the 

time the service was provided. The 

references to § 424.36(b)(5) were in 

error, as individuals are specified only 

in § 424.36(b)(1) through (b)(4). 

Comment: The majority of the 

commenters opposed our proposed 

changes to the beneficiary signature 

requirements in § 424.36. The 

commenters stated that the proposed 

changes would have the unintended 

effect of increasing the administrative 

and compliance burden on providers 

and suppliers of ambulance services and 

on the hospitals. 

Response: The proposal would not 

have imposed any additional burdens 

on providers and suppliers of 

ambulance services. Rather, the 

proposal, which we are adopting with 

some modification, set forth an alternate 

method of satisfying the beneficiary 

signature requirement for claims 

submitted for emergency ambulance 

services. Those ambulance providers 

and suppliers that believe that it is 

burdensome to comply with new 

§ 424.36(b)(6), may avail themselves of 

the other means specified in § 424.36 for 

satisfying the beneficiary signature 

requirement. 

Comment: Commenters asserted that 

when a beneficiary is physically or 

mentally incapable of signing a claim, 

the ambulance industry has already 

been signing claims on behalf of such 

beneficiaries in accordance with the 

requirements listed in the CMS InternetOnly Manual (IOM), Pub. 100–02, 

Medicare Benefit Policy Manual, 

Chapter 10, Section 20.1.2 and IOM, 

Pub. 100–04, Medicare Claims 

Processing Manual, Chapter 1, Section 

50.1.6(A)(3)(c), without any objections 

from CMS contractors. The commenters 

stated that the ambulance industry has 

also been relying on § 424.36(b)(5) as 

further authority to sign claims on 

behalf of beneficiaries when 

beneficiaries are incapable of signing 

and the requirements of § 424.36(b)(1) 

through (b)(4) have not been met. 

Response: Section 424.36(b)(5) 

applies only if the beneficiary is 

physically or mentally incapable of 

signing the claim and none of the 

persons listed in § 424.36(b)(1) through 

(b)(4) is available to sign the claim. Note 

that we interpret § 424.36(b), including 

§ 424.36(b)(5), as meaning that neither 

the beneficiary nor any of the persons 

listed in § 424.36(b)(1) through (b)(4) is 

available at all, not just that none of 

them is available at the time the service 

is performed. Thus, even assuming that 

§ 424.36(b)(5) applies to ambulance 

providers (and we believe that this 

subparagraph was intended to apply 

only to institutional providers such as a 

hospital), an ambulance provider would 

not be allowed to rely on § 424.36(b)(5) 

to sign a claim for ambulance services 

simply because the beneficiary was 

incapable of signing the claim at the 

time of delivery to the hospital or ESRD 

facility and none of the persons listed in 

§ 424.36(b)(1) through (b)(4) was 

available and willing to sign the claim 

for ambulance services at the time of 

delivery. Instead, the provider would be 

required, in advance of submitting the 

claim, to make reasonable efforts to 

locate and obtain a signature from the 

beneficiary or, if the beneficiary is not 

capable of signing, one of the alternative 

individuals specified in § 424.36(b)(1) 

through (b)(4). It would make little 

sense to specify different categories of 

individuals in § 424.36(b)(1) through 

(b)(4) who could sign a claim on behalf 

of a beneficiary who is unable to sign, 

if a provider was allowed to file a claim 

without making an effort to obtain a 

signature from one of the other 

authorized individuals. To the extent 

that ambulance suppliers have been 

relying on § 424.36(b)(5) under any 

circumstances, such suppliers have 

been failing to follow the regulations, as 

this subparagraph does not pertain to 

suppliers. We are clarifying 

§ 424.36(b)(5) to provide that, before a 

provider may avail itself of the 

exception in § 424.36(b)(5), it must 

make reasonable efforts (including over 

a reasonable period of time) to have 

either the beneficiary or one of the 

individuals specified in § 424.36(b)(1) 

through (b)(4) to sign the claim. 

Similarly, the sections of the CMS IOM 

cited by the commenters, Pub. 100–02, 

Chapter 10, section 20.1.2 and Pub. 

100–04, Chapter 1, section 

50.1.6(A)(3)(c) imply that reasonable 

efforts must be made to locate other 

individuals prior to submitting the 

claim. We plan to issue clarifying 

instructions in the near future, to ensure 

that our regulations and manual 

instructions on the beneficiary signature 

requirement are fully consistent with 

each other. 

In contrast, the proposal, as adopted 

with modification, allows ambulance 

providers and suppliers, in the case of 

emergency transport, to sign the claim, 

if certain documentation requirements 

are met, where the beneficiary is not 

capable of signing the claim at the time 

of transport. 

Comment: Most of the commenters 

agreed that some of our proposed 

documentation requirements are already 

being followed by ambulance providers 

and suppliers. However, they strongly 

objected to proposed 

§ 424.36(b)(6)(ii)(C), which would have 

required a signed contemporaneous 

statement from a representative of the 

facility that received the beneficiary, 

documenting the name of the 

beneficiary, and the date and time the 

beneficiary was received by that facility. 

The commenters asserted that it is not 

practical or feasible to obtain a signed 

contemporaneous statement from a 

representative of the receiving facility 

documenting the name of the 

beneficiary and the date and time the 

beneficiary was received by that facility. 

The commenters stated that hospital 

personnel in emergency departments 

often are either too busy or refuse to 

sign any forms when receiving a patient. 

In addition, the commenters contended 

that attempting to obtain a signature 

from a representative of the hospital 

would decrease the amount of time 

available for ambulances to serve their 

respective communities. Therefore, the 

commenters recommended that CMS 

modify the proposed beneficiary 


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signature requirements for ambulance 

services in § 424.36(b)(6) to include only 

proposed subsection § 424.36(b)(6)(i). 

One commenter stated that a signature 

from hospital staff does not add any 

more credibility to the ambulance 

provider or supplier’s claim that the 

patient was unable to sign the claim 

than what is already present from the 

EMT’s attestation that the patient was 

unable to sign. 

Response: We are not persuaded to 

modify the proposed alternative to the 

beneficiary signature requirement in 

§ 424.36(b)(6) to include only 

§ 424.36(b)(6)(i). The purpose of the 

proposed requirement to secure a signed 

contemporaneous statement from a 

representative of the facility that 

received the beneficiary, as a means of 

satisfying the alternative, was to ensure 

that someone other than an ambulance 

employee verifies the transport and 

receipt of the beneficiary; the purpose 

was not to obtain verification that the 

beneficiary was unable to sign the 

claim. We continue to believe that in 

many, if not most, cases the ambulance 

transport personnel will have no 

difficulty in securing a signature from 

personnel at the hospital or other 

facility that acknowledges receipt of the 

patient. Indeed, it is our understanding 

that, as protection from liability or for 

other purposes, some ambulance 

providers and suppliers routinely secure 

a signature from the receiving facility in 

order to document that the patient was 

transported. We note that our proposal 

would not have required the hospital or 

other receiving facility to do anything 

more than acknowledge receipt through 

a signature. That is, the ambulance 

provider or supplier could add a 

signature block and an attestation 

clause, acknowledging receipt, to its trip 

ticket or other form that would already 

contain the necessary patient 

information (that is, the beneficiary’s 

name and the date and time of delivery). 

However, after further consideration, we 

are revising § 424.36(b)(6)(ii)(C) to 

provide an alternative to the 

requirement under § 424.36(b)(6) that 

ambulance providers or suppliers must 

obtain a signed contemporaneous 

statement from a representative of the 

facility that received the beneficiary, 

which documents the name of the 

beneficiary and the date and time the 

beneficiary was received by that facility. 

The final rule allows the ambulance 

provider or supplier to meet the 

condition specified in § 424.36(b)(6) by 

obtaining a secondary form of 

verification, prior to submitting the 

claim for payment. Secondary methods 

of verification may include the patient 

care or trip report, the patient medical 

record, the hospital registration/ 

admissions sheet, the hospital log, or 

other internal hospital or facility 

records. Regardless of its specific form, 

the documentation must be from the 

receiving facility must indicate that the 

beneficiary in question was transported 

to the facility by the ambulance 

provider or supplier that is submitting 

the claim, and must be signed by a 

representative of the facility. 

Comment: One commenter stated that 

the proposal was fair and correct, would 

not create a heavy burden on the service 

provider and can be accomplished in a 

timely manner. A signed 

contemporaneous statement used on a 

limited basis and tightly controlled so 

that it will not become a routine event 

should help compliance in this area. A 

clear and standardized format for the 

contemporaneous statement should be 

issued to allow for proper compliance 

with the new rule. 

Response: We understand the 

commenter as supporting our proposal 

and as saying that ambulance providers 

and suppliers should not be entitled to 

routinely rely on proposed 

§ 424.36(b)(6), but rather should be able 

to rely on this exception only when the 

beneficiary is, in fact, unable to sign the 

claim, and only when the proposed 

documentation requirements have been 

satisfied. We agree that in most cases an 

ambulance provider or supplier should 

not have difficulty in obtaining a 

signature from the hospital or other 

facility that acknowledges receipt of the 

beneficiary; however, we are modifying 

the proposal to provide for an alternate 

method of documenting that the 

beneficiary was transported to the 

facility. We do not believe that it is 

necessary to prescribe a specific form 

for ambulance providers and suppliers 

to use as a contemporaneous statement 

to document the transport of the 

beneficiary, but instead are allowing 

ambulance providers and suppliers to 

use existing forms of their own, or, 

where necessary, to modify their forms 

to comply with the requirements of the 

new § 424.36(b)(6)(ii). We again 

emphasize that ambulance providers 

and suppliers that do not wish to take 

advantage of the new exception in 

§ 424.36(b)(6) to the beneficiary 

signature requirement, may instead 

obtain the beneficiary’s signature prior 

to submitting the claim, satisfy one of 

the exceptions in § 424.36(b)(1) through 

(b)(5), or, where appropriate, bill the 

beneficiary. 

Comment: Several commenters 

recommended that we eliminate the 

beneficiary signature requirement 

entirely. They believe that the 

requirement is not necessary because, 

for every transport of a Medicare 

beneficiary, the ambulance crew 

completes a trip report that described 

the condition of the beneficiary, 

treatment, origin/destination, etc. Also, 

the origin and destination facilities 

complete their own records, which 

document that the beneficiary was sent 

or received. Commenters stated that if it 

becomes necessary to audit claims, CMS 

can obtain information from the 

transporting and receiving facilities in 

order to establish that the beneficiary 

was, in fact, transported as claimed by 

the ambulance provider or supplier. 

Response: We proposed an 

alternative, optional method of fulfilling 

the beneficiary signature requirement 

for claims for emergency transport 

services. We did not propose to 

eliminate the signature requirement and 

are not prepared to do so at this time. 

The beneficiary signature requirements 

help ensure that services were in fact 

rendered and were rendered as billed. 

Although we agree that documentation 

obtained from the transporting and 

(particularly) from the receiving facility 

may help to alleviate any concern 

whether services were furnished or were 

furnished as claimed, we do not believe 

that it is our responsibility to attempt to 

locate such documentation should 

claims be called into question (and it is 

also uncertain whether we would have 

the right to compel the transporting or 

receiving facility to provide us with 

such documentation). Therefore, to the 

extent that an ambulance provider or 

supplier wishes to use third-party 

documentation to demonstrate that a 

beneficiary was transported as claimed, 

instead of having the beneficiary sign 

the claim or meeting one of the 

exceptions in § 424.36(b)(1) through 

(b)(4), it must follow the procedures in 

new § 424.36(b)(6). 

Comment: Most of the commenters 

questioned the need for the beneficiary 

signature, because they asserted that the 

beneficiary signature is no longer 

necessary given that it is not required 

for the assignment of benefits or the 

authorization of records release to CMS 

or its contractors. In addition, the 

commenters stated that almost every 

covered ambulance transport is to or 

from a facility (that is, a hospital or 

skilled nursing facility) where a valid 

signature is already on file. These 

facilities typically obtain the 

beneficiary’s signature at the time of 

admission, authorizing the release of 

medical records for their services, or 

any related services. The commenters 

believe that ambulance transport to a 

facility, for purposes of receiving 

treatment at that facility, constitutes a 


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3Section 513(a)(1)(C) of the Federal Food, Drug, 

and Cosmetic Act has been codified as 21 U.S.C. 

360c(a)(1)(C). Accordingly, we believe that the 

references to 21 U.S.C. 360(c)(1)(C) in sections 

1834(a)(14)(G)(i), (H)(i), and (I)(i) of the Act are 

scrivener’s errors. 

‘‘related service,’’ because the 

ambulance transports the patient to or 

from that facility for treatment or 

admission. Commenters also noted that, 

with respect to beneficiaries who are 

eligible both for Medicare and 

Medicaid, a signature is already on file 

with the State Medicaid office. 

Therefore, they argued that duplicating 

the requirement for a signature is costly 

and burdensome on ambulance service 

providers. 

Response: The purpose of the 

assignment of benefits signature is 

different than the purpose of the 

beneficiary signature to file a claim. As 

stated above, the purpose of the 

beneficiary signature to file a claim is to 

ensure that services were furnished and 

were furnished as billed. Although the 

assignment of benefits signature is not 

required for services billed on 

mandatory assignment, the beneficiary 

signature is still required for submitting 

a claim to Medicare. 

A beneficiary’s signature on file at a 

hospital or a skilled nursing facility 

does not indicate that an ambulance 

provider or supplier was authorized to 

submit a claim for transport services on 

behalf of the beneficiary or that 

transport services in fact were 

furnished. Rather, the signature on file 

at a facility is used for claims filed by 

that facility for treatment the facility 

furnished to the beneficiary. Similarly, 

the fact that a beneficiary’s signature 

may be on file with a State Medicaid 

office (or elsewhere) does not in any 

way speak to the issue of whether the 

ambulance provider or supplier was 

authorized to submit a claim for 

transport services on behalf of the 

beneficiary or that transport services in 

fact were furnished. 

Comment: A commenter stated that 

when submitting claims electronically, a 

provider or supplier must answer ‘‘Y’’

or ‘‘N’’ for the question of whether the 

provider or supplier has obtained a 

beneficiary signature. The commenter 

suggested that we should add language 

to the regulations to indicate that the 

beneficiary signature requirement will 

be met if one of the exceptions to the 

requirement is met. 

Response: We agree that it is proper 

and accurate to answer ‘‘Y’’ (for yes) to 

the question in the case where the 

beneficiary has not signed the claim but 

one of the alternatives in § 424.36(b) 

through § 424.36(e) has been satisfied. 

We are clarifying § 424.32(a)(3) (basic 

requirements of all claims) accordingly. 

Comment: Many commenters stated 

that the proposal would encourage 

ambulance providers and suppliers to 

seek signatures from patients who are in 

need of medical care and under mental 

duress. They stated that beneficiaries 

under duress should not be required to 

sign anything. 

Response: We agree that beneficiaries 

under duress should not be required to 

sign claims; in fact, we consider a 

beneficiary signature obtained under 

duress to be invalid. We do not agree, 

however, that our proposal encouraged 

ambulance providers and suppliers to 

obtain beneficiary signatures under 

duress. As stated above, the proposal 

was intended to provide ambulance 

providers and suppliers with another 

alternative to obtaining the beneficiary’s 

signature. It was not, and the final rule 

is not, a narrowing of the available 

alternatives to ambulance providers and 

suppliers. Moreover, the commenters 

appear to assume that if ambulance 

providers and suppliers are to obtain a 

beneficiary’s signature, they must do so 

at the time of transport. However, 

ambulance providers and suppliers have 

always been able to obtain the 

beneficiary’s signature (or the signature 

of one of the persons specified in 

§ 424.36(b)(1) through (b)(4)) at any time 

prior to submitting the claim. In fact, as 

noted above, before providers may avail 

themselves of the exception in 

§ 424.36(b)(5), they are required to make 

reasonable efforts to have the 

beneficiary or one of the persons 

specified in § 424.36(b)(1) through (b)(4) 

sign the claim. With this final rule, 

ambulance providers and suppliers, in 

the case of emergency transport 

services, may submit the claim without 

making such reasonable efforts if they 

satisfy the documentation requirements 

of new § 424.36(b)(6). 

O. Update to Fee Schedules for Class III 

Durable Medical Equipment (DME) for 

CYs 2007 and 2008 

1. Background 

a. Durable Medical Equipment, 

Prosthetics, Orthotics, and Supplies 

(DMEPOS) Classifications 

Under § 414.210, for Medicare 

payment purposes, fee schedules are 

determined for the following classes of 

equipment and devices: 

• Inexpensive or routinely purchased 

items as specified in § 414.220. 

• Items requiring frequent and 

substantial servicing, as specified in 

§ 414.222. 

• Certain customized items, as 

specified in § 414.224. 

• Oxygen and oxygen equipment, as 

specified in § 414.226. 

• Prosthetic and orthotic devices, as 

specified in § 414.228. 

• Other DME (capped rental items), as 

specified in § 414.229. 

• Transcutaneous electric nerve 

stimulators (TENS), as specified in 

§ 414.232. 

We designate the items in each class 

of equipment or device through our 

program instructions. 

Under section 513 of the Federal 

Food, Drug, and Cosmetic Act (21 U.S.C. 

360c), the Food and Drug 

Administration (FDA) must classify 

devices into one of three regulatory 

classes: Class I, class II, or class III. FDA 

classification of a device is determined 

by the amount of regulation necessary to 

provide a reasonable assurance of safety 

and effectiveness; class III devices 

typically posing the greatest risk. See 

the CY 2008 PFS proposed rule (72 FR 

38188) for a specific explanation of the 

three regulatory classifications of 

devices. 

b. DMEPOS Payment 

Section 302(b)(1) of the MMA 

amended section 1847 of the Act to 

require the Secretary to establish and 

implement competitive acquisition 

programs for the furnishing under 

Medicare Part B of certain types of 

DMEPOS. Section 1847(a)(2)(A) of the 

Act provides that devices determined by 

the FDA to be class III devices under the 

Federal Food, Drug, and Cosmetic Act 

(21 U.S.C. 301 et seq.) cannot be 

included in the competitive acquisition 

programs. As part of the transition to 

competitive acquisition, the Congress 

mandated in sections 1834(a)(14)(G) 

through (I) of the Act that the fee 

schedule amounts for DME, other than 

class III devices, be frozen at 2003 levels 

through 2008. 

For class III devices, section 

1834(a)(14)(G)(i) of the Act mandates 

that an annual update factor based on 

the percentage change in the consumer 

price index for urban customers (CPI–U) 

be applied to the fee schedule amounts 

for CYs 2004 through 2006. Section 

1834(a)(14)(H)(i) of the Act, as added by 

section 302 of the MMA, gives the 

Secretary discretion in determining the 

appropriate fee schedule update 

percentage for CY 2007 for DME which 

are class III medical devices described 

in section 513(a)(1)(C) of the Federal 

Food, Drug, and Cosmetic Act (21 U.S.C. 

360c(a)(1)(C)).3 Specifically, for 2007, 

the 2006 fee schedule amounts for class 

III devices are to be updated by the 

percentage change determined to be 

appropriate by the Secretary, taking into 

account recommendations contained in 


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a report of the Comptroller General of 

the United States under section 

302(c)(1)(B) of the MMA. Also 

mandated by section 1834(a)(14)(I)(i) of 

the Act, for 2008, the 2007 fee schedule 

amounts for class III devices are to be 

increased by an annual factor based on 

the percentage change in the CPI–U, as 

applied to the 2007 payment amount 

determined after application of the 

percentage change under section 

1834(a)(14)(H)(i) of the Act. 

As stated above in this section of this 

final rule with comment period, section 

1834(a)(14)(H)(i) of the Act mandated 

that the Secretary take into account 

recommendations by the Comptroller 

General of the United States, who is the 

head of the Government Accountability 

Office (GAO), when determining the 

appropriate update percentage for class 

III devices for 2007. On March 1, 2006, 

the GAO published a report, ‘‘Class III 

Devices do not Warrant a Distinct 

Annual Payment Update’’ (GAO–06–

62). The GAO concluded in that report, 

‘‘because the initial payment rates for all 

classes of devices on the Medicare DME 

fee schedule are based on retail prices 

or an equivalent measure, they account 

for the costs of class III and similar class 

II devices in a consistent manner. 

Distinct updates for two different 

classes of devices are unwarranted.’’

The GAO recommended that the 

Secretary establish a uniform payment 

update to the DME fee schedule for 2007 

for class II and class III devices. 

In the May 1, 2006 Federal Register, 

we published the Competitive 

Acquisition for Certain Durable Medical 

Equipment, Prosthetics, Orthotics, and 

Supplies (DMEPOS) and Other Issues 

proposed rule (71 FR 25660). We 

solicited comments on how to 

determine the appropriate fee schedule 

percentage change for class III devices 

for 2007 and 2008. We stated that we 

would consider the comments received 

in conjunction with the 

recommendations in the GAO report in 

determining the appropriate update 

percentage for these devices for 2007 

and 2008. 

A majority of the submitted public 

comments indicated that the GAO 

report was flawed since it did not 

recommend a specific update factor or 

take into account changes over time in 

the costs of producing, supplying and 

servicing class III devices. Several 

commenters recommended that we 

continue to use the CPI–U to adjust fee 

schedule amounts for class III devices, 

but offered no substantive information 

that would otherwise support a distinct 

update factor for class III devices. 

Another commenter recommended that 

the class III proposal be included in a 

separate rulemaking procedure because 

it is not related to competitive 

acquisition. 

2. Update to Fee Schedule 

We believe that the GAO has done a 

thorough job in reviewing Medicare 

payment rules and methods and issues 

associated with the costs of furnishing 

class III devices. Accordingly, we agree 

with the finding in the report that the 

costs of furnishing class II and class III 

DME devices have been factored into 

the fee schedule amounts calculated for 

these devices. We also agree with the 

GAO recommendation that a uniform 

payment update be established to the 

DME fee schedule for 2007 for class II 

and class III devices. For class II 

devices, the MMA provided for a zero 

percent payment update from 2004 

through 2008. Accordingly, for 2007, in 

the CY 2008 PFS proposed rule we 

proposed a zero percent update for class 

III devices (72 FR 38188 through 38189). 

Also, in accordance with the MMA, we 

proposed to use the percent change in 

the CPI–U to update the class III device 

2007 fee schedule amounts for 2008. 

Comment: One commenter supported 

an update based on the CPI–U but did 

not provide any additional information. 

A second commenter indicated that 

class III devices are innovative, 

beneficial, cost-effective devices and 

supported a reasonable payment update 

but did not recommend a specific 

update and also did not provide any 

information explaining why class III 

devices should receive a different 

update for 2007 than other DME. 

Response: We do not believe that the 

information submitted by the 

commenters provides any information 

that would indicate that class III devices 

warrant a different update than other 

DME. Accordingly, for 2007, we are 

adopting the proposed update 

methodology of applying a zero percent 

update for class III devices. Also, in 

accordance with the MMA, we are 

adopting the proposed methodology of 

applying the percent change in the CPI–

U to update the class III device 2007 fee 

schedule amounts for 2008. The change 

in the CPI–U for the 12-month period 

ending with June 2007 was 2.7 percent. 

Therefore, a 2.7 percent increase will be 

applied to the 2007 fee schedule 

amounts for class III DME to determine 

the 2008 fee schedule amounts for these 

items. 

P. Discussion of Chiropractic Services 

Demonstration 

In the CY 2006 PFS final rule with 

comment period (70 FR 70266) and the 

CY 2007 PFS final rule with comment 

period (71 FR 69707), we included a 

discussion of the 2-year chiropractic 

services demonstration that ended on 

March 31, 2007. This demonstration 

was authorized by section 651 of the 

MMA to evaluate the feasibility and 

advisability of covering chiropractic 

services under Medicare. These services 

extended beyond the current coverage 

for manipulation to care for 

neuromusculoskeletal conditions 

typical among eligible beneficiaries, and 

covered diagnostic and other services 

that a chiropractor was legally 

authorized to perform by the State or 

jurisdiction in which the treatment was 

provided. The demonstration was 

conducted in four sites, two rural and 

two urban. The demonstration was 

required to be budget neutral as the 

statute requires the Secretary to ensure 

that the aggregate payment made under 

the Medicare program does not exceed 

the amount which would be paid in the 

absence of the demonstration. 

Ensuring budget neutrality requires 

that the Secretary develop a strategy for 

recouping funds should the 

demonstration result in costs higher 

than those that would occur in the 

absence of the demonstration. As we 

stated in the CY 2006 and CY 2007 PFS 

final rules with comment period, we 

would make adjustments to the 

chiropractor fees under the Medicare 

PFS to recover aggregate payments 

under 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- and postcomparison of aggregate payments and 

the rate of change for specific diagnoses 

that were treated by chiropractors and 

physicians in the demonstration sites 

and control sites. Because the aggregate 

payments under the expanded 

chiropractor services may have an 

impact on other Medicare expenditures, 

we will not limit our analysis to 

reviewing only chiropractor claims. 

Any needed reduction to chiropractor 

fees under the PFS would be made in 

the CY 2010 and CY 2011 physician fee 

schedules as it will take approximately 

2 years after the demonstration ends to 

complete the claims analysis. If we 

determine that the adjustment for BN 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 would 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 would implement 

the adjustment over a 1-year period. We 

will include the detailed analysis of 

budget neutrality and the proposed 


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offset during the CY 2009 PFS 

rulemaking process. 

Comment: We received a number of 

comments on the methodology for 

determining budget neutrality. One 

commenter indicated that it continues 

to oppose our methodology for assuring 

budget neutrality under the 

demonstration. Instead of the 

application of an adjustment to the 

national chiropractor fee schedule, the 

commenter recommends that CMS make 

an adjustment to the totality of services 

payable under the Part B Trust Fund. 

This would be consistent with the 

requirements in section 651(f)(1)(A) of 

the Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 (MMA). 

Another commenter stated that CMS 

should apply budget neutrality only to 

the chiropractic codes used in the 

demonstration project. Because the 

demonstration did not require a 

physician referral, physicians should 

not be penalized for any utilization of 

chiropractic services. The commenter 

further noted that if budget neutrality is 

not limited to the chiropractic codes, 

CMS should incorporate estimates of the 

impact on other services into its SGR 

‘‘law and regulation’’ factor estimates. 

Response: Section 651(f)(1)(B) of the 

MMA 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 

demonstration projects under this 

section were not implemented.’’ The 

statute does not specify a specific 

methodology for ensuring budget 

neutrality. Our methodology meets the 

statutory requirement for budget 

neutrality and appropriately impacts the 

chiropractic profession that is directly 

affected by the demonstration. The 

budget neutrality adjustment under the 

PFS will be limited to adjusting 

chiropractor fee schedule codes 

(comprised of the 3 currently covered 

CPT codes 98940, 98941, and 98942). 

No other codes would be affected. 

Comment: One commenter noted that 

there are numerous dimensions to the 

analysis of effectiveness of treatment. By 

restricting our analysis only to Medicare 

expenditure, CMS would miss the 

important dimension of the effect of 

care on the beneficiary. Combining 

claims data with a measurement of 

functional status would permit a more 

useful examination of the impact of 

expanding chiropractor services. The 

commenter recommends that if CMS 

undertakes any further examination of 

the effectiveness of any intervention for 

neuromuscular conditions, functional 

status be considered. 

Response: The budget neutrality 

analysis is only one part of a broader 

evaluation of the chiropractic services 

demonstration. A survey was conducted 

of beneficiaries who received 

chiropractic services under the 

demonstration to determine the benefits 

of treatment and satisfaction with the 

chiropractic care provided under the 

demonstration. These results will be 

included in a Report to Congress on the 

demonstration. 

Q. Technical Corrections 

1. Particular Services Excluded From 

Coverage (§ 411.15) 

Sections 612 and 613 of the MMA 

added coverage under Part B for 

cardiovascular disease screening tests 

and diabetes screening tests, effective 

for services furnished on or after 

January 1, 2005, subject to certain 

eligibility and other limitations. These 

provisions were implemented in the CY 

2005 PFS final rule with comment 

period (69 FR 66236) and were codified 

in § 410.17 and § 410.18, respectively. 

However, at the time we neglected to 

make additional conforming changes to 

§ 411.15, which discusses particular 

services excluded from coverage, to 

reflect this expansion in coverage. 

To conform the regulations to the 

MMA provisions, we proposed a 

technical correction to the provisions in 

§ 411.15 by specifying additional 

exceptions to provide payment for 

cardiovascular disease screening tests 

and diabetes screening tests that meet 

the eligibility limitation and the 

conditions for coverage that we 

specified under § 410.17, Cardiovascular 

Disease Screening Tests, and § 410.18, 

Diabetes Screening Tests. 

Comment: One commenter suggested 

that the psychiatric screening 

examination should be included in the 

list of preventive health screenings and 

examinations exceptions from services 

that are excluded from Medicare 

coverage under proposed § 411.15. The 

commenter suggested the advantage for 

having Medicare cover psychiatric 

screening examination is that better 

patient outcomes and decreased use of 

services often occur as a result of early 

identification of psychiatric disorders. 

Response: The purpose of the 

proposed technical correction in 

§ 411.15 was to conform that provision 

to the cardiovascular disease screening 

test and the diabetes screening test 

benefits that were established in 

§ 410.17 and § 410.18, respectively. 

These two part B screening benefits 

were specifically authorized by sections 

612 and 613 of the MMA. The proposed 

rule did not address the possibility of 

coverage of a psychiatric screening 

examination under Medicare Part B. 

There is no statutory provision that 

authorizes a benefit for psychiatric 

screening. Therefore, the commenter’s 

suggestion in this regard falls outside 

the scope of this final rule. 

2. Medical Nutrition Therapy 

(§ 410.132(a)) 

In the CY 2006 PFS final rule with 

comment period (70 FR 70160), we 

added individual medical nutrition 

therapy, as represented by HCPCS/CPT 

codes G0270, G0271, 97802, 97803, and 

97804 to the list of telehealth services. 

In the CY 2008 PFS proposed rule, we 

proposed a technical correction to 

§ 410.132(a) to conform the regulations 

to include an exception for services 

provided at § 410.78. This revised 

paragraph reads as follows: ‘‘(a) 

Conditions for coverage of MNT 

services. Medicare Part B pays for MNT 

services provided by a registered 

dietitian or nutrition professional as 

defined in § 410.134 when the 

beneficiary is referred for the service by 

the treating physician. Except as 

provided at § 410.78, services covered 

consist of face to face nutritional 

assessments and interventions in 

accordance with nationally accepted 

dietary or nutritional protocols.’’

Comment: We received one comment 

concurring with the proposed technical 

correction. 

Response: We are finalizing the 

technical correction to § 410.132(a) as 

proposed. 

3. Payment Exception: Pediatric Patient 

Mix (§ 413.184) 

In the CY 2006 PFS final rule with 

comment period (70 FR 70214), we 

revised § 413.180 through § 413.192 

regarding criteria and the application 

procedures for requesting an exception 

to the ESRD composite rate payment. As 

part of the revisions we intended to 

amend the section heading of § 413.184 

to reflect that, as specified in the statute, 

this exception only pertains to a 

pediatric ESRD facility. However, this 

change was not made. Therefore, we 

proposed to revise the section heading 

of § 413.184 to read as follows: 

‘‘Payment exception: Pediatric patient 

mix.’’

We did not receive any comments 

regarding this proposal. Therefore, we 

are finalizing this provision as 

proposed. 


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4. Diagnostic X-Ray Tests, Diagnostic 

Laboratory Tests, and Other Diagnostic 

Tests: Conditions (§ 410.32(a)(1)) 

Section 1861(r)(5) of the Act was 

amended by section 4513(a) of the BBA 

to allow Medicare payment for a 

chiropractor’s manual manipulation of 

the spine to correct subluxation, 

without requiring the subluxation to be 

demonstrated by an x-ray. The BBA 

provision was effective for services 

furnished on or after January 1, 2000. 

Prior to this statutory change, the 

subluxation was required to be 

demonstrated by an x-ray. Because 

chiropractors are limited by statute in 

the services they can provide under 

Medicare, it was necessary to create an 

exception to the requirement that 

diagnostic services (including x-rays) 

must be ordered by the treating 

physician as provided in § 410.32(a). 

This exception, which permits a 

physician who is not a treating 

physician to order and receive payment 

for an x-ray that is used by a 

chiropractor, is specified in 

§ 410.32(a)(1). 

Because of the BBA change, which 

removed the requirement that 

subluxation must be demonstrated by an 

x-ray, the so-called ‘‘chiropractic 

exception’’ at § 410.32(a)(1) is no longer 

warranted. We do not believe it is 

necessary or appropriate to continue to 

permit payment for an x-ray ordered by 

a nontreating physician when a 

chiropractor, not the ordering physician, 

will use that x-ray. Therefore, we 

proposed to revise § 410.32 by removing 

paragraph (a)(1) and redesignating 

paragraphs (a)(2) and (a)(3) as (a)(1) and 

(a)(2), respectively. 

Comment: We received several 

comments on this proposal. Some 

commenters noted that x-rays are not 

necessary to identify spinal 

subluxations, but stated that the ability 

to obtain an x-ray for Medicare 

beneficiaries is critical to providing 

responsible, safe, and medically prudent 

care. They stated that without this 

ability they fear beneficiaries and the 

chiropractic profession as a whole will 

be at a higher risk for receiving and 

providing the wrong type of care. The 

majority of commenters expressed 

concern that without the chiropractic 

exception at § 410.32(a)(1), the 

beneficiary may incur greater out of 

pocket expenses to obtain a noncovered 

x-ray when needed by the chiropractor. 

Other commenters believed that the 

overall costs for medical services may 

increase because a beneficiary wanting 

to seek chiropractic care directly may 

elect to first seek care for their condition 

from a medical doctor (MD) or doctor of 

osteopathy (DO) to obtain an order for 

a covered chiropractic x-ray, resulting in 

added costs for physician E/M services. 

Finally, many chiropractors commented 

that they are qualified to provide x-rays 

and other services that Medicare does 

not cover when furnished by a 

chiropractor and they believe that x-rays 

can be essential to rule out ‘‘red flags’’

and contraindications that may indicate 

the need for further diagnostic imaging 

or a referral to another health care 

professional. 

Response: We believe that retaining 

the chiropractic exception would be 

inconsistent with the statutory 

provision at section 1861(r)(5) of the Act 

which defines a chiropractor as a 

physician only for the purposes of 

sections 1861(s)(1) and 1861(s)(2)(A) of 

the Act and only with respect to 

treatment by means of manual 

manipulation of the spine (that is, to 

correct a subluxation). This statutory 

provision does not include diagnostic 

services at section 1861(s)(3) of the Act, 

which is the benefit category under 

which x-rays are covered under 

Medicare. In addition, commenters 

noted that x-rays are not required to 

identify subluxations; rather, 

commenters stated that they use the xrays to rule out other conditions where 

manual manipulation of the spine 

would be contraindicated or for which 

further imaging studies are indicated. 

While the use of x-rays for this purpose 

is outside the scope of covered 

chiropractic services, it is also not 

addressed by the chiropractic exception 

at § 410.32(a)(1). The chiropractic 

exception only permits a non treating 

physician to order an x-ray to identify 

a subluxation. Therefore, we are 

finalizing our proposal to revise 

§ 410.32 by removing paragraph (a)(1) 

and redesignating paragraphs (a)(2) and 

(a)(3) as (a)(1) and (a)(2), respectively, so 

that it is consistent and conforms to the 

statutory revisions mandated by the 

BBA. 

R. Other Issues 

1. Recalls and Replacement Devices 

In the CY 2008 PFS proposed rule (72 

FR 38191), we included a discussion 

about recent recalls of implantable 

cardioverter-defibrillator (ICDs) and 

cardiac resynchronization therapy 

defibrillators (CRT–Ds). These recalls, as 

well as previous recalls of ICDs and 

pacemakers in CY 2004 and CY 2005, 

raise issues both with regard to the 

additional costs of replacement devices 

and with regard to the additional 

physicians’ services and diagnostic tests 

that beneficiaries who have these 

devices often need. 

The impact of the costs of 

replacement devices for Medicare 

payment of inpatient and outpatient 

hospital services is addressed in 

separate rulemaking for the respective 

inpatient and outpatient hospital 

payment systems. However, in the CY 

2008 PFS proposed rule, we also 

acknowledged there are costs associated 

with physician monitoring of patients 

treated with recalled devices. This 

could involve extra visits to physicians’

offices or hospital outpatient 

departments, as well as additional 

diagnostic tests which might be needed 

to care for the beneficiaries who have 

the recalled devices. Based on our 

concern of the potential costs to both 

Medicare and the beneficiary for these 

unforeseen extra services, we solicited 

comments on how to identify and 

address additional health care costs and 

Medicare expenditures associated with 

device recall actions. 

Comment: We received several 

comments acknowledging the potential 

for additional costs that may result from 

recalled devices, particularly in light of 

the increases in technology. 

Commenters stated that such costs 

should be the responsibility of device 

manufacturers and not the Medicare 

program, private payers, or the general 

public. Some commenters expressed 

concern that we would impose a 

financial penalty on physicians who 

deal with the consequences of product 

recalls. Several of the commenters 

suggested alternatives that could be 

used to address this issue, such as 

development of a modifier or a specific 

‘‘recall code’’ that could be used to track 

the additional time and work associated 

with these recalls, and urged us to 

ensure that these additional costs are 

accounted for in the SGR target. 

Commenters also stressed that any 

proposal should be ‘‘vetted’’ through the 

appropriate stakeholders. 

Response: We appreciate the 

suggestions that the commenters 

provided. It is not our intention to 

‘‘penalize’’ physicians who care for 

patients affected by implantable device 

recalls. Rather, it is our intention to 

ensure that costs of the additional 

physicians’ services and diagnostic tests 

associated with recalled devices are 

recognized and appropriately addressed. 

We will consider the concerns and 

suggestions provided by the 

commenters as we develop a plan to 

address this issue. 


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2. Therapy Standards and Requirements 

a. Revisions to Personnel Qualification 

Standards for Therapy Services 

In the CY 2005 PFS final rule with 

comment period (69 FR 66354), we 

amended § 410.59, § 410.60, and 

§ 410.62 to refer to the qualifications for 

physical therapists (PTs), occupational 

therapists (OTs) and speech-language 

pathologists (SLPs) at § 484.4, which 

sets the personnel qualifications 

required under the HHA Conditions of 

Participation. 

Section 484.4 contains requirements 

for persons furnishing services in HHAs 

that include physical therapists (PTs), 

physical therapist assistants (PTAs), 

occupational therapists (OTs), 

occupational therapy assistants (OTAs) 

and SLPs. The CY 2005 PFS final rule 

with comment period clarified that the 

personnel qualifications in § 484.4 are 

applicable to all outpatient PT, OT, and 

SLP services ‘‘in order to create 

consistent requirements for therapists 

and therapy assistants’’ (69 FR 66345). 

In the CY 2008 PFS proposed rule (72 

FR 38191), we proposed to update the 

personnel qualifications in § 484.4 for 

PTs, PTAs, OTs, and OTAs. We also 

proposed to revise the qualifications for 

SLPs to remove a reference to 

audiologists in the definition for speechlanguage pathologists because a speechlanguage pathologist would not have a 

Certificate of Clinical Competence in 

audiology, as implied by the regulation, 

unless that person was dually qualified 

as an audiologist. 

We proposed these changes for the 

following reasons. 

• The current regulations at § 484.4 

contain outdated terminology relating to 

several of the relevant professional 

organizations. 

• The standards that now exist in the 

fields of physical therapy and 

occupational therapy have changed 

since a substantial portion of these 

qualification requirements were 

developed. 

• Some of the current qualification 

requirements do not address individuals 

who have been trained outside of the 

United States, or refer to outdated 

requirements. 

• These revisions would have the 

benefit of establishing consistent 

standards across provider/supplier 

lines. 

Although all States license PTs, some 

States have no licensing provisions for 

PTAs, OTs, OTAs, and SLPs. We 

proposed to revise our requirements to 

recognize as qualified PTs, OTs, PTAs, 

or OTAs who meet their respective State 

qualifications (or have received State 

recognition as PTs, OTs, PTAs or OTAs) 

before January 1, 2008. 

We did not propose to allow those 

who, before January 1, 2008, meet only 

the State qualifications to practice 

physical therapy, and not the education 

requirements, to provide services under 

the Home Health PPS or the Hospice 

PPS. As we indicated in the CY 2008 

PFS proposed rule, we did not expect 

that there are therapists furnishing 

services in a HHA or hospice that do not 

meet either the current or proposed 

revised qualifications. 

Grandfathering Provision for Home 

Health 

Comment: Commenters were 

concerned about the inconsistency in 

standards between settings, stating that 

there is no justification for the absence 

of a grandfathering provision for 

therapists and assistants practicing in 

Home Health settings. Many also 

indicated a concern that currently 

licensed or regulated professionals 

would not be allowed to continue to 

practice in a HHA or hospice, and 

recommended that sufficient time be 

allowed before implementation of the 

new standards for new professionals to 

meet their training. 

Response: The commenters make a 

compelling case for the grandfathering 

provisions to be applied uniformly 

across payment systems. We agree that 

it is important to apply consistent 

standards and we will apply the 

grandfathering provision in all settings 

as specified in part 484 of our 

regulations. Since all of part 484 

describes personnel qualifications, we 

refer to part 484 in this rule rather than 

specifically to § 484.4. The crossreference has also been changed in the 

regulation text from § 484.4 to part 484 

in all applicable sections. Although we 

proposed that these grandfathering 

provisions would be included in 

revisions to § 409.17, § 409.23, § 410.43, 

§ 410.59, § 410.60, § 482.56, § 485.70, 

§ 485.705, § 491.9, the application of the 

grandfathering provisions to home 

health in part 484 makes some sections 

of proposed regulation text unnecessary 

and necessitates changes in the language 

of others. The changes proposed to 

sections § 485.705 and § 491.9 have 

been omitted, as they are no longer 

necessary. 

Delay in Implementation of New 

Personnel Qualifications 

Comment: Some commenters 

requested that we delay implementation 

of consistent therapy standards and 

qualifications until we can apply them 

consistently to SNF services, and 

provide education to providers and 

suppliers. 

Response: We believe a 2-year delay 

in implementation of personnel 

qualifications will provide sufficient 

time for new personnel to come into 

compliance with the new standards. 

Therapists and assistants who met the 

qualifications of their State’s practice 

act (in other words, who are licensed, 

certified or otherwise regulated by the 

State as a practitioner in the particular 

discipline) prior to December 31, 2009, 

will not be required to upgrade their 

qualifications. However, in States that 

have no regulations for practitioners in 

a particular discipline and for services 

furnished incident to the services of 

physicians where licensure does not 

apply, therapists and assistants must be 

qualified by education and examination 

as described in this final rule with 

comment period. Those who currently 

qualify to provide services without 

licensure by meeting the Medicare 

education or examination standards in 

effect at the time of the CY 2008 

proposed rule will continue to qualify 

under those policies. On January 1, 

2010, any individual who has not met 

the earlier requirements must meet the 

new requirements. 

Consistent Policy Standards 

Comment: Many commenters 

indicated we have not provided a 

justification for applying the personnel 

and policy standards that we have 

articulated for Part B services 

consistently to Part A services. Most of 

these comments came from commenters 

who also support the right of States to 

create Medicare standards, who 

represent interest groups other than 

Medicare beneficiary/therapy users, and 

who believe we favor professional 

organizations in setting policies. 

Response: Under both Medicare Part 

A and B, we must ensure that all 

services are described within a statutory 

benefit category. In order to do so, we 

frequently establish qualifications for 

health care professionals who furnish, 

or are involved in furnishing, Medicare 

services. In many Part A settings, we 

have historically relied on Medicare 

contractors to review facility records, 

State laws and local policies to 

determine that services have been 

furnished by qualified therapists. As a 

result of information provided by new 

contractors, which has been confirmed 

by numerous comments to the proposed 

rule, we have concluded that therapy is 

not always being furnished by 

individuals trained as therapists—even 

in some Part A settings. Therefore, we 

believe it is critical that we establish in 

regulations consistent standards for 


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qualified therapists in the Medicare 

program. 

Comment: Some commenters objected 

to the use of the terms therapy and 

rehabilitation to mean physical therapy 

(PT), occupational therapy (OT), and 

speech-language pathology (SLP) 

services. The commenters 

recommended allowing any State 

licensed or authorized health 

professional to provide rehabilitation 

services if the provider’s medical staff 

and State law would permit them to do 

so. The commenters recommended 

convening a work group to discuss the 

creation of rational personnel 

qualifications and scope of services. 

Response: The terms ‘‘therapy’’ and 

‘‘rehabilitation’’, as used in this section 

of this final rule with comment period, 

apply only to the Medicare benefit for 

PT, OT, and SLP services and to the 

qualified professionals who provide 

them. The qualifications have been 

established to assure that all of the 

personnel who provide these services 

are suitably trained in the discipline 

they practice. We see no reason to 

believe the skills and training required 

to furnish therapy and rehabilitation in 

Part A settings are less than those 

required in Part B settings, and 

therefore, qualifications for personnel in 

the inpatient setting should not be less 

stringent than in the outpatient setting. 

Therefore, we will adopt the proposed 

qualifications (with minor 

modifications), and these qualifications 

will be made applicable in Part A and 

Part B settings. 

Grandfathering Provision 

Comment: Many commenters believe 

that a grandfathering provision is not 

necessary for physical therapists and 

speech-language pathologists since the 

changes to their qualifications are not 

substantial. 

Response: We agree and have 

removed reference to physical therapists 

and speech-language pathologists from 

the relevant grandfather clauses in the 

final rule with comment period. 

Comment: Several commenters 

believe that our proposal to require 

those who were grandfathered to 

continue to practice at least part time 

without an interruption of more than 2 

years is not necessary, and that the 

language is confusing. 

Response: We agree and have 

removed the requirement for continued 

practice from this final rule with 

comment period. 

Comment: We received many 

comments concerning application of a 

requirement for State licensure, 

registration, certification or other 

regulation to physical therapist 

assistants. The commenters indicate 

large numbers of PTAs in California and 

other States are licensed but do not meet 

the proposed education and 

examination requirements. The 

commenters report implementation of 

the proposed qualifications would cause 

severe access problems for beneficiaries 

and operational disruption for facilities. 

All commenters supported the adoption 

of a grandfather clause to allow 

currently practicing PTAs to continue 

furnishing services to Medicare patients, 

and many requested the grandfathering 

be implemented when the rule is 

finalized in November, rather than 

January 1, 2008. 

Response: We will recognize as 

qualified to provide Medicare services 

those therapists and assistants who are 

licensed or otherwise regulated by their 

States before December 31, 2009. 

Individuals who are not licensed or 

otherwise regulated as PTs, OTs, PTAs, 

and OTAs in their States may furnish 

services incident to a physician’s 

service if they meet the education and 

examination requirements in this final 

rule with comment period. These 

changes will be effective on the date this 

final rule with comment period is 

effective. 

Personnel Qualifications—General 

For therapists and assistants trained 

outside the United States or trained by 

the United States military, we proposed 

standards we considered comparable to 

those applied to therapists and 

assistants trained in the United States. 

However, we noted we would not 

recognize as qualified therapists or 

therapy assistants individuals trained in 

other disciplines for purposes of 

furnishing PT, OT, or SLP services to 

Medicare beneficiaries. 

Comment: APTA recommends the use 

of the term ‘‘substantially equivalent’’ to 

replace ‘‘comparable’’ to avoid 

confusion in the language concerning 

those trained outside the United States. 

Response: We have modified the 

language to substitute in regulations the 

term ‘‘substantially equivalent’’ for 

‘‘comparable’’. 

Comment: Several commenters 

believe that the qualifications for 

military trained OTs/OTAs (when 

applicable) and PTs/PTAs should be the 

same as for all OTs/OTAs and PTs/ 

PTAs. 

Response: We agree that separate 

qualifications for U.S. military-trained 

therapy personnel are not necessary for 

PTs, OTs, and OTAs, since the training 

programs available in the military 

already meet the same standards as 

other U.S.-trained OTs and PTs and 

OTAs. For PTAs who may, in the future, 

be trained in the military, we will apply 

the standard of substantial equivalency 

consistent with those trained outside 

the United States, or the same standards 

as other United States trained PTAs, as 

appropriate. 

Comment: Some commenters 

recommended that licensure be the only 

qualification for PTs and OTs. The 

commenters recommended we defer to 

individual States or to the medical staff 

of a hospital to determine the 

qualifications for physical therapists 

and occupational therapists. 

Commenters agreed generally that we 

should rely on State licensure in those 

States where it exists and for those 

settings where licensure is applicable. 

The commenters note that there have 

been attempts to deregulate health 

professions in the name of regulatory 

reform and they recommend inclusion 

(for OT) and continuation (for PT) of 

education and exam requirements to 

assure there will be standards in place 

when licensure does not apply. 

Response: We believe it is 

appropriate, as we proposed, to require 

qualifications related to education and 

examination to address those situations 

where licensure does not apply. We 

added language in regulations to 

indicate that when licensure or other 

regulation is not applicable for 

therapists and assistants, the education 

and examination requirements apply. 

Comment: Several commenters 

support applying the proposed 

qualifications and therapy standards for 

staff providing services incident to the 

services of physicians. Some continue to 

object to the implementation of section 

1862(a)(20) of the Act. 

Response: Section 1862(a)(20) of the 

Act excludes from payment under 

Medicare Parts A and B any expenses 

for outpatient PT or OT services 

furnished incident to the services of a 

physician that do not meet the 

standards and conditions that apply to 

therapists, except ‘‘any licensing 

requirement specified by the Secretary.’’

Therefore, as we described in the 

proposed rule, we will not apply the 

requirement that therapists and 

assistants be licensed or otherwise 

regulated by a State in the case of 

services furnished incident to the 

services of physicians. We will apply 

education and examination 

requirements. 

In the proposed rule, we explained 

that when we referred to persons who 

are licensed, certified, and otherwise 

regulated by a State, we interpreted 

‘‘otherwise regulated’’ to mean that, 

while a State may not regulate a 

profession by granting a license or 

certifying educational or training 


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credentials, it may nevertheless regulate 

the practice of a profession by 

application of certain other 

requirements. 

We received no comments on the use 

of this term, and therefore, we intend to 

use it as proposed. Because we believe 

the term ‘‘certification’’ is redundant to 

‘‘otherwise regulated’’, that term has 

been omitted. 

Occupational Therapy 

We proposed to require that OTs 

beginning their practice after January 1, 

2010, must be licensed, certified, 

registered or otherwise regulated as an 

OT, and have graduated from an 

occupational therapist curriculum 

accredited by the Accreditation Council 

for Occupational Therapy Education 

(ACOTE) of the American Occupational 

Therapy Association (AOTA), and also 

have successfully completed the 

certification examination developed and 

administered by the National Board for 

Certification in Occupational Therapy 

(NBCOT). We established that 

‘‘successfully completed’’ means the 

individual must perform sufficiently 

well on the exam to receive (or be 

eligible to receive) certification. For 

services incident to a physician’s or 

nonphysician practitioner’s service 

where the licensure requirement does 

not apply, we proposed the education 

and examination requirements continue 

to apply. 

OT Comments 

Comment: AOTA recommended 

qualifications based on licensure or 

education and examination. 

Response: We require qualifications 

based both on licensure and on 

education and examination so that there 

are appropriate qualifications that apply 

where licensure is not applicable, for 

example, to therapy services furnished 

incident to the physician’s service. 

Comment: The NBCOT recommended 

that qualified OTs be credentialed by 

their examination and be members in 

good standing of their organization. The 

AOTA recommended that AOTA 

approve any new credentialing body 

that might develop in the future. 

Response: We recognize that currently 

the ACOTE or the World Federation of 

Occupational Therapists (WFOT) 

credential education programs for OTs 

and/or OTAs and the NBCOT 

determines eligibility and furnishes 

examinations. We have modified the 

policy to approve those organizations 

and added ‘‘or successor organizations’’

to allow for changes in the ACOTE title. 

We do not agree membership in NBCOT 

should be a requirement. Since NBCOT 

is already approved by The American 

National Standards Institute (ANSI), the 

National Commission for Certifying 

Agencies and the National Organization 

for Competency Assurance, CMS does 

not believe it is necessary to grant 

AOTA’s request to permit it to approve 

any future credentialing body. 

International OT/OTA 

We also proposed that OTs who are 

educated outside the United States: (1) 

Be graduates of an occupational therapy 

curriculum accredited by the WFOT; (2) 

have successfully completed the 

NBCOT International Occupational 

Therapy Eligibility Determination 

(IOTED) review; and (3) have 

successfully completed the certification 

examination for Registered 

Occupational Therapist. We proposed to 

adopt similar standards for OTAs (but 

with an OTA curriculum) and requested 

comments on qualifications for 

internationally educated occupational 

therapy assistants. 

Comment: The AOTA and NBCOT 

support the proposal that the 

internationally educated OT standards 

should be comparable to United States 

trained OTs and that the NBCOT 

conduct the credentialing process for 

these OTs. The AOTA requests that 

there be a way to allow a professionally 

recognized credentialing body other 

than NBCOT to develop or administer 

the examination. 

NBCOT reports there are no 

internationally trained OTAs and 

recommends qualifications for such 

OTAs be stricken from the rules. 

Response: This final rule with 

comment period recognizes the ACOTE, 

NBCOT or WFOT to contribute to 

credentialing internationally trained 

OTs and OTAs. Although NBCOT may 

not now recognize internationally 

trained OTAs, such OTAs do exist. In 

addition, we are adopting regulations in 

anticipation of any international 

programs that meet the qualifications in 

the future. 

Comment: AOTA commented that the 

proposals for those who began practice 

between December 31, 1977, and 

January 1, 2008, are archaic and cannot 

be directly applied to many 

professionals qualified by their States. 

Response: We agree that the current 

language is not applicable and we have 

updated this language for the new 

qualifications in this final rule with 

comment period, adding current 

credentialing bodies for United States 

trained and internationally trained OTs. 

To assure that no one covered under the 

existing qualifications is inadvertently 

disqualified, the prior language 

continues to apply for those who are not 

licensed but were qualified under the 

previous policy. 

Comment: Commenters note that 

many States allow graduate OTs and 

OTAs to furnish services under a 

temporary license or permit while 

eligible for examination. The 

commenters expressed concern that the 

qualifications in the proposed rule 

would limit new graduates from 

entering the workforce. 

Response: We agree that it is not 

necessary to change the current 

requirement of eligibility for the 

examination for United States trained 

OTs and OTAs when they are licensed 

or otherwise regulated by their States. 

However, we will require foreign 

trained OTs and OTAs (when 

applicable) to have passed the 

examination, and not merely be eligible 

for it. We believe this requirement is 

appropriate in the case of foreign 

trained individuals in order to ensure 

that they have acquired sufficient 

knowledge through their education 

program to pass the examination and, 

thus, are adequately prepared to begin 

furnishing services to Medicare 

beneficiaries. 

Physical Therapy 

For PTs, we proposed the therapist 

must be licensed as a physical therapist 

by the State in which practicing and 

accredited by the CAPTE based on 

APTA guidelines. When the licensure 

requirement is not applicable (that is, 

for services furnished incident to the 

services of physicians and NPPs), we 

proposed to require that PTs must be 

accredited by the CAPTE. We requested 

comments on qualifications for PTs 

which include satisfactory completion 

of a curriculum and a national 

examination each approved by the 

APTA. 

Comment: APTA recommended that 

we remove the requirement that a PT 

pass a National Examination approved 

by the APTA. Since all States require a 

national licensing exam, APTA does not 

believe it is necessary for APTA to 

approve the exam. State Boards 

supported State licensing requirements, 

which include examination. 

Response: In cases where the 

licensing standards do not apply (for 

therapy services incident to a 

physician’s service or in the event a 

State deregulates PT practice), we 

believe it is important to have standards 

in place to ensure that an individual is 

qualified to furnish physical therapy 

services. We will not finalize the 

requirement for APTA to approve the 

licensing exam. Instead, we will accept 

a national licensing exam used by State 

boards to qualify personnel who have 


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been trained in a physical therapy 

curriculum. 

We proposed that licensure or 

certification, or other regulation by the 

State in which services are furnished 

would be required for PTAs under our 

regulations. We also proposed that PTAs 

be accredited by the CAPTE. We 

requested comments on appropriate 

qualifications for PTAs. 

Comment: APTA believes it is critical 

that we require approval by APTA for 

foreign trained PTAs. The Commission 

on Accreditation of Physical Therapist 

Education (CAPTE) of the APTA has 

been nationally recognized since 1977 

as the only organization that approves 

PT and PTA education programs; it has 

no financial interest in the credentialing 

bodies for PTs or PTAs. 

Some commenters disagreed with our 

proposal to allow the APTA to approve 

the credentialing body that establishes 

qualifications for foreign trained PTs 

and/or PTAs. They suggest that the U.S. 

Citizenship and Immigration Services 

and the Department of Homeland 

Security approve credentialing bodies 

that set standards and credential 

individuals and the States decide 

whether to license that individual. The 

commenters note there are currently no 

approved foreign PTA programs. 

Response: While commenters tell us 

there are no foreign PTA programs that 

meet their credentialing standards, there 

may be PTA programs in foreign 

countries that meet the standards in the 

future. Therefore, this final rule with 

comment period addresses this future 

need. The CAPTE of the APTA is 

approved by the U.S. Department of 

Education (USDE) and the Council for 

Higher Education Accreditation (CHEA). 

We find no reason to doubt that CAPTE/ 

APTA will make fair determinations on 

the appropriateness of educational 

programs in the United States or 

credentials evaluation organizations for 

foreign trained PTs and PTAs. However, 

in response to comments, we have 

recognized both CAPTE and a 

credentials evaluation organization 

identified in 8 CFR 212.15(e) (the 

Homeland Security Act) as it relates to 

physical therapists and assistants to 

determine an education program to be 

substantially equivalent to PT and PTA 

entry level education in the United 

States. We believe the additional 

requirement for passing a national 

examination will mitigate any variations 

in credentialing. 

Comment: Several commenters stated 

that adoption of the proposed 

qualifications for PTs would usurp the 

rights of State governments in licensing 

and determining the scope of practice 

for healthcare professionals, creating ‘‘a 

monopoly for curriculum approval’’. 

Response: As we indicated in the 

proposed rule, we believe it is important 

to establish consistent and meaningful 

standards and conditions for the 

provision of Medicare covered services. 

Professional standards change 

periodically and these are often 

eventually adopted by State licensing 

boards, each of which has different 

language in its statutes. We believe the 

standards we proposed would not usurp 

or interfere with the adoption of 

standards by States. Rather, in most 

cases the standards incorporate the State 

standards. However, we believe it is 

necessary for CMS to address 

circumstances where State licensing or 

other regulation are not applicable. We 

are not creating a monopoly for 

curriculum approval by recognizing 

CAPTE. While it is the only existing 

credentialing body used by the States in 

their licensing process, we assess other 

credentialing qualifications if they are 

developed. Therefore, we are finalizing 

standards that include State standards 

(licensing or other regulation), as well as 

education and examination. We will 

assess other credentialing qualifications 

if they are developed. 

b. Application of Consistent Therapy 

Standards 

(1) Personnel Qualifications 

We believe therapy services should be 

provided according to the same 

standards and policies in all settings, to 

the extent possible and consistent with 

statute. Therefore, we proposed to revise 

our regulations to cross-reference the 

personnel qualifications for therapists in 

§ 484.4 to the personnel requirements 

for PTs, OTs, PTAs, OTAs, and SLPs in 

the following sections: 

• § 409.10 and § 409.16 (Inpatient 

hospital services and inpatient critical 

access hospital services). 

• § 409.23 (Posthospital SNF care). 

• § 410.43 (Partial hospitalization 

services). 

• § 410.59 (Outpatient occupational 

therapy services). 

• § 410.60 (Outpatient physical 

therapy services). 

• § 410.62 (Outpatient SLP services). 

• § 418.92 (Hospice). 

• § 482.56 (Optional hospital services, 

Rehabilitation services). 

• § 485.70 (Specialized providers). 

• § 485.705 (Clinics, Rehabilitation 

agencies, Public health agencies). 

• § 491.9 (Rural health clinics and 

Federally qualified health centers 

(FQHCs)). 

We also solicited comments on 

whether the personnel qualifications at 

§ 484.4 should be made applicable in 

other settings. 

Consistent Personnel Qualification 

Standards 

Comment: Many commenters 

supported consistent personnel 

qualifications. Commenters indicated 

beneficiaries deserve to be treated by 

qualified professionals in both inpatient 

and outpatient settings. 

We also heard from commenters who 

oppose the application of consistent 

qualifications for therapists in Part A 

settings. The commenters stated that if 

only qualified physical therapists 

provide physical therapy services in 

Part A settings, it will prevent hospitals 

from continuing to employ athletic 

trainers to provide physical medicine 

and rehabilitation services. The 

commenters suggest the medical staff 

should decide the qualifications for 

therapists at a hospital. 

Response: The policies outlined in the 

proposed rule apply only to therapy 

services. The State Operations Manual 

Appendix A Survey Protocol, 

Regulations and Interpretive Guidelines 

for Hospitals (Rev. 1, 05–21–04) 

§ 482.56 Condition of Participation: 

Rehabilitation Services indicates that 

therapy services, if provided, must be in 

accordance with acceptable standards of 

practice which include compliance with 

any applicable Federal or State laws, 

regulations or guidelines, as well as 

standards and recommendations 

promoted by APTA, ASHA, and AOTA. 

In States where there are no personnel 

qualifications for therapists or 

assistants, hospitals should currently be 

following the personnel qualification 

standards set by those professional 

organizations. Most States and all of the 

professional organizations require 

graduation from approved education 

programs and a passing grade on a 

national examination. Therefore, we do 

not anticipate that adherence to the 

personnel qualifications in this final 

rule will cause any changes in hospital 

personnel. 

At the same time, we recognize that 

there may be athletic trainers (AT), 

lymphedema specialists, low vision 

specialists, nurses, physicians, and 

other staff employed in hospital settings 

who furnish other services for which 

they are qualified, and for which 

payment is included in the payment to 

the facility. Those services should be 

appropriately documented as, for 

example, athletic training or 

lymphedema services. Where the 

services of health care professionals 

who are not PTs, OTs, PTAs, OTAs, or 

SLPs are now being appropriately 

furnished, documented and reimbursed, 


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we anticipate the application of 

consistent personnel qualifications 

relating to PT, OT and SLP services will 

have no effect on the appropriate 

provision of these other services. In 

settings where therapy services are 

separately billable, there will only be an 

impact on current practice if services 

that are being documented as PT, OT, or 

SLP services are being furnished by 

personnel who do not meet the 

requirements to be considered qualified 

therapists. Personnel who do not meet 

the applicable professional standards to 

be considered qualified therapists 

cannot furnish or be paid for PT, OT, 

and SLP services. 

Comment: Several commenters 

indicated that therapy services are not 

covered in rural health clinics. 

Response: Rural Health Clinics 

(RHCs) provide a core set of primary 

health care services as defined in 

statute. RHC services include the 

services that would commonly be 

furnished in a physician’s office, (such 

as PT, OT, and SLP services), but only 

when directly provided by a Medicare 

approved RHC provider, such as a 

physician, nurse practitioner, or 

physician assistant. A certified nurse 

midwife, clinical psychologist, and or 

clinical social worker may provide RHC 

services, but not PT, OT, or SLP 

services, because PT, OT, and SLP 

services are not in their scope of 

practice. A face-to-face encounter with 

any other practitioner including, for 

example, a PT, OT, or SLP, athletic 

trainer, kinesiologist, or registered nurse 

is not covered as an RHC encounter, 

even if the service may be medically 

necessary, because these are not 

Medicare approved RHC providers (as 

defined in statute). Since therapists are 

not approved RHC providers, we will 

remove the reference in § 491.9 to 

personnel qualifications for therapists. 

Consistent Policies 

(2) Application of Consistent Therapy 

Standards 

In tandem with cross-referencing Part 

A and Part B therapy personnel 

requirements in the regulations, we 

proposed to clarify our policies to 

improve consistency in the standards 

and conditions for Part A and Part B 

therapy services. Many, but not all, of 

the policies described for therapy 

services in Part B settings are also 

appropriate to Part A settings. 

Specifically, in § 409.17, we proposed 

to clarify that hospital services include 

physical therapy, occupational therapy, 

and SLP. We also proposed to add 

regulations for inpatient hospital 

services to include a plan for therapy 

services consistent with the plan 

required for outpatient therapy services. 

We invited comment on PT, OT, and 

SLP plan of treatment policies that are 

appropriately applied to all therapy 

services, whether provided under 

Medicare Part A or B. 

While the concept of consistent 

policies was strongly supported, many 

commenters were concerned about the 

application of specific Part B policies to 

Part A settings. 

Comment: Several commenters 

indicated concern that application of 

the Part B policies, especially plan and 

documentation polices, to the inpatient 

hospital setting would impact treatment 

and increase the paperwork burden to 

staff. 

Response: We are aware that inpatient 

stays are short. If clinically appropriate 

documentation is now provided, the 

new policies are unlikely to increase the 

burden. We have not delineated which 

of the Part B policies would apply in 

Part A specifically to allow some 

flexibility in the application of the 

general treatment guidelines as 

appropriate to the setting. We anticipate 

addressing these issues in manual 

instructions. 

We note that we continue to believe 

the general concept that therapy 

services should be provided in a similar 

manner by qualified personnel in all 

settings is an appropriate one. 

Comment: The AOTA requests that 

any change to the therapy plan of care 

be incorporated ‘‘as soon as possible’’

rather than ‘‘immediately.’’

Response: We recognize that the term 

‘‘immediately’’ could be relative. 

Therefore, we have substituted ‘‘as soon 

as possible’’ to refer to changes in the 

plan in § 424.24 and § 482.56. 

Comment: Commenters indicated 

concern that the outpatient plan of care 

certification requirement would be 

transferred to inpatient policy and that 

an ordered service that is being 

provided under the care of a hospital 

physician would also require 

certification for every change in the 

provision of treatment. 

Response: The policy at § 409.17 and 

§ 482.56 is compatible with the concept 

of the therapy plan as part of the overall 

plan in a facility. Also, we defer to 

hospital policies and procedures for 

changes to the plan. Guidance will be 

provided in manuals concerning 

modifications in the provision of care 

that do not constitute changes to the 

plan. Requirements concerning orders 

for establishment of a therapy plan 

(development and implementation) in 

the hospital are not changed by this 

final rule with comment period. We 

anticipate clarifying further in manual 

instructions documentation 

requirements that are consistent with 

the care of inpatients and will take into 

account comments received. We believe 

that, in general, good practice would 

call for documentation of significant 

changes to the patient’s response to 

treatment in all settings, even if the 

Medicare program does not specifically 

require it. 

Comment: AOTA asserts that in the 

inpatient setting, goal setting and 

treatment planning may not fit the mold 

of what is typically required by CMS in 

outpatient settings, that is, functional 

restoration. They indicate concern that 

therapy will not be provided consistent 

with their professional guidelines or 

scope of practice. 

Response: We recognize that some of 

the services furnished by therapists in 

the acute inpatient hospital setting may 

not achieve functional changes expected 

in other settings. We have noted in 

§ 482.56 that the provision of care and 

the personnel qualifications must be in 

accordance with national acceptable 

standards of practice. Although 

documentation is not relevant to billing 

in this setting, it is still critical that the 

services furnished be accurately 

documented. We anticipate issuing 

further guidance regarding 

documentation for therapy services in 

hospital settings in Medicare manuals. 

Comment: AOTA requests removal of 

the reference to review of the plan prior 

to certification in § 409.17(e). APTA 

agrees that the review language is 

unnecessary. 

Response: We agree that it is 

unnecessary in the regulation to remind 

physicians or nonphysician 

practitioners to read the plan before 

they certify it and we have removed the 

paragraph from § 410.61(e) and 

§ 409.17(e), and § 482.56(e). 

Comment: Several commenters agree 

with the proposal that in the hospital 

setting the physician’s review and 

approval of a therapy plan should be 

implied in the physician’s review and 

approval of a facility plan that includes 

therapy services. The commenters 

believe the same rationale applies to 

services furnished in skilled nursing 

facilities and urge CMS to state that, in 

the SNF Part A setting, review of the 

therapy plan is implied by the 

physician’s review of the facility plan. 

Response: We agree with the 

commenters regarding the implied 

physician review and approval of the 

therapy plan in the Part A SNF setting. 

We have recognized this issue 

previously in the preamble to the 

Prospective Payment System and 

Consolidated Billing for Skilled Nursing 

Facilities; Update Notice (69 FR 45780), 


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where we stated that ‘‘ * * *. It is not 

necessary for a SNF to obtain a separate 

physician signature on the therapy 

treatment plan itself prior to billing Part 

A for therapy services * * * .’’

Delay in Implementing Policies 

Comment: Many commenters 

requested delays in the implementation 

of the policies for Part A therapy 

services, indicating they want time to 

have input into the manual guidelines 

and may need time to learn new 

procedures. 

Response: We will delay the 

implementation of the policies pending 

the issuance of manual guidance which 

we anticipate that we will develop in 

mid 2008. 

Students 

Comment: Many commenters believe 

that it is imperative that we not 

inadvertently develop a policy that 

prevents students from receiving 

clinical training. APTA suggests we 

consider conforming the policies for 

students to the SNF policy for services 

provided by aides and students. The 

SNF policy allows services by aides and 

students in the ‘‘line of sight’’ of the 

therapist to count toward minutes 

accrued on the Minimum Data Set. 

Response: We will consider 

conforming all policies for student 

supervision to the SNF policy for line of 

sight supervision, and will address this 

issue in manual guidance. 

c. Outpatient Therapy Certification 

Requirements 

In 1988, in an attempt to control the 

expanding utilization of therapy 

services, we added a 30-day 

recertification requirement for 

outpatient therapy services to our 

regulation at § 424.24. This requires that 

a physician certifies a plan of care for 

30 days, regardless of the appropriate 

length of treatment. To continue 

treatment past 30 days, the physician is 

required to recertify the plan. As 

explained in the CY 2008 PFS proposed 

rule, after many years of experience 

with the current recertification 

requirements, we now believe that 

requiring recertification at 30-day 

intervals may not always provide 

sufficient flexibility to the physician to 

order the appropriate amount of therapy 

for the patient’s needs. Therefore, we 

proposed to change the plan 

recertification schedule in § 424.24 to an 

episode length based on the patient’s 

needs, not to exceed 90 days. 

Comment: We received strong support 

for changing the recertification schedule 

to a date determined by the physician 

(not to exceed 90 days) from the therapy 

associations, medical societies, 

facilities, and individuals. They 

emphasized that physician approval of 

a clinically appropriate length of 

treatment at the initial certification will 

improve the patients’ access to 

treatment, reduce administrative burden 

to physicians, therapists and office staff 

and reduce unnecessary visits for 

patients. Several indicated that a limit is 

not necessary since the physician 

should determine the episode length. 

MedPAC indicated a concern about 

reducing the number of physician 

reviews of the services in the context of 

the increasing utilization of therapy 

services 

Response: We agree that a physician 

is qualified to certify the appropriate 

length of care in the initial certification; 

and that recertification should be 

required as often as the individual’s 

condition requires. However, we believe 

a 90-day limit is a reasonable 

modification of the policy at this time. 

We will continue to review the 

utilization of therapy services to assess 

any changes in the relative utilization 

patterns for beneficiaries or providers/ 

suppliers that may suggest changes in 

practice related to this policy. As we 

proposed, after 2 years, if we determine 

that there are changes in relative 

utilization patterns that suggest 

inappropriate utilization of therapy 

services based on the certification 

timing, we will reconsider this policy. 

Comment: One commenter stated that 

a physician generally does not have 

statistical data from which to make a 

decision regarding the appropriateness 

of initiation or continuation of therapy, 

and, therefore, recertification of therapy 

by physicians seems meaningless. The 

commenter urges the use of riskadjusted data based on gains in 

functional status relative to number of 

visits to inform physician decision 

making for appropriate utilization. 

Response: We agree that collection of 

data related to the patient’s functional 

condition and relative utilization of 

services may be useful in our ongoing 

development of recommendations for 

alternatives to therapy caps. On 

September 6, 2007, we released a 

Request for Task Order Proposals to the 

pool of contractors under the CMS 

MRAD (Master Research And 

Development) contract vehicle. The goal 

of this request for proposals is to 

develop recommendations for 

alternatives to therapy caps for CMS 

covered Outpatient Therapy services. 

Comment: There was very strong 

support for extension of the 90 day 

recertification policy to CORF settings, 

consistent with the proposed policy for 

all other settings. There were no 

comments opposed to consistent 

recertification policy in the CORF. 

Response: We will apply this policy 

consistently across settings, including 

the CORF reference in § 410.105(c)(ii)(2) 

and 424.27(b). 

Review of Plan 

We proposed that review of the plan 

as required in § 424.24 would continue 

to be required at certification and 

recertification. Since the plan may be 

established by a nurse practitioner, a 

clinical nurse specialist, or a physician 

assistant (nonphysician practitioners), 

as well as a physician, we proposed to 

modify the language in § 410.61 to 

include those professionals among those 

who may review the plan. Since the 

certification and recertification of the 

plan for Part B services requires a 

signature, we proposed to remove the 

current redundant requirement at 

§ 410.61(e) to date and sign a review at 

the same time the plan is certified. In 

addition, we proposed to revise § 424.24 

to remove reference to a certification 

‘‘statement.’’

Comment: We received one comment 

supporting the changes to the review 

language and no dissenting comments. 

Response: We are finalizing the 

proposed changes to the review of plan 

language in this final rule with 

comment period. 

3. Amendment of the Exemption for 

Computer-Generated Facsimile 

Transmission From the National 

Council for Prescription Drug Programs 

(NCPDP) SCRIPT Standard for 

Electronically Transmitting Prescription 

and Certain Prescription-Related 

Information for Part D Eligible 

Individuals 

a. Legislative History 

Section 101 of the MMA amended 

title XVIII of the Act to establish a 

voluntary prescription drug benefit 

program. Prescription Drug Plan (PDP) 

sponsors and Medicare Advantage (MA) 

organizations offering Medicare 

Advantage—Prescription Drug Plans 

(MA–PD) are required to establish 

electronic prescription drug programs to 

provide for electronic transmittal of 

certain information to the prescribing 

provider and dispensing pharmacy and 

pharmacist. This would include 

information about eligibility, benefits 

(including drugs included in the 

applicable formulary, any tiered 

formulary structure and any 

requirements for prior authorization), 

the drug being prescribed or dispensed 

and other drugs listed in the medication 

history, as well as the availability of 

lower cost, therapeutically appropriate 


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alternatives (if any) for the drug 

prescribed. The MMA directed the 

Secretary to issue uniform standards for 

the electronic transmission of such data. 

There is no requirement that 

prescribers or dispensers implement eprescribing. However, prescribers and 

dispensers who electronically transmit 

prescription and certain other 

prescription-related information for 

covered drugs prescribed for Medicare 

Part D eligible beneficiaries, directly or 

through an intermediary, would be 

required to comply with any applicable 

final standards that are in effect. 

b. Foundation Standards and Exemption 

for Computer Generated Facsimiles 

(Faxes) 

In the E-Prescribing and the 

Prescription Drug Program final rule (70 

FR 67568, November 7, 2005), we 

adopted the NCPDP SCRIPT standard, 

Implementation Guide, Version 5, 

Release 0 (Version 5.0), May 12, 2004, 

excluding the Prescription Fill Status 

Notification Transaction (and its three 

business cases; Prescription Fill Status 

Notification Transaction—Filled, 

Prescription Fill Status Notification 

Transaction—Not Filled, and 

Prescription Fill Status Notification 

Transaction—Partial Fill), hereafter 

referred to as NCPDP SCRIPT 5.0, as the 

standard for communicating 

prescriptions and prescription-related 

information between prescribers and 

dispensers. Subsequently, on June 23, 

2006 (71 FR 36020), HHS published an 

interim final rule that maintained 

NCPDP SCRIPT 5.0 as the adopted 

standard, but allowed for the voluntary 

use of a subsequent backward 

compatible version of the standard, 

NCPDP SCRIPT 8.1. As use of either of 

these two named versions of the NCPDP 

SCRIPT standard is permitted, for ease 

of reference, we will simply refer to 

‘‘NCPDP SCRIPT’’ in this rule. 

The November 7, 2005 final rule also 

established an exemption to the 

requirement to utilize NCPDP SCRIPT 

for entities that transmit prescriptions or 

prescription-related information by 

means of computer generated facsimiles 

(faxes generated by one computer and 

electronically transmitted to another 

computer or fax machine which prints 

out or displays a image of the 

prescription or prescription-related 

information). Providers and dispensers 

who use this technology are not 

compliant with NCPDP SCRIPT. The 

exemption was intended to allow such 

providers and dispensers time to 

upgrade to software that utilizes the 

NCPDP SCRIPT standard, rather than 

forcing them to revert to paper 

prescribing. 

c. Elimination of Exemption 

In the CY 2008 PFS proposed rule (72 

FR 38194), we proposed to revise 

§ 423.160(a)(3)(i) to eliminate the 

computer generated fax exemption to 

the NCPDP SCRIPT Standard for the 

communication of prescription or 

certain prescription related information 

between prescribers and dispensers for 

the transactions listed at 

§ 423.160(b)(1)(i) through (xii). 

Since computer-generated faxing 

retains some of the disadvantages of 

paper prescribing (for example, the 

administrative cost of keying the 

prescription into the pharmacy system 

and the related potential for data entry 

errors that may impact patient safety), 

we believed it was important to take 

steps to encourage prescribers and 

dispensers to move toward use of 

NCPDP SCRIPT. 

In our November 7, 2005 final rule 

discussion of computer-generated 

faxing, we distinguished between cases 

where the prescriber’s or dispenser’s 

software has the ability to generate 

transactions utilizing the NCPDP 

SCRIPT, but the prescriber has not 

activated the feature on their software, 

and other cases where software (such as 

a word processing program) is used to 

create a document that can be sent as a 

fax that results in print out or displays 

a image of a prescription or response at 

the receiving end, but does not have 

true e-prescribing (electronic data 

interchange using NCPDP SCRIPT) 

capabilities. 

We believed the elimination of the 

computer-generated fax exemption 

would encourage prescribers and 

dispensers using this computergenerated fax technology to, where 

available, utilize true e-prescribing 

capabilities. 

It might also encourage those without 

such capabilities to upgrade their 

current software products, or, where 

upgrades are not available, to switch to 

new products that would enable true eprescribing. 

Because the elimination of the 

computer-generated facsimile exception 

would encourage those prescribers that 

are already using e-prescribing software 

that is capable of true e-prescribing to 

utilize those capabilities, we believed 

that the elimination of the computergenerated fax exemption would increase 

the number of NCPDP SCRIPT 

transactions fairly significantly in a 

relatively short time period, and that 

this could, in turn, create a ‘‘tipping 

point’’ that could create economic 

incentives for independent pharmacies 

to adopt NCPDP SCRIPT capable 

software to begin to exchange true eprescribing transactions with their 

prescriber partners. 

We proposed to eliminate the 

computer generated fax exemption 

effective 1 year after the effective date 

of the CY 2008 PFS final rule, on 

January 1, 2009. We believed that this 

would provide sufficient notice to 

prescribers and dispensers who would 

need to implement or upgrade eprescribing software to look for products 

and upgrades that are capable of 

generating and receiving transactions 

that utilize NCPDP SCRIPT. It would 

also afford current e-prescribers time to 

work with their trading partners to 

eventually eliminate computer-to-fax 

transactions. 

We believed the elimination of the 

exemption for computer-generated 

faxing would encourage e-prescribers 

and dispensers to move as quickly as 

possible to use of the NCPDP SCRIPT 

standard with what we perceived to be 

minimal impact. 

We solicited comments on the impact 

of the proposed elimination of this 

exemption. 

Comment: Several commenters 

concurred with our proposal to 

eliminate the exemption for computergenerated faxes. These commenters 

indicated that lifting the exemption for 

computer generated faxes would act as 

an incentive to move prescribers and 

dispensers toward true e-prescribing 

(electronic data interchange using the 

NCPDP SCRIPT standard) and that once 

the benefits of true e-prescribing are 

realized by a core group of prescribers 

and dispensers, word of mouth would 

help foster more extensive adoption. 

Less than half of all commenters 

disagreed with our proposal to eliminate 

the exemptions for computer-generated 

faxes, citing concerns about increased 

hardware/software costs, transaction 

fees, certification and other activation 

costs. Some commenters agreed that 

many prescribers who are already eprescribing likely already possess the 

ability to generate NCPDP SCRIPT 

compliant transactions using their 

software or can comply by obtaining a 

version upgrade under their 

maintenance agreements. Some 

commenters also questioned whether 

lifting the exemption would move the 

industry forward toward, or raise 

barriers to, greater use of true eprescribing. We also received comments 

from some individuals who erroneously 

thought that we had proposed the 

elimination of all faxes, including 

paper-to-paper faxes. 

Response: For new e-prescribers, the 

cost of implementing a product that can 

generate an NCPDP SCRIPT-compliant 

transaction would not differ from a 


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product that could not, and we expect 

that, over time, the market will move 

toward the exclusive use of NCPDP 

SCRIPT-compliant transactions. 

Moreover, the adoption of the PQRI 

structural measure discussed section 

II.S.1. of this final rule with comment 

period will provide an incentive to 

providers to implement e-prescribing. 

We recognize that pharmacies that are 

not now conducting transactions that 

utilize NCPDP SCRIPT will incur costs 

to implement this capability, and that 

pharmacies will likely experience an 

increase in e-prescribing transaction 

volumes and costs. However, those costs 

would be balanced by administrative 

savings. We refer to the November 7, 

2005 final rule (70 FR 67568) for a 

further discussion of potential costs 

associated with e-prescribing. 

As more prescribers and dispensers 

embrace interoperable health 

information technology in general, and 

the use of e-prescribing standards in 

particular, they will see real value and 

realize costs savings. Dispenser data 

entry time and transcription errors due 

to data re-entry or illegible paper 

prescriptions will be reduced. 

Prescribers and dispensers will spend 

less time on the phone requesting and 

responding to refill requests. Improved 

workflow will free up staff time for 

patient counseling and other services. 

Patient safety will improve as providers 

are linked with medication history, 

allergy information and/or drug 

contraindications that will result in a 

reduction of adverse drug events. 

Comment: Many commenters agreed 

that the proposed compliance date of 

January 1, 2009 was a reasonable 

timeframe for those who needed to 

comply. Others urged us to extend the 

compliance date to April 1, 2009, to 

coincide with the projected effective 

date of the next set of e-prescribing 

standards, or to January 1, 2010, to give 

prospective e-prescribers more time to 

identify compliant products. Some 

commenters recommended that the 

requirement to use the adopted eprescribing standards should only apply 

to those prescribers/dispensers who 

have software or applications that have 

the ability to generate transactions 

utilizing NCPDP SCRIPT. Others 

suggested that the use of computergenerated faxes continue to be permitted 

for those prescribers and dispensers 

who already have the functionality to 

engage in transactions utilizing NCPDP 

SCRIPT, and allow those who adopt 

software that generates transactions 

utilizing NCPDP SCRIPT after the 

compliance date of January 1, 2009, an 

additional 1 year to comply with the 

NCPDP SCRIPT requirement. 

Response: The 2006 CMS eprescribing pilot noted that the majority 

of e-prescribing software currently being 

used by prescribers is already able to 

transmit information using NCPDP 

SCRIPT. Moreover, commenters agreed 

that most current e-prescribers could 

become compliant by installing an 

NCPDP SCRIPT-enabled version 

upgrade. Therefore, we believe that the 

January 1, 2009 compliance date 

provides adequate time for current eprescribers in the industry to comply 

with the NCPDP SCRIPT e-prescribing 

standard provisions while encouraging 

other prescribers and dispensers to 

move closer toward true e-prescribing. 

We do not see a purpose in affording 

new e-prescribers an additional year to 

comply, since it should not take more 

time to implement an NCPDP SCRIPTcompliant product than a noncompliant 

product. 

Comment: Many commenters 

suggested that we continue to allow for 

the use of computer-generated faxes in 

the case of transmission failure and 

network outages. 

Response: Computer-generated faxes 

may be needed for prescriptions which 

fail in electronic data interchange (EDI) 

transmission. Allowing computergenerated faxes as a fall back measure 

would allow the prescription to be 

expedited to the pharmacy, ensuring 

timely dispensing of the medication, 

thus enhancing patient safety. We agree 

that there should be a viable 

contingency plan in the event that an 

EDI-transmitted prescription fails due to 

network transmission failures or similar, 

temporary communication problems 

that are episodic and non-repetitive in 

nature. We find the use of computergenerated faxes, but only in instances of 

the aforementioned transmission 

failures or similar communication 

problems of a temporary/transient 

nature, to be an acceptable and viable 

solution. We do not, however, consider 

it to be a permanent substitute for 

ongoing EDI transmission problems. As 

we will continue to allow computergenerated faxes as a fallback in cases of 

temporary/transient transmission 

failures and communications problems, 

we will not totally eliminate but instead 

amend the exemption for computergenerated facsimile transmission from 

the NCPDP SCRIPT Standard to account 

for this contingency. 

Comment: Approximately one-fourth 

of commenters from all sectors of the 

health care industry called for the delay 

of the elimination of the exemption for 

computer-generated faxes until such 

time as the Drug Enforcement Agency 

(DEA) changes its rules to allow the eprescribing of controlled substances. 

Commenters believe that the current 

DEA position on disallowing eprescribing of controlled substances 

creates a barrier to adoption, and the 

proposed CMS compliance date of 

January 2009 will only exacerbate the 

issue. 

Response: As we have no indication 

as to when the Drug Enforcement 

Agency will make a determination on 

the e-prescribing of controlled 

substances, it would be difficult for us 

to predicate eliminating the exemption 

for computer-generated faxes based 

upon such an unknown timetable. 

However, we concur with commenters 

who stated that the inability to prescribe 

these controlled substances 

electronically hampers e-prescribing 

adoption by providers. We continue to 

work with the DEA to help facilitate a 

solution that addresses both the 

enforcement requirements of the DEA 

with respect to prescribing of controlled 

substances, and the needs of the 

healthcare community for a solution 

that is scalable and commercially viable. 

Comment: One commenter suggested 

that we exempt controlled substances 

from this requirement. 

Response: The November 7, 2005 Eprescribing final rule (70 FR 67568) 

recognizes the DEA’s role in the 

enforcement of the prescribing of 

controlled substances. As controlled 

substances cannot be legally eprescribed, an exemption from the 

NCPDP SCRIPT standard for the eprescribing of controlled substances 

would have no effect. 

Comment: Some commenters were 

confused as to whether the computer 

generated fax exemption would affect 

the exemption in the long term care 

setting, and requested that we clarify 

that prescribers and dispensers in the 

long term care setting were exempt from 

the requirement to use NCPDP SCRIPT 

despite the amendment of the 

exemption of the computer generated 

faxes. 

Response: Our amendment of the 

exemption for computer generated faxes 

does not apply at this time to the long 

term care industry as defined under 

Medicare Part D. At the time the CY 

2008 PFS proposed rule (72 FR 38194) 

was published in the Federal Register, 

the long term care industry exemption 

for using adopted standards in eprescribing (as contained in the 

November 7, 2005 final rule (70 FR 

67568)) was, and remains, in place. 

Based on the comments we received, we 

are finalizing an amendment of the 

exemption for computer-generated 

faxes. 


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S. Division B of the Tax Relief and 

Health Care Act of 2006—Medicare 

Improvements and Extension Act of 

2006 (Pub. L. 109–432) (MIEA–TRHCA) 

In addition to the provisions of the 

MIEA–TRHCA discussed in sections 

II.B. (GPCIs) and II.F. (CAP), additional 

provisions of the MIEA–TRHCA are 

discussed in this section of the final rule 

with comment period. 

1. Section 101(b)—Physician Quality 

Reporting Initiative (PQRI) 

a. Background 

(i) Program Background and Statutory 

Basis 

Section 101(b) of the MIEA–TRHCA 

amended section 1848 of the Act by 

adding subsection (k). Section 

1848(k)(1) of the Act requires the 

Secretary to implement a system for the 

reporting by eligible professionals of 

data on quality measures as described in 

section 1848(k)(2) of the Act. Section 

1848(k)(3)(B) of the Act specifies that for 

the purpose of the quality reporting 

system, eligible professionals include 

physicians, other practitioners as 

described in section 1842(b)(18)(C) of 

the Act, physical and occupational 

therapists, and qualified speechlanguage pathologists. Section 101(c) of 

the MIEA–TRHCA authorizes 

‘‘Transitional Bonus Incentive Payments 

for Quality Reporting’’ in 2007, 

specifically for satisfactory reporting of 

quality data, as defined by section 

101(c)(2) of the MIEA–TRHCA. We have 

named this quality reporting system the 

‘‘Physician Quality Reporting Initiative 

(PQRI)’’ for ease of reference. 

For 2007, section 1848(k)(2)(A)(i) of 

the Act, as added by the MIEA–TRHCA, 

provides that the quality measures for 

the PQRI shall be the 66 physician 

quality measures published as 2007 

Physician Voluntary Reporting Program 

(PVRP) quality measures on the CMS 

web site as of the date of enactment of 

this subsection, except for any changes 

based on the results of a consensusbased process in January 2007. Based on 

actions approved at the AQA Alliance 

(formerly the Ambulatory Care Quality 

Alliance) meeting on January 22, 2007, 

8 measures were added to the 66 

measures from the PVRP. Thus, the final 

‘‘2007 PQRI Quality Measures’’

comprise 74 measures, which are 

applicable to specific combinations of 

patient conditions and Medicare 

Physician Fee Schedule (PFS) covered 

professional services. The measure 

titles, descriptions, and specifications 

are available for download from the 

PQRI Measures/Codes page of the PQRI 

section of the CMS Web site at http:// 

www.cms.hhs.gov/PQRI. 

Section 1848(k)(2)(A)(ii) of the Act 

does not allow for any further additions 

to or deletions from the 2007 PQRI 

Quality Measures after January 2007, 

and does not allow modifications or 

refinements (such as code additions, 

corrections, or revisions) to the detailed 

specifications for the 2007 PQRI quality 

measures after the July 1, 2007, 

beginning date of the reporting period. 

The final 2007 specifications for the 

2007 PQRI quality measures are 

available as a download from the 

Measures/Codes page of the PQRI 

section of the CMS Web site at http:// 

www.cms.hhs.gov/pqri. Additional 

information on the 2007 PQRI is also 

available from this section of the CMS 

Web site, including, but not limited to: 

• Tools to help professionals select 

measures; 

• Tools to help professionals capture 

data on 2007 PQRI quality measures; 

• Explanations of the calculation of 

eligibility for and amount of bonus 

payment for satisfactory reporting; and 

• A description of the methodology 

that we will use to validate whether 

professionals have satisfactorily 

reported the MIEA–TRHCA required 

minimum number of applicable 

measures. 

Section 1848(k)(2)(B) of the Act 

further requires that the Secretary 

publish in the Federal Register not later 

than August 15, 2007, proposed quality 

measures that would be appropriate for 

eligible professionals to use to submit 

data to the Secretary in 2008. The final 

2008 PQRI quality measures must be 

determined and published by November 

15, 2007, as specified in section 

1848(k)(2)(B) of the Act as amended by 

the MIEA–TRHCA. 

(ii) Overview of the PQRI Section in the 

Final Rule With Comment Period 

In the CY 2008 PFS proposed rule (72 

FR 38196 through 38199), we provided 

a slightly longer summary of the MIEA–

TRHCA requirements and the PQRI 

program than is provided immediately 

above in this section, and explained our 

interpretation of applicable statutory 

and government-wide policies relevant 

to defining a consensus organization 

and consensus-based measure 

development process, and our policy for 

determining which measures meet 

requirements for inclusion in PQRI. In 

satisfaction of the MIEA–TRHCA 

requirement to publish proposed 2008 

PQRI measures by August 15th, we 

published 148 proposed 2008 PQRI 

quality measures in the CY 2008 PFS 

proposed rule (72 FR 38199 through 

38202). We invited comments on the 

implications of including or not 

including any specific measure(s), and 

on our plans to explore mechanisms for 

submission of electronic clinical 

performance measurement information 

and/or summary measure results 

information extracted from electronic 

health records (EHRs) and/or clinical 

data registries. 

In this PQRI section of the final rule 

with comment period, we first address 

the general or overview public 

comments. 

(iii) General/Program Comments and 

Responses 

Comment: We received a number of 

comments commending CMS and the 

PQRI program for being responsive to 

stakeholder concerns, focusing on 

health care quality and performance 

improvement, and consistently using 

accurate and inclusive terminology (for 

example, where appropriate, ‘‘eligible 

professionals’’ rather than ‘‘physicians’’) 

while implementing on an aggressive 

timeline a functional program with an 

extensive and well-received education 

and outreach component. A number of 

commenters also expressed a desire to 

continue to work with us in a spirit of 

partnership to advance and improve the 

program and its utility to beneficiaries, 

professionals, and the industry at large. 

Response: We appreciate the 

constructive input of the wide variety of 

stakeholders who have provided 

insights, information, and partnered 

with us to disseminate informational 

materials about PQRI to the eligible 

professionals in the health care 

community. We plan to continue 

dialogue with stakeholder organizations 

and will consider their and PQRI 

participants’ input (including questions 

and comments submitted via informal, 

as well as formal, channels of inquiry) 

as we continue working to provide 2007 

PQRI participants with reporting rate 

and clinical performance results 

feedback reports and (for those 

participants achieving satisfactory 

reporting per MIEA–TRHCA 

requirements) PQRI incentive payments 

in mid-2008, and as we develop and 

implement strategies for individualclinician-level and related quality 

reporting and improvement initiatives 

for 2008 and beyond. 

Comment: We received numerous 

comments identifying specific ways in 

which commenters recommended we 

enhance the PQRI in the future. One 

theme was that, although defined per 

MIEA–TRHCA as professionals eligible 

to participate in PQRI, some clinicians 

may be unable to participate due to lack 

of PQRI measures applicable to their 

practices. A closely related concern was 

that some clinicians with otherwise 

applicable PQRI measures may be 


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unable to participate due to data 

submission relying on the Part B PFS 

Fee-For-Service claims mechanism. 

These limitations include that some 

PQRI-eligible professionals (such as 

physical and occupational therapists) 

who cannot currently participate in 

PQRI because reimbursement for the 

MPFS covered professional services 

they furnish is claimed in a format (X12 

837–I electronic transaction or the UB04 

form) that does not allow for attribution 

of each service to the individual 

professional who furnished it. 

Several commenters suggested that 

submission of electronic clinical 

information (ECI) from registries and/or 

electronic health records (EHRs) may 

potentially address the limitations of 

claims-based quality measures data 

submission. Other commenters simply 

urged us to find a mechanism, 

potentially a claims-based mechanism, 

to afford all eligible professionals the 

opportunity to participate prior to 

proceeding with PQRI subsequent to 

2007. 

Response: We agree with the goal of 

offering the opportunity to participate in 

PQRI to as many eligible professionals 

as feasible and practical, consistent with 

the MIEA–TRHCA statutory 

requirements. In support of this goal, 

especially where there are gaps in 

available consensus measures for 

specific practitioners, we have worked 

to encourage and contract for the 

development of quality measures and to 

fund consensus projects. For 2008, we 

have supported via contract with 

Quality Insights of Pennsylvania (QIP) 

the development of structural measures 

and measures applicable to a broad 

cross-section of PQRI eligible 

professionals, including some 

nonphysician practitioners (NPPs) who 

had few or no measures available in 

2007. We prioritized development of 

these measures based on the existing 

gaps in measures available or otherwise 

in development and on a need to 

address as broad a cross section of 

eligible professions or specialties as 

possible within the limited volume of 

measures for which we could support 

development in time for inclusion in the 

2008 PQRI. 

We plan to continue working to fill 

gaps in available consensus-endorsed or 

-adopted measures consistent with 

available time and resources. However, 

we largely depend on and encourage the 

development of measures by 

professional organizations and other 

measure developers. We note that 

MIEA–TRHCA includes a provision that 

requires the Secretary to include 

measures developed by specialty 

societies. Ideally, in the future CMS 

would not need to be closely involved 

in the development of clinician-level 

quality measures, but would select from 

measures that meet the MIEA–TRHCA 

requirements. 

In regard to the potential use of 

nonclaims mechanisms for submission 

of electronic clinical information, we 

agree with this goal; however it is not 

feasible to implement for 2008. In regard 

to claims-based alternatives to enable 

participation by professionals for whose 

covered professional services payment 

is made under or based on the MPFS but 

claimed via institutional formats (X12 

837–I electronic transaction or UB04 

form), we have analyzed the 

possibilities and determined that the 

MIEA–TRHCA requirement that 

satisfactory reporting and amount of any 

incentive payment be determined at the 

individual-professional level cannot be 

satisfied without extensive 

modifications to the claims processing 

systems of CMS and providers, which 

would represent a material 

administrative burden to us and 

providers, and/or modifications to the 

industry standard claims formats, which 

would require substantial time to effect 

via established processes and structures 

that we do not maintain or control. 

Comment: Although most 

commenters acknowledged that we 

proposed and will finalize 2008 

measures in response to MIEA–TRHCA 

statutory mandate, numerous 

commenters expressed concerns that we 

are proceeding with design and 

implementation of PQRI 2008 before we 

have been able to evaluate the 2007 

PQRI. One such commenter specifically 

declined to comment on the 2007 PQRI 

in advance of public availability of 2007 

PQRI evaluation information and 

requested that we solicit comments on 

the 2007 PQRI, and the 2007 PQRI 

evaluation information, in the CY 2009 

PFS proposed rule. Specific examples of 

evaluation information that commenters 

requested CMS consider and publish 

include: 

• Rates of participation by eligible 

professionals; 

• Cost or administrative burden of the 

PQRI from the perspective of 

participating professionals and the 

Medicare program; 

• The apparent impact of PQRI on 

professionals’ clinical performance; and 

• The impact on beneficiaries. 

Some of these commenters, and 

several other commenters who did not 

specifically raise concerns about 

program-level evaluation, requested that 

we consider delaying the start of the 

2008 reporting period until mid-2008 to 

give 2007 participants a chance to assess 

their 2008 results to identify process 

changes to improve their 2008 reporting 

rate and clinical performance results. 

Response: We are in the process of 

operationalizing, in a phased manner 

appropriate to data availability and 

analytic infrastructure implementation, 

a comprehensive ongoing program 

monitoring strategy that will provide 

interim indications, at the program 

level, of some of the same aspects of the 

program we will ultimately examine in 

our evaluation(s) of the impact of the 

2007 program after the conclusion of the 

2007 reporting period. To the extent 

feasible within the limits of available 

resources including, but not limited to, 

funding and sufficiently complete data, 

we anticipate conducting an evaluation 

of the 2007 PQRI. The aspects of PQRI 

impact we would expect to assess 

include participation rates by specialty/ 

profession, associated trends in clinical 

performance and beneficiary outcomes, 

and other observable impacts on 

participants, the Medicare program, and 

beneficiaries. Although we have not yet 

finalized the operational details of our 

evaluation strategy, we do anticipate 

making the results of the evaluation, at 

the national level, available to the 

public. We may also make publicly 

available the results of such analyses 

aggregated at other meaningful levels 

(for example, State, specialty, or 

profession). We do not at this time plan 

to make results publicly available in a 

format or with content that would 

enable identification of individual 

professionals or specific practices’

specific reporting or performance 

results. We have not made a 

determination as to the most 

appropriate venue(s) for making PQRI 

evaluation information available to the 

public. 

This section of the final rule with 

comment period is specific to the 

establishment of measures appropriate 

for use by professionals to submit 

quality-of-care data in 2008, as we are 

directed to do by section 101(b) of the 

MIEA–TRHCA. The incentive bonus 

requirements and reporting period for 

PQRI in 2008 are addressed in section 

101(d) of the MIEA–TRHCA, Physician 

Assistance and Quality Improvement 

(PAQI), section (II.S.5.) of this final rule 

with comment period. Such details of 

the 2008 bonus-incentive program are 

beyond the scope of this MIEA–TRHCA 

Section 101(b), PQRI section of this final 

rule with comment period. 

Comment: A number of comments 

requested or recommended that we 

make readily available on an ongoing 

basis more detailed information on the 

measure development process and 

measures in development. Numerous 

commenters also requested final 


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measure specifications be published as 

far in advance of the beginning of the 

reporting period as possible, and that 

more detailed information about 

measures proposed or finalized for use 

in PQRI be published in, at the same 

time as, or in advance of future 

rulemaking. 

Response: We agree that it could be 

useful to our stakeholder partners in 

health care quality measurement and 

improvement, including but not limited 

to potential measure developers, to 

make available in a prominent place 

(such as the CMS PQRI Web site) 

additional information on measure 

development in context of PQRI, 

potentially including guidance to other 

publicly available sources of general 

information on health care quality 

measurement and development of 

specific metrics. We will consider our 

options to accomplish this in a practical 

and sustainable way and use various 

appropriate communications channels 

to notify stakeholder organizations and 

the community at large of our strategy 

once we have developed it. 

We agree with the commenters that it 

is desirable to provide final measure 

specifications sufficiently in advance of 

the reporting period to allow reasonable 

time for professionals to analyze new or 

revised measures and implement any 

needed changes in their office 

workflows to accurately capture and 

successfully submit data on a selection 

of measures applicable to their practice 

on which they can act to improve the 

quality of the services they furnish. We 

are aware that such ‘‘lead time’’ should 

also help the eligible professionals’

specialty or professional societies be 

better prepared to support the 

professionals’ selection of relevant, 

actionable measures. Having detailed 

information on measures available in 

advance of the reporting period also 

enhances the ability of vendors (such as 

practice-management software, billing 

services, and electronic health records 

vendors) to support professionals’

successful implementation of revised 

data-capture processes for the measures. 

The MIEA–TRHCA requires that we 

publish the final list of 2008 PQRI 

measures no later than November 15, 

2007. We would expect to publish 

detailed specifications shortly after that 

date. Detailed measure specifications for 

measures new or revised for 2008 PQRI 

will be published on the Measures/ 

Codes page of the CMS PQRI Web site 

at http://www.cms.hhs.gov/pqri. These 

detailed specifications will include 

instructions for reporting and identify 

the circumstances in which each 

measure is applicable. The detailed 

technical specifications for measures in 

the final listing for the 2008 PQRI 

remain potentially subject to corrections 

until the start of the 2008 reporting 

period, as we stated in the proposed 

rule. 

Comment: Many commenters 

expressed concerns that recent legal 

rulings raise concerns about whether the 

individual participating professionals’

reporting and clinical performance 

results may constitute administrative 

data potentially subject to disclosure 

requirements of the Freedom of 

Information Act (FOIA). Commenters 

urged that any clinician performance 

program or system should remain 

voluntary and its results confidential. 

Response: Commenting on or 

otherwise addressing the legal standing 

of PQRI participants’ reporting and 

performance results in context of FOIA, 

other applicable statutes, or case law is 

outside the scope of this rule. At this 

time, we have no plans to publish 

without participants’ voluntary consent 

either 2007 or 2008 PQRI participants’

reporting or performance results in a 

way that would be specifically 

identified or readily identifiable at the 

individual-professional, group practicesite, or billing unit (Taxpayer 

Identification Number) levels. As 

mentioned in response to comments 

urging us to share information resulting 

from its 2007 PQRI program-evaluation 

analyses, we do plan to make available 

information at various meaningful levels 

of aggregation other than the individual 

professional, practice, or billing unit. 

Comment: Several commenters 

recommended specific enhancements to 

PQRI participant feedback reporting 

including displays of additional 

analyses (beyond the measure 

calculation as specified) for specific 

measure(s) and/or provision of interim 

reporting and performance results 

during the 2008 reporting period. Some 

commenters recommended we conduct 

additional analyses of measure data but 

did not specifically tie that 

recommendation to the participant 

feedback report content. 

Response: Detailed design of the 

participant feedback reports and 

specific analyses of PQRI data for 

purposes other than calculating bonus 

payment eligibility or amount (for 

example, for future measure 

development or refinement) are outside 

the scope of this section of this final 

rule with comment period. However, we 

will consider these recommendations as 

part of the ongoing dialogue with the 

stakeholder and participant community 

in order to collaboratively identify ways 

to enhance the measures’ and/or 

program’s value to its participants and 

the Medicare program. We are currently 

assessing the feasible options and 

timeframe within which we may be able 

to provide meaningful interim feedback 

reports to 2008 PQRI participants. As a 

matter of practical, operational reality, it 

is highly probable that we will not be 

able to make any 2008 interim feedback 

reports available until after we make 

available the 2007 final feedback 

reports. The 2007 PQRI was unable to 

offer during the reporting period any 

interim feedback reports of participants’

reporting and performance rates to date 

because the aggressive statutory 

timeframe for implementing the 

program did not allow for the necessary 

data infrastructure (including analytic 

programming and report access 

mechanisms) to be implemented in time 

to provide accurate, meaningful results 

feedback for 2007 in an appropriately 

secure/confidential report access 

environment prior to mid 2008. 

Comment: Some commenters 

requested specific or general 

clarifications or additional guidance on 

the PQRI program, and how to code its 

measures, in the implementation 

support tools (for example, a handbook, 

or worksheets) provided on the CMS 

PQRI Web site. 

Response: Although not directly 

applicable to the proposed rule content 

on which we sought comment, these 

comments are appreciated and will be 

taken into consideration along with 

other input that these materials’ users 

have provided via less formal avenues 

of communication. 

Comment: Many commenters 

expressed concern that the burden of 

data collection and submission may be 

an obstacle to program participation for 

some practices. Some commenters 

further noted that the claims-based 

submission process may be particularly 

burdensome for those practices that are 

simultaneously implementing electronic 

health records or whose PQRI-eligible 

members already participate in a 

medical data registry. 

Response: To implement a data 

submission mechanism that was 

technically feasible for CMS and 

providers, and that is broadly available 

to and already used by the vast majority 

of PQRI-eligible professionals, we 

determined that claims-based data 

submission is the only possible 

mechanism for 2007 and the only viable 

mechanism for full operationalization in 

2008. Thus, measures appropriate for 

use by professionals to submit qualityof-care data to CMS in 2008 must be 

specified for claims-based submission 

and analysis. We are, however, 

committed to exploring and supporting 

practical, effective mechanisms for 

quality-of-care data submission that 


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promote efficiency by streamlining 

participants’ and our data collection and 

handling. As discussed below in this 

section, in the registry- and EHR-based 

submission topics of this section of this 

final rule with comment period, we plan 

to test in 2008 registry- and EHR-based 

mechanisms for data submission, in 

order to develop the potential ability to 

fully implement such mechanisms in 

the future. Those professionals whose 

practices that have implemented the 

referenced HIT will have available EHR 

and e-prescribing structural measures 

for reporting in 2008, which would, if 

reported, count toward professionals’

eligibility for the incentive payment 

discussed below in section II.S.5. of this 

final rule with comment period. 

Comment: Several comments 

recommended or urged us to consider 

using the group practice as the unit of 

analysis, and to consider developing 

and implementing sampling 

methodologies at the group level as a 

means of reducing reporting burden in 

the future. 

Response: The 2007 unit of analysis is 

established at the individualprofessional level by MIEA–TRHCA, 

and we have not proposed to change 

that for 2008. As the 2007 PQRI 

evaluation results become available and 

further legislative action provides 

additional guidance, such alternatives 

may indeed prove important to explore 

or develop. 

b. MIEA–TRHCA Requirements for 

Measures Included in the 2008 PQRI 

(i) MIEA–TRHCA Requirements for 

2008 Quality Measures 

(A) Overview and Summary 

As noted in the CY 2008 PFS 

proposed rule (72 FR 38196 through 

38197), section 1848(k)(2)(B)(i) of the 

Act requires, ‘‘for purposes of reporting 

data on quality measures for covered 

professional services furnished during 

2008, the quality measures specified 

under this paragraph for covered 

professional services shall be measures 

that have been adopted or endorsed by 

a consensus organization (such as the 

National Quality Forum or AQA), that 

include measures that have been 

submitted by a physician specialty, and 

that the Secretary identifies as having 

used a consensus-based process for 

developing such measures. Such 

measures shall include structural 

measures, such as the use of electronic 

health records and electronic 

prescribing technology.’’

Section 1848(k)(2)(B)(ii) of the Act 

requires that ‘‘[n]ot later than August 15, 

2007, the Secretary shall publish in the 

Federal Register a proposed set of 

quality measures that the Secretary 

determines are described in clause (i) 

and would be appropriate for eligible 

professionals to use to submit data to 

the Secretary in 2008. The Secretary 

shall provide for a period of public 

comment on such set of measures.’’

In the CY 2008 PFS proposed rule (72 

FR 38197), we explained our 

interpretation of these statutory 

requirements and the policies used in 

selecting measures to propose as 

appropriate for professionals to use to 

submit data on the quality of covered 

professional services furnished to 

Medicare beneficiaries in 2008. 

In examining the statutory 

requirements of section 1848(k)(2)(B)(i) 

of the Act, we believe that the 

requirement that measures be endorsed 

or adopted by a consensus organization 

applies to each measure that would be 

included in the measures set for 

submitting quality data on covered 

professional services furnished during 

2008. Likewise, the requirement for 

measures to have been developed using 

a consensus based process applies to 

each measure. By contrast, we do not 

interpret the provision requiring 

inclusion of measures submitted by a 

specialty to apply to each measure. 

Rather, we believe this requirement 

means that in endorsing or adopting 

measures, a consensus organization 

must include in its consideration 

process at least some measures 

submitted by a physician or an 

organization representing a particular 

specialty. Similarly, we interpret the 

requirement that 2008 measures include 

structural measures, such as the use of 

EHRs and electronic prescribing 

technology, to mean that the 2008 

measure set must include at least 2 

structural measures. 

In examining sections 1848(k)(2)(B) of 

the Act, we believe that the Secretary is 

given broad discretion to determine 

which quality measures meet the 

statutory requirements and are 

appropriate for inclusion in the final set 

of measures for 2008. We do not 

interpret the Act to require that all 

measures that meet the basic 

requirements of section 1848(k)(2)(B)(i) 

of the Act must be included in the 2008 

set of quality measures. We next discuss 

the statutory requirements for consensus 

organizations and the use of a 

consensus-based process for developing 

quality measures as they relate to the 

requirements for the set of measures for 

2008 in the context of other applicable 

Federal law and policy. 

The MIEA–TRHCA requires that 

measures used for 2008 be identified by 

the Secretary as having been endorsed 

or adopted by a consensus organization 

and have been developed through the 

use of a consensus-based process. As 

stated in the proposed rule (72 FR 38197 

through 38199), we believe that these 

requirements should be interpreted in 

the context of the National Institute of 

Standards and Technology Act (NISTA) 

(15 U.S.C. 271 et seq.) as amended by 

the National Technology Transfer and 

Advancement Act of 1995 (Pub. L. 104–

113) (NTTAA) and implemented by 

Revised OMB Circular No. A–119 (OMB 

A–119) dated February 10, 1998. 

Per the NTTAA, except when it is 

inconsistent with applicable law or 

otherwise impractical, all Federal 

agencies and departments shall use 

standards that are developed or 

approved by voluntary consensus 

standards bodies. OMB A–119 provides 

specific policy guidance to agencies on 

the appropriate interpretation of agency 

responsibilities under the NTTAA. As 

we discussed in the proposed rule (72 

FR 38197 through 38199), OMB A–119 

establishes as government-wide policy 

that agencies ‘‘must use voluntary 

consensus standards, both domestic and 

international, in its regulatory and 

procurement activities in lieu of 

government unique standards, unless 

use of such standards would be 

inconsistent with applicable law or 

otherwise impractical.’’ OMB A–119 

further explains that in determining 

whether use of existing voluntary 

consensus standards in its regulatory 

and procurement activities is otherwise 

impractical, ‘‘ ‘Impractical’ includes 

circumstances in which such use would 

fail to serve the agency’s program needs; 

would be infeasible; would be 

inadequate, ineffectual, inefficient, or 

inconsistent with agency mission; or 

would impose more burdens, or be less 

useful, than the use of another 

standard.’’ OMB A–119 also provides 

that ‘‘voluntary consensus standards’’

are standards developed or adopted by 

voluntary consensus standards bodies, 

and defines ‘‘voluntary consensus 

standards body’’ as an organization 

maintaining the following attributes: (1) 

Openness; (2) Balance of interest; (3) 

Due process; (4) An appeals process; (5) 

Consensus; which is defined as general 

agreement, but not necessarily 

unanimity, and also includes a process 

for attempting to resolve objections by 

interested parties. The process requires 

that, as long as all comments have been 

fairly considered, each objector is 

advised of the disposition of his or her 

objection(s) and the reasons for the 

disposition, and the consensus body 

members are given an opportunity to 

change their votes after reviewing the 

comments. Voluntary consensus 


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standards must include provisions 

requiring that owners of relevant 

intellectual property have agreed to 

make that intellectual property available 

to all interested parties on a 

nondiscriminatory, royalty-free, or 

reasonable royalty basis. 

Other types of standards that are 

distinct from voluntary consensus 

standards but that may be used by 

federal agencies when voluntary 

consensus standards are not available 

and practical to address the 

government’s programmatic needs, 

include government-unique standards, 

industry standards, company standards, 

nonconsensus standards, or de facto 

standards which are developed in the 

private sector but not in the full 

consensus process of a voluntary 

consensus standards body. For further 

discussion of the NTTAA, OMB A–119, 

and their relevance to quality measures 

for use of professionals to submit 

quality-of-care data to the Secretary, 

please review the 2008 MPFS Proposed 

Rule PQRI section at 72 FR 38197–

38199. 

Two consensus organizations are 

referenced in section 1848(k)(2)(B): the 

National Quality Forum (NQF) and the 

AQA Alliance. The NQF has a formal 

organizational structure and established 

processes that are intentionally 

designed to comply with the NTTAA 

and OMB A–119. Membership is open 

and includes a broad cross-section of 

stakeholder perspectives. In 

determining whether or not to endorse 

a standard, the NQF uses a formal 

process that consists of five principal 

steps that follow a project’s 

conceptualization, prioritization, and 

planning. The steps are: (1) Consensus 

Standard Development; (2) Widespread 

Review; (3) Member Voting and Member 

Council Approval; (4) Board of Directors 

Action; and (5) Evaluation that includes 

an appeals process. The NQF meets the 

NTTAA requirements for a voluntary 

consensus standards body within the 

meaning of the NTTAA and its endorsed 

healthcare quality measures constitute 

voluntary consensus standards within 

the meaning of NTTAA. 

The AQA is also referenced in section 

1848(k)(2)(B) of the Act as a consensus 

organization for the purpose of 

identifying measures that have 

successfully completed review by a 

consensus organization, though it does 

not feature all of the structural 

characteristics or processes of a 

voluntary consensus standards body per 

NTTAA and the OMB A–119. By citing 

AQA as an example of an acceptable 

consensus organization, section 

1848(k)(2)(B) of the Act establishes that 

AQA adoption satisfies the requirement 

of section 1848(k)(2)(B) of the Act that 

PQRI quality measures be adopted or 

endorsed by a consensus organization. 

We believe it follows that the Congress 

did not intend to require all 2008 

quality measures under section 

1848(k)(2)(B) of the Act to meet the 

requirements to be considered voluntary 

consensus standards under the NTTAA. 

However, by giving NQF and AQA as 

examples of consensus organizations, 

we believe the Congress intended that 

consensus organizations should, in the 

context of section 1848(k)(2)(B) of the 

Act, have a breadth of stakeholder 

involvement and voting participation 

substantially comparable to that of the 

NQF or AQA. 

Given the potential for apparent 

overlap of NQF and AQA as consensus 

organizations under the MIEA–TRHCA, 

it is important to distinguish their roles. 

As currently established, the principal 

purpose of AQA for physician quality 

measures is to select among NQF 

endorsed measures for coordinated 

implementation. However, during a 

time of rapid physician quality 

measures development and 

implementation, it is impractical to 

delay implementation of physician 

quality measures until the formal 

processes of NQF are completed. 

Therefore, AQA has been able to enable 

CMS to incorporate new measures into 

the quality reporting system by 

providing consensus review acceptable 

under MIEA–TRHCA for 

implementation of a measure prior to 

actual NQF endorsement. In the event of 

a determination by NQF to decline 

endorsement of a particular measure 

after it had been adopted by AQA, we 

anticipate that AQA would withdraw its 

adoption of such a measure. 

Turning to the requirement of a 

consensus-based process for developing 

quality measures, we interpret this 

requirement in light of the NTTAA and 

the importance of broad consensus for 

health care quality measures used for 

regulatory purposes. In this context we 

have outlined in the proposed rule, and 

rather than cite the proposed rule, we 

will for readers’ convenience reiterate 

below the process of health care quality 

measurement development and 

distinguish basic development steps 

from the completion of a consensusbased development process as required 

under MIEA–TRHCA. 

Many organizations are involved in 

the development of health care quality 

measures. These organizations include 

physician organizations, health care 

providers, Federal agencies, 

accreditation organizations, diseasefocused not-for-profit organizations, 

research organizations, and health 

plans. The basic development processes 

of leading health care quality measure 

developers generally use standardized 

methods that include identification of a 

quality goal or gap, literature and 

evidence review, expert and technical 

evaluation, specification development, 

testing, organizational review, and that 

may include public comment. 

In the framework of the NTTAA, upon 

completion of the basic development 

work, healthcare quality measures do 

not constitute voluntary consensus 

standards, even though they may have 

utilized consensus as a mechanism of 

achieving agreement among the 

developer’s participants or within the 

developer’s organizational structure. 

Rather, to achieve the status as a 

voluntary consensus standard under 

NTTAA, the measure must go through 

the additional development that occurs 

through the broader consensus process 

of consensus endorsement. During this 

process, based on the need to achieve 

agreement, quality measures are often 

modified in order to achieve the 

necessary broad consensus. 

Consistent with this concept, we 

interpret ‘‘consensus-based process for 

developing measures’’ as used in MIEA–

TRHCA to encompass not only the basic 

development work of the formal 

measure developer, but also to include 

the achievement of consensus among 

stakeholders in the health care system 

based on at least a level of openness, 

balance of interest, and consensus 

reflected in the structures and processes 

of the NQF or the AQA as of the date 

of enactment of MIEA–TRHCA. 

Based on the considerations 

previously discussed, we apply the 

following policies in identifying 

measures that meet the MIEA–TRHCA 

requirements for having used a 

consensus-based process for 

development and the requirement for 

having been endorsed or adopted by a 

consensus organization such as the NQF 

or AQA, and that are appropriate for 

inclusion as 2008 measures: 

(1) We interpret ‘‘a consensus-based 

development process’’ as meaning that 

in addition to the measure development, 

the measure has achieved adoption or 

endorsement by a consensus 

organization having at least the basic 

characteristics of the AQA as a 

consensus organization as of December 

2006, when the MIEA–TRHCA 

incorporating reference to AQA was 

passed and signed into law. Those basic 

characteristics include a comparable 

level of openness, balance of interest, 

and consensus-based on voting 

participation. As discussed above in this 

section and further clarified in points 

(3) and (5) of this section, we do not 


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interpret ‘‘consensus-based 

development process’’ per section 

1848(k)(2)(B) of the Act to require that 

the consensus organization or process 

meet all of the criteria of the NTTAA 

and OMB A–119 definition of a 

voluntary consensus standards body. 

(2) ‘‘Voluntary consensus standard’’ is 

interpreted to mean a voluntary 

consensus standard that has been 

endorsed as such by a consensus 

organization that meets the 

requirements of the NTTAA, and the 

provisions of OMB A–119, for a 

voluntary consensus standards body. 

(3) Where there are available quality 

measures, and some of these measures 

meet the definition of ‘‘voluntary 

consensus standards’’ while others do 

not, those measures that meet the 

definition of ‘‘voluntary consensus 

standards’’ are preferred to other 

measures not meeting the requirements 

of the NTTAA. 

(4) In view of the preference for 

voluntary consensus standards, if, as of 

the earlier of November 15, 2007, or the 

date of publication of this final rule, a 

measure has been specifically 

considered by NQF for possible 

endorsement but NQF has declined to 

endorse it, we proposed not to include 

it in the final set of 2008 PQRI Quality 

Measures, even if previously adopted by 

AQA. 

(5) Although the AQA does not meet 

the requirements of the NTTAA for a 

voluntary consensus standards body, it 

is a consensus organization per section 

1848(k)(2)(B) of the Act. In 

circumstances where no voluntary 

consensus standard (NQF-endorsed) 

measure is available, and the measure 

has not been specifically declined for 

endorsement by NQF, a quality measure 

that has been adopted by the AQA (or 

another consensus organization with 

comparable consensus-organization 

characteristics), will meet the 

requirements of MIEA–TRHCA if we 

determine that it is appropriate for 

eligible professionals to use to submit 

data. 

(6) We are unaware of other 

consensus organizations that are 

comparable to the NQF in terms of 

meeting the formal requirements of the 

NTTAA, or of organizations other than 

AQA that do not strictly meet the 

requirements of the NISTA, as amended 

by the NTTAA, but that feature the 

breadth of stakeholder involvement in 

the consensus process necessary to meet 

the intent of the MIEA–TRHCA. 

However, the MIEA–TRHCA does not 

limit consensus organizations to the 

NQF or the AQA, nor restrict the field 

of potential consensus organizations. 

The MIEA–TRHCA, thereby, maintains 

flexibility in potential sources of 

measure consensus review, which is, 

like having multiple sources of measure 

development, key to maintaining a 

robust marketplace for development and 

review of quality measures. 

(7) The basic steps for developing the 

physician level measures may be carried 

out by a variety of different 

organizations. We do not interpret the 

MIEA–TRHCA to place special 

restrictions on the type or make up of 

the organizations carrying out this basic 

development of physician measures, 

such as restricting the initial 

development to physician-controlled 

organizations. Any such restriction 

would unduly limit the basic 

development of physician quality 

measures and the scope and utility of 

measures that may be considered for 

endorsement as voluntary consensus 

standards. 

(8) The policies we proposed were 

based on the preference as articulated in 

NTTAA and OMB A–119 for ‘‘voluntary 

consensus standards’’ to governmentunique standards. However, the MIEA–

TRHCA does not require that quality 

measures meet the NTTAA or OMB A–

119 definition of ‘‘voluntary consensus 

standards’’ in order to be used for PQRI. 

Thus, though we prefer to use quality 

measures meeting the NTTAA and OMB 

A–119 criteria for voluntary consensus 

standards, neither this CMS preference 

nor the NTTA or OMB A–119 preclude 

CMS from exercising our discretion 

under the MIEA–TRHCA to select 

measures for PQRI meeting the less 

stringent consensus requirements of the 

MIEA–TRHCA, when necessary to meet 

our program needs as determined by the 

Secretary. 

(B) Summary of Comments and CMS’s 

Responses 

Comment: Many commenters thanked 

us for clarifying the requirements for 

consensus-based development, 

consensus endorsement or adoption, 

and the basic, high level structure of the 

measure-development process. As 

discussed above in context of the PQRI 

program/overview content and 

comments topic, multiple commenters 

requested additional and more detailed 

information about measure development 

and related processes and organizations. 

In context of the consensus 

requirements, several commenters 

requested further explanation of the 

detailed definition or distinction 

between the stages of measure 

development. 

Response: We are pleased that many 

commenters that found our description 

of the measurement development 

processes useful and were supportive of 

our interpretation of the statutory 

requirements for consensus 

endorsement and adoption and 

consensus-based development process. 

In terms of providing additional 

clarification, the status for PQRI 

implementation of measures that have 

been approved by AQA but declined for 

endorsement by NQF is clarified in the 

final language. Measures approved by 

AQA are sufficient for inclusion in 2008 

PQRI in terms of the statutory 

requirements for consensus-organization 

adoption or endorsement and 

consensus-based development 

requirements of MIEA–TRHCA. 

Measures, however, that have been 

specifically declined for endorsement 

by NQF, are not selected for use in 2008 

PQRI, based on our preference for 

Voluntary Consensus Standards (72 FR 

38198). 

Comment: Many commenters 

requested or recommended that measure 

development processes employ robust 

mechanisms for incorporation of 

broadly inclusive consensus and/or 

public comment during the initial, as 

well as final phase of development. 

However, some commenters expressed 

the counterbalancing concern that we 

should more specifically clarify that 

appropriate quality measures for PQRI 

should in fact be based on evidence 

interpreted in processes which include 

consensus methods and organizations, 

as opposed to measures that are based 

primarily on stakeholder consensus 

about measure need and design without 

a firm foundation in scientifically sound 

clinical evidence. 

Response: As described in the 

proposed rule (72 FR 38197 through 

38198) the basic (initial) development 

processes of measure developers 

typically include various standardized 

processes that include both an 

evaluation of the evidence base for a 

measure and a public comment 

opportunity. We do not believe that we 

should delineate these processes via 

rulemaking, nor require a particular 

evidence base for a measure. Rather, the 

adequacy of measures from these and 

many other standpoints is subject to 

evaluation during the consensus 

process. 

Comment: Several commenters 

suggested we consider establishing as 

policy that quality measures to be used 

by, and analyzed at the level of, 

individual PQRI-eligible professionals, 

must be developed by cliniciancontrolled organizations to assure 

relevance and promote uptake by the 

eligible professional community. 

Multiple commenters suggested explicit 

preference be given for measures 

developed or endorsed by physician 


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specialty societies, in context of 

consensus-organization review and CMS 

measure selection processes. Some 

commenters stated that the AMA–PCPI 

should be the sole source for physicianlevel measures. One commenter 

specifically presented an interpretation 

of the MIEA–TRHCA requirement for 

the 2008 PQRI measures to include 

measures submitted by a physician 

specialty as meaning that the 2008 PQRI 

should include only measures 

developed by physician organizations, 

to assure physician control of available 

measures applicable to assessing the 

clinical performance of individual 

physicians. Other commenters 

expressed differing viewpoints, 

commenting on the importance of an 

open process for initial measure 

development, and noting that no single 

organization stands ready to lead in the 

quality arena. Multiple commenters 

pointed to concerns about existing 

measure development and consensus 

organizations particularly in terms of 

structure and transparency, opposing 

any single organization controlling 

measurement development, opposing 

requiring PQRI measurement 

development to come solely from 

physician controlled organizations, and 

supporting alternatives to existing 

organizations. 

Response: Physician involvement and 

leadership is standard in the work of 

both measure developers and consensus 

organizations. As a result, physicians 

are actively involved at all levels of 

measurement development and 

consensus adoption and endorsement. 

We are in agreement that physician 

expertise is an important ingredient in 

measurement development and in the 

consensus process. We further recognize 

the leadership of physician 

organizations, as is reflected in the large 

number of physician quality measures 

included in PQRI which were 

developed by the AMA–PCPI and its 

participating specialty societies. 

However, we do not agree that 

physicians should be in complete 

control of the process of measure 

development, as would be the case if 

measures were required to be developed 

solely by physician-controlled 

organizations. Any such restriction 

would unduly limit the basic 

development of physician quality 

measures and the scope and utility of 

measures that may be considered for 

endorsement as voluntary consensus 

standards. Rather, as we described in 

the proposed rule, the basic steps for 

developing the physician level measures 

are appropriately carried out by a 

variety of different organizations. We do 

not interpret the MIEA–TRHCA to place 

special restrictions on the type or make 

up of the organizations carrying out this 

basic development of physician 

measures, such as restricting the initial 

development to physician-controlled 

organizations. Similarly, we do not 

interpret MIEA–TRHCA to require that 

each measure included in the 2008 

PQRI have been developed by a 

physician specialty. 

Finally, we do not interpret MIEA–

TRHCA to limit the field of potential 

consensus organizations to those it 

named as examples of acceptable 

organizations, so long as the 

requirements for broad consensus we 

articulated as required under MIEA–

TRHCA is achieved. The MIEA–TRHCA, 

thereby, maintains flexibility in 

potential sources of measure consensus 

review, which is, like having multiple 

sources of measure development, key to 

maintaining a robust marketplace for 

development and review of quality 

measures. 

Comment: Many commenters 

suggested we establish a centralized 

process or structure to prioritize 

measure development in specific ways. 

Some commenters recommended 

priority be given to meaningful, 

actionable gaps in care or specific highimpact disease conditions. Others 

recommended that the first priority be 

assuring measure availability for all 

PQRI-eligible professions and 

specialties. Commenters recommended 

a centralized establishment of national 

priorities for measure development and 

suggested that such prioritization would 

help to align clinician-focused quality 

measures with measures used in other 

governmental and private-sector 

initiatives focused on other provider 

types, and advance measurement and 

close gaps in care for high-prevalence 

and/or high-cost conditions. 

Response: Health care quality 

measures are currently developed by a 

variety of organizations and used by a 

variety of governmental, 

nongovernmental, and public-private 

partnership initiatives which have 

various and at times differing 

programmatic needs for quality 

measures. Although a cooperative and 

voluntarily coordinated approach to 

agreeing upon quality goals which 

would guide development and selection 

of measures may be of value, the 

Secretary retains the authority to select 

from available measures meeting 

applicable statutory requirements those 

most appropriate for use in this 

program. 

Comment: Many commenters 

illustrated, directly or indirectly, that 

the proposed rule language (72 FR 

38198 through 38199) reads to a 

material proportion of reviewers as 

meaning or implying that a measure 

must be both adopted by the AQA 

‘‘and’’ endorsed by the NQF to be 

included in the PQRI for 2008. Several 

of these comments also specifically 

requested clarification of the status of 

measures that will, as of the date CMS 

finalizes the list of 2008 PQRI quality 

measures, be AQA-adopted but not yet 

reviewed by NQF. 

Response: In general, the consensus 

requirement under the MIEA-TRHCA is 

met if a measure is either NQF-endorsed 

or AQA-adopted. However, where an 

AQA-adopted measure has been 

specifically considered by NQF but 

declined for endorsement, we have not 

selected such measures for 2008. This 

derives from our stated preference for 

standards of a voluntary consensus 

standards organization (such as NQF) 

over an organization which does not 

(such as AQA). Also, as stated in the 

proposed rule (72 FR 38198), in the 

event of a determination by NQF to 

decline endorsement of a particular 

measure after it had been adopted by 

AQA, we anticipate that AQA would 

withdraw its adoption of that measure. 

Thus, a measure that has been AQA 

adopted and then reviewed by NQF 

with a decision to decline endorsement 

we would expect would, soon after the 

NQF decision, be neither NQF-endorsed 

nor AQA-adopted and therefore it 

would be undesirable to include a 

measure imminently destined to not 

retain approval of either consensus 

organization simply because we may 

have been identifying final 2008 

measures during the brief period of lag 

between the NQF’s decision to decline 

endorsement and the AQA’s 

opportunity to reconsider its adoption 

of the measure. 

To further clarify this point, of the 

measures proposed for 2008 (72 FR 

38199 through 38202), the only ones 

that might be removed as a result of 

having been AQA adopted but then 

subsequently declined NQF 

endorsement are certain measures that 

were included in the 2007 PQRI on the 

basis of AQA adoption and that have 

since been declined for endorsement by 

NQF after specifically being considered. 

For newly-proposed measures (those 

not part of the 2007 PQRI set), either 

NQF or AQA consensus endorsement or 

adoption is sufficient for PQRI. Most of 

these measures will have been adopted 

by the AQA but not yet reviewed by 

NQF. Others may have been endorsed 

by the NQF, but not yet adopted by the 

AQA. 

Comment: One commenter suggested 

that the entirety of the PQRI section of 

the proposed rule could potentially be 


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construed to imply that there may be, 

based on which specific entities develop 

or own a measure, different levels of 

consensus-standard status required for 

measures to qualify for our 

consideration for inclusion in PQRI. 

Response: The measure developer was 

listed for identification purposes only. 

This was necessary for measures that 

when proposed were still under 

development. The remaining measures 

that had achieved consensus 

endorsement or adoption were 

sufficiently identified by consensus 

organization, without listing the 

developer. The statutory requirements 

for consensus-organization adoption or 

endorsement, consensus-based 

development and statutory and policy 

preferences for measures that have 

achieved the status of voluntary 

consensus standards apply equally to all 

potential PQRI quality measures 

regardless of the organization type or 

specific identity of any given measure’s 

developer or owner. 

Comment: We received a large 

number of comments on the 

interpretation of the requirement of per 

Section 1848(k)(2)(B)(i) of the Act, that 

2008 PQRI measures ‘‘shall be measures 

that have been adopted or endorsed by 

a consensus organization (such as the 

National Quality Forum or AQA)’’. 

These comments reflected a diversity of 

opinion amongst various stakeholders 

on key conceptual points related to the 

balance between rigor and flexibility in 

measure review and approval, as well as 

on the suitability of specific 

organizations for their roles as we define 

them in the PFS rule. 

Many commenters encouraged us to 

rely solely on highly structured, 

scientifically rigorous processes for 

measure approval to promote stability in 

measures over time. Many other 

comments advised against requiring a 

degree of formality or scientific rigor in 

the review process that would unduly 

slow the availability and 

implementation of new quality 

measures to fill current gaps in 

professionals or clinical foci for which 

applicable measures exist. 

Several commenters closely related to 

the recommendation of reliance on more 

rigorous review processes further 

suggested we identify a single voluntary 

consensus standards body to be 

considered qualified to establish 

measures as PQRI measures. The 

rationales provided for this suggestion 

include enhanced probability of a 

cohesive or coordinated universe of 

endorsed measures and prevention of 

endorsement of duplicate or near 

duplicate (‘‘competing’’ or 

‘‘conflicting’’) measures. 

The value of having multiple 

consensus organizations available to 

approve measures was noted by many 

comments that were closely related to, 

or that were elaborating upon, 

maintaining flexibility and adaptability 

of the universe of available measures. 

These commenters included 

observations that setting requirements 

that limit the total available capacity for 

measure review will slow the 

development not only of specific 

additional quality measures but likely 

also innovative advancement in the 

science of health care quality 

measurement. Some of these 

commenters urged us to remain alert for 

the development of additional 

organizations into potential consensus 

organizations on par with the NQF or 

with the AQA as of the date MIEA–

TRHCA was signed into law, and two 

commenters named two specific 

potential candidates that might choose 

to develop to that degree in the near 

future. 

Response: We believe the existence of 

multiple consensus organizations 

promotes availability of a broad array of 

measures from which we can select 

those most appropriate for use in PQRI 

based on program policy goals. The 

availability of the AQA as a consensus 

organization meeting the requirements 

of MIEA–TRHCA, though it does not 

meet the full NTTAA and OMB A–119 

criteria for a voluntary consensus 

standards body (VCSB), has proven 

important to the consensus 

development of the 2008 PQRI 

measures. Specifically, the AQA’s more 

flexible and expeditious processes have 

made measures available on a shorter 

timeline than would be possible within 

the more rigorous processes of a VCSB. 

At present, we are able to identify only 

the NQF and the AQA as satisfying the 

consensus organization requirements of 

MIEA–TRHCA. Should additional 

organizations develop to feature 

consensus characteristics at least 

comparable to the level of openness, 

balance of interest, and broadly 

representative voting membership 

demonstrated by the AQA as of the date 

MIEA–TRHCA became law, we would 

consider measures endorsed by those 

organizations eligible for consideration 

for inclusion in PQRI. 

We concur with the commenters 

identifying the desirability of alignment 

or harmony of quality measures across 

settings to more effectively promote 

overall CMS quality goals. We strive to 

achieve synergy between measures used 

in various settings and quality related 

initiatives to the extent practical. 

Comment: Many commenters 

concurred with our interpretation that 

NQF is a VCSB per NTTAA and OMB 

A–119. Several commenters also 

commended NQF for the scientific rigor 

of its structure and review processes. 

Some commenters in favor of 

establishing a single consensus 

organization entity whose approval 

would qualify a measure for PQRI 

inclusion went on to name NQF as the 

leading or only named candidate for 

such an organization. Simultaneously, 

multiple concerns were raised about the 

uneven (project-driven) NQF funding 

stream and its resultant potentially long 

or uncertain review timeframes, and the 

potential for this to impede measure 

development. Several comments also 

raised concern that the NQF’s processes 

for review of physician-applicable 

measures are not yet as developed and 

predictable as those measures 

applicable to other types of providers. A 

few commenters noted that the NQF 

determinations on physician-applicable 

measures apparently vary unpredictably 

between workgroups and that the 

appeals process is not clearly 

identifiable. 

Some comments recommended that 

CMS or another agency should provide 

steady core funding to the NQF on an 

ongoing basis. 

Response: The NQF is currently the 

only organization we identified that 

reviews health care quality measures 

while simultaneously meeting the 

NTTAA and OMB A–119 definition of 

a VCSB. NQF processes for review and 

endorsement of physician-applicable 

measures are expected to develop and 

stabilize as it gains more experience 

with such measures. We will continue 

to monitor the NQF and its processes 

and work with NQF and its members to 

promote the prompt achievement of that 

growth. 

The funding stream of the NQF is 

outside the scope of this rulemaking. 

The concerns raised over the current 

NQF funding mechanism and internal 

operational structures does, however, 

highlight the desirability of having an 

alternative source or multiple 

alternative sources of consensusorganization review of quality measures 

to assure that the measure has been 

vetted in a process that offers at least a 

reasonable degree of openness, balance 

of interests, and broad voting 

participation. 

Comment: Multiple comments 

expressed concerns about the AQA’s 

structure and original intended purpose 

not being ideally suited to its current 

role in PQRI, and its role in the measure 

endorsement process being confusing or 

its role not clearly adding value to the 

process. Multiple other comments 

commended the AQA as currently 


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structured, including its responsiveness, 

openness, breadth of participation, and 

utility as a forum for building consensus 

among stakeholders in quality 

measurement. Several comments also 

noted that the AQA is currently reevaluating its structure, and 

recommended either that the AQA be 

required to restructure itself to meet the 

NTTAA and OMB A–119 criteria for a 

VCSB or that we reassess the AQA after 

any restructure to assure that it retains 

at least the comparable level of 

consensus-organization characteristics 

that it featured at the time MIEA–

TRHCA became law. 

Response: As noted above in this 

section, we interpret that the AQA 

currently meets the MIEA–TRHCA 

intended definition of a consensus 

organization for purposes of measure 

approval, as its mention in MIEA–

TRHCA as an example of a consensus 

organization confirms it did at the time 

the statute was enacted. Further, we 

have expressed what we understand its 

value to be for the purpose of making 

quality measures available for 

consideration for inclusion in the PQRI. 

We do not have direct control over the 

AQA; requiring the AQA to take any 

specific action or restructure in any 

specific way would be outside the scope 

of CMS authority. However, we are 

observing the AQA’s re-evaluation of its 

structure and will consider altering its 

role in relation to approval of future 

PQRI measures based on its resultant 

structure. 

Comment: Several commenters 

requested we specifically define the 

minimum criteria to be a non-VCSB 

consensus organization meeting the 

requirements of MIEA–TRHCA. 

Response: We have defined the 

requirement as being that an 

organization must possess a level of 

consensus-organization characteristics 

at least comparable to those of the AQA 

as of the date MIEA–TRHCA became 

law. To attempt to quantify or score an 

organization’s level of consensus 

characteristics would be difficult to do 

in a way that was not misleading or 

arbitrary. The key features, as stated in 

the proposed rule (at 72 FR 38198), 

include openness, balance of interest, 

and consensus based on voting 

participation. 

c. The Final 2008 PQRI Quality 

Measures 

In the proposed rule (72 FR 38199), 

we solicited comments on the 

implications of including or excluding 

148 specific quality measures in 7 broad 

categories. We received numerous 

comments both general and measurespecific, which are summarized and 

addressed as follows. 

Comment: Many comments on 

measure inclusion were general or 

conceptual and, in fact, mirrored 

comments on prioritization of measure 

development or endorsement. 

Specific to measure selection, some 

commenters supported our including or 

excluding measures based on a targeted 

focus on specific gaps in care, while 

other commenters supported maximum 

inclusivity of conditions, services, and 

professionals. Some of the comments 

specific to measure selection stated two 

main perspectives: (1) We should set the 

priorities and/or prioritization process 

in collaboration with a maximally 

inclusive and representative cohort of 

stakeholders (to specifically include 

pharmaceutical, device, and information 

technology manufacturers and trade 

associations, as well as clinicians and 

consumers); and (2) the prioritization or 

selection of quality measures should be 

accomplished by a VCSB in a formal 

consensus process. 

Response: In selecting measures, we 

have sought to achieve a broad 

opportunity for eligible professionals to 

participate, and to promote the quality 

goals forming the basis for the measures 

themselves. The general quality goal 

underlying the measures as developed is 

a performance gap relating to important 

processes or outcomes of care. While we 

agree that prioritized themes for quality 

improvement can be useful in certain 

contexts, for PQRI the scope of practice 

of the various eligible professionals 

varies significantly. Therefore, it would 

be difficult to limit measures selected to 

a few specific prioritized quality goals 

without also limiting the opportunity to 

participate. With respect to the role of 

a VCSB under MIEA–TRHCA, it is to 

achieve consensus endorsement of 

particular measures, rather than to 

prioritize measures for PQRI. The 

responsibility for selection of measures 

for PQRI is directed to the Secretary, 

based on proposing measures, soliciting 

public comment, and then finalizing the 

measures. Public comment could 

include the views of a VCSB as to which 

measures are most appropriate for PQRI 

based on quality goals or other 

considerations. These could then be 

considered, in conjunction with the 

other public comments and the program 

needs as determined by the Secretary, in 

finalizing the measures. 

Comment: Several comments in 

context of measure selection urged us to 

select or prioritize for PQRI inclusion 

measures aligned or harmonized with 

those used in other governmental 

initiatives that focus other provider 

types in addition to or instead of 

individual PQRI-eligible professionals. 

Response: We concur with comments 

identifying the desirability of alignment 

or harmony of quality measures across 

settings to more effectively promote 

overall CMS quality goals. We strive to 

achieve such synergy among settings 

and initiatives to the extent practical. 

Comment: We received several 

comments specifically commending or 

recommending inclusion of specific 

quality measures, including, but not 

limited to: Specific eyecare measures; 

vaccination and preventive services 

measures; diabetic foot and ankle 

measures; and perioperative care 

measures including venous 

thromboembolism(VTE) prophylaxis. 

Response: All of the proposed 

measures strongly supported by 

multiple comments are included in the 

final 2008 measures listed below in this 

section. 

Comment: We received many 

comments expressing concern that the 

following 2007 PQRI measure that has 

achieved NQF endorsement was not 

included in measures proposed for 

2008: ‘‘Age Related Macular 

Degeneration: Dilated Macular 

Examination’’. 

Response: As noted in the proposed 

rule’s correction notice (72 FR 43581), 

the omission of this measure was a 

technical/editorial error that was 

corrected via that notice. The measure 

titled ‘‘Age Related Macular 

Degeneration: Dilated Macular 

Examination’’ is included in the final 

list in Table 7. 

Comment: Several commenters 

recommended changes to specific 

quality measures’ titles, definitions, and 

detailed specifications or coding. Many 

of these recommendations were based 

on alternative interpretations of clinical 

evidence or concerns about the utility of 

the measures. Some requests were 

specifically concerned that measures be 

expanded or constrained to include or 

exclude specific professionals from 

those to whom the measure may be 

applicable. 

Response: Quality measures that have 

completed the consensus processes of 

NQF or AQA have a designated party 

(generally the developer/owner) who 

has accepted responsibility for 

maintaining the measure. In general, it 

is the role of the measure owner, 

developer or maintainer to make any 

changes to the basic elements of a 

measure. Examples of such basic 

elements would be the particular 

process of care covered by the measure, 

professional services to which the 

measure applies, or the diagnosis (or 

diagnoses) defining the denominator 


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population. A request to modify any 

basic elements of a measure should be 

addressed to the measure’s maintainer. 

In addition, NQF has for its endorsed 

measures an established maintenance 

process which may be accessed. 

Measure maintenance and modification 

activities are conducted by the 

developers/owners and/or maintainers 

of measures outside the CMS rulemaking process. In implementing the 

measures for PQRI, CMS may, when 

necessary, make certain technical 

modifications to assure that reporting 

and performance rates can be 

calculated. These technical 

modifications do not modify the basic 

elements of the measure and are carried 

out in collaboration with the measure 

developer/owner or maintainer. 

Comment: Many commenters 

requested the inclusion for 2008 of 

additional measures not proposed as 

PQRI measures in the proposed rule. 

Measures requested included additional 

structural measures, additional 

measures of medication use 

appropriateness and compliance, 

measures applicable to additional 

clinical topics, and the measures 

identified in the proposed rule as 

mandatory for erythropoietin 

stimulating agent reimbursement in 

2008. 

Response: The MIEA–TRHCA 

requires that measures proposed for use 

in the 2008 PQRI be published in the 

Federal Register prior to August 15, 

2007. We are also required by other 

applicable statutes to provide 

opportunity for public comment on 

provisions of policy or regulation that 

are established via notice and comment 

rulemaking. Measures that were not 

included in the proposed rule for 

inclusion in the 2008 PQRI that were 

recommended to CMS via comments on 

the proposed rule have not been placed 

before the public with opportunity for 

the public to comment on them within 

the rulemaking process. When measures 

have been published in the Federal 

Register, but in other contexts and not 

specifically proposed as PQRI measures, 

such publication does not provide true 

opportunity for public comment on 

those measures’ potential inclusion in 

PQRI. Thus, such additional measures 

recommended via comments on the 

proposed rule cannot be included in the 

2008 measures MIEA–TRHCA requires 

be finalized via publication in the 

Federal Register by November 15, 2007. 

However, we have captured these 

recommendations and will have them 

available for consideration in 

identifying measure sets for future 

years’ PQRI and other initiatives to 

which those measures may be pertinent. 

The measures we identify for 2008 in 

this final rule with comment period will 

be final as of the effective date of this 

final rule, and no changes (no additions 

or deletions of measures) will be made 

after that date. However, as was done for 

2007, we may make modifications or 

refinements, such as code additions, 

corrections, or revisions, to the detailed 

specifications for the 2008 measures 

until the beginning of the reporting 

period. Such specification modifications 

may be made through the last day 

preceding the beginning of the reporting 

period. The 2008 measures 

specifications will be available on the 

PQRI section of the CMS Web site at 

http://www.cms.hhs.gov/pqri when they 

are sufficiently developed or finalized, 

but in no event later than December 31, 

2007. No further changes to the 

specifications will be made after the 

start of the 2008 reporting period. The 

measures’ detailed specifications will 

include instructions for reporting and 

identify the circumstances in which 

each measure is applicable. 

The final 2008 PQRI Quality Measures 

are listed in Tables 7 through 13, and 

fall into 7 broad categories. The final 

measures for 2008 were selected based 

upon the following: 

• The achievement of NQF 

endorsement or AQA adoption by the 

earlier of November 15, 2007, or the 

date of publication of this final rule 

with comment period; 

• Identification in the proposed rule 

for use in 2008 with opportunity for 

public comment via the rulemaking 

process; 

• Development completion in a 

sufficiently timely manner that 

implementation for 2008 would be 

practical; 

• Their importance in relation to 

quality goals; 

• Their meaningfulness as measures 

of quality; 

• Their utility in the PQRI program 

such as through augmenting the scope 

of services provided by eligible 

professionals to which PQRI measures 

apply; 

• The degree to which they meet the 

needs of the Medicare program and their 

functionality in terms of ability to be 

collected and calculated in the PQRI 

program; 

• Statutory requirement for inclusion 

in quality measures for 2008. 

(i) Measures Selected From the 2007 

PQRI Quality Measures 

We include in the final 2008 PQRI 

measures the following 2007 PQRI 

measures in Table 7, proposed as 2008 

PQRI measures (72 FR 38199 through 

38200). The measures in Table 7 include 

measures submitted by specialties, in 

compliance with section 1848(k)(2)(B) 

of the Act. 

TABLE 7.—2007 PQRI MEASURES

Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus. 

Low Density Lipoprotein Control in Type 1 or 2 Diabetes Mellitus. 

High Blood Pressure Control in Type 1 or 2 Diabetes Mellitus. 

Screening for Future Fall Risk. 

Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD). 

Oral Antiplatelet Therapy Prescribed for Patients with Coronary Artery Disease. 

Beta-blocker Therapy for Coronary Artery Disease Patients with Prior Myocardial Infarction (MI). 

Heart Failure: Beta-blocker Therapy for Left Ventricular Systolic Dysfunction. 

Antidepressant Medication During Acute Phase for Patients with New Episode of Major Depression. 

Medication Reconciliation. 

Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older. 

Characterization of Urinary Incontinence in Women Aged 65 Years and Older. 

Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older. 

Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation. 

Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy. 

Asthma: Pharmacologic Therapy. 

Stroke and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Reports. 

Stroke and Stroke Rehabilitation: Carotid Imaging Reports. 

Primary Open Angle Glaucoma: Optic Nerve Evaluation. 


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TABLE 7.—2007 PQRI MEASURES—Continued 

Age-Related Macular Degeneration: Dilated Macular Examination. 

Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy. 

Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care. 

Perioperative Care: Timing of Antibiotic Prophylaxis—Ordering Physician. 

Perioperative Care: Selection of Prophylactic Antibiotic—First OR Second Generation Cephalosporin. 

Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-Cardiac Procedures). 

Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (when indicated in All patients). 

Osteoporosis: Management Following Fracture. 

Osteoporosis: Communication with the Physician Managing Ongoing Care Post-Fracture. 

Aspirin at Arrival for Acute Myocardial Infarction (AMI). 

Electrocardiogram Performed for Non-Traumatic Chest Pain. 

Electrocardiogram Performed for Syncope. 

Vital Signs for Community-Acquired Bacterial Pneumonia. 

Assessment of Oxygen Saturation for Community-Acquired Bacterial Pneumonia. 

Assessment of Mental Status for Community-Acquired Bacterial Pneumonia. 

Empiric Antibiotic for Community-Acquired Bacterial Pneumonia. 

Asthma Assessment. 

Perioperative Care: Timing of Prophylactic Antibiotics—Administering Physician. 

Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis (DVT) for Ischemic Stroke or Intracranial Hemorrhage. 

Stroke and Stroke Rehabilitation: Discharged on Antiplatelet Therapy. 

Stroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for Atrial Fibrillation at Discharge. 

Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator (t-PA) Considered. 

Stroke and Stroke Rehabilitation: Screening for Dysphagia. 

Stroke and Stroke Rehabilitation: Consideration of Rehabilitation Services. 

Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older. 

Osteoporosis: Pharmacologic Therapy. 

Use of Internal Mammary Artery (IMA) in Coronary Artery Bypass Graft (CABG) Surgery. 

Preoperative Beta-blocker in Patients with Isolated Coronary Artery Bypass Graft (CABG) Surgery. 

Perioperative Care: Discontinuation of Prophylactic Antibiotics (Cardiac Procedures). 

Appropriate Treatment for Children with Upper Respiratory Infection (URI). 

Appropriate Testing for Children with Pharyngitis. 

Myelodysplastic Syndrome (MDS) and Acute Leukemias: Baseline Cytogenetic Testing Performed on Bone Marrow. 

Myelodysplastic Syndrome (MDS): Documentation of Iron Stores in Patients Receiving Erythropoietin Therapy. 

Multiple Myeloma: Treatment with Bisphosphonates. 

Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry. 

Hormonal Therapy for Stage IC–III ER/PR Positive Breast Cancer. 

Chemotherapy for Stage III Colon Cancer Patients. 

Plan for Chemotherapy Documented Before Chemotherapy Administered. 

Radiation Therapy Recommended for Invasive Breast Cancer Patients Who Have Undergone Breast Conserving Surgery. 

Advance Care Plan. 

Please note that detailed 

specifications for some 2007 PQRI 

measures may have been updated or 

modified during the NQF endorsement 

process during 2007. The detailed 2008 

PQRI measure specifications for any 

given measure may, therefore, be 

different from detailed specifications for 

the same measure used for 2007. All 

specifications for 2008 measures must 

be obtained from the specifications 

document for 2008 measures, which 

will be available on the CMS PQRI Web 

site on or before December 31, 2007. 

The following measures proposed for 

2008 (72 FR 38200) are not included in 

the final 2008 PQRI measures listed in 

Table 7 because they have been 

considered by NQF and did not achieve 

endorsement: 

• Dialysis Dose in End Stage Renal 

Disease (ESRD) Patients. 

• Hematocrit Level in ESRD Patients. 

Comment: We did not receive any 

comments specifically suggesting that 

any of the 2007 PQRI measures 

proposed for 2008 be removed from the 

2008 PQRI measures. Some commenters 

suggested alternative measures 

apparently in addition to the measures 

we had proposed. 

Response: We have not included in 

final 2008 PQRI measures any measures 

that were not identified in the proposed 

rule as proposed 2008 measures for the 

reporting system as required by Section 

1848(k)(1) and 1848(k)(2)(B) of the Act. 

As discussed above in this rule, we were 

obligated by MIEA–TRHCA and other 

applicable statutes to publish and 

provide opportunity for public comment 

on proposed PQRI quality measures. 

Measures recommended via comments 

on the proposed rule that were not 

included in the proposed rule have not 

been placed before the public with 

opportunity for the public to comment 

on their potential use in PQRI. Thus, 

such additional measures recommended 

via comments on the proposed rule 

cannot be included in the 2008 

measures MIEA–TRHCA requires be 

finalized via publication in the Federal 

Register by November 15, 2007. 

However, we have captured these 

recommendations and will have them 

available for consideration in 

identifying measure sets for future 

years’ PQRI and other initiatives to 

which those measures may be pertinent. 

(ii) AMA—PCPI Measures 

The measures listed in Table 8, which 

were developed via the American 

Medical Association (AMA) Physicians 

Consortium for Performance 

Improvement (PCPI), are finalized as 

2008 PQRI measures as of the date of 

publication of this final rule with 

comment period. All of these measures 

were proposed as 2008 PQRI measures 

(72 FR 38200 through 38201). The 

measures listed in Table 8 achieved 

AQA adoption or NQF endorsement on 

or before October 31, 2007. 

We will publish the detailed 

specifications for all final PQRI 

measures on the CMS PQRI Web site at 

http://www.cms.hhs.gov/pqri on or 

before December 31, 2007. 


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TABLE 8.—AMA/PCPI MEASURES FINALIZED FOR 2008 WITH CONSENSUS-ORGANIZATION APPROVAL BY 10/31/2007 

Prevention of Ventilator-Associated Pneumonia—Head elevation. 

Prevention of Catheter-Related Bloodstream Infections (CRBSI)—Central Venous Catheter Insertion Protocol. 

ACE Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy in patients with CKD. 

Chronic Kidney Disease (CKD): Laboratory Testing (Calcium, Phosphorus, Intact Parathyroid Hormone (iPTH) and Lipid Profile). 

Influenza Vaccination in patients with End Stage Renal Disease (ESRD). 

Vascular Access for patients undergoing Hemodialysis. 

Plan of Care for ESRD patients with Anemia. 

Plan of Care for Inadequate Hemodialysis in ESRD patients. 

Plan of Care for Inadequate Peritoneal Dialysis. 

Assessment of GERD Symptoms in Patients Receiving Chronic Medication for GERD. 

Testing of patients with Chronic Hepatitis C (HCV) for Hepatitis C Viremia. 

Initial Hepatitis C RNA Testing. 

HCV Genotype Testing Prior to Therapy. 

Consideration for Antiviral Therapy in HCV Patients. 

HCV RNA Testing at Week 12 of Therapy. 

Hepatitis A and B Vaccination in patients with HCV. 

Counseling patients with HCV Regarding Use of Alcohol. 

Counseling of patients Regarding Use of Contraception Prior to Starting Antiviral Therapy. 

Patients who have Major Depression Disorder who meet DSM IV Criteria. 

Patients who have Major Depression Disorder who are assessed for suicide risks. 

Patients with Osteoarthritis who have an assessment of their pain and function. 

Acute Otitis Externa (AOE): Topical Therapy. 

Acute Otitis Externa (AOE): Pain Assessment. 

Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy—Avoidance of Inappropriate Use. 

Otitis Media with Effusion (OME): Diagnostic Evaluation—Assessment of Tympanic Membrane Mobility. 

Otitis Media with Effusion (OME): Hearing Testing. 

Otitis Media with Effusion (OME): Antihistamines or Decongestants—Avoidance of Inappropriate Use. 

Otitis Media with Effusion (OME): Systemic Antimicrobials—Avoidance of Inappropriate Use. 

Otitis Media with Effusion (OME): Systemic Corticosteroids—Avoidance of Inappropriate Use. 

Breast cancer patients who have a pT and pN category and histologic grade for their cancer. 

Colorectal cancer patients who have a pT and pN category and histologic grade for their cancer. 

Appropriate initial evaluation of patients with Prostate Cancer. 

Inappropriate use of Bone Scan for staging Low-Risk Prostate Cancer patients. 

Review of treatment options in patients with clinically localized Prostate Cancer. 

Adjuvant Hormonal therapy for High-risk Prostate Cancer patients. 

Three-dimensional radiotherapy for patients with Prostate Cancer. 

Chronic Kidney Disease (CKD): Blood Pressure Management. 

Chronic Kidney Disease (CKD): Plan of Care: Elevated Hemoglobin for Patients Receiving Erythropoiesis—Stimulating Agents (ESA). 

The AMA PCPI measures that were 

proposed in Table 17 of the proposed 

rule (72 FR 38200 through 38201) were 

under development at the time the 

proposed rule was published. Several of 

these measures did not complete 

development or did not complete 

development in a sufficiently timely 

manner to permit implementation in the 

2008 PQRI program. We have not 

included in the final PQRI measures 

listed in Table 8 the following proposed 

2008 measures (from Table 17 of the 

proposed rule, 72 FR 38200 through 

38201) for which development was not 

completed or not completed in 

sufficient time for implementation for 

2008: 

• Stress Ulcer Disease (SUD) 

Prophylaxis in Ventilated Patients 

• Perioperative Temperature 

Management for Surgical Procedures 

Under General Anesthesia 

• Assessment of Thromboembolic Risk 

Factors in patients with Atrial 

Fibrillation 

• Chronic Anticoagulation in patients 

with Atrial Fibrillation 

• Monthly INR Measurements in 

patients with Atrial Fibrillation 

• GFR Calculation in patients with 

Chronic Kidney Disease (CKD) 

• Permanent Catheter Vascular Access 

for patients Receiving Hemodialysis 

• Patients with Osteoarthritis who 

receive Anti inflammatory or 

Analgesia Medication 

• Documentation of hydration status in 

Pediatric Patients with Acute 

Gastroenteritis (PAG) 

• Weight measurement in patients with 

PAG 

• Recommendation of appropriate oral 

rehydration solution in PAG patients 

• Education parents of PAG patients 

• Perioperative Cardiac risk assessment 

(history) 

• Perioperative Cardiac risk assessment 

(current symptoms) 

• Perioperative Cardiac risk assessment 

(physical examination) 

• Perioperative Cardiac risk assessment 

(electrocardiogram) 

• Perioperative Cardiac risk assessment 

(continuation of Beta Blockers). 

During completion of the measure 

development process, the measure 

developer eliminated the restriction to 

ventilated patients of the proposed (72 

FR 38201) measure titled, ‘‘Prevention 

of Catheter-Related Bloodstream 

Infections in Ventilated Patients—

Catheter Insertion Protocol’’. This 

measure is, therefore, listed in the Final 

2008 PQRI measures in Table 8 as 

‘‘Prevention of Catheter-Related 

Bloodstream Infections (CRBSI)—

Central Venous Catheter Insertion 

Protocol’’. 

During completion of the measure 

development process, several of the 

measures proposed for 2008 in Table 17 

of the proposed rule (72 FR 38200 

through 38201) were combined into one 

measure by the measure developer. The 

final, combined measures contain the 

substantive components of each of the 

measures. The following is reflected in 

the Final 2008 PQRI Measures listed in 

Table 8: 

• Proposed measures (72 FR 38201) 

titled ‘‘Blood Pressure Measurement in 

patients with CKD’’ and ‘‘Plan of Care 

for patients with CKD and Elevated 

Blood Pressure’’ were combined into the 

measure entitled ‘‘Chronic Kidney 

Disease (CKD): Blood Pressure 

Management.’’

• Proposed measures (72 FR 38201) 

‘‘Calcium, Phosphorus and Intact 


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Parathyroid Hormone Measurement in 

patients with CKD’’ and ‘‘Lipid Profile 

in patients with CKD’’ were combined 

into the measure in Table 8 entitled 

‘‘Chronic Kidney Disease (CKD): 

Laboratory Testing (Calcium, 

Phosphorus, Intact Parathyroid 

Hormone (iPTH) and Lipid Profile).’’

• Proposed measures (72 FR 38201) 

‘‘Hemoglobin Monitoring in patients 

with CKD’’ and ‘‘Erythropoietin Overuse 

in patients with CKD and normal 

Hemoglobin’’ were combined into the 

measure in Table 8 entitled ‘‘Chronic 

Kidney Disease (CKD): Plan of Care: 

Elevated Hemoglobin for Patients 

Receiving Erythropoiesis-Stimulating 

Agents (ESA).’’

During the measure development 

process, several measures listed in the 

proposed rule (72 FR 38201) as 

pertaining to the medical conditions 

Acute Otitis Externa (AOE) and Otitis 

Media with Effusion (OME) were 

narrowed to apply to only one or the 

other. The measure developer made 

these refinements as a result of more indepth consideration of the evidence for 

the clinical relevance of each specific 

measure to each or either condition. 

Modifications to the measures’ titles 

reflect these decisions. Otitis Media 

with Effusion (OME) was eliminated 

from the proposed 2008 measures 

below. The revised measure titles are 

listed in Table 8 for each proposed 2008 

measures: 

• Measure proposed (72 FR 38201) as 

‘‘Patients with Acute Otitis Externa 

(AOE) or Otitis Media with Effusion 

(OME) who receive Topical Therapy’’ is 

now entitled ‘‘Acute Otitis Externa 

(AOE): Topical Therapy.’’

• Measure proposed (72 FR 38201) as 

‘‘Patients with AOE/OME who have a 

pain assessment’’ is now entitled 

‘‘Acute Otitis Externa (AOE): Pain 

Assessment.’’

• Measure proposed (72 FR 38201) as 

‘‘Patients with AOE/OME who are 

inappropriately prescribed 

antimicrobials’’ is now entitled ‘‘Acute 

Otitis Externa (AOE): Systemic 

Antimicrobial Therapy—Avoidance of 

Inappropriate Use’’. Acute Otitis 

Externa (AOE) was eliminated from the 

proposed (72 FR 38201) measures 

below. The revised measure titles are 

listed in Table J2 for each proposed 

2008 measures. 

• Measure proposed (72 FR 38201) as 

‘‘Patients with AOE/OME who have an 

assessment of tympanic membrane 

mobility’’ is now entitled ‘‘Otitis Media 

with Effusion (OME): Diagnostic 

Evaluation—Assessment of Tympanic 

Membrane Mobility.’’

• Measure proposed (72 FR 38201) as 

‘‘Patients with AOE/OME who undergo 

hearing testing’’ is now entitled ‘‘Otitis 

Media with Effusion (OME): Hearing 

Testing.’’

• Measure proposed (72 FR 38201) as 

‘‘Patients with AOE/OME who 

inappropriately receive antihistamines/ 

decongestants’’ is now entitled ‘‘Otitis 

Media with Effusion (OME): 

Antihistamines or Decongestants—

Avoidance of Inappropriate Use.’’

• Measure proposed (72 FR 38201) as 

‘‘Patients with AOE/OME who 

inappropriately receive systemic 

antimicrobials’’ is now entitled ‘‘Otitis 

Media with Effusion (OME): Systemic 

Antimicrobials—Avoidance of 

Inappropriate Use.’’

• Measure proposed (72 FR 38201) as 

‘‘Patients with AOE/OME who 

inappropriately receive systemic 

steroids’’ is now entitled ‘‘Otitis Media 

with Effusion (OME): Systemic 

Corticosteroids—Avoidance of 

Inappropriate Use.’’

Comment: We received several 

comments from organizations involved 

in the measure development process 

noting that the measure titles as 

proposed in Table 17 of the proposed 

rule (72 FR 38200 through 38201) were 

incorrect or obsolete based on progress 

in measure development between the 

time the proposed rule went on display 

(July 2, 2007) and the date the 

commenters submitted their comment 

letters (various specific dates at the end 

of August, 2007). 

Response: As stated above, the 

measure titles in Table 8 reflect the 

correct titles as of the conclusion of the 

development process preparing these 

measures for consensus-organization 

review in the late summer and early fall 

of 2007. 

Comment: We received comments in 

support of certain measures listed in 

Table 8, such as the Chronic Kidney 

Disease measures. Other commenters 

suggested including additional 

measures not proposed as 2008 PQRI 

measures. No commenters opposed 

inclusion of any of the measures listed 

on Table 8. 

Response: The measures from Table 

16 of the proposed rule (72 FR 38200 

through 38201) that were sufficiently 

completed in time for use in the 2008 

PQRI are included in Table 8. As 

discussed above, several of the CKD 

measures proposed in Table 16 of the 

proposed rule (72 FR 38201) have been 

combined into with one another as 

listed in Table 8. 

As iterated above in response to 

comments on measures in Table 7, we 

cannot include in the 2008 PQRI 

measures that were not published as 

proposed 2008 PQRI measures in the 

Federal Register by August 15, 2007. 

We have, however, made note of the 

measures suggested and may consider 

them for inclusion in future qualityreporting initiatives to which they may 

be relevant. 

(iii) Nonphysician Measures 

We include measures in the final 2008 

PQRI quality measures listed in Table 9 

developed by Quality Insights of 

Pennsylvania (under the Medicare 

Quality Improvement Organization 

(QIO) contract for the State of 

Pennsylvania) that were proposed as 

2008 PQRI measures in Table 18 of the 

proposed rule (72 FR 38201 through 

38202). These measures were developed 

primarily to afford expanded reporting 

opportunities for NPPs who had few or 

no measures available in 2007. Some 

may also be applicable to physicians. 

The clinicians who could report each 

measure are identified in the measure’s 

detailed specifications, which will be 

available on the Measures/Codes page of 

the CMS PQRI Web site at http:// 

www.cms.hhs.gov/pqri as far in advance 

of the 2008 reporting period as practical. 

We have not included in the final PQRI 

measures listed in Table 9 the following 

measures proposed in Table 18 of the 

proposed rule (72 FR 38201 through 

38202) whose development was not 

completed in a sufficiently timely 

manner for implementation in the 2008 

PQRI program: 

• Universal Hypertension Screening. 

• Universal Hypertension Screening 

Follow-up. 

During completion of the measure 

development process, several of the 

measures proposed for 2008 in Table 18 

of the proposed rule (72 FR 38201 

through 38202) were combined into one 

measure by the measure developer. The 

final, combined measures contain the 

substantive components of each of the 

measures. The following is reflected in 

the Final 2008 PQRI Measures listed in 

Table 8: 

• Proposed (72 FR 38201) measures 

titled ‘‘Universal Weight Screening 

(BMI)’’ and ‘‘Universal Weight 

Screening Follow-up (BMI)’’ were 

combined into the measure entitled 

‘‘Universal Weight Screening and 

Follow-up.’’

• Proposed (72 FR 38201) measures 

‘‘Patient Co-development of Treatment 

Plan’’ and ‘‘Patient Co-development of 

Plan of Care’’ were combined into the 

measure in Table 8 entitled ‘‘Patient Codevelopment of Treatment Plan/Plan of 

Care.’’

Comment: We received numerous 

comments pertaining to the measures 

proposed in Table 18 of the proposed 

rule (72 FR 38201 through 38202), now 

listed in Table 9 of this final rule with 


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comment period. Most of these 

comments addressed the scope of 

applicability of these measures to 

particular non-physician specialties, 

such as speech language pathologists 

(SLPs) and occupational therapists. 

Response: The applicability of the 

final 2008 PQRI measures is dependent 

on whether the given practitioner can 

bill for the services identified by the 

procedures or services represented by 

the Current Procedural Terminology 

(CPT) Category I codes in the measure’s 

denominator per its detailed 

specifications. The inclusion of specific 

procedures or services in a measure’s 

denominator is determined during the 

measure development and consensus 

process, based on the clinical relevance 

of the measure to particular services/ 

procedures. The determination of 

services/procedures to which a specific 

measure is relevant and therefore 

applicable is not subject to change via 

the rulemaking process. The measures 

in Table 9 achieved AQA consensus 

adoption on or before October 19, 2007. 

These measures have not yet been 

reviewed by the NQF. 

We will publish the detailed 

specifications for all final PQRI 

measures, including these QIP 

nonphysician measures, on the CMS 

PQRI Web site at http:// 

www.cms.hhs.gov/pqri on or before 

December 31, 2007. 

TABLE 9.—QUALITY INSIGHTS OF

PENNSYLVANIA NONPHYSICIAN

MEASURES

Universal Weight Screening (BMI) and Follow-up. 

Universal Influenza Vaccine Screening and 

Counseling. 

Universal Documentation and Verification of 

Current Medications in the Medical Record. 

Screening for Clinical Depression. 

Screening for Cognitive Impairment. 

Patient Co-development of Treatment Plan/ 

Plan of Care. 

Pain Assessment Prior to Initiation of Patient 

Treatment. 

(iv) Structural Measures Currently 

Under Development 

We include structural measures in the 

final 2008 PQRI measures listed in 

Table 10 developed by Quality Insights 

of Pennsylvania (under the Medicare 

Quality Improvement Organization 

(QIO) contract for the State of 

Pennsylvania), that were proposed as 

2008 measures in Table 19 of the 

proposed rule (72 FR 38202). These 

measures meet the requirement of 

section 1848(k)(2)(B)(i) of the Act. 

Comment: Numerous comments 

expressed support of the measures listed 

in Table 10. Other commenters stated a 

belief that there is a lack of scientific 

evidence to support the benefits of eprescribing. 

Response: As required by MIEATRHCA, the final 2008 PQRI measures 

shall include structural measures such 

as the use of EHRs and electronic 

prescribing technology. The 

determination of the sufficiency of the 

scientific basis for quality measures is 

part of the review and evaluation during 

the measure development and 

consensus processes. The measures are 

included in Table 10. These measures 

were adopted by the AQA on or before 

October 31, 2007. 

TABLE 10.—QUALITY INSIGHTS OF

PENNSYLVANIA STRUCTURAL MEASURES

HIT—Adoption/Use of E-Prescribing. 

HIT—Adoption/Use of Health Information 

Technology (Electronic Health Records). 

(v) Additional AQA Starter-Set 

Measures 

We include measures in the final 2008 

PQRI measures from the AQA starter set 

that were not included in the 2007 PQRI 

quality measures but that are relevant to 

Medicare beneficiaries and which we 

proposed as 2008 measures in Table 20 

of the proposed rule (72 FR 38202). We 

have not included in the final 2008 

measures listed in Table 11 the 

following measure that was listed in 

Table 20 of the proposed rule (72 FR 

38202), because its adaptation to the 

claims-based provider-self-reported 

format was not found to be feasible: 

• Beta Blocker Therapy (persistent for 

6 months or more) Post MI. 

We received several comments in 

support of the measures listed in Table 

20 of the proposed rule (72 FR 38202) 

and now listed in Table 11, as 

preventive care measures and measures 

related to smoking cessation. 

TABLE 11.—ADDITIONAL AQA 

STARTER-SET MEASURES

Dilated eye exam in diabetic patient. 

Screening Mammography. 

Colorectal Cancer Screening. 

Inquiry regarding Tobacco Use. 

Advising Smokers to Quit. 

(vi) Other NQF-Endorsed Measures 

We include in the final 2008 PQRI 

measures other measures endorsed by 

the NQF that were not included in the 

2007 PQRI quality measures but that 

were proposed as 2008 measures (72 FR 

38202) and that are relevant to Medicare 

beneficiaries, address overuse/misuse of 

pharmacologic therapy, and/or that 

expand the specialty applicability and 

patient population. We have not 

included in the final PQRI measures 

listed in Table 12 the following 

proposed measure (72 FR 38202), 

because its adaptation to the PQRI 

format was subsequently not found to be 

feasible: 

• Annual Therapeutic monitoring for 

patients on the following persistent 

medications: Angiotensin Converting 

Enzyme Inhibitor (ACE)/Angiotensin 

Receptor Blocker (ARB), Digoxin, 

Diuretics, Anticonvulsants; and Statins. 

We received several comments in 

support of including the measures listed 

in Table 12. We did not receive any 

comments opposing the inclusion of any 

of the measures listed in Table 12. 

TABLE 12.—OTHER NQF-ENDORSED MEASURES

Inappropriate antibiotic treatment for adults with acute bronchitis. 

Disease Modifying Anti-rheumatic Drug Therapy in Rheumatoid Arthritis. 

Angiotensin Converting Enzyme Inhibitor (ACE) or Angiotensin Receptor Blocker (ARB) Therapy for patients with coronary artery disease and 

diabetes and/or left ventricular systolic dysfunction (LVSD). 

Urine screening for microalbumin or medical attention for nephropathy in diabetic patients. 

Influenza vaccination for patients ≥ 50 years old. 

Pneumonia vaccination for patients 65 years and older. 

(vii) Podiatric Measures 

We include measures in the final 2008 

PQRI quality measures listed in Table 

13 developed by the American Podiatric 

Medical Association (APMA). These 

two measures are finalized as 2008 PQRI 

measures as of the date of publication of 

this final rule with comment period. 

These measures were proposed as 2008 

PQRI measures in Table 21 of the 

proposed rule (72 FR 38202), and were 


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adopted by the AQA on or before 

October 31, 2007. 

A third proposed measure (72 FR 

38202), titled ‘‘Diabetic Foot and Ankle 

Care, Peripheral Arterial Disease: Ankle 

Brachial Index (ABI) Measurement’’ has 

not achieved AQA adoption or NQF 

endorsement in time to be included in 

this final rule with comment period, 

and is therefore not included in the final 

2008 PQRI quality measures. 

Comment: A number of comments 

expressed support of these measures. 

We received comments requesting 

correction of the title of this topic and 

the substantive title/heading for the 

table from ‘‘Podiatric Measures’’ to 

‘‘Diabetic Foot and Ankle Measures’’ to 

reflect the potential applicability of 

these measures beyond podiatrist. At 

the same time, we received comments 

that these measures are not applicable to 

orthopedic surgeons. 

Response: We have retained the 

original measure-category title to reflect 

the developer, and thus the origin of the 

measures, rather than the scope of 

applicability. This identification of 

nomenclature is aligned with the 

nomenclature used for other categories 

of measures, such as those in Table 11, 

which are identified as originating in 

the AQA Starter Set rather than by the 

type of services to which they pertain. 

MIEA–TRHCA makes no presumption 

as to applicability based solely on 

measure title or specifications, let alone 

the categorization that may be applied 

to various groups of measures for 

identification and ease of reference. 

Rather, measures are presumed 

applicable to a practitioner based on the 

scope and pattern of practice of the 

physician reporting the measure in 

combination with its specifications. 

TABLE 13.—PODIATRIC MEASURES

Diabetic Foot and Ankle Care, Peripheral 

Neuropathy: Neurological Evaluation. 

Diabetic Foot and Ankle Care, Ulcer Prevention: Evaluation of Footwear. 

d. Addressing a Mechanism for 

Submission of Data on Quality Measures 

via a Medical Registry or Electronic 

Health Record 

(i) Addressing a Mechanism for 

Submission of Data on Quality Measures 

via a Medical Registry—Background and 

Summary of Proposed Rule 

As explained in the proposed rule (72 

FR 38202), section 1848(k)(4) of the Act, 

as amended by the MIEA–TRHCA, 

requires that ‘‘as part of the publication 

of proposed and final quality measures 

for 2008 under clauses (i) and (iii) of 

paragraph (2)(B), the Secretary shall 

address a mechanism whereby an 

eligible professional may provide data 

on quality measures through an 

appropriate medical registry’’. 

In the proposed rule, we discussed 

what constitutes a medical registry and 

the general desirability of registries 

serving as an alternative to claims based 

reporting. We proposed to address 

reporting from medical registries by 

testing one or more of five mechanisms 

for such reporting during 2008, and 

requested comment on five options for 

data submission by registries. These 

options vary as to whether individual 

beneficiary-level data is submitted by 

the registry, as well as the number and 

type of data elements needed from the 

registry. The five options were 

described in detail in the proposed rule 

(72 FR 38203 through 38204). 

The 2008 registry reporting is only a 

test of the feasibility and accuracy for 

the two selected submission options 

(identified as Options 2 and 3 in the 

proposed rule (72 FR 38203 through 

38204)) and described again, in 

summary, below in response to 

comments. In order to qualify for the 

incentive bonus for PQRI data 

submission, practitioners will need to 

continue their quality data codes 

through the claims process. 

(ii) Addressing a Mechanism for 

Submission of Data on Quality Measures 

via a Medical Registry—Summary of 

Comments and CMS’s Responses 

Comment: The majority of the 

comments advocated the use of option 

2, 3, or 5. There was not significant 

support for option 1 or option 4; instead 

the preponderance of comments on 

options 1 and 4 were in opposition to 

their implementation. 

Response: We have decided to test 

options 2 and 3 in 2008. 

We agree that option 1 should not be 

tested. Under this option only the 

quality data codes for selected PQRI 

measures would be reported by the 

registry without submission of 

associated diagnosis or service 

rendered. Under this option, the 

denominator information would have to 

be obtained from the claims and linked 

to the quality data codes submitted via 

the registry. This option would create an 

added administrative burden for the 

CMS systems that would need to link 

data from the two sources at the 

beneficiary or episode/encounter/ 

procedure level. 

We also agree that option 4 should not 

be tested. Option 4 would place 

significant burden upon practitioners, 

by requiring practitioners not only to 

submit claims to Medicare for the 

services provided, but also enter data 

obtained from the explanation of 

benefits into the registry. 

Option 5, which calls for a ‘‘data 

dump’’ was supported by some 

commenters as this option would 

potentially provide the most complete 

and robust set of data for purposes of 

clinical improvement. It could also be 

beneficial in evaluating a physician’s 

practice, particularly since it would not 

necessarily need to be limited to 

Medicare Part B beneficiaries or soley 

PQRI measures. Thus, while we agree 

that data submission via registry-based 

mechanisms in models such as Option 

5 has significant potential over time 

because of the comprehensiveness of the 

data, we do not believe that this option 

is currently practical for 

implementation even on a test basis. We 

intend to continue to explore ways to 

enhance our ability to capture registry 

data so that it may be suitable for future 

use. 

Under Option 2, the registry would 

provide the quality data codes and 

diagnosis codes and beneficiary 

identification (HIC) numbers or other 

limited beneficiary information for 

identification. Using the beneficiary 

information to match registry 

information to a submitted claim for a 

particular service, CMS would have the 

data needed to calculate a practitioner’s 

reporting and performance rates. 

Under Option 3 the registry will 

calculate and submit reporting and 

performance rates for various measures 

to CMS, rather than have CMS calculate 

the rates. While this is compatible with 

the role of a registry in providing 

feedback to the physician, for future 

PQRI implementation, a validation 

process for the registry calculations 

would need to be in place and provided 

to CMS. 

Comment: Many commenters 

requested that registry-based 

mechanisms for 2008 be made a fully 

operational alternative through which 

participants could achieve satisfactory 

reporting and quality for a 2008 PQRI 

incentive payment. Several commenters 

suggested we find a way to let 

participants in testing activities ‘‘get 

credit’’ toward PQRI reporting for their 

participation in the test. 

Response: We proposed a test of 

registry submission (72 FR 38203 

through 38204). It is not feasible or 

practical to implement registry 

submission without such testing. Any 

registries and any of their subscribers 

participating in any testing activities in 

2008 will be participating in this datasubmission testing on a strictly 

voluntary basis. Any registry seeking to 

participate in the testing should notify 

their subscribers to continue submitting 


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quality data codes on their Part B 

professional services claims in order to 

pursue PQRI bonus payments. 

Comment: We received several 

comments requesting that a specific 

organization’s registry be deemed or 

‘‘certified’’ to satisfy PQRI reporting. 

Additionally, it was suggested that we 

implement a mechanism to make those 

professionals submitting data to the 

registry potentially able to qualify for a 

2008 PQRI bonus payment on the basis 

of participating in the registry. We 

received several related comments 

suggesting we consider deeming 

specialty boards’ maintenance of 

certification (MOC) programs so that 

successful participation in a deemed 

MOC would qualify a professional for a 

2008 PQRI bonus payment. 

Response: We believe that, in the long 

run, registries having such deemed 

status may be a very suitable and 

desirable way for quality data 

submission and measures calculation to 

be conducted for physicians and other 

practitioners. However, at the present 

time we do not find it feasible or 

practical to implement such a 

suggestion. 

Comment: Several commenters 

encouraged us to maintain for the 

foreseeable future multiple options for 

PQRI participants to submit data, 

including claims based, as well as 

registry or EHR-based submission 

mechanisms. Some of these comments 

noted that the state of the art for medical 

registries is embryonic to nascent. 

Commenters also noted that the 

percentage of eligible professionals who 

use EHRs capable of successful data 

extraction and transmission to a CMS 

data warehouse is relatively low. 

Related comments recommended we 

develop a long term strategy that will be 

sufficiently flexible to allow for 

innovative developments in the registry 

field as it begins to grow in 

sophistication and market penetration. 

Response: For 2008, claims-based 

submission will remain the only 

mechanism of PQRI quality measure 

data submission. We hope in future 

years to make alternative ECI-based 

submission mechanisms available. 

However, we recognize that for the near 

future, claims-based submission is 

likely to be the only mechanism that 

will provide an avenue for virtually all 

eligible practitioners to participate 

within PQRI. As a result, we would 

anticipate that claims based submission 

would be maintained. 

Comment: Several commenters 

expressed concern that many registries 

are proprietary and charge a fee for 

using the registry. Commenters 

expressed concern about using 

proprietary registries, specifically that 

such use raises potential antitrust 

(barrier to competition) issues, as well 

as barriers to participation by 

professionals who would have to 

subscribe to a proprietary registry. 

Several commenters urged that any CMS 

registry-based mechanism be in the 

public domain and supported by a 

public domain registry available to 

individual professionals. 

Response: In the proposed rule, we 

discussed registry-based reporting as an 

alternative, not a requirement. We agree 

that physicians should not be required 

to use any particular proprietary service. 

Rather, the purpose in addressing 

registries is to allow physicians who 

find it desirable to submit data to 

registries to be able to avoid duplicate 

data submission to CMS through the 

claims process. 

Comment: A few commenters 

expressed concern that creating new 

registries or altering existing interfaces 

would be burdensome and costly. 

Response: We are not recommending 

developing new registries and any 

decision to do so should be made 

independently of PQRI. Nevertheless, 

there are currently various registries in 

existence which may, ultimately, be 

capable of interfacing with the CMS 

data warehouse. As has been previously 

discussed, for 2008, we will only be 

testing registry-based data submission. 

As envisioned for the future, registrybased submission of quality-measures 

data would be an alternative, not a 

requirement. 

Comment: Some comments expressed 

concerns about transmitting patient data 

through registries or EHRs in context of 

applicable statutes, regulations, and 

policies protecting patient privacy. 

Response: Preserving the 

confidentiality of patients’ individually 

identifiable and protected health 

information is a high priority at CMS. 

Generally, personally identifiable data 

on individuals and/or their health are 

protected by the Privacy Act of 1974 

and/or the Health Insurance Portability 

and Accountability Act of 1996 (Pub. L. 

104–191) (HIPAA). HIPAA establishes 

protections specific to certain 

individually identifiable health 

information, and the Privacy Act 

establishes the protections specific to 

certain information that the government 

maintains which is individually 

identifiable. HIPAA and its extensive 

implementing regulations have 

established privacy and security 

standards for health care plans, health 

care clearinghouses, and providers that 

conduct electronic transactions covered 

by HIPAA. These entities are termed 

‘‘covered entities’’. All patient registries, 

EHRs, data transmission, and data 

storage done by or on behalf of a 

covered entity must be HIPAA 

compliant. The claims-based method of 

reporting currently uses patient 

identifiers for submission of quality data 

along with data required to process the 

provider’s claim for payment. The use of 

registries or EHRs would require, for 

purposes of validation, the same 

information as currently used by the 

claims-based method of submitting 

quality-measures data. 

(iii) Addressing a Mechanism for 

Submission of Data on Quality Measures 

Via a Medical Registry—Final Plan 

For 2008, we will test Options 2 and 

3 on a voluntary basis, based on selfnomination by the registries. Each 

registry participating in the testing of 

each option must maintain compliance 

with all applicable statutory and 

regulatory requirements and any 

contractual obligations to the 

professionals/providers for processing, 

storing, and transmitting the data 

required by the option. 

Functionally, the registry would act as 

a data submission vendor for the eligible 

professional. A ‘‘data submission 

vendor’’ is defined for purposes of this 

rule as an entity that has permission 

from the eligible professional to provide 

medical registry data to the Quality 

Reporting System developed per the 

MIEA–TRHCA. This definition parallels 

the definition of ‘‘data submission 

vendor’’ as used in other programs, such 

as the Hospital Compare datasubmission process, where examples of 

such vendors include Joint Commission 

Oryx vendors. 

In the testing process, again in 

parallel to similar mechanisms already 

implemented for other provider types by 

CMS, we anticipate the registry, acting 

as a data submission vendor, will 

submit data to the CMS clinical data 

warehouse, using a CMS-specified 

record layout based on the quality 

measures’ specifications as published by 

CMS. For purposes of this rule, the term 

‘‘CMS clinical data warehouse’’ is 

defined as a clinical data warehouse 

designated by CMS for use in this 

testing. The exact warehouse 

infrastructure may vary between the 

testing activity in 2008 and any full 

implementation of registry-based data 

submission that may in the future 

follow from that testing. 

Options 1 and 4 as described in the 

proposed rule will not be tested in 2008, 

and we do not envision any future 

consideration. Thus, they are not 

described in this rule. Option 5, while 

of potential interest for future 

consideration, is also not described 


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below. As options 2 and 3 will be tested 

in 2008, they are described below. 

Option 2: Registries provide the 

quality codes and diagnosis codes. In 

testing this option, we will use claims 

data extracted from the National Claims 

History to capture the payment 

information at the NPI/Tax ID level. All 

PQRI reporting and performance 

calculations will be performed using 

registry data. The registries will, 

therefore, be required to include specific 

data elements in their databases in order 

to include the codes needed to calculate 

performance measures and to match 

registry data to claims data. Although 

not identified in the proposed rule, we 

have upon further technical analysis 

concluded that along with data elements 

previously identified, patient identifiers 

will also be needed from the registry 

under this option. Patient identifier data 

are needed specifically in order to allow 

matching of registry data with Medicare 

claims. It is our understanding that for 

many, if not all, registries, inclusion of 

at least the patient identifier data 

elements will represent an addition to 

their databases. 

While developing and through the 

implementation of the testing phase we 

may discover additional data elements 

are needed to support reliably valid 

analyses. The following is a list of 

examples of the minimum data elements 

we believe will be needed from a 

registry under Option 2: 

• Beneficiary/procedure-level data (ICD 

9 and CPT codes) 

• HCPCS quality-data codes (G codes 

and CPT category II codes and 

modifiers) 

• NPI and Tax ID 

• Date of service 

• Beneficiary Date of Birth 

• HIC number 

Option 3: Registries calculate the 

reporting and performance rates for 

Medicare beneficiaries only, and submit 

these rates to CMS (that is, aggregate 

information by NPI within a Tax ID). We 

assume no beneficiary level information 

will be shared. Registries will be 

required to include data elements in 

their databases to capture either qualitydata codes or the clinical data needed to 

compute the quality-data codes. 

Registries will be required to perform 

the necessary calculations to be able to 

submit completed numerator/ 

denominators for both reporting and 

performance rates. Additionally, the 

registries must have a validation 

strategy in place. 

For any option, the registry must 

maintain compliance with all applicable 

statutory or regulatory requirements and 

any contractual obligations to the 

providers for processing, storing, and 

transmitting the data required by the 

option. To be considered an appropriate 

registry from which we can accept and 

process data for the purposes of 

calculating PQRI measures, a registry 

must also comply with the 

interoperability standards recognized by 

the Secretary, and therefore, applicable 

to HHS initiatives. Examples of 

standards recognized by the Secretary 

include Consolidated Health Informatics 

Initiative (CHI) standards and standards 

subsequently recognized by the 

Secretary under Executive Order 13410 

in place of CHI standards. A description 

of the specific health informatics 

standards adopted by the Federal 

government, as well as the specific 

interoperability standards recognized by 

the Secretary, is available on the HHS 

Office of the National Coordinator for 

Health Information Technology (ONC) 

Web site at http://www.hhs.gov/ 

healthit/chiinitiative.html. 

We will request that registries 

interested in participating in the testing 

of the registry based quality data 

submission project self nominate. A 

letter stating the registries interest 

should be received by CMS by 6 PM, 

Eastern time, on January 4, 2008. Selfnomination letters should be sent to: 

‘‘PQRI IT Testing Nomination’’, Centers 

for Medicare and Medicaid Services 

Office of Clinical Standards and 

Quality, Quality Measurement and 

Health Assessment Group, 7500 

Security Boulevard, Mail Stop S3–02–

01, Baltimore, MD 21244–8532. 

We plan to select for testing, from the 

self nominees, a group of registries that 

comply with all applicable statutory 

and/or regulatory requirements, and any 

contractual obligations to the 

professionals/providers for processing, 

storing, and transmitting the data 

required by the option(s) tested. 

Registries selected must also comply 

with applicable system interoperability 

standards recognized by the Secretary 

and be technically capable of interfacing 

with the CMS clinical warehouse 

electronic data exchange interface. The 

number of registries selected for testing 

may be limited to those that are 

technically capable or those that already 

contain key minimum data elements for 

testing purposes. Additionally, the 

actual level of complexity and effort 

required for testing from the CMS data 

infrastructure may also limit registry 

participation in the testing phase. 

(Experience with other initiatives has 

suggested that some data submission 

vendors and their software are more 

easily interfaced and tested with the 

CMS data warehouse electronic data 

exchange interface than others.) 

In addition to the requirements listed 

above in this section, any registry that 

self-nominates for 2008 testing must, at 

a minimum, have the following 

characteristics: 

(1) Be able to separate and report 

information for Medicare beneficiaries 

only. 

(2) Use at least 1 PQRI measure that 

is selected for 2008 inclusion. We will 

consider other measures recommended 

by specialty registries for possible future 

use in quality reporting and 

performance. 

(3) Provide the data as outlined in the 

rule for the particular available option 

under which they are submitting data 

(that is, being able to report using option 

2 and/or option 3). 

(4) Have a validation process for their 

data. 

(5) Have or have applied for a 

QualityNet Exchange account. 

We expect that information on the 

results of the testing in 2008 will be 

posted on the CMS PQRI Web site at 

http://www.cms.hhs.gov/pqri. 

(iv) Electronic Health Records (EHRs) 

The proposed rule noted (72 FR 

38204) that we would explore the 

operational feasibility of accepting 

clinical quality data for a limited 

number of PQRI measures from EHRs, 

and solicited comments on this concept. 

The summaries of, and our responses to, 

the numerous comments we received on 

this topic are presented at the end of 

this PQRI-specific section. 

Having conducted further technical 

analyses and reviewed public comments 

received on the proposed rule, we have 

determined that we will, in 2008, 

partner with several self nominated EHR 

vendors/groups that we select to 

develop and test EHR clinical quality 

data submission. Since mechanisms for 

submission of electronic clinical data 

extracted from an EHR will only be for 

testing purposes in 2008, vendors 

should notify their clients that the 

practitioners will need to submit their 

quality data codes through the claims 

process to be eligible for a 2008 bonus 

payment. 

EHR vendors/groups who wish to 

participate in the development and 

testing process may self-nominate by 

sending a letter to CMS expressing their 

interest. Self-nomination letters should 

be sent to: ‘‘PQRI IT Testing 

Nomination’’, Centers for Medicare and 

Medicaid Services Office of Clinical 

Standards and Quality, Quality 

Measurement and Health Assessment 

Group, 7500 Security Boulevard, Mail 

Stop S3–02–01, Baltimore, MD 21244–

8532. 


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The letter must be received by CMS 

by 6 p.m., e.s.t., on January 4, 2008. 

Vendors who are selected for this 

process must: 

(1) Be able to submit data according 

to the HL7 technical specifications for 

submission of data to the Outpatient 

Clinical Warehouse, as defined for the 

Doctor’s Office Quality—Information 

Technology (DOQ–IT) Project; and 

(2) Have or have applied for a 

QualityNet Exchange account. 

As with registry-based mechanisms, 

vendors and their customers (eligible 

professionals) who choose to participate 

in the testing in 2008 will be doing so 

on a strictly voluntary basis. We will 

continue to express this, and will urge 

EHR vendors to explain this to their 

customers when seeking volunteers to 

participate in the testing with them. 

For more information on required 

capability (1), above, please see the 

QualityNet Exchange User’s Guide, and 

the DOQ–IT measures’ technical 

specifications (as implemented in the 

DOQ–IT project), both available for 

download free of charge from http:// 

qualitynet.org. Additionally, 5 

overlapping DOQ–IT and PQRI quality 

measures have been updated for 

potential use in the 2008 testing. The 

updated detailed technical 

specifications for these five DOQ–IT/ 

PQRI overlapping measures are 

available for download from the 2008 

PQRI Information page of the CMS PQRI 

Web site at http://www.cms.hhs.gov/ 

pqri. 

Comment: Numerous comments were 

received regarding accepting clinical 

quality data from EHRs for use in PQRI. 

While some commenters opposed the 

idea of using EHR-derived data in PQRI, 

the majority of responses were in favor 

of accepting clinical quality data from 

an EHR. 

Response: Although we will be unable 

to offer EHR-based data submission 

mechanism on other than a test basis, 

we are encouraged by the generally 

positive response to the pursuit of this 

option due to its substantial potential to 

enhance data quality and reduce data 

collection burden on providers. 

Comment: Numerous comments 

expressed concerns about data security, 

especially as it pertains to patient 

privacy, and patient privacy as it relates 

to CMS use of the quality data, in the 

context of EHR-based data submission 

mechanisms. 

Response: Preservation of patient 

confidentiality is imperative. It is the 

inescapable responsibility of every party 

that collects, stores, handles, or uses 

patients’ personally identifiable health 

information for any purpose. In order to 

participate in the 2008 testing, all 

participating parties must be able to 

ensure that uses and disclosures of 

protected health information EHRs, data 

transmission mechanisms, and data 

receipt and storage systems will be in 

compliance with all applicable statutes 

and regulations and any contractual 

obligations to the professionals/ 

providers for processing, storing, and 

transmitting the data required by each 

option tested. Moreover, although EHR 

submission may involve identifiable 

personal health information, that 

information is limited to what is 

minimally necessary to be able to audit 

the data accuracy and completeness in 

addition to the particular clinical 

information (lab values, vital sign 

values, documentation of a procedure or 

test ordered or performed) necessary to 

calculate the performance measure. It 

does not involve submitting the entire 

patient medical record, and it is 

possible that the information as 

transmitted can have the patient’s actual 

identifying information (for example, 

name, and HIC number) ‘‘masked’’ by 

using a practice-internal chart ID # or 

other method that still allows for 

accurate audit. 

Comment: Multiple comments urged 

us to develop and implement EHRbased data submission mechanisms in a 

way that minimizes the burden such 

submission might impose. 

Response: We agree that data 

submission burden is an important 

factor to consider in PQRI data 

submission. 

Comment: We received several 

comments expressing concern over 

professionals losing ‘‘control’’ of patient 

records as a result of EHR-based PQRI 

quality data submission. The comments 

appeared to assume that our plan was 

either to import and maintain within 

our data warehouse entire patient 

medical records or to implement an 

interface that would allow our 

warehouse to access and mine the data 

from patients’ medical records. 

Response: The patient’s health record 

is populated and maintained in a 

practitioner’s office, regardless of 

whether its content is stored on paper 

or electronic format or media. Nothing 

in this rule affects the rights of patients 

or practitioners with respect to the 

information contained in a patient’s 

health record. 

We plan to accept clinical data that is 

extracted from medical records and then 

submitted to us by a professional (or a 

data-submission vendor acting on a 

professional’s behalf). 

We would not attempt to upload 

entire medical records into the data 

warehouse, only the data elements 

minimally necessary to accomplish the 

purposes of PQRI. We do not plan to 

enable our system to directly mine data 

from the practice’s medical records 

database; that will need to be 

accomplished by the professional or a 

data vendor acting on the professional’s 

behalf. The data submission requires an 

affirmative action on the part of the 

professional to submit the data or to 

instruct his or her data submission 

vendor to submit the data to our 

warehouse. 

2. Section 110—Reporting of 

Hemoglobin or Hematocrit for Part B 

Cancer Anti-Anemia Drugs 

(§ 414.707(b)) 

Medicare Part B provides payment for 

certain drugs used to treat anemia. 

Anemia is common in cancer patients 

and may be caused by either the cancer 

itself or by various anti-cancer 

treatments, including chemotherapy, 

radiation therapy, and surgical therapy. 

Anemia occurs when the number of red 

blood cells is reduced by an anti-cancer 

treatment. This happens due to the 

effect of chemotherapy or radiation 

therapy on the bone marrow, wherein 

red blood cells are produced by dividing 

precursor cells. This chemotherapy 

effect is commonly referred to as ‘‘bone 

marrow suppression.’’ Anemia may also 

result from blood loss in association 

with surgical therapy for the cancer. 

Anemia adversely impacts the quality 

of life for beneficiaries being treated for 

cancer. Fatigue and reduced 

performance capacity are the side effects 

of anemia that cancer patients report as 

the most disabling and contributing to 

poor quality of life. The treatment of 

anemia in cancer patients commonly 

includes the use of drugs, specifically 

erythropoiesis stimulating agents (ESAs) 

such as recombinant erythropoietin and 

darbepoietin. Although other 

pharmacologic interventions are 

available, ESAs are the most commonly 

used drugs to treat anemia in this 

setting. Notably, recent research has 

prompted a Black Boxed warnings in 

the labels for ESAs, noting significant 

adverse effects including a higher risk of 

mortality and tumor progression in 

some populations. 

In 2006, we implemented a revised 

ESA claims monitoring policy based on 

the last hemoglobin or hematocrit value 

from the preceding month on Medicare 

claims for payment of ESAs 

administered to beneficiaries with 

anemia due to end-stage renal disease 

(ESRD) receiving dialysis treatments in 

facilities. For many years prior, we have 

required the reporting of these red blood 

cell indicators on the Medicare claims 

by ESRD facilities to ensure that the 

beneficiaries’ anemia was addressed. 


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Section 110 of the MIEA-TRHCA 

amends section 1842 of the Act by 

adding a new subsection (u) that reads 

as follows: ‘‘Each request for payment, 

or bill submitted, for a drug furnished 

to an individual for the treatment of 

anemia in connection with the 

treatment of cancer shall include (in a 

form and manner specified by the 

Secretary) information on the 

hemoglobin or hematocrit levels for the 

individual.’’ Section 110 of the MIEATRHCA requires such reporting for 

drugs furnished on or after January 1, 

2008. In addition, subsection (b) directs 

the Secretary to use the rulemaking 

process under section 1848 of the Act to 

address the implementation of this 

requirement. 

By requiring the reporting of anemia 

quality indicators for Medicare Part B 

anti-anemia drugs that are used in the 

context of cancer treatment, we will 

facilitate assessment of the quality of 

care for this condition. We will use the 

information reported to help determine 

the prevalence and severity of anemia 

associated with cancer therapy, the 

clinical and hematologic responses to 

the institution of anti-anemia therapy, 

and the outcomes associated with 

various doses of anti-anemia therapy. 

While not specifically addressing 

other indications, the recent research on 

the adverse effects of ESAs in patients 

with cancer does raise concerns as to 

whether patients receiving ESAs for 

other conditions, such as in the 

treatment of HIV-AIDS and for some 

surgical patients, are also at higher risk. 

We solicited public comment on the 

potential of expanding this regulation to 

include all uses of ESAs. 

Comments and Responses 

In general, commenters responded 

favorably to requiring the reporting of 

the most recent hemoglobin or 

hematocrit level on claims seeking 

payment for the administration of ESAs 

for all uses. One commenter supported 

broadening the requirement for 

reporting hemoglobin and hematocrit 

levels for all ESA claims and stated that 

such requirements would provide 

valuable data concerning reasonable 

care. The commenter stated that any 

new information on the use of ESAs for 

other, non-cancer diseases gained by the 

data collection would be helpful in 

understanding the effects of ESA use in 

different diseases. Another commenter 

supported the broad goal of gathering 

the information to improve the quality 

of care. Thus, in light of the potential 

adverse events from ESA use and in 

accordance with our reading of 

Congressional intent, we believe it is 

appropriate to require reporting of the 

hemoglobin or hematocrit with respect 

to all ESA claims, and therefore, we 

have revised the regulations text to 

reflect this policy in this final rule with 

comment period. 

Most commenters’ concerns were 

limited to the implementation of the 

requirement and possible subsequent 

undue administrative burden placed on 

providers. A few commenters addressed 

a recently published National Coverage 

Determination on the use of ESAs for 

certain patients and others included 

comments related to our ESAs claims 

monitoring policy (EMP). We are not 

addressing those comments in this final 

rule with comment period as the issues 

are outside the scope of this regulation. 

Comment: A commenter 

recommended that we exercise caution 

in implementing the anemia quality 

indicator secondary to a recent Food 

and Drug Association (FDA) Black 

Boxed Warning (BBW) on the use of 

ESAs. The commenter noted that 

anemia measures were removed from 

the Physician Consortium for 

Performance and Improvement ESRD 

measurement set pending further 

clarification by either the FDA or the 

National Kidney Foundation. 

Response: This final rule with 

comment period does not establish new 

or additional standards related to 

anemia or the administration of ESAs. It 

simply mandates the reporting of the 

most recent hemoglobin or hematocrit 

level on claims for payment of the 

administration of ESAs to treat anemia. 

Similar to claims for ESAs administered 

in renal dialysis facilities, the 

requirement to report a recent 

hemoglobin or hematocrit on claims for 

the administration of ESAs for any use 

is not a development of a clinical 

standard. Thus, we believe that 

collecting this information will not 

impact nor be impacted by any 

consensus standard organizations’

development of practice standards, 

quality measures or new scientific 

evidence. 

Comment: A commenter asked that 

we clarify if the reporting requirement 

applies to all anemia treatment, which 

includes, but is not limited to, the use 

of ESAs. 

Response: The statutory requirement 

does not limit the scope to ESAs. We 

recognize that other drugs and vitamin 

and mineral supplements such as 

Vitamin B12, folic acid, and iron may 

also be used in the treatment of anemia. 

ESAs are only FDA approved for the 

treatment of anemia while the other 

agents are commonly used to treat a 

variety of conditions other than anemia. 

Vitamin and mineral supplements are 

commonly self administered and we 

expect that most uses of these agents 

would not result in claims for Medicare 

payment in the context of the treatment 

of anemia related to anti cancer therapy. 

However, if payment is requested for 

these anti-anemia drugs furnished to an 

individual for the treatment of anemia 

in connection with the treatment of 

cancer, we believe that they are within 

the scope of the statute. 

We believe that the reporting of 

hemoglobin or hematocrit levels on 

claims for ESAs is consistent with 

Congressional intent that quality 

indicator data be submitted for patients 

receiving anti-anemia drugs and to 

ensure that anemia is addressed. 

Comment: Several commenters 

recommended that we provide clear 

instruction on the scope and reporting 

of the hemoglobin or hematocrit levels. 

Response: We will use the change 

request process to issue implementing 

instructions to Medicare contractors. 

Instructions to Medicare contractors 

include requirements for provider 

education. 

Comment: Several commenters 

expressed concern that the requirement 

will be burdensome for providers. One 

commenter asked that we delay the 

implementation of this requirement 

until the administrative burden to 

practitioners is understood. 

Response: We do not have the 

authority to delay the effective date of 

the statutory requirement. In addition, 

we believe that reporting the most 

recent hemoglobin or hematocrit level 

on a claim for ESA will not result in 

undue administrative burdens on 

providers. Many local Medicare 

contractors already require such 

reporting for claims submitting within 

their jurisdictions. ESRD providers have 

been reporting hemoglobin or 

hematocrit levels on claims for ESAs for 

several years. 

Comment: A commenter 

recommended that should we broaden 

the reporting requirement to all ESA use 

and that we should assess minimal data 

sets for understanding how beneficiaries 

with various underlying conditions 

respond to a particular course of anemia 

management. 

Response: We appreciate the 

recommendation and shall review 

available data sets when assessing 

responses to anemia management. 

Comment: A commenter 

recommended that we include anemia 

quality indicators in the Physician 

Quality Reporting Initiative (PQRI) data 

reporting. 

Response: This comment is addressed 

above in the section of this final rule 

specific to 2008 PQRI measures. The 

identification or establishment of PQRI 


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measures is not within the scope of this 

section of this final rule with comment 

period. 

Comment: A commenter asked that 

retail pharmacies be exempt from this 

requirement. 

Response: The MIEA TRHCA does not 

provide for any exemption for retail 

pharmacies. 

Comment: One commenter asked that 

we clarify whether a provider may 

report a hematocrit or hemoglobin level. 

Response: A provider seeking 

payment for ESAs may report the 

patient’s most recent hematocrit or 

hemoglobin level on the claim. 

Comment: Several commenters asked 

that we clarify the requirement to report 

‘‘the most recent’’ hemoglobin or 

hematocrit level. They expressed 

concern that we may require a patient 

to have a hemoglobin or hematocrit 

level drawn each time an ESA is 

administered. 

Response: We are not determining in 

this regulation when a hematocrit or 

hemoglobin level should be drawn to 

inform a provider’s decision to 

administer ESA therapy. The 

requirement is that ‘‘the most recent’’

hemoglobin or hematocrit level be 

reported on the claim. Thus, the 

provider should report the most recent 

level preceding the ESA administration. 

We recognize that in some instances the 

same hemoglobin or hematocrit value 

might be reported on more than one 

claim. 

Comment: Several commenters stated 

that we should permit providers to 

report hematocrit or hemoglobin levels 

in either box 19 or 24A of the CMS 1500 

form. The CMS 1500 form was recently 

modified to allow reporting in box 24A; 

however, many providers utilize billing 

vendors that provide software and are 

unable to modify their product in time 

for the January 1, 2008 implementation. 

Response: We will consider this 

information when developing claims 

processing systems instructions. 

Comment: One commenter suggested 

that we employ Q codes for reporting 

the most recent hemoglobin or 

hematocrit levels. The commenter stated 

that permitting a provider to report the 

level in box 19 would not allow an 

automated extraction of the data 

element (the hemoglobin or hematocrit 

level) for data analysis. 

Response: We are working with 

claims processing systems to ensure 

appropriate retrieval of data sets. 

3. Section 104—Extension of Treatment 

of Certain Physician Pathology Services 

Under Medicare 

The technical component (TC) of 

physician pathology services refers to 

the preparation of the slide involving 

tissue or cells that a pathologist will 

interpret. (In contrast, the pathologist’s 

interpretation of the slide is the 

professional component (PC) service. If 

this service is furnished by the hospital 

pathologist for a hospital patient, it is 

separately billable. If the independent 

laboratory’s pathologist furnishes the PC 

service, it is usually billed with the TC 

service as a combined service.) 

In the CY 2000 PFS final rule with 

comment period (64 FR 59408 through 

59409), we stated that we would 

implement a policy to pay only the 

hospital for the TC of physician 

pathology services furnished to hospital 

patients. Before that provision, any 

independent laboratory could bill the 

carrier under the PFS for the TC of 

physician pathology services for 

hospital patients. As stated in the CY 

2000 PFS final rule with comment 

period (64 FR 59408 through 59409), 

this policy has contributed to the 

Medicare program paying twice for the 

TC service, first through the inpatient 

prospective payment rate to the hospital 

where the patient is an inpatient and 

again to the independent laboratory that 

bills the carrier, instead of the hospital, 

for the TC service. 

Therefore, in the CY 2000 PFS final 

rule with comment period (64 FR 59408 

through 59409), in § 415.130, we 

specified that for services furnished on 

or after January 1, 2001, the carriers 

would no longer pay claims to the 

independent laboratory under the PFS 

for the TC of physician pathology 

services for hospital patients. 

Ordinarily, the provisions in the PFS 

final rule with comment period are 

implemented in the following year. 

However, in this case, the change to 

§ 415.130 was delayed 1 year (until 

January 1, 2001), at the request of the 

industry, to allow independent 

laboratories and hospitals sufficient 

time to negotiate arrangements. 

Moreover, our full implementation of 

§ 415.130 was further delayed by section 

542 of the Medicare, Medicaid, and 

SCHIP Benefits Improvement and 

Protection Act of 2000 (Pub. L. 106–554) 

(BIPA) and section 732 of the MMA, 

which directed us to continue payment 

to independent laboratories for the TC 

of physician pathology services for 

hospital patients through CY 2006. 

In the CY 2007 PFS final rule with 

comment period (71 FR 69700), we 

announced that beginning January 1, 

2007, we would no longer allow the 

carriers to pay the independent 

laboratory for the TC of physician 

pathology services to hospital patients. 

In effect, we would be: (1) Implementing 

the provisions of the CY 2000 PFS final 

rule with comment period whose 

implementation had been delayed by 

section 542 of the BIPA and section 732 

of the MMA; and (2) ensuring that the 

Medicare program does not make 

duplicate payments for the same 

service. 

Subsequent to publication of the CY 

2007 PFS final rule with comment 

period, the MIEA–TRHCA was enacted. 

Section 104 of the MIEA–TRHCA 

provided for an additional 1 year 

extension to allow carriers to continue 

to pay independent laboratories under 

the PFS for the TC portion of physician 

pathology services furnished to patients 

of a covered hospital. 

Consistent with this legislative 

change, we are amending § 415.130(d) to 

specify that for services furnished after 

December 31, 2007, an independent 

laboratory may not bill the carrier for 

the TC of physician pathology services 

furnished to a hospital inpatient or 

outpatient. 

Comment: Many commenters asked 

us to implement the grandfather 

provision on a permanent basis, and if 

this cannot be accomplished 

administratively, the commenter 

requested that we implement this 

provision no earlier than July 1, 2008. 

The commenter indicated that this delay 

would allow the grandfathered 

independent laboratories the 

opportunity to implement new billing 

requirements and inform customers of 

this change. 

Response: We will delay 

implementation of this provision only if 

legislation is enacted requiring a further 

delay. Otherwise, we will, as explained 

in the CY 2008 PFS proposed rule, 

implement this provision effective for 

TC services furnished on or after 

January 1, 2008. 

Comment: A commenter indicated a 

potential problem in the preamble 

language of the CY 2008 PFS proposed 

rule that explains the implementation of 

the TC physician pathology provision 

effective January 1, 2008. In the CY 2008 

PFS proposed rule, the preamble reads, 

‘‘Consistent with this legislative change, 

we are amending § 415.130(d) to reflect 

that for services furnished after 

December 31, 2007, an independent 

laboratory may not bill the carrier for 

physician pathology services furnished 

to a hospital inpatient or outpatient’’ (72 

FR 38205). As currently written, this 

language would mean that the 

independent laboratory cannot bill the 

carrier for the PC of physician pathology 

services for hospital patients, an 

unintended result. 

Response: The preamble inadvertently 

omitted the term ‘‘technical 

component’’ and should read, ‘‘For 


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services furnished after December 31, 

2007, an independent laboratory may 

not bill the carrier for the technical 

component of physician pathology 

services furnished to a hospital 

inpatient or outpatient.’’ We proposed 

this language in the regulations text of 

the proposed rule and are finalizing this 

language in this final rule with 

comment period. 

4. Section 201—Extension of Therapy 

Cap Exception Process 

Section 1833(g)(1) of the Act applies 

an annual per beneficiary combined cap 

beginning January 1, 1999, on outpatient 

physical therapy and speech-language 

pathology services, and a similar 

separate cap on outpatient occupational 

therapy services. These caps apply to 

expenses incurred for the respective 

therapy services under Medicare Part B, 

with the exception of services furnished 

as outpatient hospital services. Section 

1833(g)(2) of the Act provides that, for 

CY 1999 through CY 2001, the caps 

were $1500, and for the calendar years 

after 2001, the caps are equal to the 

preceding year’s cap increased by the 

percentage increase in the Medicare 

Economic Index (MEI) (except that if an 

increase for a year is not a multiple of 

$10, it is rounded to the nearest 

multiple of $10). 

The cap for CY 2008 will be $1810 per 

beneficiary for PT and SLP services 

combined, and $1810 for OT services. 

Therapy caps apply to expenses 

incurred for therapy services in all 

outpatient settings except the outpatient 

hospital department. As explained 

below in this section, the statute 

requires that we implement the therapy 

caps without providing for an 

exceptions process beginning on 

January 1, 2008. 

Section 5107(a) of the DRA required 

the Secretary to develop an exceptions 

process for the therapy caps effective for 

expenses incurred during CY 2006. 

Details of the CY 2006 exceptions 

process were published in a manual 

change on February 13, 2006 (CR4364, 

which consists of Transmittal 855, 

Transmittal 47, and Transmittal 140). 

Section 201 of the MIEA–TRHCA 

extended the exceptions process to 

apply for expenses incurred through 

December 31, 2007. Therapy cap 

exception policies for 2007 were 

specified in Change Request 5478 which 

consists of three transmittals with 

current numbers of—

• Transmittal 1145CP, Pub. 100–04; 

• Transmittal 63BP, Pub. 100–02; and 

• Transmittal 181PI, Pub. 100–08. 

The transmittals are incorporated into 

the Internet Only Manuals available at 

http://www.cms.hhs.gov/Manuals and 

are also available on our Web site at 

http://www.cms.hhs.gov/Transmittals/. 

In accordance with the statute as 

amended by the MIEA–TRHCA, we will 

continue to implement therapy caps, but 

the exceptions process will no longer be 

applicable for expenses incurred for 

services furnished beginning on January 

1, 2008. As noted previously in this 

section, under current law, therapy caps 

will continue to apply to expenses 

incurred for therapy services after 

December 31, 2007, with one exception. 

That is, in accordance with section 

1833(g) of the Act, the therapy caps will 

remain inapplicable to expenses 

incurred for therapy services furnished 

in the outpatient hospital setting. 

We received several comments on this 

proposal. 

Comment: Most commenters 

understood that we have no authority to 

change therapy caps, but still 

commented in favor of repealing them. 

Some commenters supported the 

continuation of the exceptions process 

as a well-conceived method of 

eliminating unnecessary treatment. 

Some commenters objected to the 

inapplicability of the caps for therapy 

expenses incurred in the outpatient 

hospital setting. One commenter 

supported the repeal of therapy caps 

and stated it is not an effective cost 

control when a steady source of 

replacement patients is available. 

Another commenter opposed the 

policy underlying the statutory 

provision to apply a financial cap on 

therapy services. The commenter cited 

other means of ensuring appropriate 

utilization of therapy services including 

CCI edits, edits required by the Deficit 

Reduction Act, local coverage 

determination policies, and Transmittal 

63, which required greater 

documentation. The commenter 

indicated that we are effectively 

achieving the objective to assure 

appropriate utilization of therapy 

services without the financial caps. 

Response: We do not have the 

authority to repeal therapy caps, to 

change the exception to applicability of 

the caps for services provided in the 

outpatient hospital setting, or to extend 

the therapy cap exceptions process 

beyond the period for which was made 

applicable by statute (CYs 2006 and 

2007). 

Comment: Several commenters urged 

CMS to implement the 

recommendations contained in the 

Computer Science Corporation (CSC) 

Outpatient Therapy Service Pilot Report 

of 2006 to collect patient-specific data 

using available measurement tools. 

Although they acknowledged that we 

may have concerns about the use of 

proprietary tools, the commenter urged 

the use of therapy-specific tools already 

on the market that were recommended 

by both CSC and MedPAC, including 

the National Outcomes Measurement 

System. 

Response: In evaluating alternative 

payment systems, we will consider all 

methods of obtaining the required 

patient-related information including 

reports of past and future contract 

deliverables. 

Comment: Many commenters are 

deeply concerned about the negative 

impact the caps would have, in the 

absence of the exceptions process, on an 

estimated 14.5 percent of the physical 

therapy (PT) users who would exceed 

the cap. The commenters commended 

CMS for progress made toward 

alternatives to the financial caps in 

recent years and urged a high priority in 

resources and funding to continuing 

research to identify alternatives that 

would also ensure access to medically 

necessary therapy services. The 

commenters support the collection of 

patient outcome data with patient 

assessment tools and use of risk 

adjustment to account for individual 

differences. They support the ongoing 

study for which CMS recently issued a 

Request for Task Order (RTOP–CMS–

07–033) and look forward to 

participating in the study. 

Many commenters reported that they 

will be collecting and reporting outcome 

data before January 1, 2008. They urged 

CMS to use clinical outcome data to 

determine the amount of care needed by 

individuals and offered assistance in 

data collection. 

Response: We recently issued a 

request for proposals (RTOP–CMS–07–

033) to continue our study of therapy 

services. The study will: (1) Identify, 

collect and use therapy-related 

information that is tied to beneficiary 

needs and treatment effectiveness; and 

(2) develop payment method 

alternatives to the current cap on 

outpatient therapy services. 

We welcome any information 

concerning clinical outcome data 

studies from providers or suppliers. If 

the information is applicable to our 

deliberations on payment alternatives, 

we will consider it along with the 

results of past and future contract 

deliverables. 

Comment: One commenter 

recommended that we continue to 

collect outpatient therapy utilization 

information for 2006 and 2007. 

Response: We contracted with the 

CSC (HHSM–500–2007–00322G) to 

extract 2006 therapy utilization data and 

provide a high level analysis. To the 

extent possible, we intend to further 


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study the impact of therapy caps 

including the 2006 exceptions process. 

5. Section 101(d)—Physician Assistance 

and Quality Initiative (PAQI) Fund 

Section 1848(l) of the Act, as added 

by section 101(d) of the MIEA–TRHCA 

requires the Secretary to establish a 

Physician Assistance and Quality 

Initiative (PAQI) Fund (the Fund) which 

shall be available for physician payment 

and quality improvement initiatives, 

and which may include application of 

an adjustment to the update of the PFS 

conversion factor (CF). The provision 

makes available $1.35 billion to the 

Fund for services furnished during CY 

2008. Specifically, the provision directs 

the Secretary to provide for 

expenditures from the Fund in a manner 

designed to provide (to the maximum 

extent feasible) for the obligation of the 

entire $1.35 billion for payment for 

physicians’ services furnished during 

CY 2008. The provision also requires 

that if expenditures from the Fund are 

applied to, or otherwise affect, a CF for 

a year, the CF for a subsequent year 

shall be computed as if the adjustment 

to the CF had never occurred. We note 

that the Transitional Medical 

Assistance, Abstinence Education, and 

Qualifying Individual Programs 

Extension Act of 2007 (Pub. L. 110–90) 

recently was signed into law and it 

provides an additional $325 million to 

be used as a part of the PAQI Fund for 

payment with regard to services 

furnished in 2009 and $60 million for 

payment for physicians’ services 

furnished on or after January 1, 2013. 

The legislation does not make any other 

changes to the program, and therefore, 

remains as discussed in the proposed 

rule. 

As the MIEA–TRHCA legislation 

indicates, this Fund can be used for 

physician payment and quality 

improvement, including application of 

an adjustment to the update of the 

conversion factor. In the CY 2007 PFS 

proposed rule, we proposed to use the 

$1.35 billion to fund bonus payments to 

be made during CY 2009 for physician 

reporting of measures during CY 2008. 

Specifically, we proposed that the 

physician quality initiative for CY 2008 

be structured and implemented in the 

same manner as the 2007 PQRI with 

regard to the professionals eligible to 

participate in the program, reporting 

quality measures via claims submission, 

and the standards for satisfactory 

reporting. 

The differences between CY 2007 and 

CY 2008 that we currently anticipate are 

noted below in this section. As we 

monitor the implementation of the 2007 

PQRI and possibly make refinements to 

the 2007 program, we anticipate that 

such refinements would also apply 

under the 2008 program. Such 

refinements, should they be needed, 

will be noted with guidance linked from 

the CMS quality reporting Web site at 

http://www.cms.hhs.gov/PQRI. 

As with the 2007 PQRI, we proposed 

that eligible professionals who 

successfully report a designated set of 

quality measures in 2008 may earn a 

bonus payment of a percentage of total 

allowed charges for covered Medicare 

services, subject to a cap based on the 

volume of quality reporting. In contrast 

to 2007, we proposed that eligible 

professionals could report applicable 

measures for services furnished from 

January 1, 2008 through December 31, 

2008, and allowed charges during such 

period would be the basis for 

calculating the bonus payments. We 

proposed that the CY 2008 measures 

that we finalize in this final rule with 

comment period would apply for CY 

2008. We also proposed to estimate all 

of the bonus payments that would be 

payable to physicians using the same 

method as the one used for reporting 

during 2007 and to calculate the amount 

of the bonus payment, after the close of 

CY 2008 reporting period. Given that we 

proposed to use the PAQI Fund for the 

2008 PQRI program, we also proposed 

that the bonus payments to individual 

physicians be subject to an aggregate 

cap of $1.35 billion. Because we 

proposed to scale aggregate payments to 

physicians in a manner such that 

Medicare would pay $1.35 billion 

during CY 2009 for measures reported 

for services furnished during CY 2008, 

we were unable to provide an exact 

percentage for the bonus payment. 

However, we anticipated that the bonus 

payments would be approximately 1.5 

percent of allowed charges for 

participating professionals (and we did 

not expect that the ultimate percentage 

amount would exceed 2 percent). 

Comment: Comments received on the 

proposed rule were generally opposed 

to using the PAQI Fund for CY 2008 

PQRI bonus payments. Almost all 

comments on this issue requested that 

we use the entire $1.35 billion to help 

offset the estimated negative 9.9 percent 

physician update for CY 2008. 

Response: In the CY 2007 PFS 

proposed rule, we acknowledged this 

alternative approach of using the $1.35 

billion in some manner to reduce the 

update to the PFS of negative 9.9 

percent that is projected for CY 2008. 

However, we noted that there are 

fundamental operational problems with 

this approach that make it not feasible. 

The $1.35 billion is a fixed dollar 

amount. Once the amount is reached, 

there is no authority to pay any more 

than that amount. Medicare is an 

entitlement program that covers 

medically necessary services for eligible 

beneficiaries, but such coverage is not 

limited to a fixed dollar amount for a 

year. While we estimate that the $1.35 

billion would reduce the negative 

update by approximately 2 percentage 

points, actual spending could be above 

or below the estimate. To insure that we 

do not exceed the Fund amount, we 

would have to estimate an amount to 

reduce the update by that is low enough 

to ensure the $1.35 billion funding cap 

is not exceeded. While this approach 

might reduce the CY 2008 negative 

update, it could still leave money in the 

Fund. We are concerned that there may 

be potential oversight or other legal 

consequences in the event that we 

significantly exceed the Fund or do not 

apply the entire Fund. Therefore, we 

believe the best use of the Fund is to 

apply it to extend PQRI into CY 2008. 

Comment: Commenters asserted that 

use of the PAQI Fund for anything other 

than the physician update was 

inconsistent with Congressional intent. 

Commenters cited TRHCA language that 

the Fund ‘‘may include application of 

an adjustment to the update of the 

conversion factor.’’ Commenters further 

noted that this use must have been 

Congressional intent, since the 

legislation includes explicit language of 

how to deal with the update in 

subsequent years when the Fund is used 

towards the update: ‘‘[I]n the case that 

expenditures from the Fund are applied 

to, or otherwise affect, a conversion 

factor * * * the conversion factor under 

such subsection shall be computed for 

a subsequent year as if such application 

or effect had never occurred.’’

Many commenters cited the 

Congressional Budget Office’s cost 

estimate for the TRHCA legislation, 

which anticipated CMS developing a 

plan to use approximately 90 percent of 

the Fund in CY 2008 and the remaining 

funds in CY 2009. These comments 

cited section 101(d) of the MIEA–

TRHCA, where the Congress stated that 

the Fund should be used ‘‘to the 

maximum extent feasible’’ for 

physicians’ services during CY 2008, 

interpreting Congressional intent to be 

that CMS do its best to distribute most 

of the money in CY 2008, and any 

remaining monies in CY 2009. 

Commenters rejected the rationale 

that there were serious legal and 

operational barriers to applying the 

PAQI Fund to the physician update; 

they expressed confidence that we 

could find some way to use the Fund to 

offset the reduction. 


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Further, commenters noted that it was 

within our discretion to apply the PAQI 

Fund to the physician update, and they 

were highly critical of our 

unwillingness to take administrative 

steps to mitigate the negative 9.9 

percent physician update. 

Response: Section 101(d) of the 

MIEA–TRHCA directs the Secretary to 

establish a PAQI Fund to be available to 

the Secretary for physician payment and 

quality improvement initiatives, which 

may include application of an 

adjustment to the update of the CF 

under that subsection. The legislation 

clearly indicates that the Secretary has 

the discretion to use the Fund for 

physician payment and quality 

improvement initiatives, including 

application of an adjustment to the 

update of the conversion factor. 

However, we are not required to use the 

funds for the update. 

As noted above, there are 

fundamental operational problems with 

applying the PAQI Fund to the 

conversion factor update. We are 

concerned that there may be potential 

oversight or other legal consequences in 

the event the Agency significantly 

exceeds the Fund or does not apply the 

entire Fund. For the reasons previously 

discussed, we believe it is in the best 

interests of the program to apply this 

Fund to the extension of PQRI. 

Comment: Commenters rejected the 

notion that use of the $1.35 billion to 

fund the CY 2008 PQRI is the best way 

to insure physicians get the greatest 

benefit from the PAQI Fund’s resources. 

Commenters stated that the PQRI does 

not provide all physicians with an 

opportunity to participate and that 

many specialties treat patients with 

conditions for which PQRI measures do 

not apply. In contrast, using the Fund to 

offset the negative update for CY 2008 

would benefit all physicians. 

Response: Medicare payment systems 

need to encourage reliable, high quality 

and efficient care, rather than making 

payment simply based on the quantity 

of services provided and resources 

consumed. Applying the $1.35 billion to 

PQRI bonuses allows CMS to further the 

goal of improving quality and efficiency 

by utilizing the infrastructure that both 

physicians and Medicare have invested 

in for the CY 2007 PQRI. We believe 

implementing this Fund through an 

extension of the PQRI program is the 

best way to ensure that the Fund is 

being used to increase quality and 

efficiency of care for Medicare 

beneficiaries. 

Comment: Commenters rejected the 

notion that using the PAQI Fund for 

bonuses would improve quality. For 

most physicians, the proposed 

estimated 1.5 percent bonus payment is 

insufficient to cover the costs to 

institute such quality reporting 

measures. Commenters noted that if 

CMS truly wished to encourage more 

providers to participate in the PQRI, 

‘‘new money’’ must be found to fund the 

initiative. Commenters suggested 

bonuses between 5 and 10 percent of 

allowed charges would more reasonably 

cover the costs of improving their 

infrastructure to appropriately report 

quality measures. 

Response: Funding the PQRI is 

consistent with the goal of improving 

quality and efficiency in Medicare. 

Eligible professional can participate in 

the PQRI by reporting the appropriate 

quality measure data on claims 

submitted to their Medicare claims 

processing contractor. We provide 

educational resources on the PQRI Web 

site that allow eligible professionals to 

integrate PQRI reporting into their care 

delivery process without significant 

changes in their infrastructures. 

We appreciate the desire of eligible 

professionals to improve their 

infrastructure to better track quality of 

care. For many eligible professionals, 

such infrastructure is already in place 

for PQRI and will not require additional 

investment. However, we note that PQRI 

bonuses are financial incentives to 

participate in a voluntary quality 

reporting program and were not 

intended to cover the costs of 

significantly improving the 

infrastructure of eligible professionals. 

Comment: Many commenters noted 

that the PQRI has not been proven to 

have any positive effect on patient care 

or health outcomes. Rather than 

utilizing the $1.35 billion to support an 

unproven program, it would be better to 

directly improve physician 

reimbursement and better cover the 

costs of the necessary care they are 

currently providing to beneficiaries. 

Response: The PAQI Fund was made 

available to the Secretary for physician 

payment and quality improvement 

initiatives. We are actively engaged with 

the physician community in identifying 

ways to align Medicare’s physician 

payment system with the goals of health 

professionals for high-quality care. 

Using the PAQI Fund to pay for the 

PQRI aligns reimbursement with quality 

and efficiency. We have worked 

collaboratively with the physician 

community to develop measures that 

capture the quality of care being 

provided to our Medicare beneficiaries. 

The PQRI encourages physicians to 

provide the type of care that is best 

suited for our beneficiaries: Care 

focused on prevention and treating 

complications; and care focused on the 

most effective, proven treatments 

available. 

We acknowledge the relative newness 

of the PQRI. To that end, we are 

committed to continue working with the 

physician community in an open and 

transparent way to insure that the PQRI 

supports the best approaches to provide 

high quality health care services. 

Comment: Commenters noted that 

Congressional intent was to provide 

some relief and stability to the 

physician payment system during CY 

2008. However, under the terms of the 

proposed rule, CMS cannot let 

physicians know the amount of the 

reporting bonus until well after the 

close of the CY 2008 reporting period, 

and physicians would not receive 

bonuses until some time in CY 2009. 

Response: Section 101(d) of the 

MIEA–TRHCA charges the Secretary 

with a timely obligation of all available 

funds for services furnished during CY 

2008, directing the Secretary to provide 

for expenditures from the Fund in a 

manner designed to provide (to the 

maximum extent feasible) for the 

obligation of the entire $1.35 billion for 

physicians’ services furnished during 

CY 2008. Although the legislation is 

clear that payment of the Fund is based 

on services furnished during CY 2008, 

the legislation does not limit the 

Secretary to paying from the PAQI Fund 

during CY 2008. 

Comment: One commenter stated that 

quality payments should not be 

geographically adjusted. The commenter 

suggested that PQRI payments should be 

based on RVUs, not allowed charges. 

Response: Section 101(c) of MIEA–

TRHCA authorizes a financial incentive 

for eligible professionals to participate 

in a voluntary quality reporting 

program. Eligible professionals, who 

choose to participate and successfully 

report on a designated set of quality 

measures for services paid under the 

Medicare Physician Fee Schedule and 

provided between July 1 and December 

31, 2007, may earn a bonus payment of 

1.5 percent of their allowed charges 

during that period, subject to a cap. In 

the CY 2008 PFS proposed rule (72 FR 

38206), we proposed that the physician 

quality initiative for CY 2008 be 

structured and implemented in the same 

manner as the 2007 PQRI, as described 

above. This includes calculating the 

amounts of the 2008 bonus payments 

based upon a percentage of allowed 

charges, as was statutorily required for 

2007 bonus payments. By definition, 

allowed charges include the 

geographical adjustments in payments, 

as determined by the geographic 

practice cost indices (GPCIs), which 


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reflect the variation in practice costs 

from area to area. 

III. Revisions to the Payment Policies of 

Ambulance Services Under the Fee 

Schedule for Ambulance Services; 

Ambulatory Inflation Factor Update for 

CY 2007 

As discussed in the CY 2008 PFS 

proposed rule (72 FR 38207), under the 

ambulance fee schedule, the Medicare 

program pays for transportation services 

for Medicare beneficiaries when other 

means of transportation are 

contraindicated. Ambulance services are 

classified into different levels of ground 

(including water) and air ambulance 

services based on the medically 

necessary treatment provided during 

transport. These services include the 

following levels of service: 

For Ground—

• Basic Life Support (BLS). 

• Advanced Life Support, Level 1 

(ALS1). 

• Advanced Life Support, Level 2 

(ALS2). 

• Specialty Care Transport (SCT). 

• Paramedic ALS Intercept (PI). 

For Air—

• Fixed Wing Air Ambulance (FW). 

• Rotary Wing Air Ambulance (RW). 

A. History of Medicare Ambulance 

Services 

1. Statutory Coverage of Ambulance 

Services 

Under sections 1834(l) and 1861(s)(7) 

of the Act, Medicare Part B covers and 

pays for ambulance services, to the 

extent prescribed in regulations, when 

the use of other methods of 

transportation would be contraindicated 

by the beneficiary’s medical condition. 

The House Ways and Means Committee 

and Senate Finance Committee Reports 

that accompanied the 1965 Social 

Security Amendments suggest that the 

Congress intended that—

• The ambulance benefit cover 

transportation services only if other 

means of transportation are 

contraindicated by the beneficiary’s 

medical condition; and 

• Only ambulance service to local 

facilities be covered unless necessary 

services are not available locally, in 

which case, transportation to the nearest 

facility furnishing those services is 

covered (H.R. Rep. No. 213, 89th Cong., 

1st Sess. 37 and Rep. No. 404, 89th 

Cong., 1st Sess. Pt 1, 43 (1965)). 

The reports indicate that 

transportation may also be provided 

from one hospital to another, to the 

beneficiary’s home, or to an extended 

care facility. 

2. Medicare Regulations for Ambulance 

Services 

Our regulations relating to ambulance 

services are set forth at 42 CFR part 410, 

subpart B and 42 CFR part 414, subpart 

H. Section 410.10(i) lists ambulance 

services as one of the covered medical 

and other health services under 

Medicare Part B. Therefore, ambulance 

services are subject to basic conditions 

and limitations set forth at § 410.12 and 

to specific conditions and limitations as 

specified in § 410.40. Part 414, subpart 

H, describes how payment is made for 

ambulance services covered by 

Medicare. 

3. Transition to National Fee Schedule 

The national fee schedule for 

ambulance services was phased in over 

a 5-year transitional period beginning 

April 1, 2002, as specified in § 414.615. 

As of January 1, 2006, the total payment 

amount for air ambulance providers and 

suppliers is based on 100 percent of the 

national ambulance fee schedule. In 

accordance with section 414 of the 

MMA, we added § 414.617 which 

specifies that for ambulance services 

furnished during the period July 1, 

2004, through December 31, 2009, the 

ground ambulance base rate is subject to 

a floor amount, which is determined by 

establishing nine fee schedules based on 

each of the nine census divisions, and 

using the same methodology as was 

used to establish the national fee 

schedule. If the regional fee schedule 

methodology for a given census division 

results in an amount that is lower than 

or equal to the national ground base 

rate, then it is not used, and the national 

fee schedule amount applies for all 

providers and suppliers in the census 

division. If the regional fee schedule 

methodology for a given census division 

results in an amount that is greater than 

the national ground base rate, then the 

fee schedule portion of the base rate for 

that census division is equal to a blend 

of the national rate and the regional rate 

through CY 2009. Thus, as of January 1, 

2007, the total payment amount for 

ground ambulance providers and 

suppliers is based on either 100 percent 

of the national ambulance fee schedule 

amount, or a combination of 80 percent 

of the national ambulance fee schedule 

and 20 percent of the regional 

ambulance fee schedule. 

B. Ambulance Inflation Factor (AIF) 

During the Transition Period 

As we noted in the previous section, 

the national fee schedule for ambulance 

services was phased in over a 5 year 

transition period beginning April 1, 

2002, as specified in § 414.615. During 

the transition period, the ambulance 

inflation factor (AIF) was applied 

separately to both the fee schedule 

portion of the blended payment amount 

(regardless of whether a national or 

regional fee schedule applied) and to 

the supplier’s reasonable charge or 

provider’s reasonable cost portion of the 

blended payment amount, respectively, 

for each ambulance provider or 

supplier. Then, the two amounts were 

added together to determine the total 

payment amount for each provider or 

supplier. 

C. Ambulance Inflation Factor (AIF) for 

CY 2008 

Section 1834(l)(3)(B) of the Act 

provides the basis for updating payment 

amounts for ambulance services. 

Section 414.610(f) specifies that certain 

components of the ambulance fee 

schedule are updated by the AIF 

annually, based on the consumer price 

index for all urban consumers (CPI–U) 

(U.S. city average) for the 12-month 

period ending with June of the previous 

year. In the CY 2008 PFS proposed rule, 

we stated the AIF for CY 2008 would be 

announced as part of this final rule with 

comment period. For CY 2008, the 

percentage is 2.7 percent. In addition, as 

set forth in Section III.D., we also 

proposed to announce the AIF for CY 

2009 and subsequent years via CMS 

instruction and on the CMS Web site. 

D. Revisions to the Publication of the 

Ambulance Fee Schedule (§ 414.620) 

Currently, § 414.620 specifies that 

changes in payment rates resulting from 

incorporation of the AIF will be 

announced by notice in the Federal 

Register without opportunity for prior 

comment. As explained in the CY 2008 

PFS proposed rule, we believe it is 

unnecessary to undertake notice and 

comment rulemaking to update the AIF 

because the statute and regulations 

specify the methods of computation of 

annual inflation updates, and we have 

no discretion in that matter. Thus, the 

annual AIF notice does not change or 

establish policy, but merely applies the 

update methods specified in the statute 

and regulations. 

As discussed in the proposed rule, by 

mid-July of each year, we have the CPI–

U for the 12-month period ending with 

June of such year. Therefore, we know 

what the AIF for the upcoming calendar 

year will be by mid-July of each year. 

However, § 414.620 currently states that 

the AIF will be announced in the 

Federal Register. Each document 

published in the Federal Register 

requires scheduling and a thorough 

review by CMS, HHS, and OMB prior to 

publication. Therefore, even though we 


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know the AIF by mid-July of each year, 

the final rule announcing the AIF is not 

published until November. This 

publication timeframe does not allow 

Medicare contractors the optimal 

amount of time to update their systems 

to implement the proper payment for 

Medicare ambulance claims by January 

1 of the coming year. In addition, it does 

not provide an optimal amount of time 

for either the Medicare contractors or 

the ambulance industry to take 

advantage of testing systems to make 

sure that the update is working properly 

as implemented. We believe that 

announcing the AIF via CMS 

instructions and on the CMS Web site 

would enable the AIF to be released 

earlier in the calendar year, allowing the 

Medicare contractors to test their data 

systems, and to timely effectuate and 

provide accurate payments on Medicare 

ambulance claims. 

Therefore, we proposed to revise 

§ 414.620 to state that we will announce 

the AIF via CMS instruction and on the 

CMS Web site and to remove the 

language that states that we will 

announce the AIF by notice in the 

Federal Register. 

Comment: Comments received 

regarding the issue of announcing the 

AIF via CMS instruction and on the 

CMS Web site were very supportive of 

this proposal. 

Response: As we proposed, we are 

revising § 414.620 to state that CMS will 

announce the AIF via CMS instruction 

and on the CMS Web site, and to 

remove the language that states that we 

will announce the AIF by notice in the 

Federal Register. 

IV. Refinement of RVUs for CY 2008 

and Response to Public Comments on 

Interim RVUs for 2007 

[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 IV.B. and IV.C. of this final 

rule with comment describes the 

methodology used to review the 

comments received on the RVUs for 

physician work, including the 

additional codes from the 5-Year 

Review of work RVUs, and the process 

used to establish RVUs for new and 

revised CPT codes. Changes to the RVUs 

and billing status codes reflected in 

Addendum B are effective for services 

furnished beginning January 1, 2008. 

B. Process for Establishing Work 

Relative Value Units for the Physician 

Fee Schedule 

The CY 2007 PFS final rule with 

comment period (71 FR 69624) 

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, 2007. We considered the 

RVUs for the interim codes to be subject 

to public comment under the annual 

refinement process. In the CY 2008 PFS 

proposed rule we also proposed work 

RVUs for additional codes from the 5- 

Year Review of work RVUs. In this 

section, we address comments and 

summarize the refinements to the 

additional codes from the 5-Year 

Review of work RVUs, the interim work 

RVUs published in the CY 2007 PFS 

final rule with comment period, and our 

establishment of the work RVUs for new 

and revised codes for the CY 2008 PFS. 

C. 5-Year Review of Work RVUS 

1. Additional Codes From the 5-Year 

Review of Work RVUs 

The CY 2008 PFS proposed rule (72 

FR 38146) discussed the RUC 

recommendations on work RVUs for a 

number of codes from the 5-Year 

Review that were deferred from the CY 

2007 PFS rulemaking and listed the 

specific codes in Table 10. We proposed 

to accept all of the RUC 

recommendations, with the exception of 

CPT code 93325, Doppler 

echocardiography color flow velocity 

mapping (List separately in addition to 

codes for echocardiography), which we 

proposed to bundle. We also noted that 

CPT codes 92557, 92567, 92568, 92569, 

92579, 92601, 92602, 92603 and 92604 

previously had no work RVUs assigned 

to them. 

Many commenters expressed support 

for our proposed valuations of many of 

the services. However, other 

commenters expressed specific concern 

or disagreement with the proposed 

valuation of approximately 17 codes. 

To evaluate these comments, we used 

a process similar to the process used 

since 1997. (See the CY 1998 PFS final 

rule published in the October 31, 1997 

Federal Register (62 FR 59084) for the 

discussion of refinement of CPT codes 

with interim work RVUs.) We convened 

a multi specialty 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 14: Work RVU 

Revisions for Additional 5-Year Review 

Codes. 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: 

• Clinicians representing the 

commenting specialty(ies), based on our 

determination of those specialties which 

are most identified with the services in 

question. Although commenting 

specialties were welcomed to observe 

the entire refinement process, they were 

only involved in the discussion of those 

services for which they were invited to 

participate. 

• Primary care clinicians nominated 

by the AAFP and the American College 

of Physicians. 

• Carrier Medical Directors. 

• Clinicians who practice in related 

specialties and have knowledge of the 

services 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 reference services 

and asked the panel members to 

compare the clinical aspects of the work 

for the service a commenter believed 

was incorrectly valued to one or more 

of the reference services. In compiling 

the reference set, we attempted to 

include: (1) Services that are commonly 

furnished for which work RVUs are not 

controversial; (2) services that span the 

entire spectrum of work intensity from 

the easiest to the most difficult; and (3) 

at least three services furnished 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 for each service, each 

participant rated the work for that 

procedure. Ratings were individual and 

confidential; 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 that 

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 general 

terms, we used statistical tests to 

determine whether there was enough 

agreement among the groups on the 

panel and, if so, whether the agreedupon work RVUs were significantly 

different from the proposed work RVUs 


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in the CY 2008 PFS proposed rule to 

demonstrate that the proposed work 

RVUs should be modified. We did not 

modify the work 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 work RVUs should be, we 

eliminated the outlier group, and looked 

for agreement among the remaining 

groups as to the basis for new work 

RVUs. We used the same methodology 

in analyzing the ratings that we first 

used in the refinement process for the 

CY 1993 PFS final rule published in the 

November 25, 1992 Federal Register 

which described the statistical tests in 

detail (57 FR 55938). Our decision to 

convene a multi-specialty panel of 

physicians and to apply the statistical 

tests described above in this section 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 14 lists the additional codes for 

the 5-Year Review on which we 

received comments. This table includes 

the following information: 

• CPT/HCPCS Code. This is the CPT 

or alphanumeric HCPCS code for a 

service. 

• Modifier. A modifier 26 is shown if 

the work RVUs represent the 

professional component (PC) of the 

service. 

• Description. This is an abbreviated 

version of the narrative description of 

the code. 

• Proposed Work RVUs. This column 

includes the work RVUs proposed in the 

CY 2008 PFS proposed rule for each 

reviewed code. 

• Requested Work RVUs. This 

column identifies the work RVUs 

requested by the commenters. If the 

commenters requested different RVUs, 

the table lists the highest requested 

RVUs. 

• RUC Recommendation. This 

column identifies the work RVUs 

recommended by the RUC that appeared 

in the CY 2008 PFS proposed rule. 

• 2008 Work RVUs. This column 

contains the work RVUs for the CY 2008 

PFS. 

• Basis for Decision. This column 

indicates whether the CY 2008 work 

RVUs resulted from comments received 

or the refinement panel process. 

TABLE 14.—WORK RVU REVISIONS FOR ADDITIONAL 5-YEAR REVIEW CODES

CPT/HCPCS 

code 1 Mod Descriptor Proposed work 

RVU 

Work RVUs 

requested by 

commenters 

RUC rec 2008 work 

RVU 

Basis for decision 

92557 .......... .................... Comprehensive hearing test 0.60 1.40 0.60 0.60 Refinement. 

92579 .......... .................... Visual audiometry (vra) ........ 0.70 1.70 0.70 0.70 Refinement. 

99326 .......... .................... Domicil/r-home visit new pat 2.27 2.85 2.27 2.63 Refinement. 

99327 .......... .................... Domicil/r-home visit new pat 3.03 3.75 3.03 3.46 Refinement. 

99328 .......... .................... Domicil/r-home visit new pat 3.78 4.26 3.78 4.09 Refinement. 

99334 .......... .................... Domicil/r-home visit est pat .. 0.76 1.25 0.76 1.07 Refinement. 

99335 .......... .................... Domicil/r-home visit est pat .. 1.26 2.00 1.26 1.72 Refinement. 

99336 .......... .................... Domicil/r-home visit est pat .. 2.02 2.75 2.02 2.46 Refinement. 

99337 .......... .................... Domicil/r-home visit est pat .. 3.03 4.05 3.03 3.58 Refinement. 

99343 .......... .................... Home visit, new patient ........ 2.27 2.65 2.27 2.53 Refinement. 

99344 .......... .................... Home visit, new patient ........ 3.03 3.60 3.03 3.38 Refinement. 

99345 .......... .................... Home visit, new patient ........ 3.78 4.26 3.78 4.09 Refinement. 

99347 .......... .................... Home visit, est patient .......... 0.76 1.10 0.76 1.00 Refinement. 

99348 .......... .................... Home visit, est patient .......... 1.26 1.70 1.26 1.56 Refinement. 

99349 .......... .................... Home visit, est patient .......... 2.02 2.50 2.02 2.33 Refinement. 

99350 .......... .................... Home visit, est patient .......... 3.03 3.45 3.03 3.28 Refinement. 

93325 .......... .................... Doppler color flow add-on .... 0.07 0.30 CPT 0.07 Comments. 

1All CPT codes and descriptors copyright 2007 American Medical Association. 

Discussion of Comments by Clinical 

Area 

For CPT code 92557, Comprehensive 

audiometry threshold evaluation and 

speech recognition, and CPT code 

92579, Visual reinforcement audiometry 

(VRA), the RUC recommended 0.60 

work RVUs for CPT 92557 and 0.70 

work RVUs for CPT code 92579, which 

we accepted. 

Comment: Commenters disagreed 

with the RUC-recommended work 

values for these services, which we had 

accepted. The commenters believed that 

the recommended values were not 

appropriate considering the time and 

intensity involved in performing 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 2007 multi-specialty 

validation panel ratings, we have 

assigned 0.60 work RVUs to CPT code 

92557 and 0.70 work RVUs to CPT code 

92579. 

For CPT code 99326, Domiciliary or 

rest home visit for the evaluation and 

management of a new patient, which 

requires these three key components: A 

detailed history; a detailed examination; 

and medical decision making of 

moderate complexity; CPT code 99327, 

Domiciliary or rest home visit for the 

evaluation and management of a new 

patient, which requires these three key 

components: A comprehensive history; 

a comprehensive examination; and 

medical decision making of moderate 

complexity; CPT code 99328, 

Domiciliary or rest home visit for the 

evaluation and management of a new 

patient, which requires these three key 

components: A comprehensive history; 

a comprehensive examination; and 

medical decision making of high 

complexity; CPT code 99334, 

Domiciliary or rest home visit for the 

evaluation and management of an 

established patient, which requires at 

least two of these three key components: 

A problem focused interval history; a 

problem focused examination; 

straightforward medical decision 

making; CPT code 99335, Domiciliary or 

rest home visit for the evaluation and 

management of an established patient, 

which requires at least two of these 

three key components: An expanded 

problem focused interval history; an 

expanded problem focused 

examination; medical decision making 

of low complexity; CPT code 99336, 

Domiciliary or rest home visit for the 

evaluation and management of an 

established patient, which requires at 

least two of these three key components: 


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A detailed interval history; a detailed 

examination; medical decision making 

of moderate complexity; CPT code 

99337, Domiciliary or rest home visit for 

the evaluation and management of an 

established patient, which requires at 

least two of these three key components: 

A comprehensive interval history; a 

comprehensive examination; and 

medical decision making of moderate to 

high complexity; CPT code 99343, Home 

visit for the evaluation and management 

of a new patient, which requires these 

three key components: A detailed 

history; a detailed examination; and 

medical decision making of moderate 

complexity; CPT code 99344, Home visit 

for the evaluation and management of 

a new patient, which requires these 

three components: A comprehensive 

history; a comprehensive examination; 

and a medical decision making of 

moderate complexity; CPT code 99345, 

Home visit for the evaluation and 

management of a new patient, which 

requires these three key components: A 

comprehensive history; a 

comprehensive examination; and 

medical decision making of high 

complexity; CPT code 99347, Home visit 

for the evaluation and management of 

an established patient, which requires at 

least two of these three key components: 

A problem focused interval history; a 

problem focused examination; 

straightforward medical decision 

making; CPT code 99348, Home visit for 

the evaluation and management of an 

established patient, which requires at 

least two of these three key components: 

A problem focused interval history; a 

problem focused examination; 

straightforward medical decision 

making; CPT code 99349, Home visit for 

the evaluation and management of an 

established patient, which requires at 

least two of these three key components: 

A detailed interval history; a detailed 

examination; medical decision making 

of moderate complexity; and CPT code 

99350, Home visit for the evaluation 

and management of an established 

patient, which requires at least tow of 

these three key components: A 

comprehensive interval history; a 

comprehensive examination; medical 

decision making of moderate to high 

complexity, the RUC recommended that 

the work RVUs for these codes be 

maintained at their current values: 2.27 

work RVUs for CPT code 99326; 3.03 

work RVUs for CPT code 99327; 3.78 

work RVUs for CPT code 99328; 0.76 

work RVUs for CPT code 99334; 1.26 

work RVUs for CPT code 99335; 2.02 

work RVUs for CPT code 99336; 3.03 

work RVUs for CPT code 99337; 2.27 

work RVUs for CPT code 99343; 3.03 for 

CPT code 99344; 3.78 work RVUs for 

CPT code 99345; 0.76 work RVUs for 

CPT code 99347; 1.26 work RVUs for 

CPT code 99348; 2.02 work RVUs for 

CPT code 99349; and 3.03 work RVUs 

for CPT code 99350, which we accepted. 

Comment: Commenters disagreed 

with the RUC-recommended work 

values for these services, which we had 

accepted. The commenters disagreed 

with the RUC-recommended work RVUs 

and believed the services were 

undervalued. The commenters also 

believed that the home visit work RVUs 

should remain ‘‘relatively’’ the same 

with respect to office visit codes as they 

did prior to the five-year review and 

requested that CMS reject the RUC 

recommended work RVUs and follow 

their survey values. Based on these 

comments, we referred these codes to 

the multi-specialty validation panel for 

review. 

Response: As a result of the statistical 

analysis of the 2007 multi-specialty 

validation panel ratings, we have 

assigned 2.63 work RVUs to CPT code 

99326; 3.46 work RVUs to CPT code 

99327; 4.09 work RVUs to CPT code 

99328; 1.07 work RVUs to CPT code 

99334; 1.72 work RVUs to CPT code 

99335; 2.46 work RVUs to CPT code 

99336; 3.58 work RVUs to CPT code 

99337; 2.53 work RVUs to CPT code 

99343; 3.38 work RVUs to CPT code 

99344; 4.09 work RVUs to CPT code 

99345; 1.00 work RVUs to CPT code 

99347; 1.56 work RVUs to CPT code 

99348; 2.33 work RVUs to CPT code 

99349; and 3.28 work RVUs to CPT code 

99350. 

For CPT code 93325, Doppler 

echocardiography color flow velocity 

mapping (List separately in addition to 

codes for echocardiography), the RUC 5- 

Year Review workgroup recommended 

sending the code to the CPT Editorial 

Panel so that it could bundle CPT code 

93325 into doppler echo code 93307. 

However, we believe that the technology 

of doppler imaging has evolved over the 

past 2 decades to enable color flow 

velocity and spectral analysis, both 

important components of doppler 

imaging, to be furnished concurrently or 

in concert to obtain more accurate 

interpretation and documentation of the 

anatomy and physiologic function of the 

structure(s) and organ being evaluated. 

Since the services described in 93325 

have become intrinsic to the 

performance of other echocardiography 

services, we proposed to bundle 93325 

into CPT codes 76825, 76826, 76827, 

76828, 93303, 93304, 93307, 93308, 

93312, 93314, 93315, 93317, 93320, 

93321, 93350 and assign CPT code 

93325 a status indicator of ‘‘B’’

(Bundled). 

Comment: Commenters uniformly 

opposed this proposal. They did not 

support the bundling of CPT codes 

93325 into all of the codes we proposed. 

The commenters would prefer for CMS 

to adopt the new CPT code and not 

bundle CPT code 93325 with any other 

codes with CPT code 93325. The 

commenters believed we are 

circumventing the existing process to 

address bundling of these services and 

we should follow that process. 

Alternatively, the commenters believed 

that if we must bundle the codes, then 

we should increase the RVUs for the 

codes in which CPT code 93325 is being 

bundled to recognize the work, PE, and 

malpractice components that are unique 

to CPT code 93325. 

Response: Based on comments 

received, we have decided to accept the 

RUC recommendation and allow the 

RUC to value the new CPT code for CY 

2009 for bundling CPT code 93325 with 

CPT codes 93320 and 93307. As a result 

of this decision, the work RVUs for CPT 

code 93325 will be maintained for CY 

2008 at the 2007 work value of 0.07. The 

cardiology community has indicated to 

the RUC and CMS that the newly 

bundled CPT code represents the first of 

a series of coding changes they intend 

to propose over the course of the next 

year. These changes would result in the 

bundling of CPT code 93325 and other 

echocardiography codes to reflect the 

utilization of ultrasound services that 

are routinely performed together when 

providing care to a patient. We 

appreciate the initiative the cardiology 

community is taking on this issue, and 

we will reassess the echocardiography 

codes once this process is complete. 

2. Anesthesia Coding (Part of 5-Year 

Review) 

Although anesthesia services are paid 

under the PFS, under section 

1848(b)(2)(B) of the Act, they are paid 

on the basis of an anesthesia code 

specific base unit and time units that 

vary based on the actual anesthesia time 

of the case. Since anesthesia services do 

not have a work RVU per code as do 

other medical and surgical services, a 

work value must be imputed for each 

anesthesia code. The imputed value is 

determined by multiplying the national 

average allowed charge for each 

anesthesia service by its anesthesia 

work share and dividing this amount by 

the general PFS conversion factor (CF). 

This places the work of the anesthesia 

service on the same relative value scale 

as all other physicians’ services. 

As discussed in the CY 2008 PFS 

proposed rule, in the second 5-Year 

Review of anesthesia work implemented 

in 2002, the AMA RUC and the 


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American Society of Anesthesiologists 

(ASA) used a building block approach 

to estimate the value of anesthesia work 

and compared this value to the imputed 

work value to determine whether the 

work of anesthesia services is properly 

valued. Under the building block 

approach, each anesthesia code was 

uniformly divided into five 

components; pre anesthesia, equipment 

and supply preparation, induction, post 

induction anesthesia, and post 

anesthesia. Work is determined for each 

of the five components and summed to 

calculate total anesthesia work for the 

anesthesia code. The imputed value for 

the anesthesia code is compared to the 

building block estimate of work in order 

to assess whether, and if so, to what 

extent, the anesthesia code is not 

properly valued. 

The most significant component of 

work for the anesthesia service is the 

intensity for the post-induction 

anesthesia time. The ASA thought that 

the RUC significantly misvalued this 

component in the second 5-Year 

Review. In addition, the ASA was 

dissatisfied that the RUC did not extend 

the analysis from the 19 high volume 

anesthesia codes reviewed by the RUC 

to all anesthesia codes. 

In the CY 2007 PFS final rule with 

comment period, we addressed the issue 

of the work of anesthesia services under 

the third 5-Year Review of work. As 

explained in that rule, we made very 

modest adjustments to the work of the 

19 anesthesia codes surveyed and 

analyzed by the RUC in the second 5- 

Year Review of work. These adjustments 

were made recognizing that the work of 

the pre- and post-anesthesia service 

components was linked to certain E/M 

services. Since we accepted the AMA 

RUC’s recommendations for increased 

work values for certain E/M codes for 

the third 5-Year Review of work, we 

recalculated the work of the 19 

anesthesia services to incorporate these 

higher work values. The adjustment in 

work was reflected by increasing the 

anesthesia CF by less than 1 percent. 

However, on the more significant 

issue of the valuation of work in the 

post induction anesthesia period, we 

took no action. Rather, in the CY 2007 

PFS final rule with comment period, we 

asked the RUC to review and consider 

this issue as part of the third 5-Year 

Review of work. We also asked the RUC 

to consider how increases in the work 

of pre- and post-anesthesia services 

could cause adjustments to the 

anesthesia services not specifically 

reviewed by the ASA and the RUC. 

In January 2007, the ASA requested 

the AMA RUC to review the 

undervaluation of the work of the postinduction anesthesia period and to 

consider also an analytic approach, 

based on linear regression analysis, 

which could be used to evaluate the 

work of the entire anesthesia service. 

The linear regression model relates the 

work of the post-induction period time 

and the work of the entire anesthesia 

service to the base unit value for the 

anesthesia code. Under this model, the 

work of anesthesia services is 

undervalued by approximately 34 

percent. 

The RUC established an anesthesia 

workgroup to examine this proposal. 

The workgroup discussed this proposal 

extensively at its two teleconferences, 

prior to the April RUC meeting, and at 

the April RUC meeting itself. In May 

2007, the AMA RUC, based on the 

analyses and recommendations of its 

workgroup, submitted a 

recommendation to CMS for a 32 

percent increase in the work of 

anesthesia services. 

The workgroup approved the ASA’s 

use of the linear regression model to 

value only the work of the postinduction period time. In contrast to the 

ASA proposal, the workgroup 

considered an analytic approach 

different from the regression model 

developed by the ASA. This approach is 

based on a building block approach that 

could be used to evaluate the work of 

all anesthesia service components other 

than the post induction period time. For 

example, for pre-anesthesia time, the 

methodology is as shown in Table 15. 

TABLE 15.—PRE-ANESTHESIA TIME

All Anesthesia codes with 3 base units—

linked to the work of 99201. 

All Anesthesia codes with 4 base units—

linked to the blend of work for 99201 and 

99202. 

All Anesthesia codes with 5 to 15 base 

units—linked to the work of 99202. 

All Anesthesia codes with 16 to 30 base 

units—linked to the work of 99252. 

Note: The source of the link for work is the 

pre anesthesia valuation from the 19 surveyed 

anesthesia codes whose base units varied 

from 3 units to 25 units. 

Similar approaches are used for each 

anesthesia component: Preparation 

time, induction period time, and postanesthesia time. Systematically, codes 

with lower anesthesia base unit values 

have lower work values for each 

component of the building block 

approach than do codes with higher 

anesthesia base unit values. For the 

given building block component, the 

work value of that component is the 

same for all anesthesia services that 

have the same base unit value. 

According to the workgroup’s revised 

methodology which is extended from 

the 19 surveyed codes to all CPT 

anesthesia codes, the work of anesthesia 

services is undervalued by 

approximately 32 percent. Thus, based 

on the acceptance of the workgroup and 

the RUC’s recommendation, an 

adjustment of approximately 25 percent 

would be applied to the anesthesia CF. 

Increases in the work of anesthesia 

services would have to be offset by 

additional adjustments to the PFS BN 

adjustor for work. We estimated that the 

increase in the anesthesia CF would 

result in an additional 1.0 percent 

increase in the BN adjuster for work. 

Other adjustments also affect the 

anesthesia CF. For example, an increase 

in anesthesia work may have 

implications for PE because indirect PEs 

are allocated based on the sum of work 

and direct PEs. When we ran the PE 

RVU program, there was a 1 percent 

decrease in the aggregate anesthesia PEs 

for CY 2008. Thus, an adjustment was 

made to the PE share of the anesthesia 

service of the CY 2008 anesthesia CF for 

this component. 

We proposed to accept the RUC’s 

recommendation and increase the work 

of anesthesia services by 32 percent. 

Comment: Organizations and 

individual commenters supported our 

proposal and urged us to take action to 

implement this proposal in CY 2008. 

They commented that this proposal 

improves the valuation of the work of 

anesthesia services and will help ensure 

that Medicare beneficiaries have access 

to quality anesthesia care. One 

commenter indicated that three 

additional anesthesia codes, 00142, 

00210 and 00562, have been identified 

as misvalued during the AMA RUC’s 

evaluation of the work of anesthesia 

services. Both CMS and the AMA RUC 

agreed that the RUC would review the 

base units for 00142 at the September 

2007 RUC meeting and that the other 

codes, as agreed by the ASA, would be 

referred to the CPT so that the codes 

descriptors could be clarified. The RUC 

reviewed and approved the ASA’s 

request to support the current base unit 

value of four units for anesthesia code 

00142. 

Response: We have decided to accept 

the RUC’s recommendation and increase 

the work of anesthesia services by 32 

percent. We have also accepted the 

RUC’s recommendation to maintain the 

value of four base units for anesthesia 

code 00142. 

3. Budget Neutrality Adjustment 

Due to the proposed work RVU 

changes for the additional codes from 

the 5-Year Review of Work RVUs and 


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the proposed increases in the work of 

anesthesia services, in the CY 2008 PFS 

proposed rule, we proposed to revise 

the work adjustor to maintain budget 

neutrality. Based upon the increases, the 

proposed revised work adjustor was 

estimated to be 0.8816. Further 

discussion of this work adjustor was 

included in the impact section of the CY 

2008 PFS proposed rule (72 FR 38211 

through 38220). 

Comment: Several commenters 

recommended that we reconsider 

applying the BN adjustment associated 

with the 5-Year Review of work RVUs 

to the CF rather than the work RVUs. 

Response: We appreciate the 

commenters’ interest in this topic. 

However, this issue was fully addressed 

in the CY 2007 PFS final rule with 

comment period (71 FR 69735), and we 

made no further proposals regarding 

this issue in the CY 2008 PFS proposed 

rule. We continue to believe that it is 

most appropriate to apply the BN 

adjustment to work RVUs and refer the 

commenters to the CY 2007 PFS final 

rule for an explanation of our decision. 

We note that as a result of the changes 

made in response to comments received 

and the work of the refinement panel, 

the separate work adjustor has changed 

from the proposed 0.8816. The separate 

work adjustor for CY 2008 will be 

0.8806. 

D. Work Relative Value Unit 

Refinements of Interim Relative Value 

Units 

1. Interim 2007 Codes 

Although the RVUs in the CY 2007 

PFS final rule with comment period 

were used to calculate 2007 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 comments on the 

following CPT codes. 

Anticoagulation Management Codes 

The CPT Editorial Panel created two 

anticoagulation management codes in 

February 2006: CPT code 99363, 

Anticoagulant management for an 

outpatient taking warfarin, physician 

review and interpretation of 

International Normalized Ratio (INR) 

testing, patient instructions, dosage 

adjustment (as needed), and ordering of 

additional tests; initial 90 days of 

therapy (must include a minimum of 8 

INR measurements), and CPT code 

99364, Anticoagulant management for 

an outpatient taking warfarin, physician 

review and interpretation of 

International Normalized Ratio (INR) 

testing, patient instructions, dosage 

adjustment (as needed), and ordering of 

additional tests; each subsequent 90 

days of therapy (must include a 

minimum of 3 INR measurements). The 

RUC reviewed the codes and 

recommended 1.65 work RVUs for code 

99363 and 0.63 work RVUs for 99364. 

In the CY 2007 PFS final rule with 

comment period, we decided not to 

accept the RUC recommendation and 

decided that the services provided by 

99363 and 99364 are bundled into 

existing E/M services. Hence, there is no 

separate payment under the PFS. 

Currently clinicians managing 

anticoagulation therapy may bill, if 

appropriate, the CPT code that best 

represents the level of outpatient E/M 

service provided on that day, including 

CPT code 99211. 

Comment: We received comments 

from commenters who strongly disagree 

with our decision to continue to 

consider anticoagulation management 

codes to be bundled into the work of E/ 

M codes and noted that these CPT codes 

recognize the important work of 

managing serious disease. The 

commenters also requested that we not 

finalize our decision to consider these 

services bundled but instead change 

their status to separately payable, 

covered services. 

Response: We generally do not pay 

separately for disease-specific 

management services. We believe the 

services represented by CPT codes 

99363 and 99364 are inherent in the 

services captured by the existing E/M 

codes. We will continue to recognize 

codes 99363 and 99364 as bundled 

services and continue to pay for E/M 

services as appropriate. 

Medical Genetics and Genetic 

Counseling 

CPT code 96040, Medical genetics 

and genetic counseling services, each 30 

minutes face-to-face with patient/ 

family, was reviewed in the CY 2007 

PFS final rule with comment period and 

assigned status B (bundled service). 

Comment: Commenters disagree with 

the assigned status indicator of B 

(bundled service) for this service and 

urge CMS to reconsider its decision to 

make this a bundled service because 

they believe it is a separate and distinct 

procedure. 

Response: The procedure does not 

contain any physician work and is a 

code that is designed to capture clinical 

labor time and PE. To the extent that 

this service is covered, we believe this 

service like other counseling services, is 

incorporated into existing E/M services, 

and therefore, will maintain the status 

assignment of B. 

Home Ventilator Management 

For CPT code 94005, Home ventilator 

management care plan oversight of a 

patient (patient not present) in home, 

domiciliary or rest home (eg, assisted 

living) requiring review of status, review 

of laboratories and other studies and 

revision of orders and respiratory care 

plan (as appropriate), within a calendar 

month, 30 minutes or more, the RUC 

recommended 1.50 work RVUs. We 

assigned a status indicator of B (bundled 

service) to this service in the CY 2007 

PFS final rule with comment period 

because: (1) The patient is not present 

when this service is rendered; and (2) 

we believe this service is captured in E/ 

M services. 

Comment: Commenters believe this 

service should not be bundled and 

recommend that this code be separately 

payable. 

Response: We continue to believe this 

service should be assigned a status 

indicator of B (Bundled) for the reasons 

previously stated in the CY 2007 PFS 

final rule with comment period: (1) The 

patient is not present when the service 

is rendered; and (2) we believe this 

service is captured in the E/M services. 

(Note: The RUC-recommended RVUs for 

this code will be reflected in Addendum 

B.) 

In the CY 2007 PFS final rule with 

comment period (70 FR 66370), we also 

responded to the RUC recommendations 

on the PE inputs for the new and 

revised CPT codes for 2007. In addition 

to PE comments discussed in section 

II.A.2. of this final rule with comment 

period, concerning PE inputs: 

Comment: One commenter, 

representing a network of providers, 

requested that the PE inputs for CPT 

codes 35475 and 35476 be reviewed. 

These codes are used as the basis for the 

PE inputs for HCPCS codes G0392 and 

G0393 that were included in Addendum 

C. The commenter believes that the PE 

inputs have changed since the service 

was reviewed in 2004. The commenters 

also believed that items were missing 

from the PE database and included a list 

of these items. 

Response: We suggest that the 

commenter work with the specialty 

group to determine if the PE inputs for 

CPT codes 35475 and 35476 should be 

reviewed by the RUC PE subcommittee. 

We have also reviewed the PE database 

regarding the missing PE items noted by 

the commenter and have verified that all 

PE inputs from CPT 35475 and 35476 

have been crosswalked to G0392 and 

G0393, respectively. 

Comment: One commenter, 

representing the specialty of 

dermatology, requested that the Unna 


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boot be removed from the PE database 

as a supply item and be assigned a 

HCPCS Q code so that it could be billed 

separately. 

Response: This issue was specifically 

addressed in the CY 2007 PFS final rule 

with comment period (71 FR 69644 

through 69645). We clarified that the 

policy we finalized relating to splint 

and cast supplies did not change the 

HCPCS Q-code descriptors or their 

pairing with certain CPT codes for 

payment purposes. 

Comment: One commenter, 

representing the ophthalmology 

association, disagreed with our 

assessment that the specific topography 

equipment priced at $44,000 is not 

typically used with CPT code 92025, 

Computerized corneal topography, 

unilateral or bilateral, with 

interpretation and report, and 

questioned our substitution of the 

topography equipment priced at 

$13,495. The commenter pointed out 

that the $44,000 topography equipment 

is the only equipment that will provide 

the services of this procedure. 

Response: We have reviewed the 

request from the commenter and agree 

that the $13,495 topography unit we 

assigned for CY 2007 should be replaced 

with the $44,000 equipment that is 

specifically designed for the procedure 

inherent to CPT code 92025. 

Comment: One commenter, 

representing therapeutic radiology, 

requested that for CPT code 77371, 

Radiation treatment delivery, 

stereotactic radiosurgery (SRS), 

complete course of treatment of cerebral 

lesion(s) consisting of 1 session; multisource Cobalt 60 based, we treat the 

radiation source (Cobalt 60), as a direct 

PE rather than an indirect one. Since 

Cobalt 60 is: (1) Purchased by the 

physician; (2) exceeds the $500 

threshold (price is $15,000); and, (3) is 

clearly attributable to the procedure; it 

meets the established criteria for 

treatment as a direct expense. The 

commenter indicated that this radiation 

source must be replaced monthly, 

requiring a useful life assignment of 

0.08 years. 

Response: Based on this comment, we 

have re-examined our assignment of the 

Cobalt 60 radiation source used in CPT 

code 77371 as indirect PE. While the 

radiation source may meet some of the 

criteria to be considered as a direct PE 

input for equipment (for example, that 

it is an expense to the physician and its 

price is above the $500 threshold), the 

commenter did not present information 

that is needed to verify the 1-month 

useful life that was requested. We lack 

the required evidence needed to 

determine the amount of viable 

radiation contained in the $15,000 

source that is consumed through the 

provision of the radiation treatments 

versus the amount that was not utilized 

but could have been used, during the 1- 

month time period. This unused amount 

would be considered a wasted resource 

and cannot be accounted for as a direct 

PE input. Consequently, we will not 

include the Cobalt-60 radiation source 

as a direct PE input as the commenter 

requested. 

E. 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 2008 

(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 2008 CPT Codes’’) 

One aspect of establishing RVUs for 

2008 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 CY 1997 PFS 

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 169 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 received approximately 7 

recommendations from the Health Care 

Professional Advisory Committee 

(HCPAC). 

Table 16: AMA RUC and HCPAC 

Recommendations and CMS Decisions 

for New and Revised 2008 CPT Codes 

lists the new or revised CPT codes, and 

their associated work RVUs, that will be 

interim in 2008. Table 16 includes the 

following information: 

• A ‘‘#’’ identifies a new code for CY 

2008. 

• CPT code. This is the CPT code for 

a service. 

• Modifier. A ‘‘26’’ in this column 

indicates that the work RVUs are for the 

PC 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. 

• 2008 Work RVUs. This column 

establishes the interim 2008 work RVUs 

for physician work. 

TABLE 16.—AMA RUC AND HCPAC RECOMMENDATIONS AND CMS’ DECISIONS FOR NEW AND REVISED 2008 CPT 

CODES

CPT 1 code Mod Descriptor RUC 

recommendation 

HCPAC 

recommendation 

CMS 

decision 2008 work RVU 

# 20555 .... ............. PLACE NDL MUSC/TIS FOR RT ..................... 6.00 ...................... ...................... Agree ............ 6.00 

20660 ........ ............. APPLY, REM FIXATION DEVICE .................... 4.00 ...................... ...................... Agree ............ 4.00 

20690 ........ ............. APPLY BONE FIXATION DEVICE ................... 8.65 ...................... ...................... Agree ............ 8.65 

20692 ........ ............. APPLY BONE FIXATION DEVICE ................... 16.00 .................... ...................... Agree ............ 16.00 

# 20985 * .. ............. CPTR–ASST DIR MS PX ................................. 2.50 ...................... ...................... Agree ............ 2.50 


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TABLE 16.—AMA RUC AND HCPAC RECOMMENDATIONS AND CMS’ DECISIONS FOR NEW AND REVISED 2008 CPT 

CODES—Continued 

CPT 1 code Mod Descriptor RUC 

recommendation 

HCPAC 

recommendation 

CMS 

decision 2008 work RVU 

# 20986 * .. ............. CPTR–ASST DIR MS PX IO IMG .................... Carrier Priced ...... ...................... Agree ............ Carrier Priced. 

# 20987 * .. ............. CPTR–ASST DIR MS PX PRE IMG ................ Carrier Priced ...... ...................... Agree ............ Carrier Priced. 

# 21073 .... ............. MNPJ OF TMJ W/ANESTH .............................. 3.33 ...................... ...................... Agree ............ 3.33 

# 22206 .... ............. CUT SPINE 3 COL, THOR .............................. 37.00 .................... ...................... Agree ............ 37.00 

# 22207 .... ............. CUT SPINE 3 COL, LUMB ............................... 36.50 .................... ...................... Agree ............ 36.50 

# 22208 .... ............. CUT SPINE 3 COL, ADDL SEG ...................... 9.66 ...................... ...................... Agree ............ 9.66 

23515 ........ ............. TREAT CLAVICLE FRACTURE ....................... 11.00 .................... ...................... Disagree ....... 9.53 

23585 ........ ............. TREAT SCAPULA FRACTURE ....................... 16.25 .................... ...................... Disagree ....... 14.07 

23615 ........ ............. TREAT HUMERUS FRACTURE ...................... 14.00 .................... ...................... Disagree ....... 12.12 

23616 ........ ............. TREAT HUMERUS FRACTURE ...................... 21.00 .................... ...................... Disagree ....... 18.19 

23630 ........ ............. TREAT HUMERUS FRACTURE ...................... 12.00 .................... ...................... Disagree ....... 10.39 

23670 ........ ............. TREAT DISLOCATION/FRACTURE ................ 14.00 .................... ...................... Disagree ....... 12.12 

23680 ........ ............. TREAT DISLOCATION/FRACTURE ................ 15.00 .................... ...................... Disagree ....... 12.99 

# 24357 .... ............. REPAIR ELBOW, PERC .................................. 5.32 ...................... ...................... Agree ............ 5.32 

# 24358 .... ............. REPAIR ELBOW W/DEB, OPEN ..................... 6.54 ...................... ...................... Agree ............ 6.54 

# 24359 .... ............. REPAIR ELBOW DEB/ATTCH OPEN ............. 8.86 ...................... ...................... Agree ............ 8.86 

24545 ........ ............. TREAT HUMERUS FRACTURE ...................... 15.00 .................... ...................... Disagree ....... 12.99 

24546 ........ ............. TREAT HUMERUS FRACTURE ...................... 17.01 .................... ...................... Disagree ....... 14.73 

24575 ........ ............. TREAT HUMERUS FRACTURE ...................... 11.00 .................... ...................... Disagree ....... 9.53 

24579 ........ ............. TREAT HUMERUS FRACTURE ...................... 13.00 .................... ...................... Disagree ....... 11.26 

24635 ........ ............. TREAT ELBOW FRACTURE ........................... 10.00 .................... ...................... Disagree ....... 8.64 

24665 ........ ............. TREAT RADIUS FRACTURE ........................... Referred to CPT .. ...................... CPT .............. 8.22 

24666 ........ ............. TREAT RADIUS FRACTURE ........................... Referred to CPT .. ...................... CPT .............. 9.74 

24685 ........ ............. TREAT ULNAR FRACTURE ............................ 9.50 ...................... ...................... Disagree ....... 8.21 

25515 ........ ............. TREAT FRACTURE OF RADIUS ..................... 10.00 .................... ...................... Disagree ....... 8.64 

25525 ........ ............. TREAT FRACTURE OF RADIUS ..................... 12.00 .................... ...................... Disagree ....... 10.37 

25526 ........ ............. TREAT FRACTURE OF RADIUS ..................... 15.00 .................... ...................... Disagree ....... 12.96 

25545 ........ ............. TREAT FRACTURE OF ULNA ......................... 9.00 ...................... ...................... Disagree ....... 7.78 

25574 ........ ............. TREAT FRACTURE RADIUS & ULNA ............ 10.00 .................... ...................... Disagree ....... 8.64 

25575 ........ ............. TREAT FRACTURE RADIUS/ULNA ................ 14.00 .................... ...................... Disagree ....... 12.10 

25628 ........ ............. TREAT WRIST BONE FRACTURE ................. 11.00 .................... ...................... Disagree ....... 9.51 

26615 ........ ............. TREAT METACARPAL FRACTURE ................ 8.00 ...................... ...................... Disagree ....... 6.91 

26650 ........ ............. TREAT THUMB FRACTURE ........................... 6.00 ...................... ...................... Disagree ....... 5.19 

26665 ........ ............. TREAT THUMB FRACTURE ........................... 9.00 ...................... ...................... Disagree ....... 7.78 

26685 ........ ............. TREAT HAND DISLOCATION ......................... 8.00 ...................... ...................... Disagree ....... 6.91 

26715 ........ ............. TREAT KNUCKLE DISLOCATION .................. 7.95 ...................... ...................... Disagree ....... 6.87 

26735 ........ ............. TREAT FINGER FRACTURE, EACH ............... 8.40 ...................... ...................... Disagree ....... 7.26 

26746 ........ ............. TREAT FINGER FRACTURE, EACH ............... 11.10 .................... ...................... Disagree ....... 9.59 

26765 ........ ............. TREAT FINGER FRACTURE, EACH ............... 6.60 ...................... ...................... Disagree ....... 5.70 

26785 ........ ............. TREAT FINGER DISLOCATION ...................... 7.45 ...................... ...................... Disagree ....... 6.44 

27248 ........ ............. TREAT THIGH FRACTURE ............................. 12.83 .................... ...................... Disagree ....... 10.64 

# 27267 .... ............. CLTX THIGH FX ............................................... 5.38 ...................... ...................... Agree ............ 5.38 

# 27268 .... ............. CLTX THIGH FX W/MNPJ ............................... 7.00 ...................... ...................... Agree ............ 7.00 

# 27269 .... ............. OPTX THIGH FX .............................................. 18.75 .................... ...................... Agree ............ 18.75 

# 27416 .... ............. OSTEOCHONDRAL KNEE AUTOGRAFT ....... 14.00 .................... ...................... Agree ............ 14.00 

27511 ........ ............. TREATMENT OF THIGH FRACTURE ............. 18.05 .................... ...................... Disagree ....... 14.97 

27513 ........ ............. TREATMENT OF THIGH FRACTURE ............. 23.04 .................... ...................... Disagree ....... 19.11 

27514 ........ ............. TREATMENT OF THIGH FRACTURE ............. 17.43 .................... ...................... Disagree ....... 14.46 

27519 ........ ............. TREAT THIGH FX GROWTH PLATE .............. 15.80 .................... ...................... Disagree ....... 13.11 

27535 ........ ............. TREAT KNEE FRACTURE .............................. 16.00 .................... ...................... Disagree ....... 13.27 

27540 ........ ............. TREAT KNEE FRACTURE .............................. 13.45 .................... ...................... Disagree ....... 11.16 

27556 ........ ............. TREAT KNEE DISLOCATION .......................... 15.50 .................... ...................... Disagree ....... 12.86 

27557 ........ ............. TREAT KNEE DISLOCATION .......................... 19.00 .................... ...................... Disagree ....... 15.76 

27558 ........ ............. TREAT KNEE DISLOCATION .......................... 22.00 .................... ...................... Disagree ....... 18.25 

# 27726 .... ............. REPAIR FIBULA NONUNION .......................... 14.20 .................... ...................... Agree ............ 14.20 

27766 ........ ............. OPTX MEDIAL ANKLE FX ............................... 8.50 ...................... ...................... Disagree ....... 7.73 

# 27767 .... ............. CLTX POST ANKLE FX ................................... 2.50 ...................... ...................... Agree ............ 2.50 

# 27768 .... ............. CLTX POST ANKLE FX W/MNPJ .................... 5.00 ...................... ...................... Agree ............ 5.00 

# 27769 .... ............. OPTX POST ANKLE FX .................................. 10.00 .................... ...................... Agree ............ 10.00 

27784 ........ ............. TREATMENT OF FIBULA FRACTURE ........... 10.45 .................... ...................... Disagree ....... 9.51 

27792 ........ ............. TREATMENT OF ANKLE FRACTURE ............ 10.50 .................... ...................... Disagree ....... 9.55 

27814 ........ ............. TREATMENT OF ANKLE FRACTURE ............ 11.50 .................... ...................... Disagree ....... 10.46 

27822 ........ ............. TREATMENT OF ANKLE FRACTURE ............ 12.12 .................... ...................... Disagree ....... 11.03 

27823 ........ ............. TREATMENT OF ANKLE FRACTURE ............ 14.26 .................... ...................... Disagree ....... 12.98 

27826 ........ ............. TREAT LOWER LEG FRACTURE ................... 12.00 .................... ...................... Disagree ....... 10.92 

27827 ........ ............. TREAT LOWER LEG FRACTURE ................... 16.00 .................... ...................... Disagree ....... 14.56 

27828 ........ ............. TREAT LOWER LEG FRACTURE ................... 20.00 .................... ...................... Disagree ....... 18.20 

27829 ........ ............. TREAT LOWER LEG JOINT ............................ 9.50 ...................... ...................... Disagree ....... 8.64 

27832 ........ ............. TREAT LOWER LEG DISLOCATION .............. 11.00 .................... ...................... Disagree ....... 10.01 


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Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66367 

TABLE 16.—AMA RUC AND HCPAC RECOMMENDATIONS AND CMS’ DECISIONS FOR NEW AND REVISED 2008 CPT 

CODES—Continued 

CPT 1 code Mod Descriptor RUC 

recommendation 

HCPAC 

recommendation 

CMS 

decision 2008 work RVU 

28415 ........ ............. TREAT HEEL FRACTURE ............................... 17.54 .................... ...................... Disagree ....... 15.96 

28420 ........ ............. TREAT/GRAFT HEEL FRACTURE .................. 19.00 .................... ...................... Disagree ....... 17.29 

28445 ........ ............. TREAT ANKLE FRACTURE ............................ 17.07 .................... ...................... Disagree ....... 15.53 

# 28446 .... ............. OSTEOCHONDRAL TALUS AUTOGRFT ....... 17.50 .................... ...................... Agree ............ 17.50 

28465 ........ ............. TREAT MIDFOOT FRACTURE, EACH ............ 9.50 ...................... ...................... Disagree ....... 8.64 

28485 ........ ............. TREAT METATARSAL FRACTURE ................ 8.00 ...................... ...................... Disagree ....... 7.28 

28505 ........ ............. TREAT BIG TOE FRACTURE ......................... 8.00 ...................... ...................... Disagree ....... 7.28 

28525 ........ ............. TREAT TOE FRACTURE ................................. 6.00 ...................... ...................... Disagree ....... 5.46 

28555 ........ ............. REPAIR FOOT DISLOCATION ........................ 10.43 .................... ...................... Disagree ....... 9.49 

28585 ........ ............. REPAIR FOOT DISLOCATION ........................ 12.00 .................... ...................... Disagree ....... 10.92 

28615 ........ ............. REPAIR FOOT DISLOCATION ........................ 11.50 .................... ...................... Disagree ....... 10.46 

28645 ........ ............. REPAIR TOE DISLOCATION .......................... 8.00 ...................... ...................... Disagree ....... 7.28 

28675 ........ ............. REPAIR OF TOE DISLOCATION .................... 6.00 ...................... ...................... Disagree ....... 5.46 

# 29828 * .. ............. ARTHROSCOPY BICEPS TENODESIS .......... 13.00 .................... ...................... Agree ............ 13.00 

# 29904 .... ............. SUBTALAR ARTHRO W/FB RMVL ................. 8.50 ...................... ...................... Agree ............ 8.50 

# 29905 .... ............. SUBTALAR ARTHRO W/EXC .......................... 9.00 ...................... ...................... Agree ............ 9.00 

# 29906 .... ............. SUBTALAR ARTHRO W/DEB .......................... 9.47 ...................... ...................... Agree ............ 9.47 

# 29907 .... ............. SUBTALAR ARTHRO W/FUSION ................... 12.00 .................... ...................... Agree ............ 12.00 

31500 ........ ............. INSERT EMERGENCY AIRWAY ..................... 2.33 ...................... ...................... Agree ............ 2.33 

# 33257 * .. ............. ABLATE ATRIA, LMTD, ADD-ON .................... 9.63 ...................... ...................... Agree ............ 9.63 

# 33258 * .. ............. ABLATE ATRIA, X10SV, ADD-ON ................... 11.00 .................... ...................... Agree ............ 11.00 

# 33259 * .. ............. ABLATE ATRIA W/BYPASS ADD-ON ............. 14.14 .................... ...................... Agree ............ 14.14 

# 33864 * .. ............. ASCENDING AORTIC GRAFT ........................ 60.00 .................... ...................... Agree ............ 60.00 

# 34806 * .. ............. ANEURYSM PRESS SENSOR ADD-ON ......... 2.06 ...................... ...................... Agree ............ 2.06 

# 35523 .... ............. ARTERY BYPASS GRAFT .............................. 24.00 .................... ...................... Agree ............ 24.00 

36620 ........ ............. INSERTION CATHETER, ARTERY ................. 1.15 ...................... ...................... Agree ............ 1.15 

# 41019 .... ............. PLACE NEEDLES H&N FOR RT ..................... 8.84 ...................... ...................... Agree ............ 8.84 

43760 ........ ............. CHANGE GASTROSTOMY TUBE ................... 0.90 ...................... ...................... Agree ............ 0.90 

# 49203 .... ............. EXC ABD TUM 5 CM OR LESS ...................... 20.00 .................... ...................... Agree ............ 20.00 

# 49204 .... ............. EXC ABD TUM OVER 5 CM ............................ 26.00 .................... ...................... Agree ............ 26.00 

# 49205 .... ............. EXC ABD TUM OVER 10 CM .......................... 30.00 .................... ...................... Agree ............ 30.00 

# 49440 .... ............. PLACE GASTROSTOMY TUBE PERC ........... 4.18 ...................... ...................... Agree ............ 4.18 

# 49441 .... ............. PLACE DUOD/JEJ TUBE PERC ..................... 4.77 ...................... ...................... Agree ............ 4.77 

# 49442 .... ............. PLACE CECOSTOMY TUBE PERC ................ 4.00 ...................... ...................... Agree ............ 4.00 

# 49446 .... ............. CHANGE G–TUBE TO G–J PERC .................. 3.31 ...................... ...................... Agree ............ 3.31 

# 49450 .... ............. REPLACE G/C TUBE PERC ............................ 1.36 ...................... ...................... Agree ............ 1.36 

# 49451 .... ............. REPLACE DUOD/JEJ TUBE PERC ................ 1.84 ...................... ...................... Agree ............ 1.84 

# 49452 .... ............. REPLACE G–J TUBE PERC ........................... 2.86 ...................... ...................... Agree ............ 2.86 

# 49460 .... ............. FIX G/COLON TUBE W/DEVICE ..................... 0.96 ...................... ...................... Agree ............ 0.96 

# 49465 .... ............. FLUORO EXAM OF G/COLON TUBE ............. 0.62 ...................... ...................... Agree ............ 0.62 

# 50385 .... ............. CHANGE STENT VIA TRANSURETH ............. 4.44 ...................... ...................... Agree ............ 4.44 

# 50386 .... ............. REMOVE STENT VIA TRANSURETH ............. 3.30 ...................... ...................... Agree ............ 3.30 

# 50593 * .. ............. PERC CRYO ABLATE RENAL TUM ............... 9.08 ...................... ...................... Agree ............ 9.08 

51797 ........ ............. INTRAABDOMINAL PRESSURE TEST ........... 0.80 ...................... ...................... Agree ............ 0.80 

# 52649 .... ............. PROSTATE LASER ENUCLEATION ............... 17.16 .................... ...................... Agree ............ 17.16 

# 55920 .... ............. PLACE NEEDLES PELVIC FOR RT ............... 8.31 ...................... ...................... Agree ............ 8.31 

57284 ........ ............. REPAIR PARAVAG DEFECT, OPEN .............. 14.25 .................... ...................... Agree ............ 14.25 

# 57285 .... ............. REPAIR PARAVAG DEFECT, VAG ................. 11.52 .................... ...................... Agree ............ 11.52 

# 57423 * .. ............. REPAIR PARAVAG DEFECT, LAP ................. 16.00 .................... ...................... Agree ............ 16.00 

# 58570 * .. ............. TLH, UTERUS 250 G OR LESS ...................... 15.75 .................... ...................... Agree ............ 15.75 

# 58571 * .. ............. TLH W/T/O 250 G OR LESS ........................... 17.56 .................... ...................... Agree ............ 17.56 

# 58572 * .. ............. TLH, UTERUS OVER 250 G ............................ 19.96 .................... ...................... Agree ............ 19.96 

# 58573 * .. ............. TLH W/T/O UTERUS OVER 250 G ................. 22.98 .................... ...................... Agree ............ 22.98 

# 67041 .... ............. VIT FOR MACULAR PUCKER ......................... 19.00 .................... ...................... Agree ............ 19.00 

# 67042 .... ............. VIT FOR MACULAR HOLE .............................. 22.13 .................... ...................... Agree ............ 22.13 

# 67043 .... ............. VIT FOR MEMBRANE DISSECT ..................... 22.94 .................... ...................... Agree ............ 22.94 

# 67113 .... ............. REPAIR RETINAL DETACH, CPLX ................. 25.00 .................... ...................... Agree ............ 25.00 

# 67229 .... ............. TR RETINAL LES PRETERM INF ................... 16.00 .................... ...................... Agree ............ 16.00 

# 68816 * .. ............. PROBE NL DUCT W/BALLOON ...................... 3.00 ...................... ...................... Agree ............ 3.00 

# 75557 * .. 26 ........ CARDIAC MRI FOR MORPH ........................... 2.35 ...................... ...................... Agree ............ 2.35 

# 75558 * .. 26 ........ CARDIAC MRI FLOW/VELOCITY .................... 2.60 ...................... ...................... Agree (c) ...... 2.60 

# 75559 * .. 26 ........ CARDIAC MRI W/STRESS IMG ...................... 2.95 ...................... ...................... Agree ............ 2.95 

# 75560 * .. 26 ........ CARDIAC MRI FLOW/VEL/STRESS ............... 3.00 ...................... ...................... Agree (c) ...... 3.00 

# 75561 * .. 26 ........ CARDIAC MRI FOR MORPH W/DYE .............. 2.60 ...................... ...................... Agree ............ 2.60 

# 75562 * .. 26 ........ CARD MRI FLOW/VEL W/DYE ........................ 2.86 ...................... ...................... Agree (c) ...... 2.86 

# 75563 * .. 26 ........ CARD MRI W/STRESS IMG & DYE ................ 3.00 ...................... ...................... Agree ............ 3.00 

# 75564 * .. 26 ........ HT MRI W/FLO/VEL/STRS & DYE .................. 3.35 ...................... ...................... Agree (c) ...... 3.35 

78811 * ...... 26 ........ PET IMAGE, LTD AREA .................................. 1.54 ...................... ...................... Agree ............ 1.54 

78812 * ...... 26 ........ PET IMAGE, SKULL–THIGH ........................... 1.93 ...................... ...................... Agree ............ 1.93 


cprice-sewell on PROD1PC72 with RULES
66368 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

TABLE 16.—AMA RUC AND HCPAC RECOMMENDATIONS AND CMS’ DECISIONS FOR NEW AND REVISED 2008 CPT 

CODES—Continued 

CPT 1 code Mod Descriptor RUC 

recommendation 

HCPAC 

recommendation 

CMS 

decision 2008 work RVU 

78813 * ...... 26 ........ PET IMAGE, FULL BODY ................................ 2.00 ...................... ...................... Agree ............ 2.00 

78814 * ...... 26 ........ PET IMAGE W/CT, LMTD ................................ 2.20 ...................... ...................... Agree ............ 2.20 

78815 * ...... 26 ........ PET IMAGE W/CT, SKULL–THIGH ................. 2.44 ...................... ...................... Agree ............ 2.44 

78816 * ...... 26 ........ PET IMAGE W/CT, FULL BODY ..................... 2.50 ...................... ...................... Agree ............ 2.50 

86486 ........ ............. SKIN TEST, NOS ANTIGEN ............................ (a) ........................ ...................... (a)* ............... 0.00 

88380 * ...... ............. MICRODISSECTION, LASER .......................... 1.56 ...................... ...................... Agree ............ 1.56 

# 88381 * .. ............. MICRODISSECTION, MANUAL ....................... 1.18 ...................... ...................... Agree ............ 1.18 

# 90769 * .. ............. SC THER INFUSION, UP TO 1 HR ................. 0.21 ...................... ...................... Agree ............ 0.21 

# 90770 * .. ............. SC THER INFUSION, ADDL HR ..................... 0.18 ...................... ...................... Agree ............ 0.18 

93503 ........ 26 ........ INSERT/PLACE HEART CATHETER .............. 2.91 ...................... ...................... Agree ............ 2.91 

# 93982 * ** ............. ANEURYSM PRESSURE SENS STUDY ........ 0.30 ...................... ...................... Agree ............ 0.30 

95004 ........ ............. PERCUT ALLERGY SKIN TESTS ................... 0.01 ...................... ...................... Agree ............ 0.01 

95024 ........ ............. ID ALLERGY TEST, DRUG/BUG ..................... 0.01 ...................... ...................... Agree ............ 0.01 

95027 ........ ............. ID ALLERGY TITRATE–AIRBORNE ................ 0.01 ...................... ...................... Agree ............ 0.01 

# 95980 * .. ............. IO ANAL GAST N–STIM INIT .......................... 0.80 ...................... ...................... Agree ............ 0.80 

# 95981 * .. ............. IO ANAL GAST N–STIM SUBSQ .................... 0.30 ...................... ...................... Agree ............ 0.30 

# 95982 * .. ............. IO GA N–STIM SUBSQ W/REPROG .............. 0.65 ...................... ...................... Agree ............ 0.65 

# 96125 .... ............. COGNITIVE TEST BY HC PRO ...................... .............................. 1.70 .............. Agree ............ 1.70 

# 98966 * .. ............. HC PRO PHONE CALL 5–10 MIN ................... .............................. 0.25 .............. Agree (c) ...... 0.25 

# 98967 * .. ............. HC PRO PHONE CALL 11–20 MIN ................. .............................. 0.50 .............. Agree (c) ...... 0.50 

# 98968 * .. ............. HC PRO PHONE CALL 21–30 MIN ................. .............................. 0.75 .............. Agree (c) ...... 0.75 

# 98969 .... ............. ONLINE SERVICE BY HC PRO ...................... .............................. Carrier Priced Agree (c) ...... Carrier Priced. 

# 99174 .... ............. OCULAR PHOTOSCREENING ........................ (a) ........................ ...................... (a)* ............... 0.00 

# 99366 .... ............. TEAM CONF W/PAT BY HC PRO ................... .............................. 0.82 .............. Agree (b) ...... 0.82 

# 99367 .... ............. TEAM CONF W/O PAT BY PHYS ................... 1.10 ...................... ...................... Agree (b) ...... 1.10 

# 99368 .... ............. TEAM CONF W/O PAT BY HC PRO ............... .............................. 0.72 .............. Agree (b) ...... 0.72 

# 99406 .... ............. BEHAV CHNG SMOKING 3–10 MIN ............... 0.24 ...................... ...................... Agree ............ 0.24 

# 99407 .... ............. BEHAV CHNG SMOKING < 10 MIN ................ 0.50 ...................... ...................... Agree ............ 0.50 

# 99408 .... ............. AUDIT/DAST, 15–30 MIN ................................. 0.65 ...................... ...................... Agree (c) ...... 0.65 

# 99409 .... ............. AUDIT/DAST, OVER 30 MIN ........................... 1.30 ...................... ...................... Agree (c) ...... 1.30 

# 99441 * .. ............. PHONE E/M BY PHYS 5–10 MIN .................... 0.25 ...................... ...................... Agree (c) ...... 0.25 

# 99442 * .. ............. PHONE E/M BY PHYS 11–20 MIN .................. 0.50 ...................... ...................... Agree (c) ...... 0.50 

# 99443 * .. ............. PHONE E/M BY PHYS 21–30 MIN .................. 0.75 ...................... ...................... Agree (c) ...... 0.75 

# 99444 .... ............. ONLINE E/M BY PHYS .................................... Carrier Priced ...... ...................... Agree (c) ...... Carrier Priced. 

# 99477 .... ............. INIT DAY HOSP NEONATE CARE ................. 7.00 ...................... ...................... Agree ............ 7.00 

# New CPT code. 

1All CPT codes copyright 2007 AMA. 

* New Code for Re-Examination at the next 5-Year Review. 

** Denotes restricted coverage of code. 

(a) No RUC work RVU recommendation. 

(a) * See code discussion in Section F, Discussion of Codes and RUC/HCPAC Recommendations. 

(b) RUC-recommended work RVU accepted but coverage status of code is Bundled. 

(c) RUC-recommended work RVU accepted but coverage status of code is Noncovered. 

Table 17: AMA RUC Anesthesia 

Recommendations and CMS Decisions 

for New and Revised 2008 CPT Codes 

lists the new or revised CPT codes for 

anesthesia and their base units that will 

be interim in CY 2008. Table 17 

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. 

• 2008 Base Units. This column 

establishes the CY 2007 base units for 

these services. 

TABLE 17.—AMA RUC ANESTHESIA RECOMMENDATIONS AND CMS DECISIONS FOR NEW AND REVISED/REVIEWED CPT 

CODES

* CPT 1 code Description 

RUC 

recommendation CMS 

decision 

2008 base 

units 

## 00142 ..... ANESTH, LENS SURGERY ............................................................................................ 4.00 Agree ....... 4.00 

# 01935 ....... ANESTH, PERC IMG DX SP PROC ............................................................................... 5.00 Agree ....... 5.00 

# 01936 ....... ANESTH, PERC IMG TX SP PROC ............................................................................... 5.00 Agree ....... 5.00 

1All CPT codes copyright 2007 AMA. 


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66369 

# New CPT code. 

## Note: CPT code 00142 is neither a new nor revised code for 2008. However, the RUC reviewed the base unit values for this code for 2008 

and recommended that the value be maintained. 

F. Discussion of Codes and RUC/HCPAC 

Recommendations 

The following is a summary of our 

rationale for not accepting particular 

RUC work RVUs. It is arranged by type 

of service in CPT order. This summary 

refers only to work RVUs. 

1. Internal Fixation Codes—Shoulder/ 

Elbow (CPT codes 23515, 23585, 23615, 

23616, 23680, 23670, 23680, 24545, 

24546, 24575 and 24579), Elbow/Hand 

(CPT codes 24635, 24685, 25515, 25525, 

25526, 25545, 25574, 25575, 25628, 

26615, 26650, 26665, 26685, 26715, 

26735, 26746, 26765, 26785), Hip and 

Knee (CPT codes 27248, 27511, 27513, 

27514, 27519, 27535, 27540, 27556, 

27557 and 27558) and Foot and Ankle 

(CPT codes 27766, 27784, 27792, 27814, 

27822, 27823, 27826, 27827, 27828, 

27829, 27832, 28415, 28420, 28445, 

28465, 28485, 28505, 28525, 28555, 

28585, 28615, 28645 and 28675) 

These codes were originally part of 

the 5-Year Review of work RVUs and 

were referred to the CPT Editorial Panel 

by the RUC for further clarification 

because it was unclear whether the 

previous valuation for these codes 

included the situation when internal 

and external fixation is applied to the 

fracture site. The CPT Editorial Panel 

agreed that these codes needed to be 

clarified and removed reference to 

external fixation from these codes. As a 

result of this editorial change, the RUC 

reexamined these families of codes and 

recommended increased work RVUs. 

The RUC recommended 11.00 work 

RVUs for CPT code 23515; 16.25 work 

RVUs for CPT code 25385; 14.00 work 

RVUs for CPT code 23615; 21.00 work 

RVUs for CPT code 23616; 12.00 work 

RVUs for CPT code 23680; 14.00 work 

RVUs for CPT code 23670; 15.00 work 

RVUs for CPT code 23680; 15.00 work 

RVUs for CPT code 24545; 17.01 work 

RVUs for CPT code 24546; 11.00 work 

RVUs for CPT code 24575; 13.00 work 

RVUs for CPT code 24579; 10.00 work 

RVUs for CPT code 24635; 9.50 work 

RVUs for CPT code 24685; 10.00 work 

RVUs for CPT code 25515; 12.00 work 

RVUs for CPT code 25525; 15.00 work 

RVUs for CPT code 25526; 9.00 work 

RVUs for CPT code 25545; 10.00 work 

RVUs for CPT code 25574; 14.00 work 

RVUs for CPT code 25575; 11.00 work 

RVUs for CPT code 25628; 8.00 work 

RVUs for CPT code 26615; 6.00 work 

RVUs for CPT code 26650; 9.00 work 

RVUs for CPT code 26665; 8.00 work 

RVUs for CPT code 26685; 7.95 work 

RVUs for CPT code 26715; 8.40 work 

RVUs for CPT code 26735; 11.10 work 

RVUs for CPT code 26746; 6.60 work 

RVUs for CPT code 26765; 7.45 work 

RVUs for CPT code 26785; 12.83 work 

RVUs for CPT code 27248; 18.05 work 

RVUs for CPT code 27511; 23.04 work 

RVUs for CPT code 27513; 17.43 work 

RVUs for CPT code 27514; 15.80 work 

RVUs for CPT code 27519; 16.00 work 

RVUs for CPT code 27535; 13.45 work 

RVUs for CPT code 27540; 15.50 work 

RVUs for CPT code 27556; 19.00 work 

RVUs for CPT code 27557; 22.00 work 

RVUs for CPT code 27558; 8.50 work 

RVUs for CPT code 27766; 10.45 work 

RVUs for CPT code 27784; 10.50 work 

RVUs for CPT code 27792; 11.50 work 

RVUs for CPT code 27814; 12.12 work 

RVUs for CPT code 27822; 14.26 work 

RVUs for CPT code 27823; 12.00 work 

RVUs for CPT code 27826; 16.00 work 

RVUs for CPT code 27827; 20.00 work 

RVUs for CPT code 27828; 9.50 work 

RVUs for CPT code 27829; 11.00 work 

RVUs for CPT code 27832; 17.54 work 

RVUs for CPT code 28415; 19.00 work 

RVUs for CPT code 28420; 17.07 work 

RVUs for CPT code 28445; 9.50 work 

RVUs for CPT code 28465; 8.00 work 

RVUs for CPT code 28485; 8.00 work 

RVUs for CPT code 28505; 6.00 work 

RVUs for CPT code 28525; 10.43 work 

RVUs for CPT code 28555; 12.00 work 

RVUs for CPT code 28585; 11.50 work 

RVUs for CPT code 28615; 8.00 work 

RVUs for CPT code 28645; and 6.00 

work RVUs for CPT code 28675. 

Although we agree with the 

relationships, the increases in work 

RVUs reestablish the relativity of the 

services in these families and in doing 

so created BN issues. In order to retain 

BN within these families of codes, the 

work RVUs associated with each code 

had to be adjusted. 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 each family will be the same as the 

sum of the current work RVUs 

(weighted by projected frequency of use) 

for each family of codes. The adjusted 

work RVUs are as follows: 9.53 work 

RVUs for CPT code 23515; 14.07 work 

RVUs for CPT code 25385; 12.12 work 

RVUs for CPT code 23615; 18.19 work 

RVUs for CPT code 23616; 10.39 work 

RVUs for CPT code 23680; 12.12 work 

RVUs for CPT code 23670; 12.99 work 

RVUs for CPT code 23680; 12.99 work 

RVUs for CPT code 24545; 14.73 work 

RVUs for CPT code 24546; 9.53 work 

RVUs for CPT code 24575; 11.26 work 

RVUs for CPT code 24579; 8.64 work 

RVUs for CPT code 24635; 8.21 work 

RVUs for CPT code 24685; 8.64 work 

RVUs for CPT code 25515; 10.37 work 

RVUs for CPT code 25525; 12.96 work 

RVUs for CPT code 25526; 7.78 work 

RVUs for CPT code 25545; 8.64 work 

RVUs for CPT code 25574; 12.10 work 

RVUs for CPT code 25575; 9.51 work 

RVUs for CPT code 25628; 6.91 work 

RVUs for CPT code 26615; 5.19 work 

RVUs for CPT code 26650; 7.78 work 

RVUs for CPT code 26665; 6.91 work 

RVUs for CPT code 26685; 6.87 work 

RVUs for CPT code 26715; 7.26 work 

RVUs for CPT code 26735; 9.59 work 

RVUs for CPT code 26746; 5.70 work 

RVUs for CPT code 26765; 6.44 work 

RVUs for CPT code 26785; 10.64 work 

RVUs for CPT code 27248; 14.97 work 

RVUs for CPT code 27511; 19.11 work 

RVUs for CPT code 27513; 14.46 work 

RVUs for CPT code 27514; 13.11 work 

RVUs for CPT code 27519; 13.27 work 

RVUs for CPT code 27535; 11.16 work 

RVUs for CPT code 27540; 12.86 work 

RVUs for CPT code 27556; 15.76 work 

RVUs for CPT code 27557; 18.25 work 

RVUs for CPT code 27558; 7.73 work 

RVUs for CPT code 27766; 9.51 work 

RVUs for CPT code 27784; 9.55 work 

RVUs for CPT code 27792; 10.46 work 

RVUs for CPT code 27814; 11.03 work 

RVUs for CPT code 27822; 12.98 work 

RVUs for CPT code 27823; 10.92 work 

RVUs for CPT code 27826; 14.56 work 

RVUs for CPT code 27827; 18.20 work 

RVUs for CPT code 27828; 8.64 work 

RVUs for CPT code 27829; 10.01 work 

RVUs for CPT code 27832; 15.96 work 

RVUs for CPT code 28415; 17.29 work 

RVUs for CPT code 28420; 15.53 work 

RVUs for CPT code 28445; 8.64 work 

RVUs for CPT code 28465; 7.28 work 

RVUs for CPT code 28485; 7.28 work 

RVUs for CPT code 28505; 5.46 work 

RVUs for CPT code 28525; 9.49 work 

RVUs for CPT code 28555; 10.92 work 

RVUs for CPT code 28585; 10.46 work 

RVUs for CPT code 28615; 7.28 work 

RVUs for CPT code 28645; and 5.46 

work RVUs for CPT code 28675. 

2. Cardiac MRI Codes 

Cardiac MRI services have evolved 

over the past decade from providing 

primarily anatomic information to 

providing both anatomic and 

physiologic information. We have had a 

national noncoverage determination in 

place for Magnetic Resonance Imaging 

(MRI) that provides blood flow 

measurement since March 1994. This 

NCD provides that CPT code 75556, 


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Cardiac magnetic resonance imaging for 

velocity flow, is not covered. 

As a result of the technological 

changes in MRI scanning, the CPT 

Editorial Panel created eight new 

Cardiac MRI codes and deleted five 

existing Cardiac MRI codes. The new 

codes are: CPT code 75557, Cardiac 

magnetic resonance imaging for 

morphology and function without 

contrast material; CPT code 75558, 

Cardiac magnetic resonance imaging for 

morphology and function without 

contrast material; with flow/velocity 

quantification; CPT code 75559, Cardiac 

magnetic resonance imaging for 

morphology and function without 

contrast material; with stress imaging; 

CPT code 75560, Cardiac magnetic 

resonance imaging for morphology and 

function without contrast material; with 

flow/velocity quantification and stress; 

CPT code 75561, Cardiac magnetic 

resonance imaging for morphology and 

function without contrast material(s), 

followed by contrast material(s) and 

further sequences; CPT code 75562, 

Cardiac magnetic resonance imaging for 

morphology and function without 

contrast material(s), followed by 

contrast material(s) and further 

sequences; with flow/velocity 

quantification; CPT code 75563, Cardiac 

magnetic resonance imaging for 

morphology and function without 

contrast material(s), followed by 

contrast material(s) and further 

sequences; with stress imaging; and CPT 

code 75564, Cardiac magnetic 

resonance imaging for morphology and 

function without contrast material(s), 

followed by contrast material(s) and 

further sequences; with flow/velocity 

quantification and stress. The RUC 

recommended 2.35 work RVUs for CPT 

code 75557; 2.60 work RVUs for CPT 

code 75558; 2.95 work RVUs for CPT 

code 75559; 3.00 work RVUs for CPT 

code 75560; 2.60 work RVUs for CPT 

code 75561; 2.86 work RVUs for CPT 

code 75562; 3.00 work RVUs for CPT 

code 75563; and 3.35 work RVUs for 

CPT code 75564. 

The deleted codes are: CPT code 

75552, Cardiac magnetic resonance 

imaging for function, without contrast 

material; CPT code 75553, Cardiac 

magnetic resonance imaging for 

function, without contrast material with 

contrast material; CPT code 75554, 

Cardiac magnetic resonance imaging for 

function, with or without morphology; 

complete study; CPT code 75555, 

Cardiac magnetic resonance imaging for 

function, with or without morphology; 

limited study; and CPT code 75556 

Cardiac magnetic resonance imaging for 

velocity flow mapping. 

Upon review of the new cardiac MRI 

codes, we recognize that four of the new 

codes incorporate blood flow 

measurement, which remains one of the 

nationally noncovered indications for 

MRI in the Medicare program. Due to a 

national non-coverage determination for 

MRI that provides blood flow 

measurement, CPT codes 75558, 75560, 

75562 and 75564 will not be recognized 

by the Medicare program and have been 

assigned a status indicator of ‘‘N’’

(Noncovered) on the Medicare 

physician fee schedule. (Note: The RUCrecommended RVUs for these codes will 

be reflected in Addendum B.) 

The remaining codes in this family 

(CPT codes 75557, 75559, 75561 and 

75563) will be recognized as active on 

the Medicare PFS. 

3. Skin Test, Unlisted Antigen 

For CPT code 86486, Skin test; 

unlisted antigen, the RUC did not make 

a work RVU recommendation. During 

our 2007 public meeting for new 

clinical laboratory tests held in 

accordance with § 414.506, we received 

approximately four comments. The 

commenters indicated the code belongs 

in the skin test code series included in 

the PFS with a payment crosswalk to 

CPT code 86490 Skin test; 

coccidioidomycosis. We agree with the 

recommendations. We are assigning the 

code a status indicator of A (Active 

code). The status indicator does not 

mean that Medicare has made a national 

coverage determination regarding this 

service. Contractors may develop local 

coverage determinations. CPT also 

deleted predecessor CPT code 86586 

effective January 1, 2008; thus, CPT 

code 86586 will be deleted from the 

2008 clinical laboratory fee schedule. 

4. Wireless Pressure Sensor 

Implantation and Study 

For CPT code 93982, Noninvasive 

physiologic study of implanted wireless 

pressure sensor in aneursymal sac 

following endovascular repair, complete 

study including recording, analysis of 

pressure and waveform tracings, 

interpretation and report, the RUC 

recommended 0.30 work RVUs. We 

have assigned a status indicator of R 

(Restricted) to this service because the 

sensor used in this procedure is FDA 

approved for pressure interpretation at 

the time of an endovascular aneurysm 

repair only and is currently not FDA 

approved for the follow-up evaluation of 

pressure analysis in the office or 

outpatient setting once the patient is 

discharged from the hospital. 

5. Non-Face-to-Face Physician and 

Qualified Healthcare Professional 

Services 

For CPT code 98966, Telephone 

assessment and management service 

provided by a qualified non-physician 

health care professional to an 

established patient, parent, or guardian 

not originating from a related 

assessment and management service 

provided within the previous seven days 

nor leading to an assessment and 

management service or procedure 

within the next 24 hours or soonest 

available appointment; 5–10 minutes of 

medical discussion; CPT code 98967, 

Telephone assessment and management 

service provided by a qualified nonphysician health care professional to an 

established patient, parent, or guardian 

not originating from a related 

assessment and management service 

provided within the previous seven days 

nor leading to an assessment and 

management service or procedure 

within the next 24 hours or soonest 

available appointment; 11–20 minutes 

of medical discussion; CPT code 98968, 

Telephone assessment and management 

service provided by a qualified nonphysician health care professional to an 

established patient, parent, or guardian 

not originating from a related 

assessment and management service 

provided within the previous seven days 

nor leading to an assessment and 

management service or procedure 

within the next 24 hours or soonest 

available appointment; 21–30 minutes 

of medical discussion; CPT code 98969, 

Online evaluation and management 

service provided by a qualified nonphysician health care professional to an 

established patient, guardian or health 

care provider not originating from a 

related assessment and management 

service provided within the previous 7 

days, using the Internet or similar 

electronic communications network; 

CPT code 99441, Telephone evaluation 

and management service provided by a 

physician to an established patient, 

parent, or guardian not originating from 

a related E/M service provided within 

the previous seven days nor leading to 

an E/M service or procedure within the 

next 24 hours or soonest available 

appointment; 5–10 minutes of medical 

discussion; CPT code 99442, Telephone 

evaluation and management service 

provided by a physician to an 

established patient, parent, or guardian 

not originating from a related E/M 

service provided within the previous 

seven days nor leading to an E/M 

service or procedure within the next 24 

hours or soonest available appointment; 

11–20 minutes of medical discussion; 


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CPT code 99443, Telephone evaluation 

and management service provided by a 

physician to an established patient, 

parent, or guardian not originating from 

a related E/M service provided within 

the previous seven days nor leading to 

an E/M service or procedure within the 

next 24 hours or soonest available 

appointment; 21–30 minutes of medical 

discussion; and CPT code 99444, Online 

evaluation and management service 

provided by a physician to an 

established patient, guardian or health 

care provider not originating from a 

related E/M service provided within the 

previous 7 days, using the Internet or 

similar electronic communications 

network, the HCPAC recommended 0.25 

work RVUs for CPT code 98966; 0.50 

work RVUs for CPT code 98967; 0.75 

work RVUs for CPT code 98968; carrier 

pricing for CPT code 98969; and the 

RUC recommended 0.25 work RVUs for 

CPT code 99441; 0.50 work RVUs for 

CPT code 99442; 0.75 work RVUs for 

CPT code 99443; and carrier pricing for 

CPT code 99444. We are assigning a 

status indicator of ‘‘N’’ (Non-covered 

service) to these services because: (1) 

These services are non-face-to-face; and 

(2) the code descriptor includes 

language that recognizes the provision 

of services to parties other than the 

beneficiary and for whom Medicare 

does not provide coverage (for example, 

guardian). (Note: The RUC or HCPAC 

recommended RVUs for these codes will 

be reflected in Addendum B.) 

6. Team Conference 

For CPT code 99366, Medical team 

conference with interdisciplinary team 

of health care professionals, face-to-face 

with patient and/or family, 30 minutes 

or more; participation by non-physician 

qualified health care professional; CPT 

code 99367, Medical team conference 

with interdisciplinary team of health 

care professionals, patient and/or 

family not present, 30 minutes or more; 

participation by physician; and CPT 

code 99368, Medical team conference 

with interdisciplinary team of health 

care professionals, patient and/or 

family not present, 30 minutes or more; 

participation by non-physician qualified 

health care professional, the HCPAC 

recommended 0.82 work RVUs for CPT 

code 99366; the RUC recommended 1.10 

work RVUs for CPT code 99367; and the 

HCPAC recommended 0.72 work RVUs 

for CPT code 99368. We are assigning a 

status indicator of ‘‘B’’ (Bundled) to 

these services because to the extent that 

these services are covered, we believe 

these services like other counseling 

services are incorporated into existing 

E/M services. (Note: The RUC or HCPAC 

recommended RVUs for these codes will 

be reflected in Addendum B.) 

7. Reporting of Alcohol and/or 

Substance Abuse Assessment and 

Intervention Services 

For CY 2008, the CPT Editorial Panel 

has created two new Category I CPT 

codes for reporting alcohol and/or 

substance abuse screening. They are 

CPT code 99408, Alcohol and/or 

substance (other than tobacco) abuse 

structured screening (e.g., AUDIT, 

DAST), and brief intervention (SBI) 

services; 15 to 30 minutes, and CPT 

code 99409, Alcohol and/or substance 

(other than tobacco) abuse structured 

screening (e.g., AUDIT, DAST), and 

brief intervention (SBI) services; greater 

than 30 minutes. 

The code descriptions for these CPT 

codes suggest that these CPT codes may 

describe services that include screening 

services. In general, screening services 

under Medicare are considered to be 

those services provided to beneficiaries 

in the absence of signs or symptoms of 

illness or injury; therefore, to the extent 

that the services described by these two 

CPT codes have a screening element, the 

screening component would not meet 

the statutory requirements for coverage 

under section 1862(a)(1)(A) of the Act. 

Screening services are not covered by 

Medicare without specific statutory 

authority, such as has been provided for 

mammography, diabetes, and colorectal 

cancer screening. Accordingly, we will 

not recognize these CPT codes that 

incorporate screening for payment 

under the PFS. 

Instead, we have created two parallel 

G-codes to allow for appropriate 

Medicare reporting and payment for 

alcohol and substance abuse assessment 

and intervention services that are not 

provided as screening services, but that 

are performed in the context of the 

diagnosis or treatment of illness or 

injury. The codes are HCPCS code 

G0396, Alcohol and/or substance (other 

than tobacco) abuse structured 

assessment (e.g., AUDIT, DAST) and 

brief intervention, 15 to 30 minutes and 

HCPCS code G0397, Alcohol and/or 

substance (other than tobacco) abuse 

structured assessment (e.g., AUDIT, 

DAST) and intervention greater than 30 

minutes. We will instruct Medicare 

contractors to pay for these codes only 

when considered reasonable and 

necessary. We will also provide coding 

and payment instructions for these 

assessment and intervention services in 

the program instructions implementing 

the CY 2008 PFS. 

We are assigning a status indicator of 

‘‘N’’ (Noncovered) to CPT codes 99408 

and 99409. However, the work RVUs 

and PE inputs for 99408 will be 

crosswalked to G0396 and the work 

RVUs and PE inputs for 99409 will be 

crosswalked to G0397. 

8. Ocular Photoscreening 

For CPT code 99174, Ocular 

photoscreening with interpretation and 

report, bilateral, the RUC did not 

provide a recommendation. We are 

assigning a status indicator of ‘‘N’’

(Noncovered) to this service because it 

is a screening service that is not covered 

under the Medicare statute. 

G. Additional Coding Issues 

1. Modifier ¥51 Exempt List 

The CPT Editorial Panel reviewed all 

of the codes on the modifier ¥51 

exempt list to identify which codes 

should be exempt from the multiple 

procedure payment reduction rules and 

which codes should be removed from 

the exemption list. We have reviewed 

all codes recommended for removal 

from the exemption list and agree with 

the CPT Editorial Panel’s 

recommendations. We have updated 

payment modifiers where applicable. 

2. New Codes for Re-Examination at the 

Next 5-Year Review 

As part of its annual 

recommendations, the RUC includes a 

list identifying new CPT codes for 

reexamination at the next 5-Year Review 

of Work RVUs. New CPT codes that 

have been added to this list are 

identified with an asterisk (*) on 

Table 16: AMA RUC and HCPAC 

Recommendations and CMS’ Decisions 

for New and Revised 2008 CPT Codes. 

H. 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 2008 

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 CY 2008 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 Table 16: AMA 

RUC and HCPAC Recommendations and 

CMS’ Decisions for New and Revised 


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2008 CPT Codes except as noted below 

in this section. 

CPT Code Series 49450 Through 49465 

In this series of nine G-, J-, and G-J 

Tubes CPT codes, 49440, 49441, 49442, 

49446, 49450, 49451, 49452, 49460 and 

49465, we made revisions to the clinical 

labor time to conform to the RUCestablished standard under which the 

time assigned to any one labor type for 

the ‘‘intra’’ time, based on the 

physician’s time to perform the 

procedure, can not exceed 100 percent 

of the physician time. These revisions 

affected the service period times for the 

angio-tech/RT for each code. For each 

CPT code, the angio-tech/RT time to 

assist the physician in performing the 

procedure was allocated at 67 percent of 

the physician time and the angio-tech/ 

RT time to assist the physician with 

image acquisition during the procedure 

was allocated the remaining 33 percent 

of the physician time. 

We also made minor revisions to the 

supply list for this family of codes in 

order to match the number of requested 

needles with the number of syringes. 

We allocated one needle for each saline 

flush syringe and 1 additional needle to 

administer the lidocaine. Each needle 

was assigned the supply category 

‘‘SC029, needle, 18–27g’’ to encompass 

both the 18g and 25g needles requested. 

In addition, we added a 10–12 ml 

syringe that could be used to administer 

the lidocaine. 

CPT Code 50593 

We disagreed with the RUC 

recommended number of renal 

cryoablation probes typically needed to 

perform this procedure. Instead of 4 

probes, we believe that an average of 2.5 

probes is typical to this procedure based 

on 2005 clinical data (collected at 

Karmonos Cancer Institute) that was 

included as an attachment to 

information provided by the 

manufacturer. Therefore, we have 

assigned 2.5 probes for renal 

cryoablation, at $1,175 each, for CPT 

50593. 

V. Physician Self-Referral Prohibition: 

Annual Update to List of CPT/HCPCS 

Codes 

A. General 

Section 1877 of the Act prohibits a 

physician from referring a Medicare 

beneficiary for certain designated health 

services (DHS) to a health care entity 

with which the physician (or a member 

of the physician’s immediate family) has 

a financial relationship, unless an 

exception applies. Section 1877 of the 

Act also prohibits the DHS entity from 

submitting claims to Medicare or billing 

the beneficiary or any other entity for 

Medicare DHS that are furnished as a 

result of a prohibited referral. 

As specified in our regulations at 

§ 411.351, the following services are 

DHS: 

• Clinical laboratory services. 

• Physical therapy, occupational 

therapy, and speech-language pathology 

services. 

• Radiology and certain other imaging 

services. 

• Radiation therapy services and 

supplies. 

• Durable medical equipment and 

supplies. 

• Parenteral and enteral nutrients, 

equipment, and supplies. 

• Prosthetics, orthotics, and 

prosthetic devices and supplies. 

• Home health services. 

• Outpatient prescription drugs. 

• Inpatient and outpatient hospital 

services. 

B. Annual Update to the Code List 

1. Background 

In § 411.351, we specify that the 

entire scope of four DHS categories is 

defined in a list of CPT/HCPCS codes 

(the Code List), which is updated 

annually to account for changes in the 

most recent CPT and HCPCS 

publications. The DHS categories 

defined and updated in this manner are: 

• Clinical laboratory services. 

• Physical therapy, occupational 

therapy, and speech-language pathology 

services. 

• Radiology and certain other imaging 

services. 

• Radiation therapy services and 

supplies. 

The Code List also identifies 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 (§ 411.355(g)). 

• Preventive screening tests, 

immunizations or vaccines 

(§ 411.355(h)). 

The Code List was last updated in the 

CY 2007 PFS final rule with comment 

period (71 FR 69624) and in a 

subsequent correction notice (72 FR 

18909). 

2. Response to Comments 

We received only one public 

comment relating to the Code List that 

became effective January 1, 2007. The 

commenter was supportive of our 

additions and deletions. 

3. Revisions Effective for 2008 

The updated, comprehensive Code 

List effective January 1, 2008, appears as 

Addendum x in this final rule with 

comment period and is available on our 

Web site at http://www.cms.hhs.gov/ 

PhysicianSelfReferral/ 

11_List_of_Codes.asp#TopOfPage. 

Tables 19 and 20 identify the 

additions and deletions, respectively, to 

the comprehensive Code List that was 

published in Addendum J of the CY 

2007 PFS final rule (71 FR 70247 

through 70251) and revised in a 

subsequent correction notice (72 FR 

18909). Tables 19 and 20 also identify 

the additions and deletions to the lists 

of codes used to identify the items and 

services that may qualify for the 

exceptions in § 411.355(g) (regarding 

EPO and other dialysis-related 

outpatient prescription drugs furnished 

in or by an ESRD facility) and 

§ 411.355(h) (regarding preventive 

screening tests, immunizations and 

vaccines). 

The additions and deletions specified 

in Tables 19 and 20 are necessary to 

conform the Code List to the most recent 

publications of CPT and HCPCS and to 

changes in Medicare payment policies. 

We will consider comments regarding 

the codes listed in Tables 19 and 20. 

Comments will be considered if we 

receive them by the date specified in the 

DATES section of this final rule with 

comment period. We will not consider 

any comment that advocates a 

substantive change to any of the DHS 

defined in § 411.351. 

TABLE 19.—ADDITIONS TO THE PHYSICIAN SELF-REFERRAL LIST OF CPT 1

HCPCS CODES

CLINICAL LABORATORY SERVICES 

[no additions] 

PHYSICAL THERAPY, OCCUPATIONAL 

THERAPY, AND SPEECH-LANGUAGE 

PATHOLOGY SERVICES 

96125 ............... Cognitive test by HC pro. 

RADIOLOGY AND CERTAIN OTHER 

IMAGING SERVICES 

75557 ............... Cardiac mri for morph. 

75558 ............... Cardiac mri flow/velocity. 

75559 ............... Cardiac mri w/stress img. 

75560 ............... Cardiac mri flow/vel/stress. 

75561 ............... Cardiac mri for morph w/ 

dye. 

75562 ............... Card mri flow/vel w/dye. 

75563 ............... Card mri w/stress img & 

dye. 

75564 ............... Ht mri w/flo/vel/strs & dye. 

A9501 ............... Technetium TC-99m 

teboroxime. 

A9509 ............... Iodine I-123 sod iodide mil. 

A9569 ............... Technetium TC-99m auto 

WBC. 

A9570 ............... Indium In-111 auto WBC. 

A9571 ............... Indium In-111 auto platelet. 


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TABLE 19.—ADDITIONS TO THE PHYSICIAN SELF-REFERRAL LIST OF CPT 1

HCPCS CODES—Continued 

A9572 ............... Indium In-111 

pentetreotide. 

A9576 ............... Inj prohance multipack. 

A9577 ............... Inj multihance. 

A9578 ............... Inj multihance multipack. 

A9579 ............... Gad-base MR contrast 

NOS, 1ml. 

Q9965 ............... LOCM 100–199mg/ml iodine, 1ml. 

Q9966 ............... LOCM 200–299mg/ml iodine, 1ml. 

Q9967 ............... LOCM 300–399mg/ml iodine, 1ml. 

RADIATION THERAPY SERVICES AND 

SUPPLIES 

0182T ............... HDR elect brachytherapy. 

20555 ............... Place ndl musc/tis for rt. 

41019 ............... Place needles h&n for rt. 

55920 ............... Place needles pelvic for rt. 

C1716 ............... Brachytx source, Gold 198. 

C1717 ............... Brachytx source, HDR Ir192. 

C1719 ............... Brachytx source, Non-HDR 

Ir-192. 

C2616 ............... Brachytx source, Yttrium-9. 

C2634 ............... Brachytx source, HA, I125. 

C2635 ............... Brachytx source, HA, P-13. 

C2636 ............... Brachytx linear source, P13. 

C2637 ............... Brachytx, Ytterbium-169. 

C2638 ............... Brachytx, stranded, I-125. 

C2639 ............... Brachytx, non-stranded, I125. 

C2640 ............... Brachytx, stranded, P-13. 

C2641 ............... Brachytx, non-stranded, P13. 

C2642 ............... Brachytx, stranded, C-131. 

C2643 ............... Brachytx, non-stranded, C131. 

C2698 ............... Brachytx, stranded, NOS. 

C2699 ............... Brachytx, non-stranded, 

NOS. 

DRUGS USED BY PATIENTS UNDERGOING 

DIALYSIS 

[no additions] 

PREVENTIVE SCREENING TESTS, 

IMMUNIZATIONS AND VACCINES 

90669 ............... Pneumococcal vacc, ped 

<5. 

1 CPT codes and descriptions only are copyright 2007 AMA. All rights are reserved and 

applicable FARS/DFARS clauses apply. 

TABLE 20.—DELETIONS TO THE PHYSICIAN SELF-REFERRAL LIST OF CPT1/ 

HCPCS CODES

CLINICAL LABORATORY SERVICES 

[no deletions] 

TABLE 20.—DELETIONS TO THE PHYSICIAN SELF-REFERRAL LIST OF CPT1/ 

HCPCS CODES—Continued 

PHYSICAL THERAPY, OCCUPATIONAL 

THERAPY, AND SPEECH-LANGUAGE 

PATHOLOGY SERVICES 

[no deletions] 

RADIOLOGY AND CERTAIN OTHER 

IMAGING SERVICES 

75552 .......... Heart mri for morph w/o dye. 

75553 .......... Heart mri for morph w/dye. 

75554 .......... Cardiac MRI/function. 

75555 .......... Cardiac MRI/limited study. 

78609 .......... Brain imaging (PET). 

78615 .......... Cerebral vascular flow image. 

A9565 .......... In111 pentetreotide. 

Q9945 ......... LOCM≤149mg/ml iodine, 1ml. 

Q9946 ......... LOCM 150–199mg/ml iodine, 

1ml. 

Q9947 ......... LOCM 200–249mg/ml iodine, 

1ml. 

Q9948 ......... LOCM 250–299mg/ml iodine, 

1ml. 

Q9949 ......... LOCM 300–349mg/ml iodine, 

1ml. 

Q9950 ......... LOCM 350–399mg/ml iodine, 

1ml. 

Q9952 ......... Inj Gad-base MR contrast, 

1ml. 

RADIATION THERAPY SERVICES AND 

SUPPLIES 

[no deletions] 

DRUGS USED BY PATIENTS UNDERGOING 

DIALYSIS 

[no deletions] 

PREVENTIVE SCREENING TESTS, 

IMMUNIZATIONS AND VACCINES 

[no deletions] 

1 CPT codes and descriptions only are copyright 2007 AMA. All rights are reserved and 

applicable FARS/DFARS clauses apply. 

VI. Physician Fee Schedule Update for 

CY 2008 

A. Physician Fee Schedule Update 

The PFS update is set under a formula 

specified in section 1848(d)(4) of the 

Act, as amended by the MIEA–TRHCA. 

Section 101 of the MIEA–TRHCA 

provided a 1 year increase in the CY 

2007 conversion factor and specified 

that the conversion factor for CY 2008 

must be computed as if the 1-year 

increase had never applied. Consistent 

with this requirement, the update for CY 

2008 is equal to the product of 1 plus 

the CY 2007 update (as published in the 

CY 2007 PFS final rule with comment 

period (71 FR 69751)), 1 plus the 

percentage increase in the MEI (divided 

by 100), and 1 plus the UAF. As stated 

in the CY 2007 PFS final rule with 

comment period, if section 101 of the 

MIEA–TRHCA had not subsequently 

been enacted, the CY 2007 update 

would have been ¥5.0 percent 

(0.94953). For CY 2008, the MEI is equal 

to 1.8 percent (1.018). The UAF is ¥7.0 

percent (0.930). The product of the 

published CY 2007 update (0.94953), 

MEI (1.018), and the UAF (0.930) equals 

the CY 2008 update of ¥10.1 percent 

(0.89896). 

Our calculations of these figures are 

explained in this section. 

B. The Percentage Change in the 

Medicare Economic Index (MEI) 

The Medicare Economic Index (MEI) 

is authorized by section 1842(b)(3) of 

the Act, which states that prevailing 

charge levels beginning after June 30, 

1973 may not exceed the level from the 

previous year except to the extent that 

the Secretary finds, on the basis of 

appropriate economic index data, that 

the higher level is justified by year-toyear economic changes. 

The MEI measures the weightedaverage annual price change for various 

inputs needed to produce physicians’

services. The MEI is a fixed-weight 

input price index, with an adjustment 

for the change in economy-wide 

multifactor productivity. This index, 

which has CY 2000 base year weights, 

is comprised of two broad categories: (1) 

Physician’s own time; and (2) 

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; prescription drugs; 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. 

In the CY 2008 PFS proposed rule (72 

FR 38190), we presented a listing of the 

cost categories with the associated cost 

weights. We also explained that the 

Bureau of Labor Statistics (BLS) has 

discontinued production and 

publication of the white collar 


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4http://www.whitehouse.gov/omb/budget/fy2008/ 

hhs.html. 

occupation employment cost index 

(ECI) series which was used as the price 

proxy for nonphysician benefits in the 

MEI. There was no other comparable 

published series that was a suitable 

replacement for the white collar benefit 

ECI. Therefore, a nationally recognized 

economic and financial forecasting firm, 

Global Insight, Inc. (GII), and CMS 

jointly developed a composite series 

which is composed of four published 

ECI series and weighted by November 

2004 National Industry Specific 

Occupational Employment and Wage 

Estimates for NAICS 6211, Office of 

Physicians. We proposed to replace the 

ECI white collar benefit series with this 

composite benefit index effective for the 

CY 2008 MEI update (See the CY 2008 

PFS proposed rule (72 FR 38190) for a 

more detailed explanation of the 

specific proposal). In addition, we also 

published a preliminary estimate of the 

expected MEI update. 

Table 21 presents a listing of the MEI 

cost categories with associated weights 

and percent changes for price proxies 

for the 2008 update. For CY 2008, the 

increase in the MEI is 1.8 percent, 

which includes a 1.4 percent 

productivity offset based on the 10-year 

moving average of multifactor 

productivity. This is the result of a 3.7 

percent increase in physician’s own 

time and a 2.7 percent increase in 

physician’s PE. Within the physician’s 

PE, the largest increase occurred in 

prescription drugs, which increased 4.2 

percent, and professional and technical 

wages, which increased 4.0 percent. 

TABLE 21.—INCREASE IN THE MEDICARE ECONOMIC INDEX UPDATE FOR CY 2008 1

Cost categories and price measures CY 2000 

weights 2

CY 2008 

percent 

changes 

Medicare Economic Index Total, productivity adjusted 3 ......................................................................................... N/A 1.8 

Productivity: 10-year moving average of multifactor productivity, private nonfarm business sector 3 4 ........... N/A 1.4 

Medicare Economic Index Total, without productivity adjustment 4 ........................................................................ 100.000 3.2 

1. Physician’s Own Time 5 ........................................................................................................................ 52.466 3.7 

a. Wages and Salaries: Average Hourly Earnings, private Nonfarm ................................................ 42.730 4.0 

b. Fringe Benefits: Employment Cost Index, benefits, private nonfarm ............................................ 9.735 2.7 

2. Physician’s Practice Expense 5 ............................................................................................................. 47.534 2.7 

a. Nonphysician Employee Compensation ........................................................................................ 18.653 3.6 

(1) Wages and Salaries: Employment Cost Index, wages and salaries, weighted by occupation ........................................................................................................................................... 13.808 3.6 

(2) Fringe Benefits: Employment Cost Index, fringe benefits, weighted by occupation 7 .......... 4.845 3.7 

b. Office Expense: Consumer Price Index for Urban Areas (CPI–U), housing ................................ 12.209 3.5 

c. Drugs and Medical Materials and Supplies ................................................................................... 4.319 2.9 

(1) Medical Materials and Supplies: Producer Price Index (PPI), surgical appliances and supplies/CPI–U, medical equipment and supplies (equally weighted) ......................................... 2.011 1.0 

(2) Pharmaceuticals: Producer Price Index (PPI ethical prescription drugs) ............................. 2.308 4.2 

d. Professional Liability Insurance: Professional liability insurance Premiums 6 ............................... 3.865 ¥0.8 

e. Medical Equipment: PPI, medical instruments and equipment ..................................................... 2.055 ¥0.4 

f. Other Expenses .............................................................................................................................. 6.433 2.6 

1The rates of historical change are estimated for the 12-month period ending June 30, 2007, which is the period used for computing the CY 

2008 update. The price proxy values are based upon the latest available Bureau of Labor Statistics data as of August 31, 2007. 2The weights shown for the MEI components are the 2000 base year weights, which may not sum to subtotals or totals because of rounding. 

The MEI is a fixed weight, Laspeyres-type input price index whose category weights indicate the distribution of expenditures among the inputs to 

physicians’ services for CY 2000. To determine the MEI level for a given year, the price proxy level for each component is multiplied by its 2000 

weight. The sum of these products (weights multiplied by the price index levels) over all cost categories yields the composite MEI level for a 

given year. The annual percent change in the MEI levels is an estimate of price change over time for a fixed market basket of inputs to physicians’ services. 3These numbers may not sum due to rounding and the multiplicative nature of their relationship. 

4On March 23, 2006, Bureau of Labor Statistics introduced a new Multi Factor Productivity (MFP) series based on the 1997 NAICS classification system to replace its SIC based series published until 2005 (the last historical value was for 2002). The new series differs historically from 

the old MFP series and adds two new historical values through 2004. Therefore, we used the most recently available information (thru CY 2006) 

to develop the productivity adjustment for the CY 2008 update. 5The measures of productivity, average hourly earnings, Employment Cost Indexes, as well as the various Producer and CPIs can be found 

on the BLS Web site at http://stats.bls.gov. 6 Derived from data collected from several major insurers (the latest available historical percent change data are for the period ending second 

quarter of 2007). 7 In April 2007, with their March 2007 publication, Bureau of Labor Statistics (BLS) discontinued production and publication of the white collar 

occupation employment cost index (ECI) series. CMS replaced this proxy with a composite benefit series. The historical percent changes for the 

non physician employee benefits match the BLS white collar benefit series through 2006Q4, and from 2007Q1 forward, the percent changes reflect those of the composite benefit series. For more detail on the composite benefit series see the CY 2008 PFS proposed rule (72 FR 38190). 

Comment: Many commenters 

proposed that we should reduce the 

productivity adjustment to the MEI to 

0.65 percentage points from the 

proposed productivity adjustment of 1.5 

percentage points. They believe the MEI 

should be subject to the same 

productivity adjustment as the 

recommended productivity adjustment 

for hospital, hospice, and ambulance 

care providers, which they state was 

recommended in the President’s Budget 

proposal. The commenters also note that 

it is not logical for CMS to believe that 

physician’s productivity is increasing at 

twice the rate of other health care 

providers. 

Response: We disagree that the 

productivity adjustment to the MEI 

should be changed based on the 

proposals made in the FY 2008 

President’s Budget.4 The MEI has 

contained a productivity adjustment 

since its inception in 1973. The 

rationale for, and technical 

appropriateness of the current MEI 

productivity adjustment has been well 

documented in the Federal Register (for 

example, 67 FR 80020 through 80023). 

Moreover, we recently partnered with 


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the Assistant Secretary of Planning and 

Evaluation of the Department of Health 

and Human Services to sponsor an 

analysis of physician-specific 

productivity. The results of this effort 

were presented at a conference of 

stakeholders in October 2006. A highly 

respected panel of experts concluded 

that the use of the 10-year moving 

average for private, nonfarm business 

sector multifactor productivity was not 

an unreasonable proxy for physicianspecific productivity. Papers from this 

research effort are expected to be 

published in the forthcoming Winter 

2007/2008 edition of the Health Care 

Financing Review. We will continue to 

monitor, on an ongoing basis, the 

appropriateness of the use of this 

economy-wide measure of multifactor 

productivity for purposes of adjusting 

the MEI. 

With respect to historical productivity 

achievement in other health care 

sectors, there is comparatively little on 

this topic in the literature. We intend to 

continue to research various healthrelated productivity measures and 

would welcome the provision of data or 

completed studies on this topic. 

Comment: One commenter questioned 

why other providers receive a 0.65 

percent adjustment while physicians 

face an adjustment of more than twice 

that amount. 

Response: To date, there are no laws 

in place requiring productivity 

adjustments for other PPS-reimbursed 

providers such as hospitals, and skilled 

nursing facilities. However, the MEI has 

contained an explicit productivity 

adjustment since its inception in 1973. 

The rationale and technical 

appropriateness of the current MEI 

productivity adjustment was addressed 

in the CY 2003 PFS final rule with 

comment period (67 FR 80019). 

Comment: Several commenters 

requested that we address the broader 

issue that the MEI only measures 

changes in the specific types of practice 

costs that existed in 1973. They note 

that inputs to the MEI are vastly 

different now than when the MEI was 

first developed in the 1970s, and suggest 

additional inputs may be needed to 

ensure that the current MEI adequately 

measures the costs of practicing 

medicine. 

Response: We disagree with the 

commenters’ claim that the MEI only 

measures changes in specific types of 

practice costs that existed in 1973. The 

current MEI is based on costs reported 

by physicians for the year 2000. The 

2000-based cost weights are derived 

from the 2003 AMA Physician 

Socioeconomic Characteristics 

publication (2003 Patient Care 

Physician Survey data), which measures 

physicians’ earnings and overall PEs for 

2000. This is the latest available data on 

the breakdown of physician expenses. 

Although cost weights in the various 

market baskets do not tend to change 

dramatically over short periods of time, 

we do recognize that they can change 

over long periods of time. We are 

presently researching alternative data 

sources for a forthcoming rebasing of the 

MEI, including the potential use of an 

AMA-sponsored Physician Practice 

Information Survey that was fielded in 

2007. We have also considered data 

from the Census Bureau’s Business 

Expenditure Survey (BES). This survey 

is the most comprehensive source of 

periodic national industry statistics on 

major economic inputs by type. Data are 

published every 5 years for years ending 

in ‘‘2’’ and ‘‘7’’. Currently the most 

recent data is reported for 2002. We 

compared the cost weights we derived 

from the 2002 BES data for NAICS 6211, 

Offices of Physicians and found that the 

overall cost weights for compensation 

and all other costs are quite similar to 

the cost weights for the current MEI 

market basket as shown in Table 22. We 

are optimistic that the new data from 

AMA or the Census Bureau will be 

sufficiently robust for the purpose of 

updating the MEI’s input cost weights. 

TABLE 22.—A COMPARISON OF MAJOR

COST CATEGORY MEI MARKET BASKET WEIGHTS USING AMA AND BES 

DATA

MB 2000 

weights 

(percent) 

2002 BES 

(excluding 

capital) 

(percent) 

Compensation ... 71.2 73.5 

Other ................. 28.8 26.5 

Comment: Several commenters 

believe that the MEI does not adequately 

account for the costs related to the 

multitude of regulations and 

requirements that physicians must 

comply with in their practices. For 

example, they note that the physician 

quality reporting initiative (PQRI) has 

reduced productivity in physician’s 

offices. Similarly, a commenter had 

concerns that employee wages used in 

the MEI formula do not capture the 

wages of highly skilled professionals 

such as nurse practitioners, physician 

assistants, certified nurse specialists, 

nurse midwives, therapists, computer 

professional, and other types of 

professional occupations. 

Response: The current MEI cost 

weights are based on input costs 

reported by physicians for 2000, which 

would reflect changes in the 

distributions of the cost weights 

associated with new governmentimposed regulatory requirements up to 

that point. These cost weights are 

derived from the 2003 AMA Physician 

Socioeconomic Characteristics 

publication (2003 Patient Care 

Physician Survey data), which measures 

physicians’ earnings and overall PEs for 

CY 2000. While we understand that 

more recent data would better measure 

relative input costs, we presently lack a 

viable alternative data source with 

which to compute new cost weights. 

The data used as the basis for the 

current MEI market basket cost weights 

represent the latest available data on 

physician expenses. As stated 

previously, we are awaiting the data 

from the 2007 AMA Physician Practice 

Information Survey and are hopeful that 

this source will be sufficiently robust for 

use in rebasing the cost weights found 

in the MEI. We would expect that any 

relative cost changes related to 

regulatory changes would be reflected in 

this new data. 

Comment: One commenter suggested 

we should discontinue use of the MEI 

to measure physician input price 

pressures and switch to the same market 

basket update used by the hospital 

outpatient prospective payment system 

(OPPS). 

Response: We disagree with the 

commenter that physicians and 

outpatient hospital departments face the 

same input costs. 

The MEI reflects the cost structure 

and price changes associated with the 

inputs used in furnishing physicians’

services while the hospital market 

basket reflects the cost structure and 

price changes associated with the inputs 

used in providing hospital services. 

Comment: One commenter noted that 

input expenses for recruiting and 

employing trained personnel and other 

PEs in the physician’s office are 

identical to those in a hospital. 

Response: The expenses for trained 

personnel are captured in the PE portion 

of the MEI. These PE cost weights are 

derived from the 2003 AMA Physician 

Socioeconomic Characteristics 

publication (2003 Patient Care 

Physician Survey data), which measures 

physicians’ earnings and overall PEs for 

CY 2000. As indicated above in this 

section, while we understand that more 

recent data would better measure 

relative input costs, we presently lack a 

viable alternative data source with 

which to compute new cost weights. 

The data used as the basis for the 

current MEI market basket cost weights 

represent the latest available data on 

physician expenses. We are awaiting the 


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data from the 2007 AMA Physician 

Practice Information Survey and are 

hopeful that this source will be 

sufficiently robust for use in rebasing 

the cost weights found in the MEI. We 

would expect that any relative cost 

changes related to PE costs would be 

reflected in this new data. 

Comment: One commenter disagreed 

with the price proxy used for office 

expenses in the MEI noting that the 

growth in office rents differ from 

apartment rents. The commenter also 

suggested that we get data from a 

contractor comparing the cost of 

building medical office space to that of 

residential living space. 

Response: We agree that the 

construction costs of a physician’s office 

differ from the construction costs of a 

residential dwelling; however, the cost 

category for office expenses is not 

designed to measure the changes in 

initial construction costs. Instead, we 

attempt to measure the rate of price 

changes related to a monthly office 

expense payment. The majority of 

monthly office expenses are related to 

rent or mortgage for commercial space. 

As we are not aware of a publiclyavailable proxy that measures the price 

changes in rental costs of commercial 

space, we use what we believe to be the 

best, technically appropriate alternative; 

the consumer price index (CPI) for 

housing. Other major office expenses, 

such as medical equipment, are broken 

out in greater detail. Once data is 

available for the next rebasing of the 

MEI, we will explore the feasibility of 

breaking office expenses into more 

comprehensive cost categories. 

Comment: One commenter has 

concerns that the forecasts of the MEI 

have been and continue to be declining 

(from over 3 percent to below 2 percent) 

for the foreseeable future. The 

commenter would like for CMS to 

examine in more detail the assumptions 

of the price proxy forecasts produced by 

Global Insight Inc. (GII). 

Response: It is important to note that 

the MEI update is based on historical 

data rather than on forecasted data. For 

example, the CY 2008 update is based 

on the actual measured price inflation 

through the second quarter of 2007. 

Since the MEI update is based on 

historical data, not on a forecast, the 

concern that GII’s work does not involve 

forecasting the price proxies for 

compensation and PEs accurately is not 

relevant. Table 23 shows the MEI 

updates for the past 5 years and the 

current CY 2008 update. While the MEI 

update for CY 2003 through CY 2006 

was closer to 3.0 percent, the MEI 

update for CY 2007 and CY 2008 is 

closer to 2.0 percent. These lower 

updates are not, however, a function of 

an incorrect forecast. The recent lower 

overall MEI updates are a function of 

both a deceleration in input price 

pressures and relatively higher gains in 

multifactor productivity. 

TABLE 23.—MEI UPDATES FOR THE PAST 5 YEARS AND THE CURRENT CY 2008 UPDATE * 

MEI final updates Adjusted Unadjusted Productivity 

CY 2003 ....................................................................................................................................... 3.0 3.8 0.8 

CY 2004 ....................................................................................................................................... 2.9 3.8 0.9 

CY 2005 ....................................................................................................................................... 3.1 4.0 0.9 

CY 2006 ....................................................................................................................................... 2.8 3.8 1.0 

CY 2007 ....................................................................................................................................... 2.1 3.5 1.3 

CY 2008 ....................................................................................................................................... 1.8 3.2 1.4 

* Prior to the update for CY 2003 the MEI was adjusted for Labor productivity rather than by private non-farm multifactor productivity. 

Comment: One commenter stated that 

the only solution the commenter would 

support at this time would be a 

nationwide legislative solution that 

would provide additional funding for 

fair and equitable payment to Medicare 

participating physicians in every State. 

Response: We do not have the 

administrative authority to make such a 

legislative change. More so, this 

comment is beyond the scope of the MEI 

proposals of the CY 2008 PFS proposed 

rule. 

C. The Update Adjustment Factor (UAF) 

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. 

Section 101 of the MIEA TRHCA 

provided a 1 year increase in the CY 

2007 conversion factor. The provision 

specified that the CF for CY 2008 must 

be computed as if the 1 year increase for 

CY 2007 had never applied. 

1. Calculation Under Current Law 

Under section 1848(d)(4)(B) of the 

Act, the UAF for a year beginning with 

CY 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 (CY 2008 in this case), the 

current CY (that is, CY 2007) and the 

preceding CY (that is, CY 2006) are to 

be determined on the basis of the best 

data available as of September 1 of the 

current year. Allowed expenditures for 

a year are initially estimated and 

subsequently revised twice. The second 

revision occurs after the CY has ended 


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(that is, we are making the final revision 

to 2006 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 24 shows annual and 

cumulative allowed and actual 

expenditures for physicians’ services 

from April 1, 1996 through the end of 

the current CY, including the short 

periods in 1999 when we transitioned to 

a CY system. Also shown is the SGR 

corresponding with each period. The 

calculation of the SGR is discussed in 

detail below in this section. 

TABLE 24.—ANNUAL AND CUMULATIVE ALLOWED AND ACTUAL EXPENDITURES FOR PHYSICIANS’ SERVICES FROM APRIL 1, 

1996 THROUGH THE END OF THE CURRENT CALENDAR YEAR

Period 

Annual 

allowed 

expenditures 

($ in billions) 

Annual 

actual 

expenditures 

($ in billions) 

Cumulative 

allowed 

expenditures 

($ in billions) 

Cumulative 

actual 

expenditures 

($ in billions) 

FY/CY SGR 

4/1/96–3/31/97 .................................................. 1 $48.9 $48.9 $48.9 $48.9 N/A 

4/1/97–3/31/98 .................................................. 50.5 49.4 99.4 98.4 FY 1998=3.2% 

4/1/98–3/31/99 .................................................. 52.6 50.5 152.0 148.9 FY 1999=4.2% 

1/1/99–3/31/99 .................................................. 13.3 13.1 (2) 148.9 FY 1999=4.2% 

4/1/99–12/31/99 ................................................ 42.1 39.5 (3) 188.4 FY 2000=6.9% 

1/1/99–12/31/99 ................................................ 55.3 52.6 194.0 188.4 FY 1999/2000 

1/1/00–12/31/00 ................................................ 59.3 58.1 253.4 246.5 CY 2000=7.3% 

1/1/01–12/31/01 ................................................ 62.0 66.3 315.4 312.8 CY 2001=4.5% 

1/1/02–12/31/02 ................................................ 67.2 70.9 382.6 383.7 CY 2002=8.3% 

1/1/03–12/31/03 ................................................ 72.1 78.2 454.6 461.9 CY 2003=7.3% 

1/1/04–12/31/04 ................................................ 76.8 87.1 531.5 549.0 CY 2004=6.6% 

1/1/05–12/31/05 ................................................ 80.1 91.8 611.5 640.8 CY 2005=4.2% 

1/1/06–12/31/06 ................................................ 81.3 93.4 692.8 734.2 CY 2006=1.5% 

1/1/07–12/31/07 ................................................ 83.9 94.6 776.6 828.8 CY 2007=3.2% 

1/1/08–12/31/08 ................................................ 83.8 NA 860.4 NA CY 2008= 0.1% 

1Allowed expenditures in the first year (April 1, 1996–March 31, 1997) are equal to actual expenditures. All subsequent figures are equal to 

quarterly allowed expenditure figures increased by the applicable SGR. Cumulative allowed expenditures are equal to the sum of annual allowed 

expenditures. We provide more detailed quarterly allowed and actual expenditure data on our Web site at the following address: http:// 

www.cms.hhs.gov/SustainableGRatesConFact/. We expect to update the Web site with the most current information later this month. 2Allowed expenditures for the first quarter of 1999 are based on the FY 1999 SGR. 

3Allowed expenditures for the last three quarters of 1999 are based on the FY 2000 SGR. 

Consistent with section 1848(d)(4)(E) 

of the Act, Table 24 includes our final 

revision of allowed expenditures for CY 

2006, a recalculation of allowed 

expenditures for CY 2007, and our 

initial estimate of allowed expenditures 

for CY 2008. To determine the UAF for 

CY 2008, the statute requires that we 

use allowed and actual expenditures 

from April 1, 1996 through December 

31, 2007 and the CY 2008 SGR. 

Consistent with section 1848(d)(4)(E) of 

the Act, we will be making revisions to 

the CY 2007 and CY 2008 SGRs and CY 

2007 and CY 2008 allowed 

expenditures. Because we have 

incomplete actual expenditure data for 

CY 2007, 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 24 in 

the following statutory formula: 

UAF08

07

= 75 − × + Target Actual − −

Actual Target 07 07 4/96 12/07 . ActualActual SGR 4/96 12/07

 08

−

×

×

07

.33

UAF08 = Update Adjustment Factor for CY 

2008 = ¥26.7 percent 

Target07 = Allowed Expenditures for CY 2007 

= $83.9 billion 

Actual07 = Estimated Actual Expenditures for 

CY 2007 = $94.6 billion 

Target 4/96–12/07 = Allowed Expenditures from 

4/1/1996–12/31/2007 = $776.6 billion 

Actual 4/96–12/07 = Estimated Actual 

Expenditures from 4/1/1996–12/31/2007 

= $828.8 billion 

SGR08 = ¥0.1 percent (0.999) 

$. $.

$ .

$ .

$ .

83 9 94 6

94 6

828 8

94 6

− × −

×

 .75 + ×

$776.6

 0.999

 .33 = − 0 267 .

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 ¥0.267 is 

less than ¥0.070, the UAF for CY 2008 

will be ¥0.070. 

Section 1848(d)(4)(A)(ii) of the Act 

indicates that 1.0 should be added to the 

UAF determined under section 

1848(d)(4)(B) of the Act. Thus, adding 

1.0 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’


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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 

CY 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-forservice beneficiaries; 

(3) The estimated projected growth in 

real 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. (The Act also provides for 

adjustments to be made to the SGRs for 

FY 1998 and FY 1999. 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 CY 2008 

SGR, a revision to the CY 2007 SGR, and 

our final revision to the CY 2006 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 

November 1, 2001 Federal Register (66 

FR 55316). 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 PAs, certified registered 

nurse anesthetists, certified nurse 

midwives, clinical psychologists, 

clinical social workers, NPs, and 

certified nurse specialists. 

• Screening tests for prostate cancer, 

colorectal cancer, and glaucoma. 

• Screening mammography, 

screening pap smears, and screening 

pelvic exams. 

• Diabetes outpatient selfmanagement training (DSMT) services. 

• MNT 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 physical 

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 (70 FR 50940). 

Telehealth services and the power 

mobility device related services were 

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) (70 

FR 70305). 

Summary of Comments on the 

Physician Update and the SGR 

We appreciate the comments we 

received expressing concern about the 

negative update for CY 2008 and the 

SGR formula. These comments and our 

responses are summarized here. 

Comment: The 2007 Medicare 

Trustees Report projected an 

approximate 10 percent reduction in 

payment for physicians’ services in CY 

2008 and about a 5 percent reduction in 

each subsequent year through CY 2016. 

The cumulative impact of the projected 

reductions from CY 2008 to CY 2016 is 

estimated to be about ¥40 percent. In 

contrast, the MEI increase over this 

same period is projected to be about 15 

percent. 

Commenters noted that Medicare 

reimbursement does not reflect the 

actual costs of delivering services to 

Medicare beneficiaries. The commenters 

stated the reimbursement system has 

been unstable, and physicians cannot 

plan for the future in an unpredictable 

reimbursement environment that fails to 

keep pace with the costs of labor and 

supplies. Commenters also stated that 

practitioners unable to absorb the 

sustained losses will refuse or limit 

Medicare patients, resulting in reduced 

access to care. Commenters believe that 

beneficiaries will be forced to seek care 

in inpatient settings, which will be more 

costly for Medicare, less efficient in 

delivering care, and yield worse health 

outcomes for beneficiaries. 

Commenters recommended that the 

SGR be replaced with a more equitable 

and sustainable formula, such as an 

appropriate inflation rate linked to 

changes in the actual costs of medical 

practice. Many commenters suggested 

the MEI as an appropriate measure. 

Commenters requested that we assume 

the leadership in pushing the Congress 

to enact legislation preventing a 

negative update for CY 2008, and to 

replace the SGR with a more sustainable 

system. 

Response: We understand the 

potential implications of more than 9 

years of negative physician updates. We 

remain concerned regarding these 

trends, and we are closely monitoring 

physicians’ participation in the 

Medicare program, as well as 

beneficiaries’ access to care. 

It is a top priority at CMS to transform 

Medicare from a passive payor to an 

active purchaser of high quality, 

efficient health care services. We are 

studying and implementing value based 

purchasing initiatives for Medicare 

payment systems, including physicians’

services. In addition, the FY 2008 

President’s Budget supports budget 

neutral physician payment reform and 

states that ‘‘an important component of 

improving quality is encouraging more 

efficient and high-quality physician 

services.’’ (For further discussion of the 

President’s FY 2008 Budget initiatives 

to improve the quality, efficiency and 

transparency of health care, see http:// 

www.whitehouse.gov/omb/budget/ 

fy2008/hhs.html.) 


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Ultimately, the formula for the SGR 

and the physician update are dictated 

by statute. We are required to follow 

this methodology when calculating the 

payment rates under the PFS. We look 

forward to working with the Congress, 

the physician community, and other 

interested parties as we continue to 

analyze appropriate alternatives to the 

current system that could ensure 

appropriate payments while promoting 

high quality care, without increasing 

Medicare costs. 

Comment: Commenters noted that 

only physicians and other practitioners 

under the PFS face steep cuts under the 

SGR formula. The commenters also 

noted that other health care providers 

have payment updates that reflect the 

cost of inflation. Further, the 

commenters stated the approximately 10 

percent cut in payment rates is in stark 

contrast to providers enrolled in 

Medicare Advantage (MA) plans, who 

are paid on average 112 percent above 

the cost of traditional Medicare. 

Response: As noted previously, the 

formula for the SGR and the physician 

update are dictated by statute. We are 

required to follow this methodology 

when calculating the payment rates 

under the PFS. Other Medicare payment 

systems have their own update 

formulas. 

Comment: Many commenters 

requested that we use our 

administrative authority to reduce the 

negative physician update for CY 2008. 

Many commenters stated that we are 

authorized to remove the cost of 

Medicare-covered physicianadministered drugs from the SGR on a 

retrospective basis. They stated that we 

must also adjust the SGR target to reflect 

the impact of National and Local 

Coverage Decisions on physician 

spending. Commenters noted that the 

current formula does not account for 

costs and savings associated with new 

technologies. The commenters stated 

that if we make such administrative 

changes now, then the cost of legislation 

revising the payment methodology for 

physicians’ services will drop, and the 

likelihood of Congressional action to fix 

the SGR permanently will increase. 

Commenters expressed frustration that 

these administrative adjustments have 

been requested numerous times, yet we 

have never implemented the changes. 

Response: We indicated in the past 

(most recently in the CY 2007 PFS final 

rule with comment period (71 FR 

69756)) that many of these 

administrative changes are statutorily 

difficult, and according to our current 

estimates, making such changes would 

not provide relief from the projected 

negative updates for the next several 

years. As indicated above in this 

section, we are working with the 

Congress and health professional 

organizations on potential reforms that 

would improve the effectiveness of the 

payment methodology for physicians 

without increasing overall Medicare 

costs. 

Comment: Commenters noted that 

payment updates under the SGR are tied 

to the gross domestic product (GDP), 

which bears little relationship to 

Medicare beneficiaries’ health care 

needs or physician practice costs. 

Commenters noted that medical needs 

of individual patients are not related to 

the growth of the overall economy, and 

beneficiaries’ medical needs do not 

decline during economic downturns. 

Commenters stated that MEI is a better 

reflection than GDP of the growth in 

health care costs. 

Response: As discussed in the CY 

2007 PFS final rule with comment 

period (71 FR 69756), the percentage 

change in the MEI is one of the key 

components used to update the PFS CF. 

GDP is a general measure of economic 

growth. It is not intended to reflect 

factors specific to operating a medical 

practice because these factors are 

captured in the MEI. The statute 

requires that GDP be used as a 

component of the SGR, which is then 

used to calculate the target level of 

expenditures. Although both MEI and 

GDP are factors that affect the 

calculation of the CF, the MEI has a 

more direct and greater impact on the 

physician update than GDP. 

Comment: Commenters stated that 

additional funds need to be added to the 

SGR allowed expenditures for all the 

ancillary costs associated with new 

benefits. New benefits adjust the target, 

but they generate other services whose 

costs are not added to the targeted 

allowed expenditures. 

Response: As discussed in the CY 

2007 PFS final rule with comment 

period (71 FR 69756 through 69757), 

our estimate of changes in expenditures 

arising from changes in laws and 

regulations includes induced spending 

impacts, when applicable and material. 

Our estimate of the additional 

expenditures associated with any new 

benefit, like all of the figures used to 

determine a particular year’s SGR, is an 

estimate that will be revised based on 

subsequent data. A 2-year look back 

window allows adjustments to the 

estimates to reflect actual impacts. 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. (See below in this section for 

a discussion of all the new benefits that 

were considered in estimating the 

change in expenditures due to changes 

in law and regulation in 2006, 2007, and 

2008.) 

C. Preliminary Estimate of the SGR for 

2008 

Our preliminary estimate of the CY 

2008 SGR is ¥0.1 percent. We first 

estimated the CY 2008 SGR in March 

2007, and made the estimate available to 

the MedPAC and on our Web site. Table 

25 shows the March 2007 estimate and 

our current estimates of the factors 

included in the CY 2008 SGR. 

TABLE 25.—2008 SGR CALCULATION

Statutory factors March estimate Current estimate 

Fees ............................................................... 2.0 percent (1.020) ............................................................................ 1.9 percent (1.019). 

Enrollment ...................................................... ¥0.2 percent (0.998) ......................................................................... ¥0.7 percent (0.993). 

Real Per Capita GDP ..................................... 1.9 percent (1.019) ............................................................................ 1.7 percent (1.017). 

Law and Regulation ....................................... ¥1.5 percent (0.985) ......................................................................... ¥2.9 percent (0.971). 

Total ........................................................ 2.2 percent (1.022) ............................................................................ ¥0.1 percent (0.999). 

Note: Consistent with section 1848(f)(2) of the Act, the statutory factors are multiplied, not added, to produce the total (that is, 1.019 × 0.993 × 

1.017 × 0.971 = 0.999). A more detailed explanation of each figure is provided in section VII.F.1 of this preamble. 


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D. Revised Sustainable Growth Rate for 

2007 

Our current estimate of the CY 2007 

SGR is 3.2 percent. Table 26 shows our 

preliminary estimate of the CY 2007 

SGR that was published in the CY 2007 

PFS final rule with comment period (71 

FR 69757) and our current estimate. 

TABLE 26.—2007 SGR CALCULATION

Statutory factors Estimate from CY 2006 

final rule Current estimate 

Fees ............................................................................................................................... 2.2 percent (1.022) ............. 1.9 percent (1.019). 

Enrollment ...................................................................................................................... ¥0.9 percent (0.991) ......... ¥2.6 percent (0.974). 

Real Per Capita GDP .................................................................................................... 2.0 percent (1.020) ............. 1.9 percent (1.019). 

Law and Regulation ....................................................................................................... ¥1.5 percent (0.985) ......... 2.0 percent (1.020). 

Total ........................................................................................................................ 1.8 percent (1.018) ............. 3.2 percent (1.032). 

A more detailed explanation of each 

figure is provided in section VIII.F.2 of 

this preamble. 

E. Final Sustainable Growth Rate for 

2006 

The SGR for 2006 is 1.5 percent. Table 

27 shows our preliminary estimate of 

the 2006 SGR from the CY 2006 PFS 

final rule with comment period (70 FR 

70309), our revised estimate from the 

CY 2007 PFS final rule with comment 

period (71 FR 69757) and the final 

figures determined using the best 

available data as of September 1, 2007. 

TABLE 27.—2006 SGR CALCULATION

Statutory factors Estimate from CY 2006 

final rule 

Estimate from CY 2007 

final rule Final 

Fees .............................................................................. 2.7 percent (1.027) ............. 2.2 percent (1.022) ............. 2.1 percent (1.021). 

Enrollment ..................................................................... ¥3.1 percent (0.969) ......... ¥2.2 percent (0.978) ......... ¥2.6 percent (0.974). 

Real Per Capita GDP ................................................... 2.2 percent (1.022) ............. 2.1 percent (1.021) ............. 2.1 percent (1.021). 

Law and Reg ................................................................. 0.0 percent (1.000) ............. 0.0 percent (1.000) ............. 0.0 percent (1.000). 

Total ....................................................................... 1.7 percent (1.017) ............. 2.1 percent (1.021) ............. 1.5 percent (1.015). 

A more detailed explanation of each 

figure is provided in section VIII.F.3. 

F. Calculation of CY 2008, CY 2007, and 

CY 2006 Sustainable Growth Rates 

1. Detail on the CY 2008 SGR 

All of the figures used to determine 

the CY 2008 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 CY 2008 

This factor is calculated as a 

weighted-average of the CY 2008 

changes in fees 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 80.4 percent of total 

allowed charges included in the SGR in 

CY 2008 and are updated using the MEI. 

The MEI for CY 2008 is 1.8 percent. 

Diagnostic laboratory tests are estimated 

to represent approximately 7.6 percent 

of Medicare allowed charges included 

in the SGR for CY 2008. 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 CY 2004 

through CY 2008. 

Drugs are estimated to represent 12.0 

percent of Medicare allowed charges 

included in the SGR in CY 2008. We 

estimated a weighted average change in 

fees for drugs included in the SGR 

(using the ASP + 6 percent pricing 

methodology) of 4.0 percent for CY 

2008. 

Table 28 shows the weighted average 

of the MEI, laboratory, and drug price 

changes for CY 2008. 

TABLE 28.—WEIGHTED AVERAGE OF

THE MEI, LABORATORY, AND DRUG

PRICE CHANGES FOR CY 2008 

Weight Update 

Physician .................. 0.804 1.8 

Laboratory ................. 0.076 0.0 

Drugs ........................ 0.120 4.0 

TABLE 28.—WEIGHTED AVERAGE OF

THE MEI, LABORATORY, AND DRUG

PRICE CHANGES FOR CY 2008—

Continued 

Weight Update 

Weighted-average .... 1.000 1.9 

We estimate that the weighted average 

increase in fees for physicians’ services 

in CY 2008 under the SGR (before 

applying any legislative adjustments) 

will be 1.9 percent. 

• Factor 2—The Percentage Change in 

the Average Number of Part B Enrollees 

From CY 2007 to CY 2008 

This factor is our estimate of the 

percent change in the average number of 

fee-for-service enrollees from CY 2007 

to CY 2008. 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 feefor-service enrollees will decrease by 0.7 

percent from CY 2007 to CY 2008. Table 

29 illustrates how this figure was 

determined. 


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TABLE 29.—AVERAGE NUMBER OF MEDICARE PART B FEE-FOR-SERVICE ENROLLEES

[(Excluding beneficiaries enrolled in MA plans) from CY 2007 to CY 2008] 

2007 2008 

Overall ..................................................................................................................................................... 40.726 million ........ 41.480 million. 

Medicare Advantage (MA) ...................................................................................................................... 7.890 million ........... 8.888 million. 

Net ........................................................................................................................................................... 32.836 million ........ 32.592 million. 

Percent Increase ..................................................................................................................................... ................................ ¥0.7 percent. 

An important factor affecting fee-forservice enrollment is beneficiary 

enrollment in Medicare Advantage (MA) 

plans. Because it is difficult to estimate 

the size of the MA enrollee population 

before the start of a CY, 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 

CY 2008 becomes known. 

• Factor 3—Estimated Real Gross 

Domestic Product Per Capita Growth in 

2008 

We estimate that the growth in real 

GDP per capita from CY 2007 to CY 

2008 will be 1.7 percent (based on the 

10-year average GDP over the 10-years 

of 1999–2008). 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 

2008. 

• Factor 4—Percentage Change in 

Expenditures for Physicians’ Services 

Resulting From Changes in Statute or 

Regulations in CY 2008 Compared With 

CY 2007 

The statutory and regulatory 

provisions that will affect expenditures 

in CY 2008 relative to CY 2007 are 

estimated to have an impact on 

expenditures of ¥2.9 percent. These 

provisions include the expiration of the 

MMA provisions for the work GPCI 

floor and HPSA bonuses, the DRA 

provision reducing payments for 

imaging services, and the MIEA–TRHCA 

provisions regarding the conversion 

factor and the 2007 PQRI reporting 

bonuses payable in 2008. The details of 

these provisions are discussed 

elsewhere in this final rule with 

comment. 

2. Detail on the 2007 SGR 

A more detailed discussion of our 

revised estimates of the four elements of 

the 2007 SGR follows. 

• Factor 1—Changes in Fees for 

Physicians’ Services (Before Applying 

Legislative Adjustments) for 2007 

This factor was calculated as a 

weighted-average of the 2007 changes in 

fees 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 82.5 

percent of total allowed charges 

included in the SGR in CY 2007. These 

services were updated using the CY 

2007 MEI of 2.1 percent. We estimate 

that diagnostic laboratory tests represent 

approximately 7.3 percent of total 

allowed charges included in the SGR in 

CY 2007. 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 CY 2004 through CY 2008. 

We estimate that drugs represent 10.2 

percent of Medicare-allowed charges 

included in the SGR in CY 2007. We 

estimate a weighted-average change in 

fees for drugs included in the SGR of 1.3 

percent for CY 2007. 

Table 30 shows the weighted-average 

of the MEI, laboratory, and drug price 

changes for CY 2007. 

TABLE 30.—WEIGHTED AVERAGE OF

THE MEI, LABORATORY, AND DRUG

PRICE CHANGES FOR CY 2007 

Weight Update 

Physician .................. 0.825 2.1 

Laboratory ................. 0.073 0.0 

Drugs ........................ 0.102 1.3 

Weighted-average .... 1.000 1.9 

After taking into account the elements 

described in Table 30, we estimate that 

the weighted-average increase in fees for 

physicians’ services in 2007 under the 

SGR (before applying any legislative 

adjustments) will be 1.9 percent. Our 

estimate of this factor in the CY 2007 

PFS final rule with comment period was 

2.2 percent. The decrease in the 

estimate is due to the availability of 

some actual data. 

• Factor 2—The Percentage Change in 

the Average Number of Part B Enrollees 

from CY 2006 to CY 2007 

OACT estimates that the average 

number of Medicare Part B fee-forservice enrollees (excluding 

beneficiaries enrolled in Medicare 

Advantage plans) decreased by 2.6 

percent in CY 2007. Table 31 illustrates 

how we determined this figure. 

TABLE 31.—AVERAGE NUMBER OF MEDICARE PART B FEE-FOR-SERVICE ENROLLEES

[(Excluding beneficiaries enrolled in MA plans) from CY 2006 to CY 2007] 

2006 2007 

Overall ............................................................... 40.271 million ................................................... 40.726 million. 

Medicare Advantage (MA) ................................. 6.550 million ..................................................... 7.890 million. 

Net ..................................................................... 33.721 million ................................................... 32.836 million. 

Percent Increase ............................................... ...................................................................... ¥2.6 percent. 

OACT’s estimate of the ¥2.6 

percentage change in the number of feefor-service enrollees, net of Medicare 

Advantage enrollment for CY 2007 

compared to CY 2006, is lower than our 

original estimate of ¥0.9 percent in the 

CY 2007 PFS final rule with comment 

period (71 FR 69758). While our current 

projection based on data from 8 months 

of 2007 is lower than our original 

estimate of ¥0.9 percent when we had 

no actual data, it is still possible that 


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our final estimate of this figure will be 

different once we have complete 

information on CY 2007 fee-for-service 

enrollment. 

• Factor 3—Estimated Real Gross 

Domestic Product Per Capita Growth in 

CY 2007 

We estimate that the growth in real 

GDP per capita will be 1.9 percent for 

CY 2007 (based on the 10-year average 

GDP over the 10 years of CY 1998 

through CY 2007). 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 CY 2007 

economic performance becomes 

available to us in 2008. 

• Factor 4—Percentage Change in 

Expenditures for Physicians’ Services 

Resulting From Changes in Statute or 

regulations in CY 2007 Compared With 

CY 2006 

The statutory and regulatory 

provisions that will affect expenditures 

in CY 2007 relative to CY 2006 are 

estimated to have an impact on 

expenditures of 2.0 percent. These 

provisions include the DRA provisions 

adding the AAA ultrasound test to the 

Welcome to Medicare visit as a 

preventive benefit and reducing 

payments for imaging services. Also 

included is the MIEA–TRHCA 1-year 

adjustment to the conversion factor. The 

details of these provisions are discussed 

elsewhere in this final rule with 

comment. 

3. Detail on the CY 2006 SGR 

A more detailed discussion of our 

final revised estimates of the four 

elements of the CY 2006 SGR follows. 

• Factor 1—Changes in Fees for 

Physicians’ Services (Before Applying 

Legislative Adjustments) for 2006 

This factor was calculated as a 

weighted average of the CY 2006 

changes in fees 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 83.8 

percent of total Medicare-allowed 

charges included in the SGR for CY 

2006 and are updated using the MEI. 

The MEI for CY 2006 was 2.8 percent. 

Diagnostic laboratory tests represented 

approximately 7.2 percent of total CY 

2006 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 CY 2004 

through CY 2008. Drugs represented 

approximately 9.1 percent of total 

Medicare-allowed charges included in 

the SGR for CY 2006. We estimate a 

weighted-average change in fees for 

drugs included in the SGR of ¥2.8 

percent for 2006. Table 32 shows the 

weighted average of the MEI, laboratory, 

and drug price changes for CY 2006. 

TABLE 32.—WEIGHTED AVERAGE OF

THE MEI, LABORATORY, AND DRUG

PRICE CHANGES FOR CY 2006 

Weight Update 

Physician .................. 0.838 2.8 

Laboratory ................. 0.072 0.0 

Drugs ........................ 0.091 ¥2.8 

Weighted-average .... 1.000 2.1 

After taking into account the elements 

described in Table 32, we estimate that 

the weighted-average increase in fees for 

physicians’ services in CY 2006 under 

the SGR (before applying any legislative 

adjustments) was 2.1 percent. This 

figure is a final one based on complete 

data for CY 2006. 

• Factor 2—The Percentage Change in 

the Average Number of Part B Enrollees 

from CY 2005 to CY 2006 

We estimate the decrease in the 

number of fee-for-service enrollees 

(excluding beneficiaries enrolled in MA 

plans) from CY 2005 to CY 2006 was 2.6 

percent. Our calculation of this factor is 

based on complete data from CY 2006. 

Table 33 illustrates the calculation of 

this factor. 

TABLE 33.—AVERAGE NUMBER OF MEDICARE PART B FEE-FOR-SERVICE ENROLLEES

[(Excluding beneficiaries enrolled in MA plans) from CY 2005 to CY 2006] 

2005 2006 

Overall ............................................................... 39.698 million ................................................... 40.271 million. 

Medicare Advantage (MA) ................................. 5.084 million ..................................................... 6.550 million. 

Net ..................................................................... 34.615 million ................................................... 33.721 million. 

Percent Increase ............................................... ...................................................................... ¥2.6 percent. 

• Factor 3—Estimated Real Gross 

Domestic Product Per Capita Growth in 

2006 

We estimate that the growth in real 

per capita GDP was 2.1 percent in 2006 

(based on the 10-year average GDP over 

the 10 years of CY 1997 through CY 

2006). This figure is a final one based on 

complete data for CY 2006. 

• Factor 4—Percentage Change in 

Expenditures for Physicians’ Services 

Resulting From Changes in Statute or 

Regulations in CY 2006 Compared With 

CY 2005 

Our final estimate for the net impact 

on expenditures from the statutory and 

regulatory provisions that affect 

expenditures in CY 2006 relative to CY 

2005 is less than 0.05 percent. These 

provisions include the expiration of the 

temporary higher payments to 

physicians in Alaska, the new power 

wheelchair code for physicians, and the 

IVIG pre-administration fee. 

VIII. Anesthesia and Physician Fee 

Schedule Conversion Factors for CY 

2008 

The CY 2008 PFS CF will be 

$34.0682. The CY 2008 national average 

anesthesia CF is $16.3176. Both CFs will 

be subject to a separate, independent BN 

adjustor, as described below. 

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 timesplied by the 

update determined under section 

1848(d)(4) of the Act, as amended by the 

MIEA–TRHCA. Section 101 of the 

MIEA–TRHCA provided a 1-year 

increase in the CY 2007 CF and 

specified that the CF for CY 2008 must 

be computed as if the 1-year increase 

had never applied. 

The PFS update for CY 2008 is 

determined by timesplying the CY 2007 

conversion factor update that would 

have occurred in the absence of the 

MIEA–TRHCA (as published in 71 FR 

69760), the estimated MEI, and the 


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estimated update adjustment factor, as 

shown in Table 34 (0.89896 = 0.94953 

× 1.018 × 0.930). To determine the 

estimated CY 2008 CF, the Pre-MIEA–

TRHCA CY 2007 CF update is applied 

to the CY 2006 CF of $37.8975 to 

produce the Pre-MIEA–TRHCA CY 2007 

CF of $35.9848. Then applying the 

estimated MEI for CY 2008 and the 

estimated UAF for CY 2008 to the PreMIEA–TRHCA CY 2007 a CF produces 

an estimated CF for CY 2008 of 

$34.0682. We illustrate the calculation 

for the 2008 PFS CF in Table 34. 

TABLE 34.—CALCULATION OF THE CY 2008 CONVERSION FACTOR

CY 2006 Conversion Factor ........................................................................................................................................... $37.8975. 

Pre-MIEA–TRHCA CY 2007 CF Update ........................................................................................................................ ¥5.0 percent (0.94953). 

CY 2007 Pre-MIEA–TRHCA Conversion Factor ............................................................................................................ $35.9848. 

2008 MEI ........................................................................................................................................................................ 1.8 percent (1.018). 

2008 Update adjustment factor ...................................................................................................................................... ¥7.0 percent (0.930). 

CY 2008 Update ............................................................................................................................................................. ¥5.3 percent (0.94674). 

CY 2008 Conversion Factor Update .............................................................................................................................. ¥10.1 percent (0.89896). 

CY 2008 Conversion Factor ........................................................................................................................................... $34.0682. 

Section 1848(c)(2)(B)(ii)(II) of the Act 

requires that increases or decreases in 

RVUs for a year may not cause the 

amount of expenditures for the year to 

differ by more than $20 million from 

what expenditures would have been in 

the absence of these changes. If this 

threshold is exceeded, we must make 

adjustments to preserve BN. 

The 5-Year Review of work RVUs, 

including the refinement to the work 

RVU changes for the additional codes 

and the increases in the work of 

anesthesia services, would result in a 

change in expenditures that would 

exceed $20 million if we made no 

offsetting adjustments to either the CF 

or RVUs. As discussed in section IV.C.3 

of this final rule with comment period, 

we are applying the following BN 

adjustor to the work RVUs in order to 

calculate payment for a service: 

2008 Work Adjustor: 11.94 percent 

(0.8806) 

Payment for services under the PFS 

will be calculated as follows: 

Payment = [(RVU work × BN adjustor 

(round product to two decimal places) 

× GPCI work) + (RVU PE × GPCI PE) + 

(RVU malpractice × GPCI malpractice)] 

× CF 

B. Anesthesia Fee Schedule Conversion 

Factor 

We calculate the physician anesthesia 

CF similar to the general PFS CF in 

Table 34. As noted, section 101 of the 

TRCHA provided for a 1-year increase 

in the CY 2007 conversion factor and 

specified the conversion factor for 2008 

must be computed as if the 1-year 

increase had never applied. The PFS 

update for CY 2008 is determined by 

timesplying the CY 2007 conversion 

factor that would have occurred in the 

absence of TRCHA by the estimated MEI 

and the estimated update adjustment 

factor for 2008. 

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 PE methodology 

using imputed anesthesia RVUs that 

were made comparable to other PFS 

services. The 2008 adjustment factor in 

Table 35 includes the combined effect of 

the PE adjustment, the increase in work 

of anesthesia services under the recent 

five year review and the BN adjustment. 

We illustrate the calculation for the 

2008 anesthesia CF in Table 35. 

TABLE 35.—CALCULATION FOR THE 2008 ANESTHESIA CONVERSION FACTOR

CY 2006 Anesthesia Conversion Factor ........................................................................................................................ $17.7663. 

Pre-TRHCA CY 2007 CF Update ................................................................................................................................... ¥5.0 percent (0.94953). 

2007 Combined Adjustment for PE and BN .................................................................................................................. 0.9089. 

CY 2007 Pre-TRHCA Anesthesia Conversion Factor .................................................................................................... $15.3328. 

2008 MEI ........................................................................................................................................................................ 1.8 percent (1.018). 

2008 Update adjustment factor ...................................................................................................................................... ¥7.0 percent (0.930). 

CY 2008 Anesthesia CF after MEI and 2008 Adjustment Factor .................................................................................. $14.5162. 

2008 Combined Adjustment for PE and BN .................................................................................................................. 1.1250. 

CY 2008 Anesthesia Conversion Factor ........................................................................................................................ $16.3307. 

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 2008 is 1.8 

percent. 

Therefore, for CY 2007, the payment 

amount for HCPCS code Q3014, 

Telehealth originating site facility fee, is 

80 percent of the lesser of the actual 

charge or $23.35. The Medicare 

telehealth originating site facility fee 

and MEI increase by the applicable time 

period is shown in Table 36. 


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TABLE 36.—THE MEDICARE TELEHEALTH ORIGINATING SITE FACILITY FEE AND MEI INCREASE BY THE APPLICABLE TIME

PERIOD

Facility fee MEI increase 

(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 

$22.94 .............................................................................................................................................. 2.1 01/01/2007–12/31/2007 

$23.35 .............................................................................................................................................. 1.8 01/01/2008–12/31/2008 

X. Provisions of the Final Rule 

The provisions of this final rule with 

comment restate the provisions of the 

CY 2008 PFS proposed rule, except as 

noted elsewhere in the preamble. 

XI. Waiver of Proposed Rulemaking 

and Delay in Effective Date 

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. 

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) require 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 in this 

section, 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. 

In addition, we ordinarily publish a 

notice of proposed rulemaking in the 

Federal Register and provide a period 

for public comment before we make 

final the provisions of the notice. We 

can waive this procedure, however, if 

we find good cause that notice-andcomment procedure is impracticable, 

unnecessary, or contrary to the public 

interest and we incorporate a statement 

of finding and its reasons in the notice 

issued. We find it unnecessary to 

undertake notice and comment 

rulemaking in this instance for the 

ambulance inflation factor because the 

law specifies the method of 

computation of annual updates, and we 

have no discretion in this matter. 

Further, we are merely applying the 

update method specified in statute and 

regulation. Therefore, under 5 U.S.C. 

553(b)(B), for good cause, we waive 

notice and comment procedures for this 

ambulance inflation factor update. 

XII. Collection of Information 

Requirements 

Under the Paperwork Reduction Act 

of 1995, we are required to provide 60- 

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. 

This final rule with comment period 

does not contain any new information 

collection requirements. However, we 

are republishing the discussion of the 

information collection requirements as 

it appeared in the CY 2008 PFS 


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proposed rule (72 FR 38122). We are 

soliciting public comment on each of 

these issues for the following sections of 

this document that contain information 

collection requirements. 

Independent Diagnostic Testing Facility 

(§ 410.33) 

Section 410.33(g)(2) states that an 

independent diagnostic testing facility 

(IDTF) should provide complete and 

accurate information on its Medicare 

enrollment application. In addition, an 

IDTF is required to notify its designated 

fee-for-service contractor within 30-days 

of any changes in ownership, changes of 

location, changes in general 

supervision, and any adverse legal 

actions. The notification must be made 

on the Medicare enrollment application. 

All of the changes to the enrollment 

application must be reported within 90 

days. 

The aforementioned requirements are 

not new. The burden associated with 

completing the Medicare enrollment 

application is currently approved under 

OMB control number 0938–0685. The 

collection has an expiration date of 

April 30, 2009. 

Section 410.33(g)(6) states the 

comprehensive liability insurance 

requirements for IDTFs. Specifically, 

§ 410.33(g)(6)(1) states they must have a 

comprehensive insurance policy to 

notify the CMS designated contractor, in 

writing, of any policy changes or 

cancellations. The burden associated 

with this requirement is the time and 

effort necessary to draft and submit the 

written notification to the CMS 

designated contractor. While this 

requirement is subject to the PRA, we 

believe it is exempt from the PRA as 

stipulated under 5 CFR 1320.3(h)(6). 

This information will be collected on 

case by case basis. 

Section 410.33(g)(8) requires an IDTF 

to answer, document, maintain 

documentation of beneficiaries 

questions and responses to beneficiary 

complaints at the physical site of the 

IDTF. Sections 410.33(g)(8) (i through 

iii) list the minimum amount of 

documentation needed to comply with 

this requirement. The burden associated 

with these requirements is the time and 

effort associated with responding to 

beneficiary questions and complaints, 

documenting the actions taken in 

response to the questions and 

complaints, and maintaining the 

documentation. While this requirement 

is subject to the PRA, we believe the 

associated burden is exempt under 5 

CFR 1320.3(b)(2). The burden associated 

with documenting and maintaining the 

documentation of the corrective actions 

is a usual and customary business 

practice. The time, effort, and financial 

resources necessary to comply this 

information collection requirement 

would be incurred by persons in the 

normal course of their activities (for 

example, in compiling and maintaining 

business records) and is not subject to 

the PRA. 

Basis of Payment (§ 414.707) 

Section 414.707(c) states that effective 

January 1, 2008, each request for 

payment for anti-anemia drugs 

furnished to treat anemia resulting from 

the treatment of cancer must report the 

beneficiary’s most recent hemoglobin or 

hematocrit level. The burden associated 

with this requirement is the time and 

effort associated with obtaining the most 

recent hemoglobin or hematocrit levels 

and documenting it on the request for 

payment. The requirement and its 

associated burden are not subject to the 

PRA under 5 CFR 1320.3(h)(5). The 

interpretation of biological analyses of 

body fluids, tissues, or other specimens, 

or the identification or classification of 

such specimens is not subject to the 

PRA. 

Term of Contract (§ 414.914) 

Section 414.914(h) states that the 

approved CAP vendor must verify drug 

administration prior to the collection of 

any applicable cost sharing amount. As 

part of the verification process, 

§ 414.914(h)(1) through (2) states lists 

the documentation that is required as 

part of the verification process. Section 

414.914(h)(3) states that the approved 

CAP vendor must provide this 

information to CMS or the beneficiary 

upon request. 

The burden associated with the 

requirements in § 414.914(1) through (3) 

is the time and effort needed to verify 

the drug administration. When 

obtaining written verification, the CAP 

vendor must document the elements 

listed in § 414.914(h)(1)(i) through (vi). 

When obtaining verbal verification, the 

CAP vendor must document the 

elements listed in § 414.914(h)(2)(i) 

through (ii). We believe the 

requirements and their associated 

burden are not subject to the PRA; they 

are part of the CAP vendor’s usual and 

customary business practices as 

stipulated under 5 CFR 1320.3(h)(5). 

In addition, § 414.914(h)(3) imposes 

both recordkeeping and reporting 

requirements. We believe that the 

burden associated with the 

recordkeeping requirement imposed by 

§ 414.914(h)(3) is not subject to the PRA 

under 5 CFR 1320.3(c)(4) because it 

would affect less than 10 persons. 

The reporting requirement places 

burden on the CAP vendor to provide 

the information listed in § 414.914(h) 

(1–2) to a beneficiary upon request. We 

estimate that the CAP vendor will 

receive 72 requests per year from 

beneficiaries. We believe it will take 15 

minutes per request for the vendor to 

provide this information to the 

beneficiary. The total annual burden 

associated with this requirement is 1080 

minutes or 18 burden hours. However, 

we believe this information collection 

requirement and the associated burden 

is not subject to the PRA as defined in 

5 CFR 1320.3(c)(4) because it would 

affect less than 10 persons. 

Compendia for Determination of 

Medically-Accepted Indications for OffLabel Uses of Drugs and Biologicals in 

an Anti-Cancer Chemotherapeutic 

Regimen (§ 414.930) 

Section 414.930(b) states the process 

for listing compendia for determining 

medically-accepted uses of drugs and 

biologicals in anti-cancer treatment. We 

will annually provide an annual 

opportunity to request changes to the 

list of compendia. As stated in 

§ 414.930(c)(1), CMS will review a 

complete written request that is 

submitted in writing, electronically or 

via hard copy. A complete written 

request must contain the following 

information as stated in 

§ 414.930(c)(1)(i) through (vi): Full name 

and contact information for the 

requestor; full identification of the 

compendium in question; a complete 

written copy of the compendium in 

question; the specific action requested 

of CMS; supporting documentation for 

the requested action; address a single 

compendium per request. 

The burden associated with the 

requirements contained in § 414.930(b) 

through (c) is the time and effort 

required to draft and submit to CMS a 

complete written request for changes to 

the list of compendia. While these 

requirements are subject to the PRA, we 

believe the burden is exempt under 5 

CFR 1320.3(c)(4) because it would affect 

less than 10 persons or entities. There 

are only 6 compendia that could 

reasonably be expected to be the subject 

of a request, so 6 requests is a likely 

maximum. 

Signature Requirements (§ 424.36) 

Section 424.36(a) requires the 

beneficiary’s signature on a claim for 

payment of services unless the 

beneficiary has died or the provisions of 

§ 424.36(b), (c), or (d) apply. Section 

424.36(b) states that if the beneficiary is 

physically or mentally incapable of 

signing the claim, the claim may be 

signed by one of the parties specified in 

§ 424.36(b)(1) through (5). Proposed 


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§ 424.36(b)(6) states that, for emergency 

ambulance transport services, if certain 

conditions and documentation 

requirements are met, an ambulance 

provider or supplier would be permitted 

to sign the claim on behalf of the 

beneficiary. Specifically, 

§ 424.36(b)(6)(ii)(A) through (C) lists the 

documentation that would be required, 

all of which would have to be 

maintained by the ambulance provider 

or supplier in its files for a period of at 

least 4 years from the date of service. An 

ambulance provider or supplier would 

be required to obtain a signed, 

contemporaneous statement from an 

ambulance employee present during 

transport of the patient that, at the time 

the service was provided, the 

beneficiary was physically or mentally 

incapable of signing the claim and that 

none of the other qualified parties listed 

in § 424.36(b)(1) through (5) were 

available or willing to sign the claim on 

behalf of the beneficiary. 

The ambulance provider or supplier 

would also be required to maintain 

documentation of the date and time that 

the beneficiary was transported and the 

name and location of the facility that 

received the beneficiary. In addition, the 

ambulance provider or supplier would 

be required to obtain and maintain a 

signed contemporaneous statement from 

a representative of the facility that 

received the beneficiary. The statement 

would have to contain the name of the 

beneficiary and the date and time the 

beneficiary was received at the facility. 

The burden associated with the 

recordkeeping requirements contained 

in § 424.36(b)(6) is the time and effort 

associated with drafting, obtaining, and 

maintaining written statements from 

both employees of the ambulance 

provider or supplier transporting the 

beneficiary and employees of the facility 

receiving the beneficiary. We estimate 

that 9,000 ambulance providers or 

suppliers will comply with these 

requirements. We estimate that it will 

take no more than five minutes for each 

provider or supplier to comply with the 

recordkeeping requirements. Based on 

the best available data at this time, we 

estimate the total annual burden 

associated with the requirements in 

§ 424.36(b)(6) to be 541,667 hours 

nationwide. The annual total number of 

burden hours was arrived at by 

multiplying five minutes by the total 

estimated number of emergency 

ambulance transports of 6,500,000. We 

note that the total number of burden 

hours may be overstated, because not 

every beneficiary who receives 

emergency ambulance transport services 

is unable to sign the claim. However, we 

also note that the 6.5 million figure for 

emergency transports is the estimated 

number of ALS1-emergency and BLSemergency ambulance claims processed 

by Part B carriers, incurred in 2006 and 

processed through April of 2007, and 

thus does not include the number of 

emergency ambulance transport services 

billed to fiscal intermediaries by 

ambulance providers (which number is 

not available to us). In any event, we 

believe our proposal will benefit 

ambulance providers and suppliers by 

allowing them an alternative procedure 

for submitting claims to Medicare. In 

the absence of the proposed procedure 

for signing claims on behalf of 

beneficiaries for emergency ambulance 

transport services, ambulance suppliers 

and providers would be required to 

track down beneficiaries after the 

emergency transport services have been 

rendered, in an attempt to have the 

beneficiary sign the claim. Moreover, 

such attempts may prove fruitless, 

thereby preventing the ambulance 

suppliers and providers from submitting 

the claim to Medicare. 

Additional Information Collection 

Requirements 

This final rule with comment period 

imposes collection of information 

requirements as outlined in the 

regulation text and specified above. 

However, this final rule with comment 

period also makes reference to several 

associated information collections that 

are not discussed in the regulation text. 

The following is a discussion of these 

collections, which have already 

received OMB approval. 

Part B Drug Payment 

Section II.F.1 of the preamble 

discusses payment for Medicare Part B 

drugs and biologicals under the ASP 

methodology. Drug manufacturers are 

required to submit ASP data to us on a 

quarterly basis. As stated in section 

II.F.1.a of the preamble, the ASP 

reporting requirements are set forth in 

section 1927(b) of the Act. 

The collection of ASP data imposes a 

reporting requirement on the public. 

The burden associated with this 

requirement is the time and effort 

required by manufacturers of Medicare 

Part B drugs and biologicals to calculate, 

record, and submit the required data to 

CMS. While the burden associated with 

this requirement is subject to the PRA, 

it is currently approved under OMB 

control number 0938–0921, with an 

expiration date of May 31, 2009. 

Competitive Acquisition Program (CAP) 

In section II.F.2.d of the preamble, we 

propose to revise the CAP physician 

election agreement. In conjunction with 

post-payment review process, we are 

revising the CAP physician election 

agreement to reflect the physician’s 

obligation to provide medical records to 

assist with claims review. The CAP 

physician election agreement is 

currently approved under 0938–0955 

with an expiration date of August 31, 

2009. Under a separate notice, we will 

make the revised instrument available 

for public comment prior to submitting 

the revised information collection 

request to OMB for approval. 

Section II.F.2.f of the preamble 

discusses details of the competitive 

acquisition program. Each year, 

physicians are given the option to elect 

to obtain Medicare Part B drugs and 

biologicals through the CAP. In 

addition, physicians are also given an 

opportunity to select an approved CAP 

vendor. The burden associated with 

these election requirements is the time 

and effort necessary for a physician to 

make an election and notify CMS. The 

burden associated with election 

requirements for participating in the 

CAP and selecting an approved CAP 

vendor is subject to the PRA. However, 

it is currently approved under OMB 

control numbers 0938–0955 and 0938–

0987 with expiration dates of August 31, 

2009 and April 30, 2009, respectively. 

Section II.F.2.g. of the preamble also 

discusses the exigent circumstances 

exception for leaving the CAP outside of 

the annual election process. A physician 

may request a release from the CAP 

within the first 60 days of his or her 

participation if he or she can show that 

CAP participation imposes a burden on 

the practice, or later if he or she can 

show that a change in circumstances 

that was not known to the practice 

previously results in a burden to the 

practice. Specifically, the physician 

must submit a release request to the 

CAP-designated carrier. 

While this burden is subject to the 

PRA, we believe it is exempt under 5 

CFR 1320.3(h)(6). Facts or opinions 

collected from a single person or entity 

are not subject to the PRA. The 

aforementioned information collection 

request will be reviewed individually 

on a case by cases basis. 

If the designated carrier receives an 

exigent circumstance removal request 

related to the approved CAP vendor’s 

service, it is required to refer the 

physician to his or her approved CAP 

vendor within 1 business day of its 

receipt of the request. As part of the 

grievance process, the CAP vendor will 

try to work with the physician to 

address their concerns with respect to 

participation in the program. The 

designated carrier can alternatively 

continue to investigate, and within 2 


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business days of its receipt of the 

request, can request a single 2-business 

day extension (after which it must 

submit findings and a recommendation 

to CMS), submit findings and a 

recommendation to CMS that the 

physician be permitted to terminate his 

or her CAP participation, or submit 

findings and a recommendation to CMS 

that the physician not be permitted to 

terminate his or her CAP participation. 

Requests from physicians will be 

reviewed by CAP vendors on an 

individual, case by case basis. We will 

continue to monitor the process. If we 

believe that we will receive 10 or more 

requests, we will submit an information 

collection request to OMB. 

Physician Quality Reporting Initiative 

(PQRI) 

Section II.U.1.a of the preamble 

discusses the background of the 

reporting initiative and provides 

information about the measures 

available to eligible professionals who 

choose to participate in PQRI. Section 

1848(k)(1) of the Act requires the 

Secretary to implement a system for 

eligible professionals to submit data 

pertaining to certain quality measures. 

As stated in section II.U.1.a, eligible 

professionals, for the purpose of the 

quality reporting system, include 

physicians, other practitioners as 

described in section 1842(b)(18)(c) of 

the Act, physical and occupational 

therapists, and qualified speechlanguage pathologists. As also stated in 

section II.U.1.a, this is a voluntary 

initiative. Eligible professionals may 

choose whether to participate and, to 

the extent they satisfactorily submit data 

on quality measures for covered 

professional services, they can qualify to 

receive a bonus incentive payment. 

Specifically, to qualify to receive a 

bonus incentive payment for satisfactory 

reporting of quality data on covered 

professional services furnished in 2007, 

an eligible professional must submit 

data on 1, 2, or 3 measures selected from 

the 74 PQRI 2007 quality measures. The 

minimum number of measures each 

professional must report in order to 

qualify for the bonus payment is 

determined by how many available 

measures are applicable to the services 

that professional furnishes to Medicare 

beneficiaries. For a majority of the 

eligible professionals, the requirement, 

per 1848(k) of the Act, will be that they 

satisfactorily report on at least three 

measures. An eligible professional could 

meet the satisfactory reporting 

requirement, and thus be eligible for the 

bonus incentive payment, by reporting 

fewer than three measures only if his or 

her practice has fewer than three 

applicable measures. The quality 

measures are posted and available for 

download on the CMS Web site at 

http://www.cms.hhs.gov/pqri. 

The burden associated with this 

requirement is the time and effort 

associated with eligible professionals 

identifying applicable PQRI quality 

measures for which they can report the 

necessary information. In addition, they 

must gather the required information, 

select the appropriate quality data 

codes, and include the appropriate 

quality-data codes on the claims they 

submit for payment. 

In 2007, the PQRI will collect qualitydata codes exclusively as additional 

(optional) line items on the existing 

HIPAA transaction 837–P and/or CMS 

Form 1500. There will be no new forms 

and no modifications to the existing 

transaction or form in support of 2007 

PQRI. CMS also does not anticipate 

changes to the 837–P or CMS Form 1500 

for 2008. 

Because this is a voluntary program, 

it is impossible to estimate with any 

degree of accuracy how many eligible 

professionals will opt to participate in 

the PQRI in 2008. Moreover, the time 

needed for an eligible professional to 

review the quality measures and other 

information, select measures applicable 

to his or her patients and the services he 

or she furnishes to them, and 

incorporate the use of quality data codes 

into the office work flows is expected to 

vary along with the number of measures 

that are potentially applicable to a given 

professional’s practice. We estimate that 

the additional time required to put 

quality data codes on each claim is not 

a material increment to the time 

required to code the claim for payment. 

The total estimated annual burden for 

this requirement will also vary along 

with the volume of claims on which 

quality data is reported. 

TABLE 37.—ESTIMATED ANNUAL REPORTING AND RECORDKEEPING BURDEN

Regulation section(s) OMB control 

No. Respondents Responses 

Total annual 

burden 

(hours) 

Preamble section II.F.1 .................................................................................... 0938–0921 120 480 17,760 

Preamble section II.F.2.f .................................................................................. 0938–0955 12 12 480 

§ 410.33 ........................................................................................................... 0938–0685 400,000 400,000 1,000,000 

§ 424.36 ........................................................................................................... 0938–New 9,000 6,500,000 541,667 

Total .......................................................................................................... ........................ ........................ ........................ 1,579,907 

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: William N. Parham, III, 

CMS–1385–FC, 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: Carolyn 

Lovett, CMS Desk Officer, [CMS–1385–

P], carolyn_lovett@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 

Mandates Reform Act of 1995 (Pub. L. 

104–4), and Executive Order 13132. 

Executive Order 12866 (as amended 

by Executive Order 13258, which 


cprice-sewell on PROD1PC72 with RULES
66388 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

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 in this regulatory impact 

analysis, we estimate that the PFS 

provisions included in this final rule 

with comment period rule will 

redistribute more than $100 million in 

1 year. We are considering this final rule 

with comment period rule 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 period is 

a major rule and we have prepared a 

regulatory impact analysis. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

entities. For purposes of the RFA, small 

entities include small businesses, 

nonprofit organizations, and small 

governmental jurisdictions. Most 

hospitals and most other providers and 

suppliers are small entities, either by 

nonprofit status or by having revenues 

of $6.5 million to $31.5 million in any 

1 year (For further information, see the 

Small Business Administration’s 

regulation at 70 FR 72577, December 6, 

2003.) Individuals and States are not 

included in the definition of a small 

entity. 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. 

For purposes of the RFA, physicians, 

NPPs, and suppliers, including IDTFs, 

are considered small businesses if they 

generate revenues of $6.5 million or 

less. Approximately 95 percent of 

physicians are considered to be small 

entities. There are about 980,000 

physicians, other practitioners and 

medical suppliers that receive Medicare 

payment under the PFS. 

The CAP provides alternatives to 

physicians who do not wish to purchase 

drugs directly or collect coinsurance. 

The impact of the CAP provisions on an 

individual physician is dependent on 

whether the drugs they furnish to 

Medicare beneficiaries are included in 

the list of CAP drugs, whether the 

physician chooses to obtain drugs 

administered to Medicare beneficiaries 

through the CAP. The CAP provisions in 

this final rule with comment period will 

also have a potential impact on entities 

that are involved in the dispensing or 

distribution of drugs, plan to become 

approved CAP vendors, or are approved 

CAP vendors. 

For purposes of the RFA, 

approximately 80 percent of clinical 

diagnostic laboratories are considered 

small businesses according to the Small 

Business Administration’s size 

standards. Ambulance providers and 

suppliers for purposes of the RFA are 

also considered to be small entities. 

In addition, most ESRD facilities are 

considered small entities, either based 

on nonprofit status or by having 

revenues of $31.5 million or less in any 

year. We consider a substantial number 

of entities to be affected if the rule is 

estimated to impact more than 5 percent 

of the total number of small entities. 

Based on our analysis of the 915 

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 period will have a 0.9 percent 

increase in overall payments to 

nonprofit ESRD facilities relative to 

current overall payments. The analysis 

and discussion provided in this section, 

as well as elsewhere in this final rule 

with comment period, complies with 

the RFA requirements. 

For the e-prescribing provisions, 

physician practices and independent 

pharmacies are considered small 

entities. 

Because we acknowledge that many of 

the affected entities are small entities, 

the analysis discussed throughout the 

preamble of this final rule with 

comment period constitutes our 

regulatory flexibility analysis for the 

remaining provisions. 

Section 1102(b) of the Act requires us 

to prepare a regulatory impact analysis 

for any final rule with comment period 

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 period would have 

minimal impact on small hospitals 

located in rural areas. Of the 202 

hospital based ESRD facilities located in 

rural areas, only 40 are affiliated with 

hospitals with fewer than 100 beds. 

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 $127 million. This 

final rule with comment period will not 

mandate any requirements for State, 

local, or tribal governments. Medicare 

beneficiaries are considered to be part of 

the private sector for this purpose. A 

discussion concerning the impact of this 

rule on beneficiaries is found later in 

this section. 

We have examined this final rule with 

comment period 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. 

We have prepared the following 

analysis, which, together with the 

information provided in the rest of this 

preamble, meets all assessment 

requirements. The analysis explains the 

rationale for and purposes of this final 

rule with comment period rule; details 

the costs and benefits of the rule; 

analyzes alternatives; and presents the 

measures we use to minimize the 

burden on small entities. As indicated 

elsewhere in this final rule with 

comment period, 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 period. We are 

unaware of any relevant Federal rules 

that duplicate, overlap or conflict with 

this final rule with comment period. 

The relevant sections of this final rule 

with comment period contain a 

description of significant alternatives if 

applicable. 


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Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66389 

A. RVU Impacts 

1. Resource-Based Work and PE RVUs 

Section 1848(c)(2)(B)(ii) of the Act 

requires that increases or decreases in 

RVUs may not cause the amount of 

expenditures for the year to differ by 

more than $20 million from what 

expenditures would have been in the 

absence of these changes. If this 

threshold is exceeded, we make 

adjustments to preserve BN. In the CY 

2007 PFS final rule with comment 

period, the $4 billion impact of changes 

in work RVUs resulting from the 5-Year 

Review required that a BN adjustment 

be made. 

As discussed in section IV.D.3 of the 

CY 2007 PFS final rule with comment 

period (71 FR 69735), we carefully 

reviewed the comments received 

concerning the BN adjustment needed 

to offset the $4 billion impact of changes 

in work RVUs resulting from the 5-Year 

Review. To meet the requirements set 

forth in section 1848(c)(2)(B)(ii)(II) of 

the Act, we implemented a BN adjustor 

of 0.8994 or 10.1 percent to be applied 

to the work RVUs. 

Subsequent to the publication of the 

CY 2007 PFS final rule with comment 

period and the announcement of the 

0.8994 BN adjustment to the work 

RVUs, the AMA RUC supplied work 

RVU recommendations on additional 

CPT codes from the 5-Year Review and 

recommendations for an increase in the 

work of anesthesia services. As stated in 

the CY 2007 PFS final rule with 

comment period, these additional codes 

are still considered part of the 5-Year 

Review. The impact of these additional 

recommendations and increases in the 

work of anesthesia services on the BN 

adjustment must be accounted for by 

revising the current work adjustor of 

0.8994. The work adjustor for CY 2008, 

based upon the final work RVUs for 

these additional CPT codes and 

increases in the work of anesthesia 

services, is approximately 0.8806. Table 

38 shows the specialty-level impact of 

the work and PE RVU changes. 

Our estimates of changes in Medicare 

revenues for PFS services compare 

payment rates for CY 2007 with 

payment rates for CY 2008 using CY 

2006 Medicare utilization for all years. 

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 in Table 38. 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 38 shows only the payment 

impact on PFS services. The following 

is an explanation of the information 

represented in Table 38. 

• Specialty: The physician specialty 

or type of practitioner/supplier. 

• Allowed charges: Allowed charges 

are the Medicare Fee Schedule amounts 

for covered services and include 

copayments and deductibles (which are 

the financial responsibility of the 

beneficiary.) These amounts have been 

summed across all services furnished by 

physicians, practitioners, or suppliers 

within a specialty to arrive at the total 

allowed charges for the specialty. 

• Impact of Work RVU Changes for 

additional changes in work RVUs from 

the 5-Year Review. 

• Impact of PE RVU changes. The 

impact is shown for both 2008 which is 

the second year of the 4-year transition 

using the new methodology and the 

fully implemented 2010 PE RVUs. 

• Combined impact of the finalized 

work RVUs and PE RVUs for both 2008 

and the fully implemented 2010 PE 

RVUs. 

TABLE 38.—COMBINED TOTAL ALLOWED CHARGE IMPACT FOR WORK AND PRACTICE EXPENSE RVU CHANGES

Specialty 

Allowed 

charges 

(mil) 

Impact of 

work RVU 

changes 

(percent) 

Impact of PE RVU 

changes 

(percent) 

Combined impact of PE 

and work changes* 

2008 

(PE trans. 

year 2) 

(percent) 

2010 

(PE full implement.) 

(percent) 

2008 

(PE trans. 

year 2) 

(percent) 

2010 

(PE full implement.) 

(percent) 

TOTAL .............................................................................. $76,551 0 0 0 0 0 

ALLERGY/IMMUNOLOGY ............................................... 173 1 1 3 2 4 

ANESTHESIOLOGY ........................................................ 1,579 15 ¥1 ¥3 14 12 

CARDIAC SURGERY ...................................................... 396 ¥1 ¥1 ¥2 ¥2 ¥3 

CARDIOLOGY ................................................................. 7,519 ¥1 ¥1 ¥3 ¥2 ¥4 

COLON AND RECTAL SURGERY ................................. 122 ¥1 1 2 0 2 

CRITICAL CARE .............................................................. 199 ¥1 0 0 ¥1 ¥2 

DERMATOLOGY ............................................................. 2,248 ¥1 2 7 2 7 

EMERGENCY MEDICINE ............................................... 2,203 ¥2 0 ¥1 ¥2 ¥2 

ENDOCRINOLOGY ......................................................... 350 ¥1 0 0 ¥1 ¥1 

FAMILY PRACTICE ......................................................... 5,060 0 0 1 0 1 

GASTROENTEROLOGY ................................................. 1,750 ¥1 1 4 0 3 

GENERAL PRACTICE ..................................................... 974 0 0 0 0 0 

GENERAL SURGERY ..................................................... 2,309 ¥1 0 0 ¥1 0 

GERIATRICS ................................................................... 147 3 0 1 3 4 

HAND SURGERY ............................................................ 80 ¥1 ¥1 ¥3 ¥2 ¥4 

HEMATOLOGY/ONCOLOGY .......................................... 1,917 ¥1 0 0 ¥1 ¥1 

INFECTIOUS DISEASE ................................................... 504 ¥1 0 1 ¥1 0 

INTERNAL MEDICINE ..................................................... 9,981 1 0 0 0 0 

INTERVENTIONAL RADIOLOGY ................................... 244 ¥1 ¥1 ¥3 ¥2 ¥4 

NEPHROLOGY ................................................................ 1,664 ¥1 ¥1 ¥4 ¥3 ¥5 

NEUROLOGY .................................................................. 1,398 ¥1 0 ¥1 ¥1 ¥2 

NEUROSURGERY .......................................................... 576 ¥1 ¥1 ¥2 ¥2 ¥3 

NUCLEAR MEDICINE ..................................................... 78 ¥1 5 14 4 14 


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66390 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

TABLE 38.—COMBINED TOTAL ALLOWED CHARGE IMPACT FOR WORK AND PRACTICE EXPENSE RVU CHANGES—

Continued 

Specialty 

Allowed 

charges 

(mil) 

Impact of 

work RVU 

changes 

(percent) 

Impact of PE RVU 

changes 

(percent) 

Combined impact of PE 

and work changes* 

2008 

(PE trans. 

year 2) 

(percent) 

2010 

(PE full implement.) 

(percent) 

2008 

(PE trans. 

year 2) 

(percent) 

2010 

(PE full implement.) 

(percent) 

OBSTETRICS/GYNECOLOGY ........................................ 628 ¥1 0 ¥1 ¥1 ¥1 

OPHTHALMOLOGY ........................................................ 4,664 2 ¥1 ¥3 1 ¥1 

ORTHOPEDIC SURGERY .............................................. 3,248 ¥1 0 ¥1 ¥1 ¥2 

OTOLARNGOLOGY ........................................................ 913 2 ¥1 ¥3 1 ¥1 

PATHOLOGY ................................................................... 948 ¥1 ¥1 ¥3 ¥2 ¥4 

PEDIATRICS .................................................................... 74 0 0 0 0 0 

PHYSICAL MEDICINE ..................................................... 784 1 ¥1 ¥2 ¥1 ¥2 

PLASTIC SURGERY ....................................................... 272 ¥1 0 1 ¥1 0 

PSYCHIATRY .................................................................. 1,099 ¥1 1 2 0 1 

PULMONARY DISEASE .................................................. 1,691 ¥1 0 1 ¥1 0 

RADIATION ONCOLOGY ................................................ 1,612 ¥1 1 2 0 1 

RADIOLOGY .................................................................... 5,245 ¥1 1 2 0 1 

RHEUMATOLOGY ........................................................... 494 ¥1 0 ¥1 ¥1 ¥2 

THORACIC SURGERY ................................................... 436 ¥1 ¥1 ¥2 ¥2 ¥3 

UROLOGY ....................................................................... 2,033 ¥1 0 0 ¥1 ¥1 

VASCULAR SURGERY ................................................... 641 ¥1 0 0 ¥1 ¥1 

AUDIOLOGIST ................................................................. 31 26 ¥14 ¥43 12 ¥17 

CHIROPRACTOR ............................................................ 725 ¥1 ¥1 ¥2 ¥2 ¥3 

CLINICAL PSYCHOLOGIST ........................................... 531 ¥1 ¥2 ¥6 ¥3 ¥7 

CLINICAL SOCIAL WORKER ......................................... 354 ¥1 ¥2 ¥5 ¥3 ¥6 

NURSE ANESTHETIST ................................................... 608 22 0 0 22 21 

NURSE PRACTITIONER ................................................. 796 2 0 1 2 3 

OPTOMETRY .................................................................. 790 4 0 ¥1 4 3 

ORAL/MAXILLOFACIAL SURGERY ............................... 37 ¥1 1 3 1 3 

PHYSICAL/OCCUPATIONAL THERAPY ........................ 1,391 ¥1 1 4 1 4 

PHYSICIAN ASSISTANT ................................................. 600 0 0 1 0 0 

PODIATRY ....................................................................... 1,575 0 2 5 2 5 

DIAGNOSTIC TESTING FACILITY ................................. 1,191 0 0 1 0 1 

INDEPENDENT LABORATORY ...................................... 1,087 0 3 10 3 10 

PORTABLE X-RAY SUPPLIER ....................................... 81 0 2 7 2 7 

* Components may not sum to total due to rounding. 

2. Adjustments for Payments for 

Imaging Services 

Section 1848(c)(2)(B)(iv)(II) of the Act 

as added by section 5102 of the Deficit 

Reduction Act of 2005 (Pub. L. 109–171) 

(DRA) exempts the estimated savings 

from the application of the OPPS based 

payment limitation on PFS imaging 

services from the PFS BN requirement. 

We estimate that the combined impact 

of the current BN exemptions instituted 

by such section, the addition of 6 codes 

to the list of services subject to the DRA 

OPPS cap (discussed in section II.E.1.), 

and the payment revisions to OPPS cap 

amounts would result in no measurable 

changes in the specialty specific 

impacts of the DRA provisions with the 

exception of vascular surgery in CY 

2008. 

3. Combined Impact 

Table 39 shows the specialty-level 

impact of the work and PE RVU 

changes, section 5102 of the DRA 

(including the additional 6 services that 

were added to the list of services subject 

to the DRA OPPS cap and the revision 

to OPPS payment amounts), and our 

most recent estimate (¥10.1 percent) of 

the CY 2008 Medicare PFS update. 

Additionally, the impacts in this final 

rule with comment period rule reflect 

the use of updated physician time data 

from the AMA–RUC. 

As indicated in Table 39, our 

estimates of changes in Medicare 

revenues for PFS services compare 

payment rates for CY 2007 with 

payment rates for CY 2008 using CY 

2006 Medicare utilization crosswalked 

to 2008 services. To the extent that there 

are year-to-year changes in the volume 

and mix of services furnished by 

physicians, the actual impact on total 

Medicare revenues will be different than 

those shown in Table 39. 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 furnishes. 

Table 39 shows only the payment 

impact on PFS services. The following 

is an explanation of the information 

represented in Table 39. 

• Specialty: The physician specialty 

or type of practitioner/supplier. 

• Allowed Charges: Allowed charges 

are the Medicare Fee Schedule amounts 

for covered services and include 

copayments and deductibles (which are 

the financial responsibility of the 

beneficiary.) These amounts have been 

summed across all services furnished by 

physicians, practitioners, or suppliers 

within a specialty to arrive at the total 

allowed charges for the specialty. 

• Impact of the CY 2008 Work and PE 

RVU changes using the methodology 

finalized in the CY 2007 PFS final rule 

with comment period and the revised 

data sources discussed in this final rule 

with comment period. 

• Impact of section 5102 of the DRA: 

The CY 2008 percentage decrease in 

allowed charges attributed to section 

5102 of the DRA with the addition of six 

codes to the OPPS cap list and revisions 

to the OPPS payment amounts. 


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Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66391 

• Combined impact of the finalized 

work and PE RVUs, section 5102 of the 

DRA and the addition of six codes to the 

OPPS cap list, and the revisions to 

OPPS payment amounts. 

• CY 2008 Update: The percentage 

decrease in allowed charges attributed 

to the estimated CY 2008 PFS 

conversion factor update of ¥10.1 

percent. 

• Combined impact with CY 2008 

update: The CY 2008 percentage 

decrease in allowed charges attributed 

to the impact of the work and PE RVU 

changes, section 5102 of the DRA (plus 

six additions to OPPS cap list), revisions 

to OPPS payment amounts, and the CY 

2008 update. 

TABLE 39.—COMBINED CY 2008 TOTAL ALLOWED CHARGE IMPACT FOR THE REMAINING 5-YEAR REVIEW OF WORK

RVUS AND PRACTICE EXPENSE CHANGES, OPPS IMAGING CAP, AND THE CY 2008 UPDATE

Specialty 

Allowed 

charges 

(mil) 

Impact of 

work and 

PE RVU 

changes * 

(percent) 

Impact of 

DRA 5102 

(percent) 

Combined 

impact RVU 

and DRA 

5102 ** 

(percent) 

CY 2008 

update 

(percent) 

Combined 

impact with 

CY 2008 

update ** 

(percent) 

TOTAL .............................................................................. $76,551 0 0 0 ¥10 ¥10 

ALLERGY/IMMUNOLOGY ............................................... 173 2 0 2 ¥10 ¥8 

ANESTHESIOLOGY ........................................................ 1,579 14 0 14 ¥10 4 

CARDIAC SURGERY ...................................................... 396 ¥2 0 ¥2 ¥10 ¥12 

CARDIOLOGY ................................................................. 7,519 ¥2 0 ¥2 ¥10 ¥12 

COLON AND RECTAL SURGERY ................................. 122 0 0 0 ¥10 ¥10 

CRITICAL CARE .............................................................. 199 ¥1 0 ¥1 ¥10 ¥11 

DERMATOLOGY ............................................................. 2,248 2 0 2 ¥10 ¥8 

EMERGENCY MEDICINE ............................................... 2,203 ¥2 0 ¥2 ¥10 ¥12 

ENDOCRINOLOGY ......................................................... 350 ¥1 0 ¥1 ¥10 ¥11 

FAMILY PRACTICE ......................................................... 5,060 0 0 0 ¥10 ¥10 

GASTROENTEROLOGY ................................................. 1,750 0 0 0 ¥10 ¥10 

GENERAL PRACTICE ..................................................... 974 0 0 0 ¥10 ¥10 

GENERAL SURGERY ..................................................... 2,309 ¥1 0 ¥1 ¥10 ¥11 

GERIATRICS ................................................................... 147 3 0 3 ¥10 ¥7 

HAND SURGERY ............................................................ 80 ¥2 0 ¥2 ¥10 ¥12 

HEMATOLOGY/ONCOLOGY .......................................... 1,917 ¥1 0 ¥1 ¥10 ¥11 

INFECTIOUS DISEASE ................................................... 504 ¥1 0 ¥1 ¥10 ¥11 

INTERNAL MEDICINE ..................................................... 9,981 0 0 0 ¥10 ¥10 

INTERVENTIONAL RADIOLOGY ................................... 244 ¥2 0 ¥2 ¥10 ¥12 

NEPHROLOGY ................................................................ 1,664 ¥3 0 ¥3 ¥10 ¥13 

NEUROLOGY .................................................................. 1,398 ¥1 0 ¥1 ¥10 ¥11 

NEUROSURGERY .......................................................... 576 ¥2 0 ¥2 ¥10 ¥12 

NUCLEAR MEDICINE ..................................................... 78 4 0 5 ¥10 ¥5 

OBSTETRICS/GYNECOLOGY ........................................ 628 ¥1 0 ¥1 ¥10 ¥11 

OPHTHALMOLOGY ........................................................ 4,664 1 0 1 ¥10 ¥9 

ORTHOPEDIC SURGERY .............................................. 3,248 ¥1 0 ¥1 ¥10 ¥11 

OTOLARNGOLOGY ........................................................ 913 1 0 1 ¥10 ¥9 

PATHOLOGY ................................................................... 948 ¥2 0 ¥2 ¥10 ¥12 

PEDIATRICS .................................................................... 74 0 0 0 ¥10 ¥10 

PHYSICAL MEDICINE ..................................................... 784 ¥1 0 ¥1 ¥10 ¥11 

PLASTIC SURGERY ....................................................... 272 ¥1 0 ¥1 ¥10 ¥11 

PSYCHIATRY .................................................................. 1,099 0 0 0 ¥10 ¥10 

PULMONARY DISEASE .................................................. 1,691 ¥1 0 ¥1 ¥10 ¥11 

RADIATION ONCOLOGY ................................................ 1,612 0 0 0 ¥10 ¥10 

RADIOLOGY .................................................................... 5,245 0 0 0 ¥10 ¥10 

RHEUMATOLOGY ........................................................... 494 ¥1 0 ¥1 ¥10 ¥11 

THORACIC SURGERY ................................................... 436 ¥2 0 ¥2 ¥10 ¥12 

UROLOGY ....................................................................... 2,033 ¥1 0 ¥1 ¥10 ¥11 

VASCULAR SURGERY ................................................... 641 ¥1 ¥1 ¥1 ¥10 ¥11 

AUDIOLOGIST ................................................................. 31 12 0 12 ¥10 2 

CHIROPRACTOR ............................................................ 725 ¥2 0 ¥2 ¥10 ¥12 

CLINICAL PSYCHOLOGIST ........................................... 531 ¥3 0 ¥3 ¥10 ¥13 

CLINICAL SOCIAL WORKER ......................................... 354 ¥3 0 ¥3 ¥10 ¥13 

NURSE ANESTHETIST ................................................... 608 22 0 22 ¥10 12 

NURSE PRACTITIONER ................................................. 796 2 0 2 ¥10 ¥8 

OPTOMETRY .................................................................. 790 4 0 4 ¥10 ¥6 

ORAL/MAXILLOFACIAL SURGERY ............................... 37 1 0 1 ¥10 ¥9 

PHYSICAL/OCCUPATIONAL THERAPY ........................ 1,391 1 0 1 ¥10 ¥9 

PHYSICIAN ASSISTANT ................................................. 600 0 0 0 ¥10 ¥10 

PODIATRY ....................................................................... 1,575 2 0 2 ¥10 ¥8 

DIAGNOSTIC TESTING FACILITY ................................. 1,191 0 0 0 ¥10 ¥10 

INDEPENDENT LABORATORY ...................................... 1,087 3 0 3 ¥10 ¥7 

PORTABLE X-RAY SUPPLIER ....................................... 81 2 0 2 ¥10 ¥8 

* PE changes are CY 2008 second year transition changes. For fully implemented CY 2010 PE changes see Table 1. 

** Components may not sum to total due to rounding. 


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66392 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

Table 40 shows the estimated impact 

on total payments for selected high 

volume procedures of all of the changes 

discussed previously. We selected these 

procedures because they are the most 

commonly furnished 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 

Addendum A of this final rule with 

comment period rule. 

TABLE 40.—IMPACT OF FINAL RULE WITH COMMENT PERIOD AND ESTIMATED PHYSICIAN UPDATE ON 2008 PAYMENT FOR

SELECTED PROCEDURES

CPT/HCPCS MOD Description 

Facility Non-facility 

2007 2008 Percent 

change 2007 2008 Percent change 

11721 .......... ............ Debride nail, 6 or more .................................. $28.80 $24.53 ¥15 $39.03 $35.43 ¥9 

17000 .......... ............ Destruct premalg lesion ................................. 44.72 41.56 ¥7 63.29 60.30 ¥5 

27130 .......... ............ Total hip arthroplasty ..................................... 1,360.52 1,194.77 ¥12 na na na 

27244 .......... ............ Treat thigh fracture ......................................... 1,100.92 963.11 ¥13 na na na 

27447 .......... ............ Total knee arthroplasty .................................. 1,464.74 1,283.35 ¥12 na na na 

33533 .......... ............ CABG, arterial, single .................................... 1,908.52 1,658.44 ¥13 na na na 

35301 .......... ............ Rechanneling of artery ................................... 1,071.74 934.49 ¥13 na na na 

43239 .......... ............ Upper GI endoscopy, biopsy ......................... 155.00 140.36 ¥9 325.16 294.01 ¥10 

66821 .......... ............ After cataract laser surgery ............................ 253.53 222.81 ¥12 270.97 237.80 ¥12 

66984 .......... ............ Cataract surg w/iol, 1 stage ........................... 641.98 560.08 ¥13 na na na 

67210 .......... ............ Treatment of retinal lesion ............................. 556.34 487.86 ¥12 580.59 507.96 ¥13 

71010 .......... ............ Chest x-ray ..................................................... na na na 26.15 22.83 ¥13 

71010 .......... 26 Chest x-ray ..................................................... 8.72 7.84 ¥10 8.72 7.84 ¥10 

77056 .......... ............ Mammogram, both breasts ............................ na na na 97.40 93.35 ¥4 

77056 .......... 26 Mammogram, both breasts ............................ 41.31 37.48 ¥9 41.31 37.48 ¥9 

77057 .......... ............ Mammogram, screening ................................ na na na 81.86 73.93 ¥10 

77057 .......... 26 Mammogram, screening ................................ 33.35 30.32 ¥9 33.35 30.32 ¥9 

77427 .......... ............ Radiation tx management, x5 ........................ 176.22 158.42 ¥10 176.22 158.42 ¥10 

78465 .......... 26 Heart image (3d), multiple ............................. 73.14 66.43 ¥9 73.14 66.43 ¥9 

88305 .......... 26 Tissue exam by pathologist ........................... 37.90 32.36 ¥15 37.90 32.36 ¥15 

90801 .......... ............ Psy dx interview ............................................. 129.99 112.08 ¥14 145.15 131.50 ¥9 

90862 .......... ............ Medication management ................................ 44.72 39.18 ¥12 50.40 46.67 ¥7 

90935 .......... ............ Hemodialysis, one evaluation ........................ 67.46 58.26 ¥14 na na na 

92012 .......... ............ Eye exam established pat .............................. 34.11 38.50 13 61.77 62.69 1 

92014 .......... ............ Eye exam & treatment ................................... 55.71 59.28 6 91.33 90.96 0 

92980 .......... ............ Insert intracoronary stent ............................... 795.85 720.88 ¥9 na na na 

93000 .......... ............ Electrocardiogram, complete ......................... 24.63 20.78 ¥16 24.63 20.78 ¥16 

93010 .......... ............ Electrocardiogram report ................................ 8.34 7.50 ¥10 8.34 7.50 ¥10 

93015 .......... ............ Cardiovascular stress test .............................. 104.22 93.01 ¥11 104.22 93.01 ¥11 

93307 .......... 26 Echo exam of heart ........................................ 46.99 42.24 ¥10 46.99 42.24 ¥10 

93510 .......... 26 Left heart catheterization ............................... 242.92 215.31 ¥11 242.92 215.31 ¥11 

98941 .......... ............ Chiropractic manipulation ............................... 28.80 25.55 ¥11 33.35 29.64 ¥11 

99203 .......... ............ Office/outpatient visit, new ............................. 67.08 58.60 ¥13 91.71 81.42 ¥11 

99213 .......... ............ Office/outpatient visit, est ............................... 42.07 37.48 ¥11 59.50 53.15 ¥11 

99214 .......... ............ Office/outpatient visit, est ............................... 66.32 58.60 ¥12 90.20 80.40 ¥11 

99222 .......... ............ Initial hospital care ......................................... 119.00 104.59 ¥12 na na na 

99223 .......... ............ Initial hospital care ......................................... 173.57 153.65 ¥11 na na na 

99231 .......... ............ Subsequent hospital care .............................. 35.62 31.68 ¥11 na na na 

99232 .......... ............ Subsequent hospital care .............................. 63.67 56.55 ¥11 na na na 

99233 .......... ............ Subsequent hospital care .............................. 90.95 81.08 ¥11 na na na 

99236 .......... ............ Observ/hosp same date ................................. 205.40 179.20 ¥13 na na na 

99239 .......... ............ Hospital discharge day ................................... 94.74 83.13 ¥12 na na na 

99243 .......... ............ Office consultation .......................................... 93.23 83.13 ¥11 122.41 109.36 ¥11 

99244 .......... ............ Office consultation .......................................... 145.91 130.14 ¥11 179.26 160.12 ¥11 

99253 .......... ............ Inpatient consultation ..................................... 108.77 97.09 ¥11 na na na 

99254 .......... ............ Inpatient consultation ..................................... 156.52 140.02 ¥11 na na na 

99283 .......... ............ Emergency dept visit ...................................... 60.64 52.81 ¥13 na na na 

99284 .......... ............ Emergency dept visit ...................................... 110.28 97.44 ¥12 na na na 

99291 .......... ............ Critical care, first hour .................................... 208.82 182.61 ¥13 256.19 224.17 ¥12 

99292 .......... ............ Critical care, addtl 30 min .............................. 104.60 91.64 ¥12 114.45 100.16 ¥12 

99348 .......... ............ Home visit, est patient ................................... na na na 66.32 68.14 2 

99350 .......... ............ Home visit, est patient ................................... na na na 150.83 139.34 ¥8 

G0008 .......... ............ Admin influenza virus vac .............................. na na na 18.95 18.40 ¥3 

G0317 .......... ............ ESRD related svs 4+mo 20+yrs .................... 283.09 245.29 ¥13 283.09 245.29 ¥13 


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Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66393 

B. Geographic Practice Cost Index 

Changes 

Section 1848(e)(1)(A) of the Act 

requires that payments under the 

Medicare physician fee schedule vary 

among payment areas only to the extent 

that area costs vary as reflected by the 

area GPCIs. The GPCIs measure area 

cost differences in the three components 

of the physician fee schedule: Physician 

work, PEs (employee wages, rent, 

medical supplies, and equipment), and 

malpractice insurance. Section 

1848(e)(1)(C) of the Act requires that the 

GPCIs be reviewed and, if necessary, 

revised at least every 3 years. The first 

GPCI revision occurred in 1993. The 

second revision was implemented in 

1998, the next in 2001, and the last in 

2005. We are implementing the next 

GPCI update in this rule and the 2008 

updated, budget neutralized values are 

shown in Addendum E. These values 

reflect the removal of the 1.000 floor on 

physician work as mandated by the 

MIEA-TRHCA law of December 2006. 

As required by law, the GPCIs are 

phased in over a two year period; 

therefore the 2008 GPCI values are 

calculated as one-half the difference 

between the fully implemented 2007 

GPCIs and the fully implemented 2009 

(updated) GPCIs. 

An estimate of the overall effects of 

GPCI changes on fee schedule area 

payments can be demonstrated by a 

comparison of area geographic 

adjustment factors (GAFs). The GAFs 

are a weighted composite of each area’s 

work, PE, and malpractice expense 

GPCIs using the national GPCI cost 

share weights. While we do not actually 

use the GAFs in computing the fee 

schedule payment for a specific service, 

they are useful in comparing overall 

area costs and payments. The actual 

effect on payment for any actual service 

will deviate from the GAF to the extent 

that the services proportions of work, 

PE, and malpractice expense RVUs 

differ from those of the GAF. The GAFs 

reflect the removal of the 1.000 floor on 

physician work as mandated by the 

MIEA-TRHCA law of December 2006. 

The most significant positive changes 

occur in seven payment localities where 

the GAF moves up between 5.91 percent 

(Rest of Maine) and 2.05 percent 

(Ventura, Calif.). Nineteen payment 

localities show an increase in GAF of 

between 1.99 percent (Rest of Texas) to 

1.05 percent (New Hampshire). Twentytwo payment localities have increases of 

less than 1 percent. 

The Detroit, Michigan payment 

locality shows a drop in the GAF value 

of 4.32 percent, the largest, and eight 

other payment localities (including 

Santa Clara, California, Atlanta, Georgia, 

Fort Worth, Texas, and Chicago, Illinois) 

decrease between 3.8 percent and 2.16 

percent in the GAF value. Fourteen 

payment localities show decreases 

between 1.10 percent (Rest of Michigan) 

and 1.92 percent (Miami, Florida). 

Twenty-two payment localities show 

decreases between 0.01 percent 

(Anaheim, California) and 0.90 percent 

(Seattle, Washington). 

Increases or decreases in GPCI values 

do not necessarily reflect increases or 

decreases in the actual costs associated 

with a specific locality, but rather reflect 

the relative costs compared to a national 

average. As an example, when rents go 

up in Wisconsin or Ohio, the index for 

California or New York goes down, even 

if actual costs for California or New 

York stay the same or even increase. 

Other factors also play a part in the 

overall GPCI picture. We do not have 

sufficient data to undertake a sensitivity 

analysis of exact elements of the change 

but we can make some generalized 

assumptions. For example, the changes 

in GAF values for several areas of 

California reflect significant changes in 

the malpractice GPCIs; and, a lowering 

of the PE GPCI in many urban settings 

is offset by increases in the PE GPCI of 

more rural settings. 

The 2008 GPCIs are budget 

neutralized so the update does not 

result in an increase in spending as a 

result of the changes. 

C. Telehealth 

In section II.D of this rule, we are 

adding neurobehavioral status exam as 

represented by HCPCS code 96116 to 

the list of telehealth services. To date, 

Medicare expenditures for telehealth 

services have been extremely low. For 

instance, in CY 2006, the total Medicare 

payment amount for telehealth services 

(including the originating site facility 

fee) was approximately $2 million. 

Moreover, previous additions to the list 

of Medicare telehealth services have not 

resulted in a significant increase in 

Medicare program expenditures. For 

example, the psychiatric diagnostic 

interview examination (as described by 

CPT code 90801) was added to the list 

of Medicare telehealth services in CY 

2003. The addition of CPT code 90801 

resulted in an increase in Medicare 

payment amounts of approximately 

$100,000 in CY 2006. 

The neurobehavioral status exam 

(CPT code 96116) includes an initial 

assessment and evaluation of the mental 

status for a psychiatric patient. In this 

regard, the neurobehavioral status exam 

is similar to the psychiatric diagnostic 

interview examination (CPT code 

90801). However, the utilization rate of 

psychiatric diagnostic interview 

examination is much greater than the 

neurobehavioral status exam. For 

instance, in CY 2006, the total allowed 

services for CPT code 90801 was 

approximately 1.3 million while total 

allowed services for neurobehavioral 

status exam in CY 2006 was 

approximately 105,000. Because 

utilization of neurobehavioral status 

exam is substantially less than the 

psychiatric diagnostic interview 

examination, we believe the budgetary 

impact of adding neurobehavioral status 

exam to the list of Medicare telehealth 

services will be even less than the 

previously added psychiatric diagnostic 

interview examination. 

While we believe that addition of this 

service to the telehealth service list will 

enable more beneficiaries to access to 

these services, we do not anticipate that 

this change will have a significant 

budgetary impact on the Medicare 

program. 

D. Payment for Covered Outpatient 

Drugs and Biologicals 

1. ASP Issues 

The issues discussed in section II.F.1. 

with respect to payment for covered 

outpatient drugs and biologicals, are 

estimated to have no impact on 

Medicare expenditures. However, we 

believe the policies we are adopting will 

assist in clarifying existing policy with 

respect to ASP payment. 

2. CAP issues 

This final rule describes a significant 

change in how CAP drug claims are 

paid due to the implementation of 

section 108(a)(2) of the MIEA–TRHCA. 

This rule also addresses comments and 

finalizes regulations on certain 

approaches to refining the CAP that seek 

to improve service by improving 

compliance, increasing flexibility, and 

increasing choices available to 

participating CAP physicians. The 

finalized CAP provisions will also have 

a potential impact on entities that are 

involved in the dispensing or 

distribution of drugs, that plan to 

become approved CAP vendors, or are 

approved CAP vendors. Changes 

associated with section 108(a)(2) of the 

MIEA–TRHCA, especially the provision 

for payment to vendors upon receipt of 

a claim, will almost certainly be 

perceived as a positive step. Other 

finalized changes seek to improve 

service by improving compliance and 

increasing flexibility under the CAP. At 

this time, we anticipate that these 

changes will result in no significant 

additional cost savings or increases 


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66394 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

associated with the CAP, relative to the 

ASP payment system. 

E. Clinical Laboratory Fee Schedule 

Issues 

As discussed in section II.G of this 

final rule, we are adopting § 414.509 for 

establishing payment for a new clinical 

diagnostic laboratory paid under the 

Medicare Part B clinical laboratory fee 

schedule. Also, we are clarifying dates 

in § 414.502 and § 414.508. These 

changes will not increase or decrease 

payments for current clinical diagnostic 

laboratory tests. For newly developed 

tests, we will permit an opportunity for 

the public to request a reconsideration 

of a payment amount. Because any new 

laboratory tests to undergo a 

reconsideration request of a payment 

amount are unknown to us at the 

current time, we do not have any data 

to estimate the impact. However, we 

anticipate that the reconsideration 

process will apply to fewer than five 

new tests per year so that no significant 

additional costs to the clinical 

laboratory payment system will occur. 

F. Provisions Related to Payment for 

Renal Dialysis Services Furnished by 

End State Renal Disease (ESRD) 

Facilities 

The ESRD-related provisions in this 

final rule are discussed in section II.H. 

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 year (CY 

2007 payments) to estimated payments 

under the revisions to the composite 

rate payment system as discussed in 

II.H. of this final rule with comment 

period (2008 payments). To estimate the 

impact among various classes of ESRD 

facilities, it is imperative that the 

estimates of current payments and 

projected payments contain similar 

inputs. Therefore, we simulated 

payments only for those ESRD facilities 

that we are able to calculate both 

current 2007 payments and projected 

2008 payments. 

ESRD providers were grouped into the 

categories based on characteristics 

furnished 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 2007 update of CY 2006 

National Claims History file as a basis 

for Medicare dialysis treatments and 

separately billable drugs and 

biologicals. Due to data limitations, we 

are unable to estimate current 2007 

payments and projected 2008 payments 

for 153 of the 4,813 ESRD facilities that 

billed for ESRD dialysis treatments in 

CY 2006. 

Table 41 shows the impact of this 

year’s changes to CY 2008 payments to 

hospital-based and independent ESRD 

facilities. The first column of Table 41 

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 

the change to the wage index floor as it 

affects the composite rate payments to 

ESRD facilities for CY 2008. The fourth 

column compares aggregate ESRD wage 

adjusted composite rate payments in the 

third year of the transition (CY 2008) 

using the CY 2008 wage index with a 

0.80 floor compared to aggregate ESRD 

wage adjusted composite rate payments 

in the third year of the transition (CY 

2008) using the CY 2008 wage index 

with a 0.75 floor. Note that the fourth 

column only includes the effect of the 

change to the wage index floor and does 

not include the effects of other wage 

index changes, such as, moving from the 

second to third year of the transition 

and updated wage index values from CY 

2007 to CY 2008. 

The fifth column shows the effect of 

all changes to the ESRD wage index for 

CY 2008 as it affects the composite rate 

payments to ESRD facilities. It is 

inclusive of the changes in the fourth 

column. The fifth column compares 

aggregate ESRD wage adjusted 

composite rate payments in the third 

year of the transition (CY 2008) to 

aggregate ESRD wage adjusted 

composite rate payments in the second 

year of the transition (CY 2007). In the 

third year of the transition (CY 2008), 

ESRD facilities receive 75 percent of the 

CBSA wage adjusted composite rate and 

25 percent of the MSA wage adjusted 

composite rate. In the second year of the 

transition, ESRD facilities receive 50 

percent of the CBSA wage adjusted 

composite rate and 50 percent of the 

MSA wage adjusted composite rate. The 

overall effect to all ESRD providers in 

aggregate is zero because the CY 2008 

ESRD wage index has been multiplied 

by a BN adjustment factor 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 

decreases shown among census regions 

is primarily due to reducing the wage 

index floor, as there were areas in these 

areas with wage index values below the 

reduced floor. 

The sixth column shows the overall 

effect of the changes in composite rate 

payments to ESRD providers. The 

overall effect is measured as the 

difference between the projected CY 

2008 payment with all changes in this 

final rule and CY 2007 payment. This 

payment amount is computed by 

multiplying the wage adjusted 

composite rate with the drug add-on for 

each provider times the number of 

dialysis treatments from the CY 2006 

claims. The projected CY 2008 payment 

is the transition year 3 wage-adjusted 

composite rate for each provider (with 

the 15.5 percent drug add-on) times 

dialysis treatments from CY 2006 

claims. The CY 2007 current payment is 

the transition year 2 wage-adjusted 

composite rate for each provider (with 

the current 14.9 percent drug add-on) 

times dialysis treatments from CY 2006 

claims. 

The overall impact to ESRD providers 

in aggregate is 0.5 percent. This increase 

corresponds to the 0.5 percent increase 

to the drug add-on. The variation shown 

in column 6 is due to variation in 

changes in the wage index (column 5). 

All provider types receive the same 0.5 

percent increase to the drug add-on. 

TABLE 41.—IMPACT OF CY 2008 CHANGES IN PAYMENTS TO HOSPITAL BASED AND INDEPENDENT ESRD FACILITIES

[Percent change in composite rate payments to ESRD facilities (both program and beneficiaries)] 

Number of 

facilities 

Number of 

dialysis 

treatments 

(in millions) 

Effect of 

changes in 

floor only 1

Effect of 

changes in 

wage 

index 2

Overall 

effect 3

All Providers ............................................................................................. 4,660 35.5 0.0 0.0 0.5 

Independent ...................................................................................... 4,101 31.8 0.0 ¥0.1 0.5 

Hospital Based ................................................................................. 559 3.7 0.0 0.5 1.0 

By Facility Size 

Less than 5000 treatments ............................................................... 1,650 4.7 ¥0.1 ¥0.3 0.3 


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Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66395 

TABLE 41.—IMPACT OF CY 2008 CHANGES IN PAYMENTS TO HOSPITAL BASED AND INDEPENDENT ESRD FACILITIES—

Continued 

[Percent change in composite rate payments to ESRD facilities (both program and beneficiaries)] 

Number of 

facilities 

Number of 

dialysis 

treatments 

(in millions) 

Effect of 

changes in 

floor only 1

Effect of 

changes in 

wage 

index 2

Overall 

effect 3

5000 to 9999 treatments .................................................................. 1,800 13.0 0.0 0.0 0.5 

Greater than 9999 treatments .......................................................... 1,210 17.7 0.0 0.1 0.6 

Type of Ownership 

Profit ................................................................................................. 3,745 28.9 0.0 ¥0.1 0.4 

Nonprofit ........................................................................................... 915 6.5 0.0 0.3 0.9 

By Geographic Location 

Rural ................................................................................................. 1,261 7.3 ¥0.4 ¥0.6 0.0 

Urban ................................................................................................ 3,399 28.1 0.1 0.1 0.7 

By Region 

New England .................................................................................... 141 1.1 0.1 1.4 2.0 

Middle Atlantic .................................................................................. 553 4.5 0.1 0.5 1.0 

East North Central ............................................................................ 727 5.7 0.1 ¥0.6 ¥0.1 

West North Central ........................................................................... 358 1.9 0.1 ¥0.3 0.3 

South Atlantic ................................................................................... 1,063 8.1 0.0 0.0 0.6 

East South Central ........................................................................... 365 2.6 ¥0.5 ¥1.4 ¥0.8 

West South Central .......................................................................... 646 5.0 ¥0.1 ¥0.7 ¥0.2 

Mountain ........................................................................................... 254 1.6 0.1 0.3 0.8 

Pacific ............................................................................................... 523 4.4 0.1 1.4 2.0 

Puerto Rico ....................................................................................... 30 0.4 ¥2.1 ¥3.0 ¥2.5 

1This column shows the effect of the wage index floor changes on ESRD providers. Composite rate payments computed using the CY 2008 

wage index with a 0.80 floor are compared to composite rate payments using the CY 2008 wage index with a 0.75 floor. 2This column shows the overall effect of wage index changes on ESRD providers. Composite rate payments computed using the current wage 

index are compared to composite rate payments using the CY 2008 wage index changes. 3This column shows the percent change between CY 2008 and CY 2007 composite rate payments to ESRD facilities. The CY 2008 payments 

include the CY 2008 wage adjusted composite rate, and the 15.5% drug add-on times treatments The CY 2007 payments to ESRD facilities includes the CY 2007 wage adjusted composite rate and the 14.9% drug add-on times treatments. 

G. IDTF Changes 

We believe that our provisions 

regarding IDTFs as discussed in section 

II.I. of this final rule with comment 

period would have no budgetary impact. 

However, we believe that these changes 

are necessary to ensure that only 

legitimate IDTFs are enrolled into the 

program. In addition, we believe that 

the IDTF provisions contained in this 

final rule will help ensure that 

beneficiaries receive quality care. 

Therefore, we expect to have an impact 

on an unknown number of persons and 

entities who will be denied enrollment 

into the Medicare program. 

H. CORF Issues 

The revisions to the CORF regulations 

discussed in section II.K. update the 

regulations for consistency with the PFS 

payment rules. These revisions will 

help to clarify payment for CORF 

services and are expected to have 

minimal impact on Medicare 

expenditures. 

I. Compendia for Determination of 

Medically-Accepted Indications for OffLabel Use of Drugs and Biologicals in an 

Anti-Cancer Chemotherapeutic 

Regimen. 

We anticipate that the changes related 

to the compendia discussed in section 

II.L. of this final rule with comment 

period will have a negligible cost to the 

Medicare program. The changes will 

enable CMS to respond quickly should 

changes in the number and quality of 

the compendia indicate a need to amend 

the list. 

J. Physician Self-Referral Provisions 

We anticipate that our provisions in 

section II.M. of this final rule with 

comment period for the reassignment 

and anti-markup provisions, and the 

physician self-referral provisions will 

result in savings to the program by 

reducing overutilization and anticompetitive business arrangements. We 

cannot gauge with any certainty the 

extent of these savings to the Medicare 

program. 

K. Beneficiary Signature for Ambulance 

Transport Services 

We believe that our provision in 

section II.N. of this final rule with 

comment period for allowing the 

ambulance provider or supplier to sign 

the claim on behalf of the beneficiary 

with respect to emergency transport 

services, provided that certain 

conditions are satisfied, will have no 

budget impact. 

L. Update to Fee Schedules for Class III 

DME for CYs 2007 and 2008 

In section II.O. of this final rule with 

comment period, we discuss the update 

to the fee schedules for class III DME for 

CYs 2007 and 2008. Total allowed 

charges for class III devices in 2005 

were $71 million. Accordingly, with a 

zero percent increase for DME, other 

than class III devices, for 2005 and 2006 

and with the establishment of an update 

for 2007 of zero percent for class III 

devices, rather than 4.3 percent based 

on the CPI–U, this results in a savings 

to the Medicare program of 

approximately $2 million in FY 2007, 

$4 million in FY 2008, $4 million in FY 

2009, $5 million in FY 2010, $5 million 

in FY 2011, and $5 million in FY 2012. 

M. Therapy Services 

In section II.R.2., we are changing the 

certification requirement for the plan of 

care, for outpatient physical therapy, 

occupational therapy and speechlanguage pathology services from every 

30 days to an appropriate length, based 

on the patient’s needs, limited to 90 

days. As we stated in the proposed rule, 

analysis of Medicare claims data shows 

negative or no impact for this change 

and this was also supported by 

commenters. In most cases, the 

appropriate length of treatment will be 


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less than 30 days. Certification of the 

appropriate length of treatment will 

discourage the practice of billing for reevaluations prior to recertification 

regardless of need. 

The 30-day recertification allows 

treatment under a plan of care for 30 

days after initial certification, regardless 

of the appropriate length of treatment. 

The initial certification cannot assure 

that a physician reviews the plan or 

follows the patient’s progress. 

We will review the utilization of 

therapy services after a 2-year trial to 

assess any changes that might be related 

to certification of a plan of care for an 

appropriate length of treatment. At that 

time, if we determine that this change 

has caused an increase in inappropriate 

utilization, we will reconsider the 30- 

day certification requirement. 

N. TRHCA 101(b) Physician Quality 

Reporting Initiative 

As discussed section II.S.1. of this 

rule, the final 2008 PQRI measures 

satisfy the requirement of section 

1848(k)(2)(B)(ii) of the Act that the 

Secretary publish in the Federal 

Register by August 15, 2007, measures 

that the Secretary proposes as 

appropriate for eligible professionals to 

use to submit data to the Secretary in 

2008. We also expect to address registryand EHR-based data submission on a 

test basis in 2008, as discussed in 

section II.T.1. of this rule. Although 

there may be some cost incurred for 

maintaining the measures and their 

associated code sets, and for enhancing 

an existing clinical data warehouse to 

accommodate the registry- and EHRbased data submission, we do not 

anticipate a significant cost impact on 

the Medicare program. 

O. TRHCA 101(d) Physician Assistance 

and Quality Initiative Fund 

As discussed in section II.S.5. of this 

final rule with comment period, section 

101(d) of the MIEA–TRHCA created the 

Physician Assistance and Quality 

Initiative Fund (PAQI) which provides 

$1.35 billion for physician payment and 

quality improvement initiatives. The 

legislation directs the Secretary to 

provide for expenditures from the Fund 

in a manner designed to provide (to the 

maximum extent feasible) for the 

obligation of the entire $1.35 billion for 

payment for physicians’ services 

furnished during 2008. As discussed in 

section II.S.5. of this final rule with 

comment period, we will scale aggregate 

payments to physicians in a manner 

such that Medicare would pay $1.35 

billion during CY 2009 for measures 

reported for services furnished during 

CY 2008. We are unable to provide an 

exact percentage for the bonus payment, 

but we anticipate that the bonus 

payments will be approximately 1.5 

percent of allowed charges for 

participating professionals (and we do 

not expect that the ultimate percentage 

amount would exceed 2 percent). We 

also note that the Transitional Medical 

Assistance, Abstinence Education, and 

Qualifying Individual Programs 

Extension Act of 2007 (Pub. L. 110–90) 

provided an additional $325 million to 

be used as a part of the PAQI Fund for 

payment with regard to services 

furnished in 2009 and $60,000,000 for 

payment with respect to physicians’

services furnished on or after January 1, 

2013. 

P. TRHCA 110 Reporting of Anemia 

Quality Indicators 

As discussed in section II.S.2. of this 

final rule with comment period, there 

are no program cost savings or increased 

expenditures associated with this 

change; however, we expect that the 

regulation will have a positive impact 

on patient care. 

Q. Amendment of the Exemption From 

NCPDP SCRIPT Standard for ComputerGenerated Facsimile Transmissions 

Under Medicare Part D 

The amendment of the exemption for 

computer-generated fax transactions 

under Medicare Part D is discussed in 

section II.R.3. of this rule. E-prescribing 

is voluntary for providers and 

pharmacies. This amendment only 

affects providers and pharmacies that 

already conduct e-prescribing using 

products that generate faxes rather than 

SCRIPT transactions. 

We believe that providers and 

pharmacies that are now e-prescribing 

using products that generate faxes 

generally already possess the hardware 

necessary to e-prescribe. Many would 

need to obtain software upgrades to 

send and receive the SCRIPT 

transaction. This software will generally 

be available to providers through 

automatic version upgrades built into 

annual software vendor maintenance 

fees. However, providers currently using 

software that cannot be upgraded to 

generate SCRIPT transactions would 

need to purchase and install new eprescribing software or revert to sending 

paper fax transactions to pharmacies. 

Dispensers that currently e-prescribe 

but have not established the 

connectivity necessary to receive and 

send SCRIPT transactions would need 

to connect to a network, and may need 

to install software upgrades, which will 

generally be covered under annual fees. 

Because pharmacies customarily bear 

the cost of transaction fees for the 

SCRIPT transactions they receive and 

send, these costs would increase as the 

rate of e-prescribing increases. 

The amendment of this exemption 

will have indirect benefits in that it will 

help to encourage e-prescribing using 

electronic data interchange, which will 

ultimately result in improved patient 

safety. We also will continue to allow 

computer-generated faxes as a fallback 

in cases of temporary/transient 

transmission failures and 

communications problems. 

Because of the voluntary nature of eprescribing for physicians and 

pharmacies, the relatively small number 

of entities currently e-prescribing, and 

the minimal nature of the anticipated 

costs, we believe this provision does not 

constitute a major rule for purposes of 

this analysis. 

R. Revisions to Payment Policies Under 

the Ambulance Fee Schedule and the 

Ambulance Inflation Factor Update for 

CY 2008 

For the purposes of the RFA, 

ambulance providers and suppliers are 

considered to be small entities. 

Removing the requirement that the AIF 

be published annually via Federal 

Register notice has no monetary impact 

on small entities or small businesses. It 

merely allows for the earlier 

dissemination of necessary information 

to the ambulance industry, the Medicare 

contractors, and the general public. 

We estimate that the total program 

expenditure for CY 2007 for ambulance 

services covered by the Medicare 

program is approximately $5.2 billion. 

Application of an AIF of 2.7 percent 

will result in an additional total 

program expenditure for CY 2008 of 

approximately $140 million over CY 

2007 expenditures. 

S. Alternatives Considered 

This final rule with comment period 

contains a range of policies, including 

some provisions 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. 

T. Impact on Beneficiaries 

There are a number of changes made 

in this final rule with comment period 

that would have an effect on 

beneficiaries. In general, we believe 

these changes, particularly the 

implementation of the PQRI with its 

continuing focus on measuring, 

submitting, and analyzing quality data, 

will have a positive impact and improve 


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the quality and value of care furnished 

to Medicare beneficiaries. 

We do not believe that beneficiaries 

will experience drug access issues as a 

result of the changes with respect to Part 

B drugs and CAP. 

As explained in more detail 

subsequently in this section, the 

regulatory provisions may affect 

beneficiary liability in some cases. Most 

changes in aggregate beneficiary liability 

from a particular provision would 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). In 2008, 

total cost sharing (coinsurance and 

deductible) per Part B enrollee 

associated with physician fee schedule 

services is estimated to be $590. In 

addition, the portion of the 2008 

standard monthly Part B premium 

attributable to PFS services is estimated 

to be $38.60. 

To illustrate this point, as shown in 

Table 40, the 2007 national payment 

amount in the nonfacility setting for 

CPT code 99203 (Office/outpatient visit, 

new), is $91.71 which means that 

currently a beneficiary is responsible for 

20 percent of this amount, or $18.34. 

Based on this final rule with comment 

period, the 2008 national payment 

amount in the nonfacility setting for 

CPT code 99203, as shown in Table 40, 

is $81.42 which means that, in 2008, the 

beneficiary coinsurance for this service 

would be $16.28. 

Policies discussed in this rule that do 

affect overall spending, such as the 

additions to the list of codes that are 

subject to section 5102 of the DRA 

imaging provisions, would similarly 

impact beneficiaries’’ coinsurance. 

U. Accounting Statement 

As required by OMB Circular A–4 

(available at http://www.white

house.gov/omb/circulars/a004/a-4.pdf), 

in Table 42, we have prepared an 

accounting statement showing the 

classification of the expenditures 

associated with this final rule with 

comment period. This estimate includes 

the incurred benefit impact associated 

with the estimated CY 2008 PFS update, 

shown in this final rule with comment 

period, based on the 2007 Trustees 

Report baseline. All estimated impacts 

are classified as transfers. 

TABLE 42.—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES FOR CY 2008 

[In billions] 

Category Transfers 

Annualized Monetized 

Transfers.

¥$6.0. 

From Whom To Whom? ..... Federal Government to physicians, other practitioners and suppliers who receive payment under the Medicare 

Physician Fee Schedule; ESRD Medicare Providers; ambulance suppliers, DME suppliers, and Medicare suppliers billing for Part B drugs. 

In accordance with the provisions of 

Executive Order 12866, this final rule 

with comment period was reviewed by 

the Office of Management and Budget. 

List of Subjects 

42 CFR Part 409 

Health facilities, Medicare. 

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 recordkeeping 

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. 

42 CFR Part 415 

Health facilities, Health professions, 

Medicare, Reporting and recordkeeping 

requirements. 

42 CFR Part 418 

Health facilities, Hospice care, 

Medicare, Reporting and recordkeeping 

requirements. 

42 CFR Part 423 

Administrative practice and 

procedure, Emergency medical services, 

Health facilities, Health maintenance 

organizations (HMO), Health 

Professionals, Medicare, Penalties, 

Privacy, Reporting and recordkeeping 

requirements. 

42 CFR Part 424 

Emergency medical services, Health 

facilities, Health professions, Medicare, 

Reporting and recordkeeping 

requirements. 

42 CFR Part 482 

Grant programs—health, Hospitals, 

Medicaid, Medicare, Reporting and 

recordkeeping requirements. 

42 CFR Part 484 

Grant programs—health, Health 

facilities, Health professions, Health 

records, Medicaid, Medicare, Nursing 

homes, Nutrition, Reporting and 

recordkeeping requirements, Safety. 

42 CFR Part 485 

Grant programs—health, Health 

facilities, Medicaid, Medicare, 

Reporting and recordkeeping 

requirements. 

■ For the reasons set forth in the 

preamble, the Centers for Medicare & 

Medicaid Services amends 42 CFR 

chapter IV as set forth below: 

PART 409—HOSPITAL INSURANCE 

BENEFITS 

■ 1. The authority citation for part 409 

continues to read as follows: 

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh). 

Subpart B—Inpatient Hospital Services 

and Inpatient Critical Access Hospital 

Services 

■ 2. Section 409.17 is added to read as 

follows: 

§ 409.17 Physical therapy, occupational 

therapy, and speech-language pathology 

services. 

(a) General rules. (1) Except as 

specified in paragraph (a)(1)(ii) of this 

section, physical therapy, occupational 


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therapy or speech-language pathology 

services must be furnished by qualified 

physical therapists, physical therapist 

assistants, occupational therapists, 

occupational therapy assistants or 

speech-language pathologists who meet 

the requirements specified part 484 of 

this chapter. 

(2) Physical therapy, occupational 

therapy or speech-language pathology 

services must be furnished under a plan 

that meets the requirements of 

paragraphs (b) through (d) of this 

section, or plan requirements specific to 

the payment policy under which the 

services are rendered, if applicable. 

(b) Establishment of the plan. The 

plan must be established before 

treatment begins by one of the 

following: 

(1) A physician. 

(2) A nurse practitioner, a clinical 

nurse specialist or a physician assistant. 

(3) The physical therapist furnishing 

the physical therapy services. 

(4) A speech-language pathologist 

furnishing the speech-language 

pathology services. 

(5) An occupational therapist 

furnishing the occupational therapy 

services. 

(c) Content of the plan. The plan: 

(1) Prescribes the type, amount, 

frequency, and duration of the physical 

therapy, occupational therapy, or 

speech-language pathology services to 

be furnished to the individual; and 

(2) Indicates the diagnosis and 

anticipated goals. 

(d) Changes in the plan. Any changes 

in the plan are implemented in 

accordance with hospital policies and 

procedures. 

Subpart C—Posthospital SNF Care 

■ 3. Section 409.23 is amended by 

adding paragraph (c) to read as follows: 

§ 409.23 Physical, occupational, and 

speech therapy. 

* * * * * 

(c) Except as specified in paragraph 

(c)(1)(ii) of this section, physical 

therapy, occupational therapy or 

speech-language pathology services 

must be furnished—

(1) By qualified physical therapists, 

physical therapist assistants, 

occupational therapists, occupational 

therapy assistants or speech-language 

pathologists as defined in part 484 of 

this chapter 

(2) In accordance with a plan that 

meets the requirements of § 409.17(b) 

through (d) of this part. 

PART 410—SUPPLEMENTARY 

MEDICAL INSURANCE (SMI) 

BENEFITS 

■ 4. The authority citation for part 410 

continues to read as follows: 

Authority: Secs. 1102, 1834, 1871, and 

1893 of the Social Security Act (42 U.S.C. 

1302, 1395m, 1395hh, and 1395ddd). 

Subpart B—Medical and Other Health 

Services 

§ 410.32 [Amended] 

■ 5. Section 410.32 is amended by—

■ A. Removing paragraph (a)(1). 

■ B. Redesignating paragraphs (a)(2) and 

(a)(3) as paragraphs (a)(1) and (a)(2). 

■ 6. Section 410.33 is amended by—

■ A. Revising paragraphs (b)(1), (g)(2), 

(g)(3), (g)(6), and (g)(8). 

■ B. Adding paragraphs (g)(15) and (i). 

The revisions and addition read as 

follows: 

§ 410.33 Independent diagnostic testing 

facility. 

* * * * * 

(b) * * * 

(1) Each supervising physician must 

be limited to providing general 

supervision to no more than three IDTF 

sites. This applies to both fixed sites 

and mobile units where three 

concurrent operations are capable of 

performing tests. 

* * * * * 

(g) * * * 

(2) Provides complete and accurate 

information on its enrollment 

application. Changes in ownership, 

changes of location, changes in general 

supervision, and adverse legal actions 

must be reported to the Medicare feefor-service contractor on the Medicare 

enrollment application within 30 

calendar days of the change. All other 

changes to the enrollment application 

must be reported within 90 days. 

(3) Maintain a physical facility on an 

appropriate site. For the purposes of this 

standard, a post office box, commercial 

mailbox, hotel, or motel is not 

considered an appropriate site. 

(i) The physical facility, including 

mobile units, must contain space for 

equipment appropriate to the services 

designated on the enrollment 

application, facilities for hand washing, 

adequate patient privacy 

accommodations, and the storage of 

both business records and current 

medical records within the office setting 

of the IDTF, or IDTF home office, not 

within the actual mobile unit. 

(ii) IDTF suppliers that provide 

services remotely and do not see 

beneficiaries at their practice location 

are exempt from providing hand 

washing and adequate patient privacy 

accommodations. 

* * * * * 

(6) Have a comprehensive liability 

insurance policy of at least $300,000 per 

location that covers both the place of 

business and all customers and 

employees of the IDTF. The policy must 

be carried by a nonrelative-owned 

company. Failure to maintain required 

insurance at all times will result in 

revocation of the IDTF’s billing 

privileges retroactive to the date the 

insurance lapsed. IDTF suppliers are 

responsible for providing the contact 

information for the issuing insurance 

agent and the underwriter. In addition, 

the IDTF must—

(i) Ensure that the insurance policy 

must remain in force at all times and 

provide coverage of at least $300,000 

per incident; and 

(ii) Notify the CMS designated 

contractor in writing of any policy 

changes or cancellations. 

* * * * * 

(8) Answer, document, and maintain 

documentation of a beneficiary’s written 

clinical complaint at the physical site of 

the IDTF (For mobile IDTFs, this 

documentation would be stored at their 

home office.) This includes, but is not 

limited to, the following: 

(i) The name, address, telephone 

number, and health insurance claim 

number of the beneficiary. 

(ii) The date the complaint was 

received; the name of the person 

receiving the complaint; and a summary 

of actions taken to resolve the 

complaint. 

(iii) If an investigation was not 

conducted, the name of the person 

making the decision and the reason for 

the decision. 

* * * * * 

(15) With the exception of hospitalbased and mobile IDTFs, a fixed-base 

IDTF does not include the following: 

(i) Sharing a practice location with 

another Medicare-enrolled individual or 

organization; 

(ii) Leasing or subleasing its 

operations or its practice location to 

another Medicare-enrolled individual or 

organization; or 

(iii) Sharing diagnostic testing 

equipment used in the initial diagnostic 

test with another Medicare-enrolled 

individual or organization. 

* * * * * 

(i) Effective date of billing privileges. 

The filing date of the Medicare 

enrollment application is the date that 

the Medicare contractor receives a 

signed provider enrollment application 

that it is able to process to approval. The 

effective date of billing privileges for a 


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newly enrolled IDTF is the later of the 

following: 

(1) The filing date of the Medicare 

enrollment application that was 

subsequently approved by a Medicare 

fee-for-service contractor; or 

(2) The date the IDTF first started 

furnishing services at its new practice 

location. 

■ 7. Section 410.43 is amended by 

revising paragraph (a)(3)(ii) to read as 

follows: 

§ 410.43 Partial hospitalization services: 

Conditions and exclusions. 

(a) * * * 

(3) * * * 

(ii) Occupational therapy requiring 

the skills of a qualified occupational 

therapist, provided by an occupational 

therapist, or under appropriate 

supervision of a qualified occupational 

therapist by an occupational therapy 

assistant as specified in part 484 of this 

chapter. 

■ 8. Section 410.59 is amended by 

revising the introductory text to 

paragraph (a) to read as follows: 

§ 410.59 Outpatient occupational therapy 

services: Conditions. 

(a) Basic rule. Except as specified in 

paragraph (a)(3)(iii) of this section, 

Medicare Part B pays for outpatient 

occupational therapy services only if 

they are furnished by an individual 

meeting the qualifications in part 484 of 

this chapter for an occupational 

therapist or an appropriately supervised 

occupational therapy assistant but only 

under the following conditions: 

* * * * * 

■ 9. Section 410.60 is amended by 

revising the introductory text of 

paragraph (a) to read as follows: 

§ 410.60 Outpatient physical therapy 

services: Conditions. 

* * * * * 

(a) Basic rule. Except as specified in 

paragraph (a)(3)(iii) of this section, 

Medicare Part B pays for outpatient 

physical therapy services only if they 

are furnished by an individual meeting 

the qualifications in part 484 of this 

chapter for a physical therapist or an 

appropriately supervised physical 

therapist assistant but only under the 

following conditions: 

* * * * * 

§ 410.61 [Amended] 

■ 10. Section 410.61 is amended by 

removing paragraph (e). 

■ 11. Section 410.78 is amended by 

revising the introductory text of 

paragraph (b) to read as follows: 

§ 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), individual 

medical nutrition therapy, and 

neurobehavioral status exam furnished 

by an interactive telecommunications 

system if the following conditions are 

met: 

* * * * * 

Subpart D—Comprehensive Outpatient 

Rehabilitation Facility (CORF) Services 

■ 12. Section 410.100 is amended by—

■ A. Revising the introductory text and 

paragraphs (a), (e), and (h). 

■ B. Removing paragraph (i). 

■ C. Redesignating paragraphs (j), (k), 

(l), and (m) to (i), (j), (k), and (l) 

respectively. 

■ D. Revising new paragraphs (i), (j), (k), 

and (l). 

The revisions read as follows: 

§ 410.100 Included services. 

Subject to the conditions and 

limitations set forth in § 410.102 and 

§ 410.105, CORF services means the 

following services furnished to an 

outpatient of the CORF by personnel 

that meet the qualifications set forth in 

§ 485.70 of this chapter. Payment for 

CORF services are made in accordance 

with § 414.1105. 

(a) Physician’s services. CORF facility 

physician services are administrative in 

nature and include consultation with 

and medical supervision of 

nonphysician staff, participation in plan 

of treatment reviews and patient care 

review conferences, and other medical 

and facility administration activities. 

Diagnostic and therapeutic services 

furnished to an individual CORF patient 

by a physician in a CORF facility are not 

CORF physician services. These 

services, if covered, are physician 

services under § 410.20 with payment 

for these services made to the physician 

in accordance with part 414 subpart B. 

* * * * * 

(e) Respiratory therapy services. (1) 

Respiratory therapy services are for the 

assessment, treatment, and monitoring 

of patients with deficiencies or 

abnormalities of cardiopulmonary 

function. 

(2) Respiratory therapy services 

include the following: 

(i) Application of techniques for 

support of oxygenation and ventilation 

of the patient. 

(ii) Therapeutic use and monitoring of 

gases, mists, and aerosols and related 

equipment. 

(iii) Bronchial hygiene therapy. 

(iv) Pulmonary rehabilitation 

techniques to develop strength and 

endurance of respiratory muscles and 

other techniques to increase respiratory 

function, such as graded activity 

services; these services include 

physiologic monitoring and patient 

education. 

* * * * * 

(h) Social and psychological services. 

Social and psychological services 

include the assessment and treatment of 

an individual’s mental and emotional 

functioning and the response to and rate 

of progress as it relates to the 

individual’s rehabilitation plan of 

treatment, including physical therapy 

services, occupational therapy services, 

speech-language pathology services and 

respiratory therapy services. 

(i) Nursing care services. Nursing care 

services include nursing services 

provided by a registered nurse that are 

prescribed by a physician and are 

specified in or directly related to the 

rehabilitation treatment plan and 

necessary for the attainment of the 

rehabilitation goals of the physical 

therapy, occupational therapy, speechlanguage pathology, or respiratory 

therapy plan of treatment. 

(j) Drugs and biologicals. These are 

drugs and biologicals that are the 

following: 

(1) Prescribed by a physician and 

administered by or under the 

supervision of a physician or by a 

registered professional nurse; and 

(2) Not excluded from Medicare Part 

B payment for reasons specified in 

§ 410.29. 

(k) Supplies and durable medical 

equipment. Supplies and durable 

medical equipment include the 

following: 

(1) Disposable supplies. 

(2) Durable medical equipment of the 

type specified in § 410.38 (except for 

renal dialysis systems) for a patient’s 

use outside the CORF, whether 

purchased or rented. 

(l) Home environment evaluation. A 

home environment evaluation—

(1) Is a single home visit to evaluate 

the potential impact of the home 

situation on the patient’s rehabilitation 

goals. 

(2) Requires the presence of the 

patient and the physical therapist, 

occupational therapist, or speechlanguage pathologist, as appropriate. 


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■ 13. Section 410.105 is amended by 

revising paragraphs (b)(3)(i), (b)(3)(ii), 

(c)(1) introductory text, and (c)(2) to 

read as follows: 

§ 410.105 Requirements for coverage of 

CORF services. 

* * * * * 

(b) * * * 

(3) * * * 

(i) Physical therapy, occupational 

therapy, and speech-language pathology 

services may be furnished away from 

the premises of the CORF including the 

individual’s home when payment is not 

otherwise made under Title XVIII of the 

Act. 

(ii) The single home environment 

evaluation visit specified in 

§ 410.100(m) is also covered. 

(c) * * * 

(1) The service must be furnished 

under a written plan of treatment that—

(i) * * * 

(ii) Indicates the diagnosis and 

rehabilitation goals, and prescribes the 

type, amount, frequency, and duration 

of the skilled rehabilitation services, 

including physical therapy, 

occupational therapy, speech-language 

pathology and respiratory therapy 

services, and indicates the other CORF 

services to be furnished that relate 

directly to such rehabilitation goals. 

(2) The plan must be reviewed at least 

every 60 days for respiratory therapy 

services and every 90 days for physical 

therapy, occupational therapy and 

speech-language pathology services by a 

facility physician or the referring 

physician who, when appropriate, 

consults with the professional personnel 

providing the services. 

* * * * * 

Subpart G—Medical Nutrition Therapy 

■ 14. Section 410.132 is amended by 

revising paragraph (a) to read as follows: 

§ 410.132 Medical nutrition therapy. 

(a) Conditions for coverage of MNT 

services. Medicare Part B pays for MNT 

services provided by a registered 

dietitian or nutrition professional as 

defined in § 410.134 when the 

beneficiary is referred for the service by 

the treating physician. Except as 

provided at § 410.78, services covered 

consist of face-to-face nutritional 

assessments and interventions in 

accordance with nationally-accepted 

dietary or nutritional protocols. 

* * * * * 

PART 411—EXCLUSIONS FROM 

MEDICARE AND LIMITATIONS ON 

MEDICARE PAYMENT 

■ 15. The authority citation for part 411 

continues to read as follows: 

Authority: Secs. 1102, 1860D–1 through 

1860D–42, 1871, and 1877 of the Social 

Security Act (42 U.S.C. 1302, 1395w–101 

through 1395w–152, 1395hh, and 1395nn). 

Subpart A—General Exclusions and 

Exclusion of Particular Services 

■ 16. Section 411.15 is amended by—

■ A. Revising paragraph (a)(1). 

■ B. Adding paragraphs (k)(13) and 

(k)(14). 

The revision and additions read as 

follows: 

§ 411.15 Particular services excluded from 

coverage. 

* * * * * 

(a) * * * 

(1) Examinations performed for a 

purpose other than treatment or 

diagnosis of a specific illness, 

symptoms, complaint, or injury, except 

for screening mammography, colorectal 

cancer screening tests, screening pelvic 

exams, prostate cancer screening tests, 

glaucoma screening exams, initial 

preventive physical exams, ultrasound 

screening for abdominal aortic 

aneurysms (AAA), cardiovascular 

disease screening tests, or diabetes 

screening tests that meet the criteria 

specified in paragraphs (k)(6) through 

(k)(14) of this section. 

* * * * * 

(k) * * * 

(13) In the case of cardiovascular 

disease screening tests for the early 

detection of cardiovascular disease or 

abnormalities associated with an 

elevated risk for that disease, subject to 

the conditions specified in § 410.17 of 

this chapter. 

(14) In the case of diabetes screening 

tests furnished to an individual at risk 

for diabetes for the purpose of the early 

detection of that disease, subject to the 

conditions specified in § 410.18 of this 

chapter. 

* * * * * 

Subpart J—Financial Relationships 

Between Physicians and Entities 

Furnishing Designated Health Services 

■ 17. Section 411.351 is amended by 

revising the definition of ‘‘entity’’ to 

read as follows: 

§ 411.351 Definitions. 

* * * * * 

Entity means—

* * * * * 

(3) For purposes of this subpart, 

‘‘entity’’ does not include a physician’s 

practice when it bills Medicare for the 

technical component or professional 

component of a diagnostic test for 

which the anti-markup provision is 

applicable in accordance with § 414.50 

of this chapter and section 30.2.9 of the 

CMS Internet-only Manual, publication 

100–04, Claims Processing Manual, 

Chapter 1 (general billing requirements). 

PART 413—PRINCIPLES OF 

REASONABLE COST 

REIMBURSEMENT; PAYMENT FOR 

END-STAGE RENAL DISEASE 

SERVICES; PROSPECTIVELY 

DETERMINED PAYMENT RATES FOR 

SKILLED NURSING FACILITIES 

■ 18. The authority citation for part 413 

continues to read as follows: 

Authority: Secs. 1102, 1812(d), 1814(b), 

1815, 1833(a), (i), and (n), 1861(v), 1871, 

1881, 1883, and 1886 of the Social Security 

Act (42 U.S.C. 1302, 1395d(d), 1395f(b), 

1395g, 1395l(a), (i), and (n), 1395x(v), 

1395hh, 1395rr, 1395tt, and 1395ww); and 

sec. 124 of Pub. L. 106–133 (113 Stat. 1501A–

332). 

Subpart A—Introduction and General 

Rules 

§ 413.1 [Amended] 

■ 19. Section 413.1 is amended by—

■ A. Removing paragraphs (a)(2)(iv) and 

(vi). 

■ B. Redesignating paragraphs (a)(2)(v) 

and (vii) as paragraphs (a)(2)(iv) and (v), 

respectively. 

Subpart H—Payment for End-Stage 

Renal Disease (ESRD) Services and 

Organ Procurement Costs 

■ 20. Section 413.184 is amended by 

revising the section heading as set forth 

below: 

§ 413.184 Payment exception: Pediatric 

patient mix. 

* * * * * 

PART 414—PAYMENT FOR PART B 

MEDICAL AND OTHER HEALTH 

SERVICES 

■ 21. The authority citation for part 414 

continues to read as follows: 

Authority: Secs. 1102, 1871, and 1881(b)(l) 

of the Social Security Act (42 U.S.C. 1302, 

1395hh, and 1395rr(b)(l)). 

Subpart B—Physicians and Other 

Practitioners 

■ 22. Section 414.50 is revised to read 

as follows: 


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§ 414.50 Physician or other supplier billing 

for diagnostic tests performed or 

interpreted by an outside supplier or at a 

site other than the office of the billing 

physician or other supplier. 

(a) General rules. (1) The services 

covered under section 1861(s)(3) of the 

Act and paid for under part 414 of this 

chapter (other than clinical diagnostic 

laboratory tests paid under section 

1833(a)(2)(D) of the Act, which are 

subject to the special billing rules set 

forth in section 1833(h)(5)(A) of the 

Act), if a physician or other supplier 

bills for the technical component or 

professional component of a diagnostic 

test that was ordered by the physician 

or other supplier (or ordered by a party 

related to such physician or other 

supplier through common ownership or 

control as described in § 413.17 of this 

chapter) and the diagnostic test is either 

purchased from an outside supplier or 

performed at a site other than the office 

of the billing physician or other 

supplier, the payment to the billing 

physician or other supplier (less the 

applicable deductibles and coinsurance 

paid by the beneficiary or on behalf of 

the beneficiary) for the technical 

component or professional component 

of the diagnostic test may not exceed the 

lowest of the following amounts: 

(i) The performing supplier’s net 

charge to the billing physician or other 

supplier. 

(ii) The billing physician or other 

supplier’s actual charge. 

(iii) The fee schedule amount for the 

test that would be allowed if the 

performing supplier billed directly. 

(2) The following requirements are 

applicable for purposes of paragraph (a) 

of this section: 

(i) The net charge must be determined 

without regard to any charge that is 

intended to reflect the cost of equipment 

or space leased to the performing 

supplier by or through the billing 

physician or other supplier. 

(ii) An ‘‘outside supplier’’ is someone 

who is not an employee of the billing 

physician or other supplier and who 

does not furnish the test or 

interpretation to the billing physician or 

other supplier under a reassignment that 

meets the requirements of § 424.80. 

(iii) The ‘‘office of the billing 

physician or other supplier’’ is medical 

office space where the physician or 

other supplier regularly furnishes 

patient care. With respect to a billing 

physician or other supplier that is a 

physician organization (as defined at 

§ 411.351 of this chapter), the ‘‘office of 

the billing physician or other supplier’’

is space in which the physician 

organization provides substantially the 

full range of patient care services that 

the physician organization provides 

generally. 

(b) Restriction on payment. (1) The 

billing physician or other supplier must 

identify the performing supplier and 

indicate the performing supplier’s net 

charge for the test. If the billing 

physician or other supplier fails to 

provide this information, CMS makes no 

payment to the billing physician or 

other supplier and the billing physician 

or other supplier may not bill the 

beneficiary. 

(2) Physicians and other suppliers 

that accept Medicare assignment may 

bill beneficiaries for only the applicable 

deductibles and coinsurance. 

(3) Physicians and other suppliers 

that do not accept Medicare assignment 

may not bill the beneficiary more than 

the payment amount described in 

paragraph (a) of this section. 

■ 23. Section 414.65 is amended by 

revising paragraph (a)(1) to read as 

follows: 

§ 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), 

individual medical nutrition therapy, 

and neurobehavioral status exam 

furnished via an interactive 

telecommunications system is equal to 

the current fee schedule amount 

applicable for the service of the 

physician or practitioner. 

* * * * * 

Subpart G—Payment for New Clinical 

Diagnostic Laboratory Tests 

■ 24. Section § 414.502 is amended by 

adding the definition, ‘‘New test’’ in 

alphabetical order to read as follows: 

§ 414.502 Definitions. 

* * * * * 

New test means any clinical 

diagnostic laboratory test for which a 

new or substantially revised Healthcare 

Common Procedure Coding System 

Code is assigned on or after January 1, 

2005. 

■ 25. Section 414.506 is amended by 

revising the introductory text to read as 

follows: 

§ 414.506 Procedures for public 

consultation for payment for a new clinical 

diagnostic laboratory test. 

For a new test, CMS determines the 

basis for and amount of payment after 

performance of the following: 

* * * * * 

■ 26. Section 414.508 is amended by 

revising paragraph (b)(3) to read as 

follows: 

§ 414.508 Payment for a new clinical 

diagnostic laboratory test. 

* * * * * 

(b) * * * 

(3) For a new test for which a new or 

substantially revised HCPCS code was 

assigned on or before December 31, 

2007, after the first year of gapfilling, 

CMS determines whether the carrierspecific amounts will pay for the test 

appropriately. If CMS determines that 

the carrier-specific amounts will not pay 

for the test appropriately, CMS may 

crosswalk the test. 

■ 27. Section 414.509 is added to read 

as follows: 

§ 414.509 Reconsideration of basis for and 

amount of payment for a new clinical 

diagnostic laboratory test. 

For a new test for which a new or 

substantially revised HCPCS code was 

assigned on or after January 1, 2008, the 

following reconsideration procedures 

apply: 

(a) Reconsideration of basis for 

payment. (1) CMS will receive 

reconsideration requests in written 

format for 60 days after making a 

determination of the basis for payment 

under § 414.506(d)(2) regarding whether 

CMS should reconsider the basis for 

payment and why a different basis for 

payment would be more appropriate. If 

a requestor recommends that the basis 

for payment should be changed from 

gapfilling to crosswalking, the requestor 

may also recommend the code or codes 

to which to crosswalk the new test. 

(2)(i) A requestor that submitted a 

request under paragraph (a)(1) of this 

section may also present its 

reconsideration request at the public 

meeting convened under § 414.506(c), 

provided that the requestor requests an 

opportunity to present at the public 

meeting as part of its written submission 

under paragraph (a)(1) of this section. 

(ii) If the requestor presents its 

reconsideration request at the public 

meeting convened under § 414.506(c), 

members of public may comment on the 

reconsideration request verbally at the 

public meeting and may submit written 

comments after the public meeting 

(within the timeframe for public 

comments established by CMS). 


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(3) Considering reconsideration 

requests and other comments received, 

CMS may reconsider its determination 

of the basis for payment. As the result 

of such a reconsideration, CMS may 

change the basis for payment from 

crosswalking to gapfilling or from 

gapfilling to crosswalking. 

(4) If the basis for payment is revised 

as the result of a reconsideration, the 

new basis for payment is final and is not 

subject to further reconsideration. 

(b) Reconsideration of amount of 

payment—(1) Crosswalking. (i) For 60 

days after making a determination under 

§ 414.506(d)(2) of the code or codes to 

which a new test will be crosswalked, 

CMS receives reconsideration requests 

in written format regarding whether 

CMS should reconsider its 

determination and the recommended 

code or codes to which to crosswalk the 

new test. 

(ii)(A) A requestor that submitted a 

request under paragraph (b)(1)(i) of this 

section may also present its 

reconsideration request at the public 

meeting convened under § 414.506(c), 

provided that the requestor requests an 

opportunity to present at the public 

meeting as part of its written submission 

under paragraph (b)(1)(i) of this section. 

(B) If a requestor presents its 

reconsideration request at the public 

meeting convened under § 414.506(c), 

members of public may comment on the 

reconsideration request verbally at the 

public meeting and may submit written 

comments after the public meeting 

(within the timeframe for public 

comments established by CMS). 

(iii) Considering comments received, 

CMS may reconsider its determination 

of the amount of payment. As the result 

of such a reconsideration, CMS may 

change the code or codes to which the 

new test is crosswalked. 

(iv) If CMS changes the basis for 

payment from gapfilling to crosswalking 

as a result of a reconsideration, the 

crosswalked amount of payment is not 

subject to reconsideration. 

(2) Gapfilling. (i) By April 30 of the 

year after CMS makes a determination 

under § 414.506(d)(2) or § 414.509(a)(3) 

that the basis for payment for a new test 

will be gapfilling, CMS posts interim 

carrier-specific amounts on the CMS 

Web site. 

(ii) For 60 days after CMS posts 

interim carrier-specific amounts on the 

CMS Web site, CMS will receive public 

comments in written format regarding 

the interim carrier-specific amounts. 

(iii) After considering the public 

comments, CMS will post final carrierspecific amounts on the CMS Web site. 

(iv) For 30 days after CMS posts final 

carrier-specific amounts on the CMS 

Web site, CMS will receive 

reconsideration requests in written 

format regarding whether CMS should 

reconsider the final payment amounts 

and the appropriate national limitation 

amount for the new test. 

(v) Considering reconsideration 

requests received, CMS may reconsider 

its determination of the amount of 

payment. As the result of a 

reconsideration, CMS may revise the 

national limitation amount for the new 

test. 

(3) For both gapfilled and crosswalked 

new tests, if CMS revises the amount of 

payment as the result of a 

reconsideration, the new amount of 

payment is final and is not subject to 

further reconsideration. 

(c) Effective date. If CMS changes a 

determination as the result of a 

reconsideration, the new determination 

regarding the basis for or amount of 

payment is effective January 1 of the 

year following reconsideration. Claims 

for services with dates of service prior 

to the effective date will not be 

reopened or otherwise reprocessed. 

(d) Jurisdiction for Reconsideration 

Decisions. Jurisdiction for reconsidering 

a determination rests exclusively with 

the Secretary. A decision whether to 

reconsider a determination is committed 

to the discretion of the Secretary. A 

decision not to reconsider an initial 

determination is not subject to 

administrative or judicial review. 

■ 28. Section 414.510 is amended by—

■ A. Revising the section heading to 

read as set forth below. 

■ B. Revising the introductory text. 

The revisions read as follows: 

§ 414.510 Laboratory date of service for 

clinical laboratory and pathology 

specimens. 

The date of service for either a clinical 

laboratory test or the technical 

component of physician pathology 

service is as follows: 

* * * * * 

Subpart H—Fee Schedule for 

Ambulance Services 

§ 414.620 [Amended] 

■ 29. In § 414.620, the phrase ‘‘notice in 

the Federal Register without 

opportunity for prior comment’’ is 

removed and the phrase ‘‘CMS by 

instruction and on the CMS Web site’’

is added in its place. 

Subpart I—Payment for Drugs and 

Biologicals 

■ 30. Section 414.707 is amended by 

adding paragraph (c) to read as follows: 

§ 414.707 Basis of payment 

* * * * * 

(c) Mandatory reporting of anemia 

quality indicators. The following 

provisions are effective January 1, 2008: 

(1) Each request for payment for antianemia drugs furnished to treat anemia 

resulting from the treatment of cancer 

must report the beneficiary’s most 

recent hemoglobin or hematocrit level; 

(2) Each request for payment for use 

of erythropoiesis stimulating agents 

must report the beneficiary’s most 

recent hemoglobin or hematocrit level. 

Subpart K—Payment for Drugs and 

Biologicals Under Part B 

■ 31. Section 414.904 is amended by 

revising paragraph (d)(3) to read as 

follows: 

§ 414.904 Average sales price as the basis 

for payment. 

* * * * * 

(d) * * * 

(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 CY 2005, 2006, 2007 or 2008, 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. 

* * * * * 

■ 32. Section 414.908 is amended by—

■ A. Revising paragraphs (a)(2)(iv), 

(a)(3)(x), and (a)(3)(xi). 

■ B. Adding paragraph (a)(2)(v). 

■ C. Removing paragraph (a)(5). 

The revisions and addition read as 

follows: 

§ 414.908 Competitive acquisition 

program. 

(a) * * * 

(2) * * * 

(iv) The approved CAP vendor refuses 

to ship to the participating CAP 

physician because the conditions of 

§ 414.914(i) have been met (if this 

subparagraph (a)(2)(iv) applies, the 

physician can withdraw from the CAP 

category for the remainder of the year 

immediately upon notice to CMS and 

the approved CAP vendor); or 

(v) Other exigent circumstances 

defined by CMS are present, 

including—

(A) If, up to and including 60 days 

after the effective date of the physician’s 

CAP election agreement, the 

participating CAP physician submits a 

written request to the designated carrier 

to terminate the CAP election agreement 


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because CAP participation imposes a 

burden on the physician’s practice. The 

written request must document the 

burden. The designated carrier will 

process the participating CAP 

physician’s request and CMS will 

approve or deny the request under the 

dispute resolution process as specified 

under § 414.917 of this subpart. 

(B) If, more than 60 days after the 

effective date of the physician’s CAP 

election agreement, the participating 

CAP physician submits a written 

request to the designated carrier to 

terminate the CAP election agreement 

because, based on a change in 

circumstances of which the 

participating CAP physician was not 

previously aware, CAP participation 

imposes a burden on the physician’s 

practice. The written request must 

document the burden. The designated 

carrier will process the participating 

CAP physician’s request and CMS will 

approve or deny the request under the 

dispute resolution process as specified 

under § 414.917 of this subpart. 

(3) * * * 

(x) Agrees to file the Medicare claim 

within 30 calendar days of the date of 

drug administration. 

(xi) Agrees to submit documentation 

such as medical records or certification, 

as necessary, to support payment for a 

CAP drug; 

* * * * * 

■ 33. Section 414.914 is amended by—

■ A. Redesignating paragraph (h) as (i) 

■ B. Adding new paragraph (h). 

■ C. Revising new paragraphs (i)(1) and 

(2). 

■ D. Removing the reference 

‘‘§ 414.914(h)’’ in paragraph (f)(12) and 

adding in its place the reference 

‘‘§ 414.914(i)’’. 

■ E. Revising new paragraph (i)(5). 

The addition and revision read as 

follows: 

§ 414.914 Terms of contract. 

* * * * * 

(h) The approved CAP vendor must 

verify drug administration prior to 

collection of any applicable cost sharing 

amount. 

(1) The approved CAP vendor 

documents, in writing, the following 

information necessary to verify drug 

administration: 

(i) Beneficiary name. 

(ii) Health insurance number. 

(iii) Expected date of administration. 

(iv) Actual date of administration. 

(v) Identity of the participating CAP 

physician. 

(vi) Prescription order number. 

(vii) Identity of the individuals who 

supply and receive the information. 

(viii) Dosage supplied. 

(ix) Dosage administered. 

* * * * * 

(2) If the information is obtained 

verbally, the approved CAP vendor 

must also maintain the following 

information: 

(i) The identities of individuals who 

exchanged the information. 

(ii) The date and time that the 

information was obtained. 

(3) The approved CAP vendor must 

provide this information to CMS or the 

beneficiary upon request. 

(i) * * * 

(1) Subsequent to receipt of 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) An approved CAP vendor that has 

received payment from the designated 

carrier for CAP drugs that have not been 

administered must promptly refund 

payment for such drugs to the 

designated carrier and must refund any 

coinsurance and deductible collected 

from the beneficiary and his or her 

supplemental insurer. 

* * * * * 

(5) For purposes of paragraph (i) of 

this section 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 

(i)(5)(ii) of this section, 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 (i)(6), (i)(7), or (i)(8) of this 

section, apply. 

■ 34. Section 414.916 is amended by 

revising paragraph (c)(1) to read as 

follows: 

§ 414.916 Dispute resolution for vendors 

and beneficiaries. 

* * * * * 

(c) * * * 

(1) Right to a reconsideration. A 

participating CAP physician dissatisfied 

with a determination that his or her 

CAP election agreement has been 

suspended by CMS or a determination 

under § 414.917(d) denying the 

participating CAP physician’s request to 

terminate participation in the CAP 

under § 414.908(a)(v) is entitled to a 

reconsideration as provided in this 

subpart. 

* * * * * 

■ 35. Section 414.917 is amended by—

■ A. Revising the section heading as set 

forth below. 

■ B. Adding paragraph (d). 

The revision and addition read as 

follows: 

§ 414.917 Dispute resolution and process 

for suspension or termination of approved 

CAP contract and termination of physician 

participation under exigent circumstances. 

* * * * * 

(d) CAP participating physicians’

exigent circumstances provision. The 

following process must be completed for 

participating CAP physicians’ requests 

to terminate their participation in the 

program under exigent circumstances 

provisions described in 

§ 414.908(a)(2)(v): 

(1) The designated carrier must—

(i) Determine whether a request to 

terminate CAP participation was related 

to approved CAP vendor service, and if 

so, forward the issue to the approved 

CAP vendor’s grievance process within 

1 business day of the receipt of the 

request; or 

(ii) Continue to investigate, consistent 

with § 414.916(b)(2) of this chapter, and 

within 2 business days of receipt, do 

any of the following: 

(A) Request a single, 2-business day 

extension. No later than the end of any 

2-business day extension, the 

designated carrier must make findings 

and a recommendation as provided in 

subparagraph (B) or (C). 

(B) Submit a recommendation and 

relevant findings to CMS that the 

requesting participating CAP physician 

be permitted to terminate his or her 

participation in the CAP. 

(C) Submit a recommendation and 

relevant findings to CMS that the 

requesting participating CAP physician 

not be permitted to terminate his or her 

participation in the CAP. 

(ii) In the case of a request made 

under § 414.908(a)(2)(v)(B), the 

designated carrier also shall include in 

its recommendation its finding with 

respect to whether the request is based 

on a change in circumstances of which 

the participating CAP physician was 

previously unaware. 

(2) CMS will consider the carrier’s 

findings and recommendation and may 

also make its own findings. As a result, 

CMS will—

(i) Approve or deny the request to 

terminate participation in the CAP 

within 2 business days of receipt of the 

recommendation. 


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(ii) Communicate the decision to the 

appropriate Medicare contractors and 

the participating CAP physician. 

(3) A denial of the participating CAP 

physician’s request to terminate 

participation in the CAP must include 

written notification of the right to 

request reconsideration under 

§ 414.916(c). 

(4) Upon termination of participation 

in the CAP a physician must—

(i) Continue to submit claims for 

drugs supplied and administered under 

the CAP prior to the effective date of the 

physician’s termination from the CAP 

consistent with § 414.908(a) until all 

such claims are timely submitted. 

(ii) Return any unused CAP drugs that 

had not been administered to the 

beneficiary prior to the effective date of 

the physician’s termination from the 

CAP to the approved CAP vendor 

consistent with applicable law and 

regulation and any agreement with the 

approved CAP vendor. 

(iii) Cooperate in any post-payment 

review activities on claims submitted 

under the CAP, as required under 

section 1847B(a)(3) of the Act. 

(5) An approved CAP vendor that has 

billed and been paid for CAP drugs that 

have not been administered must refund 

any payments made by CMS or the 

beneficiary and his or her supplemental 

insurer in accordance with 

§ 414.914(h)(3)(i)(2) of this chapter. 

■ 36. Section 414.930 is added to 

subpart K to read as follows: 

§ 414.930 Compendia for determination of 

medically-accepted indications for off-label 

uses of drugs and biologicals in an anticancer chemotherapeutic regimen. 

(a) Definition. For purposes of this 

section, compendium means a 

comprehensive listing of FDA-approved 

drugs and biologicals or a 

comprehensive listing of a specific 

subset of drugs and biologicals in a 

specialty compendium, for example a 

compendium of anti-cancer treatment. A 

compendium includes a summary of the 

pharmacologic characteristics of each 

drug or biological and may include 

information on dosage, as well as 

recommended or endorsed uses in 

specific diseases. A compendium is 

indexed by drug or biological. 

(b) Process for listing compendia for 

determining medically-accepted uses of 

drugs and biologicals in anti-cancer 

treatment. (1) The CMS process—

(i) Receives formal written requests 

for changes to the list of compendia 

during a 30 day window beginning 

January 15 each year. 

(ii) Publishes a listing of the timely, 

complete requests by March 15th and 

solicits public comment on the requests 

for 30 days. The listing identifies the 

requestor and the requested action. 

(iii) Considers a compendium’s 

attainment of the MedCAC (Medicare 

Evidence Development and Coverage 

Advisory Committee, previously known 

as the MCAC—Medicare Coverage 

Advisory Committee) recommended 

desirable characteristics of compendia 

(including explicit listing and 

recommendations) in reviewing 

requests. CMS may consider additional 

reasonable factors. 

(iv) Considers a compendium’s 

grading of evidence used in making 

recommendations regarding off-label 

uses and the process by which the 

compendium grades the evidence. 

(v) Publishes its decision no later than 

90 days after the close of the public 

comment period. 

(2) Exception. In addition to the 

annual process outlined in paragraph 

(b)(1) of this section, CMS may 

internally generate a request for changes 

to the list of compendia at any time. 

(c) Written request for review. (1) CMS 

will review a complete, written request 

that is submitted in writing, 

electronically or via hard copy (no 

duplicate submissions) and includes the 

following: 

(i) The full name and contact 

information of the requestor. 

(ii) The full identification of the 

compendium that is the subject of the 

request, including name, publisher, 

edition if applicable, date of 

publication, and any other information 

needed for the accurate and precise 

identification of the specific 

compendium. 

(iii) A complete written copy of the 

compendium that is the subject of the 

request. 

(iv) The specific action that is 

requested of CMS. 

(v) Materials that the requestor must 

submit for CMS review in support of the 

requested action. 

(vi) A single compendium as its 

subject. 

(d) CMS may at its discretion combine 

and consider multiple requests that refer 

to the same compendium. 

(e) For the purposes of this section, 

publication by CMS may be 

accomplished by posting on the CMS 

Web site. 

■ 37. Subpart M is added to read as 

follows: 

Subpart M—Payment for 

Comprehensive Outpatient 

Rehabilitation Facility (CORF) Services 

§ 414.1100 Basis and Scope. 

This subpart implements sections 

1834(k)(1) and (k)(3) of the Act by 

specifying the payment methodology for 

comprehensive outpatient rehabilitation 

facility services covered under Part B of 

Title XVIII of the Act that are described 

at section 1861(cc)(1) of the Act. 

§ 414.1105 Payment for Comprehensive 

Outpatient Rehabilitation Facility (CORF) 

Services. 

(a) Payment under the physician fee 

schedule. Except as otherwise specified 

under paragraphs (b), (c), (d), and (e) of 

this section payment for CORF services, 

as defined under § 410.100 of this 

chapter, is paid the lesser of 80 percent 

of the following: 

(1) The actual charge for the item or 

service; or 

(2) The nonfacility amount 

determined under the physician fee 

schedule established under section 

1848(b) of the Act for the item or 

service. 

(b) Payment for physician services. No 

separate payment for physician services 

that are CORF services under 

§ 410.100(a) of this chapter will be 

made. 

(c) Payment for supplies and durable 

medical equipment, prosthetic and 

orthotic devices, and drugs and 

biologicals. Supplies and durable 

medical equipment that are CORF 

services under § 410.100(l) of this 

chapter, prosthetic device services that 

are CORF services under § 410.100(f), 

orthotic devices that are CORF services 

under § 410.100(g) of this chapter and 

drugs and biologicals that are CORF 

services under § 410.100(k) of this 

chapter are paid the lesser of 80 percent 

of the following: 

(1) The actual charge for the service 

provided that payment for such item is 

not included in the payment amount for 

other CORF services paid under 

paragraphs (a) or (d); or 

(2) The amount determined under the 

DMEPOS fee schedule established 

under part 414 subparts D and F for the 

item or the single payment amount 

established under the DMEPOS 

competitive bidding program provided 

that payment for such item is not 

included in the payment amount for 

other CORF services paid under 

paragraphs (a) or (d). 

(d) Payment for drugs and biologicals. 

Drugs and biologicals that are CORF 

services under § 410.100(j) of this 

chapter, are paid the lesser of 80 percent 

of the following: 

(1) The actual charge for the service 

provided that payment for such item is 

not included in the payment amount for 

other CORF services paid under 

paragraphs (a) or (c); or 

(2) The amount determined using the 

same methodology for drugs (as defined 


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in § 414.704 of this chapter) described 

in section 1842(o)(1) of the Act provided 

that payment for such drug is not 

included in the payment amount for 

other CORF services paid under 

paragraphs (a) or (c). 

(e) Payment for CORF services when 

no fee schedule amount for the service. 

If there is no fee schedule amount 

established for a CORF service, payment 

for the item or service will be the lesser 

of 80 percent of: 

(i) The actual charge for the service 

provided that payment for such item or 

service is not included in the payment 

amount for other CORF services paid 

under paragraphs (a), (c), or (d) of this 

section. 

(ii) The amount determined under the 

fee schedule established for a 

comparable service as specified by the 

Secretary provided that payment for 

such item or service is not included in 

the payment amount for other CORF 

services paid under paragraphs (a), (c), 

or (d) of this section. 

PART 415—SERVICES FURNISHED BY 

PHYSICIANS IN PROVIDERS, 

SUPERVISING PHYSICIANS IN 

TEACHING SETTINGS, AND 

RESIDENTS IN CERTAIN SETTINGS 

■ 38. The authority citation for part 415 

continues to read as follows: 

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh). 

Subpart C—Part B Carrier Payments 

for Physician Services to Beneficiaries 

in Providers 

■ 39. Section 415.130 is amended by 

revising paragraph (d) to read as 

follows: 

§ 415.130 Conditions for payment: 

Physician pathology services. 

* * * * * 

(d) Physician pathology services 

furnished by an independent laboratory. 

The technical component of physician 

pathology services furnished by an 

independent laboratory to a hospital 

inpatient or outpatient on or before 

December 31, 2007, may be paid to the 

laboratory by the carrier under the 

physician fee schedule if the Medicare 

beneficiary is a patient of a covered 

hospital as defined in paragraph (a)(1) of 

this section. For services furnished after 

December 31, 2007, an independent 

laboratory may not bill the carrier for 

the technical component of physician 

pathology services furnished to a 

hospital inpatient or outpatient. For 

services furnished on or after January 1, 

2008, the date of service policy in 

§ 414.510 of this chapter applies for the 

technical component of specimens for 

physician pathology services. 

PART 418—HOSPICE CARE 

■ 40. The authority citation for part 418 

continues to read as follows: 

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh). 

Subpart E—Condition of Participation: 

Other Services 

■ 41. Section 418.92 is amended by 

revising paragraph (a) to read as follows: 

§ 418.92 Condition of participation—

Physical therapy, occupational therapy, and 

speech-language pathology. 

(a) Physical therapy, occupational 

therapy, and speech-language pathology 

services must be—

(1) Available, and when provided, 

offered in a manner consistent with 

accepted standards of practice; and 

(2) Furnished by personnel who meet 

the qualifications specified in part 484 

of this chapter. 

* * * * * 

PART 423—VOLUNTARY MEDICARE 

PRESCRIPTION DRUG BENEFIT 

■ 42. The authority citation for part 423 

continues to read as follows: 

Authority: Secs 1102, 1860D–1 through 

1860D–42, and 1871 of the Social Security 

Act (42 U.S.C. 1302, 1395w–101 through 

1395w–152, and 1395hh). 

Subpart D—Cost Control and Quality 

Improvement Requirements 

■ 43. Section 423.160 is amended by—

■ A. Revising paragraph (a)(3)(i). 

■ B. Redesignating paragraphs (a)(3)(ii) 

and (iii) to (a)(3)(iii) and (iv), 

respectively. 

■ C. Adding new paragraph (a)(3)(ii). 

The revision and addition reads as 

follows: 

§ 423.160 Standards for electronic 

prescribing. 

(a) * * * 

(3) * * * 

(i) Entities transmitting prescriptions 

or prescription-related information by 

means of computer-generated facsimile 

are exempt from the requirement to use 

the NCPDP SCRIPT Standard adopted 

by this section in transmitting such 

prescriptions or prescription-related 

information until January 1, 2009; 

(ii) After January 1, 2009, electronic 

transmission of prescriptions or 

prescription-related information by 

means of computer-generated facsimile 

is only permitted in instances of 

temporary/transient transmission failure 

and communication problems that 

would preclude the use of the NCPDP 

SCRIPT Standard adopted by this 

section. 

* * * * * 

PART 424—CONDITIONS FOR 

MEDICARE PAYMENT 

■ 44. 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). 

■ 45. The heading for subpart B is 

revised to read as set forth below. 

Subpart B—Certification and Plan 

Requirements 

■ 46. Section 424.24 is amended by 

revising paragraphs (c)(2) and (c)(4) to 

read as follows: 

§ 424.24 Requirements for medical and 

other health services furnished by 

providers under Medicare Part B. 

* * * * * 

(c) * * * 

(2) Timing. The initial certification 

must be obtained as soon as possible 

after the plan is established. 

(4) Recertification. (i) Timing. 

Recertification is required at least every 

90 days. 

(ii) Content. When it is recertified, the 

plan or other documentation in the 

patient’s record must indicate the 

continuing need for physical therapy, 

occupational therapy or speechlanguage pathology services. 

(iii) Signature. The physician, nurse 

practitioner, clinical nurse specialist, or 

physician assistant who reviews the 

plan must recertify the plan by signing 

the medical record. 

* * * * * 

■ 47. Section 424.27 is amended by 

revising paragraph (b)(1) to read as 

follows: 

§ 424.27 Requirements for comprehensive 

outpatient rehabilitation facility (CORF) 

services 

* * * * * 

(b) * * * 

(1) Timing. Recertification is required 

at least every 60 days for respiratory 

therapy services and every 90 days for 

physical therapy, occupational therapy, 

and speech-language pathology services 

based on review by a facility physician 

or the referring physician who, when 

appropriate, consults with the 

professional personnel who furnish the 

services. 

* * * * * 

■ 48. In § 424.32, paragraph (a)(3) is 

revised to read as follows: 


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§ 424.32 Basic requirements for all claims. 

(a) * * * 

(3) A claim must be signed by the 

beneficiary or on behalf of the 

beneficiary (in accordance with 

§ 424.36). 

* * * * * 

Subpart C—Claims for Payment 

■ 49. Section 424.36 is amended by—

■ A. Revising paragraph (b)(5). 

■ B. Adding paragraph (b)(6). 

The revision and addition read as 

follows: 

§ 424.36 Signature requirements. 

* * * * * 

(b) * * * 

(5) A representative of the provider or 

of the nonparticipating hospital 

claiming payment for services it has 

furnished if the provider or 

nonparticipating hospital is unable to 

have the claim signed in accordance 

with paragraph (b)(1), (2), (3), or (4) of 

this section after making reasonable 

efforts to locate and obtain the signature 

of one of the individuals specified in 

paragraph (b)(1), (2), (3), or (4) of this 

section. 

(6) An ambulance provider or 

supplier with respect to emergency 

ambulance transport services, if the 

following conditions and 

documentation requirements are met. 

(i) None of the individuals listed in 

paragraph (b)(1), (2), (3), or (4) of this 

section was available or willing to sign 

the claim on behalf of the beneficiary at 

the time the service was provided; 

(ii) The ambulance provider or 

supplier maintains in its files the 

following information and 

documentation for a period of at least 

four years from the date of service: 

(A) A contemporaneous statement, 

signed by an ambulance employee 

present during the trip to the receiving 

facility, that, at the time the service was 

provided, the beneficiary was physically 

or mentally incapable of signing the 

claim and that none of the individuals 

listed in paragraph (b)(1), (2), (3), or (4) 

of this section were available or willing 

to sign the claim on behalf of the 

beneficiary, and 

(B) Documentation with the date and 

time the beneficiary was transported, 

and the name and location of the facility 

that received the beneficiary, and 

(C) Either of the following: 

(1) A signed contemporaneous 

statement from a representative of the 

facility that received the beneficiary, 

which documents the name of the 

beneficiary and the date and time the 

beneficiary was received by that facility; 

or 

(2) The requested information from a 

representative of the facility using a 

secondary form of verification obtained 

at a later date, but prior to submitting 

the claim to Medicare for payment. 

Secondary forms of verification include 

a copy of any of the following—

(i) The signed patient care/trip report; 

(ii) The hospital registration/ 

admissions sheet; 

(iii) The patient medical record; 

(iv) The hospital log; or 

(v) Other internal hospital records. 

* * * * * 

Subpart F—Limitations on Assignment 

and Reassignment of Claims 

■ 50. Section 424.80 is amended by 

adding paragraph (d)(3) to read as 

follows: 

§ 424.80 Prohibition of reassignment of 

claims by suppliers. 

* * * * * 

(d) * * * 

(3) Reassignment of the technical or 

professional component of a diagnostic 

test. If a physician or other supplier bills 

for the technical or professional 

component of a diagnostic test covered 

under section 1861(s)(3) of the Act and 

paid for under part 414 of this chapter 

(other than clinical diagnostic 

laboratory tests paid under section 

1833(a)(2)(D) of the Act, which are 

subject to the special rules set forth in 

section 1833(h)(5)(A) of the Act) 

following a reassignment from a 

physician or other supplier who 

performed the technical or professional 

component, the amount payable to the 

billing physician or other supplier may 

be subject to the limits specified in 

§ 414.50 of this chapter. 

PART 482—CONDITIONS OF 

PARTICIPATION FOR HOSPITALS 

■ 51. The authority citation for part 482 

continues to read as follows: 

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh). 

■ 52. Section 482.56 is amended by 

revising paragraphs (a)(2) and (b) to read 

as follows: 

§ 482.56 Condition of participation: 

Rehabilitation services. 

(a) * * * 

(2) Physical therapy, occupational 

therapy, speech-language pathology or 

audiology services, if provided, must be 

provided by qualified physical 

therapists, physical therapist assistants, 

occupational therapists, occupational 

therapy assistants, speech-language 

pathologists, or audiologists as defined 

in part 484 of this chapter. 

(b) Standard: Delivery of services. 

Services must be given in accordance 

with orders of practitioners who are 

authorized by the medical staff to order 

the services, and the orders must be 

incorporated in the patient’s record. The 

provision of care and the personnel 

qualifications must be in accordance 

with national acceptable standards of 

practice and must also meet the 

requirements of § 409.17 

PART 484—HOME HEALTH SERVICES 

■ 53. The authority citation for part 484 

continues to read as follows: 

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395(hh)) unless otherwise indicated. 

Subpart A—General Provisions 

■ 54. Section 484.4 is amended by 

revising the definitions of 

‘‘Occupational therapist,’’

‘‘Occupational therapy assistant,’’

‘‘Physical therapist,’’ ‘‘Physical therapist 

assistant’’ and ‘‘Speech language 

pathologist’’ to read as follows: 

§ 484.4 Personnel Qualifications. 

* * * * * 

Occupational therapist. A person 

who—

(a)(1) Is licensed or otherwise 

regulated, if applicable, as an 

occupational therapist by the State in 

which practicing, unless licensure does 

not apply; 

(2) Graduated after successful 

completion of an occupational therapist 

education program accredited by the 

Accreditation Council for Occupational 

Therapy Education (ACOTE) of the 

American Occupational Therapy 

Association, Inc. (AOTA), or successor 

organizations of ACOTE; and 

(3) Is eligible to take, or has 

successfully completed the entry-level 

certification examination for 

occupational therapists developed and 

administered by the National Board for 

Certification in Occupational Therapy, 

Inc. (NBCOT). 

(b) On or before December 31, 2009—

(1) Is licensed or otherwise regulated, 

if applicable, as an occupational 

therapist by the State in which 

practicing; or 

(2) When licensure or other regulation 

does not apply—

(i) Graduated after successful 

completion of an occupational therapist 

education program accredited by the 

Accreditation Council for Occupational 

Therapy Education (ACOTE) of the 

American Occupational Therapy 

Association, Inc. (AOTA) or successor 

organizations of ACOTE; and 


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(ii) Is eligible to take, or has 

successfully completed the entry-level 

certification examination for 

occupational therapists developed and 

administered by the National Board for 

Certification in Occupational Therapy, 

Inc., (NBCOT). 

(c) On or before January 1, 2008—

(1) Graduated after successful 

completion of an occupational therapy 

program accredited jointly by the 

committee on Allied Health Education 

and Accreditation of the American 

Medical Association and the American 

Occupational Therapy Association; or 

(2) Is eligible for the National 

Registration Examination of the 

American Occupational Therapy 

Association or the National Board for 

Certification in Occupational Therapy. 

(d) On or before December 31, 1977—

(1) Had 2 years of appropriate 

experience as an occupational therapist; 

and 

(2) Had achieved a satisfactory grade 

on an occupational therapist proficiency 

examination conducted, approved, or 

sponsored by the U.S. Public Health 

Service. 

(e) If educated outside the United 

States—

(1) Must meet both of the following: 

(i) Graduated after successful 

completion of an occupational therapist 

education program accredited as 

substantially equivalent to occupational 

therapist assistant entry level education 

in the United States by one of the 

following: 

(A) The Accreditation Council for 

Occupational Therapy Education 

(ACOTE). 

(B) Successor organizations of 

ACOTE. 

(C) The World Federation of 

Occupational Therapists. 

(D) A credentialing body approved by 

the American Occupational Therapy 

Association. 

(ii) Successfully completed the entrylevel certification examination for 

occupational therapists developed and 

administered by the National Board for 

Certification in Occupational Therapy, 

Inc. (NBCOT). 

(2) On or before December 31, 2009, 

is licensed or otherwise regulated, if 

applicable, as an occupational therapist 

by the State in which practicing. 

Occupational therapy assistant. A 

person who—

(a) Meets all of the following: 

(1) Is licensed or otherwise regulated, 

if applicable, as an occupational therapy 

assistant by the State in which 

practicing, unless licensure does apply. 

(2) Graduated after successful 

completion of an occupational therapy 

assistant education program accredited 

by the Accreditation Council for 

Occupational Therapy Education, 

(ACOTE) of the American Occupational 

Therapy Association, Inc. (AOTA) or its 

successor organizations. 

(3) Is eligible to take or successfully 

completed the entry-level certification 

examination for occupational therapy 

assistants developed and administered 

by the National Board for Certification 

in Occupational Therapy, Inc. (NBCOT). 

(b) On or before December 31, 2009—

(1) Is licensed or otherwise regulated 

as an occupational therapy assistant, if 

applicable, by the State in which 

practicing; or any qualifications defined 

by the State in which practicing, unless 

licensure does not apply; or 

(2) Must meet both of the following: 

(i) Completed certification 

requirements to practice as an 

occupational therapy assistant 

established by a credentialing 

organization approved by the American 

Occupational Therapy Association. 

(ii) After January 1, 2010, meets the 

requirements in paragraph (a) of this 

section. 

(c) After December 31, 1977 and on or 

before December 31, 2007—

(1) Completed certification 

requirements to practice as an 

occupational therapy assistant 

established by a credentialing 

organization approved by the American 

Occupational Therapy Association; or 

(2) Completed the requirements to 

practice as an occupational therapy 

assistant applicable in the State in 

which practicing. 

(d) On or before December 31, 1977—

(1) Had 2 years of appropriate 

experience as an occupational therapy 

assistant; and 

(2) Had achieved a satisfactory grade 

on an occupational therapy assistant 

proficiency examination conducted, 

approved, or sponsored by the U.S. 

Public Health Service. 

(e) If educated outside the United 

States, on or after January 1, 2008—

(1) Graduated after successful 

completion of an occupational therapy 

assistant education program that is 

accredited as substantially equivalent to 

occupational therapist assistant entry 

level education in the United States 

by—

(i) The Accreditation Council for 

Occupational Therapy Education 

(ACOTE). 

(ii) Its successor organizations. 

(iii) The World Federation of 

Occupational Therapists. 

(iv) By a credentialing body approved 

by the American Occupational Therapy 

Association; and 

(2) Successfully completed the entrylevel certification examination for 

occupational therapy assistants 

developed and administered by the 

National Board for Certification in 

Occupational Therapy, Inc. (NBCOT). 

Physical therapist. A person who is 

licensed, if applicable, by the State in 

which practicing, unless licensure does 

not apply and meets one of the 

following requirements: 

(a)(1) Graduated after successful 

completion of one of a physical 

therapist eduction program approved by 

one of the following: 

(i) The Commission on Accreditation 

in Physical Therapy Education 

(CAPTE). 

(ii) Successor organizations of CAPTE. 

(iii) An education program outside the 

United States determined to be 

substantially equivalent to physical 

therapist entry level education in the 

United States by a credentials 

evaluation organization approved by the 

American Physical Therapy Association 

or an organization identified in 8 CFR 

212.15(e) as it relates to physical 

therapists. 

(2) Passed an examination for 

physical therapists approved by the 

State in which physical therapy services 

are provided. 

(b) On or before December 31, 2009—

(1) Graduated after successful 

completion of a physical therapy 

curriculum approved by the 

Commission on Accreditation in 

Physical Therapy Education (CAPTE); 

or 

(2) Meets both of the following: 

(i) Graduated after successful 

completion of an education program 

determined to be substantially 

equivalent to physical therapist entry 

level education in the United States by 

a credentials evaluation organization 

approved by the American Physical 

Therapy Association or identified in 8 

CFR 212.15(e) as it relates to physical 

therapists. 

(ii) Passed an examination for 

physical therapists approved by the 

State in which physical therapy services 

are provided. 

(c) Before January 1, 2008—

(1) Graduated from a physical therapy 

curriculum approved by one of the 

following: 

(i) The American Physical Therapy 

Association. 

(ii) The Committee on Allied Health 

Education and Accreditation of the 

American Medical Association. 

(iii) The Council on Medical 

Education of the American Medical 

Association and the American Physical 

Therapy Association. 

(d) On or before December 31, 1977 

was licensed or qualified as a physical 

therapist and meets both of the 

following: 


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(1) Has 2 years of appropriate 

experience as a physical therapist. 

(2) Has achieved a satisfactory grade 

on a proficiency examination 

conducted, approved, or sponsored by 

the U.S. Public Health Service. 

(e) Before January 1, 1966—

(1) Was admitted to membership by 

the American Physical Therapy 

Association; 

(2) Was admitted to registration by the 

American Registry of Physical 

Therapists; and 

(3) Graduated from a physical therapy 

curriculum in a 4-year college or 

university approved by a State 

department of education. 

(f) Before January 1, 1966 was 

licensed or registered, and before 

January 1, 1970, had 15 years of fulltime experience in the treatment of 

illness or injury through the practice of 

physical therapy in which services were 

rendered under the order and direction 

of attending and referring doctors of 

medicine or osteopathy. 

(g) If trained outside the United States 

before January 1, 2008, meets the 

following requirements: 

(1) Was graduated since 1928 from a 

physical therapy curriculum approved 

in the country in which the curriculum 

was located and in which there is a 

member organization of the World 

Confederation for Physical Therapy. 

(2) Meets the requirements for 

membership in a member organization 

of the World Confederation for Physical 

Therapy. 

Physical therapist assistant. A person 

who is licensed, registered or certified 

as a physical therapist assistant, if 

applicable, by the State in which 

practicing, unless licensure does not 

apply and meets one of the following 

requirements: 

(a)(1)(i) Graduated from a physical 

therapist assistant curriculum approved 

by the Commission on Accreditation in 

Physical Therapy Education of the 

American Physical Therapy 

Association; or if educated outside the 

United States or trained in the United 

States military, graduated from an 

education program determined to be 

substantially equivalent to physical 

therapist assistant entry level education 

in the United States by a credentials 

evaluation organization approved by the 

American Physical Therapy Association 

or identified at 8 CFR 212.15(e); and 

(ii) Passed a national examination for 

physical therapist assistants. 

(b) On or before December 31, 2009, 

meets one of the following: 

(1) Is licensed, or otherwise regulated 

in the State in which practicing. 

(2) In States where licensure or other 

regulations do not apply, graduated 

before December 31, 2009, from a 2-year 

college-level program approved by the 

American Physical Therapy Association 

and after January 1, 2010, meets the 

requirements of paragraph (a) of this 

definition. 

(c) Before January 1, 2008, where 

licensure or other regulation does not 

apply, graduated from a 2-year collegelevel program approved by the 

American Physical Therapy 

Association. 

(d) On or before December 31, 1977, 

was licensed or qualified as a physical 

therapist assistant and has achieved a 

satisfactory grade on a proficiency 

examination conducted, approved, or 

sponsored by the U.S. Public Health 

Service. 

* * * * * 

Speech-language pathologist. A 

person who meets either of the 

following requirements: 

(a) The education and experience 

requirements for a Certificate of Clinical 

Competence in speech-language 

pathology granted by the American 

Speech-Language-Hearing Association. 

(b) The educational requirements for 

certification and is in the process of 

accumulating the supervised experience 

required for certification. 

PART 485—CONDITIONS OF 

PARTICIPATION: SPECIALIZED 

PROVIDERS 

■ 55. The authority citation for part 485 

continues to read as follows: 

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395(hh)). 

Subpart B—Conditions of 

Participation: Comprehensive 

Outpatient Rehabilitation Facilities 

■ 56. Section 485.51 is amended by—

■ A. Revising paragraph (a). 

■ B. Adding paragraph (c). 

The revision and addition read as 

follows: 

§ 485.51 Definition. 

* * * * * 

(a) Is established and operated 

exclusively for the purpose of providing 

diagnostic, therapeutic, and restorative 

services to outpatients for the 

rehabilitation of injured, disabled, or 

sick persons, at a single fixed location, 

by or under the supervision of a 

physician except as provided in 

paragraph (c) of this section; 

* * * * * 

(c) Exception. May provide influenza, 

pneumococcal and Hepatitis B vaccines 

provided the applicable conditions of 

coverage under § 410.58 and § 410.63 of 

this chapter are met. 

■ 57. Section 485.70 is amended by 

revising paragraphs (c), (e), and (m) to 

read as follows: 

§ 485.70 Personnel qualifications. 

* * * * * 

(c) An occupational therapist and an 

occupational therapy assistant must 

meet the qualifications in part 484 of 

this chapter. 

* * * * * 

(e) A physical therapist and a physical 

therapist assistant must meet the 

qualifications in part 484 of this 

chapter. 

* * * * * 

(m) A speech-language pathologist 

must meet the qualifications set forth in 

part 484 of this chapter. 

Subpart F—Conditions of 

Participation: Critical Access Hospitals 

(CAHs) 

■ 58. Section 485.635 is amended by 

adding paragraph (e) to read as follows: 

§ 485.635 Condition of participation: 

Provision of services. 

* * * * * 

(e) Standard: Rehabilitation Therapy 

Services. Physical therapy, occupational 

therapy, and speech-language pathology 

services furnished at the CAH, if 

provided, are provided as direct services 

by staff qualified under State law, and 

consistent with the requirements for 

therapy services in 409.17. 

(Catalog of Federal Domestic Assistance 

Program No. 93.774, Medicare—

Supplementary Medical Insurance Program) 

Dated: October 23, 2007. 

Kerry Weems, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Approved: October 31, 2007. 

Michael O. Leavitt, 

Secretary. 

Addendum A: 

Note: These addenda will not appear in the 

Code of Federal Regulations. Addendum A: 

Explanation and Use of Addendum B. 

The addenda on the following pages 

provide various data pertaining to the 

Medicare fee schedule for physicians’

services furnished in 2008. 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 or the 

alphanumeric codes (Healthcare Common 

Procedure Coding System (HCPCS) codes not 

included in CPT) not paid under the PFS in 

Addendum B. 


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Addendum B—2008 Relative Value 

Units and Related Information Used in 

Determining Medicare Payments for 

2008 

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). If there is an ‘‘NA’’ in the non-facility 

PE RVU column, and the contractor 

determines that this service can be performed 

in the non-facility setting, the service will be 

paid at the facility PE RVU rate. 

• 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, for example, a colonoscopy that is 

not completed. There will be RVUs for a code 

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 = Carriers price the 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. 

E = Excluded from the PFS by regulation. 

These codes are for items and services that 

CMS chose to exclude from the fee schedule 

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 year and are never subject to a grace 

period. This indicator is no longer effective 

beginning with the 2005 fee schedule as of 

January 1, 2005. 

G = Code not valid for Medicare purposes. 

Medicare uses another code for reporting of, 

and payment for, these services. (Codes 

subject to a 90-day grace period.) This 

indicator is no longer effective with the 2005 

PFS as of January 1, 2005. 

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 database with the 

H status indicator. 

I = Not valid for Medicare purposes. 

Medicare uses another code for the reporting 

of, and the payment for these services. (Codes 

not subject to a 90-day grace period.) 

L = Local codes. Carriers will apply this 

status to all local codes in effect on January 

1, 1998 or subsequently approved by central 

office for use. Carriers will complete the 

RVUs and payment amounts for these codes. 

M = Measurement codes, used for reporting 

purposes only. There are no RVUs and no 

payment amounts for these codes. Medicare 

uses them to aid with performance 

measurement. No separate payment is made. 

These codes should be billed with a zero 

(($0.00) charge and are denied) on the 

MPFSDB. 

N = Non-covered 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. 

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 = Statutory exclusion. These codes 

represent an item or service that is not within 

the statutory 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 2008. 

Note: The separate budget neutrality 

adjustor is not reflected in these physician 

work RVUs. 

6. Fully implemented non-facility practice 

expense RVUs. These are the fully 

implemented resource-based PE RVUs for 

non-facility settings. 

7. Year 2008 Transitional Non-facility 

practice expense RVUs. These are the 2008 

resource-based PE RVUs for non-facility 

settings. 

8. Fully implemented facility practice 

expense RVUs. These are the fully 

implemented resource-based PE RVUs for 

facility settings. 

9. Year 2008 Transitional facility practice 

expense RVUs. These are the 2008 resourcebased PE RVUs for facility settings. 

10. Malpractice expense RVUs. These are 

the RVUs for the malpractice expense for the 

service for 2008. 

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 = 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 in the post service time. 

*Codes with these indicators had a 90 day 

grace period before January 1, 2005. 


cprice-sewell on PROD1PC72 with RULES
66410 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

0016T .... ............ C ........ Thermotx choroid vasc lesion ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0017T .... ............ C ........ Photocoagulat macular drusen ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0019T .... ............ C ........ Extracorp shock wv tx,ms nos ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0026T .... ............ C ........ Measure remnant lipoproteins ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0027T .... ............ C ........ Endoscopic epidural lysis ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0028T .... ............ C ........ Dexa body composition study ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0029T .... ............ C ........ Magnetic tx for incontinence ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0030T .... ............ C ........ Antiprothrombin antibody .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0031T .... ............ C ........ Speculoscopy ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0032T .... ............ C ........ Speculoscopy w/direct sample ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0041T .... ............ C ........ Detect ur infect agnt w/cpas ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0042T .... ............ C ........ Ct perfusion w/contrast, cbf ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0043T .... ............ C ........ Co expired gas analysis ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0046T .... ............ C ........ Cath lavage, mammary duct(s) .......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0047T .... ............ C ........ Cath lavage, mammary duct(s) .......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0048T .... ............ C ........ Implant ventricular device ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0049T .... ............ C ........ External circulation assist ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0050T .... ............ C ........ Removal circulation assist .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0051T .... ............ C ........ Implant total heart system .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0052T .... ............ C ........ Replace component heart syst ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0053T .... ............ C ........ Replace component heart syst ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0058T .... ............ C ........ Cryopreservation, ovary tiss ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0059T .... ............ C ........ Cryopreservation, oocyte .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0060T .... ............ C ........ Electrical impedance scan .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0061T .... ............ C ........ Destruction of tumor, breast ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0062T .... ............ C ........ Rep intradisc annulus;1 lev ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0063T .... ............ C ........ Rep intradisc annulus;>1lev ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0064T .... ............ C ........ Spectroscop eval expired gas ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0066T .... ............ N ........ Ct colonography;screen ...................... 0.00 0.00 0.00 NA NA 0.00 XXX 

0066T .... TC ...... N ........ Ct colonography;screen ...................... 0.00 0.00 0.00 NA NA 0.00 XXX 

0066T .... 26 ....... N ........ Ct colonography;screen ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0067T .... ............ C ........ Ct colonography;dx ............................. 0.00 0.00 0.00 NA NA 0.00 XXX 

0067T .... TC ...... C ........ Ct colonography;dx ............................. 0.00 0.00 0.00 NA NA 0.00 XXX 

0067T .... 26 ....... C ........ Ct colonography;dx ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0068T .... ............ C ........ Interp/rept heart sound ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0069T .... ............ C ........ Analysis only heart sound ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0070T .... ............ C ........ Interp only heart sound ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0071T .... ............ C ........ U/s leiomyomata ablate <200 ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0072T .... ............ C ........ U/s leiomyomata ablate >200 ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0073T .... ............ A ........ Delivery, comp imrt ............................. 0.00 13.15 15.58 NA NA 0.13 XXX 

0075T .... ............ C ........ Perq stent/chest vert art ..................... 0.00 0.00 0.00 NA NA 0.00 XXX 

0075T .... TC ...... C ........ Perq stent/chest vert art ..................... 0.00 0.00 0.00 NA NA 0.00 XXX 

0075T .... 26 ....... C ........ Perq stent/chest vert art ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0076T .... ............ C ........ S&i stent/chest vert art ....................... 0.00 0.00 0.00 NA NA 0.00 XXX 

0076T .... TC ...... C ........ S&i stent/chest vert art ....................... 0.00 0.00 0.00 NA NA 0.00 XXX 

0076T .... 26 ....... C ........ S&i stent/chest vert art ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0077T .... ............ C ........ Cereb therm perfusion probe .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0078T .... ............ C ........ Endovasc aort repr w/device .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0079T .... ............ C ........ Endovasc visc extnsn repr .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0080T .... ............ C ........ Endovasc aort repr rad s&i ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0081T .... ............ C ........ Endovasc visc extnsn s&i ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0084T .... ............ C ........ Temp prostate urethral stent .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0085T .... ............ C ........ Breath test heart reject ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0086T .... ............ C ........ L ventricle fill pressure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0087T .... ............ C ........ Sperm eval hyaluronan ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0088T .... ............ C ........ Rf tongue base vol reduxn ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0089T .... ............ C ........ Actigraphy testing, 3-day .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0090T .... ............ C ........ Cervical artific disc .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0092T .... ............ C ........ Artific disc addl .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0093T .... ............ C ........ Cervical artific diskectomy .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0095T .... ............ C ........ Artific diskectomy addl ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0096T .... ............ C ........ Rev cervical artific disc ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

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 receive&gen .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0101T .... ............ C ........ Extracorp shockwv tx,hi enrg .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0102T .... ............ C ........ Extracorp shockwv tx,anesth .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0103T .... ............ C ........ Holotranscobalamin ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0104T .... ............ C ........ At rest cardio gas rebreathe ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 


cprice-sewell on PROD1PC72 with RULES
66411 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

0105T .... ............ C ........ Exerc cardio gas rebreathe ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0106T .... ............ C ........ Touch quant sensory test ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0107T .... ............ C ........ Vibrate quant sensory test .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0108T .... ............ C ........ Cool quant sensory test ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0109T .... ............ C ........ Heat quant sensory test ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0110T .... ............ C ........ Nos quant sensory test ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0111T .... ............ C ........ Rbc membranes fatty acids ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0123T .... ............ C ........ Scleral fistulization .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0124T .... ............ C ........ Conjunctival drug placement .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0126T .... ............ C ........ Chd risk imt study ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0130T .... ............ C ........ Chron care drug investigatn ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0137T .... ............ C ........ Prostate saturation sampling .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0140T .... ............ C ........ Exhaled breath condensate ph ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0141T .... ............ I .......... Perq islet transplant ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0142T .... ............ I .......... Open islet transplant ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0143T .... ............ I .......... Laparoscopic islet transplnt ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0144T .... ............ C ........ CT heart wo dye; qual calc ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

0144T .... TC ...... C ........ CT heart wo dye; qual calc ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

0144T .... 26 ....... C ........ CT heart wo dye; qual calc ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0145T .... ............ C ........ CT heart w/wo dye funct ..................... 0.00 0.00 0.00 NA NA 0.00 XXX 

0145T .... TC ...... C ........ CT heart w/wo dye funct ..................... 0.00 0.00 0.00 NA NA 0.00 XXX 

0145T .... 26 ....... C ........ CT heart w/wo dye funct ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0146T .... ............ C ........ CCTA w/wo dye .................................. 0.00 0.00 0.00 NA NA 0.00 XXX 

0146T .... TC ...... C ........ CCTA w/wo dye .................................. 0.00 0.00 0.00 NA NA 0.00 XXX 

0146T .... 26 ....... C ........ CCTA w/wo dye .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0147T .... ............ C ........ CCTA w/wo, quan calcium ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

0147T .... TC ...... C ........ CCTA w/wo, quan calcium ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

0147T .... 26 ....... C ........ CCTA w/wo, quan calcium ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0148T .... ............ C ........ CCTA w/wo, strxr ................................ 0.00 0.00 0.00 NA NA 0.00 XXX 

0148T .... TC ...... C ........ CCTA w/wo, strxr ................................ 0.00 0.00 0.00 NA NA 0.00 XXX 

0148T .... 26 ....... 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 calc ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

0149T .... TC ...... C ........ CCTA w/wo, strxr quan calc ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

0149T .... 26 ....... C ........ CCTA w/wo, strxr quan calc ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0150T .... ............ C ........ CCTA w/wo, disease strxr .................. 0.00 0.00 0.00 NA NA 0.00 XXX 

0150T .... TC ...... C ........ CCTA w/wo, disease strxr .................. 0.00 0.00 0.00 NA NA 0.00 XXX 

0150T .... 26 ....... C ........ CCTA w/wo, disease strxr .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0151T .... ............ C ........ CT heart funct add-on ......................... 0.00 0.00 0.00 NA NA 0.00 XXX 

0151T .... TC ...... C ........ CT heart funct add-on ......................... 0.00 0.00 0.00 NA NA 0.00 XXX 

0151T .... 26 ....... C ........ CT heart funct add-on ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0155T .... ............ C ........ Lap impl gast curve electrd ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0156T .... ............ C ........ Lap remv gast curve electrd ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0157T .... ............ C ........ Open impl gast curve electrd .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0158T .... ............ C ........ Open remv gast curve electrd ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0159T .... ............ C ........ Cad breast mri .................................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

0159T .... TC ...... C ........ Cad breast mri .................................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

0159T .... 26 ....... C ........ Cad breast mri .................................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

0160T .... ............ C ........ Tcranial magn stim tx plan ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0161T .... ............ C ........ Tcranial magn stim tx deliv ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0162T .... ............ C ........ Anal program gast neurostim ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0163T .... ............ C ........ Lumb artif diskectomy addl ................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

0164T .... ............ C ........ Remove lumb artif disc addl ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

0165T .... ............ C ........ Revise lumb artif disc addl ................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

0166T .... ............ C ........ Tcath vsd close w/o bypass ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0167T .... ............ C ........ Tcath vsd close w bypass .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0168T .... ............ C ........ Rhinophototx light app bilat ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0169T .... ............ C ........ Place stereo cath brain ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0170T .... ............ C ........ Anorectal fistula plug rpr ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0171T .... ............ C ........ Lumbar spine proces distract ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0172T .... ............ C ........ Lumbar spine process addl ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0173T .... ............ C ........ Iop monit io pressure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0174T .... ............ C ........ Cad cxr with interp .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0175T .... ............ C ........ Cad cxr remote ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0176T .... ............ C ........ Aqu canal dilat w/o retent ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0177T .... ............ C ........ Aqu canal dilat w retent ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0178T .... ............ C ........ 64 lead ecg w i&r ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0179T .... ............ C ........ 64 lead ecg w tracing ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0180T .... ............ C ........ 64 lead ecg w i&r only ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0181T .... ............ C ........ Corneal hysteresis .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0182T .... ............ C ........ Hdr elect brachytherapy ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0183T .... ............ C ........ Wound ultrasound ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0184T .... ............ C ........ Exc rectal tumor endoscopic .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 


cprice-sewell on PROD1PC72 with RULES
66412 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

0185T .... ............ C ........ Comptr probability analysis ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0186T .... ............ C ........ Suprachoroidal drug delivery .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0187T .... ............ C ........ Ophthalmic dx image anterior ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

10021 .... ............ A ........ Fna w/o image .................................... 1.27 2.18 2.17 0.37 0.46 0.10 XXX 

10022 .... ............ A ........ Fna w/image ....................................... 1.27 2.15 2.35 0.41 0.41 0.08 XXX 

10040 .... ............ A ........ Acne surgery ....................................... 1.19 1.33 1.17 0.98 0.88 0.05 010 

10060 .... ............ A ........ Drainage of skin abscess ................... 1.19 1.50 1.35 1.08 1.01 0.12 010 

10061 .... ............ A ........ Drainage of skin abscess ................... 2.42 2.06 1.94 1.51 1.50 0.26 010 

10080 .... ............ A ........ Drainage of pilonidal cyst ................... 1.19 2.68 2.89 1.10 1.10 0.11 010 

10081 .... ............ A ........ Drainage of pilonidal cyst ................... 2.47 3.48 3.77 1.45 1.47 0.24 010 

10120 .... ............ A ........ Remove foreign body .......................... 1.23 1.95 2.06 0.94 0.95 0.12 010 

10121 .... ............ A ........ Remove foreign body .......................... 2.71 3.51 3.51 1.65 1.72 0.33 010 

10140 .... ............ A ........ Drainage of hematoma/fluid ................ 1.55 2.26 2.01 1.29 1.29 0.19 010 

10160 .... ............ A ........ Puncture drainage of lesion ................ 1.22 1.85 1.72 1.07 1.08 0.14 010 

10180 .... ............ A ........ Complex drainage, wound .................. 2.27 3.25 3.11 1.80 1.89 0.35 010 

11000 .... ............ A ........ Debride infected skin .......................... 0.60 0.72 0.65 0.16 0.19 0.07 000 

11001 .... ............ A ........ Debride infected skin add-on .............. 0.30 0.23 0.23 0.08 0.10 0.04 ZZZ 

11004 .... ............ A ........ Debride genitalia & perineum ............. 10.80 NA NA 3.20 3.55 0.67 000 

11005 .... ............ A ........ Debride abdom wall ............................ 14.24 NA NA 3.78 4.67 0.96 000 

11006 .... ............ A ........ Debride genit/per/abdom wall ............. 13.10 NA NA 3.95 4.40 1.28 000 

11008 .... ............ A ........ Remove mesh from abd wall .............. 5.00 NA NA 1.29 1.66 0.61 ZZZ 

11010 .... ............ A ........ Debride skin, fx ................................... 4.19 6.80 6.83 2.34 2.48 0.66 010 

11011 .... ............ A ........ Debride skin/muscle, fx ....................... 4.94 7.03 7.59 2.01 2.18 0.74 000 

11012 .... ............ A ........ Debride skin/muscle/bone, fx .............. 6.87 9.00 10.55 3.10 3.47 1.16 000 

11040 .... ............ A ........ Debride skin, partial ............................ 0.50 0.68 0.60 0.16 0.18 0.06 000 

11041 .... ............ A ........ Debride skin, full ................................. 0.60 0.72 0.69 0.19 0.26 0.10 000 

11042 .... ............ A ........ Debride skin/tissue .............................. 0.80 0.95 0.96 0.24 0.34 0.13 000 

11043 .... ............ A ........ Debride tissue/muscle ......................... 3.04 3.50 3.44 2.60 2.59 0.32 010 

11044 .... ............ A ........ Debride tissue/muscle/bone ................ 4.11 4.84 4.64 3.58 3.66 0.43 010 

11055 .... ............ R ........ Trim skin lesion ................................... 0.43 0.81 0.68 0.11 0.14 0.05 000 

11056 .... ............ R ........ Trim skin lesions, 2 to 4 ..................... 0.61 0.88 0.76 0.16 0.19 0.07 000 

11057 .... ............ R ........ Trim skin lesions, over 4 ..................... 0.79 0.99 0.86 0.20 0.25 0.10 000 

11100 .... ............ A ........ Biopsy, skin lesion .............................. 0.81 1.88 1.56 0.38 0.38 0.03 000 

11101 .... ............ A ........ Biopsy, skin add-on ............................ 0.41 0.41 0.37 0.20 0.19 0.02 ZZZ 

11200 .... ............ A ........ Removal of skin tags .......................... 0.79 1.23 1.13 0.90 0.83 0.04 010 

11201 .... ............ A ........ Remove skin tags add-on ................... 0.29 0.16 0.16 0.11 0.12 0.02 ZZZ 

11300 .... ............ A ........ Shave skin lesion ................................ 0.51 1.19 1.09 0.21 0.21 0.03 000 

11301 .... ............ A ........ Shave skin lesion ................................ 0.85 1.51 1.31 0.38 0.38 0.04 000 

11302 .... ............ A ........ Shave skin lesion ................................ 1.05 1.76 1.53 0.48 0.47 0.05 000 

11303 .... ............ A ........ Shave skin lesion ................................ 1.24 2.03 1.80 0.55 0.53 0.07 000 

11305 .... ............ A ........ Shave skin lesion ................................ 0.67 1.06 0.96 0.20 0.24 0.07 000 

11306 .... ............ A ........ Shave skin lesion ................................ 0.99 1.42 1.26 0.38 0.40 0.07 000 

11307 .... ............ A ........ Shave skin lesion ................................ 1.14 1.70 1.49 0.47 0.48 0.07 000 

11308 .... ............ A ........ Shave skin lesion ................................ 1.41 1.70 1.57 0.49 0.54 0.13 000 

11310 .... ............ A ........ Shave skin lesion ................................ 0.73 1.38 1.24 0.31 0.32 0.04 000 

11311 .... ............ A ........ Shave skin lesion ................................ 1.05 1.64 1.43 0.48 0.48 0.05 000 

11312 .... ............ A ........ Shave skin lesion ................................ 1.20 1.92 1.67 0.56 0.55 0.06 000 

11313 .... ............ A ........ Shave skin lesion ................................ 1.62 2.18 1.99 0.73 0.72 0.10 000 

11400 .... ............ A ........ Exc tr-ext b9+marg 0.5 < cm .............. 0.87 1.88 1.94 0.93 0.91 0.06 010 

11401 .... ............ A ........ Exc tr-ext b9+marg 0.6–1 cm ............. 1.25 2.19 2.12 1.15 1.08 0.10 010 

11402 .... ............ A ........ Exc tr-ext b9+marg 1.1–2 cm ............. 1.42 2.40 2.31 1.21 1.14 0.13 010 

11403 .... ............ A ........ Exc tr-ext b9+marg 2.1–3 cm ............. 1.81 2.55 2.47 1.56 1.44 0.17 010 

11404 .... ............ A ........ Exc tr-ext b9+marg 3.1–4 cm ............. 2.08 2.85 2.78 1.63 1.51 0.21 010 

11406 .... ............ A ........ Exc tr-ext b9+marg > 4.0 cm .............. 3.47 3.53 3.30 2.10 1.87 0.32 010 

11420 .... ............ A ........ Exc h-f-nk-sp b9+marg 0.5 < .............. 1.00 1.83 1.79 0.93 0.93 0.09 010 

11421 .... ............ A ........ Exc h-f-nk-sp b9+marg 0.6–1 ............. 1.44 2.21 2.14 1.16 1.13 0.13 010 

11422 .... ............ A ........ Exc h-f-nk-sp b9+marg 1.1–2 ............. 1.65 2.43 2.34 1.53 1.43 0.16 010 

11423 .... ............ A ........ Exc h-f-nk-sp b9+marg 2.1–3 ............. 2.03 2.67 2.62 1.66 1.55 0.20 010 

11424 .... ............ A ........ Exc h-f-nk-sp b9+marg 3.1–4 ............. 2.45 2.97 2.89 1.77 1.68 0.25 010 

11426 .... ............ A ........ Exc h-f-nk-sp b9+marg > 4 cm ........... 4.04 3.59 3.53 2.31 2.20 0.44 010 

11440 .... ............ A ........ Exc face-mm b9+marg 0.5 < cm ........ 1.02 2.00 2.10 1.31 1.31 0.08 010 

11441 .... ............ A ........ Exc face-mm b9+marg 0.6–1 cm ....... 1.50 2.38 2.35 1.55 1.52 0.13 010 

11442 .... ............ A ........ Exc face-mm b9+marg 1.1–2 cm ....... 1.74 2.64 2.59 1.66 1.61 0.16 010 

11443 .... ............ A ........ Exc face-mm b9+marg 2.1–3 cm ....... 2.31 2.88 2.90 1.84 1.83 0.22 010 

11444 .... ............ A ........ Exc face-mm b9+marg 3.1–4 cm ....... 3.16 3.31 3.39 2.10 2.14 0.30 010 

11446 .... ............ A ........ Exc face-mm b9+marg > 4 cm ........... 4.75 4.09 4.06 2.68 2.73 0.43 010 

11450 .... ............ A ........ Removal, sweat gland lesion .............. 3.14 5.12 5.07 2.41 2.22 0.34 090 

11451 .... ............ A ........ Removal, sweat gland lesion .............. 4.35 6.37 6.49 2.91 2.73 0.53 090 

11462 .... ............ A ........ Removal, sweat gland lesion .............. 2.92 5.32 5.21 2.47 2.24 0.32 090 

11463 .... ............ A ........ Removal, sweat gland lesion .............. 4.35 6.52 6.67 2.94 2.81 0.54 090 

11470 .... ............ A ........ Removal, sweat gland lesion .............. 3.66 5.47 5.26 2.62 2.44 0.40 090 

11471 .... ............ A ........ Removal, sweat gland lesion .............. 4.81 6.50 6.60 3.01 2.88 0.58 090 


cprice-sewell on PROD1PC72 with RULES
66413 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

11600 .... ............ A ........ Exc tr-ext mlg+marg 0.5 < cm ............ 1.58 2.74 2.69 1.14 1.05 0.10 010 

11601 .... ............ A ........ Exc tr-ext mlg+marg 0.6–1 cm ........... 2.02 3.44 3.07 1.51 1.36 0.12 010 

11602 .... ............ A ........ Exc tr-ext mlg+marg 1.1–2 cm ........... 2.22 3.84 3.33 1.69 1.47 0.12 010 

11603 .... ............ A ........ Exc tr-ext mlg+marg 2.1–3 cm ........... 2.77 4.05 3.56 1.87 1.60 0.16 010 

11604 .... ............ A ........ Exc tr-ext mlg+marg 3.1–4 cm ........... 3.12 4.33 3.85 1.93 1.66 0.20 010 

11606 .... ............ A ........ Exc tr-ext mlg+marg > 4 cm ............... 4.97 5.49 4.77 2.46 2.10 0.36 010 

11620 .... ............ A ........ Exc h-f-nk-sp mlg+marg 0.5 < ............ 1.59 2.85 2.72 1.19 1.07 0.09 010 

11621 .... ............ A ........ Exc h-f-nk-sp mlg+marg 0.6–1 ........... 2.03 3.50 3.10 1.54 1.39 0.12 010 

11622 .... ............ A ........ Exc h-f-nk-sp mlg+marg 1.1–2 ........... 2.36 3.90 3.43 1.75 1.57 0.14 010 

11623 .... ............ A ........ Exc h-f-nk-sp mlg+marg 2.1–3 ........... 3.06 4.11 3.72 1.95 1.76 0.20 010 

11624 .... ............ A ........ Exc h-f-nk-sp mlg+marg 3.1–4 ........... 3.57 4.43 4.08 2.08 1.93 0.27 010 

11626 .... ............ A ........ Exc h-f-nk-sp mlg+mar > 4 cm ........... 4.56 4.96 4.79 2.32 2.36 0.45 010 

11640 .... ............ A ........ Exc face-mm malig+marg 0.5 < ......... 1.62 3.05 2.85 1.29 1.20 0.11 010 

11641 .... ............ A ........ Exc face-mm malig+marg 0.6–1 ......... 2.12 3.63 3.33 1.61 1.57 0.16 010 

11642 .... ............ A ........ Exc face-mm malig+marg 1.1–2 ......... 2.57 4.04 3.72 1.84 1.77 0.19 010 

11643 .... ............ A ........ Exc face-mm malig+marg 2.1–3 ......... 3.37 4.28 4.04 2.11 2.04 0.26 010 

11644 .... ............ A ........ Exc face-mm malig+marg 3.1–4 ......... 4.29 5.07 4.87 2.46 2.46 0.37 010 

11646 .... ............ A ........ Exc face-mm mlg+marg > 4 cm ......... 6.21 5.90 5.83 3.13 3.30 0.61 010 

11719 .... ............ R ........ Trim nail(s) .......................................... 0.17 0.38 0.31 0.04 0.06 0.02 000 

11720 .... ............ A ........ Debride nail, 1–5 ................................. 0.32 0.47 0.40 0.08 0.10 0.04 000 

11721 .... ............ A ........ Debride nail, 6 or more ....................... 0.54 0.55 0.49 0.14 0.17 0.07 000 

11730 .... ............ A ........ Removal of nail plate .......................... 1.10 1.33 1.18 0.28 0.36 0.14 000 

11732 .... ............ A ........ Remove nail plate, add-on .................. 0.57 0.54 0.49 0.15 0.18 0.07 ZZZ 

11740 .... ............ A ........ Drain blood from under nail ................ 0.37 0.80 0.67 0.43 0.39 0.04 000 

11750 .... ............ A ........ Removal of nail bed ............................ 2.40 2.95 2.56 1.88 1.82 0.22 010 

11752 .... ............ A ........ Remove nail bed/finger tip .................. 3.48 4.06 3.52 2.77 2.88 0.35 010 

11755 .... ............ A ........ Biopsy, nail unit ................................... 1.31 2.02 1.79 0.76 0.76 0.14 000 

11760 .... ............ A ........ Repair of nail bed ............................... 1.60 3.40 3.01 1.43 1.61 0.21 010 

11762 .... ............ A ........ Reconstruction of nail bed .................. 2.91 3.70 3.29 1.68 2.01 0.36 010 

11765 .... ............ A ........ Excision of nail fold, toe ...................... 0.71 2.67 2.23 1.01 0.88 0.08 010 

11770 .... ............ A ........ Removal of pilonidal lesion ................. 2.63 3.45 3.47 1.52 1.51 0.33 010 

11771 .... ............ A ........ Removal of pilonidal lesion ................. 5.98 6.63 6.14 3.69 3.50 0.74 090 

11772 .... ............ A ........ Removal of pilonidal lesion ................. 7.23 8.03 7.76 5.55 5.31 0.89 090 

11900 .... ............ A ........ Injection into skin lesions .................... 0.52 0.92 0.78 0.25 0.23 0.02 000 

11901 .... ............ A ........ Added skin lesions injection ............... 0.80 1.01 0.83 0.39 0.37 0.03 000 

11920 .... ............ R ........ Correct skin color defects ................... 1.61 2.34 3.02 1.09 1.09 0.24 000 

11921 .... ............ R ........ Correct skin color defects ................... 1.93 2.66 3.31 1.25 1.26 0.29 000 

11922 .... ............ R ........ Correct skin color defects ................... 0.49 0.92 1.03 0.22 0.24 0.07 ZZZ 

11950 .... ............ R ........ Therapy for contour defects ................ 0.84 0.88 1.01 0.36 0.37 0.06 000 

11951 .... ............ R ........ Therapy for contour defects ................ 1.19 0.90 1.19 0.36 0.43 0.11 000 

11952 .... ............ R ........ Therapy for contour defects ................ 1.69 1.63 1.74 0.77 0.72 0.16 000 

11954 .... ............ R ........ Therapy for contour defects ................ 1.85 1.79 2.11 0.77 0.83 0.25 000 

11960 .... ............ A ........ Insert tissue expander(s) .................... 11.01 NA NA 10.56 10.47 1.31 090 

11970 .... ............ A ........ Replace tissue expander .................... 7.86 NA NA 6.16 6.15 1.05 090 

11971 .... ............ A ........ Remove tissue expander(s) ................ 3.21 7.39 8.25 4.01 3.90 0.32 090 

11975 .... ............ N ........ Insert contraceptive cap ...................... 1.48 1.53 1.47 0.34 0.45 0.17 XXX 

11976 .... ............ R ........ Removal of contraceptive cap ............ 1.78 1.72 1.72 0.47 0.58 0.21 000 

11977 .... ............ N ........ Removal/reinsert contra cap ............... 3.30 1.98 2.13 0.76 1.01 0.37 XXX 

11980 .... ............ A ........ Implant hormone pellet(s) ................... 1.48 1.07 1.07 0.49 0.51 0.13 000 

11981 .... ............ A ........ Insert drug implant device .................. 1.48 1.89 1.79 0.58 0.63 0.12 XXX 

11982 .... ............ A ........ Remove drug implant device .............. 1.78 2.02 1.98 0.70 0.76 0.17 XXX 

11983 .... ............ A ........ Remove/insert drug implant ................ 3.30 2.63 2.46 1.32 1.39 0.23 XXX 

12001 .... ............ A ........ Repair superficial wound(s) ................ 1.72 1.73 1.86 0.73 0.75 0.15 010 

12002 .... ............ A ........ Repair superficial wound(s) ................ 1.88 1.80 1.92 0.84 0.87 0.17 010 

12004 .... ............ A ........ Repair superficial wound(s) ................ 2.26 2.08 2.20 0.92 0.96 0.21 010 

12005 .... ............ A ........ Repair superficial wound(s) ................ 2.88 2.52 2.67 1.06 1.13 0.27 010 

12006 .... ............ A ........ Repair superficial wound(s) ................ 3.68 3.06 3.22 1.30 1.40 0.35 010 

12007 .... ............ A ........ Repair superficial wound(s) ................ 4.13 3.35 3.58 1.46 1.64 0.45 010 

12011 .... ............ A ........ Repair superficial wound(s) ................ 1.78 1.91 2.02 0.76 0.77 0.16 010 

12013 .... ............ A ........ Repair superficial wound(s) ................ 2.01 2.06 2.17 0.89 0.91 0.18 010 

12014 .... ............ A ........ Repair superficial wound(s) ................ 2.48 2.29 2.43 0.98 1.02 0.23 010 

12015 .... ............ A ........ Repair superficial wound(s) ................ 3.21 2.79 2.96 1.12 1.18 0.29 010 

12016 .... ............ A ........ Repair superficial wound(s) ................ 3.94 3.17 3.36 1.28 1.40 0.37 010 

12017 .... ............ A ........ Repair superficial wound(s) ................ 4.72 NA NA 1.52 1.71 0.47 010 

12018 .... ............ A ........ Repair superficial wound(s) ................ 5.54 NA NA 1.92 2.09 0.64 010 

12020 .... ............ A ........ Closure of split wound ........................ 2.64 3.69 3.75 1.75 1.84 0.30 010 

12021 .... ............ A ........ Closure of split wound ........................ 1.86 1.85 1.83 1.33 1.37 0.24 010 

12031 .... ............ A ........ Layer closure of wound(s) .................. 2.17 3.89 3.09 1.77 1.36 0.17 010 

12032 .... ............ A ........ Layer closure of wound(s) .................. 2.49 5.21 4.52 2.28 2.04 0.16 010 

12034 .... ............ A ........ Layer closure of wound(s) .................. 2.94 4.61 3.90 1.99 1.72 0.25 010 

12035 .... ............ A ........ Layer closure of wound(s) .................. 3.44 5.29 5.24 2.11 2.13 0.39 010 

12036 .... ............ A ........ Layer closure of wound(s) .................. 4.06 5.40 5.48 2.23 2.39 0.55 010 


cprice-sewell on PROD1PC72 with RULES
66414 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

12037 .... ............ A ........ Layer closure of wound(s) .................. 4.68 5.98 6.04 2.63 2.80 0.66 010 

12041 .... ............ A ........ Layer closure of wound(s) .................. 2.39 3.87 3.20 1.77 1.45 0.19 010 

12042 .... ............ A ........ Layer closure of wound(s) .................. 2.76 4.49 3.88 2.12 1.79 0.17 010 

12044 .... ............ A ........ Layer closure of wound(s) .................. 3.16 5.40 4.31 1.95 1.77 0.27 010 

12045 .... ............ A ........ Layer closure of wound(s) .................. 3.65 5.03 5.14 2.06 2.17 0.41 010 

12046 .... ............ A ........ Layer closure of wound(s) .................. 4.26 5.65 6.08 2.29 2.52 0.54 010 

12047 .... ............ A ........ Layer closure of wound(s) .................. 4.66 6.49 6.41 2.66 2.87 0.58 010 

12051 .... ............ A ........ Layer closure of wound(s) .................. 2.49 4.11 3.69 1.92 1.68 0.20 010 

12052 .... ............ A ........ Layer closure of wound(s) .................. 2.81 4.86 4.04 2.56 1.99 0.17 010 

12053 .... ............ A ........ Layer closure of wound(s) .................. 3.14 5.38 4.31 2.12 1.82 0.23 010 

12054 .... ............ A ........ Layer closure of wound(s) .................. 3.47 5.42 4.49 2.05 1.84 0.30 010 

12055 .... ............ A ........ Layer closure of wound(s) .................. 4.44 6.01 5.24 2.09 2.11 0.45 010 

12056 .... ............ A ........ Layer closure of wound(s) .................. 5.25 6.56 6.65 2.58 2.81 0.59 010 

12057 .... ............ A ........ Layer closure of wound(s) .................. 5.97 7.75 6.94 2.93 3.34 0.56 010 

13100 .... ............ A ........ Repair of wound or lesion ................... 3.14 4.42 4.23 2.46 2.38 0.26 010 

13101 .... ............ A ........ Repair of wound or lesion ................... 3.93 5.94 5.30 2.97 2.83 0.26 010 

13102 .... ............ A ........ Repair wound/lesion add-on ............... 1.24 1.35 1.26 0.53 0.55 0.13 ZZZ 

13120 .... ............ A ........ Repair of wound or lesion ................... 3.32 4.58 4.36 2.57 2.46 0.26 010 

13121 .... ............ A ........ Repair of wound or lesion ................... 4.36 6.71 5.78 3.64 3.21 0.25 010 

13122 .... ............ A ........ Repair wound/lesion add-on ............... 1.44 1.37 1.44 0.58 0.60 0.15 ZZZ 

13131 .... ............ A ........ Repair of wound or lesion ................... 3.80 5.01 4.68 2.88 2.78 0.26 010 

13132 .... ............ A ........ Repair of wound or lesion ................... 6.48 7.88 6.89 4.95 4.55 0.32 010 

13133 .... ............ A ........ Repair wound/lesion add-on ............... 2.19 1.87 1.76 0.98 1.00 0.18 ZZZ 

13150 .... ............ A ........ Repair of wound or lesion ................... 3.82 4.72 4.79 2.72 2.74 0.34 010 

13151 .... ............ A ........ Repair of wound or lesion ................... 4.46 5.51 5.15 3.22 3.18 0.31 010 

13152 .... ............ A ........ Repair of wound or lesion ................... 6.34 7.53 6.78 3.91 3.97 0.40 010 

13153 .... ............ A ........ Repair wound/lesion add-on ............... 2.38 2.05 1.99 1.03 1.08 0.24 ZZZ 

13160 .... ............ A ........ Late closure of wound ........................ 11.84 NA NA 7.02 7.09 1.54 090 

14000 .... ............ A ........ Skin tissue rearrangement .................. 6.83 8.94 8.39 6.04 5.75 0.59 090 

14001 .... ............ A ........ Skin tissue rearrangement .................. 9.60 11.01 10.21 7.48 7.27 0.82 090 

14020 .... ............ A ........ Skin tissue rearrangement .................. 7.66 10.02 9.31 6.88 6.70 0.64 090 

14021 .... ............ A ........ Skin tissue rearrangement .................. 11.18 12.45 11.21 8.65 8.46 0.81 090 

14040 .... ............ A ........ Skin tissue rearrangement .................. 8.44 10.19 9.49 6.98 7.09 0.62 090 

14041 .... ............ A ........ Skin tissue rearrangement .................. 12.67 13.56 12.07 9.34 9.00 0.73 090 

14060 .... ............ A ........ Skin tissue rearrangement .................. 9.07 9.68 9.23 7.17 7.30 0.68 090 

14061 .... ............ A ........ Skin tissue rearrangement .................. 13.67 14.82 13.21 10.17 9.83 0.76 090 

14300 .... ............ A ........ Skin tissue rearrangement .................. 13.26 13.51 12.32 9.44 9.30 1.16 090 

14350 .... ............ A ........ Skin tissue rearrangement .................. 10.82 NA NA 6.89 7.01 1.34 090 

15002 .... ............ A ........ Wnd prep, ch/inf, trk/arm/lg ................ 3.65 4.21 4.21 1.68 1.68 0.49 000 

15003 .... ............ A ........ Wnd prep, ch/inf addl 100 cm ............ 0.80 0.90 0.90 0.26 0.26 0.11 ZZZ 

15004 .... ............ A ........ Wnd prep ch/inf, f/n/hf/g ..................... 4.58 4.87 4.87 2.01 2.01 0.62 000 

15005 .... ............ A ........ Wnd prep, f/n/hf/g, addl cm ................ 1.60 1.24 1.24 0.52 0.52 0.22 ZZZ 

15040 .... ............ A ........ Harvest cultured skin graft .................. 2.00 3.93 4.24 1.05 1.09 0.24 000 

15050 .... ............ A ........ Skin pinch graft ................................... 5.37 7.62 7.26 5.00 5.05 0.57 090 

15100 .... ............ A ........ Skin splt grft, trnk/arm/leg ................... 9.74 9.76 11.17 6.67 7.24 1.28 090 

15101 .... ............ A ........ Skin splt grft t/a/l, add-on .................... 1.72 2.47 3.10 0.85 1.01 0.24 ZZZ 

15110 .... ............ A ........ Epidrm autogrft trnk/arm/leg ............... 10.88 8.74 9.70 6.36 6.68 1.31 090 

15111 .... ............ A ........ Epidrm autogrft t/a/l add-on ................ 1.85 0.87 1.08 0.62 0.70 0.26 ZZZ 

15115 .... ............ A ........ Epidrm a-grft face/nck/hf/g .................. 11.19 9.22 9.22 6.73 7.04 1.15 090 

15116 .... ............ A ........ Epidrm a-grft f/n/hf/g addl ................... 2.50 1.19 1.38 0.86 0.99 0.33 ZZZ 

15120 .... ............ A ........ Skn splt a-grft fac/nck/hf/g .................. 10.96 11.34 11.03 7.45 7.61 1.16 090 

15121 .... ............ A ........ Skn splt a-grft f/n/hf/g add .................. 2.67 3.43 3.96 1.29 1.57 0.36 ZZZ 

15130 .... ............ A ........ Derm autograft, trnk/arm/leg ............... 7.41 7.95 8.90 5.57 5.95 0.97 090 

15131 .... ............ A ........ Derm autograft t/a/l add-on ................. 1.50 0.65 0.86 0.48 0.56 0.21 ZZZ 

15135 .... ............ A ........ Derm autograft face/nck/hf/g .............. 10.91 9.48 9.67 7.04 7.58 1.23 090 

15136 .... ............ A ........ Derm autograft, f/n/hf/g add ................ 1.50 0.66 0.77 0.51 0.59 0.20 ZZZ 

15150 .... ............ A ........ Cult epiderm grft t/arm/leg .................. 9.30 7.04 7.74 5.75 6.10 1.14 090 

15151 .... ............ A ........ Cult epiderm grft t/a/l addl .................. 2.00 0.88 1.09 0.67 0.76 0.28 ZZZ 

15152 .... ............ A ........ Cult epiderm graft t/a/l +% .................. 2.50 1.05 1.30 0.84 0.95 0.35 ZZZ 

15155 .... ............ A ........ Cult epiderm graft, f/n/hf/g .................. 10.05 7.65 7.73 6.30 6.63 1.05 090 

15156 .... ............ A ........ Cult epidrm grft f/n/hfg add ................. 2.75 1.15 1.35 0.94 1.09 0.36 ZZZ 

15157 .... ............ A ........ Cult epiderm grft f/n/hfg +% ................ 3.00 1.33 1.55 1.03 1.19 0.39 ZZZ 

15170 .... ............ A ........ Acell graft trunk/arms/legs .................. 5.99 4.01 3.92 2.60 2.48 0.55 090 

15171 .... ............ A ........ Acell graft t/arm/leg add-on ................ 1.55 0.60 0.64 0.46 0.54 0.19 ZZZ 

15175 .... ............ A ........ Acellular graft, f/n/hf/g ......................... 7.99 4.46 4.94 3.14 3.57 0.82 090 

15176 .... ............ A ........ Acell graft, f/n/hf/g add-on .................. 2.45 1.04 1.07 0.79 0.89 0.29 ZZZ 

15200 .... ............ A ........ Skin full graft, trunk ............................. 8.97 9.90 9.65 6.34 6.27 0.98 090 

15201 .... ............ A ........ Skin full graft trunk add-on ................. 1.32 2.02 2.29 0.47 0.54 0.19 ZZZ 

15220 .... ............ A ........ Skin full graft sclp/arm/leg .................. 7.95 10.45 9.82 6.69 6.68 0.84 090 

15221 .... ............ A ........ Skin full graft add-on ........................... 1.19 2.00 2.16 0.50 0.53 0.16 ZZZ 

15240 .... ............ A ........ Skin full grft face/genit/hf .................... 10.15 12.03 11.11 8.89 8.42 0.92 090 

15241 .... ............ A ........ Skin full graft add-on ........................... 1.86 2.54 2.49 0.81 0.86 0.23 ZZZ 


cprice-sewell on PROD1PC72 with RULES
66415 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

15260 .... ............ A ........ Skin full graft een & lips ...................... 11.39 13.00 11.60 9.33 8.95 0.69 090 

15261 .... ............ A ........ Skin full graft add-on ........................... 2.23 2.97 2.83 1.15 1.28 0.21 ZZZ 

15300 .... ............ A ........ Apply skinallogrft, t/arm/lg ................... 4.65 3.44 3.32 2.15 2.19 0.49 090 

15301 .... ............ A ........ Apply sknallogrft t/a/l addl ................... 1.00 0.46 0.46 0.32 0.36 0.14 ZZZ 

15320 .... ............ A ........ Apply skin allogrft f/n/hf/g ................... 5.36 3.78 3.70 2.35 2.44 0.58 090 

15321 .... ............ A ........ Aply sknallogrft f/n/hfg add ................. 1.50 0.69 0.69 0.51 0.55 0.21 ZZZ 

15330 .... ............ A ........ Aply acell alogrft t/arm/leg .................. 3.99 3.49 3.34 2.14 2.18 0.49 090 

15331 .... ............ A ........ Aply acell grft t/a/l add-on ................... 1.00 0.49 0.47 0.36 0.38 0.14 ZZZ 

15335 .... ............ A ........ Apply acell graft, f/n/hf/g ..................... 4.50 3.32 3.39 2.01 2.22 0.55 090 

15336 .... ............ A ........ Aply acell grft f/n/hf/g add ................... 1.43 0.74 0.71 0.51 0.54 0.20 ZZZ 

15340 .... ............ A ........ Apply cult skin substitute .................... 3.76 3.68 3.84 2.64 2.69 0.41 010 

15341 .... ............ A ........ Apply cult skin sub add-on ................. 0.50 0.64 0.62 0.13 0.17 0.06 ZZZ 

15360 .... ............ A ........ Apply cult derm sub, t/a/l .................... 3.93 4.85 4.66 3.53 3.31 0.43 090 

15361 .... ............ A ........ Aply cult derm sub t/a/l add ................ 1.15 0.50 0.54 0.32 0.39 0.14 ZZZ 

15365 .... ............ A ........ Apply cult derm sub f/n/hf/g ................ 4.21 4.21 4.38 3.09 3.14 0.46 090 

15366 .... ............ A ........ Apply cult derm f/hf/g add ................... 1.45 0.67 0.68 0.47 0.53 0.17 ZZZ 

15400 .... ............ A ........ Apply skin xenograft, t/a/l ................... 4.38 4.99 4.50 3.76 3.88 0.47 090 

15401 .... ............ A ........ Apply skn xenogrft t/a/l add ................ 1.00 1.01 1.45 0.33 0.39 0.14 ZZZ 

15420 .... ............ A ........ Apply skin xgraft, f/n/hf/g .................... 4.89 5.43 5.10 4.17 3.98 0.52 090 

15421 .... ............ A ........ Apply skn xgrft f/n/hf/g add ................. 1.50 1.16 1.24 0.48 0.55 0.21 ZZZ 

15430 .... ............ A ........ Apply acellular xenograft .................... 5.93 6.60 6.75 6.05 6.33 0.66 090 

15431 .... ............ C ........ Apply acellular xgraft add ................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

15570 .... ............ A ........ Form skin pedicle flap ......................... 10.00 10.08 10.69 6.27 6.51 1.34 090 

15572 .... ............ A ........ Form skin pedicle flap ......................... 9.94 9.78 9.63 6.66 6.55 1.20 090 

15574 .... ............ A ........ Form skin pedicle flap ......................... 10.52 10.54 10.61 7.03 7.41 1.20 090 

15576 .... ............ A ........ Form skin pedicle flap ......................... 9.24 9.66 9.70 6.51 6.70 0.87 090 

15600 .... ............ A ........ Skin graft ............................................. 1.95 5.31 6.45 2.75 2.90 0.27 090 

15610 .... ............ A ........ Skin graft ............................................. 2.46 5.56 5.12 3.04 3.23 0.35 090 

15620 .... ............ A ........ Skin graft ............................................. 3.62 6.47 7.12 3.90 3.89 0.35 090 

15630 .... ............ A ........ Skin graft ............................................. 3.95 7.07 7.05 4.31 4.23 0.34 090 

15650 .... ............ A ........ Transfer skin pedicle flap .................... 4.64 7.27 7.20 4.38 4.29 0.42 090 

15731 .... ............ A ........ Forehead flap w/vasc pedicle ............. 14.12 11.89 11.89 9.33 9.33 1.28 090 

15732 .... ............ A ........ Muscle-skin graft, head/neck .............. 19.70 14.64 16.34 11.09 11.65 2.00 090 

15734 .... ............ A ........ Muscle-skin graft, trunk ....................... 19.62 15.68 16.89 11.84 12.10 2.62 090 

15736 .... ............ A ........ Muscle-skin graft, arm ........................ 16.92 13.39 15.80 9.59 10.40 2.46 090 

15738 .... ............ A ........ Muscle-skin graft, leg .......................... 18.92 13.76 15.86 10.18 10.95 2.66 090 

15740 .... ............ A ........ Island pedicle flap graft ....................... 11.57 13.56 11.84 9.41 8.83 0.63 090 

15750 .... ............ A ........ Neurovascular pedicle graft ................ 12.73 NA NA 8.85 8.94 1.42 090 

15756 .... ............ A ........ Free myo/skin flap microvasc ............. 36.74 NA NA 18.55 19.55 4.62 090 

15757 .... ............ A ........ Free skin flap, microvasc .................... 36.95 NA NA 17.85 19.71 3.90 090 

15758 .... ............ A ........ Free fascial flap, microvasc ................ 36.70 NA NA 17.56 19.56 4.24 090 

15760 .... ............ A ........ Composite skin graft ........................... 9.68 10.41 10.21 7.05 7.15 0.85 090 

15770 .... ............ A ........ Derma-fat-fascia graft ......................... 8.73 NA NA 6.63 6.66 1.05 090 

15775 .... ............ R ........ Hair transplant punch grafts ............... 3.95 2.88 3.55 1.23 1.26 0.52 000 

15776 .... ............ R ........ Hair transplant punch grafts ............... 5.53 4.85 5.10 2.14 2.47 0.72 000 

15780 .... ............ A ........ Abrasion treatment of skin .................. 8.50 11.23 11.37 6.52 7.38 0.67 090 

15781 .... ............ A ........ Abrasion treatment of skin .................. 4.91 8.67 7.79 5.64 5.50 0.34 090 

15782 .... ............ A ........ Abrasion treatment of skin .................. 4.36 8.70 9.28 4.96 5.75 0.34 090 

15783 .... ............ A ........ Abrasion treatment of skin .................. 4.33 7.91 7.39 4.96 4.57 0.28 090 

15786 .... ............ A ........ Abrasion, lesion, single ....................... 2.05 3.89 3.62 1.24 1.28 0.11 010 

15787 .... ............ A ........ Abrasion, lesions, add-on ................... 0.33 0.83 0.96 0.08 0.12 0.04 ZZZ 

15788 .... ............ R ........ Chemical peel, face, epiderm ............. 2.09 9.45 8.08 4.12 3.60 0.11 090 

15789 .... ............ R ........ Chemical peel, face, dermal ............... 4.91 9.42 8.75 5.83 5.31 0.20 090 

15792 .... ............ R ........ Chemical peel, nonfacial ..................... 1.86 8.97 8.03 4.58 4.51 0.13 090 

15793 .... ............ A ........ Chemical peel, nonfacial ..................... 3.82 8.09 7.19 4.90 4.64 0.19 090 

15819 .... ............ A ........ Plastic surgery, neck ........................... 10.45 NA NA 6.68 6.93 0.97 090 

15820 .... ............ A ........ Revision of lower eyelid ...................... 6.09 6.39 6.68 5.19 5.38 0.40 090 

15821 .... ............ A ........ Revision of lower eyelid ...................... 6.66 6.56 6.95 5.28 5.49 0.45 090 

15822 .... ............ A ........ Revision of upper eyelid ..................... 4.51 5.23 5.53 4.09 4.29 0.37 090 

15823 .... ............ A ........ Revision of upper eyelid ..................... 8.12 7.38 7.61 6.10 6.27 0.50 090 

15824 .... ............ R ........ Removal of forehead wrinkles ............ 0.00 0.00 0.00 0.00 0.00 0.00 000 

15825 .... ............ R ........ Removal of neck wrinkles ................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15826 .... ............ R ........ Removal of brow wrinkles ................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15828 .... ............ R ........ Removal of face wrinkles .................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15829 .... ............ R ........ Removal of skin wrinkles .................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15830 .... ............ R ........ Exc skin abd ....................................... 16.90 NA NA 9.81 9.81 2.93 090 

15832 .... ............ A ........ Excise excessive skin tissue .............. 12.65 NA NA 8.27 8.30 1.66 090 

15833 .... ............ A ........ Excise excessive skin tissue .............. 11.70 NA NA 7.50 7.85 1.49 090 

15834 .... ............ A ........ Excise excessive skin tissue .............. 11.97 NA NA 8.15 7.92 1.61 090 

15835 .... ............ A ........ Excise excessive skin tissue .............. 12.79 NA NA 7.85 7.69 1.60 090 

15836 .... ............ A ........ Excise excessive skin tissue .............. 10.41 NA NA 6.82 6.80 1.34 090 

15837 .... ............ A ........ Excise excessive skin tissue .............. 9.37 8.67 8.61 5.78 6.57 1.18 090 


cprice-sewell on PROD1PC72 with RULES
66416 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

15838 .... ............ A ........ Excise excessive skin tissue .............. 8.07 NA NA 5.44 5.75 0.58 090 

15839 .... ............ A ........ Excise excessive skin tissue .............. 10.32 9.75 9.29 6.46 6.42 1.22 090 

15840 .... ............ A ........ Graft for face nerve palsy ................... 14.76 NA NA 8.91 9.44 1.32 090 

15841 .... ............ A ........ Graft for face nerve palsy ................... 25.69 NA NA 13.52 14.25 2.55 090 

15842 .... ............ A ........ Flap for face nerve palsy .................... 40.68 NA NA 20.86 21.88 4.94 090 

15845 .... ............ A ........ Skin and muscle repair, face .............. 14.04 NA NA 8.35 8.83 0.81 090 

15847 .... ............ C ........ Exc skin abd add-on ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

15850 .... ............ B ........ Removal of sutures ............................. 0.78 1.20 1.38 0.18 0.24 0.05 XXX 

15851 .... ............ A ........ Removal of sutures ............................. 0.86 1.33 1.50 0.24 0.27 0.06 000 

15852 .... ............ A ........ Dressing change not for burn ............. 0.86 NA NA 0.25 0.29 0.09 000 

15860 .... ............ A ........ Test for blood flow in graft .................. 1.95 NA NA 0.64 0.71 0.27 000 

15876 .... ............ R ........ Suction assisted lipectomy ................. 0.00 0.00 0.00 0.00 0.00 0.00 000 

15877 .... ............ R ........ Suction assisted lipectomy ................. 0.00 0.00 0.00 0.00 0.00 0.00 000 

15878 .... ............ R ........ Suction assisted lipectomy ................. 0.00 0.00 0.00 0.00 0.00 0.00 000 

15879 .... ............ R ........ Suction assisted lipectomy ................. 0.00 0.00 0.00 0.00 0.00 0.00 000 

15920 .... ............ A ........ Removal of tail bone ulcer .................. 8.15 NA NA 5.34 5.45 1.04 090 

15922 .... ............ A ........ Removal of tail bone ulcer .................. 10.23 NA NA 7.16 7.18 1.42 090 

15931 .... ............ A ........ Remove sacrum pressure sore .......... 9.96 NA NA 5.56 5.62 1.25 090 

15933 .... ............ A ........ Remove sacrum pressure sore .......... 11.60 NA NA 7.30 7.57 1.52 090 

15934 .... ............ A ........ Remove sacrum pressure sore .......... 13.54 NA NA 7.72 7.87 1.79 090 

15935 .... ............ A ........ Remove sacrum pressure sore .......... 15.58 NA NA 9.17 9.74 2.10 090 

15936 .... ............ A ........ Remove sacrum pressure sore .......... 13.04 NA NA 7.41 7.81 1.77 090 

15937 .... ............ A ........ Remove sacrum pressure sore .......... 15.00 NA NA 8.93 9.37 2.07 090 

15940 .... ............ A ........ Remove hip pressure sore ................. 10.11 NA NA 5.80 5.99 1.31 090 

15941 .... ............ A ........ Remove hip pressure sore ................. 12.24 NA NA 8.42 8.93 1.66 090 

15944 .... ............ A ........ Remove hip pressure sore ................. 12.27 NA NA 8.13 8.36 1.65 090 

15945 .... ............ A ........ Remove hip pressure sore ................. 13.57 NA NA 8.80 9.22 1.85 090 

15946 .... ............ A ........ Remove hip pressure sore ................. 23.80 NA NA 13.69 14.03 3.17 090 

15950 .... ............ A ........ Remove thigh pressure sore .............. 7.91 NA NA 5.40 5.40 1.04 090 

15951 .... ............ A ........ Remove thigh pressure sore .............. 11.41 NA NA 7.33 7.59 1.49 090 

15952 .... ............ A ........ Remove thigh pressure sore .............. 12.14 NA NA 7.45 7.60 1.60 090 

15953 .... ............ A ........ Remove thigh pressure sore .............. 13.39 NA NA 8.22 8.61 1.80 090 

15956 .... ............ A ........ Remove thigh pressure sore .............. 16.59 NA NA 9.54 10.15 2.22 090 

15958 .... ............ A ........ Remove thigh pressure sore .............. 16.55 NA NA 10.42 10.72 2.26 090 

15999 .... ............ C ........ Removal of pressure sore .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

16000 .... ............ A ........ Initial treatment of burn(s) ................... 0.89 0.72 0.79 0.23 0.25 0.08 000 

16020 .... ............ A ........ Dress/debrid p-thick burn, s ................ 0.80 1.11 1.20 0.56 0.57 0.08 000 

16025 .... ............ A ........ Dress/debrid p-thick burn, m .............. 1.85 1.57 1.67 0.86 0.91 0.19 000 

16030 .... ............ A ........ Dress/debrid p-thick burn, l ................. 2.08 2.08 2.13 1.02 1.07 0.24 000 

16035 .... ............ A ........ Incision of burn scab, initi ................... 3.74 NA NA 1.22 1.40 0.46 000 

16036 .... ............ A ........ Escharotomy; add’l incision ................ 1.50 NA NA 0.46 0.53 0.20 ZZZ 

17000 .... ............ A ........ Destruct premalg lesion ...................... 0.62 1.41 1.19 0.74 0.64 0.03 010 

17003 .... ............ A ........ Destruct premalg les, 2–14 ................. 0.07 0.10 0.11 0.03 0.05 0.01 ZZZ 

17004 .... ............ A ........ Destroy premlg lesions 15+ ................ 1.82 2.44 2.37 1.38 1.48 0.11 010 

17106 .... ............ A ........ Destruction of skin lesions .................. 4.62 4.69 4.64 3.28 3.30 0.35 090 

17107 .... ............ A ........ Destruction of skin lesions .................. 9.19 6.97 7.08 4.94 5.20 0.63 090 

17108 .... ............ A ........ Destruction of skin lesions .................. 13.22 8.86 9.06 6.38 7.02 0.54 090 

17110 .... ............ A ........ Destruct b9 lesion, 1–14 ..................... 0.67 1.79 1.70 0.88 0.79 0.05 010 

17111 .... ............ A ........ Destruct lesion, 15 or more ................ 0.94 2.25 1.96 1.11 0.96 0.05 010 

17250 .... ............ A ........ Chemical cautery, tissue ..................... 0.50 1.32 1.27 0.38 0.36 0.06 000 

17260 .... ............ A ........ Destruction of skin lesions .................. 0.93 1.41 1.34 0.71 0.69 0.04 010 

17261 .... ............ A ........ Destruction of skin lesions .................. 1.19 2.49 2.05 1.07 0.95 0.05 010 

17262 .... ............ A ........ Destruction of skin lesions .................. 1.60 2.83 2.36 1.27 1.14 0.06 010 

17263 .... ............ A ........ Destruction of skin lesions .................. 1.81 3.06 2.56 1.37 1.23 0.07 010 

17264 .... ............ A ........ Destruction of skin lesions .................. 1.96 3.27 2.74 1.43 1.28 0.08 010 

17266 .... ............ A ........ Destruction of skin lesions .................. 2.36 3.50 3.00 1.59 1.40 0.09 010 

17270 .... ............ A ........ Destruction of skin lesions .................. 1.34 2.43 2.06 1.10 0.98 0.05 010 

17271 .... ............ A ........ Destruction of skin lesions .................. 1.51 2.66 2.22 1.22 1.10 0.06 010 

17272 .... ............ A ........ Destruction of skin lesions .................. 1.79 2.97 2.48 1.36 1.24 0.07 010 

17273 .... ............ A ........ Destruction of skin lesions .................. 2.07 3.21 2.71 1.49 1.35 0.08 010 

17274 .... ............ A ........ Destruction of skin lesions .................. 2.61 3.60 3.08 1.74 1.59 0.10 010 

17276 .... ............ A ........ Destruction of skin lesions .................. 3.22 3.88 3.41 1.97 1.82 0.16 010 

17280 .... ............ A ........ Destruction of skin lesions .................. 1.19 2.36 1.98 1.03 0.92 0.05 010 

17281 .... ............ A ........ Destruction of skin lesions .................. 1.74 2.73 2.32 1.33 1.21 0.07 010 

17282 .... ............ A ........ Destruction of skin lesions .................. 2.06 3.14 2.64 1.49 1.36 0.08 010 

17283 .... ............ A ........ Destruction of skin lesions .................. 2.66 3.55 3.05 1.76 1.62 0.11 010 

17284 .... ............ A ........ Destruction of skin lesions .................. 3.23 3.97 3.44 2.02 1.89 0.13 010 

17286 .... ............ A ........ Destruction of skin lesions .................. 4.45 4.44 4.06 2.49 2.46 0.23 010 

17311 .... ............ A ........ Mohs, 1 stage, h/n/hf/g ....................... 6.20 10.70 10.70 3.05 3.05 0.24 000 

17312 .... ............ A ........ Mohs addl stage ................................. 3.30 6.88 6.88 1.62 1.62 0.13 ZZZ 

17313 .... ............ A ........ Mohs, 1 stage, t/a/l ............................. 5.56 9.87 9.87 2.73 2.73 0.22 000 

17314 .... ............ A ........ Mohs, addl stage, t/a/l ........................ 3.06 6.37 6.37 1.50 1.50 0.12 ZZZ 


cprice-sewell on PROD1PC72 with RULES
66417 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

17315 .... ............ A ........ Mohs surg, addl block ......................... 0.87 1.14 1.14 0.43 0.43 0.03 ZZZ 

17340 .... ............ A ........ Cryotherapy of skin ............................. 0.76 0.35 0.36 0.38 0.37 0.05 010 

17360 .... ............ A ........ Skin peel therapy ................................ 1.44 1.86 1.65 1.01 0.94 0.06 010 

17380 .... ............ R ........ Hair removal by electrolysis ................ 0.00 0.00 0.00 0.00 0.00 0.00 000 

17999 .... ............ C ........ Skin tissue procedure ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

19000 .... ............ A ........ Drainage of breast lesion .................... 0.84 1.91 1.95 0.26 0.29 0.08 000 

19001 .... ............ A ........ Drain breast lesion add-on ................. 0.42 0.25 0.25 0.14 0.14 0.04 ZZZ 

19020 .... ............ A ........ Incision of breast lesion ...................... 3.74 6.62 6.48 3.03 2.85 0.45 090 

19030 .... ............ A ........ Injection for breast x-ray ..................... 1.53 2.66 2.76 0.54 0.52 0.09 000 

19100 .... ............ A ........ Bx breast percut w/o image ................ 1.27 2.08 2.08 0.33 0.37 0.16 000 

19101 .... ............ A ........ Biopsy of breast, open ........................ 3.20 4.37 4.43 1.78 1.85 0.39 010 

19102 .... ............ A ........ Bx breast percut w/image ................... 2.00 3.46 3.64 0.68 0.67 0.14 000 

19103 .... ............ A ........ Bx breast percut w/device .................. 3.69 10.09 10.79 1.19 1.21 0.30 000 

19105 .... ............ A ........ Cryosurg ablate fa, each .................... 3.69 46.46 46.46 0.99 0.99 0.30 000 

19110 .... ............ A ........ Nipple exploration ............................... 4.35 6.06 5.93 3.09 2.98 0.57 090 

19112 .... ............ A ........ Excise breast duct fistula .................... 3.72 6.22 6.14 3.12 2.90 0.48 090 

19120 .... ............ A ........ Removal of breast lesion .................... 5.84 5.08 4.81 3.36 3.21 0.73 090 

19125 .... ............ A ........ Excision, breast lesion ........................ 6.59 5.55 5.16 3.64 3.46 0.80 090 

19126 .... ............ A ........ Excision, addl breast lesion ................ 2.93 NA NA 0.75 0.87 0.38 ZZZ 

19260 .... ............ A ........ Removal of chest wall lesion .............. 17.60 NA NA 10.14 10.64 2.14 090 

19271 .... ............ A ........ Revision of chest wall ......................... 21.86 NA NA 15.81 16.87 2.63 090 

19272 .... ............ A ........ Extensive chest wall surgery .............. 24.82 NA NA 16.95 17.93 3.00 090 

19290 .... ............ A ........ Place needle wire, breast ................... 1.27 2.89 2.87 0.45 0.43 0.07 000 

19291 .... ............ A ........ Place needle wire, breast ................... 0.63 1.14 1.17 0.22 0.21 0.04 ZZZ 

19295 .... ............ A ........ Place breast clip, percut ..................... 0.00 2.28 2.48 NA NA 0.01 ZZZ 

19296 .... ............ A ........ Place po breast cath for rad ............... 3.63 85.92 105.62 1.19 1.36 0.36 000 

19297 .... ............ A ........ Place breast cath for rad .................... 1.72 NA NA 0.44 0.54 0.17 ZZZ 

19298 .... ............ A ........ Place breast rad tube/caths ................ 6.00 21.99 32.06 2.10 2.26 0.43 000 

19300 .... ............ A ........ Removal of breast tissue .................... 5.20 8.05 7.59 3.85 3.62 0.69 090 

19301 .... ............ A ........ Partical mastectomy ............................ 10.00 NA NA 4.62 4.02 0.79 090 

19302 .... ............ A ........ P-mastectomy w/ln removal ................ 13.88 NA NA 6.14 6.23 1.80 090 

19303 .... ............ A ........ Mast, simple, complete ....................... 15.67 NA NA 6.99 6.00 1.18 090 

19304 .... ............ A ........ Mast, subq .......................................... 7.81 NA NA 4.93 4.84 1.04 090 

19305 .... ............ A ........ Mast, radical ........................................ 17.23 NA NA 8.11 8.03 1.93 090 

19306 .... ............ A ........ Mast, rad, urban type .......................... 17.85 NA NA 8.71 8.47 2.08 090 

19307 .... ............ A ........ Mast, mod rad ..................................... 17.95 NA NA 8.76 8.48 2.13 090 

19316 .... ............ A ........ Suspension of breast .......................... 10.98 NA NA 6.94 7.22 1.64 090 

19318 .... ............ A ........ Reduction of large breast ................... 15.91 NA NA 9.90 10.53 2.93 090 

19324 .... ............ A ........ Enlarge breast ..................................... 6.65 NA NA 4.46 4.67 0.84 090 

19325 .... ............ A ........ Enlarge breast with implant ................ 8.52 NA NA 6.40 6.46 1.33 090 

19328 .... ............ A ........ Removal of breast implant .................. 6.35 NA NA 4.99 5.00 0.91 090 

19330 .... ............ A ........ Removal of implant material ............... 8.39 NA NA 5.95 5.99 1.26 090 

19340 .... ............ A ........ Immediate breast prosthesis ............... 6.32 NA NA 2.81 2.96 1.06 ZZZ 

19342 .... ............ A ........ Delayed breast prosthesis .................. 12.40 NA NA 8.92 8.92 1.84 090 

19350 .... ............ A ........ Breast reconstruction .......................... 8.99 9.88 11.86 6.58 6.87 1.41 090 

19355 .... ............ A ........ Correct inverted nipple(s) ................... 8.37 7.40 8.82 4.67 4.68 0.92 090 

19357 .... ............ A ........ Breast reconstruction .......................... 20.57 NA NA 15.37 15.49 2.94 090 

19361 .... ............ A ........ Breast reconstr w/lat flap .................... 23.17 NA NA 16.78 14.60 2.93 090 

19364 .... ............ A ........ Breast reconstruction .......................... 42.40 NA NA 22.15 22.84 6.24 090 

19366 .... ............ A ........ Breast reconstruction .......................... 21.70 NA NA 9.90 10.73 3.25 090 

19367 .... ............ A ........ Breast reconstruction .......................... 26.59 NA NA 15.17 15.93 4.04 090 

19368 .... ............ A ........ Breast reconstruction .......................... 33.61 NA NA 18.01 18.46 5.54 090 

19369 .... ............ A ........ Breast reconstruction .......................... 31.02 NA NA 16.31 17.35 4.51 090 

19370 .... ............ A ........ Surgery of breast capsule ................... 8.99 NA NA 6.78 6.84 1.29 090 

19371 .... ............ A ........ Removal of breast capsule ................. 10.42 NA NA 7.68 7.75 1.62 090 

19380 .... ............ A ........ Revise breast reconstruction .............. 10.21 NA NA 7.60 7.65 1.44 090 

19396 .... ............ A ........ Design custom breast implant ............ 2.17 4.53 2.80 1.28 1.13 0.30 000 

19499 .... ............ C ........ Breast surgery procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

20000 .... ............ A ........ Incision of abscess ............................. 2.14 2.78 2.74 1.52 1.63 0.25 010 

20005 .... ............ A ........ Incision of deep abscess .................... 3.55 3.66 3.58 2.01 2.13 0.46 010 

20100 .... ............ A ........ Explore wound, neck .......................... 10.33 NA NA 3.58 4.02 1.21 010 

20101 .... ............ A ........ Explore wound, chest ......................... 3.22 6.59 6.26 1.53 1.57 0.44 010 

20102 .... ............ A ........ Explore wound, abdomen ................... 3.95 6.94 7.20 1.84 1.87 0.49 010 

20103 .... ............ A ........ Explore wound, extremity ................... 5.31 7.80 8.19 2.78 3.09 0.75 010 

20150 .... ............ A ........ Excise epiphyseal bar ......................... 14.60 NA NA 7.64 7.33 2.04 090 

20200 .... ............ A ........ Muscle biopsy ..................................... 1.46 3.09 3.06 0.69 0.72 0.23 000 

20205 .... ............ A ........ Deep muscle biopsy ........................... 2.35 3.82 3.85 1.10 1.14 0.33 000 

20206 .... ............ A ........ Needle biopsy, muscle ........................ 0.99 5.22 5.86 0.57 0.60 0.07 000 

20220 .... ............ A ........ Bone biopsy, trocar/needle ................. 1.27 2.71 3.63 0.68 0.73 0.08 000 

20225 .... ............ A ........ Bone biopsy, trocar/needle ................. 1.87 11.99 18.21 1.02 1.07 0.22 000 

20240 .... ............ A ........ Bone biopsy, excisional ...................... 3.25 NA NA 2.02 2.29 0.44 010 

20245 .... ............ A ........ Bone biopsy, excisional ...................... 8.77 NA NA 5.74 6.15 1.31 010 


cprice-sewell on PROD1PC72 with RULES
66418 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

20250 .... ............ A ........ Open bone biopsy ............................... 5.16 NA NA 3.63 3.56 1.02 010 

20251 .... ............ A ........ Open bone biopsy ............................... 5.69 NA NA 3.84 4.00 1.15 010 

20500 .... ............ A ........ Injection of sinus tract ......................... 1.25 1.34 1.80 0.88 1.20 0.12 010 

20501 .... ............ A ........ Inject sinus tract for x-ray ................... 0.76 2.36 2.64 0.27 0.26 0.04 000 

20520 .... ............ A ........ Removal of foreign body ..................... 1.87 2.60 2.76 1.45 1.61 0.21 010 

20525 .... ............ A ........ Removal of foreign body ..................... 3.51 7.11 8.12 2.21 2.41 0.51 010 

20526 .... ............ A ........ Ther injection, carp tunnel .................. 0.94 0.81 0.89 0.41 0.46 0.13 000 

20550 .... ............ A ........ Inj tendon sheath/ligament .................. 0.75 0.63 0.67 0.28 0.25 0.09 000 

20551 .... ............ A ........ Inj tendon origin/insertion .................... 0.75 0.64 0.66 0.29 0.31 0.08 000 

20552 .... ............ A ........ Inj trigger point, 1/2 muscl .................. 0.66 0.58 0.65 0.24 0.22 0.05 000 

20553 .... ............ A ........ Inject trigger points, =/> 3 ................... 0.75 0.64 0.73 0.26 0.24 0.04 000 

20555 .... ............ A ........ Place ndl musc/tis for rt ...................... 6.00 NA NA 2.18 2.18 0.43 000 

20600 .... ............ A ........ Drain/inject, joint/bursa ....................... 0.66 0.66 0.66 0.31 0.33 0.08 000 

20605 .... ............ A ........ Drain/inject, joint/bursa ....................... 0.68 0.74 0.75 0.32 0.34 0.08 000 

20610 .... ............ A ........ Drain/inject, joint/bursa ....................... 0.79 1.06 1.01 0.40 0.41 0.11 000 

20612 .... ............ A ........ Aspirate/inj ganglion cyst .................... 0.70 0.70 0.70 0.32 0.34 0.10 000 

20615 .... ............ A ........ Treatment of bone cyst ....................... 2.30 2.71 3.11 1.41 1.63 0.20 010 

20650 .... ............ A ........ Insert and remove bone pin ................ 2.25 2.46 2.41 1.45 1.50 0.31 010 

20660 .... ............ A ........ Apply, rem fixation device ................... 4.00 1.50 2.27 1.50 1.55 0.59 000 

20661 .... ............ A ........ Application of head brace ................... 5.14 NA NA 6.04 5.47 1.14 090 

20662 .... ............ A ........ Application of pelvis brace .................. 6.26 NA NA 4.80 5.16 0.56 090 

20663 .... ............ A ........ Application of thigh brace ................... 5.62 NA NA 4.85 4.84 0.94 090 

20664 .... ............ A ........ Halo brace application ........................ 9.86 NA NA 7.80 7.42 1.75 090 

20665 .... ............ A ........ Removal of fixation device .................. 1.33 1.37 1.76 0.98 1.16 0.19 010 

20670 .... ............ A ........ Removal of support implant ................ 1.76 6.62 9.07 1.67 1.88 0.28 010 

20680 .... ............ A ........ Removal of support implant ................ 5.90 8.13 8.46 4.06 3.89 0.56 090 

20690 .... ............ A ........ Apply bone fixation device .................. 8.65 NA NA 4.91 3.71 0.59 090 

20692 .... ............ A ........ Apply bone fixation device .................. 16.00 NA NA 9.79 6.78 1.05 090 

20693 .... ............ A ........ Adjust bone fixation device ................. 5.97 NA NA 4.49 4.96 0.98 090 

20694 .... ............ A ........ Remove bone fixation device ............. 4.20 5.31 6.22 3.52 3.78 0.71 090 

20802 .... ............ A ........ Replantation, arm, complete ............... 42.30 NA NA 13.22 17.08 3.82 090 

20805 .... ............ A ........ Replant forearm, complete ................. 51.14 NA NA 17.97 26.13 4.85 090 

20808 .... ............ A ........ Replantation hand, complete .............. 62.77 NA NA 30.31 36.25 6.88 090 

20816 .... ............ A ........ Replantation digit, complete ............... 31.74 NA NA 16.35 27.06 4.53 090 

20822 .... ............ A ........ Replantation digit, complete ............... 26.42 NA NA 15.05 24.81 4.19 090 

20824 .... ............ A ........ Replantation thumb, complete ............ 31.74 NA NA 16.19 26.36 4.62 090 

20827 .... ............ A ........ Replantation thumb, complete ............ 27.24 NA NA 14.73 25.59 3.67 090 

20838 .... ............ A ........ Replantation foot, complete ................ 42.56 NA NA 14.01 18.14 1.12 090 

20900 .... ............ A ........ Removal of bone for graft ................... 5.77 9.22 8.82 4.90 5.28 0.94 090 

20902 .... ............ A ........ Removal of bone for graft ................... 7.98 NA NA 5.98 6.43 1.30 090 

20910 .... ............ A ........ Remove cartilage for graft .................. 5.41 NA NA 4.56 4.87 0.71 090 

20912 .... ............ A ........ Remove cartilage for graft .................. 6.42 NA NA 4.94 5.37 0.69 090 

20920 .... ............ A ........ Removal of fascia for graft ................. 5.42 NA NA 4.33 4.28 0.66 090 

20922 .... ............ A ........ Removal of fascia for graft ................. 6.84 7.56 7.54 4.99 4.93 0.70 090 

20924 .... ............ A ........ Removal of tendon for graft ................ 6.59 NA NA 4.97 5.42 1.04 090 

20926 .... ............ A ........ Removal of tissue for graft ................. 5.70 NA NA 4.49 4.62 0.87 090 

20930 .... ............ B ........ Sp bone algrft morsel add-on ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

20931 .... ............ A ........ Sp bone algrft struct add-on ............... 1.81 NA NA 0.68 0.80 0.43 ZZZ 

20936 .... ............ B ........ Sp bone agrft local add-on ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

20937 .... ............ A ........ Sp bone agrft morsel add-on .............. 2.79 NA NA 1.08 1.26 0.54 ZZZ 

20938 .... ............ A ........ Sp bone agrft struct add-on ................ 3.02 NA NA 1.15 1.35 0.64 ZZZ 

20950 .... ............ A ........ Fluid pressure, muscle ........................ 1.26 4.23 5.53 0.88 0.93 0.20 000 

20955 .... ............ A ........ Fibula bone graft, microvasc .............. 40.02 NA NA 18.53 21.39 4.90 090 

20956 .... ............ A ........ Iliac bone graft, microvasc .................. 40.93 NA NA 20.31 22.52 7.03 090 

20957 .... ............ A ........ Mt bone graft, microvasc .................... 42.33 NA NA 15.87 17.40 7.07 090 

20962 .... ............ A ........ Other bone graft, microvasc ............... 39.21 NA NA 21.29 23.90 6.57 090 

20969 .... ............ A ........ Bone/skin graft, microvasc .................. 45.11 NA NA 21.09 23.85 4.80 090 

20970 .... ............ A ........ Bone/skin graft, iliac crest ................... 44.26 NA NA 20.89 23.13 6.62 090 

20972 .... ............ A ........ Bone/skin graft, metatarsal ................. 44.19 NA NA 14.92 17.74 5.32 090 

20973 .... ............ A ........ Bone/skin graft, great toe ................... 46.95 NA NA 14.15 19.64 5.56 090 

20974 .... ............ A ........ Electrical bone stimulation .................. 0.62 0.98 0.83 0.48 0.51 0.11 000 

20975 .... ............ A ........ Electrical bone stimulation .................. 2.60 NA NA 1.46 1.58 0.51 000 

20979 .... ............ A ........ Us bone stimulation ............................ 0.62 0.61 0.71 0.20 0.27 0.09 000 

20982 .... ............ A ........ Ablate, bone tumor(s) perq ................. 7.27 79.99 94.74 2.68 2.83 0.69 000 

20985 .... ............ A ........ Cptr-asst dir ms px ............................. 2.50 0.99 0.99 0.99 0.99 0.48 ZZZ 

20986 .... ............ C ........ Cptr-asst dir ms px io img .................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

20987 .... ............ C ........ Cptr-asst dir ms px pre img ................ 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

20999 .... ............ C ........ Musculoskeletal surgery ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

21010 .... ............ A ........ Incision of jaw joint ............................. 10.90 NA NA 6.29 6.69 1.11 090 

21015 .... ............ A ........ Resection of facial tumor .................... 5.59 NA NA 4.30 4.65 0.70 090 

21025 .... ............ A ........ Excision of bone, lower jaw ................ 11.07 12.54 12.39 8.74 9.04 1.32 090 

21026 .... ............ A ........ Excision of facial bone(s) .................... 5.54 8.82 8.34 5.93 6.12 0.60 090 


cprice-sewell on PROD1PC72 with RULES
66419 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

21029 .... ............ A ........ Contour of face bone lesion ............... 8.26 9.55 9.46 6.52 6.76 0.94 090 

21030 .... ............ A ........ Excise max/zygoma b9 tumor ............ 4.80 7.19 6.76 4.68 4.85 0.54 090 

21031 .... ............ A ........ Remove exostosis, mandible .............. 3.26 5.91 5.54 3.47 3.54 0.48 090 

21032 .... ............ A ........ Remove exostosis, maxilla ................. 3.28 6.04 5.69 3.36 3.43 0.47 090 

21034 .... ............ A ........ Excise max/zygoma mlg tumor ........... 17.17 13.92 14.92 10.11 11.38 1.72 090 

21040 .... ............ A ........ Excise mandible lesion ....................... 4.80 7.19 6.79 4.64 4.68 0.54 090 

21044 .... ............ A ........ Removal of jaw bone lesion ............... 12.61 NA NA 8.10 8.73 1.12 090 

21045 .... ............ A ........ Extensive jaw surgery ......................... 18.13 NA NA 10.78 11.56 1.52 090 

21046 .... ............ A ........ Remove mandible cyst complex ......... 13.97 NA NA 11.48 11.69 1.86 090 

21047 .... ............ A ........ Excise lwr jaw cyst w/repair ................ 19.83 NA NA 10.21 11.82 2.13 090 

21048 .... ............ A ........ Remove maxilla cyst complex ............ 14.47 NA NA 11.38 11.75 1.77 090 

21049 .... ............ A ........ Excis uppr jaw cyst w/repair ............... 19.08 NA NA 10.28 11.65 1.59 090 

21050 .... ............ A ........ Removal of jaw joint ........................... 11.54 NA NA 8.20 8.82 1.47 090 

21060 .... ............ A ........ Remove jaw joint cartilage .................. 10.91 NA NA 7.19 7.89 1.38 090 

21070 .... ............ A ........ Remove coronoid process .................. 8.50 NA NA 6.26 6.68 1.27 090 

21073 .... ............ A ........ Mnpj of tmj w/anesth ........................... 3.33 5.50 5.50 2.31 2.31 0.43 090 

21076 .... ............ A ........ Prepare face/oral prosthesis ............... 13.40 8.01 10.18 4.68 7.34 2.00 010 

21077 .... ............ A ........ Prepare face/oral prosthesis ............... 33.70 18.42 24.86 11.82 18.90 4.56 090 

21079 .... ............ A ........ Prepare face/oral prosthesis ............... 22.31 13.95 17.72 8.09 12.62 3.16 090 

21080 .... ............ A ........ Prepare face/oral prosthesis ............... 25.06 16.14 20.31 9.01 14.18 3.75 090 

21081 .... ............ A ........ Prepare face/oral prosthesis ............... 22.85 15.01 18.65 8.40 12.94 3.21 090 

21082 .... ............ A ........ Prepare face/oral prosthesis ............... 20.84 14.89 17.11 8.26 11.99 3.12 090 

21083 .... ............ A ........ Prepare face/oral prosthesis ............... 19.27 14.89 16.83 7.77 11.10 2.89 090 

21084 .... ............ A ........ Prepare face/oral prosthesis ............... 22.48 16.83 19.63 8.94 13.31 2.19 090 

21085 .... ............ A ........ Prepare face/oral prosthesis ............... 8.99 6.92 7.60 3.51 5.14 1.27 010 

21086 .... ............ A ........ Prepare face/oral prosthesis ............... 24.88 12.90 18.31 8.44 13.93 3.72 090 

21087 .... ............ A ........ Prepare face/oral prosthesis ............... 24.88 13.03 18.15 8.54 13.86 3.45 090 

21088 .... ............ C ........ Prepare face/oral prosthesis ............... 0.00 0.00 0.00 0.00 0.00 0.00 090 

21089 .... ............ C ........ Prepare face/oral prosthesis ............... 0.00 0.00 0.00 0.00 0.00 0.00 090 

21100 .... ............ A ........ Maxillofacial fixation ............................ 4.56 14.86 13.19 5.53 5.13 0.34 090 

21110 .... ............ A ........ Interdental fixation ............................... 5.80 13.04 11.30 9.73 9.04 0.72 090 

21116 .... ............ A ........ Injection, jaw joint x-ray ...................... 0.81 2.52 3.42 0.23 0.28 0.06 000 

21120 .... ............ A ........ Reconstruction of chin ........................ 4.99 9.64 10.11 6.64 7.06 0.60 090 

21121 .... ............ A ........ Reconstruction of chin ........................ 7.70 10.63 10.18 7.58 7.70 0.90 090 

21122 .... ............ A ........ Reconstruction of chin ........................ 8.59 NA NA 8.45 8.53 1.07 090 

21123 .... ............ A ........ Reconstruction of chin ........................ 11.22 NA NA 7.03 8.91 1.40 090 

21125 .... ............ A ........ Augmentation, lower jaw bone ........... 10.68 63.93 59.56 6.42 7.37 0.79 090 

21127 .... ............ A ........ Augmentation, lower jaw bone ........... 12.24 84.93 63.85 7.49 8.47 1.52 090 

21137 .... ............ A ........ Reduction of forehead ........................ 10.12 NA NA 7.43 7.58 1.32 090 

21138 .... ............ A ........ Reduction of forehead ........................ 12.73 NA NA 7.78 8.65 1.75 090 

21139 .... ............ A ........ Reduction of forehead ........................ 14.90 NA NA 6.98 9.02 1.18 090 

21141 .... ............ A ........ Reconstruct midface, lefort ................. 19.27 NA NA 11.85 12.75 2.36 090 

21142 .... ............ A ........ Reconstruct midface, lefort ................. 19.98 NA NA 10.07 11.44 2.39 090 

21143 .... ............ A ........ Reconstruct midface, lefort ................. 20.75 NA NA 11.80 13.05 1.66 090 

21145 .... ............ A ........ Reconstruct midface, lefort ................. 23.64 NA NA 12.96 13.43 2.85 090 

21146 .... ............ A ........ Reconstruct midface, lefort ................. 24.54 NA NA 9.17 12.25 3.10 090 

21147 .... ............ A ........ Reconstruct midface, lefort ................. 26.14 NA NA 14.29 14.67 1.85 090 

21150 .... ............ A ........ Reconstruct midface, lefort ................. 25.78 NA NA 16.90 16.83 2.56 090 

21151 .... ............ A ........ Reconstruct midface, lefort ................. 28.84 NA NA 11.60 17.27 2.31 090 

21154 .... ............ A ........ Reconstruct midface, lefort ................. 31.05 NA NA 17.87 20.49 2.49 090 

21155 .... ............ A ........ Reconstruct midface, lefort ................. 34.98 NA NA 18.15 21.02 6.66 090 

21159 .... ............ A ........ Reconstruct midface, lefort ................. 42.90 NA NA 15.12 22.09 8.20 090 

21160 .... ............ A ........ Reconstruct midface, lefort ................. 46.95 NA NA 23.21 25.33 4.14 090 

21172 .... ............ A ........ Reconstruct orbit/forehead .................. 28.07 NA NA 13.73 13.74 3.56 090 

21175 .... ............ A ........ Reconstruct orbit/forehead .................. 33.43 NA NA 13.51 15.65 4.84 090 

21179 .... ............ A ........ Reconstruct entire forehead ............... 22.53 NA NA 11.21 12.66 2.81 090 

21180 .... ............ A ........ Reconstruct entire forehead ............... 25.46 NA NA 12.98 14.18 3.49 090 

21181 .... ............ A ........ Contour cranial bone lesion ................ 10.18 NA NA 6.82 7.14 1.32 090 

21182 .... ............ A ........ Reconstruct cranial bone .................... 32.45 NA NA 15.26 17.18 2.81 090 

21183 .... ............ A ........ Reconstruct cranial bone .................... 35.57 NA NA 19.20 20.01 4.48 090 

21184 .... ............ A ........ Reconstruct cranial bone .................... 38.49 NA NA 15.61 18.77 5.72 090 

21188 .... ............ A ........ Reconstruction of midface .................. 22.97 NA NA 15.63 17.24 1.70 090 

21193 .... ............ A ........ Reconst lwr jaw w/o graft ................... 18.65 NA NA 9.80 11.23 2.24 090 

21194 .... ............ A ........ Reconst lwr jaw w/graft ....................... 21.54 NA NA 12.12 12.93 2.03 090 

21195 .... ............ A ........ Reconst lwr jaw w/o fixation ............... 18.88 NA NA 13.06 13.94 1.64 090 

21196 .... ............ A ........ Reconst lwr jaw w/fixation .................. 20.55 NA NA 13.93 14.81 2.08 090 

21198 .... ............ A ........ Reconstr lwr jaw segment .................. 15.48 NA NA 11.88 12.29 1.44 090 

21199 .... ............ A ........ Reconstr lwr jaw w/advance ............... 16.62 NA NA 7.56 8.34 1.39 090 

21206 .... ............ A ........ Reconstruct upper jaw bone ............... 15.36 NA NA 10.88 11.75 1.33 090 

21208 .... ............ A ........ Augmentation of facial bones ............. 11.15 33.14 27.73 8.00 8.79 1.09 090 

21209 .... ............ A ........ Reduction of facial bones ................... 7.58 12.19 11.49 7.39 7.72 0.90 090 

21210 .... ............ A ........ Face bone graft ................................... 11.40 43.44 34.15 7.63 8.49 1.30 090 


cprice-sewell on PROD1PC72 with RULES
66420 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

21215 .... ............ A ........ Lower jaw bone graft .......................... 11.94 86.03 63.95 7.96 8.66 1.53 090 

21230 .... ............ A ........ Rib cartilage graft ................................ 11.06 NA NA 7.01 7.52 1.29 090 

21235 .... ............ A ........ Ear cartilage graft ............................... 7.31 10.10 9.97 6.18 6.29 0.61 090 

21240 .... ............ A ........ Reconstruction of jaw joint .................. 15.77 NA NA 9.43 10.73 2.25 090 

21242 .... ............ A ........ Reconstruction of jaw joint .................. 14.32 NA NA 9.01 10.25 1.79 090 

21243 .... ............ A ........ Reconstruction of jaw joint .................. 24.03 NA NA 14.14 15.78 3.26 090 

21244 .... ............ A ........ Reconstruction of lower jaw ................ 13.35 NA NA 11.51 11.80 1.25 090 

21245 .... ............ A ........ Reconstruction of jaw ......................... 12.88 14.20 14.30 8.61 9.23 1.19 090 

21246 .... ............ A ........ Reconstruction of jaw ......................... 12.78 NA NA 7.42 8.23 1.35 090 

21247 .... ............ A ........ Reconstruct lower jaw bone ............... 24.05 NA NA 12.69 15.01 2.84 090 

21248 .... ............ A ........ Reconstruction of jaw ......................... 12.54 12.60 12.36 7.51 8.45 1.55 090 

21249 .... ............ A ........ Reconstruction of jaw ......................... 18.57 15.72 16.22 9.61 11.15 2.49 090 

21255 .... ............ A ........ Reconstruct lower jaw bone ............... 18.14 NA NA 14.03 15.08 2.39 090 

21256 .... ............ A ........ Reconstruction of orbit ........................ 17.42 NA NA 9.57 10.69 1.50 090 

21260 .... ............ A ........ Revise eye sockets ............................. 17.74 NA NA 12.95 12.85 0.97 090 

21261 .... ............ A ........ Revise eye sockets ............................. 33.78 NA NA 14.74 19.48 3.43 090 

21263 .... ............ A ........ Revise eye sockets ............................. 30.72 NA NA 14.03 16.55 2.63 090 

21267 .... ............ A ........ Revise eye sockets ............................. 20.45 NA NA 16.03 17.90 1.71 090 

21268 .... ............ A ........ Revise eye sockets ............................. 26.78 NA NA 13.13 16.66 3.66 090 

21270 .... ............ A ........ Augmentation, cheek bone ................. 10.52 11.15 11.39 5.90 6.57 0.72 090 

21275 .... ............ A ........ Revision, orbitofacial bones ................ 11.65 NA NA 7.15 7.65 1.29 090 

21280 .... ............ A ........ Revision of eyelid ................................ 6.92 NA NA 5.66 5.79 0.42 090 

21282 .... ............ A ........ Revision of eyelid ................................ 4.11 NA NA 4.16 4.32 0.26 090 

21295 .... ............ A ........ Revision of jaw muscle/bone .............. 1.82 NA NA 2.23 2.38 0.16 090 

21296 .... ............ A ........ Revision of jaw muscle/bone .............. 4.67 NA NA 5.43 5.16 0.34 090 

21299 .... ............ C ........ Cranio/maxillofacial surgery ................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

21310 .... ............ A ........ Treatment of nose fracture ................. 0.58 1.99 2.14 0.11 0.13 0.05 000 

21315 .... ............ A ........ Treatment of nose fracture ................. 1.78 4.71 4.47 1.78 1.83 0.14 010 

21320 .... ............ A ........ Treatment of nose fracture ................. 1.86 4.29 4.10 1.36 1.49 0.18 010 

21325 .... ............ A ........ Treatment of nose fracture ................. 4.07 NA NA 6.97 7.79 0.31 090 

21330 .... ............ A ........ Treatment of nose fracture ................. 5.68 NA NA 7.62 8.66 0.56 090 

21335 .... ............ A ........ Treatment of nose fracture ................. 8.91 NA NA 8.47 9.04 0.74 090 

21336 .... ............ A ........ Treat nasal septal fracture .................. 6.56 NA NA 8.66 9.13 0.55 090 

21337 .... ............ A ........ Treat nasal septal fracture .................. 3.26 6.14 6.13 3.56 3.56 0.28 090 

21338 .... ............ A ........ Treat nasoethmoid fracture ................. 6.76 NA NA 9.92 11.97 0.82 090 

21339 .... ............ A ........ Treat nasoethmoid fracture ................. 8.39 NA NA 9.82 11.86 0.96 090 

21340 .... ............ A ........ Treatment of nose fracture ................. 11.33 NA NA 7.24 7.82 1.15 090 

21343 .... ............ A ........ Treatment of sinus fracture ................. 14.11 NA NA 12.79 14.12 1.47 090 

21344 .... ............ A ........ Treatment of sinus fracture ................. 21.36 NA NA 13.05 14.77 2.44 090 

21345 .... ............ A ........ Treat nose/jaw fracture ....................... 8.87 10.48 10.16 6.55 6.86 0.92 090 

21346 .... ............ A ........ Treat nose/jaw fracture ....................... 11.29 NA NA 10.82 11.51 1.21 090 

21347 .... ............ A ........ Treat nose/jaw fracture ....................... 13.37 NA NA 11.73 13.96 1.47 090 

21348 .... ............ A ........ Treat nose/jaw fracture ....................... 17.36 NA NA 10.99 11.05 2.49 090 

21355 .... ............ A ........ Treat cheek bone fracture .................. 4.32 5.90 6.07 3.25 3.36 0.34 010 

21356 .... ............ A ........ Treat cheek bone fracture .................. 4.70 6.97 7.04 4.05 4.30 0.46 010 

21360 .... ............ A ........ Treat cheek bone fracture .................. 7.03 NA NA 5.39 5.66 0.74 090 

21365 .... ............ A ........ Treat cheek bone fracture .................. 16.52 NA NA 9.09 9.95 1.70 090 

21366 .... ............ A ........ Treat cheek bone fracture .................. 18.44 NA NA 10.50 10.91 2.50 090 

21385 .... ............ A ........ Treat eye socket fracture .................... 9.46 NA NA 7.13 7.70 0.97 090 

21386 .... ............ A ........ Treat eye socket fracture .................... 9.46 NA NA 6.00 6.53 0.97 090 

21387 .... ............ A ........ Treat eye socket fracture .................... 10.00 NA NA 7.44 8.20 1.08 090 

21390 .... ............ A ........ Treat eye socket fracture .................... 11.07 NA NA 7.01 7.40 0.90 090 

21395 .... ............ A ........ Treat eye socket fracture .................... 14.62 NA NA 8.33 8.68 1.44 090 

21400 .... ............ A ........ Treat eye socket fracture .................... 1.44 2.70 2.66 1.96 1.92 0.15 090 

21401 .... ............ A ........ Treat eye socket fracture .................... 3.57 7.03 7.51 3.04 3.27 0.38 090 

21406 .... ............ A ........ Treat eye socket fracture .................... 7.31 NA NA 5.29 5.68 0.73 090 

21407 .... ............ A ........ Treat eye socket fracture .................... 8.91 NA NA 5.92 6.39 0.94 090 

21408 .... ............ A ........ Treat eye socket fracture .................... 12.67 NA NA 7.44 8.16 1.44 090 

21421 .... ............ A ........ Treat mouth roof fracture .................... 5.80 12.45 10.89 9.20 8.75 0.73 090 

21422 .... ............ A ........ Treat mouth roof fracture .................... 8.62 NA NA 7.04 7.56 0.99 090 

21423 .... ............ A ........ Treat mouth roof fracture .................... 10.71 NA NA 7.39 8.36 1.27 090 

21431 .... ............ A ........ Treat craniofacial fracture ................... 7.74 NA NA 10.83 10.18 0.70 090 

21432 .... ............ A ........ Treat craniofacial fracture ................... 8.76 NA NA 6.81 7.43 0.81 090 

21433 .... ............ A ........ Treat craniofacial fracture ................... 26.13 NA NA 12.13 14.26 2.79 090 

21435 .... ............ A ........ Treat craniofacial fracture ................... 20.02 NA NA 11.07 11.88 1.99 090 

21436 .... ............ A ........ Treat craniofacial fracture ................... 30.01 NA NA 13.13 15.67 3.10 090 

21440 .... ............ A ........ Treat dental ridge fracture .................. 3.28 10.06 8.58 7.45 6.80 0.38 090 

21445 .... ............ A ........ Treat dental ridge fracture .................. 6.04 12.27 11.01 8.46 8.41 0.78 090 

21450 .... ............ A ........ Treat lower jaw fracture ...................... 3.55 10.50 8.94 7.71 7.29 0.33 090 

21451 .... ............ A ........ Treat lower jaw fracture ...................... 5.46 12.97 11.16 9.67 9.03 0.63 090 

21452 .... ............ A ........ Treat lower jaw fracture ...................... 2.29 12.02 12.52 6.05 5.33 0.27 090 

21453 .... ............ A ........ Treat lower jaw fracture ...................... 6.40 14.80 12.76 11.64 11.18 0.74 090 


cprice-sewell on PROD1PC72 with RULES
66421 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

21454 .... ............ A ........ Treat lower jaw fracture ...................... 7.17 NA NA 5.72 5.99 0.82 090 

21461 .... ............ A ........ Treat lower jaw fracture ...................... 9.07 41.68 33.06 12.80 12.73 0.98 090 

21462 .... ............ A ........ Treat lower jaw fracture ...................... 10.77 42.97 35.28 13.40 13.05 1.27 090 

21465 .... ............ A ........ Treat lower jaw fracture ...................... 12.88 NA NA 8.11 8.96 1.50 090 

21470 .... ............ A ........ Treat lower jaw fracture ...................... 17.24 NA NA 10.17 11.09 1.97 090 

21480 .... ............ A ........ Reset dislocated jaw ........................... 0.61 1.52 1.64 0.18 0.18 0.06 000 

21485 .... ............ A ........ Reset dislocated jaw ........................... 4.58 12.09 10.15 9.10 8.38 0.51 090 

21490 .... ............ A ........ Repair dislocated jaw .......................... 12.71 NA NA 8.12 8.90 1.97 090 

21495 .... ............ A ........ Treat hyoid bone fracture ................... 6.55 NA NA 10.47 9.44 0.46 090 

21497 .... ............ A ........ Interdental wiring ................................. 4.45 12.21 10.33 9.34 8.49 0.50 090 

21499 .... ............ C ........ Head surgery procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

21501 .... ............ A ........ Drain neck/chest lesion ....................... 3.87 6.55 6.49 3.52 3.67 0.43 090 

21502 .... ............ A ........ Drain chest lesion ............................... 7.43 NA NA 4.56 5.09 0.97 090 

21510 .... ............ A ........ Drainage of bone lesion ...................... 6.06 NA NA 4.80 5.23 0.80 090 

21550 .... ............ A ........ Biopsy of neck/chest ........................... 2.08 4.35 3.97 1.78 1.75 0.16 010 

21555 .... ............ A ........ Remove lesion, neck/chest ................. 4.40 5.78 5.65 3.43 3.31 0.56 090 

21556 .... ............ A ........ Remove lesion, neck/chest ................. 5.63 NA NA 4.14 4.12 0.65 090 

21557 .... ............ A ........ Remove tumor, neck/chest ................. 8.91 NA NA 4.51 4.93 1.08 090 

21600 .... ............ A ........ Partial removal of rib ........................... 7.14 NA NA 5.96 5.85 0.99 090 

21610 .... ............ A ........ Partial removal of rib ........................... 15.76 NA NA 8.89 8.88 3.08 090 

21615 .... ............ A ........ Removal of rib ..................................... 10.31 NA NA 5.16 5.92 1.45 090 

21616 .... ............ A ........ Removal of rib and nerves ................. 12.54 NA NA 6.51 7.26 1.87 090 

21620 .... ............ A ........ Partial removal of sternum .................. 7.16 NA NA 4.76 5.36 0.98 090 

21627 .... ............ A ........ Sternal debridement ............................ 7.18 NA NA 5.54 5.92 1.02 090 

21630 .... ............ A ........ Extensive sternum surgery ................. 19.01 NA NA 10.34 11.09 2.59 090 

21632 .... ............ A ........ Extensive sternum surgery ................. 19.51 NA NA 9.42 10.26 2.66 090 

21685 .... ............ A ........ Hyoid myotomy & suspension ............ 14.89 NA NA 8.76 9.36 1.06 090 

21700 .... ............ A ........ Revision of neck muscle ..................... 6.23 NA NA 4.39 4.41 0.32 090 

21705 .... ............ A ........ Revision of neck muscle/rib ................ 9.83 NA NA 4.35 4.97 1.43 090 

21720 .... ............ A ........ Revision of neck muscle ..................... 5.72 NA NA 4.10 3.28 0.91 090 

21725 .... ............ A ........ Revision of neck muscle ..................... 7.10 NA NA 5.14 5.29 1.21 090 

21740 .... ............ A ........ Reconstruction of sternum .................. 17.47 NA NA 8.20 8.35 2.37 090 

21742 .... ............ C ........ Repair stern/nuss w/o scope .............. 0.00 0.00 0.00 0.00 0.00 0.00 090 

21743 .... ............ C ........ Repair sternum/nuss w/scope ............ 0.00 0.00 0.00 0.00 0.00 0.00 090 

21750 .... ............ A ........ Repair of sternum separation ............. 11.35 NA NA 5.31 5.71 1.63 090 

21800 .... ............ A ........ Treatment of rib fracture ..................... 0.98 1.36 1.35 1.43 1.38 0.09 090 

21805 .... ............ A ........ Treatment of rib fracture ..................... 2.80 NA NA 3.27 3.23 0.38 090 

21810 .... ............ A ........ Treatment of rib fracture(s) ................. 6.92 NA NA 5.37 5.17 0.94 090 

21820 .... ............ A ........ Treat sternum fracture ........................ 1.31 1.82 1.82 1.89 1.83 0.16 090 

21825 .... ............ A ........ Treat sternum fracture ........................ 7.65 NA NA 5.37 5.88 1.11 090 

21899 .... ............ C ........ Neck/chest surgery procedure ............ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

21920 .... ............ A ........ Biopsy soft tissue of back ................... 2.08 4.43 3.86 1.88 1.67 0.14 010 

21925 .... ............ A ........ Biopsy soft tissue of back ................... 4.54 5.34 5.25 3.36 3.30 0.60 090 

21930 .... ............ A ........ Remove lesion, back or flank ............. 5.06 6.04 5.88 3.77 3.58 0.66 090 

21935 .... ............ A ........ Remove tumor, back ........................... 18.38 NA NA 8.44 9.03 2.48 090 

22010 .... ............ A ........ I&d, p-spine, c/t/cerv-thor .................... 12.57 NA NA 8.35 8.61 1.74 090 

22015 .... ............ A ........ I&d, p-spine, l/s/ls ............................... 12.46 NA NA 8.33 8.58 1.72 090 

22100 .... ............ A ........ Remove part of neck vertebra ............ 10.80 NA NA 8.19 7.86 2.14 090 

22101 .... ............ A ........ Remove part, thorax vertebra ............. 10.88 NA NA 8.11 7.93 1.91 090 

22102 .... ............ A ........ Remove part, lumbar vertebra ............ 10.88 NA NA 7.92 8.01 1.88 090 

22103 .... ............ A ........ Remove extra spine segment ............. 2.34 NA NA 0.90 1.05 0.44 ZZZ 

22110 .... ............ A ........ Remove part of neck vertebra ............ 13.80 NA NA 9.11 9.14 2.77 090 

22112 .... ............ A ........ Remove part, thorax vertebra ............. 13.87 NA NA 9.02 9.15 2.53 090 

22114 .... ............ A ........ Remove part, lumbar vertebra ............ 13.87 NA NA 9.00 9.13 2.64 090 

22116 .... ............ A ........ Remove extra spine segment ............. 2.32 NA NA 0.89 1.03 0.50 ZZZ 

22206 .... ............ A ........ Cut spine 3 col, thor ........................... 37.00 NA NA 17.71 17.71 6.23 090 

22207 .... ............ A ........ Cut spine 3 col, lumb .......................... 36.50 NA NA 17.59 17.59 6.07 090 

22208 .... ............ A ........ Cut spine 3 col, addl seg .................... 9.66 3.72 3.72 3.72 3.72 2.07 ZZZ 

22210 .... ............ A ........ Revision of neck spine ........................ 25.13 NA NA 14.54 14.97 5.46 090 

22212 .... ............ A ........ Revision of thorax spine ..................... 20.74 NA NA 12.44 12.85 3.91 090 

22214 .... ............ A ........ Revision of lumbar spine .................... 20.77 NA NA 12.53 13.17 3.92 090 

22216 .... ............ A ........ Revise, extra spine segment .............. 6.03 NA NA 2.32 2.73 1.29 ZZZ 

22220 .... ............ A ........ Revision of neck spine ........................ 22.69 NA NA 13.35 13.48 5.08 090 

22222 .... ............ A ........ Revision of thorax spine ..................... 22.84 NA NA 10.46 10.79 4.13 090 

22224 .... ............ A ........ Revision of lumbar spine .................... 22.84 NA NA 12.89 13.55 4.19 090 

22226 .... ............ A ........ Revise, extra spine segment .............. 6.03 NA NA 2.28 2.68 1.29 ZZZ 

22305 .... ............ A ........ Treat spine process fracture ............... 2.08 2.15 2.23 1.80 1.86 0.39 090 

22310 .... ............ A ........ Treat spine fracture ............................. 3.69 2.98 2.89 2.50 2.42 0.50 090 

22315 .... ............ A ........ Treat spine fracture ............................. 9.91 9.88 9.78 7.43 7.38 1.86 090 

22318 .... ............ A ........ Treat odontoid fx w/o graft .................. 22.54 NA NA 13.25 13.31 5.30 090 

22319 .... ............ A ........ Treat odontoid fx w/graft ..................... 25.15 NA NA 13.45 14.07 6.05 090 

22325 .... ............ A ........ Treat spine fracture ............................. 19.62 NA NA 12.13 12.10 3.88 090 


cprice-sewell on PROD1PC72 with RULES
66422 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

22326 .... ............ A ........ Treat neck spine fracture .................... 20.64 NA NA 12.02 12.36 4.43 090 

22327 .... ............ A ........ Treat thorax spine fracture ................. 20.52 NA NA 12.32 12.34 3.99 090 

22328 .... ............ A ........ Treat each add spine fx ...................... 4.60 NA NA 1.76 2.01 0.94 ZZZ 

22505 .... ............ A ........ Manipulation of spine .......................... 1.87 NA NA 1.10 1.02 0.36 010 

22520 .... ............ A ........ Percut vertebroplasty thor ................... 9.17 43.78 52.71 4.58 4.84 1.72 010 

22521 .... ............ A ........ Percut vertebroplasty lumb ................. 8.60 44.96 50.45 4.36 4.65 1.60 010 

22522 .... ............ A ........ Percut vertebroplasty add’l ................. 4.30 NA NA 1.51 1.59 0.82 ZZZ 

22523 .... ............ A ........ Percut kyphoplasty, thor ..................... 9.21 NA NA 4.67 5.28 1.72 010 

22524 .... ............ A ........ Percut kyphoplasty, lumbar ................ 8.81 NA NA 4.52 5.11 1.60 010 

22525 .... ............ A ........ Percut kyphoplasty, add-on ................ 4.47 NA NA 1.69 1.98 0.82 ZZZ 

22526 .... ............ A ........ Idet, single level .................................. 6.07 46.67 46.67 2.04 2.04 1.16 010 

22527 .... ............ A ........ Idet, 1 or more levels .......................... 3.03 40.35 40.35 0.70 0.70 0.58 ZZZ 

22532 .... ............ A ........ Lat thorax spine fusion ....................... 25.81 NA NA 13.77 14.29 4.35 090 

22533 .... ............ A ........ Lat lumbar spine fusion ...................... 24.61 NA NA 13.56 13.57 3.16 090 

22534 .... ............ A ........ Lat thor/lumb, add’l seg ...................... 5.99 NA NA 2.28 2.65 1.25 ZZZ 

22548 .... ............ A ........ Neck spine fusion ............................... 26.86 NA NA 14.92 15.36 5.61 090 

22554 .... ............ A ........ Neck spine fusion ............................... 17.54 NA NA 10.64 11.49 4.46 090 

22556 .... ............ A ........ Thorax spine fusion ............................ 24.50 NA NA 12.95 13.83 4.35 090 

22558 .... ............ A ........ Lumbar spine fusion ........................... 23.33 NA NA 11.42 12.35 3.16 090 

22585 .... ............ A ........ Additional spinal fusion ....................... 5.52 NA NA 2.05 2.42 1.25 ZZZ 

22590 .... ............ A ........ Spine & skull spinal fusion .................. 21.56 NA NA 13.07 13.19 4.79 090 

22595 .... ............ A ........ Neck spinal fusion ............................... 20.44 NA NA 12.63 12.73 4.41 090 

22600 .... ............ A ........ Neck spine fusion ............................... 17.20 NA NA 11.19 11.19 3.73 090 

22610 .... ............ A ........ Thorax spine fusion ............................ 17.08 NA NA 10.81 11.11 3.53 090 

22612 .... ............ A ........ Lumbar spine fusion ........................... 23.38 NA NA 12.49 13.34 4.47 090 

22614 .... ............ A ........ Spine fusion, extra segment ............... 6.43 NA NA 2.45 2.90 1.38 ZZZ 

22630 .... ............ A ........ Lumbar spine fusion ........................... 21.89 NA NA 12.53 13.06 4.73 090 

22632 .... ............ A ........ Spine fusion, extra segment ............... 5.22 NA NA 1.99 2.32 1.16 ZZZ 

22800 .... ............ A ........ Fusion of spine ................................... 19.30 NA NA 11.15 11.96 3.76 090 

22802 .... ............ A ........ Fusion of spine ................................... 31.91 NA NA 15.98 17.78 6.17 090 

22804 .... ............ A ........ Fusion of spine ................................... 37.30 NA NA 18.11 20.40 7.00 090 

22808 .... ............ A ........ Fusion of spine ................................... 27.31 NA NA 14.05 15.17 4.93 090 

22810 .... ............ A ........ Fusion of spine ................................... 31.30 NA NA 14.90 16.62 5.15 090 

22812 .... ............ A ........ Fusion of spine ................................... 34.00 NA NA 17.37 18.71 5.30 090 

22818 .... ............ A ........ Kyphectomy, 1–2 segments ............... 34.18 NA NA 16.61 17.73 6.47 090 

22819 .... ............ A ........ Kyphectomy, 3 or more ...................... 39.18 NA NA 18.86 19.45 7.67 090 

22830 .... ............ A ........ Exploration of spinal fusion ................. 11.13 NA NA 7.05 7.50 2.30 090 

22840 .... ............ A ........ Insert spine fixation device ................. 12.52 NA NA 4.77 5.63 2.79 ZZZ 

22841 .... ............ B ........ Insert spine fixation device ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

22842 .... ............ A ........ Insert spine fixation device ................. 12.56 NA NA 4.79 5.64 2.75 ZZZ 

22843 .... ............ A ........ Insert spine fixation device ................. 13.44 NA NA 5.15 5.88 2.86 ZZZ 

22844 .... ............ A ........ Insert spine fixation device ................. 16.42 NA NA 6.40 7.57 3.19 ZZZ 

22845 .... ............ A ........ Insert spine fixation device ................. 11.94 NA NA 4.48 5.27 2.86 ZZZ 

22846 .... ............ A ........ Insert spine fixation device ................. 12.40 NA NA 4.66 5.49 2.96 ZZZ 

22847 .... ............ A ........ Insert spine fixation device ................. 13.78 NA NA 5.19 6.10 3.00 ZZZ 

22848 .... ............ A ........ Insert pelv fixation device ................... 5.99 NA NA 2.33 2.76 1.15 ZZZ 

22849 .... ............ A ........ Reinsert spinal fixation ........................ 19.08 NA NA 10.16 10.94 3.90 090 

22850 .... ............ A ........ Remove spine fixation device ............. 9.74 NA NA 6.40 6.69 2.05 090 

22851 .... ............ A ........ Apply spine prosth device ................... 6.70 NA NA 2.54 2.95 1.49 ZZZ 

22852 .... ............ A ........ Remove spine fixation device ............. 9.29 NA NA 6.17 6.48 1.90 090 

22855 .... ............ A ........ Remove spine fixation device ............. 15.77 NA NA 9.17 9.41 3.52 090 

22857 .... ............ R ........ Lumbar artif diskectomy ...................... 26.93 NA NA 14.80 14.80 3.56 090 

22862 .... ............ R ........ Revise lumbar artif disc ...................... 32.43 NA NA 10.06 10.06 5.36 090 

22865 .... ............ R ........ Remove lumb artif disc ....................... 31.55 NA NA 9.86 9.86 5.18 090 

22899 .... ............ C ........ Spine surgery procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

22900 .... ............ A ........ Remove abdominal wall lesion ........... 6.14 NA NA 3.53 3.38 0.76 090 

22999 .... ............ C ........ Abdomen surgery procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

23000 .... ............ A ........ Removal of calcium deposits .............. 4.40 7.88 8.20 3.73 4.07 0.68 090 

23020 .... ............ A ........ Release shoulder joint ........................ 9.24 NA NA 6.48 7.02 1.54 090 

23030 .... ............ A ........ Drain shoulder lesion .......................... 3.44 6.28 6.83 2.40 2.65 0.57 010 

23031 .... ............ A ........ Drain shoulder bursa .......................... 2.76 6.51 7.18 2.21 2.47 0.46 010 

23035 .... ............ A ........ Drain shoulder bone lesion ................. 9.04 NA NA 6.45 7.35 1.47 090 

23040 .... ............ A ........ Exploratory shoulder surgery .............. 9.63 NA NA 6.74 7.30 1.60 090 

23044 .... ............ A ........ Exploratory shoulder surgery .............. 7.48 NA NA 5.51 5.97 1.24 090 

23065 .... ............ A ........ Biopsy shoulder tissues ...................... 2.28 2.95 2.72 1.74 1.68 0.20 010 

23066 .... ............ A ........ Biopsy shoulder tissues ...................... 4.21 7.75 7.71 3.61 3.79 0.63 090 

23075 .... ............ A ........ Removal of shoulder lesion ................ 2.41 3.70 3.68 1.72 1.75 0.34 010 

23076 .... ............ A ........ Removal of shoulder lesion ................ 7.77 NA NA 5.32 5.43 1.13 090 

23077 .... ............ A ........ Remove tumor of shoulder ................. 18.08 NA NA 9.60 9.90 2.34 090 

23100 .... ............ A ........ Biopsy of shoulder joint ...................... 6.09 NA NA 4.99 5.32 1.04 090 

23101 .... ............ A ........ Shoulder joint surgery ......................... 5.63 NA NA 4.53 4.93 0.96 090 

23105 .... ............ A ........ Remove shoulder joint lining .............. 8.36 NA NA 6.09 6.60 1.42 090 


cprice-sewell on PROD1PC72 with RULES
66423 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

23106 .... ............ A ........ Incision of collarbone joint .................. 6.02 NA NA 4.78 5.24 0.99 090 

23107 .... ............ A ........ Explore treat shoulder joint ................. 8.75 NA NA 6.25 6.82 1.49 090 

23120 .... ............ A ........ Partial removal, collar bone ................ 7.23 NA NA 5.47 5.96 1.23 090 

23125 .... ............ A ........ Removal of collar bone ....................... 9.52 NA NA 6.39 6.97 1.62 090 

23130 .... ............ A ........ Remove shoulder bone, part .............. 7.63 NA NA 6.07 6.60 1.30 090 

23140 .... ............ A ........ Removal of bone lesion ...................... 7.01 NA NA 4.90 5.06 1.08 090 

23145 .... ............ A ........ Removal of bone lesion ...................... 9.28 NA NA 6.49 6.96 1.49 090 

23146 .... ............ A ........ Removal of bone lesion ...................... 7.96 NA NA 5.91 6.51 1.35 090 

23150 .... ............ A ........ Removal of humerus lesion ................ 8.79 NA NA 6.25 6.58 1.32 090 

23155 .... ............ A ........ Removal of humerus lesion ................ 10.72 NA NA 7.25 7.78 1.81 090 

23156 .... ............ A ........ Removal of humerus lesion ................ 8.99 NA NA 6.28 6.83 1.50 090 

23170 .... ............ A ........ Remove collar bone lesion ................. 7.10 NA NA 5.00 5.51 1.12 090 

23172 .... ............ A ........ Remove shoulder blade lesion ........... 7.20 NA NA 5.51 5.90 1.01 090 

23174 .... ............ A ........ Remove humerus lesion ..................... 9.90 NA NA 7.17 7.76 1.65 090 

23180 .... ............ A ........ Remove collar bone lesion ................. 8.85 NA NA 6.41 7.70 1.47 090 

23182 .... ............ A ........ Remove shoulder blade lesion ........... 8.47 NA NA 6.42 7.48 1.37 090 

23184 .... ............ A ........ Remove humerus lesion ..................... 9.76 NA NA 6.92 8.12 1.63 090 

23190 .... ............ A ........ Partial removal of scapula .................. 7.36 NA NA 5.31 5.74 1.17 090 

23195 .... ............ A ........ Removal of head of humerus ............. 10.24 NA NA 6.91 7.32 1.71 090 

23200 .... ............ A ........ Removal of collar bone ....................... 12.69 NA NA 7.11 7.92 1.94 090 

23210 .... ............ A ........ Removal of shoulder blade ................. 13.16 NA NA 7.80 8.40 2.03 090 

23220 .... ............ A ........ Partial removal of humerus ................. 15.36 NA NA 9.14 9.98 2.49 090 

23221 .... ............ A ........ Partial removal of humerus ................. 18.41 NA NA 10.61 11.16 3.06 090 

23222 .... ............ A ........ Partial removal of humerus ................. 25.44 NA NA 13.33 14.55 3.95 090 

23330 .... ............ A ........ Remove shoulder foreign body ........... 1.87 3.35 3.52 1.51 1.70 0.24 010 

23331 .... ............ A ........ Remove shoulder foreign body ........... 7.51 NA NA 5.83 6.31 1.27 090 

23332 .... ............ A ........ Remove shoulder foreign body ........... 12.23 NA NA 7.96 8.64 2.03 090 

23350 .... ............ A ........ Injection for shoulder x-ray ................. 1.00 2.73 3.09 0.35 0.34 0.06 000 

23395 .... ............ A ........ Muscle transfer,shoulder/arm ............. 18.29 NA NA 11.20 12.03 2.94 090 

23397 .... ............ A ........ Muscle transfers .................................. 16.62 NA NA 9.54 10.45 2.74 090 

23400 .... ............ A ........ Fixation of shoulder blade .................. 13.73 NA NA 8.54 9.30 2.30 090 

23405 .... ............ A ........ Incision of tendon & muscle ............... 8.43 NA NA 5.92 6.42 1.45 090 

23406 .... ............ A ........ Incise tendon(s) & muscle(s) .............. 10.90 NA NA 6.90 7.62 1.88 090 

23410 .... ............ A ........ Repair rotator cuff, acute .................... 12.63 NA NA 7.77 8.59 2.17 090 

23412 .... ............ A ........ Repair rotator cuff, chronic ................. 13.55 NA NA 8.15 9.02 2.32 090 

23415 .... ............ A ........ Release of shoulder ligament ............. 10.09 NA NA 6.58 7.28 1.74 090 

23420 .... ............ A ........ Repair of shoulder .............................. 14.75 NA NA 9.70 10.27 2.32 090 

23430 .... ............ A ........ Repair biceps tendon .......................... 10.05 NA NA 6.77 7.43 1.74 090 

23440 .... ............ A ........ Remove/transplant tendon .................. 10.53 NA NA 6.77 7.51 1.83 090 

23450 .... ............ A ........ Repair shoulder capsule ..................... 13.58 NA NA 8.17 9.00 2.33 090 

23455 .... ............ A ........ Repair shoulder capsule ..................... 14.55 NA NA 8.55 9.49 2.50 090 

23460 .... ............ A ........ Repair shoulder capsule ..................... 15.68 NA NA 9.36 10.36 2.67 090 

23462 .... ............ A ........ Repair shoulder capsule ..................... 15.60 NA NA 9.07 9.91 2.60 090 

23465 .... ............ A ........ Repair shoulder capsule ..................... 16.16 NA NA 9.49 10.33 2.77 090 

23466 .... ............ A ........ Repair shoulder capsule ..................... 15.55 NA NA 9.99 10.67 2.47 090 

23470 .... ............ A ........ Reconstruct shoulder joint .................. 17.75 NA NA 10.11 11.18 2.99 090 

23472 .... ............ A ........ Reconstruct shoulder joint .................. 22.47 NA NA 12.14 13.27 3.67 090 

23480 .... ............ A ........ Revision of collar bone ....................... 11.42 NA NA 7.29 8.03 1.95 090 

23485 .... ............ A ........ Revision of collar bone ....................... 13.79 NA NA 8.20 9.04 2.34 090 

23490 .... ............ A ........ Reinforce clavicle ................................ 12.04 NA NA 6.74 7.72 1.47 090 

23491 .... ............ A ........ Reinforce shoulder bones ................... 14.40 NA NA 8.71 9.71 2.47 090 

23500 .... ............ A ........ Treat clavicle fracture ......................... 2.13 2.64 2.76 2.71 2.62 0.30 090 

23505 .... ............ A ........ Treat clavicle fracture ......................... 3.74 4.01 4.21 3.61 3.73 0.61 090 

23515 .... ............ A ........ Treat clavicle fracture ......................... 9.53 NA NA 7.00 6.77 1.28 090 

23520 .... ............ A ........ Treat clavicle dislocation ..................... 2.21 2.77 2.81 2.84 2.79 0.34 090 

23525 .... ............ A ........ Treat clavicle dislocation ..................... 3.67 4.16 4.35 3.64 3.79 0.46 090 

23530 .... ............ A ........ Treat clavicle dislocation ..................... 7.37 NA NA 5.30 5.62 1.20 090 

23532 .... ............ A ........ Treat clavicle dislocation ..................... 8.08 NA NA 6.01 6.49 1.38 090 

23540 .... ............ A ........ Treat clavicle dislocation ..................... 2.28 2.66 2.76 2.73 2.55 0.29 090 

23545 .... ............ A ........ Treat clavicle dislocation ..................... 3.32 3.74 3.96 3.26 3.31 0.35 090 

23550 .... ............ A ........ Treat clavicle dislocation ..................... 7.48 NA NA 5.54 5.95 1.25 090 

23552 .... ............ A ........ Treat clavicle dislocation ..................... 8.70 NA NA 6.25 6.78 1.46 090 

23570 .... ............ A ........ Treat shoulder blade fx ....................... 2.28 2.78 2.89 2.92 2.91 0.36 090 

23575 .... ............ A ........ Treat shoulder blade fx ....................... 4.12 4.59 4.73 4.08 4.19 0.59 090 

23585 .... ............ A ........ Treat scapula fracture ......................... 14.07 NA NA 8.50 8.07 1.54 090 

23600 .... ............ A ........ Treat humerus fracture ....................... 3.00 4.07 4.31 3.65 3.60 0.48 090 

23605 .... ............ A ........ Treat humerus fracture ....................... 4.94 5.38 5.76 4.59 4.85 0.84 090 

23615 .... ............ A ........ Treat humerus fracture ....................... 12.12 NA NA 8.05 8.44 1.62 090 

23616 .... ............ A ........ Treat humerus fracture ....................... 18.19 NA NA 10.45 12.29 3.70 090 

23620 .... ............ A ........ Treat humerus fracture ....................... 2.46 3.41 3.51 3.14 3.06 0.40 090 

23625 .... ............ A ........ Treat humerus fracture ....................... 3.99 4.44 4.69 3.91 4.09 0.67 090 

23630 .... ............ A ........ Treat humerus fracture ....................... 10.39 NA NA 7.36 7.00 1.27 090 


cprice-sewell on PROD1PC72 with RULES
66424 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

23650 .... ............ A ........ Treat shoulder dislocation ................... 3.44 3.29 3.53 2.82 2.79 0.30 090 

23655 .... ............ A ........ Treat shoulder dislocation ................... 4.64 NA NA 4.15 4.16 0.69 090 

23660 .... ............ A ........ Treat shoulder dislocation ................... 7.55 NA NA 5.68 6.03 1.29 090 

23665 .... ............ A ........ Treat dislocation/fracture .................... 4.54 4.85 5.09 4.26 4.49 0.71 090 

23670 .... ............ A ........ Treat dislocation/fracture .................... 12.12 NA NA 7.92 7.37 1.36 090 

23675 .... ............ A ........ Treat dislocation/fracture .................... 6.13 6.12 6.47 5.13 5.48 1.01 090 

23680 .... ............ A ........ Treat dislocation/fracture .................... 12.99 NA NA 8.23 8.16 1.76 090 

23700 .... ............ A ........ Fixation of shoulder ............................ 2.54 NA NA 1.90 2.04 0.44 010 

23800 .... ............ A ........ Fusion of shoulder joint ...................... 14.59 NA NA 8.86 9.63 2.36 090 

23802 .... ............ A ........ Fusion of shoulder joint ...................... 18.17 NA NA 11.20 10.68 2.71 090 

23900 .... ............ A ........ Amputation of arm & girdle ................. 20.57 NA NA 10.41 11.06 3.19 090 

23920 .... ............ A ........ Amputation at shoulder joint ............... 16.03 NA NA 9.21 9.56 2.47 090 

23921 .... ............ A ........ Amputation follow-up surgery ............. 5.61 NA NA 4.85 4.96 0.78 090 

23929 .... ............ C ........ Shoulder surgery procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

23930 .... ............ A ........ Drainage of arm lesion ....................... 2.96 4.98 5.65 1.98 2.14 0.43 010 

23931 .... ............ A ........ Drainage of arm bursa ........................ 1.81 4.35 5.13 1.75 1.96 0.28 010 

23935 .... ............ A ........ Drain arm/elbow bone lesion .............. 6.27 NA NA 5.09 5.50 1.05 090 

24000 .... ............ A ........ Exploratory elbow surgery .................. 5.99 NA NA 4.75 5.08 0.97 090 

24006 .... ............ A ........ Release elbow joint ............................. 9.62 NA NA 6.59 7.17 1.50 090 

24065 .... ............ A ........ Biopsy arm/elbow soft tissue .............. 2.10 4.15 3.68 1.92 1.83 0.17 010 

24066 .... ............ A ........ Biopsy arm/elbow soft tissue .............. 5.26 8.26 8.60 3.92 4.02 0.80 090 

24075 .... ............ A ........ Remove arm/elbow lesion .................. 3.96 7.18 7.26 3.26 3.33 0.56 090 

24076 .... ............ A ........ Remove arm/elbow lesion .................. 6.36 NA NA 4.59 4.72 0.95 090 

24077 .... ............ A ........ Remove tumor of arm/elbow .............. 11.95 NA NA 6.85 7.29 1.73 090 

24100 .... ............ A ........ Biopsy elbow joint lining ..................... 4.98 NA NA 4.09 4.30 0.85 090 

24101 .... ............ A ........ Explore/treat elbow joint ..................... 6.19 NA NA 5.04 5.49 1.03 090 

24102 .... ............ A ........ Remove elbow joint lining ................... 8.15 NA NA 5.80 6.33 1.33 090 

24105 .... ............ A ........ Removal of elbow bursa ..................... 3.67 NA NA 4.02 4.20 0.61 090 

24110 .... ............ A ........ Remove humerus lesion ..................... 7.46 NA NA 5.65 6.15 1.28 090 

24115 .... ............ A ........ Remove/graft bone lesion ................... 10.00 NA NA 4.32 5.76 1.68 090 

24116 .... ............ A ........ Remove/graft bone lesion ................... 12.11 NA NA 7.67 8.37 2.06 090 

24120 .... ............ A ........ Remove elbow lesion .......................... 6.71 NA NA 5.17 5.55 1.10 090 

24125 .... ............ A ........ Remove/graft bone lesion ................... 8.02 NA NA 5.99 6.07 1.06 090 

24126 .... ............ A ........ Remove/graft bone lesion ................... 8.50 NA NA 6.00 6.51 1.16 090 

24130 .... ............ A ........ Removal of head of radius ................. 6.31 NA NA 5.12 5.57 1.04 090 

24134 .... ............ A ........ Removal of arm bone lesion ............... 10.10 NA NA 6.90 7.87 1.64 090 

24136 .... ............ A ........ Remove radius bone lesion ................ 8.29 NA NA 5.76 6.49 1.38 090 

24138 .... ............ A ........ Remove elbow bone lesion ................ 8.33 NA NA 6.48 7.13 1.34 090 

24140 .... ............ A ........ Partial removal of arm bone ............... 9.43 NA NA 6.57 7.83 1.51 090 

24145 .... ............ A ........ Partial removal of radius ..................... 7.70 NA NA 5.64 6.84 1.25 090 

24147 .... ............ A ........ Partial removal of elbow ..................... 7.69 NA NA 6.28 7.43 1.30 090 

24149 .... ............ A ........ Radical resection of elbow .................. 15.92 NA NA 10.76 11.19 2.35 090 

24150 .... ............ A ........ Extensive humerus surgery ................ 13.70 NA NA 8.49 9.24 2.33 090 

24151 .... ............ A ........ Extensive humerus surgery ................ 16.08 NA NA 9.68 10.59 2.60 090 

24152 .... ............ A ........ Extensive radius surgery .................... 10.24 NA NA 6.16 6.94 1.48 090 

24153 .... ............ A ........ Extensive radius surgery .................... 11.73 NA NA 4.87 5.22 0.74 090 

24155 .... ............ A ........ Removal of elbow joint ....................... 11.97 NA NA 7.41 7.90 1.93 090 

24160 .... ............ A ........ Remove elbow joint implant ................ 7.89 NA NA 5.82 6.35 1.30 090 

24164 .... ............ A ........ Remove radius head implant .............. 6.34 NA NA 4.89 5.33 1.03 090 

24200 .... ............ A ........ Removal of arm foreign body ............. 1.78 2.74 3.07 1.36 1.49 0.20 010 

24201 .... ............ A ........ Removal of arm foreign body ............. 4.61 7.79 8.80 3.66 3.94 0.72 090 

24220 .... ............ A ........ Injection for elbow x-ray ...................... 1.31 2.66 3.14 0.46 0.45 0.08 000 

24300 .... ............ A ........ Manipulate elbow w/anesth ................ 3.86 NA NA 5.16 5.43 0.65 090 

24301 .... ............ A ........ Muscle/tendon transfer ....................... 10.26 NA NA 6.83 7.50 1.66 090 

24305 .... ............ A ........ Arm tendon lengthening ...................... 7.51 NA NA 5.65 6.18 1.15 090 

24310 .... ............ A ........ Revision of arm tendon ....................... 6.03 NA NA 4.73 5.15 0.96 090 

24320 .... ............ A ........ Repair of arm tendon .......................... 10.74 NA NA 7.02 7.27 1.74 090 

24330 .... ............ A ........ Revision of arm muscles .................... 9.67 NA NA 6.63 7.25 1.60 090 

24331 .... ............ A ........ Revision of arm muscles .................... 10.83 NA NA 6.94 7.81 1.78 090 

24332 .... ............ A ........ Tenolysis, triceps ................................ 7.77 NA NA 5.91 6.34 1.23 090 

24340 .... ............ A ........ Repair of biceps tendon ...................... 7.96 NA NA 5.96 6.47 1.36 090 

24341 .... ............ A ........ Repair arm tendon/muscle .................. 9.24 NA NA 7.52 7.71 1.36 090 

24342 .... ............ A ........ Repair of ruptured tendon ................... 10.74 NA NA 7.06 7.79 1.86 090 

24343 .... ............ A ........ Repr elbow lat ligmnt w/tiss ................ 8.99 NA NA 6.98 7.56 1.43 090 

24344 .... ............ A ........ Reconstruct elbow lat ligmnt ............... 14.97 NA NA 9.95 10.73 2.37 090 

24345 .... ............ A ........ Repr elbw med ligmnt w/tissu ............. 8.99 NA NA 6.93 7.47 1.44 090 

24346 .... ............ A ........ Reconstruct elbow med ligmnt ........... 14.97 NA NA 10.03 10.68 2.34 090 

24357 .... ............ A ........ Repair elbow, perc .............................. 5.32 NA NA 4.72 5.15 0.87 090 

24358 .... ............ A ........ Repair elbow w/deb, open .................. 6.54 NA NA 5.27 5.73 1.07 090 

24359 .... ............ A ........ Repair elbow deb/attch open .............. 8.86 NA NA 6.19 6.19 1.41 090 

24360 .... ............ A ........ Reconstruct elbow joint ....................... 12.53 NA NA 7.84 8.65 2.06 090 

24361 .... ............ A ........ Reconstruct elbow joint ....................... 14.27 NA NA 8.75 9.66 2.19 090 


cprice-sewell on PROD1PC72 with RULES
66425 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

24362 .... ............ A ........ Reconstruct elbow joint ....................... 15.18 NA NA 5.73 7.88 2.61 090 

24363 .... ............ A ........ Replace elbow joint ............................. 22.47 NA NA 12.16 12.93 3.02 090 

24365 .... ............ A ........ Reconstruct head of radius ................. 8.51 NA NA 5.96 6.58 1.41 090 

24366 .... ............ A ........ Reconstruct head of radius ................. 9.25 NA NA 6.30 6.92 1.52 090 

24400 .... ............ A ........ Revision of humerus ........................... 11.19 NA NA 7.49 8.17 1.93 090 

24410 .... ............ A ........ Revision of humerus ........................... 14.96 NA NA 9.24 9.77 2.58 090 

24420 .... ............ A ........ Revision of humerus ........................... 13.58 NA NA 8.50 9.52 2.18 090 

24430 .... ............ A ........ Repair of humerus .............................. 15.07 NA NA 9.22 9.48 2.22 090 

24435 .... ............ A ........ Repair humerus with graft .................. 14.74 NA NA 9.80 10.34 2.28 090 

24470 .... ............ A ........ Revision of elbow joint ........................ 8.81 NA NA 5.65 6.68 1.48 090 

24495 .... ............ A ........ Decompression of forearm ................. 8.30 NA NA 6.41 7.57 1.18 090 

24498 .... ............ A ........ Reinforce humerus .............................. 12.16 NA NA 7.66 8.46 2.07 090 

24500 .... ............ A ........ Treat humerus fracture ....................... 3.29 4.45 4.64 3.80 3.74 0.50 090 

24505 .... ............ A ........ Treat humerus fracture ....................... 5.25 5.83 6.21 4.87 5.13 0.89 090 

24515 .... ............ A ........ Treat humerus fracture ....................... 11.97 NA NA 8.03 8.71 2.03 090 

24516 .... ............ A ........ Treat humerus fracture ....................... 12.07 NA NA 7.64 8.37 2.03 090 

24530 .... ............ A ........ Treat humerus fracture ....................... 3.57 4.73 4.97 4.00 4.02 0.57 090 

24535 .... ............ A ........ Treat humerus fracture ....................... 6.96 6.81 7.32 5.86 6.24 1.18 090 

24538 .... ............ A ........ Treat humerus fracture ....................... 9.63 NA NA 7.18 7.94 1.64 090 

24545 .... ............ A ........ Treat humerus fracture ....................... 12.99 NA NA 8.27 8.36 1.83 090 

24546 .... ............ A ........ Treat humerus fracture ....................... 14.73 NA NA 9.10 10.20 2.74 090 

24560 .... ............ A ........ Treat humerus fracture ....................... 2.87 4.11 4.29 3.43 3.31 0.44 090 

24565 .... ............ A ........ Treat humerus fracture ....................... 5.64 5.93 6.27 5.04 5.28 0.93 090 

24566 .... ............ A ........ Treat humerus fracture ....................... 8.86 NA NA 6.79 7.47 1.30 090 

24575 .... ............ A ........ Treat humerus fracture ....................... 9.53 NA NA 6.96 7.68 1.87 090 

24576 .... ............ A ........ Treat humerus fracture ....................... 2.94 4.41 4.58 3.71 3.71 0.46 090 

24577 .... ............ A ........ Treat humerus fracture ....................... 5.87 6.03 6.48 5.08 5.46 0.95 090 

24579 .... ............ A ........ Treat humerus fracture ....................... 11.26 NA NA 7.74 8.28 2.03 090 

24582 .... ............ A ........ Treat humerus fracture ....................... 9.89 NA NA 8.17 8.64 1.48 090 

24586 .... ............ A ........ Treat elbow fracture ............................ 15.64 NA NA 9.31 10.27 2.65 090 

24587 .... ............ A ........ Treat elbow fracture ............................ 15.65 NA NA 9.31 10.16 2.53 090 

24600 .... ............ A ........ Treat elbow dislocation ....................... 4.28 3.86 4.36 3.28 3.39 0.50 090 

24605 .... ............ A ........ Treat elbow dislocation ....................... 5.50 NA NA 4.91 5.13 0.89 090 

24615 .... ............ A ........ Treat elbow dislocation ....................... 9.72 NA NA 6.55 7.18 1.60 090 

24620 .... ............ A ........ Treat elbow fracture ............................ 7.07 NA NA 5.48 5.87 1.07 090 

24635 .... ............ A ........ Treat elbow fracture ............................ 8.64 NA NA 6.55 10.29 2.29 090 

24640 .... ............ A ........ Treat elbow dislocation ....................... 1.22 1.52 1.68 0.83 0.81 0.12 010 

24650 .... ............ A ........ Treat radius fracture ........................... 2.22 3.42 3.60 2.99 2.87 0.35 090 

24655 .... ............ A ........ Treat radius fracture ........................... 4.48 5.18 5.56 4.40 4.59 0.70 090 

24665 .... ............ A ........ Treat radius fracture ........................... 8.22 NA NA 6.51 7.01 1.41 090 

24666 .... ............ A ........ Treat radius fracture ........................... 9.74 NA NA 6.95 7.50 1.62 090 

24670 .... ............ A ........ Treat ulnar fracture ............................. 2.60 3.72 3.91 3.15 3.11 0.41 090 

24675 .... ............ A ........ Treat ulnar fracture ............................. 4.79 5.37 5.68 4.57 4.77 0.81 090 

24685 .... ............ A ........ Treat ulnar fracture ............................. 8.21 NA NA 6.51 7.01 1.52 090 

24800 .... ............ A ........ Fusion of elbow joint ........................... 11.27 NA NA 6.88 7.81 1.63 090 

24802 .... ............ A ........ Fusion/graft of elbow joint ................... 14.18 NA NA 8.02 9.20 2.38 090 

24900 .... ............ A ........ Amputation of upper arm .................... 10.04 NA NA 6.41 6.73 1.53 090 

24920 .... ............ A ........ Amputation of upper arm .................... 10.02 NA NA 6.03 6.48 1.61 090 

24925 .... ............ A ........ Amputation follow-up surgery ............. 7.19 NA NA 4.94 5.51 1.14 090 

24930 .... ............ A ........ Amputation follow-up surgery ............. 10.72 NA NA 6.19 6.71 1.68 090 

24931 .... ............ A ........ Amputate upper arm & implant ........... 13.32 NA NA 5.07 5.40 1.90 090 

24935 .... ............ A ........ Revision of amputation ....................... 16.30 NA NA 10.46 9.24 2.14 090 

24940 .... ............ C ........ Revision of upper arm ........................ 0.00 0.00 0.00 0.00 0.00 0.00 090 

24999 .... ............ C ........ Upper arm/elbow surgery ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

25000 .... ............ A ........ Incision of tendon sheath .................... 3.44 NA NA 3.98 5.42 0.55 090 

25001 .... ............ A ........ Incise flexor carpi radialis ................... 3.68 NA NA 3.94 4.08 0.55 090 

25020 .... ............ A ........ Decompress forearm 1 space ............ 5.97 NA NA 6.94 8.25 0.93 090 

25023 .... ............ A ........ Decompress forearm 1 space ............ 13.69 NA NA 11.32 13.12 2.04 090 

25024 .... ............ A ........ Decompress forearm 2 spaces ........... 10.62 NA NA 7.08 7.27 1.36 090 

25025 .... ............ A ........ Decompress forearm 2 spaces ........... 17.77 NA NA 9.69 9.83 1.83 090 

25028 .... ............ A ........ Drainage of forearm lesion ................. 5.30 NA NA 6.19 7.17 0.81 090 

25031 .... ............ A ........ Drainage of forearm bursa .................. 4.18 NA NA 3.49 5.70 0.63 090 

25035 .... ............ A ........ Treat forearm bone lesion .................. 7.54 NA NA 5.62 9.60 1.24 090 

25040 .... ............ A ........ Explore/treat wrist joint ....................... 7.41 NA NA 5.39 6.34 1.15 090 

25065 .... ............ A ........ Biopsy forearm soft tissues ................ 2.01 4.33 3.77 1.98 1.94 0.15 010 

25066 .... ............ A ........ Biopsy forearm soft tissues ................ 4.18 NA NA 3.83 5.45 0.64 090 

25075 .... ............ A ........ Removal forearm lesion subcu ........... 3.78 NA NA 3.31 4.60 0.55 090 

25076 .... ............ A ........ Removal forearm lesion deep ............. 4.97 NA NA 4.11 6.82 0.74 090 

25077 .... ............ A ........ Remove tumor, forearm/wrist ............. 9.90 NA NA 6.17 9.13 1.42 090 

25085 .... ............ A ........ Incision of wrist capsule ...................... 5.55 NA NA 4.61 5.86 0.85 090 

25100 .... ............ A ........ Biopsy of wrist joint ............................. 3.94 NA NA 3.77 4.52 0.59 090 

25101 .... ............ A ........ Explore/treat wrist joint ....................... 4.74 NA NA 4.35 5.12 0.75 090 


cprice-sewell on PROD1PC72 with RULES
66426 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

25105 .... ............ A ........ Remove wrist joint lining ..................... 5.91 NA NA 4.97 6.13 0.92 090 

25107 .... ............ A ........ Remove wrist joint cartilage ................ 7.50 NA NA 6.24 7.28 0.99 090 

25109 .... ............ A ........ Excise tendon forearm/wrist ............... 6.81 NA NA 5.23 5.23 0.96 090 

25110 .... ............ A ........ Remove wrist tendon lesion ............... 3.96 NA NA 3.62 5.33 0.62 090 

25111 .... ............ A ........ Remove wrist tendon lesion ............... 3.44 NA NA 3.61 4.15 0.53 090 

25112 .... ............ A ........ Reremove wrist tendon lesion ............ 4.58 NA NA 4.07 4.66 0.70 090 

25115 .... ............ A ........ Remove wrist/forearm lesion .............. 9.89 NA NA 7.33 10.68 1.31 090 

25116 .... ............ A ........ Remove wrist/forearm lesion .............. 7.38 NA NA 6.18 9.66 1.11 090 

25118 .... ............ A ........ Excise wrist tendon sheath ................. 4.42 NA NA 4.14 4.94 0.68 090 

25119 .... ............ A ........ Partial removal of ulna ........................ 6.10 NA NA 5.06 6.33 0.96 090 

25120 .... ............ A ........ Removal of forearm lesion .................. 6.16 NA NA 5.09 8.58 1.00 090 

25125 .... ............ A ........ Remove/graft forearm lesion .............. 7.55 NA NA 5.68 9.26 1.06 090 

25126 .... ............ A ........ Remove/graft forearm lesion .............. 7.62 NA NA 5.86 9.43 1.27 090 

25130 .... ............ A ........ Removal of wrist lesion ....................... 5.32 NA NA 4.72 5.57 0.80 090 

25135 .... ............ A ........ Remove & graft wrist lesion ................ 6.96 NA NA 5.62 6.56 1.02 090 

25136 .... ............ A ........ Remove & graft wrist lesion ................ 6.03 NA NA 5.09 5.84 1.03 090 

25145 .... ............ A ........ Remove forearm bone lesion ............. 6.43 NA NA 5.21 8.63 1.01 090 

25150 .... ............ A ........ Partial removal of ulna ........................ 7.27 NA NA 5.53 6.86 1.14 090 

25151 .... ............ A ........ Partial removal of radius ..................... 7.57 NA NA 5.64 9.18 1.18 090 

25170 .... ............ A ........ Extensive forearm surgery .................. 11.34 NA NA 7.36 11.25 1.78 090 

25210 .... ............ A ........ Removal of wrist bone ........................ 6.01 NA NA 5.04 5.91 0.88 090 

25215 .... ............ A ........ Removal of wrist bones ...................... 8.02 NA NA 6.02 7.39 1.19 090 

25230 .... ............ A ........ Partial removal of radius ..................... 5.28 NA NA 4.49 5.32 0.79 090 

25240 .... ............ A ........ Partial removal of ulna ........................ 5.22 NA NA 4.46 5.70 0.81 090 

25246 .... ............ A ........ Injection for wrist x-ray ........................ 1.45 2.73 3.08 0.53 0.50 0.09 000 

25248 .... ............ A ........ Remove forearm foreign body ............ 5.20 NA NA 4.04 6.28 0.72 090 

25250 .... ............ A ........ Removal of wrist prosthesis ................ 6.66 NA NA 5.27 5.68 1.01 090 

25251 .... ............ A ........ Removal of wrist prosthesis ................ 9.70 NA NA 6.74 7.33 1.26 090 

25259 .... ............ A ........ Manipulate wrist w/anesthes ............... 3.86 NA NA 5.15 5.43 0.62 090 

25260 .... ............ A ........ Repair forearm tendon/muscle ........... 7.89 NA NA 6.37 9.84 1.19 090 

25263 .... ............ A ........ Repair forearm tendon/muscle ........... 7.90 NA NA 6.09 9.67 1.18 090 

25265 .... ............ A ........ Repair forearm tendon/muscle ........... 9.96 NA NA 7.10 10.70 1.47 090 

25270 .... ............ A ........ Repair forearm tendon/muscle ........... 6.06 NA NA 4.97 8.49 0.95 090 

25272 .... ............ A ........ Repair forearm tendon/muscle ........... 7.10 NA NA 5.48 9.13 1.11 090 

25274 .... ............ A ........ Repair forearm tendon/muscle ........... 8.82 NA NA 6.37 9.99 1.36 090 

25275 .... ............ A ........ Repair forearm tendon sheath ............ 8.82 NA NA 6.48 7.02 1.31 090 

25280 .... ............ A ........ Revise wrist/forearm tendon ............... 7.28 NA NA 5.55 9.09 1.08 090 

25290 .... ............ A ........ Incise wrist/forearm tendon ................. 5.34 NA NA 4.50 9.74 0.82 090 

25295 .... ............ A ........ Release wrist/forearm tendon ............. 6.61 NA NA 5.29 8.72 1.00 090 

25300 .... ............ A ........ Fusion of tendons at wrist .................. 8.88 NA NA 6.65 7.55 1.26 090 

25301 .... ............ A ........ Fusion of tendons at wrist .................. 8.47 NA NA 6.18 7.12 1.29 090 

25310 .... ............ A ........ Transplant forearm tendon ................. 8.26 NA NA 5.93 9.48 1.21 090 

25312 .... ............ A ........ Transplant forearm tendon ................. 9.70 NA NA 6.70 10.32 1.41 090 

25315 .... ............ A ........ Revise palsy hand tendon(s) .............. 10.56 NA NA 7.10 10.74 1.58 090 

25316 .... ............ A ........ Revise palsy hand tendon(s) .............. 12.76 NA NA 7.81 12.01 1.75 090 

25320 .... ............ A ........ Repair/revise wrist joint ....................... 12.38 NA NA 9.86 10.62 1.61 090 

25332 .... ............ A ........ Revise wrist joint ................................. 11.60 NA NA 7.60 8.39 1.84 090 

25335 .... ............ A ........ Realignment of hand ........................... 13.25 NA NA 8.30 9.94 1.93 090 

25337 .... ............ A ........ Reconstruct ulna/radioulnar ................ 11.44 NA NA 8.62 9.85 1.61 090 

25350 .... ............ A ........ Revision of radius ............................... 8.97 NA NA 6.34 10.15 1.46 090 

25355 .... ............ A ........ Revision of radius ............................... 10.41 NA NA 6.74 10.67 1.74 090 

25360 .... ............ A ........ Revision of ulna .................................. 8.62 NA NA 6.23 10.05 1.41 090 

25365 .... ............ A ........ Revise radius & ulna ........................... 12.77 NA NA 8.17 11.90 2.16 090 

25370 .... ............ A ........ Revise radius or ulna .......................... 13.93 NA NA 9.00 12.53 2.29 090 

25375 .... ............ A ........ Revise radius & ulna ........................... 13.41 NA NA 8.36 12.39 2.27 090 

25390 .... ............ A ........ Shorten radius or ulna ........................ 10.58 NA NA 7.06 10.82 1.65 090 

25391 .... ............ A ........ Lengthen radius or ulna ...................... 14.14 NA NA 8.66 12.60 2.22 090 

25392 .... ............ A ........ Shorten radius & ulna ......................... 14.44 NA NA 8.90 12.43 2.11 090 

25393 .... ............ A ........ Lengthen radius & ulna ....................... 16.42 NA NA 9.55 13.56 2.77 090 

25394 .... ............ A ........ Repair carpal bone, shorten ............... 10.71 NA NA 6.94 7.50 1.59 090 

25400 .... ............ A ........ Repair radius or ulna .......................... 11.16 NA NA 7.26 11.22 1.83 090 

25405 .... ............ A ........ Repair/graft radius or ulna .................. 14.87 NA NA 8.92 13.09 2.33 090 

25415 .... ............ A ........ Repair radius & ulna ........................... 13.66 NA NA 8.79 12.64 2.18 090 

25420 .... ............ A ........ Repair/graft radius & ulna ................... 16.89 NA NA 9.92 14.09 2.62 090 

25425 .... ............ A ........ Repair/graft radius or ulna .................. 13.58 NA NA 8.48 14.93 2.09 090 

25426 .... ............ A ........ Repair/graft radius & ulna ................... 16.31 NA NA 9.19 12.86 2.55 090 

25430 .... ............ A ........ Vasc graft into carpal bone ................. 9.57 NA NA 7.03 7.18 1.27 090 

25431 .... ............ A ........ Repair nonunion carpal bone ............. 10.75 NA NA 7.15 7.77 1.91 090 

25440 .... ............ A ........ Repair/graft wrist bone ........................ 10.56 NA NA 6.89 8.14 1.63 090 

25441 .... ............ A ........ Reconstruct wrist joint ......................... 13.15 NA NA 8.10 9.05 2.08 090 

25442 .... ............ A ........ Reconstruct wrist joint ......................... 10.98 NA NA 7.50 8.19 1.53 090 

25443 .... ............ A ........ Reconstruct wrist joint ......................... 10.52 NA NA 7.21 7.99 1.37 090 


cprice-sewell on PROD1PC72 with RULES
66427 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

25444 .... ............ A ........ Reconstruct wrist joint ......................... 11.28 NA NA 7.43 8.23 1.72 090 

25445 .... ............ A ........ Reconstruct wrist joint ......................... 9.76 NA NA 6.69 7.34 1.55 090 

25446 .... ............ A ........ Wrist replacement ............................... 17.16 NA NA 9.98 10.94 2.48 090 

25447 .... ............ A ........ Repair wrist joint(s) ............................. 10.95 NA NA 7.86 8.26 1.61 090 

25449 .... ............ A ........ Remove wrist joint implant .................. 14.80 NA NA 8.95 9.81 2.22 090 

25450 .... ............ A ........ Revision of wrist joint .......................... 7.94 NA NA 3.84 7.01 1.36 090 

25455 .... ............ A ........ Revision of wrist joint .......................... 9.57 NA NA 6.84 8.85 0.96 090 

25490 .... ............ A ........ Reinforce radius .................................. 9.61 NA NA 6.57 10.15 1.43 090 

25491 .... ............ A ........ Reinforce ulna ..................................... 10.03 NA NA 6.78 10.62 1.60 090 

25492 .... ............ A ........ Reinforce radius and ulna ................... 12.52 NA NA 8.33 11.81 2.15 090 

25500 .... ............ A ........ Treat fracture of radius ....................... 2.51 3.30 3.44 2.86 2.79 0.35 090 

25505 .... ............ A ........ Treat fracture of radius ....................... 5.30 5.82 6.18 4.98 5.20 0.90 090 

25515 .... ............ A ........ Treat fracture of radius ....................... 8.64 NA NA 6.46 6.96 1.59 090 

25520 .... ............ A ........ Treat fracture of radius ....................... 6.35 5.69 6.27 5.14 5.60 1.08 090 

25525 .... ............ A ........ Treat fracture of radius ....................... 10.37 NA NA 7.41 8.70 2.13 090 

25526 .... ............ A ........ Treat fracture of radius ....................... 12.96 NA NA 8.68 11.09 2.20 090 

25530 .... ............ A ........ Treat fracture of ulna .......................... 2.15 3.48 3.62 2.97 2.92 0.34 090 

25535 .... ............ A ........ Treat fracture of ulna .......................... 5.22 5.57 5.79 4.83 5.06 0.89 090 

25545 .... ............ A ........ Treat fracture of ulna .......................... 7.78 NA NA 6.23 6.94 1.53 090 

25560 .... ............ A ........ Treat fracture radius & ulna ................ 2.50 3.36 3.53 2.85 2.73 0.35 090 

25565 .... ............ A ........ Treat fracture radius & ulna ................ 5.71 5.90 6.30 4.92 5.17 0.93 090 

25574 .... ............ A ........ Treat fracture radius & ulna ................ 8.64 NA NA 6.55 6.87 1.21 090 

25575 .... ............ A ........ Treat fracture radius/ulna .................... 12.10 NA NA 8.36 8.93 1.82 090 

25600 .... ............ A ........ Treat fracture radius/ulna .................... 2.69 3.68 3.88 3.17 3.07 0.42 090 

25605 .... ............ A ........ Treat fracture radius/ulna .................... 7.02 6.86 7.04 6.13 6.17 1.00 090 

25606 .... ............ A ........ Treat fx distal radial ............................ 8.10 NA NA 6.69 7.82 1.26 090 

25607 .... ............ A ........ Treat fx rad extra-articul ..................... 9.35 NA NA 7.19 7.19 1.36 090 

25608 .... ............ A ........ Treat fx rad intra-articul ...................... 10.86 NA NA 7.79 7.79 1.84 090 

25609 .... ............ A ........ Treat fx radial 3+ frag ......................... 14.12 NA NA 9.65 9.65 2.38 090 

25622 .... ............ A ........ Treat wrist bone fracture ..................... 2.68 3.90 4.08 3.35 3.23 0.41 090 

25624 .... ............ A ........ Treat wrist bone fracture ..................... 4.62 5.63 5.96 4.77 4.92 0.76 090 

25628 .... ............ A ........ Treat wrist bone fracture ..................... 9.51 NA NA 6.84 7.33 1.37 090 

25630 .... ............ A ........ Treat wrist bone fracture ..................... 2.94 3.75 3.96 3.25 3.09 0.45 090 

25635 .... ............ A ........ Treat wrist bone fracture ..................... 4.47 5.11 5.53 4.34 4.12 0.74 090 

25645 .... ............ A ........ Treat wrist bone fracture ..................... 7.31 NA NA 5.55 6.09 1.20 090 

25650 .... ............ A ........ Treat wrist bone fracture ..................... 3.12 3.84 4.07 3.44 3.31 0.45 090 

25651 .... ............ A ........ Pin ulnar styloid fracture ..................... 5.68 NA NA 5.15 5.31 0.86 090 

25652 .... ............ A ........ Treat fracture ulnar styloid .................. 7.92 NA NA 6.16 6.58 1.21 090 

25660 .... ............ A ........ Treat wrist dislocation ......................... 4.84 NA NA 4.32 4.51 0.58 090 

25670 .... ............ A ........ Treat wrist dislocation ......................... 7.98 NA NA 5.81 6.40 1.28 090 

25671 .... ............ A ........ Pin radioulnar dislocation .................... 6.32 NA NA 5.53 5.84 1.00 090 

25675 .... ............ A ........ Treat wrist dislocation ......................... 4.75 4.71 5.18 3.99 4.32 0.62 090 

25676 .... ............ A ........ Treat wrist dislocation ......................... 8.17 NA NA 6.13 6.71 1.34 090 

25680 .... ............ A ........ Treat wrist fracture .............................. 6.08 NA NA 4.38 4.56 0.78 090 

25685 .... ............ A ........ Treat wrist fracture .............................. 9.97 NA NA 6.62 7.21 1.60 090 

25690 .... ............ A ........ Treat wrist dislocation ......................... 5.58 NA NA 4.85 5.17 0.88 090 

25695 .... ............ A ........ Treat wrist dislocation ......................... 8.40 NA NA 6.00 6.54 1.32 090 

25800 .... ............ A ........ Fusion of wrist joint ............................. 9.95 NA NA 6.79 7.94 1.57 090 

25805 .... ............ A ........ Fusion/graft of wrist joint ..................... 11.59 NA NA 7.67 8.96 1.81 090 

25810 .... ............ A ........ Fusion/graft of wrist joint ..................... 11.75 NA NA 8.03 8.97 1.68 090 

25820 .... ............ A ........ Fusion of hand bones ......................... 7.52 NA NA 6.41 7.12 1.22 090 

25825 .... ............ A ........ Fuse hand bones with graft ................ 9.54 NA NA 7.65 8.44 1.41 090 

25830 .... ............ A ........ Fusion, radioulnar jnt/ulna .................. 10.69 NA NA 10.57 12.49 1.55 090 

25900 .... ............ A ........ Amputation of forearm ........................ 9.46 NA NA 6.73 9.64 1.30 090 

25905 .... ............ A ........ Amputation of forearm ........................ 9.48 NA NA 6.06 9.17 1.40 090 

25907 .... ............ A ........ Amputation follow-up surgery ............. 7.98 NA NA 5.77 8.76 1.10 090 

25909 .... ............ A ........ Amputation follow-up surgery ............. 9.20 NA NA 6.32 9.30 1.44 090 

25915 .... ............ A ........ Amputation of forearm ........................ 17.38 NA NA 5.97 12.42 2.94 090 

25920 .... ............ A ........ Amputate hand at wrist ....................... 8.92 NA NA 6.59 7.21 1.35 090 

25922 .... ............ A ........ Amputate hand at wrist ....................... 7.54 NA NA 6.27 6.66 1.12 090 

25924 .... ............ A ........ Amputation follow-up surgery ............. 8.70 NA NA 6.12 7.10 1.32 090 

25927 .... ............ A ........ Amputation of hand ............................. 8.98 NA NA 8.65 10.16 1.27 090 

25929 .... ............ A ........ Amputation follow-up surgery ............. 7.71 NA NA 5.66 5.77 1.14 090 

25931 .... ............ A ........ Amputation follow-up surgery ............. 7.93 NA NA 8.32 9.89 1.15 090 

25999 .... ............ C ........ Forearm or wrist surgery .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

26010 .... ............ A ........ Drainage of finger abscess ................. 1.56 4.06 4.81 1.52 1.57 0.18 010 

26011 .... ............ A ........ Drainage of finger abscess ................. 2.21 6.24 7.53 1.96 2.14 0.33 010 

26020 .... ............ A ........ Drain hand tendon sheath .................. 4.97 NA NA 4.74 5.05 0.73 090 

26025 .... ............ A ........ Drainage of palm bursa ...................... 4.99 NA NA 4.46 4.78 0.76 090 

26030 .... ............ A ........ Drainage of palm bursa(s) .................. 6.16 NA NA 5.00 5.36 0.92 090 

26034 .... ............ A ........ Treat hand bone lesion ....................... 6.49 NA NA 5.57 5.96 1.01 090 

26035 .... ............ A ........ Decompress fingers/hand ................... 11.14 NA NA 8.12 7.99 1.47 090 


cprice-sewell on PROD1PC72 with RULES
66428 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

26037 .... ............ A ........ Decompress fingers/hand ................... 7.48 NA NA 5.49 5.91 1.13 090 

26040 .... ............ A ........ Release palm contracture ................... 3.38 NA NA 3.60 3.82 0.53 090 

26045 .... ............ A ........ Release palm contracture ................... 5.62 NA NA 4.88 5.26 0.93 090 

26055 .... ............ A ........ Incise finger tendon sheath ................ 3.00 9.04 11.69 3.82 3.88 0.43 090 

26060 .... ............ A ........ Incision of finger tendon ..................... 2.85 NA NA 3.05 3.28 0.45 090 

26070 .... ............ A ........ Explore/treat hand joint ....................... 3.73 NA NA 3.05 3.21 0.48 090 

26075 .... ............ A ........ Explore/treat finger joint ...................... 3.83 NA NA 3.37 3.57 0.53 090 

26080 .... ............ A ........ Explore/treat finger joint ...................... 4.36 NA NA 4.32 4.58 0.66 090 

26100 .... ............ A ........ Biopsy hand joint lining ....................... 3.71 NA NA 3.66 3.89 0.54 090 

26105 .... ............ A ........ Biopsy finger joint lining ...................... 3.75 NA NA 3.68 3.95 0.59 090 

26110 .... ............ A ........ Biopsy finger joint lining ...................... 3.57 NA NA 3.60 3.82 0.53 090 

26115 .... ............ A ........ Removal hand lesion subcut .............. 3.92 9.83 11.46 4.23 4.49 0.59 090 

26116 .... ............ A ........ Removal hand lesion, deep ................ 5.61 NA NA 5.30 5.65 0.84 090 

26117 .... ............ A ........ Remove tumor, hand/finger ................ 8.62 NA NA 6.18 6.62 1.26 090 

26121 .... ............ A ........ Release palm contracture ................... 7.61 NA NA 5.92 6.44 1.17 090 

26123 .... ............ A ........ Release palm contracture ................... 10.63 NA NA 8.21 8.53 1.43 090 

26125 .... ............ A ........ Release palm contracture ................... 4.60 NA NA 1.87 2.15 0.70 ZZZ 

26130 .... ............ A ........ Remove wrist joint lining ..................... 5.48 NA NA 4.88 5.11 0.94 090 

26135 .... ............ A ........ Revise finger joint, each ..................... 7.02 NA NA 5.47 5.96 1.07 090 

26140 .... ............ A ........ Revise finger joint, each ..................... 6.23 NA NA 5.16 5.60 0.92 090 

26145 .... ............ A ........ Tendon excision, palm/finger .............. 6.38 NA NA 5.18 5.62 0.97 090 

26160 .... ............ A ........ Remove tendon sheath lesion ............ 3.46 9.03 10.70 3.94 4.03 0.49 090 

26170 .... ............ A ........ Removal of palm tendon, each ........... 4.82 NA NA 4.37 4.65 0.69 090 

26180 .... ............ A ........ Removal of finger tendon ................... 5.24 NA NA 4.71 5.06 0.78 090 

26185 .... ............ A ........ Remove finger bone ........................... 6.32 NA NA 5.73 5.88 0.81 090 

26200 .... ............ A ........ Remove hand bone lesion .................. 5.56 NA NA 4.55 4.95 0.88 090 

26205 .... ............ A ........ Remove/graft bone lesion ................... 7.82 NA NA 5.85 6.37 1.20 090 

26210 .... ............ A ........ Removal of finger lesion ..................... 5.21 NA NA 4.73 5.08 0.79 090 

26215 .... ............ A ........ Remove/graft finger lesion .................. 7.16 NA NA 5.54 5.92 0.98 090 

26230 .... ............ A ........ Partial removal of hand bone ............. 6.38 NA NA 4.95 5.43 1.01 090 

26235 .... ............ A ........ Partial removal, finger bone ................ 6.24 NA NA 4.94 5.38 0.95 090 

26236 .... ............ A ........ Partial removal, finger bone ................ 5.37 NA NA 4.57 4.95 0.81 090 

26250 .... ............ A ........ Extensive hand surgery ...................... 7.61 NA NA 5.71 6.07 1.07 090 

26255 .... ............ A ........ Extensive hand surgery ...................... 12.80 NA NA 8.28 8.82 1.69 090 

26260 .... ............ A ........ Extensive finger surgery ..................... 7.09 NA NA 5.46 5.82 1.01 090 

26261 .... ............ A ........ Extensive finger surgery ..................... 9.28 NA NA 6.72 6.44 1.14 090 

26262 .... ............ A ........ Partial removal of finger ...................... 5.72 NA NA 4.74 5.04 0.88 090 

26320 .... ............ A ........ Removal of implant from hand ........... 4.02 NA NA 3.79 4.05 0.59 090 

26340 .... ............ A ........ Manipulate finger w/anesth ................. 2.62 NA NA 4.60 4.74 0.39 090 

26350 .... ............ A ........ Repair finger/hand tendon .................. 6.07 NA NA 9.52 12.06 0.93 090 

26352 .... ............ A ........ Repair/graft hand tendon .................... 7.75 NA NA 10.06 12.70 1.13 090 

26356 .... ............ A ........ Repair finger/hand tendon .................. 10.22 NA NA 13.70 16.03 1.21 090 

26357 .... ............ A ........ Repair finger/hand tendon .................. 8.65 NA NA 10.35 12.99 1.33 090 

26358 .... ............ A ........ Repair/graft hand tendon .................... 9.22 NA NA 10.94 13.79 1.38 090 

26370 .... ............ A ........ Repair finger/hand tendon .................. 7.17 NA NA 9.50 12.30 1.12 090 

26372 .... ............ A ........ Repair/graft hand tendon .................... 8.89 NA NA 10.53 13.52 1.40 090 

26373 .... ............ A ........ Repair finger/hand tendon .................. 8.29 NA NA 10.16 13.10 1.23 090 

26390 .... ............ A ........ Revise hand/finger tendon .................. 9.31 NA NA 9.20 11.24 1.40 090 

26392 .... ............ A ........ Repair/graft hand tendon .................... 10.38 NA NA 11.16 13.94 1.57 090 

26410 .... ............ A ........ Repair hand tendon ............................ 4.68 NA NA 7.63 9.78 0.73 090 

26412 .... ............ A ........ Repair/graft hand tendon .................... 6.37 NA NA 8.62 10.94 0.97 090 

26415 .... ............ A ........ Excision, hand/finger tendon .............. 8.40 NA NA 7.46 9.62 0.98 090 

26416 .... ............ A ........ Graft hand or finger tendon ................ 9.44 NA NA 9.04 11.81 0.79 090 

26418 .... ............ A ........ Repair finger tendon ........................... 4.33 NA NA 8.14 10.23 0.67 090 

26420 .... ............ A ........ Repair/graft finger tendon ................... 6.83 NA NA 8.80 11.21 1.07 090 

26426 .... ............ A ........ Repair finger/hand tendon .................. 6.21 NA NA 5.11 9.13 0.95 090 

26428 .... ............ A ........ Repair/graft finger tendon ................... 7.28 NA NA 9.25 11.55 1.09 090 

26432 .... ............ A ........ Repair finger tendon ........................... 4.07 NA NA 6.78 8.52 0.64 090 

26433 .... ............ A ........ Repair finger tendon ........................... 4.61 NA NA 7.01 8.90 0.72 090 

26434 .... ............ A ........ Repair/graft finger tendon ................... 6.15 NA NA 7.93 9.73 0.93 090 

26437 .... ............ A ........ Realignment of tendons ...................... 5.88 NA NA 7.81 9.68 0.89 090 

26440 .... ............ A ........ Release palm/finger tendon ................ 5.07 NA NA 8.48 10.95 0.75 090 

26442 .... ............ A ........ Release palm & finger tendon ............ 9.50 NA NA 11.81 13.87 1.20 090 

26445 .... ............ A ........ Release hand/finger tendon ................ 4.36 NA NA 8.23 10.68 0.65 090 

26449 .... ............ A ........ Release forearm/hand tendon ............ 8.34 NA NA 7.27 11.52 1.06 090 

26450 .... ............ A ........ Incision of palm tendon ....................... 3.71 NA NA 5.19 6.26 0.59 090 

26455 .... ............ A ........ Incision of finger tendon ..................... 3.68 NA NA 5.15 6.21 0.58 090 

26460 .... ............ A ........ Incise hand/finger tendon ................... 3.50 NA NA 5.11 6.12 0.55 090 

26471 .... ............ A ........ Fusion of finger tendons ..................... 5.79 NA NA 7.79 9.51 0.88 090 

26474 .... ............ A ........ Fusion of finger tendons ..................... 5.38 NA NA 7.60 9.49 0.76 090 

26476 .... ............ A ........ Tendon lengthening ............................ 5.24 NA NA 7.35 9.14 0.79 090 

26477 .... ............ A ........ Tendon shortening .............................. 5.21 NA NA 7.57 9.31 0.81 090 


cprice-sewell on PROD1PC72 with RULES
66429 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

26478 .... ............ A ........ Lengthening of hand tendon ............... 5.86 NA NA 7.78 9.80 0.90 090 

26479 .... ............ A ........ Shortening of hand tendon ................. 5.80 NA NA 7.73 9.64 0.92 090 

26480 .... ............ A ........ Transplant hand tendon ...................... 6.76 NA NA 9.65 12.34 1.02 090 

26483 .... ............ A ........ Transplant/graft hand tendon .............. 8.36 NA NA 10.22 12.85 1.26 090 

26485 .... ............ A ........ Transplant palm tendon ...................... 7.77 NA NA 10.07 12.71 1.15 090 

26489 .... ............ A ........ Transplant/graft palm tendon .............. 9.74 NA NA 10.82 11.43 1.26 090 

26490 .... ............ A ........ Revise thumb tendon .......................... 8.48 NA NA 8.87 10.84 1.21 090 

26492 .... ............ A ........ Tendon transfer with graft ................... 9.70 NA NA 9.82 11.71 1.40 090 

26494 .... ............ A ........ Hand tendon/muscle transfer .............. 8.54 NA NA 9.23 11.10 1.28 090 

26496 .... ............ A ........ Revise thumb tendon .......................... 9.66 NA NA 9.57 11.40 1.45 090 

26497 .... ............ A ........ Finger tendon transfer ........................ 9.64 NA NA 9.52 11.54 1.41 090 

26498 .... ............ A ........ Finger tendon transfer ........................ 14.07 NA NA 11.65 13.90 2.11 090 

26499 .... ............ A ........ Revision of finger ................................ 9.05 NA NA 8.84 10.94 1.35 090 

26500 .... ............ A ........ Hand tendon reconstruction ................ 6.02 NA NA 7.74 9.59 0.90 090 

26502 .... ............ A ........ Hand tendon reconstruction ................ 7.20 NA NA 8.32 10.17 1.13 090 

26508 .... ............ A ........ Release thumb contracture ................. 6.07 NA NA 7.80 9.73 0.98 090 

26510 .... ............ A ........ Thumb tendon transfer ....................... 5.49 NA NA 7.63 9.48 0.79 090 

26516 .... ............ A ........ Fusion of knuckle joint ........................ 7.21 NA NA 8.30 10.26 1.10 090 

26517 .... ............ A ........ Fusion of knuckle joints ...................... 8.96 NA NA 8.99 11.24 1.41 090 

26518 .... ............ A ........ Fusion of knuckle joints ...................... 9.15 NA NA 8.96 11.17 1.35 090 

26520 .... ............ A ........ Release knuckle contracture .............. 5.36 NA NA 8.86 11.37 0.80 090 

26525 .... ............ A ........ Release finger contracture .................. 5.39 NA NA 8.88 11.42 0.81 090 

26530 .... ............ A ........ Revise knuckle joint ............................ 6.76 NA NA 5.41 5.77 1.04 090 

26531 .... ............ A ........ Revise knuckle with implant ............... 7.99 NA NA 6.16 6.64 1.17 090 

26535 .... ............ A ........ Revise finger joint ............................... 5.30 NA NA 4.09 3.91 0.71 090 

26536 .... ............ A ........ Revise/implant finger joint ................... 6.44 NA NA 9.24 9.44 0.96 090 

26540 .... ............ A ........ Repair hand joint ................................. 6.49 NA NA 8.05 9.96 0.99 090 

26541 .... ............ A ........ Repair hand joint with graft ................. 8.69 NA NA 9.11 11.25 1.28 090 

26542 .... ............ A ........ Repair hand joint with graft ................. 6.84 NA NA 8.19 10.11 1.02 090 

26545 .... ............ A ........ Reconstruct finger joint ....................... 6.99 NA NA 8.45 10.29 1.05 090 

26546 .... ............ A ........ Repair nonunion hand ........................ 10.53 NA NA 11.42 13.22 1.44 090 

26548 .... ............ A ........ Reconstruct finger joint ....................... 8.10 NA NA 8.80 10.82 1.20 090 

26550 .... ............ A ........ Construct thumb replacement ............. 21.54 NA NA 14.53 16.05 2.46 090 

26551 .... ............ A ........ Great toe-hand transfer ...................... 48.23 NA NA 17.15 24.79 7.98 090 

26553 .... ............ A ........ Single transfer, toe-hand .................... 47.92 NA NA 27.34 25.01 2.42 090 

26554 .... ............ A ........ Double transfer, toe-hand ................... 56.73 NA NA 35.78 36.65 9.44 090 

26555 .... ............ A ........ Positional change of finger ................. 16.94 NA NA 13.99 16.08 2.49 090 

26556 .... ............ A ........ Toe joint transfer ................................. 49.43 NA NA 18.03 25.67 2.58 090 

26560 .... ............ A ........ Repair of web finger ........................... 5.43 NA NA 6.65 8.22 0.85 090 

26561 .... ............ A ........ Repair of web finger ........................... 10.98 NA NA 9.50 10.92 1.45 090 

26562 .... ............ A ........ Repair of web finger ........................... 16.40 NA NA 8.76 12.95 2.24 090 

26565 .... ............ A ........ Correct metacarpal flaw ...................... 6.80 NA NA 8.15 10.07 1.00 090 

26567 .... ............ A ........ Correct finger deformity ...................... 6.88 NA NA 8.11 10.03 1.04 090 

26568 .... ............ A ........ Lengthen metacarpal/finger ................ 9.15 NA NA 10.69 13.05 1.49 090 

26580 .... ............ A ........ Repair hand deformity ........................ 19.50 NA NA 9.73 11.68 2.29 090 

26587 .... ............ A ........ Reconstruct extra finger ...................... 14.36 NA NA 8.01 8.61 1.53 090 

26590 .... ............ A ........ Repair finger deformity ....................... 18.51 NA NA 12.41 13.17 2.78 090 

26591 .... ............ A ........ Repair muscles of hand ...................... 3.30 NA NA 6.21 7.91 0.48 090 

26593 .... ............ A ........ Release muscles of hand ................... 5.38 NA NA 7.79 9.46 0.78 090 

26596 .... ............ A ........ Excision constricting tissue ................. 9.02 NA NA 7.48 8.15 1.43 090 

26600 .... ............ A ........ Treat metacarpal fracture ................... 2.48 3.83 3.72 3.49 3.07 0.30 090 

26605 .... ............ A ........ Treat metacarpal fracture ................... 2.92 4.08 4.32 3.50 3.58 0.49 090 

26607 .... ............ A ........ Treat metacarpal fracture ................... 5.40 NA NA 4.88 5.58 0.87 090 

26608 .... ............ A ........ Treat metacarpal fracture ................... 5.43 NA NA 5.22 5.74 0.88 090 

26615 .... ............ A ........ Treat metacarpal fracture ................... 6.91 NA NA 6.01 5.66 0.86 090 

26641 .... ............ A ........ Treat thumb dislocation ...................... 4.01 4.03 4.30 3.40 3.46 0.39 090 

26645 .... ............ A ........ Treat thumb fracture ........................... 4.47 4.60 4.88 3.92 4.05 0.67 090 

26650 .... ............ A ........ Treat thumb fracture ........................... 5.19 NA NA 4.88 5.78 0.94 090 

26665 .... ............ A ........ Treat thumb fracture ........................... 7.78 NA NA 6.31 6.46 0.90 090 

26670 .... ............ A ........ Treat hand dislocation ........................ 3.74 3.62 3.94 3.03 2.99 0.39 090 

26675 .... ............ A ........ Treat hand dislocation ........................ 4.71 5.25 5.36 4.51 4.49 0.77 090 

26676 .... ............ A ........ Pin hand dislocation ............................ 5.60 NA NA 5.56 6.12 0.91 090 

26685 .... ............ A ........ Treat hand dislocation ........................ 6.91 NA NA 5.97 6.05 1.09 090 

26686 .... ............ A ........ Treat hand dislocation ........................ 8.06 NA NA 6.07 6.48 1.24 090 

26700 .... ............ A ........ Treat knuckle dislocation .................... 3.74 3.30 3.53 2.93 2.89 0.35 090 

26705 .... ............ A ........ Treat knuckle dislocation .................... 4.26 4.74 5.04 4.04 4.17 0.66 090 

26706 .... ............ A ........ Pin knuckle dislocation ....................... 5.19 NA NA 4.70 4.89 0.81 090 

26715 .... ............ A ........ Treat knuckle dislocation .................... 6.87 NA NA 5.99 5.75 0.91 090 

26720 .... ............ A ........ Treat finger fracture, each .................. 1.70 2.58 2.68 2.30 2.18 0.24 090 

26725 .... ............ A ........ Treat finger fracture, each .................. 3.39 4.08 4.42 3.41 3.45 0.53 090 

26727 .... ............ A ........ Treat finger fracture, each .................. 5.30 NA NA 5.18 5.70 0.84 090 

26735 .... ............ A ........ Treat finger fracture, each .................. 7.26 NA NA 6.12 5.84 0.95 090 


cprice-sewell on PROD1PC72 with RULES
66430 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

26740 .... ............ A ........ Treat finger fracture, each .................. 1.99 3.01 3.07 2.71 2.71 0.31 090 

26742 .... ............ A ........ Treat finger fracture, each .................. 3.90 4.26 4.62 3.56 3.72 0.58 090 

26746 .... ............ A ........ Treat finger fracture, each .................. 9.59 NA NA 7.19 6.38 0.91 090 

26750 .... ............ A ........ Treat finger fracture, each .................. 1.74 2.25 2.36 2.26 2.14 0.22 090 

26755 .... ............ A ........ Treat finger fracture, each .................. 3.15 3.74 4.08 2.94 2.97 0.42 090 

26756 .... ............ A ........ Pin finger fracture, each ..................... 4.46 NA NA 4.86 5.29 0.71 090 

26765 .... ............ A ........ Treat finger fracture, each .................. 5.70 NA NA 5.47 4.93 0.66 090 

26770 .... ............ A ........ Treat finger dislocation ....................... 3.07 2.92 3.17 2.54 2.48 0.27 090 

26775 .... ............ A ........ Treat finger dislocation ....................... 3.78 4.62 4.90 3.88 3.84 0.54 090 

26776 .... ............ A ........ Pin finger dislocation ........................... 4.87 NA NA 4.98 5.49 0.77 090 

26785 .... ............ A ........ Treat finger dislocation ....................... 6.44 NA NA 5.77 5.15 0.68 090 

26820 .... ............ A ........ Thumb fusion with graft ...................... 8.33 NA NA 8.96 11.10 1.30 090 

26841 .... ............ A ........ Fusion of thumb .................................. 7.21 NA NA 8.76 10.99 1.18 090 

26842 .... ............ A ........ Thumb fusion with graft ...................... 8.37 NA NA 9.01 11.19 1.32 090 

26843 .... ............ A ........ Fusion of hand joint ............................ 7.67 NA NA 8.56 10.45 1.15 090 

26844 .... ............ A ........ Fusion/graft of hand joint .................... 8.86 NA NA 9.15 11.25 1.33 090 

26850 .... ............ A ........ Fusion of knuckle ................................ 7.03 NA NA 8.26 10.23 1.06 090 

26852 .... ............ A ........ Fusion of knuckle with graft ................ 8.59 NA NA 9.13 11.01 1.22 090 

26860 .... ............ A ........ Fusion of finger joint ........................... 4.76 NA NA 7.53 9.35 0.73 090 

26861 .... ............ A ........ Fusion of finger jnt, add-on ................. 1.74 NA NA 0.70 0.81 0.27 ZZZ 

26862 .... ............ A ........ Fusion/graft of finger joint ................... 7.44 NA NA 8.66 10.50 1.10 090 

26863 .... ............ A ........ Fuse/graft added joint ......................... 3.89 NA NA 1.58 1.85 0.56 ZZZ 

26910 .... ............ A ........ Amputate metacarpal bone ................. 7.67 NA NA 8.27 9.74 1.16 090 

26951 .... ............ A ........ Amputation of finger/thumb ................. 5.85 NA NA 8.39 9.27 0.71 090 

26952 .... ............ A ........ Amputation of finger/thumb ................. 6.37 NA NA 7.90 9.78 0.95 090 

26989 .... ............ C ........ Hand/finger surgery ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

26990 .... ............ A ........ Drainage of pelvis lesion .................... 7.84 NA NA 6.20 6.70 1.22 090 

26991 .... ............ A ........ Drainage of pelvis bursa ..................... 6.97 8.61 9.88 4.88 5.15 1.11 090 

26992 .... ............ A ........ Drainage of bone lesion ...................... 13.37 NA NA 8.41 9.39 2.17 090 

27000 .... ............ A ........ Incision of hip tendon .......................... 5.66 NA NA 4.51 4.90 0.98 090 

27001 .... ............ A ........ Incision of hip tendon .......................... 7.05 NA NA 5.22 5.66 1.24 090 

27003 .... ............ A ........ Incision of hip tendon .......................... 7.70 NA NA 5.72 6.10 1.12 090 

27005 .... ............ A ........ Incision of hip tendon .......................... 9.96 NA NA 6.48 7.15 1.73 090 

27006 .... ............ A ........ Incision of hip tendons ........................ 9.99 NA NA 6.75 7.36 1.70 090 

27025 .... ............ A ........ Incision of hip/thigh fascia .................. 12.66 NA NA 8.20 8.37 1.85 090 

27030 .... ............ A ........ Drainage of hip joint ............................ 13.54 NA NA 8.03 8.83 2.27 090 

27033 .... ............ A ........ Exploration of hip joint ........................ 13.99 NA NA 8.39 9.15 2.33 090 

27035 .... ............ A ........ Denervation of hip joint ....................... 17.23 NA NA 8.52 9.87 2.16 090 

27036 .... ............ A ........ Excision of hip joint/muscle ................ 14.18 NA NA 8.91 9.45 2.27 090 

27040 .... ............ A ........ Biopsy of soft tissues .......................... 2.89 5.19 5.21 1.87 1.94 0.27 010 

27041 .... ............ A ........ Biopsy of soft tissues .......................... 10.07 NA NA 5.73 6.18 1.35 090 

27047 .... ............ A ........ Remove hip/pelvis lesion .................... 7.51 7.02 7.06 4.49 4.63 1.03 090 

27048 .... ............ A ........ Remove hip/pelvis lesion .................... 6.44 NA NA 4.60 4.70 0.92 090 

27049 .... ............ A ........ Remove tumor, hip/pelvis ................... 15.20 NA NA 8.16 8.28 2.07 090 

27050 .... ............ A ........ Biopsy of sacroiliac joint ..................... 4.65 NA NA 3.01 3.71 0.60 090 

27052 .... ............ A ........ Biopsy of hip joint ............................... 7.27 NA NA 5.64 5.76 1.08 090 

27054 .... ............ A ........ Removal of hip joint lining .................. 9.09 NA NA 6.49 6.91 1.47 090 

27060 .... ............ A ........ Removal of ischial bursa .................... 5.78 NA NA 4.36 4.37 0.80 090 

27062 .... ............ A ........ Remove femur lesion/bursa ................ 5.66 NA NA 4.60 4.89 0.93 090 

27065 .... ............ A ........ Removal of hip bone lesion ................ 6.44 NA NA 4.99 5.21 1.01 090 

27066 .... ............ A ........ Removal of hip bone lesion ................ 11.06 NA NA 7.43 7.93 1.80 090 

27067 .... ............ A ........ Remove/graft hip bone lesion ............. 14.57 NA NA 8.83 9.74 1.85 090 

27070 .... ............ A ........ Partial removal of hip bone ................. 11.44 NA NA 8.02 8.58 1.75 090 

27071 .... ............ A ........ Partial removal of hip bone ................. 12.25 NA NA 8.47 9.29 1.93 090 

27075 .... ............ A ........ Extensive hip surgery ......................... 36.77 NA NA 16.13 17.66 5.66 090 

27076 .... ............ A ........ Extensive hip surgery ......................... 24.25 NA NA 12.82 13.66 3.71 090 

27077 .... ............ A ........ Extensive hip surgery ......................... 42.54 NA NA 19.92 21.29 6.14 090 

27078 .... ............ A ........ Extensive hip surgery ......................... 14.54 NA NA 8.81 9.37 2.23 090 

27079 .... ............ A ........ Extensive hip surgery ......................... 14.91 NA NA 8.00 8.77 1.95 090 

27080 .... ............ A ........ Removal of tail bone ........................... 6.80 NA NA 4.58 4.70 0.93 090 

27086 .... ............ A ........ Remove hip foreign body .................... 1.89 3.66 4.10 1.48 1.65 0.25 010 

27087 .... ............ A ........ Remove hip foreign body .................... 8.72 NA NA 5.65 6.15 1.35 090 

27090 .... ............ A ........ Removal of hip prosthesis .................. 11.57 NA NA 7.40 8.09 1.95 090 

27091 .... ............ A ........ Removal of hip prosthesis .................. 24.15 NA NA 12.90 13.44 3.85 090 

27093 .... ............ A ........ Injection for hip x-ray .......................... 1.30 3.15 3.80 0.47 0.48 0.13 000 

27095 .... ............ A ........ Injection for hip x-ray .......................... 1.50 3.71 4.71 0.51 0.51 0.14 000 

27096 .... ............ A ........ Inject sacroiliac joint ............................ 1.40 2.52 3.43 0.33 0.33 0.08 000 

27097 .... ............ A ........ Revision of hip tendon ........................ 9.16 NA NA 6.33 6.37 1.57 090 

27098 .... ............ A ........ Transfer tendon to pelvis .................... 9.20 NA NA 4.91 5.96 0.95 090 

27100 .... ............ A ........ Transfer of abdominal muscle ............ 11.21 NA NA 7.39 8.03 1.86 090 

27105 .... ............ A ........ Transfer of spinal muscle ................... 11.90 NA NA 7.35 8.25 1.73 090 

27110 .... ............ A ........ Transfer of iliopsoas muscle ............... 13.63 NA NA 8.27 8.69 2.19 090 


cprice-sewell on PROD1PC72 with RULES
66431 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

27111 .... ............ A ........ Transfer of iliopsoas muscle ............... 12.46 NA NA 8.06 8.60 1.95 090 

27120 .... ............ A ........ Reconstruction of hip socket .............. 19.10 NA NA 10.81 11.32 3.09 090 

27122 .... ............ A ........ Reconstruction of hip socket .............. 15.95 NA NA 9.43 10.23 2.62 090 

27125 .... ............ A ........ Partial hip replacement ....................... 16.46 NA NA 9.59 10.10 2.55 090 

27130 .... ............ A ........ Total hip arthroplasty .......................... 21.61 NA NA 11.76 12.53 3.51 090 

27132 .... ............ A ........ Total hip arthroplasty .......................... 25.49 NA NA 13.42 14.52 4.05 090 

27134 .... ............ A ........ Revise hip joint replacement .............. 30.13 NA NA 14.67 16.23 4.95 090 

27137 .... ............ A ........ Revise hip joint replacement .............. 22.55 NA NA 11.72 12.82 3.68 090 

27138 .... ............ A ........ Revise hip joint replacement .............. 23.55 NA NA 12.10 13.24 3.85 090 

27140 .... ............ A ........ Transplant femur ridge ........................ 12.66 NA NA 7.87 8.64 2.12 090 

27146 .... ............ A ........ Incision of hip bone ............................. 18.72 NA NA 10.68 11.40 2.97 090 

27147 .... ............ A ........ Revision of hip bone ........................... 21.87 NA NA 12.00 12.62 3.58 090 

27151 .... ............ A ........ Incision of hip bones ........................... 23.92 NA NA 12.87 10.41 3.92 090 

27156 .... ............ A ........ Revision of hip bones ......................... 26.03 NA NA 13.71 14.88 4.22 090 

27158 .... ............ A ........ Revision of pelvis ................................ 20.89 NA NA 11.51 11.23 3.17 090 

27161 .... ............ A ........ Incision of neck of femur .................... 17.74 NA NA 10.35 11.22 2.95 090 

27165 .... ............ A ........ Incision/fixation of femur ..................... 20.06 NA NA 11.56 12.23 3.11 090 

27170 .... ............ A ........ Repair/graft femur head/neck ............. 17.46 NA NA 9.75 10.52 2.82 090 

27175 .... ............ A ........ Treat slipped epiphysis ....................... 9.29 NA NA 5.16 5.91 1.46 090 

27176 .... ............ A ........ Treat slipped epiphysis ....................... 12.78 NA NA 8.17 8.59 2.23 090 

27177 .... ............ A ........ Treat slipped epiphysis ....................... 15.94 NA NA 9.63 10.26 2.62 090 

27178 .... ............ A ........ Treat slipped epiphysis ....................... 12.78 NA NA 7.97 8.19 2.09 090 

27179 .... ............ A ........ Revise head/neck of femur ................. 13.83 NA NA 8.56 9.27 2.26 090 

27181 .... ............ A ........ Treat slipped epiphysis ....................... 15.98 NA NA 9.73 9.96 1.57 090 

27185 .... ............ A ........ Revision of femur epiphysis ................ 9.67 NA NA 6.64 7.08 2.40 090 

27187 .... ............ A ........ Reinforce hip bones ............................ 14.09 NA NA 8.68 9.50 2.38 090 

27193 .... ............ A ........ Treat pelvic ring fracture ..................... 5.98 4.62 4.85 4.75 4.92 0.96 090 

27194 .... ............ A ........ Treat pelvic ring fracture ..................... 10.08 NA NA 6.60 7.12 1.65 090 

27200 .... ............ A ........ Treat tail bone fracture ....................... 1.87 2.07 2.15 2.22 2.19 0.28 090 

27202 .... ............ A ........ Treat tail bone fracture ....................... 7.25 NA NA 4.90 10.88 1.06 090 

27215 .... ............ A ........ Treat pelvic fracture(s) ........................ 10.45 NA NA 6.54 6.81 1.98 090 

27216 .... ............ A ........ Treat pelvic ring fracture ..................... 15.73 NA NA 9.13 9.36 2.64 090 

27217 .... ............ A ........ Treat pelvic ring fracture ..................... 14.65 NA NA 8.62 9.38 2.42 090 

27218 .... ............ A ........ Treat pelvic ring fracture ..................... 20.93 NA NA 11.32 11.35 3.49 090 

27220 .... ............ A ........ Treat hip socket fracture ..................... 6.72 5.24 5.48 5.14 5.39 1.07 090 

27222 .... ............ A ........ Treat hip socket fracture ..................... 13.97 NA NA 8.51 9.24 2.20 090 

27226 .... ............ A ........ Treat hip wall fracture ......................... 15.45 NA NA 8.92 8.36 2.49 090 

27227 .... ............ A ........ Treat hip fracture(s) ............................ 25.21 NA NA 13.37 14.38 4.06 090 

27228 .... ............ A ........ Treat hip fracture(s) ............................ 29.13 NA NA 14.83 16.22 4.67 090 

27230 .... ............ A ........ Treat thigh fracture ............................. 5.69 4.93 5.22 4.86 4.98 0.95 090 

27232 .... ............ A ........ Treat thigh fracture ............................. 11.66 NA NA 6.09 6.63 1.86 090 

27235 .... ............ A ........ Treat thigh fracture ............................. 12.88 NA NA 7.97 8.71 2.12 090 

27236 .... ............ A ........ Treat thigh fracture ............................. 17.43 NA NA 10.13 10.58 2.72 090 

27238 .... ............ A ........ Treat thigh fracture ............................. 5.64 NA NA 4.65 4.89 0.89 090 

27240 .... ............ A ........ Treat thigh fracture ............................. 13.66 NA NA 8.20 8.83 2.17 090 

27244 .... ............ A ........ Treat thigh fracture ............................. 17.08 NA NA 9.61 10.45 2.78 090 

27245 .... ............ A ........ Treat thigh fracture ............................. 21.09 NA NA 11.33 12.53 3.53 090 

27246 .... ............ A ........ Treat thigh fracture ............................. 4.75 3.91 4.18 3.94 4.18 0.81 090 

27248 .... ............ A ........ Treat thigh fracture ............................. 10.64 NA NA 6.37 7.29 1.82 090 

27250 .... ............ A ........ Treat hip dislocation ............................ 7.21 NA NA 4.29 4.45 0.62 090 

27252 .... ............ A ........ Treat hip dislocation ............................ 10.92 NA NA 6.48 6.95 1.66 090 

27253 .... ............ A ........ Treat hip dislocation ............................ 13.46 NA NA 8.16 8.97 2.25 090 

27254 .... ............ A ........ Treat hip dislocation ............................ 18.80 NA NA 10.53 11.27 3.18 090 

27256 .... ............ A ........ Treat hip dislocation ............................ 4.25 2.52 3.02 1.41 1.74 0.46 010 

27257 .... ............ A ........ Treat hip dislocation ............................ 5.35 NA NA 2.54 2.67 0.69 010 

27258 .... ............ A ........ Treat hip dislocation ............................ 16.04 NA NA 9.47 10.17 2.65 090 

27259 .... ............ A ........ Treat hip dislocation ............................ 23.03 NA NA 12.77 13.44 3.75 090 

27265 .... ............ A ........ Treat hip dislocation ............................ 5.12 NA NA 3.94 4.36 0.63 090 

27266 .... ............ A ........ Treat hip dislocation ............................ 7.67 NA NA 5.50 5.92 1.29 090 

27267 .... ............ A ........ Cltx thigh fx ......................................... 5.38 NA NA 4.39 4.39 0.89 090 

27268 .... ............ A ........ Cltx thigh fx w/mnpj ............................ 7.00 NA NA 5.02 5.02 1.16 090 

27269 .... ............ A ........ Optx thigh fx ........................................ 18.75 NA NA 9.88 9.88 2.93 090 

27275 .... ............ A ........ Manipulation of hip joint ...................... 2.29 NA NA 1.85 1.97 0.39 010 

27280 .... ............ A ........ Fusion of sacroiliac joint ..................... 14.49 NA NA 8.87 9.56 2.54 090 

27282 .... ............ A ........ Fusion of pubic bones ........................ 11.71 NA NA 7.77 7.88 1.87 090 

27284 .... ............ A ........ Fusion of hip joint ............................... 24.91 NA NA 12.00 13.37 3.93 090 

27286 .... ............ A ........ Fusion of hip joint ............................... 24.97 NA NA 12.60 14.19 3.13 090 

27290 .... ............ A ........ Amputation of leg at hip ...................... 24.38 NA NA 12.10 13.07 3.44 090 

27295 .... ............ A ........ Amputation of leg at hip ...................... 19.54 NA NA 9.57 10.44 2.96 090 

27299 .... ............ C ........ Pelvis/hip joint surgery ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

27301 .... ............ A ........ Drain thigh/knee lesion ....................... 6.67 8.19 9.13 4.64 4.89 1.04 090 

27303 .... ............ A ........ Drainage of bone lesion ...................... 8.52 NA NA 5.99 6.48 1.43 090 


cprice-sewell on PROD1PC72 with RULES
66432 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

27305 .... ............ A ........ Incise thigh tendon & fascia ............... 6.09 NA NA 4.68 4.93 1.01 090 

27306 .... ............ A ........ Incision of thigh tendon ....................... 4.66 NA NA 4.07 4.39 0.85 090 

27307 .... ............ A ........ Incision of thigh tendons ..................... 5.97 NA NA 4.74 5.06 1.04 090 

27310 .... ............ A ........ Exploration of knee joint ..................... 9.88 NA NA 6.77 7.17 1.61 090 

27323 .... ............ A ........ Biopsy, thigh soft tissues .................... 2.30 4.19 3.85 1.93 1.90 0.24 010 

27324 .... ............ A ........ Biopsy, thigh soft tissues .................... 4.95 NA NA 3.82 4.00 0.75 090 

27325 .... ............ A ........ Neurectomy, hamstring ....................... 7.09 NA NA 4.99 4.96 1.09 090 

27326 .... ............ A ........ Neurectomy, popliteal ......................... 6.36 NA NA 5.12 5.17 1.06 090 

27327 .... ............ A ........ Removal of thigh lesion ...................... 4.52 6.03 6.01 3.57 3.65 0.64 090 

27328 .... ............ A ........ Removal of thigh lesion ...................... 5.62 NA NA 4.06 4.21 0.84 090 

27329 .... ............ A ........ Remove tumor, thigh/knee .................. 15.68 NA NA 8.46 8.74 2.15 090 

27330 .... ............ A ........ Biopsy, knee joint lining ...................... 5.02 NA NA 4.26 4.41 0.86 090 

27331 .... ............ A ........ Explore/treat knee joint ....................... 5.93 NA NA 4.79 5.16 1.02 090 

27332 .... ............ A ........ Removal of knee cartilage .................. 8.34 NA NA 6.12 6.62 1.43 090 

27333 .... ............ A ........ Removal of knee cartilage .................. 7.43 NA NA 5.68 6.17 1.26 090 

27334 .... ............ A ........ Remove knee joint lining .................... 9.07 NA NA 6.43 6.92 1.51 090 

27335 .... ............ A ........ Remove knee joint lining .................... 10.43 NA NA 7.01 7.61 1.75 090 

27340 .... ............ A ........ Removal of kneecap bursa ................. 4.23 NA NA 4.03 4.29 0.72 090 

27345 .... ............ A ........ Removal of knee cyst ......................... 5.98 NA NA 4.88 5.25 1.00 090 

27347 .... ............ A ........ Remove knee cyst .............................. 6.58 NA NA 5.25 5.34 0.98 090 

27350 .... ............ A ........ Removal of kneecap ........................... 8.54 NA NA 6.24 6.74 1.41 090 

27355 .... ............ A ........ Remove femur lesion .......................... 7.89 NA NA 5.80 6.29 1.32 090 

27356 .... ............ A ........ Remove femur lesion/graft .................. 9.97 NA NA 6.83 7.34 1.65 090 

27357 .... ............ A ........ Remove femur lesion/graft .................. 11.02 NA NA 7.47 8.08 1.96 090 

27358 .... ............ A ........ Remove femur lesion/fixation ............. 4.73 NA NA 1.81 2.16 0.82 ZZZ 

27360 .... ............ A ........ Partial removal, leg bone(s) ................ 11.34 NA NA 8.04 8.79 1.84 090 

27365 .... ............ A ........ Extensive leg surgery ......................... 17.93 NA NA 10.40 11.04 2.80 090 

27370 .... ............ A ........ Injection for knee x-ray ....................... 0.96 2.99 3.36 0.36 0.34 0.08 000 

27372 .... ............ A ........ Removal of foreign body ..................... 5.12 8.30 9.17 4.04 4.36 0.84 090 

27380 .... ............ A ........ Repair of kneecap tendon .................. 7.34 NA NA 6.05 6.66 1.24 090 

27381 .... ............ A ........ Repair/graft kneecap tendon .............. 10.64 NA NA 7.56 8.32 1.80 090 

27385 .... ............ A ........ Repair of thigh muscle ........................ 8.00 NA NA 6.30 6.96 1.36 090 

27386 .... ............ A ........ Repair/graft of thigh muscle ................ 10.99 NA NA 7.92 8.71 1.86 090 

27390 .... ............ A ........ Incision of thigh tendon ....................... 5.44 NA NA 4.46 4.78 0.92 090 

27391 .... ............ A ........ Incision of thigh tendons ..................... 7.38 NA NA 5.54 6.05 1.23 090 

27392 .... ............ A ........ Incision of thigh tendons ..................... 9.51 NA NA 6.66 7.12 1.57 090 

27393 .... ............ A ........ Lengthening of thigh tendon ............... 6.50 NA NA 4.95 5.39 1.10 090 

27394 .... ............ A ........ Lengthening of thigh tendons ............. 8.68 NA NA 6.14 6.68 1.47 090 

27395 .... ............ A ........ Lengthening of thigh tendons ............. 12.10 NA NA 7.92 8.62 2.05 090 

27396 .... ............ A ........ Transplant of thigh tendon .................. 8.04 NA NA 5.82 6.41 1.34 090 

27397 .... ............ A ........ Transplants of thigh tendons .............. 12.46 NA NA 8.34 8.69 1.83 090 

27400 .... ............ A ........ Revise thigh muscles/tendons ............ 9.21 NA NA 6.51 6.88 1.31 090 

27403 .... ............ A ........ Repair of knee cartilage ...................... 8.51 NA NA 6.02 6.60 1.44 090 

27405 .... ............ A ........ Repair of knee ligament ...................... 8.96 NA NA 6.38 6.93 1.51 090 

27407 .... ............ A ........ Repair of knee ligament ...................... 10.71 NA NA 6.82 7.57 1.79 090 

27409 .... ............ A ........ Repair of knee ligaments .................... 13.57 NA NA 8.25 9.10 2.25 090 

27412 .... ............ A ........ Autochondrocyte implant knee ........... 24.53 NA NA 13.64 14.22 4.36 090 

27415 .... ............ A ........ Osteochondral knee allograft .............. 19.79 NA NA 11.77 12.16 4.36 090 

27416 .... ............ A ........ Osteochondral knee autograft ............ 14.00 NA NA 8.38 8.38 2.32 090 

27418 .... ............ A ........ Repair degenerated kneecap ............. 11.46 NA NA 7.57 8.23 1.89 090 

27420 .... ............ A ........ Revision of unstable kneecap ............. 10.14 NA NA 6.90 7.50 1.72 090 

27422 .... ............ A ........ Revision of unstable kneecap ............. 10.09 NA NA 6.87 7.49 1.71 090 

27424 .... ............ A ........ Revision/removal of kneecap .............. 10.12 NA NA 6.89 7.49 1.71 090 

27425 .... ............ A ........ Lat retinacular release open ............... 5.28 NA NA 4.70 5.11 0.90 090 

27427 .... ............ A ........ Reconstruction, knee .......................... 9.67 NA NA 6.69 7.24 1.63 090 

27428 .... ............ A ........ Reconstruction, knee .......................... 15.33 NA NA 10.03 10.63 2.43 090 

27429 .... ............ A ........ Reconstruction, knee .......................... 17.24 NA NA 11.25 11.83 2.71 090 

27430 .... ............ A ........ Revision of thigh muscles ................... 10.04 NA NA 6.84 7.41 1.70 090 

27435 .... ............ A ........ Incision of knee joint ........................... 10.68 NA NA 7.58 8.03 1.70 090 

27437 .... ............ A ........ Revise kneecap .................................. 8.82 NA NA 6.18 6.71 1.49 090 

27438 .... ............ A ........ Revise kneecap with implant .............. 11.77 NA NA 7.49 8.01 1.96 090 

27440 .... ............ A ........ Revision of knee joint ......................... 10.97 NA NA 6.99 6.49 1.82 090 

27441 .... ............ A ........ Revision of knee joint ......................... 11.42 NA NA 7.35 7.03 1.89 090 

27442 .... ............ A ........ Revision of knee joint ......................... 12.25 NA NA 7.64 8.27 2.10 090 

27443 .... ............ A ........ Revision of knee joint ......................... 11.29 NA NA 7.34 8.03 1.91 090 

27445 .... ............ A ........ Revision of knee joint ......................... 18.52 NA NA 10.40 11.38 3.09 090 

27446 .... ............ A ........ Revision of knee joint ......................... 16.26 NA NA 9.28 10.27 2.81 090 

27447 .... ............ A ........ Total knee arthroplasty ....................... 23.04 NA NA 12.56 13.58 3.80 090 

27448 .... ............ A ........ Incision of thigh ................................... 11.48 NA NA 7.31 7.95 1.95 090 

27450 .... ............ A ........ Incision of thigh ................................... 14.47 NA NA 8.83 9.70 2.43 090 

27454 .... ............ A ........ Realignment of thigh bone .................. 18.97 NA NA 10.72 11.61 3.13 090 

27455 .... ............ A ........ Realignment of knee ........................... 13.24 NA NA 8.30 9.09 2.25 090 


cprice-sewell on PROD1PC72 with RULES
66433 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

27457 .... ............ A ........ Realignment of knee ........................... 13.92 NA NA 8.22 9.07 2.35 090 

27465 .... ............ A ........ Shortening of thigh bone .................... 18.44 NA NA 10.28 10.25 2.48 090 

27466 .... ............ A ........ Lengthening of thigh bone .................. 17.13 NA NA 10.05 10.94 2.78 090 

27468 .... ............ A ........ Shorten/lengthen thighs ...................... 19.82 NA NA 11.16 11.75 3.31 090 

27470 .... ............ A ........ Repair of thigh .................................... 16.97 NA NA 10.15 10.96 2.80 090 

27472 .... ............ A ........ Repair/graft of thigh ............................ 18.57 NA NA 10.63 11.65 3.08 090 

27475 .... ............ A ........ Surgery to stop leg growth ................. 8.82 NA NA 6.19 6.70 1.36 090 

27477 .... ............ A ........ Surgery to stop leg growth ................. 10.03 NA NA 6.59 7.16 1.74 090 

27479 .... ............ A ........ Surgery to stop leg growth ................. 13.04 NA NA 8.84 9.24 2.79 090 

27485 .... ............ A ........ Surgery to stop leg growth ................. 9.02 NA NA 6.21 6.80 1.53 090 

27486 .... ............ A ........ Revise/replace knee joint .................... 20.92 NA NA 11.62 12.55 3.37 090 

27487 .... ............ A ........ Revise/replace knee joint .................... 26.91 NA NA 13.97 15.25 4.40 090 

27488 .... ............ A ........ Removal of knee prosthesis ............... 17.40 NA NA 10.24 10.96 2.75 090 

27495 .... ............ A ........ Reinforce thigh .................................... 16.40 NA NA 9.59 10.49 2.72 090 

27496 .... ............ A ........ Decompression of thigh/knee ............. 6.66 NA NA 4.97 5.29 0.99 090 

27497 .... ............ A ........ Decompression of thigh/knee ............. 7.70 NA NA 4.98 5.21 1.15 090 

27498 .... ............ A ........ Decompression of thigh/knee ............. 8.54 NA NA 5.18 5.57 1.24 090 

27499 .... ............ A ........ Decompression of thigh/knee ............. 9.31 NA NA 5.98 6.40 1.47 090 

27500 .... ............ A ........ Treatment of thigh fracture ................. 6.21 5.36 5.74 4.58 4.78 1.02 090 

27501 .... ............ A ........ Treatment of thigh fracture ................. 6.34 5.00 5.40 4.91 5.15 1.03 090 

27502 .... ............ A ........ Treatment of thigh fracture ................. 11.24 NA NA 6.85 7.48 1.79 090 

27503 .... ............ A ........ Treatment of thigh fracture ................. 11.13 NA NA 7.21 7.74 1.85 090 

27506 .... ............ A ........ Treatment of thigh fracture ................. 19.42 NA NA 11.35 12.07 3.04 090 

27507 .... ............ A ........ Treatment of thigh fracture ................. 14.39 NA NA 8.12 8.98 2.43 090 

27508 .... ............ A ........ Treatment of thigh fracture ................. 6.08 5.68 6.07 5.05 5.26 0.97 090 

27509 .... ............ A ........ Treatment of thigh fracture ................. 8.02 NA NA 6.53 7.24 1.34 090 

27510 .... ............ A ........ Treatment of thigh fracture ................. 9.68 NA NA 6.26 6.79 1.53 090 

27511 .... ............ A ........ Treatment of thigh fracture ................. 14.97 NA NA 8.10 9.65 2.38 090 

27513 .... ............ A ........ Treatment of thigh fracture ................. 19.11 NA NA 9.74 11.81 3.13 090 

27514 .... ............ A ........ Treatment of thigh fracture ................. 14.46 NA NA 7.88 10.61 3.01 090 

27516 .... ............ A ........ Treat thigh fx growth plate .................. 5.45 5.71 6.03 5.07 5.29 0.81 090 

27517 .... ............ A ........ Treat thigh fx growth plate .................. 8.98 NA NA 6.41 6.93 1.22 090 

27519 .... ............ A ........ Treat thigh fx growth plate .................. 13.11 NA NA 7.38 9.48 2.56 090 

27520 .... ............ A ........ Treat kneecap fracture ........................ 2.93 4.10 4.31 3.52 3.48 0.47 090 

27524 .... ............ A ........ Treat kneecap fracture ........................ 10.25 NA NA 6.93 7.58 1.75 090 

27530 .... ............ A ........ Treat knee fracture ............................. 3.97 4.82 5.06 4.26 4.34 0.65 090 

27532 .... ............ A ........ Treat knee fracture ............................. 7.43 6.39 6.87 5.62 6.03 1.26 090 

27535 .... ............ A ........ Treat knee fracture ............................. 13.27 NA NA 7.44 8.77 2.01 090 

27536 .... ............ A ........ Treat knee fracture ............................. 17.19 NA NA 10.19 10.89 2.74 090 

27538 .... ............ A ........ Treat knee fracture(s) ......................... 4.95 5.51 5.82 4.89 5.04 0.84 090 

27540 .... ............ A ........ Treat knee fracture ............................. 11.16 NA NA 7.38 8.44 2.28 090 

27550 .... ............ A ........ Treat knee dislocation ......................... 5.84 5.21 5.61 4.50 4.71 0.76 090 

27552 .... ............ A ........ Treat knee dislocation ......................... 8.04 NA NA 6.08 6.51 1.36 090 

27556 .... ............ A ........ Treat knee dislocation ......................... 12.86 NA NA 7.25 9.45 2.51 090 

27557 .... ............ A ........ Treat knee dislocation ......................... 15.76 NA NA 8.44 10.78 2.98 090 

27558 .... ............ A ........ Treat knee dislocation ......................... 18.25 NA NA 9.28 11.16 3.09 090 

27560 .... ............ A ........ Treat kneecap dislocation ................... 3.88 4.24 4.54 3.71 3.45 0.40 090 

27562 .... ............ A ........ Treat kneecap dislocation ................... 5.86 NA NA 4.61 4.69 0.94 090 

27566 .... ............ A ........ Treat kneecap dislocation ................... 12.59 NA NA 7.88 8.60 2.13 090 

27570 .... ............ A ........ Fixation of knee joint ........................... 1.76 NA NA 1.61 1.69 0.30 010 

27580 .... ............ A ........ Fusion of knee .................................... 20.90 NA NA 12.17 13.48 3.38 090 

27590 .... ............ A ........ Amputate leg at thigh .......................... 13.35 NA NA 6.01 6.34 1.75 090 

27591 .... ............ A ........ Amputate leg at thigh .......................... 13.82 NA NA 7.34 7.99 2.03 090 

27592 .... ............ A ........ Amputate leg at thigh .......................... 10.86 NA NA 5.45 5.81 1.45 090 

27594 .... ............ A ........ Amputation follow-up surgery ............. 7.17 NA NA 4.72 4.94 1.02 090 

27596 .... ............ A ........ Amputation follow-up surgery ............. 11.15 NA NA 5.97 6.39 1.57 090 

27598 .... ............ A ........ Amputate lower leg at knee ................ 11.08 NA NA 6.19 6.60 1.65 090 

27599 .... ............ C ........ Leg surgery procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

27600 .... ............ A ........ Decompression of lower leg ............... 5.94 NA NA 3.79 4.16 0.86 090 

27601 .... ............ A ........ Decompression of lower leg ............... 5.94 NA NA 4.17 4.51 0.80 090 

27602 .... ............ A ........ Decompression of lower leg ............... 7.71 NA NA 4.29 4.71 1.10 090 

27603 .... ............ A ........ Drain lower leg lesion ......................... 5.12 7.04 7.26 3.90 4.03 0.74 090 

27604 .... ............ A ........ Drain lower leg bursa .......................... 4.51 6.48 6.28 3.42 3.69 0.69 090 

27605 .... ............ A ........ Incision of achilles tendon .................. 2.89 5.15 6.41 1.74 2.03 0.41 010 

27606 .... ............ A ........ Incision of achilles tendon .................. 4.15 NA NA 2.62 2.99 0.69 010 

27607 .... ............ A ........ Treat lower leg bone lesion ................ 8.51 NA NA 5.70 5.93 1.31 090 

27610 .... ............ A ........ Explore/treat ankle joint ...................... 9.01 NA NA 6.10 6.55 1.40 090 

27612 .... ............ A ........ Exploration of ankle joint .................... 8.01 NA NA 5.17 5.63 1.13 090 

27613 .... ............ A ........ Biopsy lower leg soft tissue ................ 2.19 3.91 3.57 1.77 1.79 0.20 010 

27614 .... ............ A ........ Biopsy lower leg soft tissue ................ 5.71 7.75 7.44 3.93 4.18 0.78 090 

27615 .... ............ A ........ Remove tumor, lower leg .................... 12.93 NA NA 7.27 8.33 1.84 090 

27618 .... ............ A ........ Remove lower leg lesion .................... 5.14 6.43 6.22 3.80 3.89 0.72 090 


cprice-sewell on PROD1PC72 with RULES
66434 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

27619 .... ............ A ........ Remove lower leg lesion .................... 8.47 9.99 9.75 5.27 5.61 1.25 090 

27620 .... ............ A ........ Explore/treat ankle joint ...................... 6.04 NA NA 4.56 5.01 0.97 090 

27625 .... ............ A ........ Remove ankle joint lining .................... 8.37 NA NA 5.49 5.98 1.28 090 

27626 .... ............ A ........ Remove ankle joint lining .................... 8.98 NA NA 5.77 6.34 1.48 090 

27630 .... ............ A ........ Removal of tendon lesion ................... 4.85 7.98 7.76 3.80 4.09 0.74 090 

27635 .... ............ A ........ Remove lower leg bone lesion ........... 7.91 NA NA 5.63 6.18 1.31 090 

27637 .... ............ A ........ Remove/graft leg bone lesion ............. 10.17 NA NA 6.90 7.59 1.66 090 

27638 .... ............ A ........ Remove/graft leg bone lesion ............. 10.87 NA NA 7.04 7.66 1.85 090 

27640 .... ............ A ........ Partial removal of tibia ........................ 12.10 NA NA 7.46 8.88 1.89 090 

27641 .... ............ A ........ Partial removal of fibula ...................... 9.73 NA NA 6.09 7.21 1.46 090 

27645 .... ............ A ........ Extensive lower leg surgery ................ 14.78 NA NA 8.73 10.38 2.42 090 

27646 .... ............ A ........ Extensive lower leg surgery ................ 13.21 NA NA 7.64 9.33 2.06 090 

27647 .... ............ A ........ Extensive ankle/heel surgery .............. 12.85 NA NA 6.54 7.07 1.76 090 

27648 .... ............ A ........ Injection for ankle x-ray ...................... 0.96 2.88 3.20 0.34 0.34 0.08 000 

27650 .... ............ A ........ Repair achilles tendon ........................ 9.94 NA NA 6.15 6.83 1.59 090 

27652 .... ............ A ........ Repair/graft achilles tendon ................ 10.64 NA NA 6.44 7.23 1.72 090 

27654 .... ............ A ........ Repair of achilles tendon .................... 10.32 NA NA 5.98 6.56 1.58 090 

27656 .... ............ A ........ Repair leg fascia defect ...................... 4.62 7.95 8.24 3.58 3.67 0.69 090 

27658 .... ............ A ........ Repair of leg tendon, each ................. 5.03 NA NA 3.88 4.22 0.79 090 

27659 .... ............ A ........ Repair of leg tendon, each ................. 6.99 NA NA 4.67 5.16 1.09 090 

27664 .... ............ A ........ Repair of leg tendon, each ................. 4.64 NA NA 3.88 4.21 0.76 090 

27665 .... ............ A ........ Repair of leg tendon, each ................. 5.46 NA NA 4.32 4.64 0.89 090 

27675 .... ............ A ........ Repair lower leg tendons .................... 7.24 NA NA 4.67 5.20 1.11 090 

27676 .... ............ A ........ Repair lower leg tendons .................... 8.61 NA NA 5.72 6.23 1.37 090 

27680 .... ............ A ........ Release of lower leg tendon ............... 5.79 NA NA 4.16 4.63 0.93 090 

27681 .... ............ A ........ Release of lower leg tendons ............. 6.94 NA NA 5.09 5.50 1.15 090 

27685 .... ............ A ........ Revision of lower leg tendon .............. 6.57 8.77 8.03 4.57 5.02 0.97 090 

27686 .... ............ A ........ Revise lower leg tendons ................... 7.64 NA NA 5.28 5.89 1.24 090 

27687 .... ............ A ........ Revision of calf tendon ....................... 6.30 NA NA 4.47 4.89 1.00 090 

27690 .... ............ A ........ Revise lower leg tendon ..................... 8.96 NA NA 5.37 5.86 1.33 090 

27691 .... ............ A ........ Revise lower leg tendon ..................... 10.28 NA NA 6.65 7.20 1.64 090 

27692 .... ............ A ........ Revise additional leg tendon .............. 1.87 NA NA 0.71 0.82 0.32 ZZZ 

27695 .... ............ A ........ Repair of ankle ligament ..................... 6.58 NA NA 4.87 5.37 1.05 090 

27696 .... ............ A ........ Repair of ankle ligaments ................... 8.46 NA NA 5.25 5.84 1.28 090 

27698 .... ............ A ........ Repair of ankle ligament ..................... 9.49 NA NA 5.87 6.40 1.47 090 

27700 .... ............ A ........ Revision of ankle joint ......................... 9.54 NA NA 5.20 5.44 1.30 090 

27702 .... ............ A ........ Reconstruct ankle joint ....................... 14.28 NA NA 8.64 9.55 2.38 090 

27703 .... ............ A ........ Reconstruction, ankle joint .................. 16.79 NA NA 9.77 10.50 2.77 090 

27704 .... ............ A ........ Removal of ankle implant ................... 7.69 NA NA 5.61 5.60 1.27 090 

27705 .... ............ A ........ Incision of tibia .................................... 10.74 NA NA 6.95 7.56 1.81 090 

27707 .... ............ A ........ Incision of fibula .................................. 4.67 NA NA 4.48 4.71 0.76 090 

27709 .... ............ A ........ Incision of tibia & fibula ....................... 17.32 NA NA 9.95 9.04 1.74 090 

27712 .... ............ A ........ Realignment of lower leg .................... 15.67 NA NA 9.44 10.09 2.48 090 

27715 .... ............ A ........ Revision of lower leg .......................... 15.36 NA NA 9.03 9.89 2.50 090 

27720 .... ............ A ........ Repair of tibia ...................................... 12.22 NA NA 7.92 8.66 2.05 090 

27722 .... ............ A ........ Repair/graft of tibia ............................. 12.31 NA NA 7.88 8.50 2.06 090 

27724 .... ............ A ........ Repair/graft of tibia ............................. 19.18 NA NA 10.28 11.32 3.17 090 

27725 .... ............ A ........ Repair of lower leg .............................. 17.15 NA NA 10.58 11.24 2.72 090 

27726 .... ............ A ........ Repair fibula nonunion ........................ 14.20 NA NA 7.67 7.67 1.43 090 

27727 .... ............ A ........ Repair of lower leg .............................. 14.69 NA NA 9.06 9.70 2.44 090 

27730 .... ............ A ........ Repair of tibia epiphysis ..................... 7.59 NA NA 5.30 5.86 1.73 090 

27732 .... ............ A ........ Repair of fibula epiphysis ................... 5.37 NA NA 4.16 4.54 0.77 090 

27734 .... ............ A ........ Repair lower leg epiphyses ................ 8.72 NA NA 6.16 6.22 1.35 090 

27740 .... ............ A ........ Repair of leg epiphyses ...................... 9.49 NA NA 6.60 7.29 1.62 090 

27742 .... ............ A ........ Repair of leg epiphyses ...................... 10.49 NA NA 4.60 5.08 1.80 090 

27745 .... ............ A ........ Reinforce tibia ..................................... 10.37 NA NA 6.99 7.58 1.76 090 

27750 .... ............ A ........ Treatment of tibia fracture .................. 3.26 4.32 4.54 3.73 3.79 0.55 090 

27752 .... ............ A ........ Treatment of tibia fracture .................. 6.15 5.94 6.29 5.10 5.39 1.01 090 

27756 .... ............ A ........ Treatment of tibia fracture .................. 7.33 NA NA 5.75 6.10 1.17 090 

27758 .... ............ A ........ Treatment of tibia fracture .................. 12.40 NA NA 8.02 8.60 2.04 090 

27759 .... ............ A ........ Treatment of tibia fracture .................. 14.31 NA NA 8.66 9.48 2.39 090 

27760 .... ............ A ........ Cltx medial ankle fx ............................ 3.09 4.28 4.47 3.67 3.63 0.48 090 

27762 .... ............ A ........ Cltx med ankle fx w/mnpj ................... 5.33 5.47 5.90 4.65 4.96 0.85 090 

27766 .... ............ A ........ Optx medial ankle fx ........................... 7.73 NA NA 6.12 6.67 1.44 090 

27767 .... ............ A ........ Cltx post ankle fx ................................ 2.50 3.62 3.62 3.65 3.65 0.30 090 

27768 .... ............ A ........ Cltx post ankle fx w/mnpj .................... 5.00 NA NA 4.29 4.29 0.79 090 

27769 .... ............ A ........ Optx post ankle fx ............................... 10.00 NA NA 6.07 6.07 1.45 090 

27780 .... ............ A ........ Treatment of fibula fracture ................ 2.72 3.86 4.02 3.31 3.26 0.41 090 

27781 .... ............ A ........ Treatment of fibula fracture ................ 4.47 4.87 5.18 4.26 4.45 0.73 090 

27784 .... ............ A ........ Treatment of fibula fracture ................ 9.51 NA NA 6.84 6.65 1.23 090 

27786 .... ............ A ........ Treatment of ankle fracture ................ 2.91 4.05 4.25 3.43 3.38 0.46 090 

27788 .... ............ A ........ Treatment of ankle fracture ................ 4.52 4.96 5.30 4.23 4.44 0.74 090 


cprice-sewell on PROD1PC72 with RULES
66435 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

27792 .... ............ A ........ Treatment of ankle fracture ................ 9.55 NA NA 6.80 6.88 1.32 090 

27808 .... ............ A ........ Treatment of ankle fracture ................ 2.91 4.39 4.59 3.70 3.70 0.46 090 

27810 .... ............ A ........ Treatment of ankle fracture ................ 5.20 5.40 5.82 4.55 4.85 0.82 090 

27814 .... ............ A ........ Treatment of ankle fracture ................ 10.46 NA NA 7.23 7.89 1.86 090 

27816 .... ............ A ........ Treatment of ankle fracture ................ 2.96 3.99 4.18 3.33 3.37 0.43 090 

27818 .... ............ A ........ Treatment of ankle fracture ................ 5.57 5.41 5.89 4.44 4.80 0.82 090 

27822 .... ............ A ........ Treatment of ankle fracture ................ 11.03 NA NA 8.20 9.42 1.92 090 

27823 .... ............ A ........ Treatment of ankle fracture ................ 12.98 NA NA 8.93 10.19 2.26 090 

27824 .... ............ A ........ Treat lower leg fracture ....................... 3.20 3.65 3.85 3.47 3.51 0.45 090 

27825 .... ............ A ........ Treat lower leg fracture ....................... 6.60 5.78 6.19 4.75 5.07 1.02 090 

27826 .... ............ A ........ Treat lower leg fracture ....................... 10.92 NA NA 8.20 8.51 1.47 090 

27827 .... ............ A ........ Treat lower leg fracture ....................... 14.56 NA NA 10.17 11.47 2.44 090 

27828 .... ............ A ........ Treat lower leg fracture ....................... 18.20 NA NA 11.56 12.74 2.82 090 

27829 .... ............ A ........ Treat lower leg joint ............................ 8.64 NA NA 6.97 6.87 0.95 090 

27830 .... ............ A ........ Treat lower leg dislocation .................. 3.85 4.09 4.24 3.56 3.70 0.54 090 

27831 .... ............ A ........ Treat lower leg dislocation .................. 4.62 NA NA 4.05 4.25 0.73 090 

27832 .... ............ A ........ Treat lower leg dislocation .................. 10.01 NA NA 6.83 6.50 1.03 090 

27840 .... ............ A ........ Treat ankle dislocation ........................ 4.65 NA NA 3.65 3.70 0.46 090 

27842 .... ............ A ........ Treat ankle dislocation ........................ 6.34 NA NA 4.85 4.98 1.00 090 

27846 .... ............ A ........ Treat ankle dislocation ........................ 10.16 NA NA 6.76 7.34 1.71 090 

27848 .... ............ A ........ Treat ankle dislocation ........................ 11.56 NA NA 7.31 8.51 1.95 090 

27860 .... ............ A ........ Fixation of ankle joint .......................... 2.36 NA NA 1.68 1.83 0.39 010 

27870 .... ............ A ........ Fusion of ankle joint, open ................. 15.21 NA NA 9.07 9.79 2.37 090 

27871 .... ............ A ........ Fusion of tibiofibular joint .................... 9.42 NA NA 6.53 7.05 1.59 090 

27880 .... ............ A ........ Amputation of lower leg ...................... 15.24 NA NA 6.64 6.88 1.76 090 

27881 .... ............ A ........ Amputation of lower leg ...................... 13.32 NA NA 7.37 8.11 1.99 090 

27882 .... ............ A ........ Amputation of lower leg ...................... 9.67 NA NA 4.90 5.69 1.29 090 

27884 .... ............ A ........ Amputation follow-up surgery ............. 8.64 NA NA 5.10 5.43 1.22 090 

27886 .... ............ A ........ Amputation follow-up surgery ............. 9.88 NA NA 5.65 6.08 1.40 090 

27888 .... ............ A ........ Amputation of foot at ankle ................. 10.23 NA NA 6.00 6.75 1.51 090 

27889 .... ............ A ........ Amputation of foot at ankle ................. 10.72 NA NA 5.43 5.95 1.46 090 

27892 .... ............ A ........ Decompression of leg ......................... 7.82 NA NA 5.09 5.34 1.10 090 

27893 .... ............ A ........ Decompression of leg ......................... 7.78 NA NA 5.12 5.29 1.10 090 

27894 .... ............ A ........ Decompression of leg ......................... 12.42 NA NA 7.33 7.55 1.65 090 

27899 .... ............ C ........ Leg/ankle surgery procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

28001 .... ............ A ........ Drainage of bursa of foot .................... 2.75 4.00 3.49 1.61 1.78 0.33 010 

28002 .... ............ A ........ Treatment of foot infection .................. 5.78 6.67 5.83 3.57 3.67 0.61 010 

28003 .... ............ A ........ Treatment of foot infection .................. 8.95 7.77 7.00 4.55 4.89 1.12 090 

28005 .... ............ A ........ Treat foot bone lesion ......................... 9.30 NA NA 5.52 5.78 1.16 090 

28008 .... ............ A ........ Incision of foot fascia .......................... 4.50 6.17 5.36 3.00 3.10 0.57 090 

28010 .... ............ A ........ Incision of toe tendon ......................... 2.89 2.86 2.62 2.35 2.36 0.36 090 

28011 .... ............ A ........ Incision of toe tendons ........................ 4.19 3.79 3.55 3.03 3.16 0.59 090 

28020 .... ............ A ........ Exploration of foot joint ....................... 5.06 7.36 6.68 3.58 3.85 0.72 090 

28022 .... ............ A ........ Exploration of foot joint ....................... 4.72 6.92 6.06 3.33 3.59 0.62 090 

28024 .... ............ A ........ Exploration of toe joint ........................ 4.43 6.55 5.88 3.11 3.52 0.58 090 

28035 .... ............ A ........ Decompression of tibia nerve ............. 5.14 7.27 6.56 3.54 3.81 0.70 090 

28043 .... ............ A ........ Excision of foot lesion ......................... 3.58 4.78 4.29 2.73 2.95 0.46 090 

28045 .... ............ A ........ Excision of foot lesion ......................... 4.77 7.02 6.20 3.24 3.42 0.63 090 

28046 .... ............ A ........ Resection of tumor, foot ..................... 10.55 10.36 9.56 5.76 6.11 1.36 090 

28050 .... ............ A ........ Biopsy of foot joint lining ..................... 4.30 6.94 5.91 3.29 3.44 0.60 090 

28052 .... ............ A ........ Biopsy of foot joint lining ..................... 3.98 6.30 5.60 2.87 3.15 0.53 090 

28054 .... ............ A ........ Biopsy of toe joint lining ...................... 3.49 6.25 5.48 2.79 3.01 0.46 090 

28055 .... ............ A ........ Neurectomy, foot ................................. 6.20 NA NA 3.44 3.54 0.74 090 

28060 .... ............ A ........ Partial removal, foot fascia ................. 5.29 7.07 6.27 3.54 3.70 0.70 090 

28062 .... ............ A ........ Removal of foot fascia ........................ 6.58 7.82 7.17 3.82 3.91 0.83 090 

28070 .... ............ A ........ Removal of foot joint lining ................. 5.15 7.36 6.29 3.54 3.67 0.73 090 

28072 .... ............ A ........ Removal of foot joint lining ................. 4.63 7.56 6.54 3.60 3.95 0.68 090 

28080 .... ............ A ........ Removal of foot lesion ........................ 4.65 7.66 6.38 4.19 3.93 0.47 090 

28086 .... ............ A ........ Excise foot tendon sheath .................. 4.83 7.86 7.92 3.81 4.24 0.76 090 

28088 .... ............ A ........ Excise foot tendon sheath .................. 3.90 7.00 6.37 3.19 3.54 0.61 090 

28090 .... ............ A ........ Removal of foot lesion ........................ 4.46 6.77 5.95 3.18 3.31 0.59 090 

28092 .... ............ A ........ Removal of toe lesions ....................... 3.69 6.46 5.84 2.98 3.25 0.49 090 

28100 .... ............ A ........ Removal of ankle/heel lesion .............. 5.72 8.09 8.02 3.99 4.34 0.82 090 

28102 .... ............ A ........ Remove/graft foot lesion ..................... 7.80 NA NA 4.84 5.39 1.14 090 

28103 .... ............ A ........ Remove/graft foot lesion ..................... 6.56 NA NA 4.02 4.31 0.91 090 

28104 .... ............ A ........ Removal of foot lesion ........................ 5.17 7.23 6.35 3.46 3.69 0.70 090 

28106 .... ............ A ........ Remove/graft foot lesion ..................... 7.23 NA NA 4.22 4.32 0.97 090 

28107 .... ............ A ........ Remove/graft foot lesion ..................... 5.62 7.69 7.11 3.66 3.93 0.74 090 

28108 .... ............ A ........ Removal of toe lesions ....................... 4.21 6.35 5.46 2.98 3.12 0.53 090 

28110 .... ............ A ........ Part removal of metatarsal ................. 4.13 6.92 6.07 3.06 3.14 0.54 090 

28111 .... ............ A ........ Part removal of metatarsal ................. 5.06 7.09 6.68 3.20 3.42 0.67 090 

28112 .... ............ A ........ Part removal of metatarsal ................. 4.54 7.18 6.49 3.24 3.40 0.61 090 


cprice-sewell on PROD1PC72 with RULES
66436 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

28113 .... ............ A ........ Part removal of metatarsal ................. 5.88 8.36 7.20 4.61 4.46 0.63 090 

28114 .... ............ A ........ Removal of metatarsal heads ............. 11.61 13.38 12.49 8.29 8.33 1.42 090 

28116 .... ............ A ........ Revision of foot ................................... 8.94 9.44 8.11 5.34 5.25 1.03 090 

28118 .... ............ A ........ Removal of heel bone ......................... 6.02 7.92 7.08 4.02 4.18 0.84 090 

28119 .... ............ A ........ Removal of heel spur .......................... 5.45 7.21 6.31 3.57 3.65 0.70 090 

28120 .... ............ A ........ Part removal of ankle/heel .................. 5.64 8.08 7.68 3.96 4.18 0.77 090 

28122 .... ............ A ........ Partial removal of foot bone ............... 7.56 8.46 7.64 4.77 5.02 0.98 090 

28124 .... ............ A ........ Partial removal of toe .......................... 4.88 6.77 5.88 3.46 3.55 0.60 090 

28126 .... ............ A ........ Partial removal of toe .......................... 3.56 5.96 5.08 2.66 2.82 0.45 090 

28130 .... ............ A ........ Removal of ankle bone ....................... 9.30 NA NA 6.15 6.43 1.26 090 

28140 .... ............ A ........ Removal of metatarsal ........................ 7.03 7.81 7.51 4.11 4.43 0.92 090 

28150 .... ............ A ........ Removal of toe .................................... 4.14 6.35 5.59 2.97 3.13 0.53 090 

28153 .... ............ A ........ Partial removal of toe .......................... 3.71 6.21 5.26 2.89 2.78 0.47 090 

28160 .... ............ A ........ Partial removal of toe .......................... 3.79 6.31 5.43 2.92 3.13 0.49 090 

28171 .... ............ A ........ Extensive foot surgery ........................ 9.85 NA NA 5.25 5.34 1.33 090 

28173 .... ............ A ........ Extensive foot surgery ........................ 9.05 8.72 8.15 4.61 4.90 1.12 090 

28175 .... ............ A ........ Extensive foot surgery ........................ 6.17 7.14 6.42 3.62 3.66 0.73 090 

28190 .... ............ A ........ Removal of foot foreign body ............. 1.98 4.01 3.70 1.34 1.41 0.22 010 

28192 .... ............ A ........ Removal of foot foreign body ............. 4.69 6.71 6.09 3.19 3.41 0.61 090 

28193 .... ............ A ........ Removal of foot foreign body ............. 5.79 7.33 6.47 3.63 3.77 0.73 090 

28200 .... ............ A ........ Repair of foot tendon .......................... 4.65 6.87 5.98 3.23 3.39 0.61 090 

28202 .... ............ A ........ Repair/graft of foot tendon .................. 6.96 7.76 7.48 3.93 4.21 0.91 090 

28208 .... ............ A ........ Repair of foot tendon .......................... 4.42 6.69 5.75 3.18 3.24 0.58 090 

28210 .... ............ A ........ Repair/graft of foot tendon .................. 6.41 7.62 6.91 3.93 3.97 0.81 090 

28220 .... ............ A ........ Release of foot tendon ....................... 4.58 6.41 5.54 3.07 3.25 0.57 090 

28222 .... ............ A ........ Release of foot tendons ...................... 5.67 6.92 6.08 3.34 3.73 0.69 090 

28225 .... ............ A ........ Release of foot tendon ....................... 3.70 6.01 5.14 2.71 2.81 0.46 090 

28226 .... ............ A ........ Release of foot tendons ...................... 4.58 6.88 5.83 3.25 3.49 0.58 090 

28230 .... ............ A ........ Incision of foot tendon(s) .................... 4.28 6.26 5.46 2.87 3.27 0.55 090 

28232 .... ............ A ........ Incision of toe tendon ......................... 3.43 5.93 5.22 2.67 2.99 0.44 090 

28234 .... ............ A ........ Incision of foot tendon ........................ 3.43 6.29 5.48 3.05 3.20 0.44 090 

28238 .... ............ A ........ Revision of foot tendon ....................... 7.85 8.38 7.81 4.37 4.64 1.06 090 

28240 .... ............ A ........ Release of big toe ............................... 4.40 6.35 5.49 2.95 3.21 0.58 090 

28250 .... ............ A ........ Revision of foot fascia ........................ 5.97 7.55 6.58 3.82 3.97 0.82 090 

28260 .... ............ A ........ Release of midfoot joint ...................... 8.08 8.44 7.38 4.61 4.80 1.14 090 

28261 .... ............ A ........ Revision of foot tendon ....................... 12.91 10.66 9.63 6.33 6.81 1.57 090 

28262 .... ............ A ........ Revision of foot and ankle .................. 17.01 15.52 14.53 9.72 10.31 2.60 090 

28264 .... ............ A ........ Release of midfoot joint ...................... 10.53 10.31 9.02 5.95 6.61 1.54 090 

28270 .... ............ A ........ Release of foot contracture ................ 4.82 6.91 5.90 3.44 3.58 0.62 090 

28272 .... ............ A ........ Release of toe joint, each ................... 3.84 5.83 5.00 2.65 2.75 0.46 090 

28280 .... ............ A ........ Fusion of toes ..................................... 5.24 7.28 6.76 3.54 4.01 0.73 090 

28285 .... ............ A ........ Repair of hammertoe .......................... 4.65 6.70 5.78 3.34 3.38 0.59 090 

28286 .... ............ A ........ Repair of hammertoe .......................... 4.61 6.52 5.65 3.06 3.15 0.57 090 

28288 .... ............ A ........ Partial removal of foot bone ............... 5.81 8.59 7.26 4.69 4.78 0.65 090 

28289 .... ............ A ........ Repair hallux rigidus ........................... 8.11 9.42 8.70 5.33 5.55 1.02 090 

28290 .... ............ A ........ Correction of bunion ........................... 5.72 8.18 7.21 3.96 4.34 0.82 090 

28292 .... ............ A ........ Correction of bunion ........................... 8.72 10.33 8.89 6.15 5.84 0.91 090 

28293 .... ............ A ........ Correction of bunion ........................... 11.10 14.46 12.60 6.91 6.50 1.13 090 

28294 .... ............ A ........ Correction of bunion ........................... 8.63 9.45 8.44 4.77 4.74 1.09 090 

28296 .... ............ A ........ Correction of bunion ........................... 9.31 9.57 8.86 4.79 5.10 1.19 090 

28297 .... ............ A ........ Correction of bunion ........................... 9.31 10.46 9.70 5.33 5.79 1.32 090 

28298 .... ............ A ........ Correction of bunion ........................... 8.01 9.29 8.25 4.59 4.79 1.05 090 

28299 .... ............ A ........ Correction of bunion ........................... 11.39 10.54 9.65 5.72 5.89 1.37 090 

28300 .... ............ A ........ Incision of heel bone ........................... 9.61 NA NA 6.03 6.53 1.54 090 

28302 .... ............ A ........ Incision of ankle bone ......................... 9.62 NA NA 6.21 6.54 1.42 090 

28304 .... ............ A ........ Incision of midfoot bones .................... 9.29 9.55 8.74 5.08 5.40 1.27 090 

28305 .... ............ A ........ Incise/graft midfoot bones ................... 10.63 NA NA 5.78 6.25 1.27 090 

28306 .... ............ A ........ Incision of metatarsal .......................... 5.91 8.41 7.62 3.89 4.03 0.84 090 

28307 .... ............ A ........ Incision of metatarsal .......................... 6.39 9.27 10.14 4.33 4.81 0.90 090 

28308 .... ............ A ........ Incision of metatarsal .......................... 5.36 7.91 6.83 3.82 3.75 0.70 090 

28309 .... ............ A ........ Incision of metatarsals ........................ 13.96 NA NA 7.68 7.81 2.05 090 

28310 .... ............ A ........ Revision of big toe .............................. 5.48 7.54 6.64 3.42 3.48 0.70 090 

28312 .... ............ A ........ Revision of toe .................................... 4.60 7.37 6.40 3.23 3.43 0.63 090 

28313 .... ............ A ........ Repair deformity of toe ....................... 5.06 7.26 6.27 3.60 4.21 0.73 090 

28315 .... ............ A ........ Removal of sesamoid bone ................ 4.91 6.67 5.78 3.22 3.27 0.63 090 

28320 .... ............ A ........ Repair of foot bones ........................... 9.25 NA NA 5.68 6.19 1.43 090 

28322 .... ............ A ........ Repair of metatarsals .......................... 8.41 9.74 9.45 5.31 5.82 1.27 090 

28340 .... ............ A ........ Resect enlarged toe tissue ................. 7.04 8.09 7.26 4.07 4.15 0.84 090 

28341 .... ............ A ........ Resect enlarged toe ............................ 8.60 8.59 7.76 4.42 4.61 1.01 090 

28344 .... ............ A ........ Repair extra toe(s) .............................. 4.31 6.41 6.07 2.93 3.28 0.51 090 

28345 .... ............ A ........ Repair webbed toe(s) ......................... 5.98 7.61 6.90 3.78 4.23 0.80 090 

28360 .... ............ A ........ Reconstruct cleft foot .......................... 14.67 NA NA 6.34 8.41 2.29 090 


cprice-sewell on PROD1PC72 with RULES
66437 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

28400 .... ............ A ........ Treatment of heel fracture .................. 2.22 3.36 3.49 2.91 2.98 0.35 090 

28405 .... ............ A ........ Treatment of heel fracture .................. 4.63 4.42 4.62 3.67 4.14 0.73 090 

28406 .... ............ A ........ Treatment of heel fracture .................. 6.44 NA NA 5.55 6.17 1.11 090 

28415 .... ............ A ........ Treat heel fracture .............................. 15.96 NA NA 10.23 11.75 2.67 090 

28420 .... ............ A ........ Treat/graft heel fracture ...................... 17.29 NA NA 10.27 11.59 2.81 090 

28430 .... ............ A ........ Treatment of ankle fracture ................ 2.14 3.12 3.25 2.57 2.57 0.31 090 

28435 .... ............ A ........ Treatment of ankle fracture ................ 3.45 3.98 3.93 3.26 3.50 0.55 090 

28436 .... ............ A ........ Treatment of ankle fracture ................ 4.78 NA NA 4.74 5.32 0.81 090 

28445 .... ............ A ........ Treat ankle fracture ............................. 15.53 NA NA 9.48 10.25 2.59 090 

28446 .... ............ A ........ Osteochondral talus autogrft ............... 17.50 NA NA 10.34 10.34 2.45 090 

28450 .... ............ A ........ Treat midfoot fracture, each ............... 1.95 2.91 3.01 2.41 2.44 0.28 090 

28455 .... ............ A ........ Treat midfoot fracture, each ............... 3.15 3.74 3.58 3.10 3.26 0.44 090 

28456 .... ............ A ........ Treat midfoot fracture ......................... 2.75 NA NA 3.72 3.94 0.44 090 

28465 .... ............ A ........ Treat midfoot fracture, each ............... 8.64 NA NA 6.06 6.18 1.10 090 

28470 .... ............ A ........ Treat metatarsal fracture .................... 1.99 2.80 2.96 2.36 2.40 0.30 090 

28475 .... ............ A ........ Treat metatarsal fracture .................... 2.97 3.13 3.23 2.51 2.86 0.44 090 

28476 .... ............ A ........ Treat metatarsal fracture .................... 3.46 NA NA 4.32 4.65 0.54 090 

28485 .... ............ A ........ Treat metatarsal fracture .................... 7.28 NA NA 5.56 5.50 0.83 090 

28490 .... ............ A ........ Treat big toe fracture .......................... 1.12 2.09 2.05 1.67 1.65 0.14 090 

28495 .... ............ A ........ Treat big toe fracture .......................... 1.62 2.46 2.32 1.86 1.96 0.20 090 

28496 .... ............ A ........ Treat big toe fracture .......................... 2.39 7.41 7.83 2.99 3.09 0.36 090 

28505 .... ............ A ........ Treat big toe fracture .......................... 7.28 8.45 8.27 4.81 4.36 0.56 090 

28510 .... ............ A ........ Treatment of toe fracture .................... 1.12 1.68 1.60 1.61 1.57 0.14 090 

28515 .... ............ A ........ Treatment of toe fracture .................... 1.50 2.22 2.06 1.82 1.86 0.18 090 

28525 .... ............ A ........ Treat toe fracture ................................ 5.46 8.11 7.81 4.31 3.87 0.49 090 

28530 .... ............ A ........ Treat sesamoid bone fracture ............. 1.08 1.62 1.53 1.34 1.39 0.14 090 

28531 .... ............ A ........ Treat sesamoid bone fracture ............. 2.51 6.54 6.90 2.42 2.24 0.34 090 

28540 .... ............ A ........ Treat foot dislocation .......................... 2.10 2.74 2.57 2.30 2.35 0.26 090 

28545 .... ............ A ........ Treat foot dislocation .......................... 2.51 3.43 2.88 2.81 2.57 0.37 090 

28546 .... ............ A ........ Treat foot dislocation .......................... 3.28 8.05 7.48 3.64 4.01 0.52 090 

28555 .... ............ A ........ Repair foot dislocation ........................ 9.49 10.80 10.35 6.29 5.98 1.04 090 

28570 .... ............ A ........ Treat foot dislocation .......................... 1.70 2.49 2.45 1.91 2.12 0.23 090 

28575 .... ............ A ........ Treat foot dislocation .......................... 3.38 4.41 4.06 3.71 3.71 0.56 090 

28576 .... ............ A ........ Treat foot dislocation .......................... 4.48 NA NA 4.06 4.11 0.69 090 

28585 .... ............ A ........ Repair foot dislocation ........................ 10.92 11.56 9.44 6.96 6.40 1.25 090 

28600 .... ............ A ........ Treat foot dislocation .......................... 1.94 3.02 2.92 2.37 2.53 0.27 090 

28605 .... ............ A ........ Treat foot dislocation .......................... 2.78 3.89 3.50 3.27 3.19 0.40 090 

28606 .... ............ A ........ Treat foot dislocation .......................... 4.97 NA NA 4.11 4.40 0.82 090 

28615 .... ............ A ........ Repair foot dislocation ........................ 10.46 NA NA 8.13 8.08 1.30 090 

28630 .... ............ A ........ Treat toe dislocation ........................... 1.72 1.84 1.70 0.91 0.95 0.20 010 

28635 .... ............ A ........ Treat toe dislocation ........................... 1.93 2.27 2.15 1.33 1.43 0.26 010 

28636 .... ............ A ........ Treat toe dislocation ........................... 2.77 4.38 4.12 2.05 2.34 0.43 010 

28645 .... ............ A ........ Repair toe dislocation ......................... 7.28 8.33 6.64 4.61 3.94 0.57 090 

28660 .... ............ A ........ Treat toe dislocation ........................... 1.25 1.30 1.28 0.78 0.78 0.13 010 

28665 .... ............ A ........ Treat toe dislocation ........................... 1.94 1.82 1.62 1.32 1.37 0.26 010 

28666 .... ............ A ........ Treat toe dislocation ........................... 2.66 NA NA 1.82 2.20 0.43 010 

28675 .... ............ A ........ Repair of toe dislocation ..................... 5.46 8.23 7.68 4.44 3.90 0.45 090 

28705 .... ............ A ........ Fusion of foot bones ........................... 20.12 NA NA 10.64 11.54 3.09 090 

28715 .... ............ A ........ Fusion of foot bones ........................... 14.40 NA NA 8.48 9.11 2.17 090 

28725 .... ............ A ........ Fusion of foot bones ........................... 11.97 NA NA 6.82 7.52 1.87 090 

28730 .... ............ A ........ Fusion of foot bones ........................... 12.21 NA NA 7.75 8.11 1.71 090 

28735 .... ............ A ........ Fusion of foot bones ........................... 12.03 NA NA 6.96 7.39 1.69 090 

28737 .... ............ A ........ Revision of foot bones ........................ 10.83 NA NA 6.06 6.43 1.47 090 

28740 .... ............ A ........ Fusion of foot bones ........................... 9.09 10.86 10.86 5.98 6.22 1.22 090 

28750 .... ............ A ........ Fusion of big toe joint ......................... 8.37 10.76 11.33 5.88 6.27 1.13 090 

28755 .... ............ A ........ Fusion of big toe joint ......................... 4.79 7.25 6.67 3.35 3.55 0.65 090 

28760 .... ............ A ........ Fusion of big toe joint ......................... 8.94 9.86 8.91 5.26 5.39 1.05 090 

28800 .... ............ A ........ Amputation of midfoot ......................... 8.65 NA NA 5.00 5.40 1.15 090 

28805 .... ............ A ........ Amputation thru metatarsal ................. 12.55 NA NA 5.89 5.77 1.18 090 

28810 .... ............ A ........ Amputation toe & metatarsal .............. 6.52 NA NA 4.06 4.26 0.86 090 

28820 .... ............ A ........ Amputation of toe ................................ 4.89 7.64 7.59 3.55 3.66 0.61 090 

28825 .... ............ A ........ Partial amputation of toe ..................... 3.71 7.13 7.06 3.12 3.30 0.50 090 

28890 .... ............ A ........ High energy eswt, plantar f ................. 3.36 4.56 5.14 2.20 2.14 0.41 090 

28899 .... ............ C ........ Foot/toes surgery procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

29000 .... ............ A ........ Application of body cast ...................... 2.25 4.00 3.48 1.64 1.69 0.41 000 

29010 .... ............ A ........ Application of body cast ...................... 2.06 4.38 3.83 1.62 1.70 0.45 000 

29015 .... ............ A ........ Application of body cast ...................... 2.41 3.61 3.29 1.56 1.58 0.28 000 

29020 .... ............ A ........ Application of body cast ...................... 2.11 3.81 3.49 1.41 1.41 0.28 000 

29025 .... ............ A ........ Application of body cast ...................... 2.40 4.04 3.59 1.76 1.81 0.44 000 

29035 .... ............ A ........ Application of body cast ...................... 1.77 3.70 3.65 1.48 1.53 0.28 000 

29040 .... ............ A ........ Application of body cast ...................... 2.22 3.28 2.87 1.34 1.42 0.36 000 

29044 .... ............ A ........ Application of body cast ...................... 2.12 3.57 3.77 1.47 1.69 0.35 000 


cprice-sewell on PROD1PC72 with RULES
66438 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

29046 .... ............ A ........ Application of body cast ...................... 2.41 4.49 3.86 1.91 2.00 0.42 000 

29049 .... ............ A ........ Application of figure eight ................... 0.89 1.11 1.21 0.59 0.56 0.13 000 

29055 .... ............ A ........ Application of shoulder cast ................ 1.78 2.82 2.90 1.23 1.35 0.30 000 

29058 .... ............ A ........ Application of shoulder cast ................ 1.31 1.26 1.41 0.67 0.70 0.17 000 

29065 .... ............ A ........ Application of long arm cast ............... 0.87 1.28 1.30 0.70 0.73 0.15 000 

29075 .... ............ A ........ Application of forearm cast ................. 0.77 1.23 1.24 0.66 0.67 0.13 000 

29085 .... ............ A ........ Apply hand/wrist cast .......................... 0.87 1.26 1.27 0.68 0.66 0.14 000 

29086 .... ............ A ........ Apply finger cast ................................. 0.62 1.07 1.02 0.55 0.52 0.07 000 

29105 .... ............ A ........ Apply long arm splint .......................... 0.87 1.09 1.16 0.53 0.52 0.12 000 

29125 .... ............ A ........ Apply forearm splint ............................ 0.59 0.97 0.99 0.42 0.41 0.07 000 

29126 .... ............ A ........ Apply forearm splint ............................ 0.77 1.01 1.11 0.48 0.47 0.07 000 

29130 .... ............ A ........ Application of finger splint ................... 0.50 0.43 0.45 0.18 0.18 0.06 000 

29131 .... ............ A ........ Application of finger splint ................... 0.55 0.59 0.66 0.24 0.24 0.03 000 

29200 .... ............ A ........ Strapping of chest ............................... 0.65 0.60 0.66 0.34 0.34 0.04 000 

29220 .... ............ A ........ Strapping of low back ......................... 0.64 0.65 0.68 0.38 0.38 0.04 000 

29240 .... ............ A ........ Strapping of shoulder .......................... 0.71 0.68 0.76 0.40 0.38 0.06 000 

29260 .... ............ A ........ Strapping of elbow or wrist ................. 0.55 0.67 0.70 0.37 0.35 0.05 000 

29280 .... ............ A ........ Strapping of hand or finger ................. 0.51 0.67 0.73 0.37 0.35 0.03 000 

29305 .... ............ A ........ Application of hip cast ......................... 2.03 3.28 3.31 1.56 1.66 0.35 000 

29325 .... ............ A ........ Application of hip casts ....................... 2.32 3.33 3.43 1.58 1.77 0.40 000 

29345 .... ............ A ........ Application of long leg cast ................. 1.40 1.66 1.71 0.94 1.00 0.24 000 

29355 .... ............ A ........ Application of long leg cast ................. 1.53 1.62 1.66 0.93 1.03 0.26 000 

29358 .... ............ A ........ Apply long leg cast brace ................... 1.43 2.01 2.03 0.91 1.00 0.25 000 

29365 .... ............ A ........ Application of long leg cast ................. 1.18 1.58 1.62 0.85 0.90 0.20 000 

29405 .... ............ A ........ Apply short leg cast ............................ 0.86 1.19 1.20 0.65 0.68 0.14 000 

29425 .... ............ A ........ Apply short leg cast ............................ 1.01 1.22 1.22 0.65 0.70 0.15 000 

29435 .... ............ A ........ Apply short leg cast ............................ 1.18 1.52 1.54 0.81 0.87 0.20 000 

29440 .... ............ A ........ Addition of walker to cast ................... 0.57 0.64 0.67 0.26 0.26 0.08 000 

29445 .... ............ A ........ Apply rigid leg cast ............................. 1.78 1.56 1.68 0.89 0.92 0.27 000 

29450 .... ............ A ........ Application of leg cast ......................... 2.08 1.59 1.53 0.90 0.99 0.27 000 

29505 .... ............ A ........ Application, long leg splint .................. 0.69 1.07 1.12 0.45 0.45 0.08 000 

29515 .... ............ A ........ Application lower leg splint ................. 0.73 0.96 0.91 0.46 0.46 0.09 000 

29520 .... ............ A ........ Strapping of hip ................................... 0.54 0.66 0.75 0.37 0.42 0.03 000 

29530 .... ............ A ........ Strapping of knee ................................ 0.57 0.65 0.72 0.36 0.35 0.05 000 

29540 .... ............ A ........ Strapping of ankle and/or ft ................ 0.51 0.55 0.48 0.31 0.31 0.06 000 

29550 .... ............ A ........ Strapping of toes ................................. 0.47 0.56 0.49 0.30 0.29 0.06 000 

29580 .... ............ A ........ Application of paste boot .................... 0.55 0.71 0.68 0.33 0.34 0.07 000 

29590 .... ............ A ........ Application of foot splint ...................... 0.76 0.59 0.55 0.26 0.27 0.09 000 

29700 .... ............ A ........ Removal/revision of cast ..................... 0.57 0.95 0.92 0.25 0.26 0.08 000 

29705 .... ............ A ........ Removal/revision of cast ..................... 0.76 0.76 0.79 0.36 0.37 0.13 000 

29710 .... ............ A ........ Removal/revision of cast ..................... 1.34 1.32 1.42 0.55 0.62 0.20 000 

29715 .... ............ A ........ Removal/revision of cast ..................... 0.94 1.20 1.18 0.43 0.42 0.09 000 

29720 .... ............ A ........ Repair of body cast ............................. 0.68 1.17 1.16 0.35 0.37 0.12 000 

29730 .... ............ A ........ Windowing of cast ............................... 0.75 0.74 0.77 0.34 0.34 0.12 000 

29740 .... ............ A ........ Wedging of cast .................................. 1.12 1.03 1.09 0.47 0.48 0.18 000 

29750 .... ............ A ........ Wedging of clubfoot cast .................... 1.26 1.06 1.06 0.52 0.55 0.21 000 

29799 .... ............ C ........ Casting/strapping procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

29800 .... ............ A ........ Jaw arthroscopy/surgery ..................... 6.73 NA NA 4.62 5.79 0.99 090 

29804 .... ............ A ........ Jaw arthroscopy/surgery ..................... 8.71 NA NA 5.69 6.65 1.38 090 

29805 .... ............ A ........ Shoulder arthroscopy, dx .................... 5.94 NA NA 4.71 5.19 1.02 090 

29806 .... ............ A ........ Shoulder arthroscopy/surgery ............. 14.95 NA NA 9.35 10.25 2.50 090 

29807 .... ............ A ........ Shoulder arthroscopy/surgery ............. 14.48 NA NA 9.19 10.09 2.42 090 

29819 .... ............ A ........ Shoulder arthroscopy/surgery ............. 7.68 NA NA 5.62 6.20 1.32 090 

29820 .... ............ A ........ Shoulder arthroscopy/surgery ............. 7.12 NA NA 5.17 5.70 1.22 090 

29821 .... ............ A ........ Shoulder arthroscopy/surgery ............. 7.78 NA NA 5.65 6.22 1.33 090 

29822 .... ............ A ........ Shoulder arthroscopy/surgery ............. 7.49 NA NA 5.57 6.13 1.28 090 

29823 .... ............ A ........ Shoulder arthroscopy/surgery ............. 8.24 NA NA 6.04 6.63 1.41 090 

29824 .... ............ A ........ Shoulder arthroscopy/surgery ............. 8.82 NA NA 6.53 7.03 1.42 090 

29825 .... ............ A ........ Shoulder arthroscopy/surgery ............. 7.68 NA NA 5.63 6.19 1.32 090 

29826 .... ............ A ........ Shoulder arthroscopy/surgery ............. 9.05 NA NA 6.18 6.85 1.55 090 

29827 .... ............ A ........ Arthroscop rotator cuff repr ................. 15.44 NA NA 9.31 10.41 2.67 090 

29828 .... ............ A ........ Arthroscopy biceps tenodesis ............. 13.00 NA NA 8.17 8.17 2.17 090 

29830 .... ............ A ........ Elbow arthroscopy .............................. 5.80 NA NA 4.48 4.91 0.99 090 

29834 .... ............ A ........ Elbow arthroscopy/surgery ................. 6.33 NA NA 4.85 5.34 1.08 090 

29835 .... ............ A ........ Elbow arthroscopy/surgery ................. 6.53 NA NA 4.96 5.42 1.13 090 

29836 .... ............ A ........ Elbow arthroscopy/surgery ................. 7.61 NA NA 5.54 6.16 1.22 090 

29837 .... ............ A ........ Elbow arthroscopy/surgery ................. 6.92 NA NA 5.06 5.59 1.19 090 

29838 .... ............ A ........ Elbow arthroscopy/surgery ................. 7.77 NA NA 5.65 6.27 1.30 090 

29840 .... ............ A ........ Wrist arthroscopy ................................ 5.59 NA NA 4.62 4.97 0.84 090 

29843 .... ............ A ........ Wrist arthroscopy/surgery ................... 6.06 NA NA 4.80 5.21 0.92 090 

29844 .... ............ A ........ Wrist arthroscopy/surgery ................... 6.42 NA NA 4.87 5.35 1.04 090 

29845 .... ............ A ........ Wrist arthroscopy/surgery ................... 7.58 NA NA 5.59 6.03 0.99 090 


cprice-sewell on PROD1PC72 with RULES
66439 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

29846 .... ............ A ........ Wrist arthroscopy/surgery ................... 6.80 NA NA 5.11 5.58 1.07 090 

29847 .... ............ A ........ Wrist arthroscopy/surgery ................... 7.13 NA NA 5.27 5.73 1.08 090 

29848 .... ............ A ........ Wrist endoscopy/surgery .................... 6.24 NA NA 5.27 5.44 0.86 090 

29850 .... ............ A ........ Knee arthroscopy/surgery ................... 8.18 NA NA 4.72 4.88 1.25 090 

29851 .... ............ A ........ Knee arthroscopy/surgery ................... 13.08 NA NA 8.21 9.00 2.35 090 

29855 .... ............ A ........ Tibial arthroscopy/surgery ................... 10.60 NA NA 7.27 8.02 1.85 090 

29856 .... ............ A ........ Tibial arthroscopy/surgery ................... 14.12 NA NA 8.69 9.67 2.40 090 

29860 .... ............ A ........ Hip arthroscopy, dx ............................. 8.85 NA NA 6.24 6.60 1.36 090 

29861 .... ............ A ........ Hip arthroscopy/surgery ...................... 9.95 NA NA 6.39 6.86 1.59 090 

29862 .... ............ A ........ Hip arthroscopy/surgery ...................... 10.97 NA NA 7.57 8.06 1.62 090 

29863 .... ............ A ........ Hip arthroscopy/surgery ...................... 10.97 NA NA 7.48 7.99 1.42 090 

29866 .... ............ A ........ Autgrft implnt, knee w/scope .............. 14.48 NA NA 9.46 10.40 2.40 090 

29867 .... ............ A ........ Allgrft implnt, knee w/scope ................ 18.18 NA NA 11.03 12.12 2.79 090 

29868 .... ............ A ........ Meniscal trnspl, knee w/scpe .............. 24.89 NA NA 13.79 15.29 4.36 090 

29870 .... ............ A ........ Knee arthroscopy, dx .......................... 5.11 NA NA 4.18 4.53 0.85 090 

29871 .... ............ A ........ Knee arthroscopy/drainage ................. 6.60 NA NA 5.05 5.46 1.14 090 

29873 .... ............ A ........ Knee arthroscopy/surgery ................... 6.09 NA NA 5.59 6.08 1.04 090 

29874 .... ............ A ........ Knee arthroscopy/surgery ................... 7.10 NA NA 5.08 5.58 1.11 090 

29875 .... ............ A ........ Knee arthroscopy/surgery ................... 6.36 NA NA 4.88 5.37 1.09 090 

29876 .... ............ A ........ Knee arthroscopy/surgery ................... 8.72 NA NA 6.18 6.60 1.37 090 

29877 .... ............ A ........ Knee arthroscopy/surgery ................... 8.15 NA NA 5.97 6.36 1.28 090 

29879 .... ............ A ........ Knee arthroscopy/surgery ................... 8.84 NA NA 6.23 6.67 1.39 090 

29880 .... ............ A ........ Knee arthroscopy/surgery ................... 9.30 NA NA 6.42 6.89 1.47 090 

29881 .... ............ A ........ Knee arthroscopy/surgery ................... 8.56 NA NA 6.13 6.55 1.34 090 

29882 .... ............ A ........ Knee arthroscopy/surgery ................... 9.45 NA NA 6.45 6.84 1.50 090 

29883 .... ............ A ........ Knee arthroscopy/surgery ................... 11.61 NA NA 7.58 8.32 1.93 090 

29884 .... ............ A ........ Knee arthroscopy/surgery ................... 8.13 NA NA 5.96 6.33 1.27 090 

29885 .... ............ A ........ Knee arthroscopy/surgery ................... 10.03 NA NA 7.03 7.49 1.58 090 

29886 .... ............ A ........ Knee arthroscopy/surgery ................... 8.34 NA NA 6.03 6.44 1.30 090 

29887 .... ............ A ........ Knee arthroscopy/surgery ................... 9.98 NA NA 6.96 7.44 1.57 090 

29888 .... ............ A ........ Knee arthroscopy/surgery ................... 14.14 NA NA 8.26 9.23 2.42 090 

29889 .... ............ A ........ Knee arthroscopy/surgery ................... 17.15 NA NA 10.61 11.52 2.79 090 

29891 .... ............ A ........ Ankle arthroscopy/surgery .................. 9.47 NA NA 6.64 7.07 1.39 090 

29892 .... ............ A ........ Ankle arthroscopy/surgery .................. 10.07 NA NA 6.38 7.06 1.41 090 

29893 .... ............ A ........ Scope, plantar fasciotomy .................. 6.08 8.83 7.56 4.66 4.32 0.63 090 

29894 .... ............ A ........ Ankle arthroscopy/surgery .................. 7.26 NA NA 4.72 5.09 1.15 090 

29895 .... ............ A ........ Ankle arthroscopy/surgery .................. 7.04 NA NA 4.51 4.99 1.11 090 

29897 .... ............ A ........ Ankle arthroscopy/surgery .................. 7.23 NA NA 4.81 5.35 1.17 090 

29898 .... ............ A ........ Ankle arthroscopy/surgery .................. 8.38 NA NA 5.24 5.71 1.28 090 

29899 .... ............ A ........ Ankle arthroscopy/surgery .................. 15.21 NA NA 9.20 9.87 2.41 090 

29900 .... ............ A ........ Mcp joint arthroscopy, dx .................... 5.74 NA NA 4.66 5.26 0.94 090 

29901 .... ............ A ........ Mcp joint arthroscopy, surg ................ 6.45 NA NA 5.09 5.68 1.06 090 

29902 .... ............ A ........ Mcp joint arthroscopy, surg ................ 7.02 NA NA 4.70 5.62 1.12 090 

29904 .... ............ A ........ Subtalar arthro w/fb rmvl .................... 8.50 NA NA 5.89 5.89 1.25 090 

29905 .... ............ A ........ Subtalar arthro w/exc .......................... 9.00 NA NA 6.51 6.51 1.32 090 

29906 .... ............ A ........ Subtalar arthro w/deb ......................... 9.47 NA NA 6.87 6.87 1.39 090 

29907 .... ............ A ........ Subtalar arthro w/fusion ...................... 12.00 NA NA 7.86 7.86 1.90 090 

29999 .... ............ C ........ Arthroscopy of joint ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

30000 .... ............ A ........ Drainage of nose lesion ...................... 1.45 4.01 4.04 1.34 1.36 0.12 010 

30020 .... ............ A ........ Drainage of nose lesion ...................... 1.45 4.16 3.72 1.39 1.43 0.12 010 

30100 .... ............ A ........ Intranasal biopsy ................................. 0.94 2.58 2.28 0.75 0.78 0.07 000 

30110 .... ............ A ........ Removal of nose polyp(s) ................... 1.65 3.90 3.57 1.45 1.51 0.14 010 

30115 .... ............ A ........ Removal of nose polyp(s) ................... 4.38 NA NA 5.99 5.87 0.41 090 

30117 .... ............ A ........ Removal of intranasal lesion .............. 3.20 18.15 15.64 4.91 4.77 0.26 090 

30118 .... ............ A ........ Removal of intranasal lesion .............. 9.81 NA NA 8.55 8.87 0.78 090 

30120 .... ............ A ........ Revision of nose ................................. 5.31 7.07 6.78 5.09 5.54 0.52 090 

30124 .... ............ A ........ Removal of nose lesion ...................... 3.14 NA NA 3.68 3.64 0.25 090 

30125 .... ............ A ........ Removal of nose lesion ...................... 7.21 NA NA 7.40 7.86 0.63 090 

30130 .... ............ A ........ Excise inferior turbinate ...................... 3.41 NA NA 5.63 5.61 0.31 090 

30140 .... ............ A ........ Resect inferior turbinate ...................... 3.48 NA NA 7.10 6.64 0.35 090 

30150 .... ............ A ........ Partial removal of nose ....................... 9.44 NA NA 9.02 10.01 0.93 090 

30160 .... ............ A ........ Removal of nose ................................. 9.88 NA NA 8.87 9.54 0.88 090 

30200 .... ............ A ........ Injection treatment of nose ................. 0.78 2.02 1.82 0.67 0.70 0.06 000 

30210 .... ............ A ........ Nasal sinus therapy ............................ 1.10 2.51 2.30 1.27 1.29 0.09 010 

30220 .... ............ A ........ Insert nasal septal button ................... 1.56 5.81 5.02 1.42 1.47 0.12 010 

30300 .... ............ A ........ Remove nasal foreign body ................ 1.06 4.29 4.46 1.87 1.89 0.08 010 

30310 .... ............ A ........ Remove nasal foreign body ................ 1.98 NA NA 2.91 3.00 0.16 010 

30320 .... ............ A ........ Remove nasal foreign body ................ 4.56 NA NA 6.35 6.69 0.39 090 

30400 .... ............ R ........ Reconstruction of nose ....................... 10.58 NA NA 13.90 14.69 1.04 090 

30410 .... ............ R ........ Reconstruction of nose ....................... 13.72 NA NA 15.32 16.84 1.42 090 

30420 .... ............ R ........ Reconstruction of nose ....................... 16.62 NA NA 15.82 16.86 1.46 090 

30430 .... ............ R ........ Revision of nose ................................. 7.96 NA NA 13.24 14.62 0.77 090 


cprice-sewell on PROD1PC72 with RULES
66440 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

30435 .... ............ R ........ Revision of nose ................................. 12.45 NA NA 15.42 17.38 1.22 090 

30450 .... ............ R ........ Revision of nose ................................. 19.38 NA NA 16.88 19.38 1.97 090 

30460 .... ............ A ........ Revision of nose ................................. 10.24 NA NA 7.48 8.71 1.03 090 

30462 .... ............ A ........ Revision of nose ................................. 20.12 NA NA 14.64 17.44 2.54 090 

30465 .... ............ A ........ Repair nasal stenosis ......................... 12.20 NA NA 11.07 11.52 1.06 090 

30520 .... ............ A ........ Repair of nasal septum ....................... 6.85 NA NA 8.04 7.35 0.46 090 

30540 .... ............ A ........ Repair nasal defect ............................. 7.81 NA NA 8.54 8.91 0.67 090 

30545 .... ............ A ........ Repair nasal defect ............................. 11.50 NA NA 11.08 11.48 1.71 090 

30560 .... ............ A ........ Release of nasal adhesions ............... 1.28 5.28 5.02 2.02 2.08 0.10 010 

30580 .... ............ A ........ Repair upper jaw fistula ...................... 6.76 8.13 7.95 4.69 5.24 0.89 090 

30600 .... ............ A ........ Repair mouth/nose fistula ................... 6.07 7.67 7.59 4.18 4.60 0.70 090 

30620 .... ............ A ........ Intranasal reconstruction ..................... 6.04 NA NA 8.66 8.75 0.57 090 

30630 .... ............ A ........ Repair nasal septum defect ................ 7.18 NA NA 7.73 7.83 0.61 090 

30801 .... ............ A ........ Ablate inf turbinate, superf .................. 1.11 4.30 4.21 2.12 2.02 0.09 010 

30802 .... ............ A ........ Cauterization, inner nose .................... 2.05 4.97 4.79 2.51 2.44 0.16 010 

30901 .... ............ A ........ Control of nosebleed ........................... 1.21 1.27 1.31 0.30 0.31 0.11 000 

30903 .... ............ A ........ Control of nosebleed ........................... 1.54 3.27 2.99 0.43 0.46 0.13 000 

30905 .... ............ A ........ Control of nosebleed ........................... 1.97 3.93 3.72 0.51 0.63 0.17 000 

30906 .... ............ A ........ Repeat control of nosebleed ............... 2.45 4.28 4.08 0.76 0.98 0.20 000 

30915 .... ............ A ........ Ligation, nasal sinus artery ................. 7.36 NA NA 6.46 6.57 0.58 090 

30920 .... ............ A ........ Ligation, upper jaw artery ................... 11.03 NA NA 8.96 8.96 0.80 090 

30930 .... ............ A ........ Ther fx, nasal inf turbinate .................. 1.28 NA NA 1.64 1.63 0.12 010 

30999 .... ............ C ........ Nasal surgery procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

31000 .... ............ A ........ Irrigation, maxillary sinus .................... 1.17 3.22 3.03 1.34 1.37 0.09 010 

31002 .... ............ A ........ Irrigation, sphenoid sinus .................... 1.93 NA NA 2.69 2.96 0.15 010 

31020 .... ............ A ........ Exploration, maxillary sinus ................ 2.99 8.60 8.56 5.54 5.36 0.29 090 

31030 .... ............ A ........ Exploration, maxillary sinus ................ 5.95 10.40 10.94 6.44 6.55 0.60 090 

31032 .... ............ A ........ Explore sinus, remove polyps ............. 6.61 NA NA 7.00 7.11 0.59 090 

31040 .... ............ A ........ Exploration behind upper jaw ............. 9.66 NA NA 7.37 8.59 0.87 090 

31050 .... ............ A ........ Exploration, sphenoid sinus ................ 5.31 NA NA 6.50 6.43 0.49 090 

31051 .... ............ A ........ Sphenoid sinus surgery ...................... 7.16 NA NA 8.36 8.30 0.62 090 

31070 .... ............ A ........ Exploration of frontal sinus ................. 4.32 NA NA 6.18 6.06 0.38 090 

31075 .... ............ A ........ Exploration of frontal sinus ................. 9.40 NA NA 9.32 9.52 0.75 090 

31080 .... ............ A ........ Removal of frontal sinus ..................... 12.54 NA NA 10.61 12.07 1.23 090 

31081 .... ............ A ........ Removal of frontal sinus ..................... 13.99 NA NA 15.36 14.67 2.47 090 

31084 .... ............ A ........ Removal of frontal sinus ..................... 14.75 NA NA 12.87 13.18 1.19 090 

31085 .... ............ A ........ Removal of frontal sinus ..................... 15.44 NA NA 14.42 14.19 1.73 090 

31086 .... ............ A ........ Removal of frontal sinus ..................... 14.16 NA NA 12.77 13.02 1.07 090 

31087 .... ............ A ........ Removal of frontal sinus ..................... 14.39 NA NA 11.64 12.08 1.44 090 

31090 .... ............ A ........ Exploration of sinuses ......................... 10.88 NA NA 13.40 12.97 0.94 090 

31200 .... ............ A ........ Removal of ethmoid sinus .................. 5.03 NA NA 7.43 8.32 0.29 090 

31201 .... ............ A ........ Removal of ethmoid sinus .................. 8.49 NA NA 8.99 9.08 0.82 090 

31205 .... ............ A ........ Removal of ethmoid sinus .................. 10.47 NA NA 9.51 10.69 0.67 090 

31225 .... ............ A ........ Removal of upper jaw ......................... 26.44 NA NA 17.88 17.85 1.59 090 

31230 .... ............ A ........ Removal of upper jaw ......................... 30.56 NA NA 19.48 19.41 1.78 090 

31231 .... ............ A ........ Nasal endoscopy, dx .......................... 1.10 3.59 3.49 0.77 0.82 0.09 000 

31233 .... ............ A ........ Nasal/sinus endoscopy, dx ................. 2.18 4.26 4.28 1.12 1.30 0.20 000 

31235 .... ............ A ........ Nasal/sinus endoscopy, dx ................. 2.64 4.64 4.77 1.26 1.49 0.26 000 

31237 .... ............ A ........ Nasal/sinus endoscopy, surg .............. 2.98 4.90 5.05 1.39 1.63 0.28 000 

31238 .... ............ A ........ Nasal/sinus endoscopy, surg .............. 3.26 4.82 5.03 1.48 1.79 0.27 000 

31239 .... ............ A ........ Nasal/sinus endoscopy, surg .............. 9.23 NA NA 6.42 7.21 0.62 010 

31240 .... ............ A ........ Nasal/sinus endoscopy, surg .............. 2.61 NA NA 1.27 1.50 0.24 000 

31254 .... ............ A ........ Revision of ethmoid sinus ................... 4.64 NA NA 1.93 2.39 0.45 000 

31255 .... ............ A ........ Removal of ethmoid sinus .................. 6.95 NA NA 2.69 3.40 0.73 000 

31256 .... ............ A ........ Exploration maxillary sinus ................. 3.29 NA NA 1.49 1.80 0.33 000 

31267 .... ............ A ........ Endoscopy, maxillary sinus ................ 5.45 NA NA 2.20 2.74 0.55 000 

31276 .... ............ A ........ Sinus endoscopy, surgical .................. 8.84 NA NA 3.31 4.21 0.92 000 

31287 .... ............ A ........ Nasal/sinus endoscopy, surg .............. 3.91 NA NA 1.69 2.07 0.39 000 

31288 .... ............ A ........ Nasal/sinus endoscopy, surg .............. 4.57 NA NA 1.91 2.36 0.46 000 

31290 .... ............ A ........ Nasal/sinus endoscopy, surg .............. 18.50 NA NA 9.04 10.54 1.40 010 

31291 .... ............ A ........ Nasal/sinus endoscopy, surg .............. 19.45 NA NA 9.53 11.00 1.69 010 

31292 .... ............ A ........ Nasal/sinus endoscopy, surg .............. 15.79 NA NA 8.05 9.33 1.21 010 

31293 .... ............ A ........ Nasal/sinus endoscopy, surg .............. 17.36 NA NA 8.68 10.02 1.28 010 

31294 .... ............ A ........ Nasal/sinus endoscopy, surg .............. 20.20 NA NA 9.66 11.26 1.53 010 

31299 .... ............ C ........ Sinus surgery procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

31300 .... ............ A ........ Removal of larynx lesion .................... 15.71 NA NA 14.57 14.77 1.17 090 

31320 .... ............ A ........ Diagnostic incision, larynx .................. 5.62 NA NA 10.14 10.22 0.46 090 

31360 .... ............ A ........ Removal of larynx ............................... 29.57 NA NA 20.06 18.39 1.38 090 

31365 .... ............ A ........ Removal of larynx ............................... 38.47 NA NA 22.97 21.66 1.98 090 

31367 .... ............ A ........ Partial removal of larynx ..................... 30.23 NA NA 22.50 22.19 1.79 090 

31368 .... ............ A ........ Partial removal of larynx ..................... 33.85 NA NA 24.58 25.03 2.21 090 

31370 .... ............ A ........ Partial removal of larynx ..................... 27.23 NA NA 22.13 22.19 1.75 090 


cprice-sewell on PROD1PC72 with RULES
66441 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

31375 .... ............ A ........ Partial removal of larynx ..................... 25.73 NA NA 21.14 20.75 1.63 090 

31380 .... ............ A ........ Partial removal of larynx ..................... 25.23 NA NA 20.78 20.69 1.71 090 

31382 .... ............ A ........ Partial removal of larynx ..................... 28.23 NA NA 22.68 22.14 1.68 090 

31390 .... ............ A ........ Removal of larynx & pharynx ............. 42.17 NA NA 25.96 25.16 2.24 090 

31395 .... ............ A ........ Reconstruct larynx & pharynx ............. 43.46 NA NA 28.50 28.39 2.49 090 

31400 .... ............ A ........ Revision of larynx ............................... 11.48 NA NA 12.49 13.12 0.83 090 

31420 .... ............ A ........ Removal of epiglottis .......................... 11.32 NA NA 8.58 9.06 0.83 090 

31500 .... ............ A ........ Insert emergency airway ..................... 2.33 NA NA 0.42 0.48 0.17 000 

31502 .... ............ A ........ Change of windpipe airway ................ 0.65 NA NA 0.21 0.25 0.05 000 

31505 .... ............ A ........ Diagnostic laryngoscopy ..................... 0.61 1.42 1.43 0.59 0.60 0.05 000 

31510 .... ............ A ........ Laryngoscopy with biopsy ................... 1.92 3.22 3.26 1.00 1.12 0.16 000 

31511 .... ............ A ........ Remove foreign body, larynx .............. 2.16 2.94 3.03 1.03 1.04 0.19 000 

31512 .... ............ A ........ Removal of larynx lesion .................... 2.07 2.97 3.08 1.06 1.21 0.18 000 

31513 .... ............ A ........ Injection into vocal cord ...................... 2.10 NA NA 1.08 1.27 0.17 000 

31515 .... ............ A ........ Laryngoscopy for aspiration ................ 1.80 3.19 3.37 0.88 0.97 0.14 000 

31520 .... ............ A ........ Dx laryngoscopy, newborn ................. 2.56 NA NA 1.21 1.38 0.20 000 

31525 .... ............ A ........ Dx laryngoscopy excl nb ..................... 2.63 3.45 3.54 1.23 1.44 0.21 000 

31526 .... ............ A ........ Dx laryngoscopy w/oper scope ........... 2.57 NA NA 1.25 1.48 0.21 000 

31527 .... ............ A ........ Laryngoscopy for treatment ................ 3.27 NA NA 1.40 1.63 0.26 000 

31528 .... ............ A ........ Laryngoscopy and dilation .................. 2.37 NA NA 1.09 1.27 0.19 000 

31529 .... ............ A ........ Laryngoscopy and dilation .................. 2.68 NA NA 1.25 1.48 0.22 000 

31530 .... ............ A ........ Laryngoscopy w/fb removal ................ 3.38 NA NA 1.45 1.70 0.29 000 

31531 .... ............ A ........ Laryngoscopy w/fb & op scope .......... 3.58 NA NA 1.58 1.93 0.29 000 

31535 .... ............ A ........ Laryngoscopy w/biopsy ....................... 3.16 NA NA 1.44 1.72 0.26 000 

31536 .... ............ A ........ Laryngoscopy w/bx & op scope .......... 3.55 NA NA 1.57 1.91 0.29 000 

31540 .... ............ A ........ Laryngoscopy w/exc of tumor ............. 4.12 NA NA 1.76 2.15 0.33 000 

31541 .... ............ A ........ Larynscop w/tumr exc + scope ........... 4.52 NA NA 1.89 2.34 0.37 000 

31545 .... ............ A ........ Remove vc lesion w/scope ................. 6.30 NA NA 2.51 2.99 0.37 000 

31546 .... ............ A ........ Remove vc lesion scope/graft ............ 9.73 NA NA 3.43 4.20 0.78 000 

31560 .... ............ A ........ Laryngoscop w/arytenoidectom .......... 5.45 NA NA 2.15 2.65 0.43 000 

31561 .... ............ A ........ Larynscop, remve cart + scop ............ 5.99 NA NA 2.32 2.84 0.49 000 

31570 .... ............ A ........ Laryngoscope w/vc inj ........................ 3.86 4.26 4.96 1.64 2.01 0.31 000 

31571 .... ............ A ........ Laryngoscop w/vc inj + scope ............ 4.26 NA NA 1.81 2.20 0.35 000 

31575 .... ............ A ........ Diagnostic laryngoscopy ..................... 1.10 1.69 1.80 0.76 0.82 0.09 000 

31576 .... ............ A ........ Laryngoscopy with biopsy ................... 1.97 3.52 3.59 1.04 1.16 0.14 000 

31577 .... ............ A ........ Remove foreign body, larynx .............. 2.47 3.37 3.56 1.17 1.35 0.21 000 

31578 .... ............ A ........ Removal of larynx lesion .................... 2.84 3.99 4.13 1.34 1.43 0.23 000 

31579 .... ............ A ........ Diagnostic laryngoscopy ..................... 2.26 2.86 3.32 1.15 1.31 0.18 000 

31580 .... ............ A ........ Revision of larynx ............................... 14.46 NA NA 13.82 14.86 1.00 090 

31582 .... ............ A ........ Revision of larynx ............................... 22.87 NA NA 22.55 24.16 1.76 090 

31584 .... ............ A ........ Treat larynx fracture ............................ 20.35 NA NA 15.26 16.70 1.72 090 

31587 .... ............ A ........ Revision of larynx ............................... 15.12 NA NA 8.63 8.95 0.97 090 

31588 .... ............ A ........ Revision of larynx ............................... 14.62 NA NA 12.50 13.05 1.06 090 

31590 .... ............ A ........ Reinnervate larynx .............................. 7.63 NA NA 12.78 14.15 0.84 090 

31595 .... ............ A ........ Larynx nerve surgery .......................... 8.75 NA NA 9.64 10.09 0.68 090 

31599 .... ............ C ........ Larynx surgery procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

31600 .... ............ A ........ Incision of windpipe ............................ 7.17 NA NA 2.28 2.73 0.80 000 

31601 .... ............ A ........ Incision of windpipe ............................ 4.44 NA NA 1.74 2.07 0.40 000 

31603 .... ............ A ........ Incision of windpipe ............................ 4.14 NA NA 1.19 1.45 0.44 000 

31605 .... ............ A ........ Incision of windpipe ............................ 3.57 NA NA 0.82 1.00 0.40 000 

31610 .... ............ A ........ Incision of windpipe ............................ 9.29 NA NA 7.72 7.99 0.79 090 

31611 .... ............ A ........ Surgery/speech prosthesis ................. 5.92 NA NA 7.07 7.06 0.46 090 

31612 .... ............ A ........ Puncture/clear windpipe ...................... 0.91 1.09 1.09 0.26 0.30 0.08 000 

31613 .... ............ A ........ Repair windpipe opening .................... 4.63 NA NA 6.13 6.06 0.42 090 

31614 .... ............ A ........ Repair windpipe opening .................... 8.47 NA NA 9.57 9.14 0.58 090 

31615 .... ............ A ........ Visualization of windpipe .................... 2.09 2.37 2.48 1.04 1.12 0.16 000 

31620 .... ............ A ........ Endobronchial us add-on .................... 1.40 6.01 5.83 0.33 0.44 0.11 ZZZ 

31622 .... ............ A ........ Dx bronchoscope/wash ....................... 2.78 5.23 5.44 0.90 0.98 0.18 000 

31623 .... ............ A ........ Dx bronchoscope/brush ...................... 2.88 5.97 6.20 0.89 0.97 0.13 000 

31624 .... ............ A ........ Dx bronchoscope/lavage .................... 2.88 5.33 5.55 0.89 0.97 0.13 000 

31625 .... ............ A ........ Bronchoscopy w/biopsy(s) .................. 3.36 5.48 5.64 1.01 1.11 0.18 000 

31628 .... ............ A ........ Bronchoscopy/lung bx, each ............... 3.80 6.95 6.98 1.10 1.20 0.18 000 

31629 .... ............ A ........ Bronchoscopy/needle bx, each ........... 4.09 12.00 13.12 1.17 1.28 0.16 000 

31630 .... ............ A ........ Bronchoscopy dilate/fx repr ................ 3.81 NA NA 1.27 1.49 0.32 000 

31631 .... ............ A ........ Bronchoscopy, dilate w/stent .............. 4.36 NA NA 1.42 1.59 0.34 000 

31632 .... ............ A ........ Bronchoscopy/lung bx, add’l ............... 1.03 0.85 0.83 0.24 0.27 0.18 ZZZ 

31633 .... ............ A ........ Bronchoscopy/needle bx add’l ............ 1.32 0.99 0.95 0.31 0.35 0.16 ZZZ 

31635 .... ............ A ........ Bronchoscopy w/fb removal ................ 3.67 5.19 5.65 1.13 1.28 0.24 000 

31636 .... ............ A ........ Bronchoscopy, bronch stents ............. 4.30 NA NA 1.34 1.55 0.31 000 

31637 .... ............ A ........ Bronchoscopy, stent add-on ............... 1.58 NA NA 0.41 0.48 0.13 ZZZ 

31638 .... ............ A ........ Bronchoscopy, revise stent ................. 4.88 NA NA 1.54 1.76 0.22 000 

31640 .... ............ A ........ Bronchoscopy w/tumor excise ............ 4.93 NA NA 1.53 1.80 0.46 000 


cprice-sewell on PROD1PC72 with RULES
66442 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

31641 .... ............ A ........ Bronchoscopy, treat blockage ............ 5.02 NA NA 1.49 1.68 0.35 000 

31643 .... ............ A ........ Diag bronchoscope/catheter ............... 3.49 NA NA 1.04 1.13 0.20 000 

31645 .... ............ A ........ Bronchoscopy, clear airways .............. 3.16 4.72 4.93 0.96 1.04 0.16 000 

31646 .... ............ A ........ Bronchoscopy, reclear airway ............. 2.72 4.41 4.63 0.85 0.92 0.14 000 

31656 .... ............ A ........ Bronchoscopy, inj for x-ray ................. 2.17 5.68 6.48 0.68 0.76 0.15 000 

31715 .... ............ A ........ Injection for bronchus x-ray ................ 1.11 NA NA 0.25 0.29 0.07 000 

31717 .... ............ A ........ Bronchial brush biopsy ....................... 2.12 5.84 7.04 0.72 0.75 0.14 000 

31720 .... ............ A ........ Clearance of airways .......................... 1.06 NA NA 0.27 0.30 0.07 000 

31725 .... ............ A ........ Clearance of airways .......................... 1.96 NA NA 0.41 0.49 0.14 000 

31730 .... ............ A ........ Intro, windpipe wire/tube ..................... 2.85 25.71 13.95 0.74 0.87 0.21 000 

31750 .... ............ A ........ Repair of windpipe .............................. 15.19 NA NA 17.44 17.49 1.05 090 

31755 .... ............ A ........ Repair of windpipe .............................. 17.19 NA NA 23.97 24.24 1.29 090 

31760 .... ............ A ........ Repair of windpipe .............................. 23.36 NA NA 9.77 10.24 2.95 090 

31766 .... ............ A ........ Reconstruction of windpipe ................. 31.58 NA NA 11.68 12.66 4.53 090 

31770 .... ............ A ........ Repair/graft of bronchus ..................... 23.48 NA NA 8.53 9.38 2.84 090 

31775 .... ............ A ........ Reconstruct bronchus ......................... 24.51 NA NA 9.50 10.64 3.02 090 

31780 .... ............ A ........ Reconstruct windpipe .......................... 19.70 NA NA 8.79 9.92 1.65 090 

31781 .... ............ A ........ Reconstruct windpipe .......................... 24.77 NA NA 9.66 10.89 2.25 090 

31785 .... ............ A ........ Remove windpipe lesion ..................... 18.29 NA NA 7.67 8.92 1.59 090 

31786 .... ............ A ........ Remove windpipe lesion ..................... 25.34 NA NA 9.61 11.35 3.30 090 

31800 .... ............ A ........ Repair of windpipe injury .................... 8.10 NA NA 8.67 8.95 0.79 090 

31805 .... ............ A ........ Repair of windpipe injury .................... 13.34 NA NA 6.21 6.71 1.83 090 

31820 .... ............ A ........ Closure of windpipe lesion .................. 4.58 5.85 5.76 3.26 3.45 0.38 090 

31825 .... ............ A ........ Repair of windpipe defect ................... 6.98 7.44 7.55 4.47 4.92 0.53 090 

31830 .... ............ A ........ Revise windpipe scar .......................... 4.54 5.93 5.84 3.56 3.77 0.44 090 

31899 .... ............ C ........ Airways surgical procedure ................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

32035 .... ............ A ........ Exploration of chest ............................ 11.20 NA NA 6.08 5.96 1.26 090 

32036 .... ............ A ........ Exploration of chest ............................ 12.21 NA NA 6.29 6.36 1.43 090 

32095 .... ............ A ........ Biopsy through chest wall ................... 10.06 NA NA 5.10 5.23 1.22 090 

32100 .... ............ A ........ Exploration/biopsy of chest ................. 16.08 NA NA 7.00 7.41 2.24 090 

32110 .... ............ A ........ Explore/repair chest ............................ 25.15 NA NA 9.87 10.29 3.22 090 

32120 .... ............ A ........ Re-exploration of chest ....................... 14.27 NA NA 6.78 6.92 1.63 090 

32124 .... ............ A ........ Explore chest free adhesions ............. 15.33 NA NA 6.95 7.08 1.90 090 

32140 .... ............ A ........ Removal of lung lesion(s) ................... 16.54 NA NA 7.39 7.53 1.97 090 

32141 .... ............ A ........ Remove/treat lung lesions .................. 27.10 NA NA 10.17 8.86 2.01 090 

32150 .... ............ A ........ Removal of lung lesion(s) ................... 16.70 NA NA 7.50 7.55 2.01 090 

32151 .... ............ A ........ Remove lung foreign body .................. 16.82 NA NA 7.91 7.95 2.04 090 

32160 .... ............ A ........ Open chest heart massage ................ 13.02 NA NA 5.84 5.55 1.31 090 

32200 .... ............ A ........ Drain, open, lung lesion ...................... 18.48 NA NA 8.76 8.68 2.14 090 

32201 .... ............ A ........ Drain, percut, lung lesion .................... 3.99 19.84 20.27 1.42 1.36 0.24 000 

32215 .... ............ A ........ Treat chest lining ................................ 12.93 NA NA 6.23 6.56 1.69 090 

32220 .... ............ A ........ Release of lung ................................... 26.41 NA NA 11.90 12.42 3.57 090 

32225 .... ............ A ........ Partial release of lung ......................... 16.63 NA NA 7.45 7.55 2.07 090 

32310 .... ............ A ........ Removal of chest lining ...................... 15.16 NA NA 6.92 7.15 2.00 090 

32320 .... ............ A ........ Free/remove chest lining .................... 27.04 NA NA 11.44 11.79 3.52 090 

32400 .... ............ A ........ Needle biopsy chest lining .................. 1.76 2.15 2.14 0.57 0.56 0.10 000 

32402 .... ............ A ........ Open biopsy chest lining .................... 8.89 NA NA 4.68 4.89 1.07 090 

32405 .... ............ A ........ Biopsy, lung or mediastinum .............. 1.93 0.69 0.68 0.69 0.66 0.11 000 

32420 .... ............ A ........ Puncture/clear lung ............................. 2.18 NA NA 0.71 0.69 0.12 000 

32421 .... ............ A ........ Thoracentesis for aspiration ............... 1.54 2.40 2.73 0.47 0.47 0.08 000 

32422 .... ............ A ........ Thoracentesis w/tube insert ................ 2.19 2.87 3.04 1.03 1.04 0.12 000 

32440 .... ............ A ........ Removal of lung .................................. 27.17 NA NA 10.91 11.90 3.69 090 

32442 .... ............ A ........ Sleeve pneumonectomy ..................... 56.37 NA NA 18.71 16.73 3.85 090 

32445 .... ............ A ........ Removal of lung .................................. 63.60 NA NA 22.77 18.41 3.72 090 

32480 .... ............ A ........ Partial removal of lung ........................ 25.71 NA NA 10.18 11.12 3.50 090 

32482 .... ............ A ........ Bilobectomy ......................................... 27.28 NA NA 11.08 11.99 3.67 090 

32484 .... ............ A ........ Segmentectomy .................................. 25.30 NA NA 9.56 10.47 3.04 090 

32486 .... ............ A ........ Sleeve lobectomy ................................ 42.80 NA NA 14.60 13.92 3.52 090 

32488 .... ............ A ........ Completion pneumonectomy .............. 42.83 NA NA 15.56 14.67 3.81 090 

32491 .... ............ R ........ Lung volume reduction ....................... 25.09 NA NA 10.42 11.52 2.99 090 

32500 .... ............ A ........ Partial removal of lung ........................ 24.48 NA NA 10.26 11.30 3.26 090 

32501 .... ............ A ........ Repair bronchus add-on ..................... 4.68 NA NA 1.33 1.43 0.65 ZZZ 

32503 .... ............ A ........ Resect apical lung tumor .................... 31.61 NA NA 12.08 13.57 4.38 090 

32504 .... ............ A ........ Resect apical lung tum/chest .............. 36.41 NA NA 13.46 15.06 5.09 090 

32540 .... ............ A ........ Removal of lung lesion ....................... 30.22 NA NA 11.48 10.55 2.08 090 

32550 .... ............ A ........ Insert pleural cath ............................... 4.17 14.95 17.45 1.51 1.58 0.42 000 

32551 .... ............ A ........ Insertion of chest tube ........................ 3.29 NA NA 0.97 1.16 0.43 000 

32560 .... ............ A ........ Treat lung lining chemically ................ 2.19 5.05 5.75 0.58 0.64 0.23 000 

32601 .... ............ A ........ Thoracoscopy, diagnostic ................... 5.45 NA NA 2.06 2.21 0.80 000 

32602 .... ............ A ........ Thoracoscopy, diagnostic ................... 5.95 NA NA 2.22 2.37 0.87 000 

32603 .... ............ A ........ Thoracoscopy, diagnostic ................... 7.80 NA NA 2.74 2.88 1.14 000 

32604 .... ............ A ........ Thoracoscopy, diagnostic ................... 8.77 NA NA 3.05 3.25 1.25 000 


cprice-sewell on PROD1PC72 with RULES
66443 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

32605 .... ............ A ........ Thoracoscopy, diagnostic ................... 6.92 NA NA 2.57 2.74 1.00 000 

32606 .... ............ A ........ Thoracoscopy, diagnostic ................... 8.39 NA NA 2.97 3.15 1.22 000 

32650 .... ............ A ........ Thoracoscopy, surgical ....................... 10.77 NA NA 5.24 6.00 1.58 090 

32651 .... ............ A ........ Thoracoscopy, surgical ....................... 18.70 NA NA 7.69 7.46 1.87 090 

32652 .... ............ A ........ Thoracoscopy, surgical ....................... 29.00 NA NA 11.13 10.63 2.73 090 

32653 .... ............ A ........ Thoracoscopy, surgical ....................... 18.09 NA NA 7.45 7.21 1.89 090 

32654 .... ............ A ........ Thoracoscopy, surgical ....................... 20.44 NA NA 7.95 7.74 1.63 090 

32655 .... ............ A ........ Thoracoscopy, surgical ....................... 16.09 NA NA 6.88 7.06 1.90 090 

32656 .... ............ A ........ Thoracoscopy, surgical ....................... 13.18 NA NA 5.95 6.94 1.90 090 

32657 .... ............ A ........ Thoracoscopy, surgical ....................... 12.85 NA NA 5.97 6.82 2.00 090 

32658 .... ............ A ........ Thoracoscopy, surgical ....................... 11.65 NA NA 5.50 6.42 1.70 090 

32659 .... ............ A ........ Thoracoscopy, surgical ....................... 11.86 NA NA 5.79 6.62 1.62 090 

32660 .... ............ A ........ Thoracoscopy, surgical ....................... 17.69 NA NA 7.58 8.53 2.09 090 

32661 .... ............ A ........ Thoracoscopy, surgical ....................... 13.27 NA NA 6.05 6.91 1.93 090 

32662 .... ............ A ........ Thoracoscopy, surgical ....................... 14.91 NA NA 6.63 7.73 2.18 090 

32663 .... ............ A ........ Thoracoscopy, surgical ....................... 24.56 NA NA 9.39 10.07 2.73 090 

32664 .... ............ A ........ Thoracoscopy, surgical ....................... 14.22 NA NA 5.61 6.62 2.33 090 

32665 .... ............ A ........ Thoracoscopy, surgical ....................... 21.45 NA NA 8.56 8.34 2.16 090 

32800 .... ............ A ........ Repair lung hernia .............................. 15.59 NA NA 6.92 7.16 1.99 090 

32810 .... ............ A ........ Close chest after drainage .................. 14.83 NA NA 6.97 7.24 1.94 090 

32815 .... ............ A ........ Close bronchial fistula ......................... 49.79 NA NA 18.57 14.77 3.28 090 

32820 .... ............ A ........ Reconstruct injured chest ................... 22.33 NA NA 10.56 11.36 2.53 090 

32850 .... ............ X ........ Donor pneumonectomy ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

32851 .... ............ A ........ Lung transplant, single ........................ 40.94 NA NA 20.17 23.91 5.58 090 

32852 .... ............ A ........ Lung transplant with bypass ............... 44.65 NA NA 22.56 27.85 6.02 090 

32853 .... ............ A ........ Lung transplant, double ...................... 50.11 NA NA 22.77 27.25 7.07 090 

32854 .... ............ A ........ Lung transplant with bypass ............... 53.88 NA NA 25.76 30.24 7.22 090 

32855 .... ............ C ........ Prepare donor lung, single ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

32856 .... ............ C ........ Prepare donor lung, double ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

32900 .... ............ A ........ Removal of rib(s) ................................ 23.69 NA NA 9.56 9.72 2.94 090 

32905 .... ............ A ........ Revise & repair chest wall .................. 23.17 NA NA 9.52 9.82 3.16 090 

32906 .... ............ A ........ Revise & repair chest wall .................. 29.18 NA NA 11.03 11.54 3.98 090 

32940 .... ............ A ........ Revision of lung .................................. 21.22 NA NA 8.48 8.98 2.89 090 

32960 .... ............ A ........ Therapeutic pneumothorax ................. 1.84 1.61 1.67 0.68 0.62 0.16 000 

32997 .... ............ A ........ Total lung lavage ................................ 7.31 NA NA 1.83 1.87 0.55 000 

32998 .... ............ A ........ Perq rf ablate tx, pul tumor ................. 5.68 70.18 70.18 1.98 1.98 0.36 000 

32999 .... ............ C ........ Chest surgery procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

33010 .... ............ A ........ Drainage of heart sac ......................... 2.24 NA NA 1.04 0.91 0.14 000 

33011 .... ............ A ........ Repeat drainage of heart sac ............. 2.24 NA NA 1.12 0.97 0.15 000 

33015 .... ............ A ........ Incision of heart sac ............................ 8.44 NA NA 5.15 5.05 0.65 090 

33020 .... ............ A ........ Incision of heart sac ............................ 14.87 NA NA 6.37 6.57 1.80 090 

33025 .... ............ A ........ Incision of heart sac ............................ 13.65 NA NA 5.84 6.09 1.81 090 

33030 .... ............ A ........ Partial removal of heart sac ................ 22.27 NA NA 9.11 9.31 2.84 090 

33031 .... ............ A ........ Partial removal of heart sac ................ 25.30 NA NA 9.57 9.80 3.14 090 

33050 .... ............ A ........ Removal of heart sac lesion ............... 16.85 NA NA 7.36 7.60 2.15 090 

33120 .... ............ A ........ Removal of heart lesion ...................... 27.33 NA NA 10.55 11.06 3.70 090 

33130 .... ............ A ........ Removal of heart lesion ...................... 24.05 NA NA 9.36 9.73 3.01 090 

33140 .... ............ A ........ Heart revascularize (tmr) .................... 28.26 NA NA 10.29 10.58 2.86 090 

33141 .... ............ A ........ Heart tmr w/other procedure ............... 2.54 NA NA 0.78 1.18 0.69 ZZZ 

33202 .... ............ A ........ Insert epicard eltrd, open .................... 13.15 NA NA 6.07 6.07 1.71 090 

33203 .... ............ A ........ Insert epicard eltrd, endo .................... 13.92 NA NA 6.13 6.13 1.39 090 

33206 .... ............ A ........ Insertion of heart pacemaker .............. 7.31 NA NA 5.12 4.79 0.52 090 

33207 .... ............ A ........ Insertion of heart pacemaker .............. 8.00 NA NA 5.22 4.94 0.59 090 

33208 .... ............ A ........ Insertion of heart pacemaker .............. 8.72 NA NA 5.65 5.21 0.56 090 

33210 .... ............ A ........ Insertion of heart electrode ................. 3.30 NA NA 1.66 1.45 0.18 000 

33211 .... ............ A ........ Insertion of heart electrode ................. 3.39 NA NA 1.59 1.45 0.21 000 

33212 .... ............ A ........ Insertion of pulse generator ................ 5.51 NA NA 3.70 3.53 0.43 090 

33213 .... ............ A ........ Insertion of pulse generator ................ 6.36 NA NA 4.21 3.96 0.45 090 

33214 .... ............ A ........ Upgrade of pacemaker system ........... 7.78 NA NA 5.36 5.12 0.58 090 

33215 .... ............ A ........ Reposition pacing-defib lead .............. 4.89 NA NA 3.48 3.33 0.37 090 

33216 .... ............ A ........ Insert lead pace-defib, one ................. 5.81 NA NA 4.54 4.37 0.36 090 

33217 .... ............ A ........ Insert lead pace-defib, dual ................ 5.78 NA NA 4.43 4.33 0.39 090 

33218 .... ............ A ........ Repair lead pace-defib, one ............... 5.97 NA NA 4.82 4.56 0.37 090 

33220 .... ............ A ........ Repair lead pace-defib, dual ............... 6.05 NA NA 4.78 4.52 0.37 090 

33222 .... ............ A ........ Revise pocket, pacemaker ................. 5.01 NA NA 4.30 4.29 0.42 090 

33223 .... ............ A ........ Revise pocket, pacing-defib ................ 6.49 NA NA 4.87 4.73 0.45 090 

33224 .... ............ A ........ Insert pacing lead & connect .............. 9.04 NA NA 4.90 4.45 0.54 000 

33225 .... ............ A ........ L ventric pacing lead add-on .............. 8.33 NA NA 4.35 3.80 0.45 ZZZ 

33226 .... ............ A ........ Reposition l ventric lead ..................... 8.68 NA NA 4.73 4.28 0.59 000 

33233 .... ............ A ........ Removal of pacemaker system .......... 3.33 NA NA 3.26 3.27 0.22 090 

33234 .... ............ A ........ Removal of pacemaker system .......... 7.85 NA NA 5.48 5.19 0.56 090 

33235 .... ............ A ........ Removal pacemaker electrode ........... 9.93 NA NA 7.23 7.02 0.73 090 


cprice-sewell on PROD1PC72 with RULES
66444 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

33236 .... ............ A ........ Remove electrode/thoracotomy .......... 12.64 NA NA 6.37 6.90 1.69 090 

33237 .... ............ A ........ Remove electrode/thoracotomy .......... 13.75 NA NA 8.01 7.89 1.59 090 

33238 .... ............ A ........ Remove electrode/thoracotomy .......... 15.28 NA NA 8.04 8.12 2.03 090 

33240 .... ............ A ........ Insert pulse generator ......................... 7.61 NA NA 5.25 4.91 0.41 090 

33241 .... ............ A ........ Remove pulse generator .................... 3.26 NA NA 3.00 2.98 0.18 090 

33243 .... ............ A ........ Remove eltrd/thoracotomy .................. 23.42 NA NA 10.93 11.19 2.10 090 

33244 .... ............ A ........ Remove eltrd, transven ....................... 13.84 NA NA 9.43 9.16 0.99 090 

33249 .... ............ A ........ Eltrd/insert pace-defib ......................... 15.02 NA NA 10.15 9.25 0.77 090 

33250 .... ............ A ........ Ablate heart dysrhythm focus ............. 25.78 NA NA 10.88 10.94 3.19 090 

33251 .... ............ A ........ Ablate heart dysrhythm focus ............. 28.80 NA NA 10.95 11.30 3.60 090 

33254 .... ............ A ........ Ablate atria, lmtd ................................. 23.58 NA NA 9.76 9.76 3.35 090 

33255 .... ............ A ........ Ablate atria w/o bypass, ext ............... 28.91 NA NA 11.36 11.36 3.94 090 

33256 .... ............ A ........ Ablate atria w/bypass, exten ............... 34.77 NA NA 13.11 13.11 4.95 090 

33257 .... ............ A ........ Ablate atria, lmtd, add-on ................... 9.63 NA NA 5.46 5.46 0.89 ZZZ 

33258 .... ............ A ........ Ablate atria, x10sv, add-on ................. 11.00 NA NA 5.98 5.98 1.09 ZZZ 

33259 .... ............ A ........ Ablate atria w/bypass add-on ............. 14.14 NA NA 7.79 7.79 1.78 ZZZ 

33261 .... ............ A ........ Ablate heart dysrhythm focus ............. 28.80 NA NA 11.68 11.72 3.46 090 

33265 .... ............ A ........ Ablate atria, lmtd, endo ....................... 23.58 NA NA 9.76 9.76 3.35 090 

33266 .... ............ A ........ Ablate atria, x10sv, endo .................... 32.91 NA NA 12.55 12.55 4.80 090 

33282 .... ............ A ........ Implant pat-active ht record ................ 4.70 NA NA 4.23 4.12 0.23 090 

33284 .... ............ A ........ Remove pat-active ht record .............. 3.04 NA NA 3.37 3.45 0.14 090 

33300 .... ............ A ........ Repair of heart wound ........................ 44.89 NA NA 15.05 12.14 2.66 090 

33305 .... ............ A ........ Repair of heart wound ........................ 76.85 NA NA 25.11 17.85 3.13 090 

33310 .... ............ A ........ Exploratory heart surgery ................... 20.22 NA NA 8.35 8.96 2.59 090 

33315 .... ............ A ........ Exploratory heart surgery ................... 26.05 NA NA 10.34 10.61 3.28 090 

33320 .... ............ A ........ Repair major blood vessel(s) .............. 18.46 NA NA 8.00 8.11 2.08 090 

33321 .... ............ A ........ Repair major vessel ............................ 20.71 NA NA 8.37 9.07 2.91 090 

33322 .... ............ A ........ Repair major blood vessel(s) .............. 24.30 NA NA 9.54 9.95 2.86 090 

33330 .... ............ A ........ Insert major vessel graft ..................... 25.17 NA NA 9.49 9.87 2.82 090 

33332 .... ............ A ........ Insert major vessel graft ..................... 24.46 NA NA 9.45 9.98 3.03 090 

33335 .... ............ A ........ Insert major vessel graft ..................... 33.79 NA NA 12.48 12.90 4.28 090 

33400 .... ............ A ........ Repair of aortic valve .......................... 41.37 NA NA 14.56 15.11 4.11 090 

33401 .... ............ A ........ Valvuloplasty, open ............................. 24.41 NA NA 10.27 11.88 3.57 090 

33403 .... ............ A ........ Valvuloplasty, w/cp bypass ................. 25.39 NA NA 12.52 13.41 3.55 090 

33404 .... ............ A ........ Prepare heart-aorta conduit ................ 31.25 NA NA 12.00 13.27 4.33 090 

33405 .... ............ A ........ Replacement of aortic valve ............... 41.19 NA NA 15.10 16.69 5.33 090 

33406 .... ............ A ........ Replacement of aortic valve ............... 52.55 NA NA 18.36 18.74 5.45 090 

33410 .... ............ A ........ Replacement of aortic valve ............... 46.28 NA NA 16.51 16.54 4.69 090 

33411 .... ............ A ........ Replacement of aortic valve ............... 61.94 NA NA 21.08 19.90 5.48 090 

33412 .... ............ A ........ Replacement of aortic valve ............... 43.77 NA NA 16.20 18.30 6.39 090 

33413 .... ............ A ........ Replacement of aortic valve ............... 59.74 NA NA 23.52 22.16 6.53 090 

33414 .... ............ A ........ Repair of aortic valve .......................... 39.29 NA NA 14.27 14.20 4.57 090 

33415 .... ............ A ........ Revision, subvalvular tissue ............... 37.19 NA NA 13.14 12.57 4.14 090 

33416 .... ............ A ........ Revise ventricle muscle ...................... 36.43 NA NA 13.23 13.36 4.57 090 

33417 .... ............ A ........ Repair of aortic valve .......................... 29.17 NA NA 11.69 12.65 4.10 090 

33420 .... ............ A ........ Revision of mitral valve ....................... 25.67 NA NA 9.49 9.52 1.82 090 

33422 .... ............ A ........ Revision of mitral valve ....................... 29.61 NA NA 11.35 12.50 3.94 090 

33425 .... ............ A ........ Repair of mitral valve .......................... 49.83 NA NA 17.59 15.32 4.07 090 

33426 .... ............ A ........ Repair of mitral valve .......................... 43.15 NA NA 15.74 16.43 5.03 090 

33427 .... ............ A ........ Repair of mitral valve .......................... 44.70 NA NA 15.69 17.52 6.09 090 

33430 .... ............ A ........ Replacement of mitral valve ............... 50.75 NA NA 18.55 17.91 5.10 090 

33460 .... ............ A ........ Revision of tricuspid valve .................. 44.62 NA NA 14.70 13.00 3.45 090 

33463 .... ............ A ........ Valvuloplasty, tricuspid ....................... 56.95 NA NA 19.71 16.31 3.87 090 

33463 .... ............ A ........ Valvuloplasty, tricuspid ....................... 56.95 NA NA 19.71 16.31 3.87 090 

33464 .... ............ A ........ Valvuloplasty, tricuspid ....................... 44.49 NA NA 15.83 14.67 4.15 090 

33465 .... ............ A ........ Replace tricuspid valve ....................... 50.59 NA NA 17.63 15.29 4.39 090 

33468 .... ............ A ........ Revision of tricuspid valve .................. 32.82 NA NA 15.23 14.44 4.07 090 

33470 .... ............ A ........ Revision of pulmonary valve ............... 21.32 NA NA 7.92 9.30 1.03 090 

33471 .... ............ A ........ Valvotomy, pulmonary valve ............... 22.83 NA NA 11.58 10.67 3.39 090 

33472 .... ............ A ........ Revision of pulmonary valve ............... 22.90 NA NA 8.78 10.31 3.55 090 

33474 .... ............ A ........ Revision of pulmonary valve ............... 39.27 NA NA 12.93 11.90 3.22 090 

33475 .... ............ A ........ Replacement, pulmonary valve .......... 42.27 NA NA 15.05 15.21 4.93 090 

33476 .... ............ A ........ Revision of heart chamber .................. 26.41 NA NA 10.36 11.15 2.42 090 

33478 .... ............ A ........ Revision of heart chamber .................. 27.38 NA NA 11.01 12.03 3.89 090 

33496 .... ............ A ........ Repair, prosth valve clot ..................... 29.71 NA NA 11.08 11.91 4.13 090 

33500 .... ............ A ........ Repair heart vessel fistula .................. 27.82 NA NA 11.02 11.24 3.87 090 

33501 .... ............ A ........ Repair heart vessel fistula .................. 19.43 NA NA 7.99 8.13 1.91 090 

33502 .... ............ A ........ Coronary artery correction .................. 21.69 NA NA 9.33 10.19 3.00 090 

33503 .... ............ A ........ Coronary artery graft ........................... 22.29 NA NA 12.31 11.02 1.78 090 

33504 .... ............ A ........ Coronary artery graft ........................... 25.30 NA NA 10.58 11.19 3.36 090 

33505 .... ............ A ........ Repair artery w/tunnel ......................... 38.35 NA NA 15.12 14.01 2.19 090 

33506 .... ............ A ........ Repair artery, translocation ................. 37.80 NA NA 12.69 13.62 4.66 090 


cprice-sewell on PROD1PC72 with RULES
66445 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

33507 .... ............ A ........ Repair art, intramural .......................... 31.35 NA NA 11.08 12.36 4.06 090 

33508 .... ............ A ........ Endoscopic vein harvest ..................... 0.31 NA NA 0.09 0.10 0.04 ZZZ 

33510 .... ............ A ........ CABG, vein, single .............................. 34.87 NA NA 12.90 14.61 4.41 090 

33511 .... ............ A ........ CABG, vein, two ................................. 38.34 NA NA 14.15 15.60 4.56 090 

33512 .... ............ A ........ CABG, vein, three ............................... 43.87 NA NA 15.93 16.76 4.67 090 

33513 .... ............ A ........ CABG, vein, four ................................. 45.26 NA NA 16.36 17.07 4.88 090 

33514 .... ............ A ........ CABG, vein, five ................................. 47.97 NA NA 17.33 17.69 4.77 090 

33516 .... ............ A ........ Cabg, vein, six or more ...................... 49.65 NA NA 17.95 18.37 5.13 090 

33517 .... ............ A ........ CABG, artery-vein, single ................... 3.61 NA NA 1.08 0.96 0.39 ZZZ 

33518 .... ............ A ........ CABG, artery-vein, two ....................... 7.93 NA NA 2.36 1.97 0.73 ZZZ 

33519 .... ............ A ........ CABG, artery-vein, three .................... 10.49 NA NA 3.14 2.73 1.04 ZZZ 

33521 .... ............ A ........ CABG, artery-vein, four ...................... 12.59 NA NA 3.77 3.42 1.37 ZZZ 

33522 .... ............ A ........ CABG, artery-vein, five ....................... 14.14 NA NA 4.23 4.02 1.78 ZZZ 

33523 .... ............ A ........ Cabg, art-vein, six or more ................. 16.08 NA NA 4.78 4.65 2.13 ZZZ 

33530 .... ............ A ........ Coronary artery, bypass/reop ............. 10.13 NA NA 2.95 2.43 0.88 ZZZ 

33533 .... ............ A ........ CABG, arterial, single ......................... 33.64 NA NA 12.55 14.50 4.56 090 

33534 .... ............ A ........ CABG, arterial, two ............................. 39.77 NA NA 14.73 16.22 4.70 090 

33535 .... ............ A ........ CABG, arterial, three .......................... 44.64 NA NA 16.29 17.20 5.03 090 

33536 .... ............ A ........ Cabg, arterial, four or more ................ 48.32 NA NA 17.31 17.80 5.44 090 

33542 .... ............ A ........ Removal of heart lesion ...................... 48.08 NA NA 16.88 14.93 4.38 090 

33545 .... ............ A ........ Repair of heart damage ...................... 56.93 NA NA 20.13 17.87 5.21 090 

33548 .... ............ A ........ Restore/remodel, ventricle .................. 53.96 NA NA 19.32 19.30 5.53 090 

33572 .... ............ A ........ Open coronary endarterectomy .......... 4.44 NA NA 1.31 1.38 0.65 ZZZ 

33600 .... ............ A ........ Closure of valve .................................. 30.15 NA NA 12.14 12.32 4.42 090 

33602 .... ............ A ........ Closure of valve .................................. 29.18 NA NA 11.16 11.80 3.82 090 

33606 .... ............ A ........ Anastomosis/artery-aorta .................... 31.37 NA NA 11.90 12.78 4.41 090 

33608 .... ............ A ........ Repair anomaly w/conduit .................. 31.72 NA NA 12.85 13.47 4.74 090 

33610 .... ............ A ........ Repair by enlargement ....................... 31.24 NA NA 13.54 13.57 4.56 090 

33611 .... ............ A ........ Repair double ventricle ....................... 35.49 NA NA 12.36 13.24 4.37 090 

33612 .... ............ A ........ Repair double ventricle ....................... 36.49 NA NA 14.30 14.72 5.30 090 

33615 .... ............ A ........ Repair, modified fontan ....................... 35.76 NA NA 13.78 13.46 4.32 090 

33617 .... ............ A ........ Repair single ventricle ........................ 38.96 NA NA 13.94 14.96 5.66 090 

33619 .... ............ A ........ Repair single ventricle ........................ 48.60 NA NA 17.97 19.38 6.46 090 

33641 .... ............ A ........ Repair heart septum defect ................ 29.50 NA NA 10.88 10.22 3.23 090 

33645 .... ............ A ........ Revision of heart veins ....................... 27.98 NA NA 10.66 11.21 3.79 090 

33647 .... ............ A ........ Repair heart septum defects .............. 29.37 NA NA 12.70 13.23 3.32 090 

33660 .... ............ A ........ Repair of heart defects ....................... 31.75 NA NA 11.82 12.65 4.49 090 

33665 .... ............ A ........ Repair of heart defects ....................... 34.77 NA NA 12.16 12.99 4.00 090 

33670 .... ............ A ........ Repair of heart chambers ................... 36.58 NA NA 15.62 14.39 4.65 090 

33675 .... ............ A ........ Close mult vsd .................................... 35.87 NA NA 15.74 15.74 4.95 090 

33676 .... ............ A ........ Close mult vsd w/resection ................. 36.87 NA NA 16.04 16.04 5.44 090 

33677 .... ............ A ........ Cl mult vsd w/rem pul band ................ 38.37 NA NA 16.61 16.61 5.68 090 

33681 .... ............ A ........ Repair heart septum defect ................ 32.16 NA NA 12.87 13.77 4.45 090 

33684 .... ............ A ........ Repair heart septum defect ................ 34.29 NA NA 13.28 13.45 3.39 090 

33688 .... ............ A ........ Repair heart septum defect ................ 34.67 NA NA 11.61 11.04 4.73 090 

33690 .... ............ A ........ Reinforce pulmonary artery ................ 20.20 NA NA 8.63 9.39 1.97 090 

33692 .... ............ A ........ Repair of heart defects ....................... 31.38 NA NA 19.57 16.74 4.58 090 

33694 .... ............ A ........ Repair of heart defects ....................... 35.49 NA NA 10.04 12.12 5.28 090 

33697 .... ............ A ........ Repair of heart defects ....................... 37.49 NA NA 16.93 15.90 4.09 090 

33702 .... ............ A ........ Repair of heart defects ....................... 27.11 NA NA 10.52 11.54 3.68 090 

33710 .... ............ A ........ Repair of heart defects ....................... 30.28 NA NA 11.25 12.60 4.43 090 

33720 .... ............ A ........ Repair of heart defect ......................... 27.13 NA NA 10.68 11.48 3.84 090 

33722 .... ............ A ........ Repair of heart defect ......................... 29.05 NA NA 10.60 12.22 1.30 090 

33724 .... ............ A ........ Repair venous anomaly ...................... 27.55 NA NA 10.37 10.37 4.00 090 

33726 .... ............ A ........ Repair pul venous stenosis ................ 37.04 NA NA 13.21 13.21 5.03 090 

33730 .... ............ A ........ Repair heart-vein defect(s) ................. 36.01 NA NA 12.85 13.48 5.03 090 

33732 .... ............ A ........ Repair heart-vein defect ..................... 28.80 NA NA 12.65 13.01 3.68 090 

33735 .... ............ A ........ Revision of heart chamber .................. 22.04 NA NA 11.03 9.99 1.92 090 

33736 .... ............ A ........ Revision of heart chamber .................. 24.16 NA NA 12.06 11.95 3.09 090 

33737 .... ............ A ........ Revision of heart chamber .................. 22.34 NA NA 9.12 10.02 3.25 090 

33750 .... ............ A ........ Major vessel shunt .............................. 22.06 NA NA 9.42 9.81 1.16 090 

33755 .... ............ A ........ Major vessel shunt .............................. 22.44 NA NA 7.79 8.29 3.26 090 

33762 .... ............ A ........ Major vessel shunt .............................. 22.44 NA NA 8.68 9.41 3.14 090 

33764 .... ............ A ........ Major vessel shunt & graft .................. 22.44 NA NA 8.94 9.58 3.01 090 

33766 .... ............ A ........ Major vessel shunt .............................. 23.41 NA NA 8.47 10.06 3.70 090 

33767 .... ............ A ........ Major vessel shunt .............................. 25.14 NA NA 8.50 10.11 3.82 090 

33768 .... ............ A ........ Cavopulmonary shunting .................... 8.00 NA NA 1.84 2.25 1.19 ZZZ 

33770 .... ............ A ........ Repair great vessels defect ................ 39.02 NA NA 11.91 13.29 5.74 090 

33771 .... ............ A ........ Repair great vessels defect ................ 40.58 NA NA 13.07 12.73 5.68 090 

33774 .... ............ A ........ Repair great vessels defect ................ 31.54 NA NA 12.19 13.42 4.81 090 

33775 .... ............ A ........ Repair great vessels defect ................ 32.83 NA NA 10.09 12.54 4.99 090 

33776 .... ............ A ........ Repair great vessels defect ................ 34.53 NA NA 10.24 13.02 5.09 090 


cprice-sewell on PROD1PC72 with RULES
66446 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

33777 .... ............ A ........ Repair great vessels defect ................ 33.95 NA NA 9.91 12.76 5.49 090 

33778 .... ............ A ........ Repair great vessels defect ................ 42.62 NA NA 14.91 15.90 6.20 090 

33779 .... ............ A ........ Repair great vessels defect ................ 43.15 NA NA 12.44 13.90 2.92 090 

33780 .... ............ A ........ Repair great vessels defect ................ 43.85 NA NA 13.13 16.10 3.68 090 

33781 .... ............ A ........ Repair great vessels defect ................ 43.16 NA NA 11.11 12.22 5.97 090 

33786 .... ............ A ........ Repair arterial trunk ............................ 41.74 NA NA 14.09 15.40 5.71 090 

33788 .... ............ A ........ Revision of pulmonary artery .............. 27.26 NA NA 8.24 10.09 4.03 090 

33800 .... ............ A ........ Aortic suspension ................................ 17.23 NA NA 6.82 7.46 2.46 090 

33802 .... ............ A ........ Repair vessel defect ........................... 18.24 NA NA 7.94 8.58 2.27 090 

33803 .... ............ A ........ Repair vessel defect ........................... 20.18 NA NA 6.38 8.07 3.20 090 

33813 .... ............ A ........ Repair septal defect ............................ 21.23 NA NA 8.80 9.85 3.13 090 

33814 .... ............ A ........ Repair septal defect ............................ 26.41 NA NA 10.39 11.52 3.85 090 

33820 .... ............ A ........ Revise major vessel ............................ 16.61 NA NA 6.95 7.65 2.35 090 

33822 .... ............ A ........ Revise major vessel ............................ 17.63 NA NA 5.93 7.44 2.68 090 

33824 .... ............ A ........ Revise major vessel ............................ 20.10 NA NA 8.45 9.21 2.89 090 

33840 .... ............ A ........ Remove aorta constriction .................. 21.21 NA NA 9.33 9.81 2.16 090 

33845 .... ............ A ........ Remove aorta constriction .................. 22.77 NA NA 9.37 10.36 3.22 090 

33851 .... ............ A ........ Remove aorta constriction .................. 21.85 NA NA 8.87 9.77 3.18 090 

33852 .... ............ A ........ Repair septal defect ............................ 24.28 NA NA 14.75 13.05 2.16 090 

33853 .... ............ A ........ Repair septal defect ............................ 32.35 NA NA 12.24 13.53 4.48 090 

33860 .... ............ A ........ Ascending aortic graft ......................... 59.33 NA NA 20.20 18.32 5.76 090 

33861 .... ............ A ........ Ascending aortic graft ......................... 43.94 NA NA 15.69 16.69 6.37 090 

33863 .... ............ A ........ Ascending aortic graft ......................... 58.71 NA NA 19.58 19.13 6.59 090 

33864 .... ............ A ........ Ascending aortic graft ......................... 60.00 NA NA 20.09 20.09 6.73 090 

33870 .... ............ A ........ Transverse aortic arch graft ................ 45.93 NA NA 16.27 17.32 6.62 090 

33875 .... ............ A ........ Thoracic aortic graft ............................ 35.68 NA NA 12.90 13.49 4.89 090 

33877 .... ............ A ........ Thoracoabdominal graft ...................... 68.85 NA NA 21.00 18.65 5.94 090 

33880 .... ............ A ........ Endovasc taa repr incl subcl .............. 34.48 NA NA 10.91 12.19 2.75 090 

33881 .... ............ A ........ Endovasc taa repr w/o subcl .............. 29.48 NA NA 9.66 10.80 2.33 090 

33883 .... ............ A ........ Insert endovasc prosth, taa ................ 20.99 NA NA 7.23 8.20 2.11 090 

33884 .... ............ A ........ Endovasc prosth, taa, add-on ............. 8.20 NA NA 2.08 2.33 0.86 ZZZ 

33886 .... ............ A ........ Endovasc prosth, delayed .................. 17.99 NA NA 6.33 7.28 1.80 090 

33889 .... ............ A ........ Artery transpose/endovas taa ............. 15.92 NA NA 3.98 4.58 2.18 000 

33891 .... ............ A ........ Car-car bp grft/endovas taa ................ 20.00 NA NA 5.81 6.38 2.73 000 

33910 .... ............ A ........ Remove lung artery emboli ................. 29.59 NA NA 11.34 11.38 3.70 090 

33915 .... ............ A ........ Remove lung artery emboli ................. 24.83 NA NA 9.11 9.37 1.44 090 

33916 .... ............ A ........ Surgery of great vessel ....................... 28.30 NA NA 10.82 11.07 3.67 090 

33917 .... ............ A ........ Repair pulmonary artery ..................... 25.14 NA NA 10.02 11.10 3.70 090 

33920 .... ............ A ........ Repair pulmonary atresia .................... 32.58 NA NA 9.46 11.64 4.38 090 

33922 .... ............ A ........ Transect pulmonary artery .................. 24.09 NA NA 10.24 10.57 3.10 090 

33924 .... ............ A ........ Remove pulmonary shunt ................... 5.49 NA NA 1.59 1.72 0.82 ZZZ 

33925 .... ............ A ........ Rpr pul art unifocal w/o cpb ................ 31.25 NA NA 16.42 15.54 4.61 090 

33926 .... ............ A ........ Repr pul art, unifocal w/cpb ................ 44.68 NA NA 14.79 16.23 6.22 090 

33930 .... ............ X ........ Removal of donor heart/lung .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

33933 .... ............ C ........ Prepare donor heart/lung .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

33935 .... ............ R ........ Transplantation, heart/lung ................. 61.68 NA NA 22.94 25.84 9.06 090 

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 heart ...................... 89.08 NA NA 30.37 25.87 6.26 090 

33960 .... ............ A ........ External circulation assist ................... 19.33 NA NA 5.25 5.08 2.67 000 

33961 .... ............ A ........ External circulation assist ................... 10.91 NA NA 2.98 3.30 0.88 ZZZ 

33967 .... ............ A ........ Insert ia percut device ........................ 4.84 NA NA 2.40 2.12 0.35 000 

33968 .... ............ A ........ Remove aortic assist device ............... 0.64 NA NA 0.26 0.24 0.07 000 

33970 .... ............ A ........ Aortic circulation assist ....................... 6.74 NA NA 2.53 2.41 0.82 000 

33971 .... ............ A ........ Aortic circulation assist ....................... 11.91 NA NA 6.00 6.00 1.25 090 

33973 .... ............ A ........ Insert balloon device ........................... 9.75 NA NA 3.94 3.62 1.26 000 

33974 .... ............ A ........ Remove intra-aortic balloon ................ 14.93 NA NA 7.73 7.80 1.74 090 

33975 .... ............ A ........ Implant ventricular device ................... 20.97 NA NA 6.29 6.29 3.07 XXX 

33976 .... ............ A ........ Implant ventricular device ................... 22.97 NA NA 7.66 7.60 3.26 XXX 

33977 .... ............ A ........ Remove ventricular device ................. 20.07 NA NA 9.41 10.23 2.81 090 

33978 .... ............ A ........ Remove ventricular device ................. 22.51 NA NA 10.42 11.08 3.31 090 

33979 .... ............ A ........ Insert intracorporeal device ................ 45.93 NA NA 13.28 14.09 6.97 XXX 

33980 .... ............ A ........ Remove intracorporeal device ............ 64.86 NA NA 23.06 24.14 8.59 090 

33999 .... ............ C ........ Cardiac surgery procedure ................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

34001 .... ............ A ........ Removal of artery clot ......................... 17.78 NA NA 6.36 6.53 1.85 090 

34051 .... ............ A ........ Removal of artery clot ......................... 16.91 NA NA 7.43 7.60 2.21 090 

34101 .... ............ A ........ Removal of artery clot ......................... 10.85 NA NA 4.30 4.82 1.41 090 

34111 .... ............ A ........ Removal of arm artery clot ................. 10.85 NA NA 4.28 4.82 1.40 090 

34151 .... ............ A ........ Removal of artery clot ......................... 26.41 NA NA 8.65 9.52 3.56 090 

34201 .... ............ A ........ Removal of artery clot ......................... 19.38 NA NA 6.54 5.98 1.45 090 

34203 .... ............ A ........ Removal of leg artery clot ................... 17.73 NA NA 6.38 7.21 2.36 090 

34401 .... ............ A ........ Removal of vein clot ........................... 26.41 NA NA 9.26 9.96 3.10 090 


cprice-sewell on PROD1PC72 with RULES
66447 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

34421 .... ............ A ........ Removal of vein clot ........................... 13.29 NA NA 5.19 5.74 1.55 090 

34451 .... ............ A ........ Removal of vein clot ........................... 28.41 NA NA 9.38 10.40 3.84 090 

34471 .... ............ A ........ Removal of vein clot ........................... 21.00 NA NA 7.86 6.58 1.18 090 

34490 .... ............ A ........ Removal of vein clot ........................... 10.83 NA NA 4.34 4.88 1.41 090 

34501 .... ............ A ........ Repair valve, femoral vein .................. 16.74 NA NA 6.42 7.45 2.35 090 

34502 .... ............ A ........ Reconstruct vena cava ....................... 27.86 NA NA 10.47 11.38 3.63 090 

34510 .... ............ A ........ Transposition of vein valve ................. 19.80 NA NA 7.52 8.46 2.33 090 

34520 .... ............ A ........ Cross-over vein graft .......................... 19.05 NA NA 7.01 7.73 2.29 090 

34530 .... ............ A ........ Leg vein fusion .................................... 17.77 NA NA 6.76 7.68 1.74 090 

34800 .... ............ A ........ Endovas aaa repr w/sm tube .............. 21.46 NA NA 7.25 8.20 2.46 090 

34802 .... ............ A ........ Endovas aaa repr w/2-p part .............. 23.71 NA NA 8.17 8.97 2.33 090 

34803 .... ............ A ........ Endovas aaa repr w/3-p part .............. 24.74 NA NA 8.01 9.11 2.01 090 

34804 .... ............ A ........ Endovas aaa repr w/1-p part .............. 23.71 NA NA 8.06 8.93 2.30 090 

34805 .... ............ A ........ Endovas aaa repr w/long tube ............ 22.59 NA NA 7.26 8.45 2.01 090 

34806 .... ............ A ........ Aneurysm press sensor add-on .......... 2.06 0.51 0.51 0.51 0.51 0.30 ZZZ 

34808 .... ............ A ........ Endovas iliac a device addon ............. 4.12 NA NA 1.05 1.21 0.59 ZZZ 

34812 .... ............ A ........ Xpose for endoprosth, femorl ............. 6.74 NA NA 1.66 1.95 1.18 000 

34813 .... ............ A ........ Femoral endovas graft add-on ........... 4.79 NA NA 1.16 1.36 0.67 ZZZ 

34820 .... ............ A ........ Xpose for endoprosth, iliac ................. 9.74 NA NA 2.45 2.84 1.50 000 

34825 .... ............ A ........ Endovasc extend prosth, init .............. 12.72 NA NA 5.14 5.64 1.28 090 

34826 .... ............ A ........ Endovasc exten prosth, add’l ............. 4.12 NA NA 1.14 1.25 0.44 ZZZ 

34830 .... ............ A ........ Open aortic tube prosth repr .............. 35.10 NA NA 10.33 12.01 4.55 090 

34831 .... ............ A ........ Open aortoiliac prosth repr ................. 37.85 NA NA 11.27 11.49 4.89 090 

34832 .... ............ A ........ Open aortofemor prosth repr .............. 37.85 NA NA 11.80 13.21 4.85 090 

34833 .... ............ A ........ Xpose for endoprosth, iliac ................. 11.98 NA NA 3.29 3.86 1.70 000 

34834 .... ............ A ........ Xpose, endoprosth, brachial ............... 5.34 NA NA 1.57 1.88 0.76 000 

34900 .... ............ A ........ Endovasc iliac repr w/graft ................. 16.77 NA NA 6.05 6.81 2.00 090 

35001 .... ............ A ........ Repair defect of artery ........................ 20.70 NA NA 7.70 8.62 2.81 090 

35002 .... ............ A ........ Repair artery rupture, neck ................. 22.12 NA NA 7.51 8.60 3.00 090 

35005 .... ............ A ........ Repair defect of artery ........................ 19.18 NA NA 8.52 8.68 1.77 090 

35011 .... ............ A ........ Repair defect of artery ........................ 18.50 NA NA 6.29 7.13 2.55 090 

35013 .... ............ A ........ Repair artery rupture, arm .................. 23.10 NA NA 7.76 8.71 3.10 090 

35021 .... ............ A ........ Repair defect of artery ........................ 22.09 NA NA 8.46 8.93 2.87 090 

35022 .... ............ A ........ Repair artery rupture, chest ................ 25.62 NA NA 10.57 10.21 3.17 090 

35045 .... ............ A ........ Repair defect of arm artery ................. 17.94 NA NA 6.27 6.88 2.45 090 

35081 .... ............ A ........ Repair defect of artery ........................ 33.37 NA NA 10.70 11.08 4.01 090 

35082 .... ............ A ........ Repair artery rupture, aorta ................ 41.93 NA NA 12.76 14.02 5.44 090 

35091 .... ............ A ........ Repair defect of artery ........................ 35.35 NA NA 9.99 11.77 5.14 090 

35092 .... ............ A ........ Repair artery rupture, aorta ................ 50.81 NA NA 14.50 16.06 6.40 090 

35102 .... ............ A ........ Repair defect of artery ........................ 36.37 NA NA 11.28 11.82 4.48 090 

35103 .... ............ A ........ Repair artery rupture, groin ................ 43.49 NA NA 12.63 14.23 5.76 090 

35111 .... ............ A ........ Repair defect of artery ........................ 26.17 NA NA 8.50 9.48 3.47 090 

35112 .... ............ A ........ Repair artery rupture,spleen ............... 32.44 NA NA 10.07 11.01 4.08 090 

35121 .... ............ A ........ Repair defect of artery ........................ 31.41 NA NA 9.96 11.16 4.30 090 

35122 .... ............ A ........ Repair artery rupture, belly ................. 37.76 NA NA 11.51 12.65 4.75 090 

35131 .... ............ A ........ Repair defect of artery ........................ 26.29 NA NA 8.63 9.68 3.80 090 

35132 .... ............ A ........ Repair artery rupture, groin ................ 32.44 NA NA 10.28 11.32 4.30 090 

35141 .... ............ A ........ Repair defect of artery ........................ 20.83 NA NA 6.93 7.92 2.90 090 

35142 .... ............ A ........ Repair artery rupture, thigh ................. 25.03 NA NA 8.24 9.30 3.36 090 

35151 .... ............ A ........ Repair defect of artery ........................ 23.61 NA NA 7.64 8.81 3.24 090 

35152 .... ............ A ........ Repair artery rupture, knee ................. 27.53 NA NA 9.11 10.24 3.61 090 

35180 .... ............ A ........ Repair blood vessel lesion .................. 15.01 NA NA 6.25 6.60 1.00 090 

35182 .... ............ A ........ Repair blood vessel lesion .................. 31.58 NA NA 10.82 11.81 4.36 090 

35184 .... ............ A ........ Repair blood vessel lesion .................. 18.72 NA NA 6.50 7.39 2.53 090 

35188 .... ............ A ........ Repair blood vessel lesion .................. 15.05 NA NA 6.28 6.95 2.16 090 

35189 .... ............ A ........ Repair blood vessel lesion .................. 29.85 NA NA 10.67 11.30 4.01 090 

35190 .... ............ A ........ Repair blood vessel lesion .................. 13.33 NA NA 5.23 5.85 1.80 090 

35201 .... ............ A ........ Repair blood vessel lesion .................. 16.84 NA NA 6.31 7.15 2.34 090 

35206 .... ............ A ........ Repair blood vessel lesion .................. 13.76 NA NA 5.30 5.92 1.87 090 

35207 .... ............ A ........ Repair blood vessel lesion .................. 10.85 NA NA 6.63 6.99 1.48 090 

35211 .... ............ A ........ Repair blood vessel lesion .................. 24.50 NA NA 9.70 10.15 3.20 090 

35216 .... ............ A ........ Repair blood vessel lesion .................. 36.47 NA NA 13.56 11.26 2.65 090 

35221 .... ............ A ........ Repair blood vessel lesion .................. 26.54 NA NA 8.33 9.13 3.37 090 

35226 .... ............ A ........ Repair blood vessel lesion .................. 15.22 NA NA 5.79 6.61 2.02 090 

35231 .... ............ A ........ Repair blood vessel lesion .................. 21.08 NA NA 7.72 8.74 2.89 090 

35236 .... ............ A ........ Repair blood vessel lesion .................. 17.94 NA NA 6.29 7.08 2.43 090 

35241 .... ............ A ........ Repair blood vessel lesion .................. 25.50 NA NA 10.02 10.56 3.53 090 

35246 .... ............ A ........ Repair blood vessel lesion .................. 28.15 NA NA 10.10 10.76 3.86 090 

35251 .... ............ A ........ Repair blood vessel lesion .................. 31.83 NA NA 9.45 10.61 4.13 090 

35256 .... ............ A ........ Repair blood vessel lesion .................. 18.98 NA NA 6.37 7.35 2.63 090 

35261 .... ............ A ........ Repair blood vessel lesion .................. 18.88 NA NA 6.97 7.49 2.61 090 

35266 .... ............ A ........ Repair blood vessel lesion .................. 15.75 NA NA 5.47 6.23 2.10 090 


cprice-sewell on PROD1PC72 with RULES
66448 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

35271 .... ............ A ........ Repair blood vessel lesion .................. 24.50 NA NA 9.68 10.09 3.16 090 

35276 .... ............ A ........ Repair blood vessel lesion .................. 25.72 NA NA 9.78 10.48 3.49 090 

35281 .... ............ A ........ Repair blood vessel lesion .................. 29.93 NA NA 9.28 10.48 3.97 090 

35286 .... ............ A ........ Repair blood vessel lesion .................. 17.06 NA NA 6.31 7.17 2.35 090 

35301 .... ............ A ........ Rechanneling of artery ........................ 19.53 NA NA 6.68 7.55 2.68 090 

35302 .... ............ A ........ Rechanneling of artery ........................ 21.27 NA NA 6.90 6.90 2.98 090 

35303 .... ............ A ........ Rechanneling of artery ........................ 23.52 NA NA 7.45 7.45 3.26 090 

35304 .... ............ A ........ Rechanneling of artery ........................ 24.52 NA NA 7.70 7.70 3.41 090 

35305 .... ............ A ........ Rechanneling of artery ........................ 23.52 NA NA 7.45 7.45 3.26 090 

35306 .... ............ A ........ Rechanneling of artery ........................ 9.25 NA NA 2.28 2.28 1.34 ZZZ 

35311 .... ............ A ........ Rechanneling of artery ........................ 28.52 NA NA 9.63 10.68 3.42 090 

35321 .... ............ A ........ Rechanneling of artery ........................ 16.51 NA NA 5.77 6.57 2.25 090 

35331 .... ............ A ........ Rechanneling of artery ........................ 27.61 NA NA 8.81 10.01 3.83 090 

35341 .... ............ A ........ Rechanneling of artery ........................ 26.10 NA NA 8.24 9.55 3.78 090 

35351 .... ............ A ........ Rechanneling of artery ........................ 24.53 NA NA 7.64 8.61 3.35 090 

35355 .... ............ A ........ Rechanneling of artery ........................ 19.78 NA NA 6.35 7.21 2.67 090 

35361 .... ............ A ........ Rechanneling of artery ........................ 30.11 NA NA 9.59 10.64 4.15 090 

35363 .... ............ A ........ Rechanneling of artery ........................ 32.22 NA NA 10.43 11.50 4.33 090 

35371 .... ............ A ........ Rechanneling of artery ........................ 15.23 NA NA 5.33 6.14 2.14 090 

35372 .... ............ A ........ Rechanneling of artery ........................ 18.50 NA NA 6.12 7.08 2.63 090 

35390 .... ............ A ........ Reoperation, carotid add-on ............... 3.19 NA NA 0.82 0.94 0.46 ZZZ 

35400 .... ............ A ........ Angioscopy .......................................... 3.00 NA NA 0.72 0.91 0.43 ZZZ 

35450 .... ............ A ........ Repair arterial blockage ...................... 10.05 NA NA 2.97 3.26 1.25 000 

35452 .... ............ A ........ Repair arterial blockage ...................... 6.90 NA NA 2.06 2.33 0.94 000 

35454 .... ............ A ........ Repair arterial blockage ...................... 6.03 NA NA 1.76 2.04 0.87 000 

35456 .... ............ A ........ Repair arterial blockage ...................... 7.34 NA NA 2.12 2.44 1.04 000 

35458 .... ............ A ........ Repair arterial blockage ...................... 9.48 NA NA 2.80 3.13 1.26 000 

35459 .... ............ A ........ Repair arterial blockage ...................... 8.62 NA NA 2.65 2.91 1.21 000 

35460 .... ............ A ........ Repair venous blockage ..................... 6.03 NA NA 1.74 2.01 0.83 000 

35470 .... ............ A ........ Repair arterial blockage ...................... 8.62 61.12 74.97 3.44 3.39 0.69 000 

35471 .... ............ A ........ Repair arterial blockage ...................... 10.05 65.97 83.09 4.68 4.31 0.67 000 

35472 .... ............ A ........ Repair arterial blockage ...................... 6.90 47.48 55.90 2.81 2.78 0.58 000 

35473 .... ............ A ........ Repair arterial blockage ...................... 6.03 46.50 53.15 2.49 2.46 0.51 000 

35474 .... ............ A ........ Repair arterial blockage ...................... 7.35 60.37 74.03 2.98 2.93 0.57 000 

35475 .... ............ R ........ Repair arterial blockage ...................... 9.48 48.63 52.35 3.38 3.47 0.62 000 

35476 .... ............ A ........ Repair venous blockage ..................... 6.03 37.11 40.91 2.23 2.29 0.34 000 

35480 .... ............ A ........ Atherectomy, open .............................. 11.06 NA NA 4.04 4.04 1.28 000 

35481 .... ............ A ........ Atherectomy, open .............................. 7.60 NA NA 2.57 2.72 1.13 000 

35482 .... ............ A ........ Atherectomy, open .............................. 6.64 NA NA 2.01 2.28 0.89 000 

35483 .... ............ A ........ Atherectomy, open .............................. 8.09 NA NA 2.56 2.79 1.15 000 

35484 .... ............ A ........ Atherectomy, open .............................. 10.42 NA NA 2.90 3.33 1.27 000 

35485 .... ............ A ........ Atherectomy, open .............................. 9.48 NA NA 2.87 3.20 1.35 000 

35490 .... ............ A ........ Atherectomy, percutaneous ................ 11.06 NA NA 5.17 4.93 0.71 000 

35491 .... ............ A ........ Atherectomy, percutaneous ................ 7.60 NA NA 3.85 3.57 0.74 000 

35492 .... ............ A ........ Atherectomy, percutaneous ................ 6.64 NA NA 3.48 3.34 0.43 000 

35493 .... ............ A ........ Atherectomy, percutaneous ................ 8.09 NA NA 3.96 3.88 0.56 000 

35494 .... ............ A ........ Atherectomy, percutaneous ................ 10.42 NA NA 5.15 4.80 0.59 000 

35495 .... ............ A ........ Atherectomy, percutaneous ................ 9.48 NA NA 4.45 4.42 0.69 000 

35500 .... ............ A ........ Harvest vein for bypass ...................... 6.44 NA NA 1.59 1.81 0.93 ZZZ 

35501 .... ............ A ........ Artery bypass graft .............................. 28.99 NA NA 11.06 9.75 4.10 090 

35506 .... ............ A ........ Artery bypass graft .............................. 25.23 NA NA 8.31 8.88 2.87 090 

35508 .... ............ A ........ Artery bypass graft .............................. 25.99 NA NA 8.76 9.10 2.78 090 

35509 .... ............ A ........ Artery bypass graft .............................. 27.99 NA NA 10.77 9.77 3.92 090 

35510 .... ............ A ........ Artery bypass graft .............................. 24.29 NA NA 7.69 8.93 2.12 090 

35511 .... ............ A ........ Artery bypass graft .............................. 22.12 NA NA 7.65 8.50 2.91 090 

35512 .... ............ A ........ Artery bypass graft .............................. 23.79 NA NA 7.47 8.73 2.12 090 

35515 .... ............ A ........ Artery bypass graft .............................. 25.99 NA NA 9.08 9.18 2.78 090 

35516 .... ............ A ........ Artery bypass graft .............................. 24.11 NA NA 7.45 7.12 2.34 090 

35518 .... ............ A ........ Artery bypass graft .............................. 22.57 NA NA 7.32 8.14 3.03 090 

35521 .... ............ A ........ Artery bypass graft .............................. 24.00 NA NA 7.94 8.88 3.13 090 

35522 .... ............ A ........ Artery bypass graft .............................. 23.05 NA NA 7.39 8.57 2.12 090 

35523 .... ............ A ........ Artery bypass graft .............................. 24.00 NA NA 9.20 9.20 2.14 090 

35525 .... ............ A ........ Artery bypass graft .............................. 21.59 NA NA 7.03 8.20 2.12 090 

35526 .... ............ A ........ Artery bypass graft .............................. 31.47 NA NA 14.03 13.26 3.63 090 

35531 .... ............ A ........ Artery bypass graft .............................. 38.98 NA NA 11.46 12.96 5.18 090 

35533 .... ............ A ........ Artery bypass graft .............................. 29.79 NA NA 9.49 10.60 3.85 090 

35536 .... ............ A ........ Artery bypass graft .............................. 33.60 NA NA 9.50 11.22 4.62 090 

35537 .... ............ A ........ Artery bypass graft .............................. 41.75 NA NA 13.08 13.08 5.72 090 

35538 .... ............ A ........ Artery bypass graft .............................. 46.82 NA NA 14.43 14.43 6.39 090 

35539 .... ............ A ........ Artery bypass graft .............................. 43.98 NA NA 13.46 13.46 6.02 090 

35540 .... ............ A ........ Artery bypass graft .............................. 49.20 NA NA 14.80 14.80 6.76 090 

35548 .... ............ A ........ Artery bypass graft .............................. 22.57 NA NA 7.73 8.57 2.98 090 


cprice-sewell on PROD1PC72 with RULES
66449 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

35549 .... ............ A ........ Artery bypass graft .............................. 24.34 NA NA 8.73 9.55 3.30 090 

35551 .... ............ A ........ Artery bypass graft .............................. 27.72 NA NA 9.37 10.42 3.75 090 

35556 .... ............ A ........ Artery bypass graft .............................. 26.62 NA NA 8.63 9.17 3.10 090 

35558 .... ............ A ........ Artery bypass graft .............................. 23.00 NA NA 7.86 8.70 3.00 090 

35560 .... ............ A ........ Artery bypass graft .............................. 33.90 NA NA 10.61 11.96 4.75 090 

35563 .... ............ A ........ Artery bypass graft .............................. 25.99 NA NA 8.87 9.69 3.52 090 

35565 .... ............ A ........ Artery bypass graft .............................. 25.00 NA NA 8.16 9.14 3.30 090 

35566 .... ............ A ........ Artery bypass graft .............................. 32.22 NA NA 9.84 10.61 3.83 090 

35571 .... ............ A ........ Artery bypass graft .............................. 25.39 NA NA 8.08 9.46 3.43 090 

35572 .... ............ A ........ Harvest femoropopliteal vein .............. 6.81 NA NA 1.92 2.08 0.99 ZZZ 

35583 .... ............ A ........ Vein bypass graft ................................ 27.62 NA NA 8.63 9.39 3.17 090 

35585 .... ............ A ........ Vein bypass graft ................................ 32.22 NA NA 10.10 11.15 4.02 090 

35587 .... ............ A ........ Vein bypass graft ................................ 26.08 NA NA 8.50 9.97 3.52 090 

35600 .... ............ A ........ Harvest art for cabg add-on ................ 4.94 NA NA 1.52 1.57 0.73 ZZZ 

35601 .... ............ A ........ Artery bypass graft .............................. 26.99 NA NA 10.42 9.52 3.72 090 

35606 .... ............ A ........ Artery bypass graft .............................. 22.36 NA NA 7.30 8.15 2.70 090 

35612 .... ............ A ........ Artery bypass graft .............................. 16.71 NA NA 6.31 7.09 2.09 090 

35616 .... ............ A ........ Artery bypass graft .............................. 21.74 NA NA 7.12 7.61 2.20 090 

35621 .... ............ A ........ Artery bypass graft .............................. 20.95 NA NA 6.77 7.72 2.92 090 

35623 .... ............ A ........ Bypass graft, not vein ......................... 25.79 NA NA 8.43 9.46 3.46 090 

35626 .... ............ A ........ Artery bypass graft .............................. 29.06 NA NA 10.27 11.12 4.08 090 

35631 .... ............ A ........ Artery bypass graft .............................. 35.90 NA NA 10.55 12.18 4.96 090 

35636 .... ............ A ........ Artery bypass graft .............................. 31.62 NA NA 9.71 11.00 4.10 090 

35637 .... ............ A ........ Artery bypass graft .............................. 32.92 NA NA 10.64 10.64 4.44 090 

35638 .... ............ A ........ Artery bypass graft .............................. 33.47 NA NA 10.78 10.78 4.52 090 

35642 .... ............ A ........ Artery bypass graft .............................. 18.85 NA NA 6.21 7.45 2.28 090 

35645 .... ............ A ........ Artery bypass graft .............................. 18.34 NA NA 7.97 8.12 2.50 090 

35646 .... ............ A ........ Artery bypass graft .............................. 32.84 NA NA 10.44 11.77 4.44 090 

35647 .... ............ A ........ Artery bypass graft .............................. 29.62 NA NA 9.65 10.70 3.99 090 

35650 .... ............ A ........ Artery bypass graft .............................. 20.08 NA NA 6.92 7.64 2.72 090 

35651 .... ............ A ........ Artery bypass graft .............................. 25.97 NA NA 8.70 9.71 3.36 090 

35654 .... ............ A ........ Artery bypass graft .............................. 26.17 NA NA 8.35 9.50 3.53 090 

35656 .... ............ A ........ Artery bypass graft .............................. 20.39 NA NA 6.83 7.71 2.80 090 

35661 .... ............ A ........ Artery bypass graft .............................. 20.22 NA NA 7.04 7.98 2.72 090 

35663 .... ............ A ........ Artery bypass graft .............................. 23.80 NA NA 7.89 8.93 3.11 090 

35665 .... ............ A ........ Artery bypass graft .............................. 22.22 NA NA 7.35 8.40 3.01 090 

35666 .... ............ A ........ Artery bypass graft .............................. 23.53 NA NA 8.50 9.56 3.16 090 

35671 .... ............ A ........ Artery bypass graft .............................. 20.64 NA NA 7.62 8.49 2.78 090 

35681 .... ............ A ........ Composite bypass graft ...................... 1.60 NA NA 0.40 0.47 0.23 ZZZ 

35682 .... ............ A ........ Composite bypass graft ...................... 7.19 NA NA 1.69 2.04 1.03 ZZZ 

35683 .... ............ A ........ Composite bypass graft ...................... 8.49 NA NA 1.96 2.39 1.20 ZZZ 

35685 .... ............ A ........ Bypass graft patency/patch ................ 4.04 NA NA 0.96 1.15 0.58 ZZZ 

35686 .... ............ A ........ Bypass graft/av fist patency ................ 3.34 NA NA 0.85 0.99 0.47 ZZZ 

35691 .... ............ A ........ Arterial transposition ........................... 18.32 NA NA 5.94 7.17 2.59 090 

35693 .... ............ A ........ Arterial transposition ........................... 15.64 NA NA 6.11 6.91 2.22 090 

35694 .... ............ A ........ Arterial transposition ........................... 19.19 NA NA 6.31 7.45 2.70 090 

35695 .... ............ A ........ Arterial transposition ........................... 19.97 NA NA 6.70 7.62 2.74 090 

35697 .... ............ A ........ Reimplant artery each ......................... 3.00 NA NA 0.74 0.88 0.41 ZZZ 

35700 .... ............ A ........ Reoperation, bypass graft ................... 3.08 NA NA 0.76 0.89 0.44 ZZZ 

35701 .... ............ A ........ Exploration, carotid artery ................... 9.11 NA NA 4.31 4.73 1.12 090 

35721 .... ............ A ........ Exploration, femoral artery .................. 7.66 NA NA 3.83 4.13 1.03 090 

35741 .... ............ A ........ Exploration popliteal artery ................. 8.61 NA NA 3.86 4.26 1.12 090 

35761 .... ............ A ........ Exploration of artery/vein .................... 5.84 NA NA 3.43 3.72 0.75 090 

35800 .... ............ A ........ Explore neck vessels .......................... 7.99 NA NA 3.95 4.30 0.95 090 

35820 .... ............ A ........ Explore chest vessels ......................... 36.81 NA NA 12.90 10.05 1.95 090 

35840 .... ............ A ........ Explore abdominal vessels ................. 10.87 NA NA 4.81 5.04 1.34 090 

35860 .... ............ A ........ Explore limb vessels ........................... 6.72 NA NA 3.38 3.70 0.78 090 

35870 .... ............ A ........ Repair vessel graft defect ................... 24.39 NA NA 7.91 8.84 3.01 090 

35875 .... ............ A ........ Removal of clot in graft ....................... 10.64 NA NA 4.28 4.73 1.41 090 

35876 .... ............ A ........ Removal of clot in graft ....................... 17.74 NA NA 5.94 6.72 2.40 090 

35879 .... ............ A ........ Revise graft w/vein ............................. 17.28 NA NA 5.97 6.83 2.28 090 

35881 .... ............ A ........ Revise graft w/vein ............................. 19.22 NA NA 6.46 7.56 2.56 090 

35883 .... ............ A ........ Revise graft w/nonauto graft ............... 23.07 NA NA 8.49 8.49 3.19 090 

35884 .... ............ A ........ Revise graft w/vein ............................. 24.57 NA NA 8.93 8.93 3.41 090 

35901 .... ............ A ........ Excision, graft, neck ............................ 8.26 NA NA 4.24 4.77 1.15 090 

35903 .... ............ A ........ Excision, graft, extremity ..................... 9.44 NA NA 4.60 5.37 1.30 090 

35905 .... ............ A ........ Excision, graft, thorax ......................... 33.39 NA NA 10.65 11.91 4.44 090 

35907 .... ............ A ........ Excision, graft, abdomen .................... 37.14 NA NA 10.87 12.51 4.92 090 

36000 .... ............ A ........ Place needle in vein ........................... 0.18 0.46 0.51 0.06 0.06 0.01 XXX 

36002 .... ............ A ........ Pseudoaneurysm injection trt ............. 1.96 2.24 2.55 0.85 0.91 0.17 000 

36005 .... ............ A ........ Injection ext venography ..................... 0.95 8.46 8.05 0.39 0.35 0.05 000 

36010 .... ............ A ........ Place catheter in vein ......................... 2.43 11.09 15.19 0.78 0.79 0.20 XXX 


cprice-sewell on PROD1PC72 with RULES
66450 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

36011 .... ............ A ........ Place catheter in vein ......................... 3.14 19.61 23.71 1.01 1.03 0.27 XXX 

36012 .... ............ A ........ Place catheter in vein ......................... 3.51 20.23 19.58 1.28 1.23 0.23 XXX 

36013 .... ............ A ........ Place catheter in artery ....................... 2.52 18.76 20.06 0.93 0.81 0.25 XXX 

36014 .... ............ A ........ Place catheter in artery ....................... 3.02 18.94 19.52 1.11 1.07 0.19 XXX 

36015 .... ............ A ........ Place catheter in artery ....................... 3.51 18.54 21.09 1.05 1.12 0.21 XXX 

36100 .... ............ A ........ Establish access to artery ................... 3.02 11.23 11.65 1.21 1.16 0.26 XXX 

36120 .... ............ A ........ Establish access to artery ................... 2.01 9.20 9.95 0.59 0.62 0.14 XXX 

36140 .... ............ A ........ Establish access to artery ................... 2.01 10.47 11.62 0.71 0.67 0.16 XXX 

36145 .... ............ A ........ Artery to vein shunt ............................. 2.01 10.28 11.41 0.66 0.66 0.11 XXX 

36160 .... ............ A ........ Establish access to aorta .................... 2.52 11.54 12.51 1.05 0.94 0.26 XXX 

36200 .... ............ A ........ Place catheter in aorta ........................ 3.02 13.65 15.08 1.02 1.01 0.24 XXX 

36215 .... ............ A ........ Place catheter in artery ....................... 4.67 25.94 26.48 1.89 1.75 0.27 XXX 

36216 .... ............ A ........ Place catheter in artery ....................... 5.27 28.03 28.54 2.09 1.94 0.31 XXX 

36217 .... ............ A ........ Place catheter in artery ....................... 6.29 45.85 50.63 2.43 2.30 0.44 XXX 

36218 .... ............ A ........ Place catheter in artery ....................... 1.01 3.76 4.42 0.39 0.36 0.07 ZZZ 

36245 .... ............ A ........ Place catheter in artery ....................... 4.67 28.77 30.42 2.11 1.89 0.31 XXX 

36246 .... ............ A ........ Place catheter in artery ....................... 5.27 27.41 28.68 1.99 1.91 0.38 XXX 

36247 .... ............ A ........ Place catheter in artery ....................... 6.29 45.15 47.31 2.36 2.25 0.47 XXX 

36248 .... ............ A ........ Place catheter in artery ....................... 1.01 3.17 3.61 0.38 0.36 0.07 ZZZ 

36260 .... ............ A ........ Insertion of infusion pump .................. 9.82 NA NA 4.64 4.76 1.29 090 

36261 .... ............ A ........ Revision of infusion pump .................. 5.55 NA NA 3.06 3.36 0.70 090 

36262 .... ............ A ........ Removal of infusion pump .................. 4.05 NA NA 2.71 2.73 0.54 090 

36299 .... ............ C ........ Vessel injection procedure .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

36400 .... ............ A ........ Bl draw < 3 yrs fem/jugular ................. 0.38 0.28 0.28 0.09 0.09 0.03 XXX 

36405 .... ............ A ........ Bl draw < 3 yrs scalp vein .................. 0.31 0.27 0.27 0.08 0.08 0.03 XXX 

36406 .... ............ A ........ Bl draw < 3 yrs other vein .................. 0.18 0.25 0.26 0.04 0.05 0.01 XXX 

36410 .... ............ A ........ Non-routine bl draw > 3 yrs ................ 0.18 0.32 0.30 0.05 0.05 0.01 XXX 

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 < 1 yr ............... 1.01 NA NA 0.21 0.24 0.07 XXX 

36425 .... ............ A ........ Vein access cutdown > 1 yr ............... 0.76 NA NA 0.21 0.21 0.06 XXX 

36430 .... ............ A ........ Blood transfusion service .................... 0.00 0.93 0.97 NA NA 0.06 XXX 

36440 .... ............ A ........ Bl push transfuse, 2 yr or < ................ 1.03 NA NA 0.25 0.27 0.10 XXX 

36450 .... ............ A ........ Bl exchange/transfuse, nb .................. 2.23 NA NA 0.77 0.74 0.21 XXX 

36455 .... ............ A ........ Bl exchange/transfuse non-nb ............ 2.43 NA NA 0.66 0.84 0.15 XXX 

36460 .... ............ A ........ Transfusion service, fetal .................... 6.58 NA NA 1.81 2.03 0.79 XXX 

36468 .... ............ R ........ Injection(s), spider veins ..................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

36469 .... ............ R ........ Injection(s), spider veins ..................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

36470 .... ............ A ........ Injection therapy of vein ...................... 1.09 2.41 2.54 0.64 0.68 0.12 010 

36471 .... ............ A ........ Injection therapy of veins .................... 1.60 2.56 2.82 0.79 0.87 0.19 010 

36475 .... ............ A ........ Endovenous rf, 1st vein ...................... 6.72 35.74 43.55 1.88 2.20 0.37 000 

36476 .... ............ A ........ Endovenous rf, vein add-on ................ 3.38 6.14 7.00 0.83 0.98 0.18 ZZZ 

36478 .... ............ A ........ Endovenous laser, 1st vein ................ 6.72 26.95 36.85 2.04 2.29 0.37 000 

36479 .... ............ A ........ Endovenous laser vein addon ............ 3.38 6.35 7.17 0.95 1.04 0.18 ZZZ 

36481 .... ............ A ........ Insertion of catheter, vein ................... 6.98 NA NA 2.35 2.47 0.55 000 

36500 .... ............ A ........ Insertion of catheter, vein ................... 3.51 NA NA 1.25 1.31 0.20 000 

36510 .... ............ A ........ Insertion of catheter, vein ................... 1.09 1.08 2.48 0.30 0.45 0.10 000 

36511 .... ............ A ........ Apheresis wbc ..................................... 1.74 NA NA 0.57 0.65 0.08 000 

36512 .... ............ A ........ Apheresis rbc ...................................... 1.74 NA NA 0.60 0.67 0.08 000 

36513 .... ............ A ........ Apheresis platelets .............................. 1.74 NA NA 0.55 0.64 0.17 000 

36514 .... ............ A ........ Apheresis plasma ............................... 1.74 10.49 13.73 0.53 0.62 0.08 000 

36515 .... ............ A ........ Apheresis, adsorp/reinfuse ................. 1.74 45.46 55.86 0.48 0.57 0.08 000 

36516 .... ............ A ........ Apheresis, selective ............................ 1.22 49.53 66.77 0.39 0.43 0.08 000 

36522 .... ............ A ........ Photopheresis ..................................... 1.67 37.40 34.87 0.94 0.95 0.13 000 

36555 .... ............ A ........ Insert non-tunnel cv cath .................... 2.68 3.81 4.78 0.59 0.69 0.11 000 

36556 .... ............ A ........ Insert non-tunnel cv cath .................... 2.50 2.85 4.24 0.55 0.65 0.19 000 

36557 .... ............ A ........ Insert tunneled cv cath ....................... 5.11 15.09 18.11 2.29 2.47 0.57 010 

36558 .... ............ A ........ Insert tunneled cv cath ....................... 4.81 14.84 17.93 2.35 2.45 0.57 010 

36560 .... ............ A ........ Insert tunneled cv cath ....................... 6.26 21.31 25.48 2.72 2.87 0.57 010 

36561 .... ............ A ........ Insert tunneled cv cath ....................... 6.01 22.24 25.90 2.64 2.79 0.57 010 

36563 .... ............ A ........ Insert tunneled cv cath ....................... 6.21 23.09 24.91 2.60 2.79 0.84 010 

36565 .... ............ A ........ Insert tunneled cv cath ....................... 6.01 17.51 21.10 2.47 2.71 0.57 010 

36566 .... ............ A ........ Insert tunneled cv cath ....................... 6.51 111.82 68.65 2.60 2.85 0.57 010 

36568 .... ............ A ........ Insert picc cath .................................... 1.92 5.87 6.70 0.59 0.59 0.11 000 

36569 .... ............ A ........ Insert picc cath .................................... 1.82 4.47 5.90 0.67 0.62 0.19 000 

36570 .... ............ A ........ Insert picvad cath ................................ 5.33 21.23 27.19 2.10 2.41 0.57 010 

36571 .... ............ A ........ Insert picvad cath ................................ 5.31 24.50 28.86 2.44 2.58 0.57 010 

36575 .... ............ A ........ Repair tunneled cv cath ...................... 0.67 3.30 3.67 0.23 0.25 0.20 000 

36576 .... ............ A ........ Repair tunneled cv cath ...................... 3.21 5.90 6.42 1.56 1.70 0.19 010 

36578 .... ............ A ........ Replace tunneled cv cath ................... 3.51 9.16 10.14 2.00 2.15 0.19 010 

36580 .... ............ A ........ Replace cvad cath .............................. 1.31 3.96 5.45 0.43 0.42 0.19 000 

36581 .... ............ A ........ Replace tunneled cv cath ................... 3.45 15.49 17.49 1.73 1.83 0.19 010 


cprice-sewell on PROD1PC72 with RULES
66451 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

36582 .... ............ A ........ Replace tunneled cv cath ................... 5.21 21.53 23.76 2.45 2.66 0.19 010 

36583 .... ............ A ........ Replace tunneled cv cath ................... 5.26 21.57 23.80 2.48 2.68 0.19 010 

36584 .... ............ A ........ Replace picc cath ............................... 1.20 3.96 5.47 0.61 0.58 0.19 000 

36585 .... ............ A ........ Replace picvad cath ........................... 4.81 22.54 25.17 2.42 2.58 0.19 010 

36589 .... ............ A ........ Removal tunneled cv cath .................. 2.27 1.86 2.05 1.23 1.31 0.24 010 

36590 .... ............ A ........ Removal tunneled cv cath .................. 3.32 3.62 3.49 1.59 1.65 0.44 010 

36591 .... ............ T ......... Draw blood off venous device ............ 0.00 0.54 0.54 NA NA 0.01 XXX 

36592 .... ............ T ......... Collect blood from picc ....................... 0.00 0.67 0.67 NA NA 0.01 XXX 

36593 .... ............ A ........ Declot vascular device ........................ 0.00 0.82 0.60 NA NA 0.37 XXX 

36595 .... ............ A ........ Mech remov tunneled cv cath ............ 3.59 10.83 14.04 1.38 1.41 0.21 000 

36596 .... ............ A ........ Mech remov tunneled cv cath ............ 0.75 2.57 3.13 0.43 0.47 0.05 000 

36597 .... ............ A ........ Reposition venous catheter ................ 1.21 2.04 2.22 0.46 0.45 0.07 000 

36598 .... ............ T ......... Inj w/fluor, eval cv device ................... 0.74 2.22 2.43 0.27 1.45 0.05 000 

36600 .... ............ A ........ Withdrawal of arterial blood ................ 0.32 0.50 0.49 0.07 0.08 0.02 XXX 

36620 .... ............ A ........ Insertion catheter, artery ..................... 1.15 NA NA 0.15 0.19 0.07 000 

36625 .... ............ A ........ Insertion catheter, artery ..................... 2.11 NA NA 0.50 0.52 0.26 000 

36640 .... ............ A ........ Insertion catheter, artery ..................... 2.10 NA NA 0.91 0.97 0.21 000 

36660 .... ............ A ........ Insertion catheter, artery ..................... 1.40 NA NA 0.41 0.42 0.14 000 

36680 .... ............ A ........ Insert needle, bone cavity ................... 1.20 NA NA 0.28 0.38 0.11 000 

36800 .... ............ A ........ Insertion of cannula ............................ 2.43 NA NA 1.53 1.67 0.25 000 

36810 .... ............ A ........ Insertion of cannula ............................ 3.96 NA NA 1.32 1.50 0.45 000 

36815 .... ............ A ........ Insertion of cannula ............................ 2.62 NA NA 1.04 1.10 0.35 000 

36818 .... ............ A ........ Av fuse, uppr arm, cephalic ................ 11.81 NA NA 4.49 5.26 1.90 090 

36819 .... ............ A ........ Av fuse, uppr arm, basilic ................... 14.39 NA NA 5.11 5.74 1.96 090 

36820 .... ............ A ........ Av fusion/forearm vein ........................ 14.39 NA NA 5.24 5.81 1.95 090 

36821 .... ............ A ........ Av fusion direct any site ..................... 9.15 NA NA 3.94 4.29 1.23 090 

36822 .... ............ A ........ Insertion of cannula(s) ........................ 5.51 NA NA 3.74 4.06 0.79 090 

36823 .... ............ A ........ Insertion of cannula(s) ........................ 22.82 NA NA 8.63 9.00 2.89 090 

36825 .... ............ A ........ Artery-vein autograft ........................... 10.00 NA NA 4.22 4.63 1.35 090 

36830 .... ............ A ........ Artery-vein nonautograft ..................... 12.00 NA NA 4.13 4.68 1.66 090 

36831 .... ............ A ........ Open thrombect av fistula ................... 8.01 NA NA 3.18 3.56 1.09 090 

36832 .... ............ A ........ Av fistula revision, open ...................... 10.50 NA NA 3.74 4.23 1.44 090 

36833 .... ............ A ........ Av fistula revision ................................ 11.95 NA NA 4.12 4.66 1.65 090 

36834 .... ............ A ........ Repair A-V aneurysm ......................... 11.11 NA NA 4.21 4.50 1.37 090 

36835 .... ............ A ........ Artery to vein shunt ............................. 7.43 NA NA 3.74 4.03 0.98 090 

36838 .... ............ A ........ Dist revas ligation, hemo .................... 21.59 NA NA 7.04 8.21 3.02 090 

36860 .... ............ A ........ External cannula declotting ................. 2.01 3.36 2.57 0.63 0.65 0.11 000 

36861 .... ............ A ........ Cannula declotting .............................. 2.52 NA NA 1.22 1.35 0.27 000 

36870 .... ............ A ........ Percut thrombect av fistula ................. 5.17 40.78 46.89 2.76 2.95 0.29 090 

37140 .... ............ A ........ Revision of circulation ......................... 25.12 NA NA 8.92 9.70 2.02 090 

37145 .... ............ A ........ Revision of circulation ......................... 26.13 NA NA 10.45 10.65 3.26 090 

37160 .... ............ A ........ Revision of circulation ......................... 23.13 NA NA 7.92 8.59 2.82 090 

37180 .... ............ A ........ Revision of circulation ......................... 26.13 NA NA 9.27 9.78 3.35 090 

37181 .... ............ A ........ Splice spleen/kidney veins .................. 28.26 NA NA 8.83 9.91 3.41 090 

37182 .... ............ A ........ Insert hepatic shunt (tips) ................... 16.97 NA NA 6.33 6.19 1.00 000 

37183 .... ............ A ........ Remove hepatic shunt (tips) ............... 7.99 NA NA 3.09 3.05 0.47 000 

37184 .... ............ A ........ Prim art mech thrombectomy ............. 8.66 49.91 60.78 3.23 3.29 0.55 000 

37185 .... ............ A ........ Prim art m-thrombect add-on .............. 3.28 16.38 19.62 1.12 1.11 0.21 ZZZ 

37186 .... ............ A ........ Sec art m-thrombect add-on ............... 4.92 34.90 42.13 1.79 1.72 0.32 ZZZ 

37187 .... ............ A ........ Venous mech thrombectomy .............. 8.03 48.21 59.18 2.99 3.06 0.51 000 

37188 .... ............ A ........ Venous m-thrombectomy add-on ....... 5.71 42.22 52.08 2.18 2.27 0.37 000 

37195 .... ............ C ........ Thrombolytic therapy, stroke .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

37200 .... ............ A ........ Transcatheter biopsy .......................... 4.55 NA NA 1.65 1.57 0.27 000 

37201 .... ............ A ........ Transcatheter therapy infuse .............. 4.99 NA NA 2.33 2.44 0.33 000 

37202 .... ............ A ........ Transcatheter therapy infuse .............. 5.67 NA NA 3.34 3.18 0.43 000 

37203 .... ............ A ........ Transcatheter retrieval ........................ 5.02 30.10 31.48 2.07 2.05 0.29 000 

37204 .... ............ A ........ Transcatheter occlusion ...................... 18.11 NA NA 6.23 6.07 1.48 000 

37205 .... ............ A ........ Transcath iv stent, percut ................... 8.27 108.64 56.20 3.25 3.50 0.60 000 

37206 .... ............ A ........ Transcath iv stent/perc addl ............... 4.12 66.45 33.94 1.58 1.50 0.31 ZZZ 

37207 .... ............ A ........ Transcath iv stent, open ..................... 8.27 NA NA 2.37 2.77 1.17 000 

37208 .... ............ A ........ Transcath iv stent/open addl .............. 4.12 NA NA 1.01 1.19 0.59 ZZZ 

37209 .... ............ A ........ Change iv cath at thromb tx ............... 2.27 NA NA 0.77 0.75 0.15 000 

37210 .... ............ A ........ Embolization uterine fibroid ................ 10.60 83.21 83.21 3.68 3.68 0.60 000 

37215 .... ............ R ........ Transcath stent, cca w/eps ................. 19.58 NA NA 9.93 9.51 1.09 090 

37216 .... ............ N ........ Transcath stent, cca w/o eps .............. 18.85 NA NA 5.75 7.28 1.04 090 

37250 .... ............ A ........ Iv us first vessel add-on ...................... 2.10 NA NA 0.77 0.76 0.21 ZZZ 

37251 .... ............ A ........ Iv us each add vessel add-on ............ 1.60 NA NA 0.50 0.52 0.19 ZZZ 

37500 .... ............ A ........ Endoscopy ligate perf veins ................ 11.54 NA NA 5.35 6.10 1.54 090 

37501 .... ............ C ........ Vascular endoscopy procedure .......... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

37565 .... ............ A ........ Ligation of neck vein ........................... 11.97 NA NA 5.13 5.38 1.33 090 

37600 .... ............ A ........ Ligation of neck artery ........................ 12.34 NA NA 4.91 5.77 1.41 090 

37605 .... ............ A ........ Ligation of neck artery ........................ 14.20 NA NA 5.44 6.17 1.99 090 


cprice-sewell on PROD1PC72 with RULES
66452 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

37606 .... ............ A ........ Ligation of neck artery ........................ 8.72 NA NA 4.86 4.71 1.23 090 

37607 .... ............ A ........ Ligation of a-v fistula ........................... 6.19 NA NA 3.02 3.29 0.85 090 

37609 .... ............ A ........ Temporal artery procedure ................. 3.02 4.19 4.34 1.82 1.89 0.36 010 

37615 .... ............ A ........ Ligation of neck artery ........................ 7.72 NA NA 4.09 4.10 0.68 090 

37616 .... ............ A ........ Ligation of chest artery ....................... 18.89 NA NA 7.92 8.00 2.33 090 

37617 .... ............ A ........ Ligation of abdomen artery ................. 23.71 NA NA 7.88 8.52 2.98 090 

37618 .... ............ A ........ Ligation of extremity artery ................. 5.95 NA NA 3.36 3.48 0.67 090 

37620 .... ............ A ........ Revision of major vein ........................ 11.49 NA NA 5.45 5.58 0.91 090 

37650 .... ............ A ........ Revision of major vein ........................ 8.41 NA NA 4.23 4.45 1.01 090 

37660 .... ............ A ........ Revision of major vein ........................ 22.20 NA NA 7.58 8.32 2.49 090 

37700 .... ............ A ........ Revise leg vein ................................... 3.76 NA NA 2.38 2.59 0.53 090 

37718 .... ............ A ........ Ligate/strip short leg vein .................... 7.05 NA NA 3.47 3.76 0.14 090 

37722 .... ............ A ........ Ligate/strip long leg vein ..................... 8.08 NA NA 3.68 4.04 0.86 090 

37735 .... ............ A ........ Removal of leg veins/lesion ................ 10.81 NA NA 4.68 5.09 1.48 090 

37760 .... ............ A ........ Ligation, leg veins, open ..................... 10.69 NA NA 4.48 4.91 1.44 090 

37765 .... ............ A ........ Phleb veins extrem 10–20 .................. 7.63 NA NA 3.57 4.09 0.48 090 

37766 .... ............ A ........ Phleb veins extrem 20+ ...................... 9.58 NA NA 4.13 4.72 0.48 090 

37780 .... ............ A ........ Revision of leg vein ............................ 3.87 NA NA 2.39 2.62 0.53 090 

37785 .... ............ A ........ Ligate/divide/excise vein ..................... 3.87 4.91 5.05 2.57 2.65 0.54 090 

37788 .... ............ A ........ Revascularization, penis ..................... 23.21 NA NA 12.03 10.56 2.26 090 

37790 .... ............ A ........ Penile venous occlusion ..................... 8.37 NA NA 5.15 4.76 0.59 090 

37799 .... ............ C ........ Vascular surgery procedure ................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

38100 .... ............ A ........ Removal of spleen, total ..................... 19.47 NA NA 6.84 6.50 1.92 090 

38101 .... ............ A ........ Removal of spleen, partial .................. 19.47 NA NA 6.91 6.71 2.05 090 

38102 .... ............ A ........ Removal of spleen, total ..................... 4.79 NA NA 1.23 1.43 0.63 ZZZ 

38115 .... ............ A ........ Repair of ruptured spleen ................... 21.80 NA NA 7.43 7.04 2.09 090 

38120 .... ............ A ........ Laparoscopy, splenectomy ................. 16.97 NA NA 6.92 7.15 2.25 090 

38129 .... ............ C ........ Laparoscope proc, spleen .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

38200 .... ............ A ........ Injection for spleen x-ray .................... 2.64 NA NA 1.09 0.99 0.14 000 

38204 .... ............ B ........ Bl donor search management ............ 2.00 0.46 0.46 0.46 0.46 0.06 XXX 

38205 .... ............ R ........ Harvest allogenic stem cells ............... 1.50 NA NA 0.53 0.60 0.07 000 

38206 .... ............ R ........ Harvest auto stem cells ...................... 1.50 NA NA 0.55 0.61 0.07 000 

38207 .... ............ I .......... Cryopreserve stem cells ..................... 0.89 0.40 0.40 0.40 0.40 0.01 XXX 

38208 .... ............ I .......... Thaw preserved stem cells ................. 0.56 0.25 0.25 0.25 0.25 0.02 XXX 

38209 .... ............ I .......... Wash harvest stem cells ..................... 0.24 0.11 0.11 0.11 0.11 0.01 XXX 

38210 .... ............ I .......... T-cell depletion of harvest .................. 1.57 0.71 0.71 0.71 0.71 0.03 XXX 

38211 .... ............ I .......... Tumor cell deplete of harvst ............... 1.42 0.64 0.64 0.64 0.64 0.02 XXX 

38212 .... ............ I .......... Rbc depletion of harvest ..................... 0.94 0.42 0.42 0.42 0.42 0.02 XXX 

38213 .... ............ I .......... Platelet deplete of harvest .................. 0.24 0.11 0.11 0.11 0.11 0.01 XXX 

38214 .... ............ I .......... Volume deplete of harvest .................. 0.81 0.36 0.36 0.36 0.36 0.01 XXX 

38215 .... ............ I .......... Harvest stem cell concentrte .............. 0.94 0.42 0.42 0.42 0.42 0.02 XXX 

38220 .... ............ A ........ Bone marrow aspiration ...................... 1.08 2.67 3.20 0.45 0.48 0.05 XXX 

38221 .... ............ A ........ Bone marrow biopsy ........................... 1.37 2.78 3.36 0.57 0.61 0.07 XXX 

38230 .... ............ R ........ Bone marrow collection ...................... 4.80 NA NA 3.13 3.17 0.48 010 

38240 .... ............ R ........ Bone marrow/stem transplant ............. 2.24 NA NA 0.93 0.98 0.11 XXX 

38241 .... ............ R ........ Bone marrow/stem transplant ............. 2.24 NA NA 0.94 0.99 0.11 XXX 

38242 .... ............ A ........ Lymphocyte infuse transplant ............. 1.71 NA NA 0.67 0.72 0.08 000 

38300 .... ............ A ........ Drainage, lymph node lesion .............. 2.28 4.22 4.26 2.03 2.04 0.25 010 

38305 .... ............ A ........ Drainage, lymph node lesion .............. 6.55 NA NA 4.20 4.32 0.88 090 

38308 .... ............ A ........ Incision of lymph channels ................. 6.73 NA NA 3.54 3.64 0.85 090 

38380 .... ............ A ........ Thoracic duct procedure ..................... 8.34 NA NA 5.05 5.37 0.74 090 

38381 .... ............ A ........ Thoracic duct procedure ..................... 13.32 NA NA 6.07 6.47 1.85 090 

38382 .... ............ A ........ Thoracic duct procedure ..................... 10.51 NA NA 5.43 5.59 1.37 090 

38500 .... ............ A ........ Biopsy/removal, lymph nodes ............. 3.76 3.75 3.72 2.02 2.05 0.49 010 

38505 .... ............ A ........ Needle biopsy, lymph nodes .............. 1.14 2.11 2.08 0.73 0.76 0.09 000 

38510 .... ............ A ........ Biopsy/removal, lymph nodes ............. 6.69 5.38 5.46 3.08 3.28 0.72 010 

38520 .... ............ A ........ Biopsy/removal, lymph nodes ............. 6.95 NA NA 3.75 3.90 0.84 090 

38525 .... ............ A ........ Biopsy/removal, lymph nodes ............. 6.35 NA NA 3.47 3.38 0.80 090 

38530 .... ............ A ........ Biopsy/removal, lymph nodes ............. 8.26 NA NA 4.12 4.25 1.12 090 

38542 .... ............ A ........ Explore deep node(s), neck ................ 6.08 NA NA 3.96 4.22 0.60 090 

38550 .... ............ A ........ Removal, neck/armpit lesion ............... 6.99 NA NA 4.28 4.09 0.88 090 

38555 .... ............ A ........ Removal, neck/armpit lesion ............... 15.42 NA NA 7.45 7.98 1.76 090 

38562 .... ............ A ........ Removal, pelvic lymph nodes ............. 10.92 NA NA 5.76 5.76 1.20 090 

38564 .... ............ A ........ Removal, abdomen lymph nodes ....... 11.29 NA NA 5.20 5.22 1.32 090 

38570 .... ............ A ........ Laparoscopy, lymph node biop ........... 9.28 NA NA 4.03 4.00 1.13 010 

38571 .... ............ A ........ Laparoscopy, lymphadenectomy ........ 14.70 NA NA 6.79 6.22 1.15 010 

38572 .... ............ A ........ Laparoscopy, lymphadenectomy ........ 16.86 NA NA 5.93 6.50 1.91 010 

38589 .... ............ C ........ Laparoscope proc, lymphatic .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

38700 .... ............ A ........ Removal of lymph nodes, neck .......... 12.68 NA NA 6.51 6.37 0.72 090 

38720 .... ............ A ........ Removal of lymph nodes, neck .......... 21.72 NA NA 10.16 9.76 1.20 090 

38724 .... ............ A ........ Removal of lymph nodes, neck .......... 23.72 NA NA 10.92 10.37 1.28 090 

38740 .... ............ A ........ Remove armpit lymph nodes .............. 10.57 NA NA 5.00 4.96 1.32 090 


cprice-sewell on PROD1PC72 with RULES
66453 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

38745 .... ............ A ........ Remove armpit lymph nodes .............. 13.71 NA NA 6.04 6.06 1.74 090 

38746 .... ............ A ........ Remove thoracic lymph nodes ........... 4.88 NA NA 1.42 1.51 0.72 ZZZ 

38747 .... ............ A ........ Remove abdominal lymph nodes ....... 4.88 NA NA 1.26 1.46 0.64 ZZZ 

38760 .... ............ A ........ Remove groin lymph nodes ................ 13.49 NA NA 5.91 6.02 1.72 090 

38765 .... ............ A ........ Remove groin lymph nodes ................ 21.78 NA NA 8.34 8.57 2.48 090 

38770 .... ............ A ........ Remove pelvis lymph nodes ............... 13.98 NA NA 6.71 6.22 1.40 090 

38780 .... ............ A ........ Remove abdomen lymph nodes ......... 17.56 NA NA 7.98 8.08 1.89 090 

38790 .... ............ A ........ Inject for lymphatic x-ray ..................... 1.29 NA NA 0.75 0.75 0.13 000 

38792 .... ............ A ........ Identify sentinel node .......................... 0.52 NA NA 0.49 0.46 0.06 000 

38794 .... ............ A ........ Access thoracic lymph duct ................ 4.51 NA NA 3.17 3.31 0.32 090 

38999 .... ............ C ........ Blood/lymph system procedure .......... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

39000 .... ............ A ........ Exploration of chest ............................ 7.49 NA NA 4.27 4.46 0.89 090 

39010 .... ............ A ........ Exploration of chest ............................ 13.11 NA NA 6.33 6.93 1.76 090 

39200 .... ............ A ........ Removal chest lesion .......................... 15.04 NA NA 6.19 6.86 2.03 090 

39220 .... ............ A ........ Removal chest lesion .......................... 19.47 NA NA 7.99 8.67 2.46 090 

39400 .... ............ A ........ Visualization of chest .......................... 8.00 NA NA 4.15 4.50 0.82 010 

39499 .... ............ C ........ Chest procedure ................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

39501 .... ............ A ........ Repair diaphragm laceration ............... 13.89 NA NA 5.81 6.13 1.78 090 

39502 .... ............ A ........ Repair paraesophageal hernia ........... 17.09 NA NA 6.58 6.86 2.17 090 

39503 .... ............ A ........ Repair of diaphragm hernia ................ 108.67 NA NA 27.38 30.37 10.98 090 

39520 .... ............ A ........ Repair of diaphragm hernia ................ 16.63 NA NA 6.79 7.41 2.24 090 

39530 .... ............ A ........ Repair of diaphragm hernia ................ 16.22 NA NA 6.23 6.68 2.11 090 

39531 .... ............ A ........ Repair of diaphragm hernia ................ 17.23 NA NA 6.58 6.98 2.22 090 

39540 .... ............ A ........ Repair of diaphragm hernia ................ 14.51 NA NA 5.70 5.96 1.80 090 

39541 .... ............ A ........ Repair of diaphragm hernia ................ 15.67 NA NA 6.06 6.32 1.93 090 

39545 .... ............ A ........ Revision of diaphragm ........................ 14.58 NA NA 6.92 7.23 1.84 090 

39560 .... ............ A ........ Resect diaphragm, simple .................. 12.97 NA NA 5.52 5.90 1.59 090 

39561 .... ............ A ........ Resect diaphragm, complex ............... 19.75 NA NA 9.31 9.32 2.45 090 

39599 .... ............ C ........ Diaphragm surgery procedure ............ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

40490 .... ............ A ........ Biopsy of lip ........................................ 1.22 2.08 1.85 0.57 0.59 0.05 000 

40500 .... ............ A ........ Partial excision of lip ........................... 4.35 7.90 7.40 4.36 4.34 0.38 090 

40510 .... ............ A ........ Partial excision of lip ........................... 4.74 6.73 6.67 3.62 3.81 0.49 090 

40520 .... ............ A ........ Partial excision of lip ........................... 4.71 6.99 7.26 3.81 3.96 0.52 090 

40525 .... ............ A ........ Reconstruct lip with flap ...................... 7.61 NA NA 5.33 5.81 0.85 090 

40527 .... ............ A ........ Reconstruct lip with flap ...................... 9.20 NA NA 6.13 6.74 0.97 090 

40530 .... ............ A ........ Partial removal of lip ........................... 5.45 7.58 7.69 4.26 4.42 0.55 090 

40650 .... ............ A ........ Repair lip ............................................. 3.69 5.98 6.38 3.16 3.23 0.38 090 

40652 .... ............ A ........ Repair lip ............................................. 4.32 7.25 7.49 4.11 4.18 0.52 090 

40654 .... ............ A ........ Repair lip ............................................. 5.37 8.08 8.34 4.68 4.80 0.60 090 

40700 .... ............ A ........ Repair cleft lip/nasal ........................... 13.97 NA NA 8.65 8.86 0.95 090 

40701 .... ............ A ........ Repair cleft lip/nasal ........................... 17.03 NA NA 7.81 9.56 1.65 090 

40702 .... ............ A ........ Repair cleft lip/nasal ........................... 14.09 NA NA 5.81 7.03 1.23 090 

40720 .... ............ A ........ Repair cleft lip/nasal ........................... 14.54 NA NA 9.52 9.70 1.80 090 

40761 .... ............ A ........ Repair cleft lip/nasal ........................... 15.69 NA NA 9.28 9.77 1.94 090 

40799 .... ............ C ........ Lip surgery procedure ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

40800 .... ............ A ........ Drainage of mouth lesion .................... 1.19 3.84 3.40 1.88 1.83 0.13 010 

40801 .... ............ A ........ Drainage of mouth lesion .................... 2.57 4.88 4.45 2.58 2.66 0.31 010 

40804 .... ............ A ........ Removal, foreign body, mouth ............ 1.26 3.78 3.59 1.83 1.84 0.11 010 

40805 .... ............ A ........ Removal, foreign body, mouth ............ 2.73 5.13 4.80 2.65 2.73 0.32 010 

40806 .... ............ A ........ Incision of lip fold ................................ 0.31 2.43 2.13 0.51 0.50 0.04 000 

40808 .... ............ A ........ Biopsy of mouth lesion ....................... 0.98 3.60 3.13 1.62 1.55 0.10 010 

40810 .... ............ A ........ Excision of mouth lesion ..................... 1.33 3.68 3.28 1.72 1.69 0.13 010 

40812 .... ............ A ........ Excise/repair mouth lesion .................. 2.33 4.54 4.13 2.28 2.34 0.28 010 

40814 .... ............ A ........ Excise/repair mouth lesion .................. 3.45 5.69 5.31 3.69 3.79 0.41 090 

40816 .... ............ A ........ Excision of mouth lesion ..................... 3.70 5.90 5.53 3.77 3.88 0.40 090 

40818 .... ............ A ........ Excise oral mucosa for graft ............... 2.72 5.82 5.49 3.74 3.85 0.21 090 

40819 .... ............ A ........ Excise lip or cheek fold ....................... 2.45 4.93 4.50 3.10 3.10 0.29 090 

40820 .... ............ A ........ Treatment of mouth lesion .................. 1.30 5.30 4.61 2.94 2.69 0.11 010 

40830 .... ............ A ........ Repair mouth laceration ...................... 1.78 4.04 3.88 2.00 2.05 0.19 010 

40831 .... ............ A ........ Repair mouth laceration ...................... 2.50 5.24 4.94 2.70 2.87 0.30 010 

40840 .... ............ R ........ Reconstruction of mouth ..................... 9.03 10.01 9.90 5.58 6.27 1.08 090 

40842 .... ............ R ........ Reconstruction of mouth ..................... 9.03 10.20 10.13 5.72 6.25 1.08 090 

40843 .... ............ R ........ Reconstruction of mouth ..................... 12.62 11.33 11.63 5.74 6.77 1.39 090 

40844 .... ............ R ........ Reconstruction of mouth ..................... 16.57 15.21 15.48 9.11 10.33 2.00 090 

40845 .... ............ R ........ Reconstruction of mouth ..................... 19.13 16.02 16.54 10.21 11.71 2.01 090 

40899 .... ............ C ........ Mouth surgery procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

41000 .... ............ A ........ Drainage of mouth lesion .................... 1.32 2.55 2.43 1.33 1.37 0.12 010 

41005 .... ............ A ........ Drainage of mouth lesion .................... 1.28 4.32 3.83 1.77 1.74 0.12 010 

41006 .... ............ A ........ Drainage of mouth lesion .................... 3.28 5.43 5.11 2.82 2.99 0.35 090 

41007 .... ............ A ........ Drainage of mouth lesion .................... 3.14 5.34 5.24 2.72 2.87 0.31 090 

41008 .... ............ A ........ Drainage of mouth lesion .................... 3.40 5.51 5.09 2.84 3.02 0.42 090 

41009 .... ............ A ........ Drainage of mouth lesion .................... 3.63 5.83 5.40 3.14 3.35 0.47 090 


cprice-sewell on PROD1PC72 with RULES
66454 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

41010 .... ............ A ........ Incision of tongue fold ......................... 1.08 3.90 3.66 1.56 1.58 0.07 010 

41015 .... ............ A ........ Drainage of mouth lesion .................... 4.00 6.29 5.84 3.98 4.06 0.46 090 

41016 .... ............ A ........ Drainage of mouth lesion .................... 4.11 6.22 5.92 4.07 4.14 0.53 090 

41017 .... ............ A ........ Drainage of mouth lesion .................... 4.11 6.37 6.00 4.12 4.21 0.53 090 

41018 .... ............ A ........ Drainage of mouth lesion .................... 5.14 6.75 6.44 4.48 4.52 0.68 090 

41019 .... ............ A ........ Place needles h&n for rt ..................... 8.84 NA NA 3.28 3.28 0.59 000 

41100 .... ............ A ........ Biopsy of tongue ................................. 1.39 2.68 2.55 1.17 1.29 0.15 010 

41105 .... ............ A ........ Biopsy of tongue ................................. 1.44 2.67 2.49 1.20 1.26 0.13 010 

41108 .... ............ A ........ Biopsy of floor of mouth ...................... 1.07 2.52 2.30 1.08 1.10 0.10 010 

41110 .... ............ A ........ Excision of tongue lesion .................... 1.53 3.65 3.32 1.64 1.64 0.13 010 

41112 .... ............ A ........ Excision of tongue lesion .................... 2.77 5.26 4.86 3.24 3.23 0.28 090 

41113 .... ............ A ........ Excision of tongue lesion .................... 3.23 5.51 5.12 3.39 3.43 0.34 090 

41114 .... ............ A ........ Excision of tongue lesion .................... 8.71 NA NA 6.30 6.74 0.83 090 

41115 .... ............ A ........ Excision of tongue fold ....................... 1.76 4.18 3.74 1.72 1.79 0.18 010 

41116 .... ............ A ........ Excision of mouth lesion ..................... 2.47 5.56 4.95 2.80 2.80 0.23 090 

41120 .... ............ A ........ Partial removal of tongue .................... 10.91 NA NA 14.32 14.81 0.79 090 

41130 .... ............ A ........ Partial removal of tongue .................... 15.51 NA NA 15.88 16.03 0.93 090 

41135 .... ............ A ........ Tongue and neck surgery ................... 29.83 NA NA 21.84 22.53 1.89 090 

41140 .... ............ A ........ Removal of tongue .............................. 28.81 NA NA 23.56 25.11 2.27 090 

41145 .... ............ A ........ Tongue removal, neck surgery ........... 37.59 NA NA 28.79 29.66 2.55 090 

41150 .... ............ A ........ Tongue, mouth, jaw surgery ............... 29.52 NA NA 23.02 23.86 1.95 090 

41153 .... ............ A ........ Tongue, mouth, neck surgery ............. 33.28 NA NA 23.92 24.46 2.01 090 

41155 .... ............ A ........ Tongue, jaw, & neck surgery .............. 43.96 NA NA 27.59 27.19 2.34 090 

41250 .... ............ A ........ Repair tongue laceration ..................... 1.93 3.86 3.30 1.61 1.39 0.18 010 

41251 .... ............ A ........ Repair tongue laceration ..................... 2.29 3.48 3.38 1.78 1.66 0.22 010 

41252 .... ............ A ........ Repair tongue laceration ..................... 2.99 4.59 4.24 2.12 2.19 0.29 010 

41500 .... ............ A ........ Fixation of tongue ............................... 3.74 NA NA 7.52 7.48 0.30 090 

41510 .... ............ A ........ Tongue to lip surgery .......................... 3.45 NA NA 6.47 7.20 0.20 090 

41520 .... ............ A ........ Reconstruction, tongue fold ................ 2.77 5.80 5.21 3.26 3.44 0.27 090 

41599 .... ............ C ........ Tongue and mouth surgery ................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

41800 .... ............ A ........ Drainage of gum lesion ....................... 1.21 4.80 3.69 2.12 1.70 0.12 010 

41805 .... ............ A ........ Removal foreign body, gum ................ 1.28 4.64 3.65 2.70 2.46 0.13 010 

41806 .... ............ A ........ Removal foreign body,jawbone .......... 2.73 5.82 4.70 3.34 3.19 0.37 010 

41820 .... ............ R ........ Excision, gum, each quadrant ............ 0.00 0.00 0.00 0.00 0.00 0.00 000 

41821 .... ............ R ........ Excision of gum flap ........................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

41822 .... ............ R ........ Excision of gum lesion ........................ 2.35 4.80 4.34 1.85 1.86 0.31 010 

41823 .... ............ R ........ Excision of gum lesion ........................ 3.63 6.45 6.01 3.73 3.87 0.47 090 

41825 .... ............ A ........ Excision of gum lesion ........................ 1.35 3.69 3.37 1.46 1.85 0.15 010 

41826 .... ............ A ........ Excision of gum lesion ........................ 2.35 5.09 3.76 2.57 2.34 0.30 010 

41827 .... ............ A ........ Excision of gum lesion ........................ 3.72 6.64 6.08 3.38 3.52 0.35 090 

41828 .... ............ R ........ Excision of gum lesion ........................ 3.11 4.09 3.94 1.64 2.30 0.44 010 

41830 .... ............ R ........ Removal of gum tissue ....................... 3.38 5.98 5.47 3.11 3.37 0.44 010 

41850 .... ............ R ........ Treatment of gum lesion ..................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

41870 .... ............ R ........ Gum graft ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 000 

41872 .... ............ R ........ Repair gum ......................................... 2.90 6.04 5.53 3.30 3.38 0.30 090 

41874 .... ............ R ........ Repair tooth socket ............................. 3.13 5.66 5.25 2.72 2.94 0.45 090 

41899 .... ............ C ........ Dental surgery procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

42000 .... ............ A ........ Drainage mouth roof lesion ................ 1.25 2.48 2.52 1.20 1.22 0.12 010 

42100 .... ............ A ........ Biopsy roof of mouth ........................... 1.33 2.27 2.18 1.26 1.31 0.13 010 

42104 .... ............ A ........ Excision lesion, mouth roof ................. 1.66 3.57 3.06 1.67 1.60 0.16 010 

42106 .... ............ A ........ Excision lesion, mouth roof ................. 2.12 4.45 3.83 2.07 2.25 0.25 010 

42107 .... ............ A ........ Excision lesion, mouth roof ................. 4.48 6.53 6.12 3.69 3.82 0.44 090 

42120 .... ............ A ........ Remove palate/lesion ......................... 11.70 NA NA 12.28 12.02 0.52 090 

42140 .... ............ A ........ Excision of uvula ................................. 1.65 4.58 4.15 2.11 2.10 0.13 090 

42145 .... ............ A ........ Repair palate, pharynx/uvula .............. 9.63 NA NA 7.48 7.48 0.65 090 

42160 .... ............ A ........ Treatment mouth roof lesion ............... 1.82 3.77 4.01 1.69 1.99 0.17 010 

42180 .... ............ A ........ Repair palate ....................................... 2.52 3.37 3.22 1.86 1.98 0.21 010 

42182 .... ............ A ........ Repair palate ....................................... 3.84 3.99 3.93 2.39 2.71 0.40 010 

42200 .... ............ A ........ Reconstruct cleft palate ...................... 12.41 NA NA 8.62 9.41 1.27 090 

42205 .... ............ A ........ Reconstruct cleft palate ...................... 13.57 NA NA 7.36 8.71 1.58 090 

42210 .... ............ A ........ Reconstruct cleft palate ...................... 14.91 NA NA 10.24 10.84 2.17 090 

42215 .... ............ A ........ Reconstruct cleft palate ...................... 8.88 NA NA 7.41 8.24 1.31 090 

42220 .... ............ A ........ Reconstruct cleft palate ...................... 7.07 NA NA 7.21 6.99 0.73 090 

42225 .... ............ A ........ Reconstruct cleft palate ...................... 9.66 NA NA 12.23 14.64 0.86 090 

42226 .... ............ A ........ Lengthening of palate ......................... 10.24 NA NA 11.89 13.29 1.01 090 

42227 .... ............ A ........ Lengthening of palate ......................... 9.81 NA NA 11.20 13.37 0.98 090 

42235 .... ............ A ........ Repair palate ....................................... 7.92 NA NA 10.34 11.09 0.72 090 

42260 .... ............ A ........ Repair nose to lip fistula ..................... 10.10 9.73 9.96 6.02 6.54 1.26 090 

42280 .... ............ A ........ Preparation, palate mold ..................... 1.56 2.23 2.10 0.83 0.98 0.19 010 

42281 .... ............ A ........ Insertion, palate prosthesis ................. 1.95 3.03 2.83 1.69 1.78 0.17 010 

42299 .... ............ C ........ Palate/uvula surgery ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

42300 .... ............ A ........ Drainage of salivary gland .................. 1.95 3.13 2.98 1.74 1.77 0.16 010 


cprice-sewell on PROD1PC72 with RULES
66455 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

42305 .... ............ A ........ Drainage of salivary gland .................. 6.23 NA NA 3.99 4.35 0.51 090 

42310 .... ............ A ........ Drainage of salivary gland .................. 1.58 2.29 2.28 1.39 1.46 0.13 010 

42320 .... ............ A ........ Drainage of salivary gland .................. 2.37 3.74 3.50 1.88 1.99 0.21 010 

42330 .... ............ A ........ Removal of salivary stone .................. 2.23 3.41 3.27 1.73 1.79 0.19 010 

42335 .... ............ A ........ Removal of salivary stone .................. 3.35 5.77 5.33 2.85 2.99 0.29 090 

42340 .... ............ A ........ Removal of salivary stone .................. 4.64 6.70 6.37 3.48 3.70 0.42 090 

42400 .... ............ A ........ Biopsy of salivary gland ...................... 0.78 2.00 1.82 0.65 0.68 0.06 000 

42405 .... ............ A ........ Biopsy of salivary gland ...................... 3.31 3.96 3.98 2.15 2.30 0.28 010 

42408 .... ............ A ........ Excision of salivary cyst ...................... 4.58 6.41 6.16 3.27 3.44 0.45 090 

42409 .... ............ A ........ Drainage of salivary cyst .................... 2.85 5.31 4.91 2.53 2.65 0.27 090 

42410 .... ............ A ........ Excise parotid gland/lesion ................. 9.46 NA NA 5.36 5.79 0.91 090 

42415 .... ............ A ........ Excise parotid gland/lesion ................. 17.99 NA NA 8.62 9.74 1.43 090 

42420 .... ............ A ........ Excise parotid gland/lesion ................. 20.87 NA NA 9.56 10.97 1.65 090 

42425 .... ............ A ........ Excise parotid gland/lesion ................. 13.31 NA NA 6.83 7.72 1.05 090 

42426 .... ............ A ........ Excise parotid gland/lesion ................. 22.54 NA NA 10.00 11.50 1.81 090 

42440 .... ............ A ........ Excise submaxillary gland .................. 7.05 NA NA 3.86 4.32 0.59 090 

42450 .... ............ A ........ Excise sublingual gland ...................... 4.66 6.38 6.14 4.02 4.14 0.42 090 

42500 .... ............ A ........ Repair salivary duct ............................ 4.34 6.11 5.90 3.86 4.02 0.41 090 

42505 .... ............ A ........ Repair salivary duct ............................ 6.23 7.27 7.19 4.71 5.04 0.55 090 

42507 .... ............ A ........ Parotid duct diversion ......................... 6.16 NA NA 6.33 6.43 0.49 090 

42508 .... ............ A ........ Parotid duct diversion ......................... 9.22 NA NA 8.07 8.20 1.04 090 

42509 .... ............ A ........ Parotid duct diversion ......................... 11.65 NA NA 8.91 9.55 0.93 090 

42510 .... ............ A ........ Parotid duct diversion ......................... 8.26 NA NA 6.89 7.34 0.66 090 

42550 .... ............ A ........ Injection for salivary x-ray ................... 1.25 2.28 2.74 0.44 0.43 0.07 000 

42600 .... ............ A ........ Closure of salivary fistula .................... 4.86 6.57 6.57 3.42 3.77 0.43 090 

42650 .... ............ A ........ Dilation of salivary duct ....................... 0.77 1.28 1.19 0.66 0.68 0.07 000 

42660 .... ............ A ........ Dilation of salivary duct ....................... 1.13 1.46 1.40 0.75 0.80 0.09 000 

42665 .... ............ A ........ Ligation of salivary duct ...................... 2.57 5.00 4.58 2.40 2.49 0.23 090 

42699 .... ............ C ........ Salivary surgery procedure ................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

42700 .... ............ A ........ Drainage of tonsil abscess ................. 1.64 2.97 2.81 1.65 1.67 0.13 010 

42720 .... ............ A ........ Drainage of throat abscess ................. 6.31 4.69 4.76 3.17 3.48 0.44 010 

42725 .... ............ A ........ Drainage of throat abscess ................. 12.28 NA NA 7.08 7.65 0.91 090 

42800 .... ............ A ........ Biopsy of throat ................................... 1.41 2.46 2.32 1.30 1.35 0.11 010 

42802 .... ............ A ........ Biopsy of throat ................................... 1.56 4.13 4.44 1.67 1.87 0.12 010 

42804 .... ............ A ........ Biopsy of upper nose/throat ................ 1.26 3.58 3.66 1.50 1.62 0.10 010 

42806 .... ............ A ........ Biopsy of upper nose/throat ................ 1.60 3.83 3.95 1.61 1.77 0.13 010 

42808 .... ............ A ........ Excise pharynx lesion ......................... 2.32 3.22 3.15 1.60 1.77 0.19 010 

42809 .... ............ A ........ Remove pharynx foreign body ............ 1.83 2.23 2.28 1.32 1.32 0.16 010 

42810 .... ............ A ........ Excision of neck cyst .......................... 3.30 6.22 5.96 3.73 3.63 0.29 090 

42815 .... ............ A ........ Excision of neck cyst .......................... 7.23 NA NA 6.25 6.33 0.61 090 

42820 .... ............ A ........ Remove tonsils and adenoids ............ 4.17 NA NA 2.85 3.07 0.31 090 

42821 .... ............ A ........ Remove tonsils and adenoids ............ 4.31 NA NA 2.99 3.24 0.35 090 

42825 .... ............ A ........ Removal of tonsils .............................. 3.45 NA NA 2.90 3.03 0.25 090 

42826 .... ............ A ........ Removal of tonsils .............................. 3.40 NA NA 2.68 2.86 0.27 090 

42830 .... ............ A ........ Removal of adenoids .......................... 2.60 NA NA 2.43 2.49 0.20 090 

42831 .... ............ A ........ Removal of adenoids .......................... 2.75 NA NA 2.66 2.75 0.22 090 

42835 .... ............ A ........ Removal of adenoids .......................... 2.33 NA NA 1.78 2.12 0.21 090 

42836 .... ............ A ........ Removal of adenoids .......................... 3.21 NA NA 2.64 2.80 0.26 090 

42842 .... ............ A ........ Extensive surgery of throat ................. 12.02 NA NA 12.03 11.51 0.71 090 

42844 .... ............ A ........ Extensive surgery of throat ................. 17.57 NA NA 15.46 15.84 1.16 090 

42845 .... ............ A ........ Extensive surgery of throat ................. 32.35 NA NA 21.14 22.16 1.99 090 

42860 .... ............ A ........ Excision of tonsil tags ......................... 2.25 NA NA 2.30 2.35 0.18 090 

42870 .... ............ A ........ Excision of lingual tonsil ..................... 5.44 NA NA 8.70 8.63 0.44 090 

42890 .... ............ A ........ Partial removal of pharynx .................. 18.92 NA NA 15.24 14.69 1.05 090 

42892 .... ............ A ........ Revision of pharyngeal walls .............. 25.77 NA NA 19.20 18.18 1.28 090 

42894 .... ............ A ........ Revision of pharyngeal walls .............. 33.61 NA NA 23.53 22.77 1.87 090 

42900 .... ............ A ........ Repair throat wound ........................... 5.26 NA NA 2.95 3.30 0.50 010 

42950 .... ............ A ........ Reconstruction of throat ...................... 8.16 NA NA 11.06 11.46 0.72 090 

42953 .... ............ A ........ Repair throat, esophagus ................... 9.33 NA NA 13.77 15.54 0.88 090 

42955 .... ............ A ........ Surgical opening of throat ................... 7.92 NA NA 10.10 10.38 0.80 090 

42960 .... ............ A ........ Control throat bleeding ....................... 2.35 NA NA 1.71 1.84 0.19 010 

42961 .... ............ A ........ Control throat bleeding ....................... 5.69 NA NA 4.48 4.72 0.45 090 

42962 .... ............ A ........ Control throat bleeding ....................... 7.31 NA NA 5.18 5.54 0.58 090 

42970 .... ............ A ........ Control nose/throat bleeding ............... 5.76 NA NA 3.58 3.88 0.39 090 

42971 .... ............ A ........ Control nose/throat bleeding ............... 6.54 NA NA 4.50 4.81 0.51 090 

42972 .... ............ A ........ Control nose/throat bleeding ............... 7.53 NA NA 4.98 5.34 0.62 090 

42999 .... ............ C ........ Throat surgery procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43020 .... ............ A ........ Incision of esophagus ......................... 8.14 NA NA 4.57 4.99 0.87 090 

43030 .... ............ A ........ Throat muscle surgery ........................ 7.91 NA NA 4.51 5.00 0.70 090 

43045 .... ............ A ........ Incision of esophagus ......................... 21.70 NA NA 9.30 9.99 2.59 090 

43100 .... ............ A ........ Excision of esophagus lesion ............. 9.55 NA NA 5.20 5.71 0.93 090 

43101 .... ............ A ........ Excision of esophagus lesion ............. 16.99 NA NA 7.16 7.52 2.32 090 


cprice-sewell on PROD1PC72 with RULES
66456 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

43107 .... ............ A ........ Removal of esophagus ....................... 43.97 NA NA 16.25 17.25 5.24 090 

43108 .... ............ A ........ Removal of esophagus ....................... 82.66 NA NA 24.46 19.33 4.08 090 

43112 .... ............ A ........ Removal of esophagus ....................... 47.27 NA NA 17.00 18.18 5.81 090 

43113 .... ............ A ........ Removal of esophagus ....................... 79.85 NA NA 25.34 20.22 4.43 090 

43116 .... ............ A ........ Partial removal of esophagus ............. 92.78 NA NA 30.30 23.49 3.06 090 

43117 .... ............ A ........ Partial removal of esophagus ............. 43.52 NA NA 15.14 16.20 5.19 090 

43118 .... ............ A ........ Partial removal of esophagus ............. 66.86 NA NA 21.50 17.64 4.11 090 

43121 .... ............ A ........ Partial removal of esophagus ............. 51.22 NA NA 18.26 15.96 3.91 090 

43122 .... ............ A ........ Partial removal of esophagus ............. 43.97 NA NA 15.60 16.49 5.42 090 

43123 .... ............ A ........ Partial removal of esophagus ............. 82.91 NA NA 25.75 19.92 4.16 090 

43124 .... ............ A ........ Removal of esophagus ....................... 68.83 NA NA 24.34 18.71 3.74 090 

43130 .... ............ A ........ Removal of esophagus pouch ............ 12.41 NA NA 6.37 6.96 1.16 090 

43135 .... ............ A ........ Removal of esophagus pouch ............ 26.09 NA NA 9.92 9.00 2.34 090 

43200 .... ............ A ........ Esophagus endoscopy ........................ 1.59 3.72 3.92 0.98 1.02 0.13 000 

43201 .... ............ A ........ Esoph scope w/submucous inj ........... 2.09 5.62 5.12 1.19 1.14 0.15 000 

43202 .... ............ A ........ Esophagus endoscopy, biopsy ........... 1.89 5.16 5.35 0.98 0.96 0.15 000 

43204 .... ............ A ........ Esoph scope w/sclerosis inj ................ 3.76 NA NA 2.01 1.76 0.30 000 

43205 .... ............ A ........ Esophagus endoscopy/ligation ........... 3.78 NA NA 2.06 1.79 0.28 000 

43215 .... ............ A ........ Esophagus endoscopy ........................ 2.60 NA NA 1.29 1.24 0.22 000 

43216 .... ............ A ........ Esophagus endoscopy/lesion ............. 2.40 3.08 2.07 1.26 1.16 0.20 000 

43217 .... ............ A ........ Esophagus endoscopy ........................ 2.90 6.57 6.76 1.38 1.28 0.26 000 

43219 .... ............ A ........ Esophagus endoscopy ........................ 2.80 NA NA 1.55 1.45 0.24 000 

43220 .... ............ A ........ Esoph endoscopy, dilation .................. 2.10 NA NA 1.13 1.05 0.17 000 

43226 .... ............ A ........ Esoph endoscopy, dilation .................. 2.34 NA NA 1.29 1.16 0.19 000 

43227 .... ............ A ........ Esoph endoscopy, repair .................... 3.59 NA NA 1.77 1.61 0.28 000 

43228 .... ............ A ........ Esoph endoscopy, ablation ................. 3.76 NA NA 1.89 1.72 0.34 000 

43231 .... ............ A ........ Esoph endoscopy w/us exam ............. 3.19 NA NA 1.76 1.53 0.23 000 

43232 .... ............ A ........ Esoph endoscopy w/us fn bx .............. 4.47 NA NA 2.39 2.10 0.34 000 

43234 .... ............ A ........ Upper GI endoscopy, exam ................ 2.01 4.98 5.15 1.02 0.94 0.17 000 

43235 .... ............ A ........ Uppr gi endoscopy, diagnosis ............ 2.39 5.29 5.22 1.35 1.18 0.19 000 

43236 .... ............ A ........ Uppr gi scope w/submuc inj ............... 2.92 6.71 6.55 1.65 1.43 0.21 000 

43237 .... ............ A ........ Endoscopic us exam, esoph ............... 3.98 NA NA 2.16 1.87 0.43 000 

43238 .... ............ A ........ Uppr gi endoscopy w/us fn bx ............ 5.02 NA NA 2.56 2.26 0.43 000 

43239 .... ............ A ........ Upper GI endoscopy, biopsy .............. 2.87 6.05 5.88 1.56 1.37 0.22 000 

43240 .... ............ A ........ Esoph endoscope w/drain cyst ........... 6.85 NA NA 3.28 2.94 0.56 000 

43241 .... ............ A ........ Upper GI endoscopy with tube ........... 2.59 NA NA 1.40 1.25 0.21 000 

43242 .... ............ A ........ Uppr gi endoscopy w/us fn bx ............ 7.30 NA NA 3.67 3.20 0.53 000 

43243 .... ............ A ........ Upper gi endoscopy & inject ............... 4.56 NA NA 2.35 2.07 0.33 000 

43244 .... ............ A ........ Upper GI endoscopy/ligation .............. 5.04 NA NA 2.64 2.30 0.37 000 

43245 .... ............ A ........ Uppr gi scope dilate strictr .................. 3.18 NA NA 1.63 1.46 0.26 000 

43246 .... ............ A ........ Place gastrostomy tube ...................... 4.32 NA NA 2.11 1.90 0.34 000 

43247 .... ............ A ........ Operative upper GI endoscopy ........... 3.38 NA NA 1.78 1.57 0.27 000 

43248 .... ............ A ........ Uppr gi endoscopy/guide wire ............ 3.15 NA NA 1.77 1.54 0.23 000 

43249 .... ............ A ........ Esoph endoscopy, dilation .................. 2.90 NA NA 1.62 1.41 0.22 000 

43250 .... ............ A ........ Upper GI endoscopy/tumor ................. 3.20 NA NA 1.61 1.46 0.26 000 

43251 .... ............ A ........ Operative upper GI endoscopy ........... 3.69 NA NA 1.92 1.70 0.29 000 

43255 .... ............ A ........ Operative upper GI endoscopy ........... 4.81 NA NA 2.52 2.20 0.35 000 

43256 .... ............ A ........ Uppr gi endoscopy w/stent ................. 4.34 NA NA 2.25 1.98 0.32 000 

43257 .... ............ A ........ Uppr gi scope w/thrml txmnt ............... 5.50 NA NA 2.14 2.17 0.36 000 

43258 .... ............ A ........ Operative upper GI endoscopy ........... 4.54 NA NA 2.37 2.07 0.33 000 

43259 .... ............ A ........ Endoscopic ultrasound exam .............. 5.19 NA NA 2.69 2.34 0.35 000 

43260 .... ............ A ........ Endo cholangiopancreatograph .......... 5.95 NA NA 3.06 2.67 0.43 000 

43261 .... ............ A ........ Endo cholangiopancreatograph .......... 6.26 NA NA 3.20 2.80 0.46 000 

43262 .... ............ A ........ Endo cholangiopancreatograph .......... 7.38 NA NA 3.73 3.25 0.54 000 

43263 .... ............ A ........ Endo cholangiopancreatograph .......... 7.28 NA NA 3.63 3.20 0.54 000 

43264 .... ............ A ........ Endo cholangiopancreatograph .......... 8.89 NA NA 4.44 3.87 0.65 000 

43265 .... ............ A ........ Endo cholangiopancreatograph .......... 10.00 NA NA 4.98 4.34 0.73 000 

43267 .... ............ A ........ Endo cholangiopancreatograph .......... 7.38 NA NA 3.39 3.09 0.54 000 

43268 .... ............ A ........ Endo cholangiopancreatograph .......... 7.38 NA NA 3.88 3.38 0.54 000 

43269 .... ............ A ........ Endo cholangiopancreatograph .......... 8.20 NA NA 4.10 3.58 0.60 000 

43271 .... ............ A ........ Endo cholangiopancreatograph .......... 7.38 NA NA 3.70 3.24 0.54 000 

43272 .... ............ A ........ Endo cholangiopancreatograph .......... 7.38 NA NA 3.77 3.28 0.54 000 

43280 .... ............ A ........ Laparoscopy, fundoplasty ................... 18.00 NA NA 6.65 6.96 2.28 090 

43289 .... ............ C ........ Laparoscope proc, esoph ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43300 .... ............ A ........ Repair of esophagus ........................... 9.21 NA NA 5.41 5.89 1.12 090 

43305 .... ............ A ........ Repair esophagus and fistula ............. 17.98 NA NA 8.33 9.51 1.54 090 

43310 .... ............ A ........ Repair of esophagus ........................... 26.18 NA NA 9.81 10.43 3.61 090 

43312 .... ............ A ........ Repair esophagus and fistula ............. 29.23 NA NA 10.27 11.07 4.01 090 

43313 .... ............ A ........ Esophagoplasty congenital ................. 48.17 NA NA 17.46 18.13 5.47 090 

43314 .... ............ A ........ Tracheo-esophagoplasty cong ............ 53.15 NA NA 15.09 17.13 6.65 090 

43320 .... ............ A ........ Fuse esophagus & stomach ............... 23.18 NA NA 8.60 8.90 2.74 090 

43324 .... ............ A ........ Revise esophagus & stomach ............ 22.86 NA NA 8.34 8.55 2.76 090 


cprice-sewell on PROD1PC72 with RULES
66457 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

43325 .... ............ A ........ Revise esophagus & stomach ............ 22.47 NA NA 8.38 8.58 2.60 090 

43326 .... ............ A ........ Revise esophagus & stomach ............ 22.15 NA NA 9.20 9.24 2.85 090 

43330 .... ............ A ........ Repair of esophagus ........................... 22.06 NA NA 8.09 8.31 2.63 090 

43331 .... ............ A ........ Repair of esophagus ........................... 22.93 NA NA 9.82 9.80 2.94 090 

43340 .... ............ A ........ Fuse esophagus & intestine ............... 22.86 NA NA 9.27 9.12 2.46 090 

43341 .... ............ A ........ Fuse esophagus & intestine ............... 24.10 NA NA 9.65 9.83 2.92 090 

43350 .... ............ A ........ Surgical opening, esophagus ............. 19.31 NA NA 8.75 8.59 1.42 090 

43351 .... ............ A ........ Surgical opening, esophagus ............. 21.87 NA NA 10.86 10.32 2.47 090 

43352 .... ............ A ........ Surgical opening, esophagus ............. 17.68 NA NA 7.94 8.16 2.06 090 

43360 .... ............ A ........ Gastrointestinal repair ......................... 39.90 NA NA 14.88 14.97 4.97 090 

43361 .... ............ A ........ Gastrointestinal repair ......................... 45.50 NA NA 18.13 17.50 4.50 090 

43400 .... ............ A ........ Ligate esophagus veins ...................... 25.47 NA NA 13.58 11.51 1.96 090 

43401 .... ............ A ........ Esophagus surgery for veins .............. 26.36 NA NA 9.54 9.51 3.05 090 

43405 .... ............ A ........ Ligate/staple esophagus ..................... 24.55 NA NA 10.66 10.12 2.84 090 

43410 .... ............ A ........ Repair esophagus wound ................... 16.28 NA NA 7.66 7.64 1.72 090 

43415 .... ............ A ........ Repair esophagus wound ................... 28.70 NA NA 11.83 11.78 3.53 090 

43420 .... ............ A ........ Repair esophagus opening ................. 16.65 NA NA 7.47 7.43 1.43 090 

43425 .... ............ A ........ Repair esophagus opening ................. 24.91 NA NA 10.45 10.21 3.03 090 

43450 .... ............ A ........ Dilate esophagus ................................ 1.38 2.67 2.65 0.93 0.81 0.11 000 

43453 .... ............ A ........ Dilate esophagus ................................ 1.51 6.31 6.18 1.01 0.87 0.11 000 

43456 .... ............ A ........ Dilate esophagus ................................ 2.57 13.01 13.37 1.45 1.27 0.20 000 

43458 .... ............ A ........ Dilate esophagus ................................ 3.06 6.92 6.78 1.59 1.43 0.24 000 

43460 .... ............ A ........ Pressure treatment esophagus ........... 3.79 NA NA 1.76 1.62 0.31 000 

43496 .... ............ C ........ Free jejunum flap, microvasc .............. 0.00 0.00 0.00 0.00 0.00 0.00 090 

43499 .... ............ C ........ Esophagus surgery procedure ............ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43500 .... ............ A ........ Surgical opening of stomach .............. 12.71 NA NA 5.29 5.12 1.45 090 

43501 .... ............ A ........ Surgical repair of stomach .................. 22.47 NA NA 8.09 8.19 2.65 090 

43502 .... ............ A ........ Surgical repair of stomach .................. 25.56 NA NA 8.96 9.21 3.10 090 

43510 .... ............ A ........ Surgical opening of stomach .............. 15.01 NA NA 9.13 7.85 1.48 090 

43520 .... ............ A ........ Incision of pyloric muscle .................... 11.21 NA NA 4.81 5.03 1.36 090 

43600 .... ............ A ........ Biopsy of stomach .............................. 1.91 NA NA 0.77 0.71 0.14 000 

43605 .... ............ A ........ Biopsy of stomach .............................. 13.64 NA NA 5.36 5.32 1.58 090 

43610 .... ............ A ........ Excision of stomach lesion ................. 16.26 NA NA 6.03 6.08 1.94 090 

43611 .... ............ A ........ Excision of stomach lesion ................. 20.25 NA NA 7.48 7.52 2.36 090 

43620 .... ............ A ........ Removal of stomach ........................... 33.91 NA NA 11.09 11.44 3.96 090 

43621 .... ............ A ........ Removal of stomach ........................... 39.40 NA NA 12.39 12.17 4.04 090 

43622 .... ............ A ........ Removal of stomach ........................... 39.90 NA NA 12.49 12.53 4.30 090 

43631 .... ............ A ........ Removal of stomach, partial ............... 24.38 NA NA 8.58 8.87 2.99 090 

43632 .... ............ A ........ Removal of stomach, partial ............... 35.01 NA NA 11.26 10.21 2.99 090 

43633 .... ............ A ........ Removal of stomach, partial ............... 33.01 NA NA 10.75 10.03 3.06 090 

43634 .... ............ A ........ Removal of stomach, partial ............... 36.51 NA NA 11.78 10.93 3.33 090 

43635 .... ............ A ........ Removal of stomach, partial ............... 2.06 NA NA 0.52 0.61 0.27 ZZZ 

43640 .... ............ A ........ Vagotomy & pylorus repair ................. 19.43 NA NA 7.34 7.29 2.26 090 

43641 .... ............ A ........ Vagotomy & pylorus repair ................. 19.68 NA NA 7.62 7.49 2.25 090 

43644 .... ............ A ........ Lap gastric bypass/roux-en-y .............. 29.24 NA NA 10.10 10.65 3.16 090 

43645 .... ............ A ........ Lap gastr bypass incl smll i ................ 31.37 NA NA 10.48 11.24 3.54 090 

43647 .... ............ C ........ Lap impl electrode, antrum ................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43648 .... ............ C ........ Lap revise/remv eltrd antrum .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43651 .... ............ A ........ Laparoscopy, vagus nerve .................. 10.13 NA NA 4.61 4.68 1.33 090 

43652 .... ............ A ........ Laparoscopy, vagus nerve .................. 12.13 NA NA 5.22 5.49 1.55 090 

43653 .... ............ A ........ Laparoscopy, gastrostomy .................. 8.38 NA NA 4.46 4.32 1.01 090 

43659 .... ............ C ........ Laparoscope proc, stom ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43752 .... ............ A ........ Nasal/orogastric w/stent ...................... 0.81 NA NA 0.26 0.26 0.02 000 

43760 .... ............ A ........ Change gastrostomy tube ................... 0.90 5.98 4.03 0.33 0.39 0.09 000 

43761 .... ............ A ........ Reposition gastrostomy tube .............. 2.01 1.04 1.10 0.70 0.68 0.13 000 

43770 .... ............ A ........ Lap place gastr adj device .................. 17.85 NA NA 7.40 7.55 2.19 090 

43771 .... ............ A ........ Lap revise gastr adj device ................. 20.64 NA NA 8.12 8.35 2.55 090 

43772 .... ............ A ........ Lap rmvl gastr adj device ................... 15.62 NA NA 5.99 6.21 1.93 090 

43773 .... ............ A ........ Lap replace gastr adj device .............. 20.64 NA NA 8.10 8.34 2.56 090 

43774 .... ............ A ........ Lap rmvl gastr adj all parts ................. 15.66 NA NA 6.18 6.37 1.85 090 

43800 .... ............ A ........ Reconstruction of pylorus ................... 15.35 NA NA 5.81 5.85 1.82 090 

43810 .... ............ A ........ Fusion of stomach and bowel ............. 16.80 NA NA 6.13 6.15 1.94 090 

43820 .... ............ A ........ Fusion of stomach and bowel ............. 22.40 NA NA 8.07 7.23 2.04 090 

43825 .... ............ A ........ Fusion of stomach and bowel ............. 21.63 NA NA 7.89 7.95 2.54 090 

43830 .... ............ A ........ Place gastrostomy tube ...................... 10.75 NA NA 5.17 5.00 1.25 090 

43831 .... ............ A ........ Place gastrostomy tube ...................... 8.38 NA NA 4.92 4.71 1.03 090 

43832 .... ............ A ........ Place gastrostomy tube ...................... 17.26 NA NA 7.06 6.95 1.98 090 

43840 .... ............ A ........ Repair of stomach lesion .................... 22.70 NA NA 8.14 7.45 2.06 090 

43842 .... ............ N ........ V-band gastroplasty ............................ 20.90 NA NA 6.75 7.26 2.45 090 

43843 .... ............ A ........ Gastroplasty w/o v-band ..................... 21.08 NA NA 7.84 7.79 2.46 090 

43845 .... ............ A ........ Gastroplasty duodenal switch ............. 33.12 NA NA 12.88 11.82 4.06 090 

43846 .... ............ A ........ Gastric bypass for obesity .................. 27.23 NA NA 9.97 9.99 3.19 090 


cprice-sewell on PROD1PC72 with RULES
66458 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

43847 .... ............ A ........ Gastric bypass incl small i .................. 30.10 NA NA 10.51 10.70 3.56 090 

43848 .... ............ A ........ Revision gastroplasty .......................... 32.57 NA NA 11.29 11.55 3.88 090 

43850 .... ............ A ........ Revise stomach-bowel fusion ............. 27.45 NA NA 9.49 9.65 3.28 090 

43855 .... ............ A ........ Revise stomach-bowel fusion ............. 28.56 NA NA 9.70 10.01 3.47 090 

43860 .... ............ A ........ Revise stomach-bowel fusion ............. 27.76 NA NA 9.47 9.71 3.31 090 

43865 .... ............ A ........ Revise stomach-bowel fusion ............. 28.92 NA NA 9.73 10.11 3.51 090 

43870 .... ............ A ........ Repair stomach opening ..................... 11.36 NA NA 4.95 4.73 1.27 090 

43880 .... ............ A ........ Repair stomach-bowel fistula .............. 27.05 NA NA 9.27 9.58 3.27 090 

43881 .... ............ C ........ Impl/redo electrd, antrum .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43882 .... ............ C ........ Revise/remove electrd antrum ............ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43886 .... ............ A ........ Revise gastric port, open .................... 4.54 NA NA 3.44 3.29 0.25 090 

43887 .... ............ A ........ Remove gastric port, open ................. 4.24 NA NA 3.05 2.91 0.51 090 

43888 .... ............ A ........ Change gastric port, open .................. 6.34 NA NA 4.01 3.88 0.70 090 

43999 .... ............ C ........ Stomach surgery procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

44005 .... ............ A ........ Freeing of bowel adhesion ................. 18.38 NA NA 6.58 6.64 2.15 090 

44010 .... ............ A ........ Incision of small bowel ........................ 14.18 NA NA 5.53 5.48 1.64 090 

44015 .... ............ A ........ Insert needle cath bowel ..................... 2.62 NA NA 0.68 0.78 0.35 ZZZ 

44020 .... ............ A ........ Explore small intestine ........................ 16.14 NA NA 6.00 5.96 1.86 090 

44021 .... ............ A ........ Decompress small bowel .................... 16.23 NA NA 6.15 6.05 1.87 090 

44025 .... ............ A ........ Incision of large bowel ........................ 16.43 NA NA 6.05 6.03 1.90 090 

44050 .... ............ A ........ Reduce bowel obstruction .................. 15.44 NA NA 5.82 5.88 1.86 090 

44055 .... ............ A ........ Correct malrotation of bowel ............... 25.53 NA NA 8.48 8.60 2.91 090 

44100 .... ............ A ........ Biopsy of bowel ................................... 2.01 NA NA 0.91 0.81 0.17 000 

44110 .... ............ A ........ Excise intestine lesion(s) .................... 13.96 NA NA 5.50 5.36 1.55 090 

44111 .... ............ A ........ Excision of bowel lesion(s) ................. 16.44 NA NA 6.09 6.10 1.87 090 

44120 .... ............ A ........ Removal of small intestine .................. 20.74 NA NA 7.14 7.11 2.25 090 

44121 .... ............ A ........ Removal of small intestine .................. 4.44 NA NA 1.12 1.32 0.58 ZZZ 

44125 .... ............ A ........ Removal of small intestine .................. 19.93 NA NA 7.03 7.14 2.27 090 

44126 .... ............ A ........ Enterectomy w/o taper, cong .............. 42.02 NA NA 13.59 13.85 4.69 090 

44127 .... ............ A ........ Enterectomy w/taper, cong ................. 49.09 NA NA 15.63 15.67 5.77 090 

44128 .... ............ A ........ Enterectomy cong, add-on .................. 4.44 NA NA 1.21 1.37 0.61 ZZZ 

44130 .... ............ A ........ Bowel to bowel fusion ......................... 21.98 NA NA 7.97 7.09 1.88 090 

44132 .... ............ R ........ Enterectomy, cadaver donor ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

44133 .... ............ R ........ Enterectomy, live donor ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

44135 .... ............ R ........ Intestine transplnt, cadaver ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

44136 .... ............ R ........ Intestine transplant, live ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

44137 .... ............ C ........ Remove intestinal allograft ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

44139 .... ............ A ........ Mobilization of colon ........................... 2.23 NA NA 0.56 0.66 0.28 ZZZ 

44140 .... ............ A ........ Partial removal of colon ...................... 22.46 NA NA 8.06 8.35 2.71 090 

44141 .... ............ A ........ Partial removal of colon ...................... 29.75 NA NA 11.83 10.93 2.53 090 

44143 .... ............ A ........ Partial removal of colon ...................... 27.63 NA NA 10.28 10.48 3.05 090 

44144 .... ............ A ........ Partial removal of colon ...................... 29.75 NA NA 10.62 10.11 2.86 090 

44145 .... ............ A ........ Partial removal of colon ...................... 28.45 NA NA 9.48 10.13 3.29 090 

44146 .... ............ A ........ Partial removal of colon ...................... 35.14 NA NA 13.36 13.10 3.41 090 

44147 .... ............ A ........ Partial removal of colon ...................... 33.56 NA NA 10.77 9.73 2.56 090 

44150 .... ............ A ........ Removal of colon ................................ 29.99 NA NA 12.60 12.30 3.04 090 

44151 .... ............ A ........ Removal of colon/ileostomy ................ 34.73 NA NA 13.91 13.65 3.49 090 

44155 .... ............ A ........ Removal of colon/ileostomy ................ 34.23 NA NA 13.44 13.37 3.28 090 

44156 .... ............ A ........ Removal of colon/ileostomy ................ 37.23 NA NA 14.48 14.75 3.95 090 

44157 .... ............ A ........ Colectomy w/ileoanal anast ................ 35.49 NA NA 17.08 17.08 3.93 090 

44158 .... ............ A ........ Colectomy w/neo-rectum pouch ......... 36.49 NA NA 17.42 17.42 4.06 090 

44160 .... ............ A ........ Removal of colon ................................ 20.78 NA NA 7.51 7.62 2.37 090 

44180 .... ............ A ........ Lap, enterolysis ................................... 15.19 NA NA 5.80 6.01 1.86 090 

44186 .... ............ A ........ Lap, jejunostomy ................................. 10.30 NA NA 4.58 4.68 1.27 090 

44187 .... ............ A ........ Lap, ileo/jejuno-stomy ......................... 17.27 NA NA 8.12 8.19 1.96 090 

44188 .... ............ A ........ Lap, colostomy .................................... 19.20 NA NA 8.67 8.75 2.24 090 

44202 .... ............ A ........ Lap, enterectomy ................................ 23.26 NA NA 8.31 8.61 2.85 090 

44203 .... ............ A ........ Lap resect s/intestine, addl ................. 4.44 NA NA 1.12 1.31 0.57 ZZZ 

44204 .... ............ A ........ Laparo partial colectomy ..................... 26.29 NA NA 8.88 9.41 3.11 090 

44205 .... ............ A ........ Lap colectomy part w/ileum ................ 22.86 NA NA 7.80 8.32 2.75 090 

44206 .... ............ A ........ Lap part colectomy w/stoma ............... 29.63 NA NA 10.46 10.85 3.46 090 

44207 .... ............ A ........ L colectomy/coloproctostomy .............. 31.79 NA NA 10.10 10.78 3.67 090 

44208 .... ............ A ........ L colectomy/coloproctostomy .............. 33.86 NA NA 12.01 12.57 3.88 090 

44210 .... ............ A ........ Laparo total proctocolectomy .............. 29.88 NA NA 11.17 11.52 3.42 090 

44211 .... ............ A ........ Lap colectomy w/proctectomy ............ 36.87 NA NA 13.58 14.12 4.17 090 

44212 .... ............ A ........ Laparo total proctocolectomy .............. 34.37 NA NA 13.03 13.35 3.78 090 

44213 .... ............ A ........ Lap, mobil splenic fl add-on ................ 3.50 NA NA 0.86 1.04 0.44 ZZZ 

44227 .... ............ A ........ Lap, close enterostomy ....................... 28.49 NA NA 9.48 10.05 3.38 090 

44238 .... ............ C ........ Laparoscope proc, intestine ................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

44300 .... ............ A ........ Open bowel to skin ............................. 13.65 NA NA 5.55 5.52 1.60 090 

44310 .... ............ A ........ Ileostomy/jejunostomy ......................... 17.49 NA NA 6.40 6.54 1.99 090 

44312 .... ............ A ........ Revision of ileostomy .......................... 9.33 NA NA 4.65 4.32 0.92 090 


cprice-sewell on PROD1PC72 with RULES
66459 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

44314 .... ............ A ........ Revision of ileostomy .......................... 16.61 NA NA 6.77 6.66 1.75 090 

44316 .... ............ A ........ Devise bowel pouch ............................ 23.46 NA NA 8.87 8.70 2.38 090 

44320 .... ............ A ........ Colostomy ........................................... 19.75 NA NA 7.59 7.62 2.26 090 

44322 .... ............ A ........ Colostomy with biopsies ..................... 13.15 NA NA 9.10 8.83 1.54 090 

44340 .... ............ A ........ Revision of colostomy ......................... 9.12 NA NA 4.93 4.60 0.99 090 

44345 .... ............ A ........ Revision of colostomy ......................... 17.06 NA NA 6.92 6.90 1.97 090 

44346 .... ............ A ........ Revision of colostomy ......................... 19.47 NA NA 7.52 7.45 2.13 090 

44360 .... ............ A ........ Small bowel endoscopy ...................... 2.59 NA NA 1.50 1.30 0.19 000 

44361 .... ............ A ........ Small bowel endoscopy/biopsy ........... 2.87 NA NA 1.63 1.41 0.21 000 

44363 .... ............ A ........ Small bowel endoscopy ...................... 3.49 NA NA 1.85 1.61 0.27 000 

44364 .... ............ A ........ Small bowel endoscopy ...................... 3.73 NA NA 1.97 1.73 0.27 000 

44365 .... ............ A ........ Small bowel endoscopy ...................... 3.31 NA NA 1.74 1.55 0.24 000 

44366 .... ............ A ........ Small bowel endoscopy ...................... 4.40 NA NA 2.37 2.05 0.32 000 

44369 .... ............ A ........ Small bowel endoscopy ...................... 4.51 NA NA 2.36 2.05 0.33 000 

44370 .... ............ A ........ Small bowel endoscopy/stent ............. 4.79 NA NA 2.56 2.26 0.37 000 

44372 .... ............ A ........ Small bowel endoscopy ...................... 4.40 NA NA 2.12 1.93 0.35 000 

44373 .... ............ A ........ Small bowel endoscopy ...................... 3.49 NA NA 1.76 1.59 0.27 000 

44376 .... ............ A ........ Small bowel endoscopy ...................... 5.25 NA NA 2.47 2.25 0.42 000 

44377 .... ............ A ........ Small bowel endoscopy/biopsy ........... 5.52 NA NA 2.76 2.45 0.40 000 

44378 .... ............ A ........ Small bowel endoscopy ...................... 7.12 NA NA 3.57 3.13 0.52 000 

44379 .... ............ A ........ S bowel endoscope w/stent ................ 7.46 NA NA 3.92 3.42 0.62 000 

44380 .... ............ A ........ Small bowel endoscopy ...................... 1.05 NA NA 0.74 0.65 0.08 000 

44382 .... ............ A ........ Small bowel endoscopy ...................... 1.27 NA NA 0.84 0.73 0.12 000 

44383 .... ............ A ........ Ileoscopy w/stent ................................ 2.94 NA NA 1.61 1.44 0.21 000 

44385 .... ............ A ........ Endoscopy of bowel pouch ................. 1.82 4.90 4.12 0.89 0.82 0.15 000 

44386 .... ............ A ........ Endoscopy, bowel pouch/biop ............ 2.12 6.65 6.64 1.02 0.95 0.20 000 

44388 .... ............ A ........ Colonoscopy ....................................... 2.82 6.12 5.60 1.35 1.25 0.26 000 

44389 .... ............ A ........ Colonoscopy with biopsy .................... 3.13 7.11 6.86 1.57 1.42 0.27 000 

44390 .... ............ A ........ Colonoscopy for foreign body ............. 3.82 8.33 7.72 1.92 1.70 0.32 000 

44391 .... ............ A ........ Colonoscopy for bleeding ................... 4.31 8.93 8.83 2.21 1.95 0.34 000 

44392 .... ............ A ........ Colonoscopy & polypectomy .............. 3.81 7.36 6.97 1.72 1.60 0.34 000 

44393 .... ............ A ........ Colonoscopy, lesion removal .............. 4.83 8.03 7.46 2.13 2.00 0.42 000 

44394 .... ............ A ........ Colonoscopy w/snare .......................... 4.42 8.50 8.15 2.07 1.89 0.38 000 

44397 .... ............ A ........ Colonoscopy w/stent ........................... 4.70 NA NA 2.16 1.97 0.39 000 

44500 .... ............ A ........ Intro, gastrointestinal tube .................. 0.49 NA NA 0.17 0.17 0.03 000 

44602 .... ............ A ........ Suture, small intestine ........................ 24.64 NA NA 7.61 7.00 2.12 090 

44603 .... ............ A ........ Suture, small intestine ........................ 28.03 NA NA 8.96 8.11 2.42 090 

44604 .... ............ A ........ Suture, large intestine ......................... 18.06 NA NA 6.06 6.25 2.12 090 

44605 .... ............ A ........ Repair of bowel lesion ........................ 22.00 NA NA 7.82 8.10 2.52 090 

44615 .... ............ A ........ Intestinal stricturoplasty ...................... 18.08 NA NA 6.53 6.60 2.07 090 

44620 .... ............ A ........ Repair bowel opening ......................... 14.35 NA NA 5.50 5.41 1.51 090 

44625 .... ............ A ........ Repair bowel opening ......................... 17.20 NA NA 6.14 6.22 1.86 090 

44626 .... ............ A ........ Repair bowel opening ......................... 27.82 NA NA 8.88 9.34 3.27 090 

44640 .... ............ A ........ Repair bowel-skin fistula ..................... 24.12 NA NA 8.01 8.29 2.78 090 

44650 .... ............ A ........ Repair bowel fistula ............................ 25.04 NA NA 8.30 8.59 2.93 090 

44660 .... ............ A ........ Repair bowel-bladder fistula ............... 23.83 NA NA 9.75 9.04 2.14 090 

44661 .... ............ A ........ Repair bowel-bladder fistula ............... 27.27 NA NA 9.39 9.47 2.81 090 

44680 .... ............ A ........ Surgical revision, intestine .................. 17.88 NA NA 6.68 6.56 2.00 090 

44700 .... ............ A ........ Suspend bowel w/prosthesis .............. 17.40 NA NA 6.15 6.40 1.84 090 

44701 .... ............ A ........ Intraop colon lavage add-on ............... 3.10 NA NA 0.76 0.91 0.37 ZZZ 

44715 .... ............ C ........ Prepare donor intestine ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

44720 .... ............ A ........ Prep donor intestine/venous ............... 5.00 NA NA 1.27 1.48 0.37 XXX 

44721 .... ............ A ........ Prep donor intestine/artery ................. 7.00 NA NA 1.78 2.08 0.97 XXX 

44799 .... ............ C ........ Unlisted procedure intestine ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

44800 .... ............ A ........ Excision of bowel pouch ..................... 11.94 NA NA 5.49 5.43 1.47 090 

44820 .... ............ A ........ Excision of mesentery lesion .............. 13.63 NA NA 5.56 5.52 1.59 090 

44850 .... ............ A ........ Repair of mesentery ........................... 12.03 NA NA 5.01 5.00 1.39 090 

44899 .... ............ C ........ Bowel surgery procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

44900 .... ............ A ........ Drain app abscess, open .................... 12.44 NA NA 5.02 4.85 1.33 090 

44901 .... ............ A ........ Drain app abscess, percut .................. 3.37 19.79 23.83 1.20 1.15 0.22 000 

44950 .... ............ A ........ Appendectomy .................................... 10.52 NA NA 4.04 4.17 1.31 090 

44955 .... ............ A ........ Appendectomy add-on ........................ 1.53 NA NA 0.40 0.47 0.20 ZZZ 

44960 .... ............ A ........ Appendectomy .................................... 14.39 NA NA 5.40 5.37 1.63 090 

44970 .... ............ A ........ Laparoscopy, appendectomy .............. 9.35 NA NA 4.19 4.13 1.14 090 

44979 .... ............ C ........ Laparoscope proc, app ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

45000 .... ............ A ........ Drainage of pelvic abscess ................. 6.20 NA NA 3.57 3.26 0.52 090 

45005 .... ............ A ........ Drainage of rectal abscess ................. 2.00 3.98 4.01 1.59 1.58 0.25 010 

45020 .... ............ A ........ Drainage of rectal abscess ................. 8.43 NA NA 4.54 3.91 0.55 090 

45100 .... ............ A ........ Biopsy of rectum ................................. 3.96 NA NA 2.81 2.59 0.44 090 

45108 .... ............ A ........ Removal of anorectal lesion ............... 5.04 NA NA 3.09 2.93 0.59 090 

45110 .... ............ A ........ Removal of rectum .............................. 30.57 NA NA 11.84 12.12 3.36 090 

45111 .... ............ A ........ Partial removal of rectum .................... 17.89 NA NA 6.99 7.07 2.07 090 


cprice-sewell on PROD1PC72 with RULES
66460 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

45112 .... ............ A ........ Removal of rectum .............................. 33.05 NA NA 10.30 11.02 3.43 090 

45113 .... ............ A ........ Partial proctectomy ............................. 33.09 NA NA 11.57 12.08 3.49 090 

45114 .... ............ A ........ Partial removal of rectum .................... 30.63 NA NA 10.28 10.57 3.36 090 

45116 .... ............ A ........ Partial removal of rectum .................... 27.56 NA NA 9.64 9.83 2.88 090 

45119 .... ............ A ........ Remove rectum w/reservoir ................ 33.35 NA NA 11.53 11.99 3.36 090 

45120 .... ............ A ........ Removal of rectum .............................. 26.25 NA NA 9.26 9.69 2.90 090 

45121 .... ............ A ........ Removal of rectum and colon ............. 28.93 NA NA 10.03 10.56 3.25 090 

45123 .... ............ A ........ Partial proctectomy ............................. 18.70 NA NA 6.94 6.89 1.86 090 

45126 .... ............ A ........ Pelvic exenteration .............................. 48.89 NA NA 17.87 18.53 4.33 090 

45130 .... ............ A ........ Excision of rectal prolapse .................. 18.37 NA NA 6.66 6.71 1.80 090 

45135 .... ............ A ........ Excision of rectal prolapse .................. 22.15 NA NA 8.60 8.50 2.36 090 

45136 .... ............ A ........ Excise ileoanal reservior ..................... 30.63 NA NA 11.94 12.23 2.82 090 

45150 .... ............ A ........ Excision of rectal stricture ................... 5.77 NA NA 3.34 3.15 0.61 090 

45160 .... ............ A ........ Excision of rectal lesion ...................... 16.17 NA NA 6.43 6.54 1.68 090 

45170 .... ............ A ........ Excision of rectal lesion ...................... 12.48 NA NA 5.36 5.29 1.35 090 

45190 .... ............ A ........ Destruction, rectal tumor ..................... 10.29 NA NA 5.52 5.07 1.13 090 

45300 .... ............ A ........ Proctosigmoidoscopy dx ..................... 0.80 1.96 1.74 0.45 0.37 0.04 000 

45303 .... ............ A ........ Proctosigmoidoscopy dilate ................ 1.50 19.91 19.29 0.66 0.49 0.05 000 

45305 .... ............ A ........ Proctosigmoidoscopy w/bx ................. 1.25 3.19 2.91 0.59 0.55 0.11 000 

45307 .... ............ A ........ Proctosigmoidoscopy fb ...................... 1.70 3.25 3.14 0.70 0.59 0.11 000 

45308 .... ............ A ........ Proctosigmoidoscopy removal ............ 1.40 3.40 2.70 0.63 0.53 0.09 000 

45309 .... ............ A ........ Proctosigmoidoscopy removal ............ 1.50 3.53 3.17 0.67 0.75 0.22 000 

45315 .... ............ A ........ Proctosigmoidoscopy removal ............ 1.80 3.82 3.34 0.87 0.75 0.15 000 

45317 .... ............ A ........ Proctosigmoidoscopy bleed ................ 2.00 3.36 2.90 0.76 0.71 0.15 000 

45320 .... ............ A ........ Proctosigmoidoscopy ablate ............... 1.78 3.40 3.15 0.80 0.75 0.16 000 

45321 .... ............ A ........ Proctosigmoidoscopy volvul ................ 1.75 NA NA 0.86 0.71 0.13 000 

45327 .... ............ A ........ Proctosigmoidoscopy w/stent ............. 2.00 NA NA 0.91 0.80 0.16 000 

45330 .... ............ A ........ Diagnostic sigmoidoscopy .................. 0.96 2.52 2.40 0.62 0.56 0.08 000 

45331 .... ............ A ........ Sigmoidoscopy and biopsy ................. 1.15 3.28 3.17 0.79 0.69 0.09 000 

45332 .... ............ A ........ Sigmoidoscopy w/fb removal .............. 1.79 5.53 5.26 0.99 0.90 0.16 000 

45333 .... ............ A ........ Sigmoidoscopy & polypectomy ........... 1.79 5.66 5.26 0.99 0.89 0.15 000 

45334 .... ............ A ........ Sigmoidoscopy for bleeding ................ 2.73 NA NA 1.53 1.34 0.20 000 

45335 .... ............ A ........ Sigmoidoscopy w/submuc inj .............. 1.46 5.34 4.27 0.90 0.79 0.11 000 

45337 .... ............ A ........ Sigmoidoscopy & decompress ........... 2.36 NA NA 1.25 1.12 0.21 000 

45338 .... ............ A ........ Sigmoidoscopy w/tumr remove ........... 2.34 5.90 5.56 1.28 1.14 0.19 000 

45339 .... ............ A ........ Sigmoidoscopy w/ablate tumr ............. 3.14 5.73 4.59 1.66 1.47 0.26 000 

45340 .... ............ A ........ Sig w/balloon dilation .......................... 1.89 10.25 8.21 1.03 0.93 0.15 000 

45341 .... ............ A ........ Sigmoidoscopy w/ultrasound .............. 2.60 NA NA 1.47 1.27 0.19 000 

45342 .... ............ A ........ Sigmoidoscopy w/us guide bx ............ 4.05 NA NA 2.17 1.85 0.30 000 

45345 .... ............ A ........ Sigmoidoscopy w/stent ....................... 2.92 NA NA 1.50 1.33 0.23 000 

45355 .... ............ A ........ Surgical colonoscopy .......................... 3.51 NA NA 1.58 1.48 0.36 000 

45378 .... ............ A ........ Diagnostic colonoscopy ...................... 3.69 6.38 6.26 1.82 1.64 0.30 000 

45378 .... 53 ....... A ........ Diagnostic colonoscopy ...................... 0.96 2.52 2.40 0.62 0.56 0.08 000 

45379 .... ............ A ........ Colonoscopy w/fb removal .................. 4.68 8.07 7.86 2.17 1.99 0.39 000 

45380 .... ............ A ........ Colonoscopy and biopsy ..................... 4.43 7.75 7.47 2.23 1.98 0.35 000 

45381 .... ............ A ........ Colonoscopy, submucous inj .............. 4.19 7.72 7.41 2.16 1.90 0.30 000 

45382 .... ............ A ........ Colonoscopy/control bleeding ............. 5.68 10.35 10.14 2.88 2.53 0.41 000 

45383 .... ............ A ........ Lesion removal colonoscopy .............. 5.86 8.55 8.23 2.63 2.43 0.48 000 

45384 .... ............ A ........ Lesion remove colonoscopy ............... 4.69 7.19 6.99 2.18 2.00 0.38 000 

45385 .... ............ A ........ Lesion removal colonoscopy .............. 5.30 8.37 8.08 2.59 2.31 0.42 000 

45386 .... ............ A ........ Colonoscopy dilate stricture ................ 4.57 12.35 12.38 2.17 1.98 0.39 000 

45387 .... ............ A ........ Colonoscopy w/stent ........................... 5.90 NA NA 2.80 2.57 0.48 000 

45391 .... ............ A ........ Colonoscopy w/endoscope us ............ 5.09 NA NA 2.60 2.29 0.42 000 

45392 .... ............ A ........ Colonoscopy w/endoscopic fnb .......... 6.54 NA NA 3.21 2.85 0.42 000 

45395 .... ............ A ........ Lap, removal of rectum ....................... 32.79 NA NA 12.94 13.30 3.63 090 

45397 .... ............ A ........ Lap, remove rectum w/pouch ............. 36.29 NA NA 13.38 13.82 3.67 090 

45400 .... ............ A ........ Laparoscopic proc ............................... 19.31 NA NA 7.07 7.45 2.03 090 

45402 .... ............ A ........ Lap proctopexy w/sig resect ............... 26.38 NA NA 8.73 9.35 2.82 090 

45499 .... ............ C ........ Laparoscope proc, rectum .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

45500 .... ............ A ........ Repair of rectum ................................. 7.64 NA NA 4.46 3.99 0.75 090 

45505 .... ............ A ........ Repair of rectum ................................. 8.20 NA NA 5.04 4.44 0.86 090 

45520 .... ............ A ........ Treatment of rectal prolapse ............... 0.55 2.86 2.25 0.38 0.38 0.05 000 

45540 .... ............ A ........ Correct rectal prolapse ....................... 18.02 NA NA 5.83 6.31 1.85 090 

45541 .... ............ A ........ Correct rectal prolapse ....................... 14.72 NA NA 6.59 6.26 1.55 090 

45550 .... ............ A ........ Repair rectum/remove sigmoid ........... 24.67 NA NA 8.95 9.08 2.62 090 

45560 .... ............ A ........ Repair of rectocele .............................. 11.42 NA NA 5.52 5.28 1.13 090 

45562 .... ............ A ........ Exploration/repair of rectum ................ 17.82 NA NA 8.10 7.54 1.84 090 

45563 .... ............ A ........ Exploration/repair of rectum ................ 26.22 NA NA 10.75 10.62 3.11 090 

45800 .... ............ A ........ Repair rect/bladder fistula ................... 20.18 NA NA 9.14 8.28 1.86 090 

45805 .... ............ A ........ Repair fistula w/colostomy .................. 23.19 NA NA 9.92 9.71 2.03 090 

45820 .... ............ A ........ Repair rectourethral fistula .................. 20.24 NA NA 9.09 8.35 1.58 090 

45825 .... ............ A ........ Repair fistula w/colostomy .................. 24.01 NA NA 9.46 9.63 2.32 090 


cprice-sewell on PROD1PC72 with RULES
66461 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

45900 .... ............ A ........ Reduction of rectal prolapse ............... 2.96 NA NA 1.65 1.57 0.30 010 

45905 .... ............ A ........ Dilation of anal sphincter .................... 2.32 NA NA 1.60 1.51 0.27 010 

45910 .... ............ A ........ Dilation of rectal narrowing ................. 2.82 NA NA 1.84 1.75 0.30 010 

45915 .... ............ A ........ Remove rectal obstruction .................. 3.16 4.20 4.26 2.01 2.05 0.30 010 

45990 .... ............ A ........ Surg dx exam, anorectal ..................... 1.80 NA NA 0.72 0.76 0.17 000 

45999 .... ............ C ........ Rectum surgery procedure ................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

46020 .... ............ A ........ Placement of seton ............................. 2.94 3.26 2.80 2.35 2.10 0.31 010 

46030 .... ............ A ........ Removal of rectal marker ................... 1.24 1.88 1.61 0.81 0.76 0.14 010 

46040 .... ............ A ........ Incision of rectal abscess ................... 5.26 6.53 6.01 3.98 3.78 0.62 090 

46045 .... ............ A ........ Incision of rectal abscess ................... 5.79 NA NA 3.94 3.41 0.54 090 

46050 .... ............ A ........ Incision of anal abscess ..................... 1.21 3.19 2.87 0.98 0.91 0.14 010 

46060 .... ............ A ........ Incision of rectal abscess ................... 6.24 NA NA 4.41 3.83 0.67 090 

46070 .... ............ A ........ Incision of anal septum ....................... 2.74 NA NA 2.35 2.09 0.36 090 

46080 .... ............ A ........ Incision of anal sphincter .................... 2.50 3.06 2.71 1.12 1.12 0.30 010 

46083 .... ............ A ........ Incise external hemorrhoid ................. 1.42 2.36 2.44 0.96 0.94 0.15 010 

46200 .... ............ A ........ Removal of anal fissure ...................... 3.48 6.29 5.07 3.73 3.29 0.39 090 

46210 .... ............ A ........ Removal of anal crypt ......................... 2.73 5.82 5.46 3.30 2.96 0.31 090 

46211 .... ............ A ........ Removal of anal crypts ....................... 4.31 7.84 6.62 4.66 4.08 0.48 090 

46220 .... ............ A ........ Removal of anal tag ............................ 1.58 3.02 2.66 1.10 1.02 0.17 010 

46221 .... ............ A ........ Ligation of hemorrhoid(s) .................... 2.31 3.73 3.19 2.00 1.87 0.23 010 

46230 .... ............ A ........ Removal of anal tags .......................... 2.59 3.50 3.29 1.33 1.31 0.30 010 

46250 .... ............ A ........ Hemorrhoidectomy .............................. 4.17 5.95 5.63 2.83 2.72 0.48 090 

46255 .... ............ A ........ Hemorrhoidectomy .............................. 4.88 6.34 6.08 3.06 2.95 0.58 090 

46257 .... ............ A ........ Remove hemorrhoids & fissure .......... 5.68 NA NA 3.84 3.36 0.64 090 

46258 .... ............ A ........ Remove hemorrhoids & fistula ........... 6.28 NA NA 3.95 3.61 0.68 090 

46260 .... ............ A ........ Hemorrhoidectomy .............................. 6.65 NA NA 4.06 3.62 0.76 090 

46261 .... ............ A ........ Remove hemorrhoids & fissure .......... 7.63 NA NA 4.29 3.94 0.79 090 

46262 .... ............ A ........ Remove hemorrhoids & fistula ........... 7.80 NA NA 4.65 4.19 0.83 090 

46270 .... ............ A ........ Removal of anal fistula ....................... 4.81 6.38 5.68 3.91 3.37 0.46 090 

46275 .... ............ A ........ Removal of anal fistula ....................... 5.31 6.62 5.62 3.97 3.47 0.52 090 

46280 .... ............ A ........ Removal of anal fistula ....................... 6.28 NA NA 4.27 3.76 0.66 090 

46285 .... ............ A ........ Removal of anal fistula ....................... 5.31 6.53 5.14 3.95 3.35 0.44 090 

46288 .... ............ A ........ Repair anal fistula ............................... 7.68 NA NA 4.67 4.17 0.79 090 

46320 .... ............ A ........ Removal of hemorrhoid clot ................ 1.62 2.41 2.26 0.88 0.86 0.18 010 

46500 .... ............ A ........ Injection into hemorrhoid(s) ................ 1.64 3.60 2.86 1.25 1.20 0.16 010 

46505 .... ............ A ........ Chemodenervation anal musc ............ 3.13 3.28 3.16 2.28 2.12 0.14 010 

46600 .... ............ A ........ Diagnostic anoscopy ........................... 0.55 1.37 1.46 0.38 0.36 0.05 000 

46604 .... ............ A ........ Anoscopy and dilation ......................... 1.03 12.51 10.81 0.51 0.56 0.12 000 

46606 .... ............ A ........ Anoscopy and biopsy .......................... 1.20 3.87 3.82 0.58 0.50 0.09 000 

46608 .... ............ A ........ Anoscopy, remove for body ................ 1.30 3.76 4.08 0.58 0.61 0.16 000 

46610 .... ............ A ........ Anoscopy, remove lesion .................... 1.28 3.79 3.91 0.59 0.60 0.15 000 

46611 .... ............ A ........ Anoscopy ............................................ 1.30 2.53 2.93 0.57 0.67 0.19 000 

46612 .... ............ A ........ Anoscopy, remove lesions .................. 1.50 4.70 4.94 0.72 0.85 0.28 000 

46614 .... ............ A ........ Anoscopy, control bleeding ................. 1.00 1.93 2.13 0.52 0.68 0.20 000 

46615 .... ............ A ........ Anoscopy ............................................ 1.50 1.74 2.11 0.64 0.85 0.33 000 

46700 .... ............ A ........ Repair of anal stricture ....................... 9.68 NA NA 5.15 4.67 0.94 090 

46705 .... ............ A ........ Repair of anal stricture ....................... 7.32 NA NA 4.06 3.87 0.91 090 

46706 .... ............ A ........ Repr of anal fistula w/glue .................. 2.41 NA NA 1.49 1.37 0.28 010 

46710 .... ............ A ........ Repr per/vag pouch sngl proc ............ 17.01 NA NA 7.54 7.64 1.38 090 

46712 .... ............ A ........ Repr per/vag pouch dbl proc .............. 36.32 NA NA 14.00 14.52 3.67 090 

46715 .... ............ A ........ Rep perf anoper fistu .......................... 7.54 NA NA 3.75 3.66 0.92 090 

46716 .... ............ A ........ Rep perf anoper/vestib fistu ................ 17.14 NA NA 9.59 8.77 1.58 090 

46730 .... ............ A ........ Construction of absent anus ............... 30.17 NA NA 12.49 12.25 2.47 090 

46735 .... ............ A ........ Construction of absent anus ............... 35.66 NA NA 15.00 14.27 3.21 090 

46740 .... ............ A ........ Construction of absent anus ............... 33.42 NA NA 15.28 14.25 2.42 090 

46742 .... ............ A ........ Repair of imperforated anus ............... 39.66 NA NA 13.75 15.56 3.20 090 

46744 .... ............ A ........ Repair of cloacal anomaly .................. 58.46 NA NA 18.13 19.61 6.40 090 

46746 .... ............ A ........ Repair of cloacal anomaly .................. 64.93 NA NA 19.66 22.39 7.70 090 

46748 .... ............ A ........ Repair of cloacal anomaly .................. 70.91 NA NA 21.04 22.33 3.37 090 

46750 .... ............ A ........ Repair of anal sphincter ...................... 12.02 NA NA 5.76 5.40 1.10 090 

46751 .... ............ A ........ Repair of anal sphincter ...................... 9.19 NA NA 5.02 5.22 0.94 090 

46753 .... ............ A ........ Reconstruction of anus ....................... 8.81 NA NA 4.59 4.21 0.94 090 

46754 .... ............ A ........ Removal of suture from anus ............. 2.88 3.63 3.61 2.21 1.94 0.19 010 

46760 .... ............ A ........ Repair of anal sphincter ...................... 17.21 NA NA 8.05 7.56 1.59 090 

46761 .... ............ A ........ Repair of anal sphincter ...................... 15.16 NA NA 6.47 6.23 1.43 090 

46762 .... ............ A ........ Implant artificial sphincter ................... 14.66 NA NA 7.07 6.29 1.24 090 

46900 .... ............ A ........ Destruction, anal lesion(s) .................. 1.91 3.65 3.12 1.31 1.29 0.17 010 

46910 .... ............ A ........ Destruction, anal lesion(s) .................. 1.88 3.88 3.39 1.20 1.13 0.19 010 

46916 .... ............ A ........ Cryosurgery, anal lesion(s) ................. 1.88 3.77 3.46 1.58 1.48 0.11 010 

46917 .... ............ A ........ Laser surgery, anal lesions ................. 1.88 8.78 8.95 1.22 1.17 0.21 010 

46922 .... ............ A ........ Excision of anal lesion(s) .................... 1.88 4.14 3.70 1.20 1.13 0.22 010 

46924 .... ............ A ........ Destruction, anal lesion(s) .................. 2.78 9.57 9.13 1.51 1.43 0.26 010 


cprice-sewell on PROD1PC72 with RULES
66462 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

46934 .... ............ A ........ Destruction of hemorrhoids ................. 3.79 5.56 5.31 2.87 2.91 0.32 090 

46935 .... ............ A ........ Destruction of hemorrhoids ................. 2.44 3.86 3.66 1.11 1.16 0.23 010 

46936 .... ............ A ........ Destruction of hemorrhoids ................. 3.70 6.23 5.55 2.65 2.57 0.34 090 

46937 .... ............ A ........ Cryotherapy of rectal lesion ................ 2.70 3.40 3.09 1.43 1.32 0.14 010 

46938 .... ............ A ........ Cryotherapy of rectal lesion ................ 4.70 5.62 4.80 3.55 3.30 0.58 090 

46940 .... ............ A ........ Treatment of anal fissure .................... 2.33 2.84 2.42 1.04 1.06 0.23 010 

46942 .... ............ A ........ Treatment of anal fissure .................... 2.05 2.80 2.32 0.96 0.99 0.19 010 

46945 .... ............ A ........ Ligation of hemorrhoids ...................... 2.13 4.79 4.03 2.98 2.72 0.19 090 

46946 .... ............ A ........ Ligation of hemorrhoids ...................... 2.60 4.63 4.17 2.64 2.52 0.27 090 

46947 .... ............ A ........ Hemorrhoidopexy by stapling ............. 5.49 NA NA 3.10 2.91 0.75 090 

46999 .... ............ C ........ Anus surgery procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

47000 .... ............ A ........ Needle biopsy of liver ......................... 1.90 7.66 5.36 0.70 0.66 0.12 000 

47001 .... ............ A ........ Needle biopsy, liver add-on ................ 1.90 NA NA 0.48 0.57 0.25 ZZZ 

47010 .... ............ A ........ Open drainage, liver lesion ................. 19.27 NA NA 8.31 8.35 1.81 090 

47011 .... ............ A ........ Percut drain, liver lesion ..................... 3.69 NA NA 1.32 1.26 0.22 000 

47015 .... ............ A ........ Inject/aspirate liver cyst ...................... 18.37 NA NA 8.16 7.82 1.84 090 

47100 .... ............ A ........ Wedge biopsy of liver ......................... 12.78 NA NA 6.31 6.17 1.53 090 

47120 .... ............ A ........ Partial removal of liver ........................ 38.82 NA NA 14.07 14.60 4.66 090 

47122 .... ............ A ........ Extensive removal of liver ................... 59.35 NA NA 18.74 20.08 7.21 090 

47125 .... ............ A ........ Partial removal of liver ........................ 52.91 NA NA 17.16 18.33 6.47 090 

47130 .... ............ A ........ Partial removal of liver ........................ 57.06 NA NA 18.10 19.53 6.96 090 

47133 .... ............ X ........ Removal of donor liver ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

47135 .... ............ R ........ Transplantation of liver ....................... 83.29 NA NA 27.72 29.60 9.96 090 

47136 .... ............ R ........ Transplantation of liver ....................... 70.39 NA NA 24.53 25.76 8.44 090 

47140 .... ............ A ........ Partial removal, donor liver ................. 59.22 NA NA 21.60 21.93 5.19 090 

47141 .... ............ A ........ Partial removal, donor liver ................. 71.27 NA NA 25.33 26.11 5.19 090 

47142 .... ............ A ........ Partial removal, donor liver ................. 79.21 NA NA 27.34 28.39 5.19 090 

47143 .... ............ C ........ Prep donor liver, whole ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

47144 .... ............ C ........ Prep donor liver, 3-segment ............... 0.00 0.00 0.00 0.00 0.00 0.00 090 

47145 .... ............ C ........ Prep donor liver, lobe split .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

47146 .... ............ A ........ Prep donor liver/venous ...................... 6.00 NA NA 1.52 1.78 0.83 XXX 

47147 .... ............ A ........ Prep donor liver/arterial ...................... 7.00 NA NA 1.77 2.08 0.97 XXX 

47300 .... ............ A ........ Surgery for liver lesion ........................ 18.01 NA NA 7.74 7.48 1.99 090 

47350 .... ............ A ........ Repair liver wound .............................. 22.36 NA NA 8.77 8.81 2.59 090 

47360 .... ............ A ........ Repair liver wound .............................. 31.18 NA NA 11.24 11.40 3.38 090 

47361 .... ............ A ........ Repair liver wound .............................. 52.47 NA NA 17.38 17.94 5.87 090 

47362 .... ............ A ........ Repair liver wound .............................. 23.41 NA NA 9.30 9.00 2.51 090 

47370 .... ............ A ........ Laparo ablate liver tumor rf ................ 20.67 NA NA 7.69 7.90 2.56 090 

47371 .... ............ A ........ Laparo ablate liver cryosurg ............... 20.67 NA NA 7.89 8.01 2.61 090 

47379 .... ............ C ........ Laparoscope procedure, liver ............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

47380 .... ............ A ........ Open ablate liver tumor rf ................... 24.43 NA NA 8.60 8.97 2.87 090 

47381 .... ............ A ........ Open ablate liver tumor cryo .............. 24.72 NA NA 9.31 9.44 2.85 090 

47382 .... ............ A ........ Percut ablate liver rf ............................ 15.19 NA NA 6.20 6.14 0.96 010 

47399 .... ............ C ........ Liver surgery procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

47400 .... ............ A ........ Incision of liver duct ............................ 36.23 NA NA 13.01 13.21 3.08 090 

47420 .... ............ A ........ Incision of bile duct ............................. 21.92 NA NA 8.54 8.65 2.63 090 

47425 .... ............ A ........ Incision of bile duct ............................. 22.20 NA NA 8.64 8.72 2.62 090 

47460 .... ............ A ........ Incise bile duct sphincter .................... 20.41 NA NA 9.13 8.74 2.21 090 

47480 .... ............ A ........ Incision of gallbladder ......................... 13.12 NA NA 6.64 6.27 1.42 090 

47490 .... ............ A ........ Incision of gallbladder ......................... 8.05 NA NA 5.29 5.43 0.43 090 

47500 .... ............ A ........ Injection for liver x-rays ....................... 1.96 NA NA 0.71 0.67 0.12 000 

47505 .... ............ A ........ Injection for liver x-rays ....................... 0.76 NA NA 0.27 0.26 0.04 000 

47510 .... ............ A ........ Insert catheter, bile duct ..................... 7.94 NA NA 4.63 4.82 0.46 090 

47511 .... ............ A ........ Insert bile duct drain ........................... 10.74 NA NA 5.04 5.06 0.62 090 

47525 .... ............ A ........ Change bile duct catheter ................... 5.55 14.85 14.96 2.69 2.74 0.33 010 

47530 .... ............ A ........ Revise/reinsert bile tube ..................... 5.96 30.56 32.16 3.44 3.58 0.37 090 

47550 .... ............ A ........ Bile duct endoscopy add-on ............... 3.02 NA NA 0.78 0.90 0.40 ZZZ 

47552 .... ............ A ........ Biliary endoscopy thru skin ................. 6.03 NA NA 2.48 2.43 0.42 000 

47553 .... ............ A ........ Biliary endoscopy thru skin ................. 6.34 NA NA 2.25 2.16 0.37 000 

47554 .... ............ A ........ Biliary endoscopy thru skin ................. 9.05 NA NA 3.29 3.32 0.96 000 

47555 .... ............ A ........ Biliary endoscopy thru skin ................. 7.55 NA NA 2.74 2.60 0.45 000 

47556 .... ............ A ........ Biliary endoscopy thru skin ................. 8.55 NA NA 3.09 2.93 0.50 000 

47560 .... ............ A ........ Laparoscopy w/cholangio ................... 4.88 NA NA 1.24 1.45 0.65 000 

47561 .... ............ A ........ Laparo w/cholangio/biopsy ................. 5.17 NA NA 1.58 1.75 0.66 000 

47562 .... ............ A ........ Laparoscopic cholecystectomy ........... 11.63 NA NA 5.26 5.12 1.46 090 

47563 .... ............ A ........ Laparo cholecystectomy/graph ........... 12.03 NA NA 5.06 5.18 1.58 090 

47564 .... ............ A ........ Laparo cholecystectomy/explr ............ 14.21 NA NA 5.41 5.68 1.89 090 

47570 .... ............ A ........ Laparo cholecystoenterostomy ........... 12.56 NA NA 4.96 5.16 1.65 090 

47579 .... ............ C ........ Laparoscope proc, biliary .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

47600 .... ............ A ........ Removal of gallbladder ....................... 17.35 NA NA 7.22 6.67 1.80 090 

47605 .... ............ A ........ Removal of gallbladder ....................... 15.90 NA NA 6.38 6.43 1.95 090 

47610 .... ............ A ........ Removal of gallbladder ....................... 20.84 NA NA 7.65 7.78 2.49 090 


cprice-sewell on PROD1PC72 with RULES
66463 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

47612 .... ............ A ........ Removal of gallbladder ....................... 21.13 NA NA 7.67 7.77 2.48 090 

47620 .... ............ A ........ Removal of gallbladder ....................... 22.99 NA NA 8.15 8.33 2.74 090 

47630 .... ............ A ........ Remove bile duct stone ...................... 9.57 NA NA 4.73 4.80 0.65 090 

47700 .... ............ A ........ Exploration of bile ducts ..................... 16.39 NA NA 7.30 7.35 2.07 090 

47701 .... ............ A ........ Bile duct revision ................................. 28.62 NA NA 10.64 11.05 3.68 090 

47711 .... ............ A ........ Excision of bile duct tumor ................. 25.77 NA NA 9.64 9.77 3.05 090 

47712 .... ............ A ........ Excision of bile duct tumor ................. 33.59 NA NA 11.65 12.02 3.93 090 

47715 .... ............ A ........ Excision of bile duct cyst .................... 21.42 NA NA 8.60 8.51 2.49 090 

47720 .... ............ A ........ Fuse gallbladder & bowel ................... 18.21 NA NA 7.70 7.58 2.11 090 

47721 .... ............ A ........ Fuse upper gi structures ..................... 21.86 NA NA 8.54 8.54 2.53 090 

47740 .... ............ A ........ Fuse gallbladder & bowel ................... 21.10 NA NA 8.33 8.34 2.42 090 

47741 .... ............ A ........ Fuse gallbladder & bowel ................... 24.08 NA NA 9.24 9.26 2.83 090 

47760 .... ............ A ........ Fuse bile ducts and bowel .................. 38.14 NA NA 13.03 11.93 3.42 090 

47765 .... ............ A ........ Fuse liver ducts & bowel .................... 52.01 NA NA 16.94 13.86 3.30 090 

47780 .... ............ A ........ Fuse bile ducts and bowel .................. 42.14 NA NA 14.11 12.65 3.50 090 

47785 .... ............ A ........ Fuse bile ducts and bowel .................. 56.01 NA NA 17.84 15.36 4.10 090 

47800 .... ............ A ........ Reconstruction of bile ducts ............... 26.04 NA NA 9.77 9.90 3.08 090 

47801 .... ............ A ........ Placement, bile duct support .............. 17.47 NA NA 8.43 8.28 1.16 090 

47802 .... ............ A ........ Fuse liver duct & intestine .................. 24.80 NA NA 9.68 9.66 2.86 090 

47900 .... ............ A ........ Suture bile duct injury ......................... 22.31 NA NA 8.85 8.85 2.65 090 

47999 .... ............ C ........ Bile tract surgery procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

48000 .... ............ A ........ Drainage of abdomen ......................... 31.82 NA NA 10.86 11.17 3.48 090 

48001 .... ............ A ........ Placement of drain, pancreas ............. 39.56 NA NA 12.76 13.30 4.69 090 

48020 .... ............ A ........ Removal of pancreatic stone .............. 18.96 NA NA 7.59 7.44 2.13 090 

48100 .... ............ A ........ Biopsy of pancreas, open ................... 14.38 NA NA 5.95 5.77 1.62 090 

48102 .... ............ A ........ Needle biopsy, pancreas .................... 4.68 9.60 8.77 1.91 1.93 0.28 010 

48105 .... ............ A ........ Resect/debride pancreas .................... 49.05 NA NA 15.76 16.15 5.56 090 

48120 .... ............ A ........ Removal of pancreas lesion ............... 18.33 NA NA 6.85 6.84 2.10 090 

48140 .... ............ A ........ Partial removal of pancreas ................ 26.19 NA NA 9.37 9.45 3.03 090 

48145 .... ............ A ........ Partial removal of pancreas ................ 27.26 NA NA 9.55 9.68 3.18 090 

48146 .... ............ A ........ Pancreatectomy .................................. 30.42 NA NA 11.93 11.94 3.50 090 

48148 .... ............ A ........ Removal of pancreatic duct ................ 20.26 NA NA 8.20 7.89 2.30 090 

48150 .... ............ A ........ Partial removal of pancreas ................ 52.63 NA NA 18.01 18.74 6.32 090 

48152 .... ............ A ........ Pancreatectomy .................................. 48.47 NA NA 16.82 17.50 5.80 090 

48153 .... ............ A ........ Pancreatectomy .................................. 52.61 NA NA 17.89 18.70 6.31 090 

48154 .... ............ A ........ Pancreatectomy .................................. 48.70 NA NA 17.05 17.62 5.84 090 

48155 .... ............ A ........ Removal of pancreas .......................... 29.27 NA NA 11.96 11.80 3.27 090 

48160 .... ............ N ........ Pancreas removal/transplant .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

48400 .... ............ A ........ Injection, intraop add-on ..................... 1.95 NA NA 0.66 0.65 0.15 ZZZ 

48500 .... ............ A ........ Surgery of pancreatic cyst .................. 18.03 NA NA 7.66 7.49 2.03 090 

48510 .... ............ A ........ Drain pancreatic pseudocyst .............. 17.06 NA NA 7.60 7.51 1.83 090 

48511 .... ............ A ........ Drain pancreatic pseudocyst .............. 3.99 20.17 20.53 1.43 1.37 0.24 000 

48520 .... ............ A ........ Fuse pancreas cyst and bowel ........... 18.07 NA NA 6.82 6.76 2.06 090 

48540 .... ............ A ........ Fuse pancreas cyst and bowel ........... 21.86 NA NA 7.80 7.94 2.61 090 

48545 .... ............ A ........ Pancreatorrhaphy ................................ 22.10 NA NA 8.41 8.19 2.38 090 

48547 .... ............ A ........ Duodenal exclusion ............................. 30.25 NA NA 10.28 10.37 3.42 090 

48548 .... ............ A ........ Fuse pancreas and bowel .................. 27.96 NA NA 9.88 10.01 3.28 090 

48550 .... ............ X ........ Donor pancreatectomy ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

48551 .... ............ C ........ Prep donor pancreas .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

48552 .... ............ A ........ Prep donor pancreas/venous .............. 4.30 NA NA 1.14 1.30 0.31 XXX 

48554 .... ............ R ........ Transpl allograft pancreas .................. 37.03 NA NA 20.51 19.37 4.19 090 

48556 .... ............ A ........ Removal, allograft pancreas ............... 19.24 NA NA 9.22 8.64 2.08 090 

48999 .... ............ C ........ Pancreas surgery procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

49000 .... ............ A ........ Exploration of abdomen ...................... 12.44 NA NA 5.20 5.29 1.52 090 

49002 .... ............ A ........ Reopening of abdomen ...................... 17.55 NA NA 6.38 5.69 1.37 090 

49010 .... ............ A ........ Exploration behind abdomen .............. 15.98 NA NA 6.19 6.04 1.51 090 

49020 .... ............ A ........ Drain abdominal abscess ................... 26.46 NA NA 9.88 10.03 2.85 090 

49021 .... ............ A ........ Drain abdominal abscess ................... 3.37 19.63 20.33 1.21 1.16 0.20 000 

49040 .... ............ A ........ Drain, open, abdom abscess .............. 16.41 NA NA 6.51 6.46 1.70 090 

49041 .... ............ A ........ Drain, percut, abdom abscess ............ 3.99 19.91 19.71 1.43 1.37 0.24 000 

49060 .... ............ A ........ Drain, open, retrop abscess ............... 18.42 NA NA 7.24 7.33 1.75 090 

49061 .... ............ A ........ Drain, percut, retroper absc ................ 3.69 19.74 19.68 1.33 1.27 0.22 000 

49062 .... ............ A ........ Drain to peritoneal cavity .................... 12.12 NA NA 5.11 5.27 1.39 090 

49080 .... ............ A ........ Puncture, peritoneal cavity ................. 1.35 2.73 3.35 0.48 0.47 0.08 000 

49081 .... ............ A ........ Removal of abdominal fluid ................ 1.26 2.93 2.76 0.47 0.45 0.09 000 

49180 .... ............ A ........ Biopsy, abdominal mass ..................... 1.73 2.47 2.79 0.62 0.59 0.10 000 

49203 .... ............ A ........ Exc abd tum 5 cm or less ................... 20.00 NA NA 7.65 7.65 2.27 090 

49204 .... ............ A ........ Exc abd tum over 5 cm ...................... 26.00 NA NA 9.26 9.26 2.94 090 

49205 .... ............ A ........ Exc abd tum over 10 cm .................... 30.00 NA NA 10.34 10.34 3.40 090 

49215 .... ............ A ........ Excise sacral spine tumor ................... 37.66 NA NA 12.67 13.35 4.38 090 

49220 .... ............ A ........ Multiple surgery, abdomen ................. 15.70 NA NA 6.45 6.54 1.89 090 

49250 .... ............ A ........ Excision of umbilicus .......................... 8.93 NA NA 4.34 4.30 1.08 090 


cprice-sewell on PROD1PC72 with RULES
66464 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

49255 .... ............ A ........ Removal of omentum .......................... 12.41 NA NA 5.62 5.61 1.43 090 

49320 .... ............ A ........ Diag laparo separate proc .................. 5.09 NA NA 2.44 2.53 0.65 010 

49321 .... ............ A ........ Laparoscopy, biopsy ........................... 5.39 NA NA 2.56 2.60 0.70 010 

49322 .... ............ A ........ Laparoscopy, aspiration ...................... 5.96 NA NA 2.63 2.81 0.71 010 

49323 .... ............ A ........ Laparo drain lymphocele .................... 10.13 NA NA 4.68 4.58 1.20 090 

49324 .... ............ A ........ Lap insertion perm ip cath .................. 6.27 NA NA 2.78 2.78 0.73 010 

49325 .... ............ A ........ Lap revision perm ip cath ................... 6.77 NA NA 2.91 2.91 0.86 010 

49326 .... ............ A ........ Lap w/omentopexy add-on ................. 3.50 NA NA 0.92 0.92 0.44 ZZZ 

49329 .... ............ C ........ Laparo proc, abdm/per/oment ............ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

49400 .... ............ A ........ Air injection into abdomen .................. 1.88 2.47 2.77 0.62 0.62 0.15 000 

49402 .... ............ A ........ Remove foreign body, adbomen ........ 14.01 NA NA 5.51 5.50 1.62 090 

49419 .... ............ A ........ Insrt abdom cath for chemotx ............. 7.03 NA NA 3.43 3.49 0.81 090 

49420 .... ............ A ........ Insert abdom drain, temp .................... 2.22 NA NA 1.18 1.13 0.21 000 

49421 .... ............ A ........ Insert abdom drain, perm ................... 5.87 NA NA 3.12 3.13 0.74 090 

49422 .... ............ A ........ Remove perm cannula/catheter .......... 6.26 NA NA 2.61 2.75 0.83 010 

49423 .... ............ A ........ Exchange drainage catheter ............... 1.46 13.08 13.57 0.56 0.54 0.09 000 

49424 .... ............ A ........ Assess cyst, contrast inject ................ 0.76 3.08 3.39 0.30 0.30 0.04 000 

49425 .... ............ A ........ Insert abdomen-venous drain ............. 12.13 NA NA 5.29 5.44 1.54 090 

49426 .... ............ A ........ Revise abdomen-venous shunt .......... 10.33 NA NA 4.56 4.66 1.28 090 

49427 .... ............ A ........ Injection, abdominal shunt .................. 0.89 NA NA 0.32 0.31 0.07 000 

49428 .... ............ A ........ Ligation of shunt ................................. 6.79 NA NA 2.99 3.45 0.80 010 

49429 .... ............ A ........ Removal of shunt ................................ 7.41 NA NA 2.99 3.20 1.02 010 

49435 .... ............ A ........ Insert subq exten to ip cath ................ 2.25 NA NA 0.61 0.61 0.28 ZZZ 

49436 .... ............ A ........ Embedded ip cath exit-site ................. 2.69 NA NA 1.66 1.66 0.28 010 

49440 .... ............ A ........ Place gastrostomy tube perc .............. 4.18 25.03 25.03 1.81 1.81 0.49 010 

49441 .... ............ A ........ Place duod/jej tube perc ..................... 4.77 30.10 30.10 2.00 2.00 0.29 010 

49442 .... ............ A ........ Place cecostomy tube perc ................ 4.00 24.43 24.43 1.63 1.63 0.24 010 

49446 .... ............ A ........ Change g-tube to g-j perc ................... 3.31 25.74 25.74 1.15 1.15 0.18 000 

49450 .... ............ A ........ Replace g/c tube perc ......................... 1.36 18.94 18.94 0.44 0.44 0.08 000 

49451 .... ............ A ........ Replace duod/jej tube perc ................. 1.84 19.69 19.69 0.64 0.64 0.11 000 

49452 .... ............ A ........ Replace g-j tube perc ......................... 2.86 23.48 23.48 1.00 1.00 0.18 000 

49460 .... ............ A ........ Fix g/colon tube w/device ................... 0.96 20.56 20.56 0.31 0.31 0.05 000 

49465 .... ............ A ........ Fluoro exam of g/colon tube ............... 0.62 3.88 3.88 0.22 0.22 0.03 000 

49491 .... ............ A ........ Rpr hern preemie reduc ...................... 12.42 NA NA 4.61 4.83 1.40 090 

49492 .... ............ A ........ Rpr ing hern premie, blocked ............. 15.32 NA NA 6.22 6.16 1.81 090 

49495 .... ............ A ........ Rpr ing hernia baby, reduc ................. 6.15 NA NA 3.06 3.01 0.74 090 

49496 .... ............ A ........ Rpr ing hernia baby, blocked .............. 9.32 NA NA 4.44 4.35 1.07 090 

49500 .... ............ A ........ Rpr ing hernia, init, reduce ................. 5.76 NA NA 3.64 3.38 0.71 090 

49501 .... ............ A ........ Rpr ing hernia, init blocked ................. 9.28 NA NA 4.26 4.23 1.12 090 

49505 .... ............ A ........ Prp i/hern init reduc >5 yr ................... 7.88 NA NA 3.88 3.81 1.03 090 

49507 .... ............ A ........ Prp i/hern init block >5 yr .................... 9.97 NA NA 4.45 4.45 1.27 090 

49520 .... ............ A ........ Rerepair ing hernia, reduce ................ 9.91 NA NA 4.37 4.40 1.28 090 

49521 .... ............ A ........ Rerepair ing hernia, blocked ............... 12.36 NA NA 4.98 5.11 1.59 090 

49525 .... ............ A ........ Repair ing hernia, sliding .................... 8.85 NA NA 4.12 4.09 1.13 090 

49540 .... ............ A ........ Repair lumbar hernia .......................... 10.66 NA NA 4.57 4.65 1.37 090 

49550 .... ............ A ........ Rpr rem hernia, init, reduce ................ 8.91 NA NA 4.11 4.11 1.14 090 

49553 .... ............ A ........ Rpr fem hernia, init blocked ................ 9.84 NA NA 4.41 4.41 1.24 090 

49555 .... ............ A ........ Rerepair fem hernia, reduce ............... 9.31 NA NA 4.20 4.23 1.20 090 

49557 .... ............ A ........ Rerepair fem hernia, blocked ............. 11.54 NA NA 4.83 4.90 1.47 090 

49560 .... ............ A ........ Rpr ventral hern init, reduc ................. 11.84 NA NA 4.87 5.00 1.52 090 

49561 .... ............ A ........ Rpr ventral hern init, block .................. 15.30 NA NA 5.79 5.92 1.89 090 

49565 .... ............ A ........ Rerepair ventrl hern, reduce ............... 12.29 NA NA 5.08 5.15 1.52 090 

49566 .... ............ A ........ Rerepair ventrl hern, block ................. 15.45 NA NA 5.85 5.98 1.91 090 

49568 .... ............ A ........ Hernia repair w/mesh .......................... 4.88 NA NA 1.24 1.45 0.64 ZZZ 

49570 .... ............ A ........ Rpr epigastric hern, reduce ................ 5.97 NA NA 3.38 3.27 0.75 090 

49572 .... ............ A ........ Rpr epigastric hern, blocked ............... 7.79 NA NA 3.82 3.64 0.88 090 

49580 .... ............ A ........ Rpr umbil hern, reduc < 5 yr .............. 4.39 NA NA 2.94 2.77 0.54 090 

49582 .... ............ A ........ Rpr umbil hern, block < 5 yr ............... 7.05 NA NA 3.69 3.57 0.88 090 

49585 .... ............ A ........ Rpr umbil hern, reduc > 5 yr .............. 6.51 NA NA 3.51 3.40 0.82 090 

49587 .... ............ A ........ Rpr umbil hern, block > 5 yr ............... 7.96 NA NA 3.86 3.79 0.99 090 

49590 .... ............ A ........ Repair spigelian hernia ....................... 8.82 NA NA 4.08 4.08 1.13 090 

49600 .... ............ A ........ Repair umbilical lesion ........................ 11.47 NA NA 5.38 5.35 1.32 090 

49605 .... ............ A ........ Repair umbilical lesion ........................ 86.85 NA NA 27.56 28.02 9.39 090 

49606 .... ............ A ........ Repair umbilical lesion ........................ 18.92 NA NA 6.77 7.22 2.46 090 

49610 .... ............ A ........ Repair umbilical lesion ........................ 10.83 NA NA 5.28 5.24 1.07 090 

49611 .... ............ A ........ Repair umbilical lesion ........................ 9.26 NA NA 4.21 5.59 0.78 090 

49650 .... ............ A ........ Laparo hernia repair initial .................. 6.30 NA NA 3.34 3.27 0.93 090 

49651 .... ............ A ........ Laparo hernia repair recur .................. 8.29 NA NA 4.22 4.13 1.14 090 

49659 .... ............ C ........ Laparo proc, hernia repair .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

49900 .... ............ A ........ Repair of abdominal wall .................... 12.26 NA NA 6.28 6.25 1.62 090 

49904 .... ............ A ........ Omental flap, extra-abdom ................. 22.16 NA NA 11.88 13.54 2.70 090 

49905 .... ............ A ........ Omental flap, intra-abdom .................. 6.54 NA NA 1.69 1.99 0.75 ZZZ 


cprice-sewell on PROD1PC72 with RULES
66465 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

49906 .... ............ C ........ Free omental flap, microvasc ............. 0.00 0.00 0.00 0.00 0.00 0.00 090 

49999 .... ............ C ........ Abdomen surgery procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

50010 .... ............ A ........ Exploration of kidney .......................... 12.13 NA NA 6.73 5.97 0.93 090 

50020 .... ............ A ........ Renal abscess, open drain ................. 17.88 NA NA 8.48 8.11 1.34 090 

50021 .... ............ A ........ Renal abscess, percut drain ............... 3.37 21.09 21.36 1.22 1.16 0.20 000 

50040 .... ............ A ........ Drainage of kidney .............................. 16.48 NA NA 8.82 7.81 1.03 090 

50045 .... ............ A ........ Exploration of kidney .......................... 16.67 NA NA 8.14 7.36 1.24 090 

50060 .... ............ A ........ Removal of kidney stone .................... 20.80 NA NA 10.81 9.31 1.36 090 

50065 .... ............ A ........ Incision of kidney ................................ 22.17 NA NA 11.51 8.79 1.59 090 

50070 .... ............ A ........ Incision of kidney ................................ 21.70 NA NA 11.32 9.76 1.44 090 

50075 .... ............ A ........ Removal of kidney stone .................... 26.91 NA NA 13.49 11.69 1.81 090 

50080 .... ............ A ........ Removal of kidney stone .................... 15.61 NA NA 8.55 7.41 1.04 090 

50081 .... ............ A ........ Removal of kidney stone .................... 23.32 NA NA 12.17 10.46 1.54 090 

50100 .... ............ A ........ Revise kidney blood vessels .............. 17.30 NA NA 6.51 7.14 2.07 090 

50120 .... ............ A ........ Exploration of kidney .......................... 17.06 NA NA 9.11 7.93 1.21 090 

50125 .... ............ A ........ Explore and drain kidney .................... 17.67 NA NA 9.71 8.33 1.43 090 

50130 .... ............ A ........ Removal of kidney stone .................... 18.67 NA NA 10.05 8.60 1.22 090 

50135 .... ............ A ........ Exploration of kidney .......................... 20.44 NA NA 10.69 9.23 1.33 090 

50200 .... ............ A ........ Biopsy of kidney .................................. 2.63 NA NA 1.19 1.24 0.16 000 

50205 .... ............ A ........ Biopsy of kidney .................................. 12.19 NA NA 5.51 5.25 1.30 090 

50220 .... ............ A ........ Remove kidney, open ......................... 18.53 NA NA 9.51 8.37 1.35 090 

50225 .... ............ A ........ Removal kidney open, complex .......... 21.73 NA NA 11.01 9.57 1.50 090 

50230 .... ............ A ........ Removal kidney open, radical ............ 23.68 NA NA 11.64 10.10 1.55 090 

50234 .... ............ A ........ Removal of kidney & ureter ................ 23.90 NA NA 12.03 10.42 1.59 090 

50236 .... ............ A ........ Removal of kidney & ureter ................ 26.74 NA NA 13.90 12.07 1.77 090 

50240 .... ............ A ........ Partial removal of kidney .................... 24.01 NA NA 12.60 10.80 1.55 090 

50250 .... ............ A ........ Cryoablate renal mass open ............... 22.06 NA NA 11.48 10.31 1.39 090 

50280 .... ............ A ........ Removal of kidney lesion .................... 16.94 NA NA 9.06 7.87 1.19 090 

50290 .... ............ A ........ Removal of kidney lesion .................... 16.00 NA NA 7.73 7.09 1.41 090 

50300 .... ............ X ........ Remove cadaver donor kidney ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

50320 .... ............ A ........ Remove kidney, living donor .............. 22.28 NA NA 12.30 11.47 2.36 090 

50323 .... ............ C ........ Prep cadaver renal allograft ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

50325 .... ............ C ........ Prep donor renal graft ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

50327 .... ............ A ........ Prep renal graft/venous ...................... 4.00 NA NA 1.09 1.22 0.29 XXX 

50328 .... ............ A ........ Prep renal graft/arterial ....................... 3.50 NA NA 0.98 1.08 0.26 XXX 

50329 .... ............ A ........ Prep renal graft/ureteral ...................... 3.34 NA NA 1.05 1.09 0.25 XXX 

50340 .... ............ A ........ Removal of kidney .............................. 13.86 NA NA 7.80 7.14 1.65 090 

50360 .... ............ A ........ Transplantation of kidney .................... 40.45 NA NA 18.66 17.06 3.82 090 

50365 .... ............ A ........ Transplantation of kidney .................... 45.68 NA NA 19.40 18.79 4.43 090 

50370 .... ............ A ........ Remove transplanted kidney .............. 18.68 NA NA 9.18 8.16 1.68 090 

50380 .... ............ A ........ Reimplantation of kidney .................... 29.66 NA NA 16.19 14.10 2.51 090 

50382 .... ............ A ........ Change ureter stent, percut ................ 5.50 26.34 31.22 2.05 1.96 0.34 000 

50384 .... ............ A ........ Remove ureter stent, percut ............... 5.00 20.66 27.93 1.86 1.78 0.31 000 

50385 .... ............ A ........ Change stent via transureth ............... 4.44 30.61 30.61 2.05 2.05 0.27 000 

50386 .... ............ A ........ Remove stent via transureth ............... 3.30 19.36 19.36 1.60 1.60 0.20 000 

50387 .... ............ A ........ Change ext/int ureter stent ................. 2.00 12.60 15.40 0.73 0.70 0.12 000 

50389 .... ............ A ........ Remove renal tube w/fluoro ................ 1.10 6.67 9.71 0.40 0.38 0.07 000 

50390 .... ............ A ........ Drainage of kidney lesion ................... 1.96 NA NA 0.71 0.67 0.12 000 

50391 .... ............ A ........ Instll rx agnt into rnal tub .................... 1.96 1.38 1.48 0.72 0.67 0.14 000 

50392 .... ............ A ........ Insert kidney drain .............................. 3.37 NA NA 1.52 1.52 0.20 000 

50393 .... ............ A ........ Insert ureteral tube .............................. 4.15 NA NA 1.80 1.79 0.25 000 

50394 .... ............ A ........ Injection for kidney x-ray ..................... 0.76 1.87 2.28 0.58 0.62 0.05 000 

50395 .... ............ A ........ Create passage to kidney ................... 3.37 NA NA 1.56 1.53 0.21 000 

50396 .... ............ A ........ Measure kidney pressure ................... 2.09 NA NA 1.08 1.08 0.13 000 

50398 .... ............ A ........ Change kidney tube ............................ 1.46 11.83 14.07 0.56 0.54 0.09 000 

50400 .... ............ A ........ Revision of kidney/ureter .................... 21.12 NA NA 10.94 9.40 1.38 090 

50405 .... ............ A ........ Revision of kidney/ureter .................... 25.68 NA NA 12.90 10.96 1.79 090 

50500 .... ............ A ........ Repair of kidney wound ...................... 21.07 NA NA 8.69 8.53 2.02 090 

50520 .... ............ A ........ Close kidney-skin fistula ..................... 18.73 NA NA 9.24 8.33 1.49 090 

50525 .... ............ A ........ Repair renal-abdomen fistula .............. 24.21 NA NA 11.79 10.39 1.84 090 

50526 .... ............ A ........ Repair renal-abdomen fistula .............. 26.13 NA NA 8.15 9.00 1.97 090 

50540 .... ............ A ........ Revision of horseshoe kidney ............. 20.95 NA NA 10.61 9.46 1.36 090 

50541 .... ............ A ........ Laparo ablate renal cyst ..................... 16.76 NA NA 8.69 7.58 1.13 090 

50542 .... ............ A ........ Laparo ablate renal mass ................... 21.18 NA NA 11.17 9.65 1.39 090 

50543 .... ............ A ........ Laparo partial nephrectomy ................ 27.18 NA NA 14.08 12.13 1.81 090 

50544 .... ............ A ........ Laparoscopy, pyeloplasty ................... 23.27 NA NA 11.43 9.97 1.58 090 

50545 .... ............ A ........ Laparo radical nephrectomy ............... 24.93 NA NA 12.14 10.66 1.71 090 

50546 .... ............ A ........ Laparoscopic nephrectomy ................. 21.69 NA NA 11.28 9.81 1.57 090 

50547 .... ............ A ........ Laparo removal donor kidney ............. 26.24 NA NA 12.47 11.78 2.77 090 

50548 .... ............ A ........ Laparo remove w/ureter ...................... 25.26 NA NA 12.10 10.64 1.73 090 

50549 .... ............ C ........ Laparoscope proc, renal ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

50551 .... ............ A ........ Kidney endoscopy ............................... 5.59 4.59 4.36 2.64 2.31 0.40 000 


cprice-sewell on PROD1PC72 with RULES
66466 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

50553 .... ............ A ........ Kidney endoscopy ............................... 5.98 4.49 4.42 2.63 2.40 0.39 000 

50555 .... ............ A ........ Kidney endoscopy & biopsy ............... 6.52 5.09 4.95 3.02 2.68 0.45 000 

50557 .... ............ A ........ Kidney endoscopy & treatment ........... 6.61 5.26 4.92 3.07 2.68 0.47 000 

50561 .... ............ A ........ Kidney endoscopy & treatment ........... 7.58 5.80 5.44 3.40 3.02 0.54 000 

50562 .... ............ A ........ Renal scope w/tumor resect ............... 10.90 NA NA 5.36 4.83 0.73 090 

50570 .... ............ A ........ Kidney endoscopy ............................... 9.53 NA NA 4.14 3.68 0.68 000 

50572 .... ............ A ........ Kidney endoscopy ............................... 10.33 NA NA 4.31 3.90 0.85 000 

50574 .... ............ A ........ Kidney endoscopy & biopsy ............... 11.00 NA NA 4.79 4.26 0.77 000 

50575 .... ............ A ........ Kidney endoscopy ............................... 13.96 NA NA 5.95 5.29 0.99 000 

50576 .... ............ A ........ Kidney endoscopy & treatment ........... 10.97 NA NA 4.77 4.22 0.78 000 

50580 .... ............ A ........ Kidney endoscopy & treatment ........... 11.84 NA NA 5.09 4.52 0.83 000 

50590 .... ............ A ........ Fragmenting of kidney stone .............. 9.64 17.08 14.73 6.12 5.11 0.65 090 

50592 .... ............ A ........ Perc rf ablate renal tumor ................... 6.77 75.40 112.17 3.00 2.99 0.43 010 

50593 .... ............ A ........ Perc cryo ablate renal tum ................. 9.08 114.48 114.48 3.44 3.44 0.58 010 

50600 .... ............ A ........ Exploration of ureter ........................... 17.04 NA NA 8.50 7.58 1.13 090 

50605 .... ............ A ........ Insert ureteral support ......................... 16.66 NA NA 7.88 7.31 1.45 090 

50610 .... ............ A ........ Removal of ureter stone ..................... 17.12 NA NA 8.97 7.96 1.43 090 

50620 .... ............ A ........ Removal of ureter stone ..................... 16.30 NA NA 8.87 7.60 1.07 090 

50630 .... ............ A ........ Removal of ureter stone ..................... 16.08 NA NA 8.19 7.23 1.09 090 

50650 .... ............ A ........ Removal of ureter ............................... 18.67 NA NA 9.95 8.58 1.23 090 

50660 .... ............ A ........ Removal of ureter ............................... 20.87 NA NA 10.72 9.33 1.38 090 

50684 .... ............ A ........ Injection for ureter x-ray ...................... 0.76 3.96 4.46 0.63 0.55 0.05 000 

50686 .... ............ A ........ Measure ureter pressure .................... 1.51 2.29 2.87 0.81 0.82 0.11 000 

50688 .... ............ A ........ Change of ureter tube/stent ................ 1.18 NA NA 0.95 1.00 0.07 010 

50690 .... ............ A ........ Injection for ureter x-ray ...................... 1.16 1.45 1.64 0.75 0.73 0.07 000 

50700 .... ............ A ........ Revision of ureter ................................ 16.54 NA NA 8.75 7.93 1.27 090 

50715 .... ............ A ........ Release of ureter ................................ 20.49 NA NA 8.53 8.63 2.14 090 

50722 .... ............ A ........ Release of ureter ................................ 17.80 NA NA 7.26 7.53 1.91 090 

50725 .... ............ A ........ Release/revise ureter .......................... 20.05 NA NA 8.81 8.42 1.52 090 

50727 .... ............ A ........ Revise ureter ....................................... 8.17 NA NA 5.72 5.00 0.61 090 

50728 .... ............ A ........ Revise ureter ....................................... 12.00 NA NA 6.74 6.15 1.00 090 

50740 .... ............ A ........ Fusion of ureter & kidney ................... 19.92 NA NA 8.96 8.34 1.97 090 

50750 .... ............ A ........ Fusion of ureter & kidney ................... 21.07 NA NA 11.07 9.52 1.38 090 

50760 .... ............ A ........ Fusion of ureters ................................. 19.92 NA NA 9.88 8.77 1.55 090 

50770 .... ............ A ........ Splicing of ureters ............................... 21.07 NA NA 10.87 9.41 1.45 090 

50780 .... ............ A ........ Reimplant ureter in bladder ................ 19.80 NA NA 10.10 8.84 1.51 090 

50782 .... ............ A ........ Reimplant ureter in bladder ................ 19.51 NA NA 9.88 9.32 1.61 090 

50783 .... ............ A ........ Reimplant ureter in bladder ................ 20.52 NA NA 10.11 9.15 1.99 090 

50785 .... ............ A ........ Reimplant ureter in bladder ................ 22.08 NA NA 11.18 9.73 1.45 090 

50800 .... ............ A ........ Implant ureter in bowel ....................... 16.23 NA NA 9.16 7.81 1.19 090 

50810 .... ............ A ........ Fusion of ureter & bowel .................... 22.38 NA NA 10.56 9.82 2.32 090 

50815 .... ............ A ........ Urine shunt to intestine ....................... 22.06 NA NA 11.45 9.94 1.54 090 

50820 .... ............ A ........ Construct bowel bladder ..................... 23.89 NA NA 11.84 10.24 1.90 090 

50825 .... ............ A ........ Construct bowel bladder ..................... 30.48 NA NA 14.89 13.00 2.08 090 

50830 .... ............ A ........ Revise urine flow ................................ 33.57 NA NA 15.60 13.88 2.38 090 

50840 .... ............ A ........ Replace ureter by bowel ..................... 22.19 NA NA 11.92 10.16 1.47 090 

50845 .... ............ A ........ Appendico-vesicostomy ...................... 22.21 NA NA 12.05 10.47 1.57 090 

50860 .... ............ A ........ Transplant ureter to skin ..................... 16.93 NA NA 9.21 7.91 1.29 090 

50900 .... ............ A ........ Repair of ureter ................................... 14.89 NA NA 7.98 7.06 1.14 090 

50920 .... ............ A ........ Closure ureter/skin fistula ................... 15.66 NA NA 8.51 7.54 1.01 090 

50930 .... ............ A ........ Closure ureter/bowel fistula ................ 20.04 NA NA 9.48 8.72 1.28 090 

50940 .... ............ A ........ Release of ureter ................................ 15.78 NA NA 7.78 7.08 1.26 090 

50945 .... ............ A ........ Laparoscopy ureterolithotomy ............. 17.87 NA NA 9.28 8.15 1.36 090 

50947 .... ............ A ........ Laparo new ureter/bladder .................. 25.63 NA NA 12.28 10.98 2.17 090 

50948 .... ............ A ........ Laparo new ureter/bladder .................. 23.69 NA NA 11.17 9.93 1.71 090 

50949 .... ............ C ........ Laparoscope proc, ureter .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

50951 .... ............ A ........ Endoscopy of ureter ............................ 5.83 4.82 4.55 2.76 2.40 0.41 000 

50953 .... ............ A ........ Endoscopy of ureter ............................ 6.23 4.92 4.66 3.21 2.79 0.43 000 

50955 .... ............ A ........ Ureter endoscopy & biopsy ................ 6.74 5.14 5.77 3.45 3.06 0.48 000 

50957 .... ............ A ........ Ureter endoscopy & treatment ............ 6.78 5.37 4.96 3.14 2.75 0.48 000 

50961 .... ............ A ........ Ureter endoscopy & treatment ............ 6.04 4.74 4.55 2.79 2.48 0.41 000 

50970 .... ............ A ........ Ureter endoscopy ................................ 7.13 NA NA 3.24 2.85 0.52 000 

50972 .... ............ A ........ Ureter endoscopy & catheter .............. 6.88 NA NA 3.05 2.76 0.49 000 

50974 .... ............ A ........ Ureter endoscopy & biopsy ................ 9.16 NA NA 3.76 3.43 0.64 000 

50976 .... ............ A ........ Ureter endoscopy & treatment ............ 9.03 NA NA 3.85 3.45 0.66 000 

50980 .... ............ A ........ Ureter endoscopy & treatment ............ 6.84 NA NA 3.12 2.75 0.48 000 

51020 .... ............ A ........ Incise & treat bladder .......................... 7.56 NA NA 5.38 4.62 0.47 090 

51030 .... ............ A ........ Incise & treat bladder .......................... 7.68 NA NA 4.89 4.43 0.58 090 

51040 .... ............ A ........ Incise & drain bladder ......................... 4.43 NA NA 3.68 3.22 0.31 090 

51045 .... ............ A ........ Incise bladder/drain ureter .................. 7.68 NA NA 5.14 4.53 0.52 090 

51050 .... ............ A ........ Removal of bladder stone ................... 7.87 NA NA 5.32 4.48 0.49 090 

51060 .... ............ A ........ Removal of ureter stone ..................... 9.82 NA NA 6.42 5.45 0.62 090 


cprice-sewell on PROD1PC72 with RULES
66467 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

51065 .... ............ A ........ Remove ureter calculus ...................... 9.82 NA NA 6.24 5.29 0.63 090 

51080 .... ............ A ........ Drainage of bladder abscess .............. 6.61 NA NA 4.60 4.07 0.43 090 

51100 .... ............ A ........ Drain bladder by needle ..................... 0.78 0.92 0.92 0.27 0.27 0.05 000 

51101 .... ............ A ........ Drain bladder by trocar/cath ............... 1.02 2.40 2.40 0.34 0.34 0.10 000 

51102 .... ............ A ........ Drain bl w/cath insertion ..................... 4.27 4.74 4.74 2.36 2.36 0.28 010 

51500 .... ............ A ........ Removal of bladder cyst ..................... 10.92 NA NA 5.75 5.37 1.03 090 

51520 .... ............ A ........ Removal of bladder lesion .................. 10.08 NA NA 6.31 5.48 0.69 090 

51525 .... ............ A ........ Removal of bladder lesion .................. 15.29 NA NA 8.46 7.29 0.99 090 

51530 .... ............ A ........ Removal of bladder lesion .................. 13.58 NA NA 7.38 6.56 1.05 090 

51535 .... ............ A ........ Repair of ureter lesion ........................ 13.77 NA NA 7.37 6.74 1.23 090 

51550 .... ............ A ........ Partial removal of bladder ................... 17.10 NA NA 8.70 7.71 1.31 090 

51555 .... ............ A ........ Partial removal of bladder ................... 23.03 NA NA 11.34 10.00 1.70 090 

51565 .... ............ A ........ Revise bladder & ureter(s) .................. 23.50 NA NA 12.11 10.53 1.63 090 

51570 .... ............ A ........ Removal of bladder ............................. 27.31 NA NA 13.48 11.60 1.72 090 

51575 .... ............ A ........ Removal of bladder & nodes .............. 34.00 NA NA 16.43 14.22 2.17 090 

51580 .... ............ A ........ Remove bladder/revise tract ............... 35.14 NA NA 17.57 15.02 2.25 090 

51585 .... ............ A ........ Removal of bladder & nodes .............. 39.41 NA NA 19.24 16.46 2.49 090 

51590 .... ............ A ........ Remove bladder/revise tract ............... 36.15 NA NA 17.22 14.91 2.28 090 

51595 .... ............ A ........ Remove bladder/revise tract ............... 41.12 NA NA 19.56 16.83 2.60 090 

51596 .... ............ A ........ Remove bladder/create pouch ............ 44.01 NA NA 21.18 18.19 2.78 090 

51597 .... ............ A ........ Removal of pelvic structures .............. 42.61 NA NA 20.17 17.49 2.82 090 

51600 .... ............ A ........ Injection for bladder x-ray ................... 0.88 4.23 4.64 0.32 0.31 0.06 000 

51605 .... ............ A ........ Preparation for bladder xray ............... 0.64 NA NA 0.43 0.39 0.04 000 

51610 .... ............ A ........ Injection for bladder x-ray ................... 1.05 1.91 2.10 0.70 0.65 0.07 000 

51700 .... ............ A ........ Irrigation of bladder ............................. 0.88 1.50 1.55 0.34 0.31 0.06 000 

51701 .... ............ A ........ Insert bladder catheter ........................ 0.50 1.04 1.31 0.24 0.22 0.04 000 

51702 .... ............ A ........ Insert temp bladder cath ..................... 0.50 1.53 1.80 0.33 0.29 0.04 000 

51703 .... ............ A ........ Insert bladder cath, complex .............. 1.47 2.26 2.49 0.80 0.68 0.10 000 

51705 .... ............ A ........ Change of bladder tube ...................... 1.03 2.02 2.15 0.84 0.73 0.07 010 

51710 .... ............ A ........ Change of bladder tube ...................... 1.50 2.72 3.03 1.17 0.97 0.11 010 

51715 .... ............ A ........ Endoscopic injection/implant ............... 3.73 4.41 4.15 1.72 1.54 0.29 000 

51720 .... ............ A ........ Treatment of bladder lesion ................ 1.50 1.61 1.68 0.74 0.71 0.14 000 

51725 .... ............ A ........ Simple cystometrogram ...................... 1.51 4.22 4.90 NA NA 0.16 000 

51725 .... TC ...... A ........ Simple cystometrogram ...................... 0.00 3.67 4.38 NA NA 0.04 000 

51725 .... 26 ....... A ........ Simple cystometrogram ...................... 1.51 0.55 0.52 0.55 0.52 0.12 000 

51726 .... ............ A ........ Complex cystometrogram ................... 1.71 7.11 7.30 NA NA 0.18 000 

51726 .... TC ...... A ........ Complex cystometrogram ................... 0.00 6.47 6.70 NA NA 0.05 000 

51726 .... 26 ....... A ........ Complex cystometrogram ................... 1.71 0.64 0.60 0.64 0.60 0.13 000 

51736 .... ............ A ........ Urine flow measurement ..................... 0.61 0.94 0.76 NA NA 0.06 000 

51736 .... TC ...... A ........ Urine flow measurement ..................... 0.00 0.70 0.54 NA NA 0.01 000 

51736 .... 26 ....... A ........ Urine flow measurement ..................... 0.61 0.24 0.22 0.24 0.22 0.05 000 

51741 .... ............ A ........ Electro-uroflowmetry, first ................... 1.14 1.27 1.02 NA NA 0.11 000 

51741 .... TC ...... A ........ Electro-uroflowmetry, first ................... 0.00 0.83 0.62 NA NA 0.02 000 

51741 .... 26 ....... A ........ Electro-uroflowmetry, first ................... 1.14 0.44 0.40 0.44 0.40 0.09 000 

51772 .... ............ A ........ Urethra pressure profile ...................... 1.61 5.06 5.31 NA NA 0.20 000 

51772 .... TC ...... A ........ Urethra pressure profile ...................... 0.00 4.51 4.76 NA NA 0.05 000 

51772 .... 26 ....... A ........ Urethra pressure profile ...................... 1.61 0.55 0.55 0.55 0.55 0.15 000 

51784 .... ............ A ........ Anal/urinary muscle study ................... 1.53 4.12 4.05 NA NA 0.16 000 

51784 .... TC ...... A ........ Anal/urinary muscle study ................... 0.00 3.56 3.52 NA NA 0.04 000 

51784 .... 26 ....... A ........ Anal/urinary muscle study ................... 1.53 0.56 0.53 0.56 0.53 0.12 000 

51785 .... ............ A ........ Anal/urinary muscle study ................... 1.53 4.55 4.49 NA NA 0.15 000 

51785 .... TC ...... A ........ Anal/urinary muscle study ................... 0.00 3.99 3.96 NA NA 0.04 000 

51785 .... 26 ....... A ........ Anal/urinary muscle study ................... 1.53 0.56 0.53 0.56 0.53 0.11 000 

51792 .... ............ A ........ Urinary reflex study ............................. 1.10 5.05 5.52 NA NA 0.20 000 

51792 .... TC ...... A ........ Urinary reflex study ............................. 0.00 4.66 5.12 NA NA 0.13 000 

51792 .... 26 ....... A ........ Urinary reflex study ............................. 1.10 0.39 0.40 0.39 0.40 0.07 000 

51795 .... ............ A ........ Urine voiding pressure study .............. 1.53 6.72 7.00 NA NA 0.22 000 

51795 .... TC ...... A ........ Urine voiding pressure study .............. 0.00 6.15 6.47 NA NA 0.10 000 

51795 .... 26 ....... A ........ Urine voiding pressure study .............. 1.53 0.57 0.53 0.57 0.53 0.12 000 

51797 .... ............ A ........ Intraabdominal pressure test .............. 0.80 2.43 4.11 NA NA 0.17 ZZZ 

51797 .... TC ...... A ........ Intraabdominal pressure test .............. 0.00 2.14 3.70 NA NA 0.05 ZZZ 

51797 .... 26 ....... A ........ Intraabdominal pressure test .............. 0.80 0.29 0.41 0.29 0.41 0.12 ZZZ 

51798 .... ............ A ........ Us urine capacity measure ................. 0.00 0.59 0.47 NA NA 0.08 XXX 

51800 .... ............ A ........ Revision of bladder/urethra ................. 18.74 NA NA 9.71 8.63 1.32 090 

51820 .... ............ A ........ Revision of urinary tract ...................... 19.41 NA NA 9.74 9.01 1.75 090 

51840 .... ............ A ........ Attach bladder/urethra ........................ 11.28 NA NA 5.75 5.66 1.06 090 

51841 .... ............ A ........ Attach bladder/urethra ........................ 13.60 NA NA 6.85 6.61 1.24 090 

51845 .... ............ A ........ Repair bladder neck ............................ 10.07 NA NA 5.88 5.31 0.79 090 

51860 .... ............ A ........ Repair of bladder wound .................... 12.49 NA NA 6.73 6.24 1.16 090 

51865 .... ............ A ........ Repair of bladder wound .................... 15.69 NA NA 8.32 7.49 1.23 090 

51880 .... ............ A ........ Repair of bladder opening .................. 7.81 NA NA 4.72 4.34 0.72 090 

51900 .... ............ A ........ Repair bladder/vagina lesion .............. 14.48 NA NA 7.97 7.01 1.21 090 


cprice-sewell on PROD1PC72 with RULES
66468 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

51920 .... ............ A ........ Close bladder-uterus fistula ................ 13.26 NA NA 8.03 6.83 1.18 090 

51925 .... ............ A ........ Hysterectomy/bladder repair ............... 17.35 NA NA 12.40 10.50 2.04 090 

51940 .... ............ A ........ Correction of bladder defect ............... 30.48 NA NA 11.72 11.89 2.15 090 

51960 .... ............ A ........ Revision of bladder & bowel ............... 25.20 NA NA 12.88 11.25 1.63 090 

51980 .... ............ A ........ Construct bladder opening .................. 12.44 NA NA 7.06 6.21 0.86 090 

51990 .... ............ A ........ Laparo urethral suspension ................ 13.26 NA NA 5.92 6.03 1.39 090 

51992 .... ............ A ........ Laparo sling operation ........................ 14.77 NA NA 6.51 6.35 1.41 090 

51999 .... ............ C ........ Laparoscope proc, bla ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

52000 .... ............ A ........ Cystoscopy .......................................... 2.23 3.66 3.48 1.31 1.03 0.14 000 

52001 .... ............ A ........ Cystoscopy, removal of clots .............. 5.44 5.04 5.05 2.56 2.21 0.39 000 

52005 .... ............ A ........ Cystoscopy & ureter catheter ............. 2.37 5.73 5.64 1.37 1.13 0.17 000 

52007 .... ............ A ........ Cystoscopy and biopsy ....................... 3.02 10.70 13.57 1.61 1.38 0.22 000 

52010 .... ............ A ........ Cystoscopy & duct catheter ................ 3.02 8.07 9.41 1.62 1.38 0.21 000 

52204 .... ............ A ........ Cystoscopy w/biopsy(s) ...................... 2.59 8.30 11.40 1.37 1.14 0.17 000 

52214 .... ............ A ........ Cystoscopy and treatment .................. 3.70 19.87 28.97 1.83 1.58 0.26 000 

52224 .... ............ A ........ Cystoscopy and treatment .................. 3.14 19.05 27.74 1.60 1.37 0.22 000 

52234 .... ............ A ........ Cystoscopy and treatment .................. 4.62 NA NA 2.27 1.96 0.33 000 

52235 .... ............ A ........ Cystoscopy and treatment .................. 5.44 NA NA 2.63 2.28 0.39 000 

52240 .... ............ A ........ Cystoscopy and treatment .................. 9.71 NA NA 4.34 3.82 0.69 000 

52250 .... ............ A ........ Cystoscopy and radiotracer ................ 4.49 NA NA 2.29 1.97 0.32 000 

52260 .... ............ A ........ Cystoscopy and treatment .................. 3.91 NA NA 1.93 1.67 0.28 000 

52265 .... ............ A ........ Cystoscopy and treatment .................. 2.94 7.48 10.41 1.46 1.28 0.22 000 

52270 .... ............ A ........ Cystoscopy & revise urethra ............... 3.36 7.02 9.02 1.74 1.49 0.24 000 

52275 .... ............ A ........ Cystoscopy & revise urethra ............... 4.69 9.29 12.42 2.27 1.96 0.33 000 

52276 .... ............ A ........ Cystoscopy and treatment .................. 4.99 NA NA 2.44 2.11 0.35 000 

52277 .... ............ A ........ Cystoscopy and treatment .................. 6.16 NA NA 2.90 2.56 0.44 000 

52281 .... ............ A ........ Cystoscopy and treatment .................. 2.80 5.28 6.18 1.54 1.31 0.20 000 

52282 .... ............ A ........ Cystoscopy, implant stent ................... 6.39 NA NA 2.95 2.59 0.45 000 

52283 .... ............ A ........ Cystoscopy and treatment .................. 3.73 4.06 4.00 1.86 1.62 0.26 000 

52285 .... ............ A ........ Cystoscopy and treatment .................. 3.60 4.32 4.16 1.83 1.58 0.26 000 

52290 .... ............ A ........ Cystoscopy and treatment .................. 4.58 NA NA 2.26 1.95 0.32 000 

52300 .... ............ A ........ Cystoscopy and treatment .................. 5.30 NA NA 2.55 2.23 0.38 000 

52301 .... ............ A ........ Cystoscopy and treatment .................. 5.50 NA NA 2.68 2.33 0.46 000 

52305 .... ............ A ........ Cystoscopy and treatment .................. 5.30 NA NA 2.48 2.17 0.38 000 

52310 .... ............ A ........ Cystoscopy and treatment .................. 2.81 4.00 4.34 1.42 1.23 0.20 000 

52315 .... ............ A ........ Cystoscopy and treatment .................. 5.20 6.62 7.64 2.47 2.15 0.37 000 

52317 .... ............ A ........ Remove bladder stone ........................ 6.71 17.04 22.98 2.99 2.63 0.48 000 

52318 .... ............ A ........ Remove bladder stone ........................ 9.18 NA NA 4.03 3.56 0.65 000 

52320 .... ............ A ........ Cystoscopy and treatment .................. 4.69 NA NA 2.20 1.91 0.33 000 

52325 .... ............ A ........ Cystoscopy, stone removal ................. 6.15 NA NA 2.78 2.44 0.44 000 

52327 .... ............ A ........ Cystoscopy, inject material ................. 5.18 2.04 16.92 2.04 1.93 0.37 000 

52330 .... ............ A ........ Cystoscopy and treatment .................. 5.03 20.39 29.59 2.34 2.05 0.36 000 

52332 .... ............ A ........ Cystoscopy and treatment .................. 2.83 12.41 9.07 1.55 1.30 0.21 000 

52334 .... ............ A ........ Create passage to kidney ................... 4.82 NA NA 2.33 2.03 0.35 000 

52341 .... ............ A ........ Cysto w/ureter stricture tx ................... 6.11 NA NA 3.03 2.62 0.43 000 

52342 .... ............ A ........ Cysto w/up stricture tx ........................ 6.61 NA NA 3.25 2.80 0.46 000 

52343 .... ............ A ........ Cysto w/renal stricture tx .................... 7.31 NA NA 3.48 3.03 0.51 000 

52344 .... ............ A ........ Cysto/uretero, stricture tx .................... 7.81 NA NA 3.90 3.34 0.55 000 

52345 .... ............ A ........ Cysto/uretero w/up stricture ................ 8.31 NA NA 4.10 3.53 0.58 000 

52346 .... ............ A ........ Cystouretero w/renal strict .................. 9.34 NA NA 4.50 3.89 0.65 000 

52351 .... ............ A ........ Cystouretero & or pyeloscope ............ 5.85 NA NA 2.95 2.55 0.41 000 

52352 .... ............ A ........ Cystouretero w/stone remove ............. 6.87 NA NA 3.46 2.98 0.49 000 

52353 .... ............ A ........ Cystouretero w/lithotripsy .................... 7.96 NA NA 3.90 3.37 0.57 000 

52354 .... ............ A ........ Cystouretero w/biopsy ........................ 7.33 NA NA 3.64 3.15 0.52 000 

52355 .... ............ A ........ Cystouretero w/excise tumor .............. 8.81 NA NA 4.24 3.69 0.63 000 

52400 .... ............ A ........ Cystouretero w/congen repr ............... 10.06 NA NA 5.39 4.56 0.68 090 

52402 .... ............ A ........ Cystourethro cut ejacul duct ............... 5.27 NA NA 2.15 1.92 0.40 000 

52450 .... ............ A ........ Incision of prostate .............................. 7.63 NA NA 5.47 4.57 0.54 090 

52500 .... ............ A ........ Revision of bladder neck .................... 9.39 NA NA 6.17 5.04 0.60 090 

52601 .... ............ A ........ Prostatectomy (TURP) ........................ 15.13 NA NA 8.42 6.75 0.87 090 

52606 .... ............ A ........ Control postop bleeding ...................... 8.84 NA NA 5.47 4.51 0.57 090 

52612 .... ............ A ........ Prostatectomy, first stage ................... 9.07 NA NA 5.87 4.80 0.56 090 

52614 .... ............ A ........ Prostatectomy, second stage ............. 7.81 NA NA 5.37 4.35 0.48 090 

52620 .... ............ A ........ Remove residual prostate ................... 7.19 NA NA 4.61 3.79 0.47 090 

52630 .... ............ A ........ Remove prostate regrowth ................. 7.65 NA NA 4.79 3.99 0.51 090 

52640 .... ............ A ........ Relieve bladder contracture ................ 6.89 NA NA 4.41 3.68 0.47 090 

52647 .... ............ A ........ Laser surgery of prostate .................... 11.15 41.90 57.90 6.88 5.70 0.73 090 

52648 .... ............ A ........ Laser surgery of prostate .................... 12.00 42.44 58.17 7.21 6.00 0.79 090 

52649 .... ............ A ........ 2Prostate laser enucleation ................ 17.16 NA NA 9.31 9.31 1.11 090 

52700 .... ............ A ........ Drainage of prostate abscess ............. 7.39 NA NA 4.89 4.04 0.48 090 

53000 .... ............ A ........ Incision of urethra ............................... 2.30 NA NA 1.78 1.66 0.16 010 

53010 .... ............ A ........ Incision of urethra ............................... 4.35 NA NA 3.83 3.37 0.24 090 


cprice-sewell on PROD1PC72 with RULES
66469 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

53020 .... ............ A ........ Incision of urethra ............................... 1.77 NA NA 0.95 0.81 0.13 000 

53025 .... ............ A ........ Incision of urethra ............................... 1.13 NA NA 0.82 0.66 0.08 000 

53040 .... ............ A ........ Drainage of urethra abscess .............. 6.49 NA NA 4.40 3.91 0.45 090 

53060 .... ............ A ........ Drainage of urethra abscess .............. 2.65 2.09 2.09 1.54 1.45 0.28 010 

53080 .... ............ A ........ Drainage of urinary leakage ............... 6.82 NA NA 4.96 5.46 0.52 090 

53085 .... ............ A ........ Drainage of urinary leakage ............... 11.05 NA NA 4.41 5.90 0.92 090 

53200 .... ............ A ........ Biopsy of urethra ................................. 2.59 1.70 1.51 1.29 1.13 0.20 000 

53210 .... ............ A ........ Removal of urethra ............................. 13.59 NA NA 7.75 6.79 0.89 090 

53215 .... ............ A ........ Removal of urethra ............................. 16.72 NA NA 9.11 7.87 1.10 090 

53220 .... ............ A ........ Treatment of urethra lesion ................ 7.53 NA NA 4.97 4.34 0.49 090 

53230 .... ............ A ........ Removal of urethra lesion ................... 10.31 NA NA 6.36 5.53 0.73 090 

53235 .... ............ A ........ Removal of urethra lesion ................... 10.86 NA NA 6.92 5.90 0.72 090 

53240 .... ............ A ........ Surgery for urethra pouch ................... 6.98 NA NA 4.86 4.19 0.52 090 

53250 .... ............ A ........ Removal of urethra gland ................... 6.42 NA NA 4.38 3.83 0.49 090 

53260 .... ............ A ........ Treatment of urethra lesion ................ 3.00 2.45 2.35 1.83 1.62 0.25 010 

53265 .... ............ A ........ Treatment of urethra lesion ................ 3.14 2.93 2.82 1.98 1.70 0.24 010 

53270 .... ............ A ........ Removal of urethra gland ................... 3.11 2.46 2.33 1.84 1.69 0.30 010 

53275 .... ............ A ........ Repair of urethra defect ...................... 4.54 NA NA 2.76 2.51 0.32 010 

53400 .... ............ A ........ Revise urethra, stage 1 ...................... 13.98 NA NA 8.16 7.09 0.98 090 

53405 .... ............ A ........ Revise urethra, stage 2 ...................... 15.51 NA NA 8.68 7.49 1.10 090 

53410 .... ............ A ........ Reconstruction of urethra ................... 17.53 NA NA 9.66 8.35 1.16 090 

53415 .... ............ A ........ Reconstruction of urethra ................... 20.55 NA NA 10.68 9.00 1.37 090 

53420 .... ............ A ........ Reconstruct urethra, stage 1 .............. 15.04 NA NA 7.11 6.69 0.96 090 

53425 .... ............ A ........ Reconstruct urethra, stage 2 .............. 16.94 NA NA 8.99 7.93 1.13 090 

53430 .... ............ A ........ Reconstruction of urethra ................... 17.30 NA NA 8.80 7.89 1.15 090 

53431 .... ............ A ........ Reconstruct urethra/bladder ............... 21.03 NA NA 10.97 9.50 1.41 090 

53440 .... ............ A ........ Male sling procedure .......................... 15.34 NA NA 9.18 7.57 0.96 090 

53442 .... ............ A ........ Remove/revise male sling ................... 13.29 NA NA 8.35 6.89 0.82 090 

53444 .... ............ A ........ Insert tandem cuff ............................... 14.06 NA NA 8.01 6.94 0.94 090 

53445 .... ............ A ........ Insert uro/ves nck sphincter ................ 15.21 NA NA 8.74 7.91 0.99 090 

53446 .... ............ A ........ Remove uro sphincter ......................... 10.89 NA NA 6.99 6.10 0.72 090 

53447 .... ............ A ........ Remove/replace ur sphincter .............. 14.15 NA NA 8.37 7.39 0.95 090 

53448 .... ............ A ........ Remov/replc ur sphinctr comp ............ 23.26 NA NA 12.31 10.67 1.50 090 

53449 .... ............ A ........ Repair uro sphincter ........................... 10.43 NA NA 6.60 5.66 0.68 090 

53450 .... ............ A ........ Revision of urethra .............................. 6.67 NA NA 4.75 4.02 0.43 090 

53460 .... ............ A ........ Revision of urethra .............................. 7.65 NA NA 5.04 4.36 0.50 090 

53500 .... ............ A ........ Urethrlys, transvag w/ scope .............. 12.87 NA NA 7.40 6.80 0.90 090 

53502 .... ............ A ........ Repair of urethra injury ....................... 8.16 NA NA 5.10 4.54 0.62 090 

53505 .... ............ A ........ Repair of urethra injury ....................... 8.16 NA NA 5.37 4.62 0.54 090 

53510 .... ............ A ........ Repair of urethra injury ....................... 10.83 NA NA 6.82 5.99 0.74 090 

53515 .... ............ A ........ Repair of urethra injury ....................... 14.09 NA NA 7.95 6.94 1.05 090 

53520 .... ............ A ........ Repair of urethra defect ...................... 9.35 NA NA 6.20 5.33 0.61 090 

53600 .... ............ A ........ Dilate urethra stricture ........................ 1.21 1.15 1.14 0.57 0.50 0.09 000 

53601 .... ............ A ........ Dilate urethra stricture ........................ 0.98 1.36 1.31 0.52 0.44 0.07 000 

53605 .... ............ A ........ Dilate urethra stricture ........................ 1.28 NA NA 0.51 0.46 0.09 000 

53620 .... ............ A ........ Dilate urethra stricture ........................ 1.62 1.70 1.84 0.83 0.71 0.11 000 

53621 .... ............ A ........ Dilate urethra stricture ........................ 1.35 1.81 1.94 0.67 0.58 0.10 000 

53660 .... ............ A ........ Dilation of urethra ............................... 0.71 1.32 1.31 0.45 0.38 0.05 000 

53661 .... ............ A ........ Dilation of urethra ............................... 0.72 1.29 1.29 0.41 0.35 0.05 000 

53665 .... ............ A ........ Dilation of urethra ............................... 0.76 NA NA 0.27 0.26 0.06 000 

53850 .... ............ A ........ Prostatic microwave thermotx ............. 9.98 49.19 71.60 5.86 4.90 0.67 090 

53852 .... ............ A ........ Prostatic rf thermotx ............................ 10.68 46.31 67.52 6.65 5.51 0.70 090 

53853 .... ............ A ........ Prostatic water thermother .................. 5.54 29.06 42.19 4.34 3.60 0.37 090 

53899 .... ............ C ........ Urology surgery procedure ................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

54000 .... ............ A ........ Slitting of prepuce ............................... 1.56 2.69 2.80 1.48 1.20 0.11 010 

54001 .... ............ A ........ Slitting of prepuce ............................... 2.21 3.05 3.12 1.67 1.39 0.15 010 

54015 .... ............ A ........ Drain penis lesion ............................... 5.33 NA NA 3.21 2.88 0.38 010 

54050 .... ............ A ........ Destruction, penis lesion(s) ................ 1.26 2.10 1.87 1.39 1.21 0.08 010 

54055 .... ............ A ........ Destruction, penis lesion(s) ................ 1.23 1.97 1.77 1.23 1.01 0.08 010 

54056 .... ............ A ........ Cryosurgery, penis lesion(s) ............... 1.26 2.37 2.03 1.53 1.33 0.06 010 

54057 .... ............ A ........ Laser surg, penis lesion(s) ................. 1.26 2.63 2.42 1.36 1.10 0.09 010 

54060 .... ............ A ........ Excision of penis lesion(s) .................. 1.95 3.08 3.09 1.63 1.34 0.13 010 

54065 .... ............ A ........ Destruction, penis lesion(s) ................ 2.44 3.29 2.96 1.99 1.61 0.13 010 

54100 .... ............ A ........ Biopsy of penis ................................... 1.90 3.34 3.07 1.36 1.09 0.10 000 

54105 .... ............ A ........ Biopsy of penis ................................... 3.51 3.97 4.12 2.43 2.18 0.25 010 

54110 .... ............ A ........ Treatment of penis lesion ................... 10.79 NA NA 6.71 5.73 0.72 090 

54111 .... ............ A ........ Treat penis lesion, graft ...................... 14.29 NA NA 8.02 6.89 0.96 090 

54112 .... ............ A ........ Treat penis lesion, graft ...................... 16.83 NA NA 9.30 8.04 1.11 090 

54115 .... ............ A ........ Treatment of penis lesion ................... 6.82 5.75 5.06 4.94 4.19 0.43 090 

54120 .... ............ A ........ Partial removal of penis ...................... 10.88 NA NA 6.72 5.69 0.68 090 

54125 .... ............ A ........ Removal of penis ................................ 14.43 NA NA 8.06 6.94 0.95 090 

54130 .... ............ A ........ Remove penis & nodes ...................... 21.66 NA NA 11.56 9.86 1.52 090 


cprice-sewell on PROD1PC72 with RULES
66470 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

54135 .... ............ A ........ Remove penis & nodes ...................... 27.99 NA NA 14.10 12.13 1.88 090 

54150 .... ............ A ........ Circumcision w/regionl block .............. 1.90 2.39 3.13 0.73 0.72 0.16 000 

54160 .... ............ A ........ Circumcision, neonate ........................ 2.50 3.80 3.97 1.48 1.28 0.19 010 

54161 .... ............ A ........ Circum 28 days or older ..................... 3.29 NA NA 2.20 1.88 0.23 010 

54162 .... ............ A ........ Lysis penil circumic lesion .................. 3.27 4.00 4.32 2.26 1.85 0.21 010 

54163 .... ............ A ........ Repair of circumcision ........................ 3.27 NA NA 2.85 2.43 0.21 010 

54164 .... ............ A ........ Frenulotomy of penis .......................... 2.77 NA NA 2.65 2.24 0.18 010 

54200 .... ............ A ........ Treatment of penis lesion ................... 1.08 2.01 1.90 1.30 1.13 0.08 010 

54205 .... ............ A ........ Treatment of penis lesion ................... 8.84 NA NA 6.05 5.36 0.56 090 

54220 .... ............ A ........ Treatment of penis lesion ................... 2.42 3.31 3.58 1.35 1.15 0.17 000 

54230 .... ............ A ........ Prepare penis study ............................ 1.34 1.40 1.24 0.90 0.77 0.09 000 

54231 .... ............ A ........ Dynamic cavernosometry ................... 2.04 1.97 1.67 1.24 1.06 0.16 000 

54235 .... ............ A ........ Penile injection .................................... 1.19 1.39 1.17 0.89 0.73 0.08 000 

54240 .... ............ A ........ Penis study ......................................... 1.31 1.51 1.26 NA NA 0.17 000 

54240 .... TC ...... A ........ Penis study ......................................... 0.00 1.03 0.81 NA NA 0.06 000 

54240 .... 26 ....... A ........ Penis study ......................................... 1.31 0.48 0.45 0.48 0.45 0.11 000 

54250 .... ............ A ........ Penis study ......................................... 2.22 1.22 1.06 NA NA 0.18 000 

54250 .... TC ...... A ........ Penis study ......................................... 0.00 0.37 0.28 NA NA 0.02 000 

54250 .... 26 ....... A ........ Penis study ......................................... 2.22 0.85 0.78 0.85 0.78 0.16 000 

54300 .... ............ A ........ Revision of penis ................................ 11.07 NA NA 6.70 6.13 0.76 090 

54304 .... ............ A ........ Revision of penis ................................ 13.15 NA NA 7.79 7.05 0.88 090 

54308 .... ............ A ........ Reconstruction of urethra ................... 12.49 NA NA 4.75 5.35 0.84 090 

54312 .... ............ A ........ Reconstruction of urethra ................... 14.36 NA NA 8.86 7.92 1.24 090 

54316 .... ............ A ........ Reconstruction of urethra ................... 17.90 NA NA 9.93 8.93 1.21 090 

54318 .... ............ A ........ Reconstruction of urethra ................... 12.28 NA NA 4.83 5.30 1.39 090 

54322 .... ............ A ........ Reconstruction of urethra ................... 13.85 NA NA 7.93 7.19 0.92 090 

54324 .... ............ A ........ Reconstruction of urethra ................... 17.40 NA NA 9.74 8.84 1.14 090 

54326 .... ............ A ........ Reconstruction of urethra ................... 16.87 NA NA 9.15 8.46 1.11 090 

54328 .... ............ A ........ Revise penis/urethra ........................... 16.74 NA NA 9.47 8.35 0.98 090 

54332 .... ............ A ........ Revise penis/urethra ........................... 18.22 NA NA 10.06 8.88 1.21 090 

54336 .... ............ A ........ Revise penis/urethra ........................... 21.44 NA NA 7.31 8.79 2.21 090 

54340 .... ............ A ........ Secondary urethral surgery ................ 9.58 NA NA 6.35 5.69 0.63 090 

54344 .... ............ A ........ Secondary urethral surgery ................ 16.91 NA NA 9.53 8.63 1.54 090 

54348 .... ............ A ........ Secondary urethral surgery ................ 18.17 NA NA 10.12 9.22 1.23 090 

54352 .... ............ A ........ Reconstruct urethra/penis ................... 25.95 NA NA 13.98 12.57 2.25 090 

54360 .... ............ A ........ Penis plastic surgery ........................... 12.65 NA NA 7.44 6.73 0.84 090 

54380 .... ............ A ........ Repair penis ........................................ 14.03 NA NA 8.03 7.32 0.93 090 

54385 .... ............ A ........ Repair penis ........................................ 16.38 NA NA 11.29 9.77 0.86 090 

54390 .... ............ A ........ Repair penis and bladder ................... 22.59 NA NA 7.41 8.41 1.54 090 

54400 .... ............ A ........ Insert semi-rigid prosthesis ................. 9.09 NA NA 5.74 5.04 0.64 090 

54401 .... ............ A ........ Insert self-contd prosthesis ................. 10.26 NA NA 8.14 6.93 0.73 090 

54405 .... ............ A ........ Insert multi-comp penis pros .............. 14.39 NA NA 8.11 7.01 0.95 090 

54406 .... ............ A ........ Remove muti-comp penis pros ........... 12.76 NA NA 7.59 6.50 0.86 090 

54408 .... ............ A ........ Repair multi-comp penis pros ............. 13.73 NA NA 8.24 6.98 0.90 090 

54410 .... ............ A ........ Remove/replace penis prosth ............. 16.48 NA NA 9.34 7.97 1.10 090 

54411 .... ............ A ........ Remov/replc penis pros, comp ........... 18.14 NA NA 10.39 8.71 1.13 090 

54415 .... ............ A ........ Remove self-contd penis pros ............ 8.75 NA NA 6.00 5.09 0.58 090 

54416 .... ............ A ........ Remv/repl penis contain pros ............. 11.87 NA NA 7.89 6.63 0.77 090 

54417 .... ............ A ........ Remv/replc penis pros, compl ............ 15.94 NA NA 9.09 7.63 1.00 090 

54420 .... ............ A ........ Revision of penis ................................ 12.26 NA NA 7.38 6.47 0.81 090 

54430 .... ............ A ........ Revision of penis ................................ 10.93 NA NA 6.96 6.03 0.72 090 

54435 .... ............ A ........ Revision of penis ................................ 6.71 NA NA 4.99 4.30 0.43 090 

54440 .... ............ C ........ Repair of penis .................................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

54450 .... ............ A ........ Preputial stretching ............................. 1.12 0.85 0.90 0.48 0.46 0.08 000 

54500 .... ............ A ........ Biopsy of testis .................................... 1.31 NA NA 0.76 0.66 0.10 000 

54505 .... ............ A ........ Biopsy of testis .................................... 3.47 NA NA 2.44 2.18 0.27 010 

54512 .... ............ A ........ Excise lesion testis ............................. 9.23 NA NA 5.66 4.89 0.67 090 

54520 .... ............ A ........ Removal of testis ................................ 5.25 NA NA 3.71 3.25 0.50 090 

54522 .... ............ A ........ Orchiectomy, partial ............................ 10.15 NA NA 5.58 5.22 0.89 090 

54530 .... ............ A ........ Removal of testis ................................ 9.31 NA NA 6.05 5.14 0.66 090 

54535 .... ............ A ........ Extensive testis surgery ...................... 13.06 NA NA 6.90 6.22 0.95 090 

54550 .... ............ A ........ Exploration for testis ........................... 8.31 NA NA 5.20 4.50 0.59 090 

54560 .... ............ A ........ Exploration for testis ........................... 11.97 NA NA 6.87 6.00 0.90 090 

54600 .... ............ A ........ Reduce testis torsion .......................... 7.54 NA NA 5.11 4.32 0.51 090 

54620 .... ............ A ........ Suspension of testis ............................ 5.16 NA NA 3.22 2.82 0.37 010 

54640 .... ............ A ........ Suspension of testis ............................ 7.57 NA NA 5.34 4.53 0.62 090 

54650 .... ............ A ........ Orchiopexy (Fowler-Stephens) ........... 12.24 NA NA 5.65 5.52 1.16 090 

54660 .... ............ A ........ Revision of testis ................................. 5.64 NA NA 4.34 3.67 0.44 090 

54670 .... ............ A ........ Repair testis injury .............................. 6.57 NA NA 4.79 4.16 0.47 090 

54680 .... ............ A ........ Relocation of testis(es) ....................... 13.91 NA NA 7.69 6.92 1.16 090 

54690 .... ............ A ........ Laparoscopy, orchiectomy .................. 11.60 NA NA 5.58 5.25 1.02 090 

54692 .... ............ A ........ Laparoscopy, orchiopexy .................... 13.64 NA NA 7.55 6.49 1.30 090 


cprice-sewell on PROD1PC72 with RULES
66471 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

54699 .... ............ C ........ Laparoscope proc, testis ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

54700 .... ............ A ........ Drainage of scrotum ........................... 3.44 NA NA 2.37 2.15 0.28 010 

54800 .... ............ A ........ Biopsy of epididymis ........................... 2.33 NA NA 1.22 1.06 0.23 000 

54830 .... ............ A ........ Remove epididymis lesion .................. 5.91 NA NA 4.43 3.72 0.41 090 

54840 .... ............ A ........ Remove epididymis lesion .................. 5.22 NA NA 3.79 3.28 0.37 090 

54860 .... ............ A ........ Removal of epididymis ........................ 6.85 NA NA 4.86 4.08 0.45 090 

54861 .... ............ A ........ Removal of epididymis ........................ 9.57 NA NA 6.24 5.27 0.63 090 

54865 .... ............ A ........ Explore epididymis .............................. 5.67 NA NA 4.26 3.59 0.40 090 

54900 .... ............ A ........ Fusion of spermatic ducts ................... 14.05 NA NA 5.24 5.51 0.93 090 

54901 .... ............ A ........ Fusion of spermatic ducts ................... 18.92 NA NA 10.50 9.00 1.83 090 

55000 .... ............ A ........ Drainage of hydrocele ......................... 1.43 1.85 1.96 0.91 0.78 0.11 000 

55040 .... ............ A ........ Removal of hydrocele ......................... 5.39 NA NA 3.95 3.42 0.43 090 

55041 .... ............ A ........ Removal of hydroceles ....................... 8.41 NA NA 5.68 4.82 0.60 090 

55060 .... ............ A ........ Repair of hydrocele ............................. 6.05 NA NA 4.45 3.76 0.46 090 

55100 .... ............ A ........ Drainage of scrotum abscess ............. 2.40 3.49 3.58 2.10 1.83 0.17 010 

55110 .... ............ A ........ Explore scrotum .................................. 6.23 NA NA 4.48 3.80 0.43 090 

55120 .... ............ A ........ Removal of scrotum lesion ................. 5.62 NA NA 4.20 3.57 0.39 090 

55150 .... ............ A ........ Removal of scrotum ............................ 8.01 NA NA 5.44 4.63 0.56 090 

55175 .... ............ A ........ Revision of scrotum ............................ 5.77 NA NA 4.33 3.66 0.37 090 

55180 .... ............ A ........ Revision of scrotum ............................ 11.63 NA NA 7.26 6.31 0.90 090 

55200 .... ............ A ........ Incision of sperm duct ......................... 4.50 8.00 10.15 3.30 2.84 0.33 090 

55250 .... ............ A ........ Removal of sperm duct(s) .................. 3.32 7.82 9.64 3.06 2.64 0.25 090 

55300 .... ............ A ........ Prepare, sperm duct x-ray .................. 3.50 NA NA 1.75 1.53 0.25 000 

55400 .... ............ A ........ Repair of sperm duct .......................... 8.53 NA NA 5.40 4.73 0.64 090 

55450 .... ............ A ........ Ligation of sperm duct ........................ 4.38 5.46 6.22 2.56 2.21 0.29 010 

55500 .... ............ A ........ Removal of hydrocele ......................... 6.12 NA NA 4.19 3.64 0.55 090 

55520 .... ............ A ........ Removal of sperm cord lesion ............ 6.56 NA NA 3.81 3.53 0.75 090 

55530 .... ............ A ........ Revise spermatic cord veins ............... 5.69 NA NA 4.08 3.54 0.45 090 

55535 .... ............ A ........ Revise spermatic cord veins ............... 7.09 NA NA 4.83 4.11 0.47 090 

55540 .... ............ A ........ Revise hernia & sperm veins .............. 8.20 NA NA 4.24 4.02 0.94 090 

55550 .... ............ A ........ Laparo ligate spermatic vein ............... 7.10 NA NA 4.54 3.92 0.57 090 

55559 .... ............ C ........ Laparo proc, spermatic cord ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

55600 .... ............ A ........ Incise sperm duct pouch ..................... 6.91 NA NA 4.90 4.11 0.62 090 

55605 .... ............ A ........ Incise sperm duct pouch ..................... 8.63 NA NA 4.62 4.45 0.64 090 

55650 .... ............ A ........ Remove sperm duct pouch ................. 12.52 NA NA 7.39 6.33 0.92 090 

55680 .... ............ A ........ Remove sperm pouch lesion .............. 5.59 NA NA 3.92 3.44 0.47 090 

55700 .... ............ A ........ Biopsy of prostate ............................... 2.58 3.71 3.95 1.32 0.98 0.11 000 

55705 .... ............ A ........ Biopsy of prostate ............................... 4.58 NA NA 2.85 2.57 0.32 010 

55720 .... ............ A ........ Drainage of prostate abscess ............. 7.67 NA NA 4.88 4.34 0.95 090 

55725 .... ............ A ........ Drainage of prostate abscess ............. 9.90 NA NA 6.27 5.37 0.70 090 

55801 .... ............ A ........ Removal of prostate ............................ 19.62 NA NA 10.33 8.96 1.34 090 

55810 .... ............ A ........ Extensive prostate surgery ................. 24.14 NA NA 12.33 10.62 1.60 090 

55812 .... ............ A ........ Extensive prostate surgery ................. 29.69 NA NA 14.19 12.57 2.05 090 

55815 .... ............ A ........ Extensive prostate surgery ................. 32.75 NA NA 16.18 14.02 2.17 090 

55821 .... ............ A ........ Removal of prostate ............................ 15.63 NA NA 8.66 7.43 1.01 090 

55831 .... ............ A ........ Removal of prostate ............................ 17.06 NA NA 9.23 7.93 1.10 090 

55840 .... ............ A ........ Extensive prostate surgery ................. 24.45 NA NA 12.67 10.97 1.61 090 

55842 .... ............ A ........ Extensive prostate surgery ................. 26.31 NA NA 13.46 11.64 1.73 090 

55845 .... ............ A ........ Extensive prostate surgery ................. 30.52 NA NA 14.85 12.87 2.03 090 

55860 .... ............ A ........ Surgical exposure, prostate ................ 15.71 NA NA 8.53 7.46 1.02 090 

55862 .... ............ A ........ Extensive prostate surgery ................. 19.89 NA NA 10.69 9.26 1.49 090 

55865 .... ............ A ........ Extensive prostate surgery ................. 24.39 NA NA 12.40 10.82 1.63 090 

55866 .... ............ A ........ Laparo radical prostatectomy ............. 32.25 NA NA 15.94 13.82 2.17 090 

55870 .... ............ A ........ Electroejaculation ................................ 2.58 2.49 2.01 1.45 1.26 0.16 000 

55873 .... ............ A ........ Cryoablate prostate ............................. 20.25 NA NA 11.27 10.10 1.38 090 

55875 .... ............ A ........ Transperi needle place, pros .............. 13.31 NA NA 7.83 6.83 0.89 090 

55876 .... ............ A ........ Place rt device/marker, pros ............... 1.73 2.07 2.07 1.05 1.05 0.28 000 

55899 .... ............ C ........ Genital surgery procedure .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

55920 .... ............ A ........ Place needles pelvic for rt .................. 8.31 NA NA 3.13 3.13 0.58 000 

55970 .... ............ N ........ Sex transformation, M to F ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

55980 .... ............ N ........ Sex transformation, F to M ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

56405 .... ............ A ........ I & D of vulva/perineum ...................... 1.46 1.18 1.25 1.16 1.15 0.17 010 

56420 .... ............ A ........ Drainage of gland abscess ................. 1.41 1.52 1.90 0.78 0.91 0.16 010 

56440 .... ............ A ........ Surgery for vulva lesion ...................... 2.86 NA NA 1.56 1.63 0.34 010 

56441 .... ............ A ........ Lysis of labial lesion(s) ....................... 1.99 1.71 1.76 1.56 1.48 0.20 010 

56442 .... ............ A ........ Hymenotomy ....................................... 0.68 NA NA 0.52 0.51 0.08 000 

56501 .... ............ A ........ Destroy, vulva lesions, sim ................. 1.55 1.63 1.71 1.21 1.22 0.18 010 

56515 .... ............ A ........ Destroy vulva lesion/s compl .............. 3.03 2.39 2.47 1.74 1.78 0.33 010 

56605 .... ............ A ........ Biopsy of vulva/perineum .................... 1.10 0.92 1.00 0.34 0.40 0.13 000 

56606 .... ............ A ........ Biopsy of vulva/perineum .................... 0.55 0.36 0.42 0.15 0.19 0.07 ZZZ 

56620 .... ............ A ........ Partial removal of vulva ...................... 8.44 NA NA 4.39 4.59 0.90 090 

56625 .... ............ A ........ Complete removal of vulva ................. 9.55 NA NA 4.81 5.06 1.02 090 


cprice-sewell on PROD1PC72 with RULES
66472 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

56630 .... ............ A ........ Extensive vulva surgery ...................... 14.67 NA NA 6.28 6.55 1.49 090 

56631 .... ............ A ........ Extensive vulva surgery ...................... 18.81 NA NA 7.78 8.29 1.96 090 

56632 .... ............ A ........ Extensive vulva surgery ...................... 21.61 NA NA 9.29 9.40 2.39 090 

56633 .... ............ A ........ Extensive vulva surgery ...................... 19.47 NA NA 7.80 8.19 1.98 090 

56634 .... ............ A ........ Extensive vulva surgery ...................... 20.48 NA NA 8.18 8.80 2.17 090 

56637 .... ............ A ........ Extensive vulva surgery ...................... 24.57 NA NA 9.30 10.18 2.61 090 

56640 .... ............ A ........ Extensive vulva surgery ...................... 24.65 NA NA 8.83 9.72 2.89 090 

56700 .... ............ A ........ Partial removal of hymen .................... 2.79 NA NA 1.77 1.80 0.30 010 

56740 .... ............ A ........ Remove vagina gland lesion .............. 4.83 NA NA 2.33 2.45 0.56 010 

56800 .... ............ A ........ Repair of vagina .................................. 3.90 NA NA 1.96 2.08 0.44 010 

56805 .... ............ A ........ Repair clitoris ...................................... 19.75 NA NA 7.68 8.54 2.15 090 

56810 .... ............ A ........ Repair of perineum ............................. 4.26 NA NA 2.04 2.16 0.49 010 

56820 .... ............ A ........ Exam of vulva w/scope ....................... 1.50 1.19 1.25 0.53 0.59 0.18 000 

56821 .... ............ A ........ Exam/biopsy of vulva w/scope ........... 2.05 1.53 1.64 0.68 0.79 0.25 000 

57000 .... ............ A ........ Exploration of vagina .......................... 2.99 NA NA 1.75 1.73 0.31 010 

57010 .... ............ A ........ Drainage of pelvic abscess ................. 6.74 NA NA 3.80 3.80 0.71 090 

57020 .... ............ A ........ Drainage of pelvic fluid ....................... 1.50 0.77 0.85 0.45 0.52 0.18 000 

57022 .... ............ A ........ I & d vaginal hematoma, pp ............... 2.70 NA NA 1.42 1.45 0.26 010 

57023 .... ............ A ........ I & d vag hematoma, non-ob .............. 5.13 NA NA 2.37 2.47 0.58 010 

57061 .... ............ A ........ Destroy vag lesions, simple ................ 1.27 1.52 1.58 1.11 1.12 0.15 010 

57065 .... ............ A ........ Destroy vag lesions, complex ............. 2.63 2.02 2.16 1.49 1.58 0.31 010 

57100 .... ............ A ........ Biopsy of vagina ................................. 1.20 0.95 1.01 0.37 0.42 0.14 000 

57105 .... ............ A ........ Biopsy of vagina ................................. 1.71 1.59 1.69 1.33 1.37 0.20 010 

57106 .... ............ A ........ Remove vagina wall, partial ................ 7.35 NA NA 4.27 4.22 0.73 090 

57107 .... ............ A ........ Remove vagina tissue, part ................ 24.43 NA NA 9.05 9.75 2.72 090 

57109 .... ............ A ........ Vaginectomy partial w/nodes .............. 28.25 NA NA 10.25 10.74 3.22 090 

57110 .... ............ A ........ Remove vagina wall, complete ........... 15.38 NA NA 6.19 6.73 1.74 090 

57111 .... ............ A ........ Remove vagina tissue, compl ............. 28.25 NA NA 10.42 11.51 3.18 090 

57112 .... ............ A ........ Vaginectomy w/nodes, compl ............. 30.37 NA NA 10.61 11.35 3.08 090 

57120 .... ............ A ........ Closure of vagina ................................ 8.18 NA NA 4.19 4.39 0.89 090 

57130 .... ............ A ........ Remove vagina lesion ........................ 2.44 1.96 2.06 1.47 1.50 0.29 010 

57135 .... ............ A ........ Remove vagina lesion ........................ 2.68 2.03 2.15 1.53 1.59 0.31 010 

57150 .... ............ A ........ Treat vagina infection ......................... 0.55 0.58 0.84 0.15 0.18 0.07 000 

57155 .... ............ A ........ Insert uteri tandems/ovoids ................. 6.79 NA NA 3.49 4.02 0.43 090 

57160 .... ............ A ........ Insert pessary/other device ................. 0.89 1.04 1.03 0.25 0.30 0.10 000 

57170 .... ............ A ........ Fitting of diaphragm/cap ..................... 0.91 0.57 1.02 0.25 0.29 0.11 000 

57180 .... ............ A ........ Treat vaginal bleeding ........................ 1.60 1.86 2.01 0.93 1.09 0.19 010 

57200 .... ............ A ........ Repair of vagina .................................. 4.34 NA NA 2.99 2.94 0.46 090 

57210 .... ............ A ........ Repair vagina/perineum ...................... 5.63 NA NA 3.27 3.35 0.62 090 

57220 .... ............ A ........ Revision of urethra .............................. 4.77 NA NA 3.00 3.05 0.51 090 

57230 .... ............ A ........ Repair of urethral lesion ..................... 6.22 NA NA 3.64 3.52 0.54 090 

57240 .... ............ A ........ Repair bladder & vagina ..................... 11.42 NA NA 5.48 4.65 0.62 090 

57250 .... ............ A ........ Repair rectum & vagina ...................... 11.42 NA NA 5.03 4.30 0.65 090 

57260 .... ............ A ........ Repair of vagina .................................. 14.36 NA NA 5.85 5.34 0.97 090 

57265 .... ............ A ........ Extensive repair of vagina .................. 15.86 NA NA 6.32 6.17 1.32 090 

57267 .... ............ A ........ Insert mesh/pelvic flr addon ................ 4.88 NA NA 1.49 1.73 0.64 ZZZ 

57268 .... ............ A ........ Repair of bowel bulge ......................... 7.47 NA NA 4.33 4.26 0.79 090 

57270 .... ............ A ........ Repair of bowel pouch ........................ 13.57 NA NA 5.83 6.04 1.42 090 

57280 .... ............ A ........ Suspension of vagina ......................... 16.62 NA NA 6.96 7.16 1.68 090 

57282 .... ............ A ........ Colpopexy, extraperitoneal ................. 7.84 NA NA 4.49 4.49 1.02 090 

57283 .... ............ A ........ Colpopexy, intraperitoneal .................. 11.58 NA NA 5.11 5.51 1.02 090 

57284 .... ............ A ........ Repair paravag defect, open .............. 14.25 NA NA 5.98 6.56 1.41 090 

57285 .... ............ A ........ Repair paravag defect, vag ................ 11.52 NA NA 5.16 5.16 0.63 090 

57287 .... ............ A ........ Revise/remove sling repair ................. 11.49 NA NA 6.35 5.91 0.90 090 

57288 .... ............ A ........ Repair bladder defect ......................... 14.01 NA NA 7.01 6.46 1.12 090 

57289 .... ............ A ........ Repair bladder & vagina ..................... 12.69 NA NA 6.70 6.37 1.21 090 

57291 .... ............ A ........ Construction of vagina ........................ 8.54 NA NA 4.89 4.90 0.93 090 

57292 .... ............ A ........ Construct vagina with graft ................. 13.91 NA NA 5.90 6.41 1.58 090 

57295 .... ............ A ........ Revise vag graft via vagina ................ 7.74 NA NA 4.08 4.25 0.91 090 

57296 .... ............ A ........ Revise vag graft, open abd ................ 16.46 NA NA 6.66 6.66 1.68 090 

57300 .... ............ A ........ Repair rectum-vagina fistula ............... 8.58 NA NA 4.43 4.35 0.87 090 

57305 .... ............ A ........ Repair rectum-vagina fistula ............... 15.24 NA NA 6.19 6.23 1.73 090 

57307 .... ............ A ........ Fistula repair & colostomy .................. 17.02 NA NA 6.90 6.95 2.02 090 

57308 .... ............ A ........ Fistula repair, transperine ................... 10.48 NA NA 4.96 5.02 1.14 090 

57310 .... ............ A ........ Repair urethrovaginal lesion ............... 7.55 NA NA 5.01 4.42 0.54 090 

57311 .... ............ A ........ Repair urethrovaginal lesion ............... 8.81 NA NA 5.51 4.81 0.65 090 

57320 .... ............ A ........ Repair bladder-vagina lesion .............. 8.78 NA NA 5.28 4.82 0.69 090 

57330 .... ............ A ........ Repair bladder-vagina lesion .............. 13.11 NA NA 7.20 6.45 1.06 090 

57335 .... ............ A ........ Repair vagina ...................................... 19.87 NA NA 7.82 8.42 1.92 090 

57400 .... ............ A ........ Dilation of vagina ................................ 2.27 NA NA 1.00 1.05 0.26 000 

57410 .... ............ A ........ Pelvic examination .............................. 1.75 NA NA 0.91 0.90 0.18 000 

57415 .... ............ A ........ Remove vaginal foreign body ............. 2.44 NA NA 1.49 1.45 0.24 010 


cprice-sewell on PROD1PC72 with RULES
66473 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

57420 .... ............ A ........ Exam of vagina w/scope ..................... 1.60 1.23 1.29 0.56 0.61 0.19 000 

57421 .... ............ A ........ Exam/biopsy of vag w/scope .............. 2.20 1.59 1.72 0.72 0.84 0.27 000 

57423 .... ............ A ........ Repair paravag defect, lap ................. 16.00 NA NA 6.51 6.51 1.65 090 

57425 .... ............ A ........ Laparoscopy, surg, colpopexy ............ 16.93 NA NA 6.90 6.77 1.76 090 

57452 .... ............ A ........ Exam of cervix w/scope ...................... 1.50 1.18 1.23 0.74 0.75 0.18 000 

57454 .... ............ A ........ Bx/curett of cervix w/scope ................. 2.33 1.39 1.51 0.95 1.05 0.28 000 

57455 .... ............ A ........ Biopsy of cervix w/scope .................... 1.99 1.50 1.61 0.66 0.76 0.24 000 

57456 .... ............ A ........ Endocerv curettage w/scope .............. 1.85 1.45 1.55 0.62 0.72 0.22 000 

57460 .... ............ A ........ Bx of cervix w/scope, leep .................. 2.83 4.28 5.06 1.09 1.23 0.34 000 

57461 .... ............ A ........ Conz of cervix w/scope, leep .............. 3.43 4.56 5.33 1.05 1.26 0.41 000 

57500 .... ............ A ........ Biopsy of cervix ................................... 1.20 2.01 2.28 0.64 0.64 0.12 000 

57505 .... ............ A ........ Endocervical curettage ....................... 1.16 1.32 1.39 1.07 1.08 0.14 010 

57510 .... ............ A ........ Cauterization of cervix ........................ 1.90 1.30 1.43 0.89 0.97 0.23 010 

57511 .... ............ A ........ Cryocautery of cervix .......................... 1.92 1.60 1.71 1.26 1.31 0.23 010 

57513 .... ............ A ........ Laser surgery of cervix ....................... 1.92 1.57 1.64 1.28 1.34 0.23 010 

57520 .... ............ A ........ Conization of cervix ............................ 4.06 3.38 3.65 2.51 2.69 0.49 090 

57522 .... ............ A ........ Conization of cervix ............................ 3.62 2.77 2.96 2.25 2.35 0.41 090 

57530 .... ............ A ........ Removal of cervix ............................... 5.19 NA NA 3.10 3.24 0.58 090 

57531 .... ............ A ........ Removal of cervix, radical .................. 29.77 NA NA 10.85 12.00 3.35 090 

57540 .... ............ A ........ Removal of residual cervix ................. 13.19 NA NA 5.44 5.83 1.49 090 

57545 .... ............ A ........ Remove cervix/repair pelvis ................ 14.00 NA NA 5.72 6.19 1.52 090 

57550 .... ............ A ........ Removal of residual cervix ................. 6.24 NA NA 3.61 3.71 0.67 090 

57555 .... ............ A ........ Remove cervix/repair vagina .............. 9.84 NA NA 4.75 4.91 1.09 090 

57556 .... ............ A ........ Remove cervix, repair bowel .............. 9.26 NA NA 4.60 4.72 0.92 090 

57558 .... ............ A ........ D&c of cervical stump ......................... 1.69 1.34 1.40 1.05 1.09 0.20 010 

57700 .... ............ A ........ Revision of cervix ................................ 4.22 NA NA 3.28 3.19 0.41 090 

57720 .... ............ A ........ Revision of cervix ................................ 4.53 NA NA 2.93 3.02 0.49 090 

57800 .... ............ A ........ Dilation of cervical canal ..................... 0.77 0.72 0.74 0.41 0.44 0.09 000 

58100 .... ............ A ........ Biopsy of uterus lining ........................ 1.53 1.14 1.23 0.58 0.65 0.18 000 

58110 .... ............ A ........ Bx done w/colposcopy add-on ............ 0.77 0.39 0.47 0.21 0.26 0.09 ZZZ 

58120 .... ............ A ........ Dilation and curettage ......................... 3.54 2.70 2.50 1.65 1.76 0.39 010 

58140 .... ............ A ........ Myomectomy abdom method ............. 15.69 NA NA 6.17 6.64 1.82 090 

58145 .... ............ A ........ Myomectomy vag method ................... 8.81 NA NA 4.23 4.50 0.97 090 

58146 .... ............ A ........ Myomectomy abdom complex ............ 20.24 NA NA 7.34 8.17 2.33 090 

58150 .... ............ A ........ Total hysterectomy .............................. 17.21 NA NA 6.55 7.01 1.85 090 

58152 .... ............ A ........ Total hysterectomy .............................. 21.73 NA NA 8.02 8.93 2.48 090 

58180 .... ............ A ........ Partial hysterectomy ........................... 16.50 NA NA 6.33 6.89 1.64 090 

58200 .... ............ A ........ Extensive hysterectomy ...................... 23.00 NA NA 8.14 9.06 2.55 090 

58210 .... ............ A ........ Extensive hysterectomy ...................... 30.76 NA NA 10.71 11.95 3.38 090 

58240 .... ............ A ........ Removal of pelvis contents ................. 49.02 NA NA 17.62 17.61 4.23 090 

58260 .... ............ A ........ Vaginal hysterectomy .......................... 14.02 NA NA 5.78 6.23 1.57 090 

58262 .... ............ A ........ Vag hyst including t/o ......................... 15.81 NA NA 6.23 6.80 1.80 090 

58263 .... ............ A ........ Vag hyst w/t/o & vag repair ................ 17.10 NA NA 6.63 7.25 1.95 090 

58267 .... ............ A ........ Vag hyst w/urinary repair .................... 18.23 NA NA 6.96 7.66 2.07 090 

58270 .... ............ A ........ Vag hyst w/enterocele repair .............. 15.20 NA NA 5.93 6.49 1.74 090 

58275 .... ............ A ........ Hysterectomy/revise vagina ................ 16.90 NA NA 6.60 7.18 1.92 090 

58280 .... ............ A ........ Hysterectomy/revise vagina ................ 18.20 NA NA 6.95 7.60 2.07 090 

58285 .... ............ A ........ Extensive hysterectomy ...................... 23.30 NA NA 7.93 8.93 2.71 090 

58290 .... ............ A ........ Vag hyst complex ............................... 20.17 NA NA 7.34 8.23 2.30 090 

58291 .... ............ A ........ Vag hyst incl t/o, complex ................... 21.96 NA NA 7.81 8.84 2.53 090 

58292 .... ............ A ........ Vag hyst t/o & repair, compl ............... 23.25 NA NA 8.20 9.28 2.68 090 

58293 .... ............ A ........ Vag hyst w/uro repair, compl .............. 24.23 NA NA 8.50 9.57 2.79 090 

58294 .... ............ A ........ Vag hyst w/enterocele, compl ............. 21.45 NA NA 7.50 8.52 2.40 090 

58300 .... ............ N ........ Insert intrauterine device .................... 1.01 0.63 1.02 0.23 0.31 0.12 XXX 

58301 .... ............ A ........ Remove intrauterine device ................ 1.27 1.04 1.18 0.34 0.41 0.15 000 

58321 .... ............ A ........ Artificial insemination .......................... 0.92 0.94 1.04 0.23 0.30 0.10 000 

58322 .... ............ A ........ Artificial insemination .......................... 1.10 1.03 1.11 0.31 0.36 0.13 000 

58323 .... ............ A ........ Sperm washing ................................... 0.23 0.16 0.34 0.07 0.08 0.03 000 

58340 .... ............ A ........ Catheter for hysterography ................. 0.88 2.15 2.66 0.56 0.61 0.09 000 

58345 .... ............ A ........ Reopen fallopian tube ......................... 4.67 NA NA 2.11 2.27 0.41 010 

58346 .... ............ A ........ Insert heyman uteri capsule ............... 7.48 NA NA 3.73 3.83 0.56 090 

58350 .... ............ A ........ Reopen fallopian tube ......................... 1.03 1.35 1.42 0.88 0.90 0.12 010 

58353 .... ............ A ........ Endometr ablate, thermal ................... 3.57 22.81 29.23 1.71 1.88 0.43 010 

58356 .... ............ A ........ Endometrial cryoablation .................... 6.36 43.33 52.36 1.85 2.27 0.82 010 

58400 .... ............ A ........ Suspension of uterus .......................... 7.06 NA NA 3.86 3.89 0.75 090 

58410 .... ............ A ........ Suspension of uterus .......................... 13.70 NA NA 5.55 5.99 1.45 090 

58520 .... ............ A ........ Repair of ruptured uterus .................... 13.38 NA NA 5.48 5.76 1.47 090 

58540 .... ............ A ........ Revision of uterus ............................... 15.61 NA NA 6.14 6.54 1.79 090 

58541 .... ............ A ........ Lsh, uterus 250 g or less .................... 14.57 NA NA 6.12 6.12 1.68 090 

58542 .... ............ A ........ Lsh w/t/o ut 250 g or less ................... 16.43 NA NA 6.63 6.63 1.69 090 

58543 .... ............ A ........ Lsh uterus above 250 g ...................... 16.74 NA NA 6.71 6.71 1.73 090 

58544 .... ............ A ........ Lsh w/t/o uterus above 250 g ............. 18.24 NA NA 7.11 7.11 1.89 090 


cprice-sewell on PROD1PC72 with RULES
66474 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

58545 .... ............ A ........ Laparoscopic myomectomy ................ 15.45 NA NA 5.86 6.52 1.78 090 

58546 .... ............ A ........ Laparo-myomectomy, complex ........... 19.84 NA NA 7.04 7.98 2.31 090 

58548 .... ............ A ........ Lap radical hyst ................................... 31.45 NA NA 12.45 12.45 3.52 090 

58550 .... ............ A ........ Laparo-asst vag hysterectomy ............ 14.97 NA NA 6.12 6.70 1.73 090 

58552 .... ............ A ........ Laparo-vag hyst incl t/o ...................... 16.78 NA NA 6.55 7.28 1.73 090 

58553 .... ............ A ........ Laparo-vag hyst, complex ................... 19.96 NA NA 7.08 8.00 2.31 090 

58554 .... ............ A ........ Laparo-vag hyst w/t/o, compl .............. 22.98 NA NA 8.23 9.31 2.28 090 

58555 .... ............ A ........ Hysteroscopy, dx, sep proc ................ 3.33 2.75 2.47 1.23 1.39 0.40 000 

58558 .... ............ A ........ Hysteroscopy, biopsy .......................... 4.74 3.62 2.90 1.65 1.91 0.57 000 

58559 .... ............ A ........ Hysteroscopy, lysis ............................. 6.16 NA NA 2.04 2.38 0.74 000 

58560 .... ............ A ........ Hysteroscopy, resect septum ............. 6.99 NA NA 2.31 2.70 0.84 000 

58561 .... ............ A ........ Hysteroscopy, remove myoma ........... 9.99 NA NA 3.11 3.69 1.21 000 

58562 .... ............ A ........ Hysteroscopy, remove fb .................... 5.20 3.52 2.94 1.75 2.05 0.63 000 

58563 .... ............ A ........ Hysteroscopy, ablation ........................ 6.16 37.22 46.69 2.04 2.40 0.74 000 

58565 .... ............ A ........ Hysteroscopy, sterilization .................. 7.06 41.94 45.74 3.37 3.63 1.19 090 

58570 .... ............ A ........ Tlh, uterus 250 g or less ..................... 15.75 NA NA 6.45 6.45 1.82 090 

58571 .... ............ A ........ Tlh w/t/o 250 g or less ........................ 17.56 NA NA 6.94 6.94 1.81 090 

58572 .... ............ A ........ Tlh, uterus over 250 g ........................ 19.96 NA NA 7.59 7.59 2.31 090 

58573 .... ............ A ........ Tlh w/t/o uterus over 250 g ................. 22.98 NA NA 8.41 8.41 2.28 090 

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 tube ..................... 5.86 NA NA 2.92 3.12 0.66 090 

58605 .... ............ A ........ Division of fallopian tube ..................... 5.25 NA NA 2.71 2.91 0.59 090 

58611 .... ............ A ........ Ligate oviduct(s) add-on ..................... 1.45 NA NA 0.40 0.48 0.18 ZZZ 

58615 .... ............ A ........ Occlude fallopian tube(s) .................... 3.91 NA NA 2.03 2.37 0.47 010 

58660 .... ............ A ........ Laparoscopy, lysis .............................. 11.54 NA NA 4.49 4.87 1.40 090 

58661 .... ............ A ........ Laparoscopy, remove adnexa ............ 11.30 NA NA 3.98 4.55 1.34 010 

58662 .... ............ A ........ Laparoscopy, excise lesions ............... 12.08 NA NA 4.75 5.27 1.43 090 

58670 .... ............ A ........ Laparoscopy, tubal cautery ................. 5.86 NA NA 2.94 3.11 0.67 090 

58671 .... ............ A ........ Laparoscopy, tubal block .................... 5.86 NA NA 2.93 3.10 0.68 090 

58672 .... ............ A ........ Laparoscopy, fimbrioplasty ................. 12.88 NA NA 4.77 5.47 1.60 090 

58673 .... ............ A ........ Laparoscopy, salpingostomy .............. 13.99 NA NA 5.12 5.84 1.70 090 

58679 .... ............ C ........ Laparo proc, oviduct-ovary ................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

58700 .... ............ A ........ Removal of fallopian tube ................... 12.84 NA NA 5.48 5.73 1.51 090 

58720 .... ............ A ........ Removal of ovary/tube(s) .................... 12.08 NA NA 5.08 5.43 1.39 090 

58740 .... ............ A ........ Revise fallopian tube(s) ...................... 14.79 NA NA 6.05 6.59 1.72 090 

58750 .... ............ A ........ Repair oviduct ..................................... 15.56 NA NA 6.04 6.70 1.85 090 

58752 .... ............ A ........ Revise ovarian tube(s) ........................ 15.56 NA NA 5.98 6.46 1.81 090 

58760 .... ............ A ........ Remove tubal obstruction ................... 13.85 NA NA 5.58 6.14 1.80 090 

58770 .... ............ A ........ Create new tubal opening ................... 14.69 NA NA 5.74 6.32 1.74 090 

58800 .... ............ A ........ Drainage of ovarian cyst(s) ................. 4.54 3.21 3.42 2.69 2.79 0.43 090 

58805 .... ............ A ........ Drainage of ovarian cyst(s) ................. 6.34 NA NA 3.50 3.50 0.69 090 

58820 .... ............ A ........ Drain ovary abscess, open ................. 4.62 NA NA 2.90 3.09 0.52 090 

58822 .... ............ A ........ Drain ovary abscess, percut ............... 11.71 NA NA 5.15 5.18 1.16 090 

58823 .... ............ A ........ Drain pelvic abscess, percut ............... 3.37 19.98 20.64 1.16 1.14 0.24 000 

58825 .... ............ A ........ Transposition, ovary(s) ....................... 11.70 NA NA 4.83 5.31 1.32 090 

58900 .... ............ A ........ Biopsy of ovary(s) ............................... 6.51 NA NA 3.55 3.56 0.69 090 

58920 .... ............ A ........ Partial removal of ovary(s) .................. 11.87 NA NA 5.05 5.31 1.43 090 

58925 .... ............ A ........ Removal of ovarian cyst(s) ................. 12.33 NA NA 5.24 5.46 1.41 090 

58940 .... ............ A ........ Removal of ovary(s) ............................ 8.12 NA NA 4.03 4.06 0.91 090 

58943 .... ............ A ........ Removal of ovary(s) ............................ 19.42 NA NA 7.17 7.90 2.23 090 

58950 .... ............ A ........ Resect ovarian malignancy ................. 18.24 NA NA 7.24 7.82 2.05 090 

58951 .... ............ A ........ Resect ovarian malignancy ................. 24.15 NA NA 8.59 9.51 2.64 090 

58952 .... ............ A ........ Resect ovarian malignancy ................. 27.15 NA NA 9.81 10.77 3.03 090 

58953 .... ............ A ........ Tah, rad dissect for debulk ................. 33.97 NA NA 11.62 13.08 3.84 090 

58954 .... ............ A ........ Tah rad debulk/lymph remove ............ 36.97 NA NA 12.51 14.10 4.18 090 

58956 .... ............ A ........ Bso, omentectomy w/tah .................... 22.65 NA NA 8.58 9.44 4.01 090 

58957 .... ............ A ........ Resect recurrent gyn mal ................... 26.06 NA NA 9.55 9.55 2.95 090 

58958 .... ............ A ........ Resect recur gyn mal w/lym ............... 29.06 NA NA 10.35 10.35 3.29 090 

58960 .... ............ A ........ Exploration of abdomen ...................... 15.68 NA NA 6.24 6.79 1.80 090 

58970 .... ............ A ........ Retrieval of oocyte .............................. 3.52 1.85 2.08 1.28 1.38 0.43 000 

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 1.94 2.31 1.20 1.51 0.47 000 

58999 .... ............ C ........ Genital surgery procedure .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

59000 .... ............ A ........ Amniocentesis, diagnostic .................. 1.30 1.75 1.91 0.55 0.61 0.31 000 

59001 .... ............ A ........ Amniocentesis, therapeutic ................. 3.00 NA NA 1.07 1.24 0.71 000 

59012 .... ............ A ........ Fetal cord puncture,prenatal ............... 3.44 NA NA 1.13 1.33 0.82 000 

59015 .... ............ A ........ Chorion biopsy .................................... 2.20 1.42 1.48 0.79 0.91 0.52 000 

59020 .... ............ A ........ Fetal contract stress test .................... 0.66 1.07 0.92 NA NA 0.26 000 

59020 .... TC ...... A ........ Fetal contract stress test .................... 0.00 0.89 0.70 NA NA 0.10 000 

59020 .... 26 ....... A ........ Fetal contract stress test .................... 0.66 0.18 0.22 0.18 0.22 0.16 000 

59025 .... ............ A ........ Fetal non-stress test ........................... 0.53 0.63 0.54 NA NA 0.15 000 


cprice-sewell on PROD1PC72 with RULES
66475 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

59025 .... TC ...... A ........ Fetal non-stress test ........................... 0.00 0.48 0.36 NA NA 0.02 000 

59025 .... 26 ....... A ........ Fetal non-stress test ........................... 0.53 0.15 0.18 0.15 0.18 0.13 000 

59030 .... ............ A ........ Fetal scalp blood sample .................... 1.99 NA NA 0.46 0.61 0.47 000 

59050 .... ............ A ........ Fetal monitor w/report ......................... 0.89 NA NA 0.27 0.31 0.21 XXX 

59051 .... ............ A ........ Fetal monitor/interpret only ................. 0.74 NA NA 0.20 0.25 0.17 XXX 

59070 .... ............ A ........ Transabdom amnioinfus w/us ............. 5.24 4.39 4.77 1.76 2.04 0.28 000 

59072 .... ............ A ........ Umbilical cord occlud w/us ................. 8.99 NA NA 2.39 2.75 0.16 000 

59074 .... ............ A ........ Fetal fluid drainage w/us ..................... 5.24 3.60 4.08 1.53 1.92 0.28 000 

59076 .... ............ A ........ Fetal shunt placement, w/us ............... 8.99 NA NA 2.39 2.75 0.16 000 

59100 .... ............ A ........ Remove uterus lesion ......................... 13.26 NA NA 5.55 6.00 2.95 090 

59120 .... ............ A ........ Treat ectopic pregnancy ..................... 12.56 NA NA 5.39 5.82 2.73 090 

59121 .... ............ A ........ Treat ectopic pregnancy ..................... 12.64 NA NA 5.34 5.83 2.79 090 

59130 .... ............ A ........ Treat ectopic pregnancy ..................... 14.98 NA NA 6.73 5.76 3.39 090 

59135 .... ............ A ........ Treat ectopic pregnancy ..................... 14.82 NA NA 5.08 6.15 3.31 090 

59136 .... ............ A ........ Treat ectopic pregnancy ..................... 14.15 NA NA 4.93 5.76 3.14 090 

59140 .... ............ A ........ Treat ectopic pregnancy ..................... 5.86 NA NA 3.30 2.76 1.29 090 

59150 .... ............ A ........ Treat ectopic pregnancy ..................... 12.19 NA NA 5.23 5.61 2.79 090 

59151 .... ............ A ........ Treat ectopic pregnancy ..................... 12.01 NA NA 4.86 5.45 2.74 090 

59160 .... ............ A ........ D & c after delivery ............................. 2.73 1.98 2.64 1.17 1.65 0.64 010 

59200 .... ............ A ........ Insert cervical dilator ........................... 0.79 0.94 1.06 0.22 0.26 0.19 000 

59300 .... ............ A ........ Episiotomy or vaginal repair ............... 2.41 2.19 2.18 1.00 0.98 0.57 000 

59320 .... ............ A ........ Revision of cervix ................................ 2.48 NA NA 1.00 1.12 0.59 000 

59325 .... ............ A ........ Revision of cervix ................................ 4.06 NA NA 1.44 1.66 0.88 000 

59350 .... ............ A ........ Repair of uterus .................................. 4.94 NA NA 1.21 1.54 1.17 000 

59400 .... ............ A ........ Obstetrical care ................................... 26.80 NA NA 14.08 14.69 5.50 MMM 

59409 .... ............ A ........ Obstetrical care ................................... 13.48 NA NA 3.70 4.50 3.22 MMM 

59410 .... ............ A ........ Obstetrical care ................................... 15.29 NA NA 4.91 5.60 3.52 MMM 

59412 .... ............ A ........ Antepartum manipulation .................... 1.71 NA NA 0.64 0.72 0.40 MMM 

59414 .... ............ A ........ Deliver placenta .................................. 1.61 NA NA 0.44 0.54 0.38 MMM 

59425 .... ............ A ........ Antepartum care only .......................... 6.22 4.24 4.22 1.68 1.77 1.14 MMM 

59426 .... ............ A ........ Antepartum care only .......................... 11.04 7.78 7.66 2.99 3.10 1.98 MMM 

59430 .... ............ A ........ Care after delivery .............................. 2.13 1.08 1.15 0.71 0.82 0.50 MMM 

59510 .... ............ A ........ Cesarean delivery ............................... 30.34 NA NA 15.96 16.61 6.25 MMM 

59514 .... ............ A ........ Cesarean delivery only ....................... 15.95 NA NA 4.42 5.32 3.80 MMM 

59515 .... ............ A ........ Cesarean delivery ............................... 18.26 NA NA 6.13 6.98 4.13 MMM 

59525 .... ............ A ........ Remove uterus after cesarean ........... 8.53 NA NA 2.25 2.77 1.95 ZZZ 

59610 .... ............ A ........ Vbac delivery ...................................... 28.21 NA NA 14.93 15.39 5.87 MMM 

59612 .... ............ A ........ Vbac delivery only ............................... 15.04 NA NA 4.19 5.12 3.59 MMM 

59614 .... ............ A ........ Vbac care after delivery ...................... 16.59 NA NA 5.11 6.02 3.89 MMM 

59618 .... ............ A ........ Attempted vbac delivery ..................... 31.78 NA NA 16.35 17.28 6.61 MMM 

59620 .... ............ A ........ Attempted vbac delivery only .............. 17.50 NA NA 4.66 5.71 4.17 MMM 

59622 .... ............ A ........ Attempted vbac after care .................. 19.70 NA NA 6.70 7.66 4.50 MMM 

59812 .... ............ A ........ Treatment of miscarriage .................... 4.39 3.10 2.82 2.35 2.45 0.95 090 

59820 .... ............ A ........ Care of miscarriage ............................ 4.68 4.07 4.24 3.46 3.51 0.95 090 

59821 .... ............ A ........ Treatment of miscarriage .................... 4.97 3.91 4.09 3.23 3.32 1.06 090 

59830 .... ............ A ........ Treat uterus infection .......................... 6.51 NA NA 3.44 3.71 1.44 090 

59840 .... ............ R ........ Abortion ............................................... 3.01 2.00 2.06 1.77 1.95 0.71 010 

59841 .... ............ R ........ Abortion ............................................... 5.57 3.11 3.30 2.54 2.76 1.24 010 

59850 .... ............ R ........ Abortion ............................................... 5.90 NA NA 2.45 2.85 1.28 090 

59851 .... ............ R ........ Abortion ............................................... 5.92 NA NA 3.28 3.51 1.28 090 

59852 .... ............ R ........ Abortion ............................................... 8.23 NA NA 3.82 4.43 1.81 090 

59855 .... ............ R ........ Abortion ............................................... 6.38 NA NA 3.07 3.31 1.45 090 

59856 .... ............ R ........ Abortion ............................................... 7.74 NA NA 3.31 3.68 1.79 090 

59857 .... ............ R ........ Abortion ............................................... 9.30 NA NA 3.64 4.17 2.02 090 

59866 .... ............ R ........ Abortion (mpr) ..................................... 3.99 NA NA 1.36 1.63 0.87 000 

59870 .... ............ A ........ Evacuate mole of uterus ..................... 6.40 NA NA 4.38 4.43 1.42 090 

59871 .... ............ A ........ Remove cerclage suture ..................... 2.13 NA NA 0.90 1.02 0.50 000 

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/deliver ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

59899 .... ............ C ........ Maternity care procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

60000 .... ............ A ........ Drain thyroid/tongue cyst .................... 1.78 2.08 2.00 1.70 1.70 0.15 010 

60100 .... ............ A ........ Biopsy of thyroid ................................. 1.56 1.31 1.35 0.52 0.52 0.10 000 

60200 .... ............ A ........ Remove thyroid lesion ........................ 9.91 NA NA 5.50 5.74 1.01 090 

60210 .... ............ A ........ Partial thyroid excision ........................ 11.15 NA NA 5.22 5.43 1.23 090 

60212 .... ............ A ........ Partial thyroid excision ........................ 16.32 NA NA 6.94 7.30 1.95 090 

60220 .... ............ A ........ Partial removal of thyroid .................... 12.29 NA NA 5.66 5.90 1.32 090 

60225 .... ............ A ........ Partial removal of thyroid .................... 14.67 NA NA 6.91 7.15 1.64 090 

60240 .... ............ A ........ Removal of thyroid .............................. 16.18 NA NA 6.40 6.99 1.86 090 

60252 .... ............ A ........ Removal of thyroid .............................. 21.88 NA NA 8.82 9.45 2.30 090 

60254 .... ............ A ........ Extensive thyroid surgery ................... 28.29 NA NA 11.21 12.67 2.61 090 

60260 .... ............ A ........ Repeat thyroid surgery ....................... 18.18 NA NA 7.40 8.02 1.94 090 

60270 .... ............ A ........ Removal of thyroid .............................. 23.07 NA NA 9.31 9.88 2.33 090 


cprice-sewell on PROD1PC72 with RULES
66476 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

60271 .... ............ A ........ Removal of thyroid .............................. 17.54 NA NA 7.14 7.86 1.75 090 

60280 .... ............ A ........ Remove thyroid duct lesion ................ 6.05 NA NA 4.47 4.56 0.54 090 

60281 .... ............ A ........ Remove thyroid duct lesion ................ 8.71 NA NA 5.31 5.57 0.73 090 

60300 .... ............ A ........ Aspir/inj thyroid cyst ............................ 0.97 1.94 1.67 0.30 0.31 0.07 000 

60500 .... ............ A ........ Explore parathyroid glands ................. 16.69 NA NA 6.85 7.12 2.01 090 

60502 .... ............ A ........ Re-explore parathyroids ...................... 21.01 NA NA 8.60 8.97 2.54 090 

60505 .... ............ A ........ Explore parathyroid glands ................. 22.91 NA NA 9.38 10.15 2.65 090 

60512 .... ............ A ........ Autotransplant parathyroid .................. 4.44 NA NA 1.21 1.41 0.53 ZZZ 

60520 .... ............ A ........ Removal of thymus gland ................... 17.07 NA NA 7.01 7.64 2.20 090 

60521 .... ............ A ........ Removal of thymus gland ................... 19.11 NA NA 8.12 8.83 2.82 090 

60522 .... ............ A ........ Removal of thymus gland ................... 23.37 NA NA 9.60 10.43 3.27 090 

60540 .... ............ A ........ Explore adrenal gland ......................... 17.91 NA NA 8.24 7.91 1.75 090 

60545 .... ............ A ........ Explore adrenal gland ......................... 20.82 NA NA 8.94 8.73 2.08 090 

60600 .... ............ A ........ Remove carotid body lesion ............... 24.99 NA NA 8.82 9.89 2.20 090 

60605 .... ............ A ........ Remove carotid body lesion ............... 31.86 NA NA 12.13 12.19 2.50 090 

60650 .... ............ A ........ Laparoscopy adrenalectomy ............... 20.63 NA NA 8.08 8.03 2.29 090 

60659 .... ............ C ........ Laparo proc, endocrine ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

60699 .... ............ C ........ Endocrine surgery procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

61000 .... ............ A ........ Remove cranial cavity fluid ................. 1.58 NA NA 1.24 1.09 0.13 000 

61001 .... ............ A ........ Remove cranial cavity fluid ................. 1.49 NA NA 1.08 1.07 0.16 000 

61020 .... ............ A ........ Remove brain cavity fluid ................... 1.51 NA NA 1.63 1.48 0.34 000 

61026 .... ............ A ........ Injection into brain canal ..................... 1.69 NA NA 1.30 1.34 0.33 000 

61050 .... ............ A ........ Remove brain canal fluid .................... 1.51 NA NA 1.15 1.21 0.11 000 

61055 .... ............ A ........ Injection into brain canal ..................... 2.10 NA NA 1.33 1.37 0.17 000 

61070 .... ............ A ........ Brain canal shunt procedure ............... 0.89 NA NA 1.16 1.08 0.17 000 

61105 .... ............ A ........ Twist drill hole ..................................... 5.40 NA NA 4.90 4.41 1.32 090 

61107 .... ............ A ........ Drill skull for implantation .................... 4.99 NA NA 1.83 2.18 1.29 000 

61108 .... ............ A ........ Drill skull for drainage ......................... 11.51 NA NA 8.34 7.74 2.64 090 

61120 .... ............ A ........ Burr hole for puncture ......................... 9.52 NA NA 6.77 6.38 2.10 090 

61140 .... ............ A ........ Pierce skull for biopsy ......................... 17.10 NA NA 10.40 10.14 4.12 090 

61150 .... ............ A ........ Pierce skull for drainage ..................... 18.80 NA NA 10.67 10.52 4.32 090 

61151 .... ............ A ........ Pierce skull for drainage ..................... 13.41 NA NA 8.43 8.12 3.01 090 

61154 .... ............ A ........ Pierce skull & remove clot .................. 16.92 NA NA 10.82 10.15 4.21 090 

61156 .... ............ A ........ Pierce skull for drainage ..................... 17.37 NA NA 9.71 9.77 4.23 090 

61210 .... ............ A ........ Pierce skull, implant device ................ 5.83 NA NA 2.15 2.53 1.50 000 

61215 .... ............ A ........ Insert brain-fluid device ....................... 5.77 NA NA 5.44 4.72 1.26 090 

61250 .... ............ A ........ Pierce skull & explore ......................... 11.41 NA NA 7.37 7.11 2.77 090 

61253 .... ............ A ........ Pierce skull & explore ......................... 13.41 NA NA 7.48 7.60 2.62 090 

61304 .... ............ A ........ Open skull for exploration ................... 23.31 NA NA 12.53 12.68 5.63 090 

61305 .... ............ A ........ Open skull for exploration ................... 28.51 NA NA 14.95 15.13 6.09 090 

61312 .... ............ A ........ Open skull for drainage ...................... 30.07 NA NA 15.22 15.12 6.36 090 

61313 .... ............ A ........ Open skull for drainage ...................... 27.94 NA NA 15.35 15.07 6.45 090 

61314 .... ............ A ........ Open skull for drainage ...................... 25.77 NA NA 14.14 13.58 6.28 090 

61315 .... ............ A ........ Open skull for drainage ...................... 29.52 NA NA 15.49 15.75 7.16 090 

61316 .... ............ A ........ Implt cran bone flap to abdo ............... 1.39 NA NA 0.51 0.55 0.35 ZZZ 

61320 .... ............ A ........ Open skull for drainage ...................... 27.32 NA NA 14.23 14.48 6.62 090 

61321 .... ............ A ........ Open skull for drainage ...................... 30.40 NA NA 16.05 16.08 7.14 090 

61322 .... ............ A ........ Decompressive craniotomy ................. 34.08 NA NA 17.46 16.56 7.63 090 

61323 .... ............ A ........ Decompressive lobectomy .................. 34.93 NA NA 17.29 16.68 8.03 090 

61330 .... ............ A ........ Decompress eye socket ..................... 25.17 NA NA 11.52 12.62 2.32 090 

61332 .... ............ A ........ Explore/biopsy eye socket .................. 28.50 NA NA 12.95 14.27 4.83 090 

61333 .... ............ A ........ Explore orbit/remove lesion ................ 29.17 NA NA 12.87 14.22 3.92 090 

61334 .... ............ A ........ Explore orbit/remove object ................ 19.50 NA NA 9.01 9.81 1.75 090 

61340 .... ............ A ........ Subtemporal decompression .............. 20.01 NA NA 11.67 11.39 4.84 090 

61343 .... ............ A ........ Incise skull (press relief) ..................... 31.73 NA NA 15.92 16.36 7.64 090 

61345 .... ............ A ........ Relieve cranial pressure ..................... 29.10 NA NA 14.84 15.11 7.04 090 

61440 .... ............ A ........ Incise skull for surgery ........................ 28.53 NA NA 15.22 14.70 6.90 090 

61450 .... ............ A ........ Incise skull for surgery ........................ 27.59 NA NA 14.05 14.16 5.79 090 

61458 .... ............ A ........ Incise skull for brain wound ................ 28.71 NA NA 14.87 15.18 7.03 090 

61460 .... ............ A ........ Incise skull for surgery ........................ 30.11 NA NA 14.56 15.48 6.04 090 

61470 .... ............ A ........ Incise skull for surgery ........................ 27.52 NA NA 14.04 13.94 5.90 090 

61480 .... ............ A ........ Incise skull for surgery ........................ 27.95 NA NA 8.13 11.70 6.73 090 

61490 .... ............ A ........ Incise skull for surgery ........................ 27.12 NA NA 14.21 14.26 6.92 090 

61500 .... ............ A ........ Removal of skull lesion ....................... 19.05 NA NA 10.68 10.74 4.11 090 

61501 .... ............ A ........ Remove infected skull bone ............... 16.22 NA NA 9.44 9.32 3.22 090 

61510 .... ............ A ........ Removal of brain lesion ...................... 30.63 NA NA 16.93 16.81 7.35 090 

61512 .... ............ A ........ Remove brain lining lesion ................. 36.99 NA NA 18.44 19.05 9.08 090 

61514 .... ............ A ........ Removal of brain abscess .................. 27.10 NA NA 14.40 14.41 6.54 090 

61516 .... ............ A ........ Removal of brain lesion ...................... 26.45 NA NA 14.04 14.15 6.35 090 

61517 .... ............ A ........ Implt brain chemotx add-on ................ 1.38 NA NA 0.51 0.57 0.35 ZZZ 

61518 .... ............ A ........ Removal of brain lesion ...................... 39.69 NA NA 20.29 20.68 9.65 090 

61519 .... ............ A ........ Remove brain lining lesion ................. 43.28 NA NA 20.63 21.63 10.63 090 


cprice-sewell on PROD1PC72 with RULES
66477 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

61520 .... ............ A ........ Removal of brain lesion ...................... 56.89 NA NA 25.93 28.12 11.21 090 

61521 .... ............ A ........ Removal of brain lesion ...................... 46.84 NA NA 22.14 23.17 11.39 090 

61522 .... ............ A ........ Removal of brain abscess .................. 31.41 NA NA 15.75 16.08 7.62 090 

61524 .... ............ A ........ Removal of brain lesion ...................... 29.76 NA NA 15.68 15.67 7.16 090 

61526 .... ............ A ........ Removal of brain lesion ...................... 53.90 NA NA 22.50 25.98 7.07 090 

61530 .... ............ A ........ Removal of brain lesion ...................... 45.43 NA NA 19.47 22.25 6.15 090 

61531 .... ............ A ........ Implant brain electrodes ..................... 16.28 NA NA 10.45 9.79 3.79 090 

61533 .... ............ A ........ Implant brain electrodes ..................... 21.36 NA NA 11.78 11.65 5.12 090 

61534 .... ............ A ........ Removal of brain lesion ...................... 22.88 NA NA 13.11 12.59 5.44 090 

61535 .... ............ A ........ Remove brain electrodes .................... 13.05 NA NA 8.83 8.12 3.02 090 

61536 .... ............ A ........ Removal of brain lesion ...................... 37.59 NA NA 18.51 19.14 9.21 090 

61537 .... ............ A ........ Removal of brain tissue ...................... 36.35 NA NA 17.02 15.87 6.94 090 

61538 .... ............ A ........ Removal of brain tissue ...................... 39.35 NA NA 18.35 16.82 6.94 090 

61539 .... ............ A ........ Removal of brain tissue ...................... 34.15 NA NA 16.81 17.28 8.32 090 

61540 .... ............ A ........ Removal of brain tissue ...................... 31.30 NA NA 16.28 16.76 8.32 090 

61541 .... ............ A ........ Incision of brain tissue ........................ 30.81 NA NA 16.07 16.13 6.60 090 

61542 .... ............ A ........ Removal of brain tissue ...................... 33.03 NA NA 16.76 17.29 8.03 090 

61543 .... ............ A ........ Removal of brain tissue ...................... 31.18 NA NA 13.84 15.11 7.56 090 

61544 .... ............ A ........ Remove & treat brain lesion ............... 27.26 NA NA 14.26 14.04 5.97 090 

61545 .... ............ A ........ Excision of brain tumor ....................... 46.23 NA NA 22.80 23.50 10.63 090 

61546 .... ............ A ........ Removal of pituitary gland .................. 33.31 NA NA 16.72 17.10 7.67 090 

61548 .... ............ A ........ Removal of pituitary gland .................. 23.27 NA NA 11.60 12.19 3.43 090 

61550 .... ............ A ........ Release of skull seams ....................... 15.44 NA NA 5.65 6.29 0.98 090 

61552 .... ............ A ........ Release of skull seams ....................... 20.27 NA NA 12.14 10.62 1.06 090 

61556 .... ............ A ........ Incise skull/sutures .............................. 24.00 NA NA 13.27 12.31 4.65 090 

61557 .... ............ A ........ Incise skull/sutures .............................. 23.16 NA NA 13.62 13.62 5.80 090 

61558 .... ............ A ........ Excision of skull/sutures ..................... 26.35 NA NA 14.68 14.43 1.36 090 

61559 .... ............ A ........ Excision of skull/sutures ..................... 33.82 NA NA 18.36 18.83 8.51 090 

61563 .... ............ A ........ Excision of skull tumor ........................ 28.35 NA NA 13.07 14.15 5.17 090 

61564 .... ............ A ........ Excision of skull tumor ........................ 34.59 NA NA 17.89 18.08 8.78 090 

61566 .... ............ A ........ Removal of brain tissue ...................... 32.32 NA NA 16.63 17.19 6.94 090 

61567 .... ............ A ........ Incision of brain tissue ........................ 36.84 NA NA 19.05 19.85 6.54 090 

61570 .... ............ A ........ Remove foreign body, brain ............... 26.38 NA NA 14.00 13.95 5.88 090 

61571 .... ............ A ........ Incise skull for brain wound ................ 28.29 NA NA 14.62 14.88 6.79 090 

61575 .... ............ A ........ Skull base/brainstem surgery ............. 36.43 NA NA 16.08 17.85 5.34 090 

61576 .... ............ A ........ Skull base/brainstem surgery ............. 55.11 NA NA 28.06 31.39 5.58 090 

61580 .... ............ A ........ Craniofacial approach, skull ................ 34.34 NA NA 22.82 24.19 3.37 090 

61581 .... ............ A ........ Craniofacial approach, skull ................ 38.88 NA NA 27.80 25.62 3.92 090 

61582 .... ............ A ........ Craniofacial approach, skull ................ 34.93 NA NA 30.44 28.86 7.21 090 

61583 .... ............ A ........ Craniofacial approach, skull ................ 38.41 NA NA 25.86 25.48 9.21 090 

61584 .... ............ A ........ Orbitocranial approach/skull ............... 37.61 NA NA 26.01 25.26 8.18 090 

61585 .... ............ A ........ Orbitocranial approach/skull ............... 42.46 NA NA 25.10 25.79 7.03 090 

61586 .... ............ A ........ Resect nasopharynx, skull .................. 27.28 NA NA 22.61 22.59 4.37 090 

61590 .... ............ A ........ Infratemporal approach/skull ............... 46.87 NA NA 24.78 26.69 5.31 090 

61591 .... ............ A ........ Infratemporal approach/skull ............... 46.87 NA NA 24.57 27.04 5.66 090 

61592 .... ............ A ........ Orbitocranial approach/skull ............... 42.98 NA NA 26.77 26.63 10.07 090 

61595 .... ............ A ........ Transtemporal approach/skull ............. 33.57 NA NA 21.12 21.73 3.98 090 

61596 .... ............ A ........ Transcochlear approach/skull ............. 39.31 NA NA 20.92 22.67 3.40 090 

61597 .... ............ A ........ Transcondylar approach/skull ............. 40.73 NA NA 23.25 23.11 8.84 090 

61598 .... ............ A ........ Transpetrosal approach/skull .............. 36.41 NA NA 22.13 22.68 5.70 090 

61600 .... ............ A ........ Resect/excise cranial lesion ............... 29.84 NA NA 19.74 19.75 3.79 090 

61601 .... ............ A ........ Resect/excise cranial lesion ............... 31.04 NA NA 22.35 21.42 6.63 090 

61605 .... ............ A ........ Resect/excise cranial lesion ............... 32.40 NA NA 19.44 20.69 2.86 090 

61606 .... ............ A ........ Resect/excise cranial lesion ............... 41.94 NA NA 23.74 24.44 8.97 090 

61607 .... ............ A ........ Resect/excise cranial lesion ............... 40.82 NA NA 20.98 22.37 6.90 090 

61608 .... ............ A ........ Resect/excise cranial lesion ............... 45.45 NA NA 26.29 26.43 10.75 090 

61609 .... ............ A ........ Transect artery, sinus ......................... 9.88 NA NA 3.25 4.05 2.56 ZZZ 

61610 .... ............ A ........ Transect artery, sinus ......................... 29.63 NA NA 11.05 12.09 7.68 ZZZ 

61611 .... ............ A ........ Transect artery, sinus ......................... 7.41 NA NA 1.70 2.76 1.89 ZZZ 

61612 .... ............ A ........ Transect artery, sinus ......................... 27.84 NA NA 6.40 9.85 4.31 ZZZ 

61613 .... ............ A ........ Remove aneurysm, sinus ................... 44.94 NA NA 27.32 26.78 8.45 090 

61615 .... ............ A ........ Resect/excise lesion, skull .................. 35.63 NA NA 21.27 21.99 4.73 090 

61616 .... ............ A ........ Resect/excise lesion, skull .................. 46.60 NA NA 27.21 27.92 8.26 090 

61618 .... ............ A ........ Repair dura ......................................... 18.58 NA NA 10.42 10.43 3.72 090 

61619 .... ............ A ........ Repair dura ......................................... 22.01 NA NA 11.66 11.95 3.95 090 

61623 .... ............ A ........ Endovasc tempory vessel occl ........... 9.95 NA NA 3.72 3.90 1.05 000 

61624 .... ............ A ........ Transcath occlusion, cns .................... 20.12 NA NA 7.29 7.09 1.96 000 

61626 .... ............ A ........ Transcath occlusion, non-cns ............. 16.60 NA NA 5.97 5.74 1.24 000 

61630 .... ............ N ........ Intracranial angioplasty ....................... 22.07 NA NA 6.43 9.46 2.02 090 

61635 .... ............ N ........ Intracran angioplsty w/stent ................ 24.28 NA NA 6.94 10.24 2.21 090 

61640 .... ............ N ........ Dilate ic vasospasm, init ..................... 12.32 NA NA 2.83 2.83 0.71 000 

61641 .... ............ N ........ Dilate ic vasospasm add-on ............... 4.33 NA NA 0.99 0.99 0.25 ZZZ 


cprice-sewell on PROD1PC72 with RULES
66478 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

61642 .... ............ N ........ Dilate ic vasospasm add-on ............... 8.66 NA NA 1.99 1.99 0.50 ZZZ 

61680 .... ............ A ........ Intracranial vessel surgery .................. 32.40 NA NA 16.73 17.07 7.95 090 

61682 .... ............ A ........ Intracranial vessel surgery .................. 63.31 NA NA 27.51 29.85 15.90 090 

61684 .... ............ A ........ Intracranial vessel surgery .................. 41.49 NA NA 20.35 21.17 10.31 090 

61686 .... ............ A ........ Intracranial vessel surgery .................. 67.32 NA NA 30.44 32.57 16.71 090 

61690 .... ............ A ........ Intracranial vessel surgery .................. 31.18 NA NA 16.50 16.61 6.94 090 

61692 .... ............ A ........ Intracranial vessel surgery .................. 54.43 NA NA 24.32 25.89 13.43 090 

61697 .... ............ A ........ Brain aneurysm repr, complx .............. 63.22 NA NA 28.60 28.30 12.85 090 

61698 .... ............ A ........ Brain aneurysm repr, complx .............. 69.45 NA NA 30.55 28.62 12.54 090 

61700 .... ............ A ........ Brain aneurysm repr, simple ............... 50.44 NA NA 24.00 25.89 13.02 090 

61702 .... ............ A ........ Inner skull vessel surgery ................... 59.86 NA NA 27.47 26.74 10.79 090 

61703 .... ............ A ........ Clamp neck artery ............................... 18.70 NA NA 10.05 10.25 4.06 090 

61705 .... ............ A ........ Revise circulation to head .................. 37.97 NA NA 18.30 18.77 8.87 090 

61708 .... ............ A ........ Revise circulation to head .................. 37.07 NA NA 14.86 15.00 2.51 090 

61710 .... ............ A ........ Revise circulation to head .................. 31.19 NA NA 13.77 13.70 4.52 090 

61711 .... ............ A ........ Fusion of skull arteries ........................ 38.10 NA NA 18.59 19.19 9.42 090 

61720 .... ............ A ........ Incise skull/brain surgery .................... 17.52 NA NA 7.88 8.92 2.79 090 

61735 .... ............ A ........ Incise skull/brain surgery .................... 22.22 NA NA 9.16 10.66 2.73 090 

61750 .... ............ A ........ Incise skull/brain biopsy ...................... 19.73 NA NA 10.94 10.77 4.72 090 

61751 .... ............ A ........ Brain biopsy w/ct/mr guide ................. 18.64 NA NA 11.35 11.08 4.56 090 

61760 .... ............ A ........ Implant brain electrodes ..................... 22.24 NA NA 12.05 10.38 5.42 090 

61770 .... ............ A ........ Incise skull for treatment ..................... 23.09 NA NA 9.88 11.06 3.55 090 

61790 .... ............ A ........ Treat trigeminal nerve ......................... 11.50 NA NA 7.69 6.80 2.82 090 

61791 .... ............ A ........ Treat trigeminal tract ........................... 15.31 NA NA 8.20 8.56 3.40 090 

61793 .... ............ A ........ Focus radiation beam ......................... 17.75 NA NA 9.54 9.83 4.46 090 

61795 .... ............ A ........ Brain surgery using computer ............. 4.03 NA NA 1.43 1.73 0.79 ZZZ 

61850 .... ............ A ........ Implant neuroelectrodes ..................... 13.26 NA NA 7.88 7.77 3.22 090 

61860 .... ............ A ........ Implant neuroelectrodes ..................... 22.16 NA NA 11.59 11.82 4.95 090 

61863 .... ............ A ........ Implant neuroelectrode ....................... 20.56 NA NA 12.40 12.08 5.43 090 

61864 .... ............ A ........ Implant neuroelectrde, addl ................ 4.49 NA NA 1.67 1.98 5.43 ZZZ 

61867 .... ............ A ........ Implant neuroelectrode ....................... 32.88 NA NA 16.35 17.18 5.43 090 

61868 .... ............ A ........ Implant neuroelectrde, add’l ............... 7.91 NA NA 2.94 3.47 5.43 ZZZ 

61870 .... ............ A ........ Implant neuroelectrodes ..................... 16.24 NA NA 9.68 9.69 3.87 090 

61875 .... ............ A ........ Implant neuroelectrodes ..................... 16.36 NA NA 5.33 6.94 2.95 090 

61880 .... ............ A ........ Revise/remove neuroelectrode ........... 6.87 NA NA 5.17 4.87 1.66 090 

61885 .... ............ A ........ Insrt/redo neurostim 1 array ............... 7.37 NA NA 7.05 6.18 1.59 090 

61886 .... ............ A ........ Implant neurostim arrays .................... 9.73 NA NA 8.51 7.43 1.97 090 

61888 .... ............ A ........ Revise/remove neuroreceiver ............. 5.20 NA NA 3.46 3.57 1.33 010 

62000 .... ............ A ........ Treat skull fracture .............................. 13.83 NA NA 7.61 6.56 1.06 090 

62005 .... ............ A ........ Treat skull fracture .............................. 17.53 NA NA 9.58 9.19 3.87 090 

62010 .... ............ A ........ Treatment of head injury ..................... 21.30 NA NA 11.80 11.75 5.14 090 

62100 .... ............ A ........ Repair brain fluid leakage ................... 23.40 NA NA 12.08 12.43 4.84 090 

62115 .... ............ A ........ Reduction of skull defect .................... 22.71 NA NA 13.87 12.75 5.51 090 

62116 .... ............ A ........ Reduction of skull defect .................... 24.90 NA NA 13.33 13.34 6.11 090 

62117 .... ............ A ........ Reduction of skull defect .................... 28.26 NA NA 12.73 14.04 4.53 090 

62120 .... ............ A ........ Repair skull cavity lesion .................... 24.39 NA NA 17.31 17.89 3.00 090 

62121 .... ............ A ........ Incise skull repair ................................ 22.93 NA NA 14.23 14.83 4.17 090 

62140 .... ............ A ........ Repair of skull defect .......................... 14.45 NA NA 8.63 8.47 3.47 090 

62141 .... ............ A ........ Repair of skull defect .......................... 15.97 NA NA 9.33 9.18 3.76 090 

62142 .... ............ A ........ Remove skull plate/flap ....................... 11.73 NA NA 7.78 7.38 2.73 090 

62143 .... ............ A ........ Replace skull plate/flap ....................... 14.05 NA NA 8.72 8.38 3.37 090 

62145 .... ............ A ........ Repair of skull & brain ........................ 19.99 NA NA 10.25 10.56 4.50 090 

62146 .... ............ A ........ Repair of skull with graft ..................... 17.18 NA NA 9.51 9.57 3.62 090 

62147 .... ............ A ........ Repair of skull with graft ..................... 20.57 NA NA 10.98 11.14 4.32 090 

62148 .... ............ A ........ Retr bone flap to fix skull .................... 2.00 NA NA 0.74 0.80 0.48 ZZZ 

62160 .... ............ A ........ Neuroendoscopy add-on ..................... 3.00 NA NA 1.11 1.32 0.77 ZZZ 

62161 .... ............ A ........ Dissect brain w/scope ......................... 21.10 NA NA 12.14 12.11 5.19 090 

62162 .... ............ A ........ Remove colloid cyst w/scope ............. 26.67 NA NA 14.63 14.73 5.91 090 

62163 .... ............ A ........ Neuroendoscopy w/fb removal ........... 16.40 NA NA 9.24 9.58 4.01 090 

62164 .... ............ A ........ Remove brain tumor w/scope ............. 29.27 NA NA 15.91 15.42 5.38 090 

62165 .... ............ A ........ Remove pituit tumor w/scope ............. 23.10 NA NA 11.76 12.57 3.01 090 

62180 .... ............ A ........ Establish brain cavity shunt ................ 22.45 NA NA 12.36 12.32 4.98 090 

62190 .... ............ A ........ Establish brain cavity shunt ................ 12.07 NA NA 7.36 7.22 2.80 090 

62192 .... ............ A ........ Establish brain cavity shunt ................ 13.25 NA NA 8.01 7.81 3.02 090 

62194 .... ............ A ........ Replace/irrigate catheter ..................... 5.68 NA NA 3.14 2.79 0.92 010 

62200 .... ............ A ........ Establish brain cavity shunt ................ 19.19 NA NA 10.69 10.76 4.65 090 

62201 .... ............ A ........ Brain cavity shunt w/scope ................. 15.89 NA NA 10.34 9.89 3.68 090 

62220 .... ............ A ........ Establish brain cavity shunt ................ 14.00 NA NA 8.61 8.29 3.35 090 

62223 .... ............ A ........ Establish brain cavity shunt ................ 13.90 NA NA 9.35 8.79 3.14 090 

62225 .... ............ A ........ Replace/irrigate catheter ..................... 6.11 NA NA 5.48 4.78 1.39 090 

62230 .... ............ A ........ Replace/revise brain shunt ................. 11.35 NA NA 7.20 6.84 2.71 090 

62252 .... ............ A ........ Csf shunt reprogram ........................... 0.74 1.77 1.62 NA NA 0.21 XXX 


cprice-sewell on PROD1PC72 with RULES
66479 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

62252 .... TC ...... A ........ Csf shunt reprogram ........................... 0.00 1.50 1.30 NA NA 0.02 XXX 

62252 .... 26 ....... A ........ Csf shunt reprogram ........................... 0.74 0.27 0.32 0.27 0.32 0.19 XXX 

62256 .... ............ A ........ Remove brain cavity shunt ................. 7.30 NA NA 5.90 5.29 1.72 090 

62258 .... ............ A ........ Replace brain cavity shunt ................. 15.54 NA NA 9.29 9.00 3.74 090 

62263 .... ............ A ........ Epidural lysis mult sessions ................ 6.41 9.45 11.07 2.97 3.08 0.41 010 

62264 .... ............ A ........ Epidural lysis on single day ................ 4.42 5.62 6.67 1.24 1.33 0.27 010 

62268 .... ............ A ........ Drain spinal cord cyst ......................... 4.73 6.69 9.11 1.80 1.97 0.43 000 

62269 .... ............ A ........ Needle biopsy, spinal cord ................. 5.01 6.25 10.46 1.48 1.73 0.37 000 

62270 .... ............ A ........ Spinal fluid tap, diagnostic .................. 1.37 2.39 2.69 0.57 0.57 0.08 000 

62272 .... ............ A ........ Drain cerebro spinal fluid .................... 1.35 3.13 3.37 0.62 0.66 0.18 000 

62273 .... ............ A ........ Inject epidural patch ............................ 2.15 1.67 2.19 0.57 0.64 0.13 000 

62280 .... ............ A ........ Treat spinal cord lesion ...................... 2.63 4.62 5.77 1.15 1.08 0.30 010 

62281 .... ............ A ........ Treat spinal cord lesion ...................... 2.66 4.07 4.86 1.02 0.96 0.19 010 

62282 .... ............ A ........ Treat spinal canal lesion ..................... 2.33 4.08 6.22 1.11 1.01 0.17 010 

62284 .... ............ A ........ Injection for myelogram ...................... 1.54 3.79 4.37 0.71 0.70 0.13 000 

62287 .... ............ A ........ Percutaneous diskectomy ................... 8.88 NA NA 4.30 4.92 0.58 090 

62290 .... ............ A ........ Inject for spine disk x-ray .................... 3.00 4.50 5.81 1.15 1.26 0.23 000 

62291 .... ............ A ........ Inject for spine disk x-ray .................... 2.91 4.23 5.08 1.08 1.15 0.26 000 

62292 .... ............ A ........ Injection into disk lesion ...................... 9.14 NA NA 2.87 3.67 0.82 090 

62294 .... ............ A ........ Injection into spinal artery ................... 12.77 NA NA 6.49 6.03 1.24 090 

62310 .... ............ A ........ Inject spine c/t ..................................... 1.91 3.00 3.90 0.56 0.60 0.12 000 

62311 .... ............ A ........ Inject spine l/s (cd) .............................. 1.54 2.66 3.79 0.52 0.56 0.09 000 

62318 .... ............ A ........ Inject spine w/cath, c/t ........................ 2.04 3.09 4.40 0.43 0.54 0.12 000 

62319 .... ............ A ........ Inject spine w/cath l/s (cd) .................. 1.87 2.79 3.88 0.44 0.52 0.11 000 

62350 .... ............ A ........ Implant spinal canal cath .................... 8.04 NA NA 3.98 3.96 1.02 090 

62351 .... ............ A ........ Implant spinal canal cath .................... 11.54 NA NA 7.64 7.38 2.25 090 

62355 .... ............ A ........ Remove spinal canal catheter ............ 6.60 NA NA 3.52 3.34 0.71 090 

62360 .... ............ A ........ Insert spine infusion device ................ 3.68 NA NA 3.17 2.92 0.34 090 

62361 .... ............ A ........ Implant spine infusion pump ............... 6.59 NA NA 4.06 3.99 0.80 090 

62362 .... ............ A ........ Implant spine infusion pump ............... 8.58 NA NA 4.65 4.50 1.18 090 

62365 .... ............ A ........ Remove spine infusion device ............ 6.57 NA NA 3.71 3.64 0.86 090 

62367 .... ............ A ........ Analyze spine infusion pump .............. 0.48 0.42 0.52 0.11 0.11 0.03 XXX 

62368 .... ............ A ........ Analyze spine infusion pump .............. 0.75 0.58 0.63 0.17 0.17 0.06 XXX 

63001 .... ............ A ........ Removal of spinal lamina ................... 17.51 NA NA 9.76 9.63 3.77 090 

63003 .... ............ A ........ Removal of spinal lamina ................... 17.64 NA NA 9.72 9.79 3.73 090 

63005 .... ............ A ........ Removal of spinal lamina ................... 16.28 NA NA 9.73 9.85 3.35 090 

63011 .... ............ A ........ Removal of spinal lamina ................... 15.78 NA NA 9.00 8.63 3.38 090 

63012 .... ............ A ........ Removal of spinal lamina ................... 16.72 NA NA 9.75 9.93 3.49 090 

63015 .... ............ A ........ Removal of spinal lamina ................... 20.70 NA NA 11.83 11.85 4.76 090 

63016 .... ............ A ........ Removal of spinal lamina ................... 21.90 NA NA 11.64 11.71 4.59 090 

63017 .... ............ A ........ Removal of spinal lamina ................... 17.18 NA NA 10.34 10.36 3.64 090 

63020 .... ............ A ........ Neck spine disk surgery ..................... 16.05 NA NA 9.87 9.77 3.72 090 

63030 .... ............ A ........ Low back disk surgery ........................ 13.03 NA NA 8.59 8.50 3.01 090 

63035 .... ............ A ........ Spinal disk surgery add-on ................. 3.15 NA NA 1.19 1.39 0.79 ZZZ 

63040 .... ............ A ........ Laminotomy, single cervical ................ 20.18 NA NA 11.01 11.25 4.68 090 

63042 .... ............ A ........ Laminotomy, single lumbar ................. 18.61 NA NA 10.57 10.95 4.26 090 

63043 .... ............ C ........ Laminotomy, add’l cervical ................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

63044 .... ............ C ........ Laminotomy, add’l lumbar ................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

63045 .... ............ A ........ Removal of spinal lamina ................... 17.82 NA NA 10.33 10.34 3.99 090 

63046 .... ............ A ........ Removal of spinal lamina ................... 17.12 NA NA 9.78 9.98 3.56 090 

63047 .... ............ A ........ Removal of spinal lamina ................... 15.22 NA NA 9.32 9.61 3.24 090 

63048 .... ............ A ........ Remove spinal lamina add-on ............ 3.47 NA NA 1.32 1.49 0.72 ZZZ 

63050 .... ............ A ........ Cervical laminoplasty .......................... 21.88 NA NA 11.81 11.82 4.67 090 

63051 .... ............ A ........ C-laminoplasty w/graft/plate ................ 25.38 NA NA 13.07 13.26 4.67 090 

63055 .... ............ A ........ Decompress spinal cord ..................... 23.42 NA NA 12.44 12.78 5.29 090 

63056 .... ............ A ........ Decompress spinal cord ..................... 21.73 NA NA 11.37 11.96 4.76 090 

63057 .... ............ A ........ Decompress spine cord add-on .......... 5.25 NA NA 1.98 2.30 1.22 ZZZ 

63064 .... ............ A ........ Decompress spinal cord ..................... 26.09 NA NA 13.20 13.81 5.71 090 

63066 .... ............ A ........ Decompress spine cord add-on .......... 3.26 NA NA 1.21 1.43 0.69 ZZZ 

63075 .... ............ A ........ Neck spine disk surgery ..................... 19.47 NA NA 11.00 11.54 4.63 090 

63076 .... ............ A ........ Neck spine disk surgery ..................... 4.04 NA NA 1.51 1.78 0.96 ZZZ 

63077 .... ............ A ........ Spine disk surgery, thorax .................. 22.75 NA NA 11.06 11.92 3.99 090 

63078 .... ............ A ........ Spine disk surgery, thorax .................. 3.28 NA NA 1.21 1.42 0.66 ZZZ 

63081 .... ............ A ........ Removal of vertebral body .................. 25.97 NA NA 13.48 13.89 5.56 090 

63082 .... ............ A ........ Remove vertebral body add-on .......... 4.36 NA NA 1.64 1.93 1.02 ZZZ 

63085 .... ............ A ........ Removal of vertebral body .................. 29.34 NA NA 13.52 14.49 4.49 090 

63086 .... ............ A ........ Remove vertebral body add-on .......... 3.19 NA NA 1.17 1.38 0.59 ZZZ 

63087 .... ............ A ........ Removal of vertebral body .................. 37.38 NA NA 16.63 18.03 6.22 090 

63088 .... ............ A ........ Remove vertebral body add-on .......... 4.32 NA NA 1.59 1.88 0.82 ZZZ 

63090 .... ............ A ........ Removal of vertebral body .................. 30.78 NA NA 14.38 15.20 4.22 090 

63091 .... ............ A ........ Remove vertebral body add-on .......... 3.03 NA NA 1.14 1.30 0.48 ZZZ 

63101 .... ............ A ........ Removal of vertebral body .................. 33.92 NA NA 17.02 18.14 5.71 090 


cprice-sewell on PROD1PC72 with RULES
66480 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

63102 .... ............ A ........ Removal of vertebral body .................. 33.92 NA NA 16.81 18.04 5.71 090 

63103 .... ............ A ........ Remove vertebral body add-on .......... 4.82 NA NA 1.74 2.12 0.69 ZZZ 

63170 .... ............ A ........ Incise spinal cord tract(s) .................... 22.08 NA NA 10.43 11.14 4.87 090 

63172 .... ............ A ........ Drainage of spinal cyst ....................... 19.66 NA NA 11.06 10.85 4.49 090 

63173 .... ............ A ........ Drainage of spinal cyst ....................... 24.18 NA NA 13.55 13.17 5.70 090 

63180 .... ............ A ........ Revise spinal cord ligaments .............. 20.40 NA NA 10.93 10.95 3.96 090 

63182 .... ............ A ........ Revise spinal cord ligaments .............. 22.69 NA NA 7.17 9.06 5.32 090 

63185 .... ............ A ........ Incise spinal column/nerves ................ 16.36 NA NA 9.79 8.94 2.80 090 

63190 .... ............ A ........ Incise spinal column/nerves ................ 18.76 NA NA 9.59 9.86 3.25 090 

63191 .... ............ A ........ Incise spinal column/nerves ................ 18.79 NA NA 4.10 7.28 6.36 090 

63194 .... ............ A ........ Incise spinal column & cord ................ 21.97 NA NA 11.18 11.44 3.27 090 

63195 .... ............ A ........ Incise spinal column & cord ................ 21.54 NA NA 12.09 11.56 4.88 090 

63196 .... ............ A ........ Incise spinal column & cord ................ 25.14 NA NA 13.77 13.57 5.78 090 

63197 .... ............ A ........ Incise spinal column & cord ................ 23.95 NA NA 7.46 9.83 5.38 090 

63198 .... ............ A ........ Incise spinal column & cord ................ 29.75 NA NA 8.92 8.67 6.45 090 

63199 .... ............ A ........ Incise spinal column & cord ................ 31.32 NA NA 9.28 12.15 1.40 090 

63200 .... ............ A ........ Release of spinal cord ........................ 21.31 NA NA 12.09 11.68 4.97 090 

63250 .... ............ A ........ Revise spinal cord vessels ................. 43.73 NA NA 20.89 20.40 9.04 090 

63251 .... ............ A ........ Revise spinal cord vessels ................. 44.49 NA NA 21.51 22.04 10.44 090 

63252 .... ............ A ........ Revise spinal cord vessels ................. 44.48 NA NA 20.85 21.53 10.67 090 

63265 .... ............ A ........ Excise intraspinal lesion ..................... 23.69 NA NA 12.98 12.87 5.45 090 

63266 .... ............ A ........ Excise intraspinal lesion ..................... 24.55 NA NA 13.16 13.16 5.56 090 

63267 .... ............ A ........ Excise intraspinal lesion ..................... 19.32 NA NA 11.12 11.09 4.38 090 

63268 .... ............ A ........ Excise intraspinal lesion ..................... 19.89 NA NA 11.24 10.80 3.70 090 

63270 .... ............ A ........ Excise intraspinal lesion ..................... 29.67 NA NA 15.34 15.39 6.84 090 

63271 .... ............ A ........ Excise intraspinal lesion ..................... 29.79 NA NA 15.30 15.43 6.92 090 

63272 .... ............ A ........ Excise intraspinal lesion ..................... 27.37 NA NA 14.28 14.47 6.20 090 

63273 .... ............ A ........ Excise intraspinal lesion ..................... 26.34 NA NA 14.06 14.19 5.76 090 

63275 .... ............ A ........ Biopsy/excise spinal tumor ................. 25.73 NA NA 13.73 13.74 5.82 090 

63276 .... ............ A ........ Biopsy/excise spinal tumor ................. 25.56 NA NA 13.50 13.58 5.85 090 

63277 .... ............ A ........ Biopsy/excise spinal tumor ................. 22.26 NA NA 12.11 12.31 5.03 090 

63278 .... ............ A ........ Biopsy/excise spinal tumor ................. 21.99 NA NA 11.91 12.14 4.56 090 

63280 .... ............ A ........ Biopsy/excise spinal tumor ................. 30.14 NA NA 15.86 16.08 7.29 090 

63281 .... ............ A ........ Biopsy/excise spinal tumor ................. 29.84 NA NA 15.85 16.00 7.19 090 

63282 .... ............ A ........ Biopsy/excise spinal tumor ................. 28.00 NA NA 14.99 15.15 6.78 090 

63283 .... ............ A ........ Biopsy/excise spinal tumor ................. 26.61 NA NA 14.67 14.65 6.28 090 

63285 .... ............ A ........ Biopsy/excise spinal tumor ................. 37.90 NA NA 18.07 19.00 9.21 090 

63286 .... ............ A ........ Biopsy/excise spinal tumor ................. 37.47 NA NA 18.69 19.28 9.24 090 

63287 .... ............ A ........ Biopsy/excise spinal tumor ................. 39.93 NA NA 19.59 20.00 9.42 090 

63290 .... ............ A ........ Biopsy/excise spinal tumor ................. 40.67 NA NA 19.26 19.92 9.05 090 

63295 .... ............ A ........ Repair of laminectomy defect ............. 5.25 NA NA 1.95 2.05 1.03 ZZZ 

63300 .... ............ A ........ Removal of vertebral body .................. 26.67 NA NA 13.78 14.03 5.99 090 

63301 .... ............ A ........ Removal of vertebral body .................. 31.42 NA NA 14.19 14.87 5.41 090 

63302 .... ............ A ........ Removal of vertebral body .................. 31.00 NA NA 13.77 14.80 5.55 090 

63303 .... ............ A ........ Removal of vertebral body .................. 33.42 NA NA 14.98 15.94 4.69 090 

63304 .... ............ A ........ Removal of vertebral body .................. 33.70 NA NA 17.56 17.40 6.43 090 

63305 .... ............ A ........ Removal of vertebral body .................. 36.09 NA NA 16.97 17.50 5.73 090 

63306 .... ............ A ........ Removal of vertebral body .................. 35.40 NA NA 16.63 17.20 8.35 090 

63307 .... ............ A ........ Removal of vertebral body .................. 34.81 NA NA 14.81 15.80 4.47 090 

63308 .... ............ A ........ Remove vertebral body add-on .......... 5.24 NA NA 1.95 2.27 1.29 ZZZ 

63600 .... ............ A ........ Remove spinal cord lesion ................. 15.02 NA NA 4.03 4.71 1.52 090 

63610 .... ............ A ........ Stimulation of spinal cord ................... 8.72 13.93 36.79 1.49 1.87 0.86 000 

63615 .... ............ A ........ Remove lesion of spinal cord ............. 17.22 NA NA 8.51 8.89 2.85 090 

63650 .... ............ A ........ Implant neuroelectrodes ..................... 7.57 NA NA 2.92 3.04 0.53 090 

63655 .... ............ A ........ Implant neuroelectrodes ..................... 11.43 NA NA 7.62 7.25 2.44 090 

63660 .... ............ A ........ Revise/remove neuroelectrode ........... 6.87 NA NA 3.42 3.51 0.78 090 

63685 .... ............ A ........ Insrt/redo spine n generator ............... 7.87 NA NA 3.65 3.89 1.05 090 

63688 .... ............ A ........ Revise/remove neuroreceiver ............. 6.10 NA NA 3.53 3.54 0.89 090 

63700 .... ............ A ........ Repair of spinal herniation .................. 17.32 NA NA 9.94 10.12 3.53 090 

63702 .... ............ A ........ Repair of spinal herniation .................. 19.26 NA NA 9.97 10.49 4.13 090 

63704 .... ............ A ........ Repair of spinal herniation .................. 22.23 NA NA 11.65 12.28 4.58 090 

63706 .... ............ A ........ Repair of spinal herniation .................. 25.15 NA NA 14.29 13.93 6.25 090 

63707 .... ............ A ........ Repair spinal fluid leakage ................. 12.52 NA NA 7.82 7.76 2.52 090 

63709 .... ............ A ........ Repair spinal fluid leakage ................. 15.52 NA NA 8.96 9.17 3.10 090 

63710 .... ............ A ........ Graft repair of spine defect ................. 15.27 NA NA 9.18 9.10 3.41 090 

63740 .... ............ A ........ Install spinal shunt .............................. 12.50 NA NA 8.27 7.80 2.94 090 

63741 .... ............ A ........ Install spinal shunt .............................. 9.02 NA NA 4.93 4.84 1.66 090 

63744 .... ............ A ........ Revision of spinal shunt ...................... 8.86 NA NA 5.75 5.50 1.90 090 

63746 .... ............ A ........ Removal of spinal shunt ..................... 7.25 NA NA 5.68 4.72 1.53 090 

64400 .... ............ A ........ N block inj, trigeminal ......................... 1.11 1.41 1.65 0.44 0.44 0.07 000 

64402 .... ............ A ........ N block inj, facial ................................. 1.25 1.41 1.51 0.49 0.55 0.09 000 

64405 .... ............ A ........ N block inj, occipital ............................ 1.32 1.16 1.31 0.49 0.48 0.08 000 


cprice-sewell on PROD1PC72 with RULES
66481 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

64408 .... ............ A ........ N block inj, vagus ............................... 1.41 1.45 1.51 0.71 0.78 0.10 000 

64410 .... ............ A ........ N block inj, phrenic ............................. 1.43 1.92 2.21 0.56 0.51 0.09 000 

64412 .... ............ A ........ N block inj, spinal accessor ................ 1.18 2.13 2.39 0.58 0.51 0.08 000 

64413 .... ............ A ........ N block inj, cervical plexus ................. 1.40 1.31 1.57 0.48 0.49 0.08 000 

64415 .... ............ A ........ N block inj, brachial plexus ................. 1.48 1.41 2.11 0.30 0.38 0.09 000 

64416 .... ............ A ........ N block cont infuse, b plex ................. 3.85 NA NA 0.46 0.63 0.31 010 

64417 .... ............ A ........ N block inj, axillary .............................. 1.44 1.43 2.23 0.32 0.40 0.11 000 

64418 .... ............ A ........ N block inj, suprascapular .................. 1.32 1.89 2.26 0.52 0.48 0.07 000 

64420 .... ............ A ........ N block inj, intercost, sng ................... 1.18 2.40 3.14 0.44 0.43 0.08 000 

64421 .... ............ A ........ N block inj, intercost, mlt .................... 1.68 3.55 4.81 0.53 0.52 0.11 000 

64425 .... ............ A ........ N block inj, ilio-ing/hypogi ................... 1.75 1.29 1.47 0.53 0.53 0.13 000 

64430 .... ............ A ........ N block inj, pudendal .......................... 1.46 2.39 2.45 0.77 0.66 0.10 000 

64435 .... ............ A ........ N block inj, paracervical ...................... 1.45 1.99 2.26 0.55 0.62 0.16 000 

64445 .... ............ A ........ N block inj, sciatic, sng ....................... 1.48 1.62 2.15 0.50 0.50 0.10 000 

64446 .... ............ A ........ N blk inj, sciatic, cont inf ..................... 3.61 NA NA 0.48 0.74 0.20 010 

64447 .... ............ A ........ N block inj fem, single ........................ 1.50 NA NA 0.17 0.30 0.09 000 

64448 .... ............ A ........ N block inj fem, cont inf ...................... 3.36 NA NA 0.39 0.60 0.18 010 

64449 .... ............ A ........ N block inj, lumbar plexus .................. 3.24 NA NA 0.42 0.69 0.15 010 

64450 .... ............ A ........ N block, other peripheral .................... 1.27 1.27 1.25 0.49 0.48 0.13 000 

64470 .... ............ A ........ Inj paravertebral c/t ............................. 1.85 3.82 5.52 0.70 0.70 0.11 000 

64472 .... ............ A ........ Inj paravertebral c/t add-on ................. 1.29 1.22 1.78 0.33 0.33 0.08 ZZZ 

64475 .... ............ A ........ Inj paravertebral l/s ............................. 1.41 3.64 5.26 0.58 0.60 0.10 000 

64476 .... ............ A ........ Inj paravertebral l/s add-on ................. 0.98 1.10 1.61 0.22 0.23 0.07 ZZZ 

64479 .... ............ A ........ Inj foramen epidural c/t ....................... 2.20 3.75 5.62 0.81 0.85 0.12 000 

64480 .... ............ A ........ Inj foramen epidural add-on ................ 1.54 1.55 2.19 0.39 0.43 0.10 ZZZ 

64483 .... ............ A ........ Inj foramen epidural l/s ....................... 1.90 3.81 5.85 0.75 0.79 0.11 000 

64484 .... ............ A ........ Inj foramen epidural add-on ................ 1.33 1.62 2.45 0.32 0.35 0.08 ZZZ 

64505 .... ............ A ........ N block, spenopalatine gangl ............. 1.36 1.13 1.18 0.74 0.70 0.10 000 

64508 .... ............ A ........ N block, carotid sinus s/p ................... 1.12 2.03 2.68 0.56 0.65 0.07 000 

64510 .... ............ A ........ N block, stellate ganglion .................... 1.22 1.90 2.67 0.43 0.47 0.07 000 

64517 .... ............ A ........ N block inj, hypogas plxs .................... 2.20 1.72 2.22 0.68 0.77 0.11 000 

64520 .... ............ A ........ N block, lumbar/thoracic ..................... 1.35 2.57 3.85 0.51 0.53 0.08 000 

64530 .... ............ A ........ N block inj, celiac pelus ...................... 1.58 2.79 3.62 0.65 0.65 0.10 000 

64550 .... ............ A ........ Apply neurostimulator ......................... 0.18 0.20 0.24 0.05 0.05 0.01 000 

64553 .... ............ A ........ Implant neuroelectrodes ..................... 2.33 2.64 2.74 1.44 1.65 0.18 010 

64555 .... ............ A ........ Implant neuroelectrodes ..................... 2.29 2.78 2.94 1.49 1.34 0.19 010 

64560 .... ............ A ........ Implant neuroelectrodes ..................... 2.38 2.41 2.52 1.26 1.27 0.22 010 

64561 .... ............ A ........ Implant neuroelectrodes ..................... 7.07 19.59 24.81 3.76 3.26 0.51 010 

64565 .... ............ A ........ Implant neuroelectrodes ..................... 1.78 2.47 2.87 1.29 1.27 0.13 010 

64573 .... ............ A ........ Implant neuroelectrodes ..................... 8.15 NA NA 5.16 5.20 1.60 090 

64575 .... ............ A ........ Implant neuroelectrodes ..................... 4.37 NA NA 2.05 2.36 0.61 090 

64577 .... ............ A ........ Implant neuroelectrodes ..................... 4.64 NA NA 4.78 4.03 1.04 090 

64580 .... ............ A ........ Implant neuroelectrodes ..................... 4.14 NA NA 2.70 3.13 0.36 090 

64581 .... ............ A ........ Implant neuroelectrodes ..................... 14.15 NA NA 6.60 5.98 1.05 090 

64585 .... ............ A ........ Revise/remove neuroelectrode ........... 2.08 5.91 8.59 2.28 2.21 0.20 010 

64590 .... ............ A ........ Insrt/redo pn/gastr stimul .................... 2.42 6.40 6.77 2.45 2.37 0.19 010 

64595 .... ............ A ........ Revise/rmv pn/gastr stimul ................. 1.75 6.44 8.41 2.17 2.05 0.19 010 

64600 .... ............ A ........ Injection treatment of nerve ................ 3.46 5.42 7.38 1.63 1.64 0.34 010 

64605 .... ............ A ........ Injection treatment of nerve ................ 5.62 7.21 8.38 2.26 2.22 0.79 010 

64610 .... ............ A ........ Injection treatment of nerve ................ 7.17 9.17 9.01 3.43 3.57 1.58 010 

64612 .... ............ A ........ Destroy nerve, face muscle ................ 1.98 1.58 2.03 1.33 1.32 0.11 010 

64613 .... ............ A ........ Destroy nerve, neck muscle ............... 1.98 1.37 2.15 1.14 1.18 0.11 010 

64614 .... ............ A ........ Destroy nerve, extrem musc ............... 2.20 1.61 2.42 1.30 1.31 0.10 010 

64620 .... ............ A ........ Injection treatment of nerve ................ 2.86 3.30 4.18 1.11 1.22 0.20 010 

64622 .... ............ A ........ Destr paravertebrl nerve l/s ................ 3.02 4.05 5.90 1.25 1.31 0.18 010 

64623 .... ............ A ........ Destr paravertebral n add-on .............. 0.99 1.68 2.32 0.22 0.22 0.06 ZZZ 

64626 .... ............ A ........ Destr paravertebrl nerve c/t ................ 3.82 4.74 6.25 1.87 1.92 0.20 010 

64627 .... ............ A ........ Destr paravertebral n add-on .............. 1.16 2.37 3.45 0.25 0.26 0.07 ZZZ 

64630 .... ............ A ........ Injection treatment of nerve ................ 3.02 2.76 2.75 1.84 1.62 0.22 010 

64640 .... ............ A ........ Injection treatment of nerve ................ 2.78 2.42 3.30 1.42 1.63 0.29 010 

64650 .... ............ A ........ Chemodenerv eccrine glands ............. 0.70 0.72 0.79 0.16 0.23 0.06 000 

64653 .... ............ A ........ Chemodenerv eccrine glands ............. 0.88 0.75 0.83 0.19 0.28 0.08 000 

64680 .... ............ A ........ Injection treatment of nerve ................ 2.64 4.25 5.48 1.20 1.31 0.18 010 

64681 .... ............ A ........ Injection treatment of nerve ................ 3.78 4.81 7.05 1.27 1.67 0.28 010 

64702 .... ............ A ........ Revise finger/toe nerve ....................... 6.10 NA NA 5.19 4.52 0.61 090 

64704 .... ............ A ........ Revise hand/foot nerve ....................... 4.61 NA NA 3.28 3.29 0.61 090 

64708 .... ............ A ........ Revise arm/leg nerve .......................... 6.22 NA NA 4.20 4.53 0.96 090 

64712 .... ............ A ........ Revision of sciatic nerve ..................... 7.98 NA NA 4.37 4.66 0.95 090 

64713 .... ............ A ........ Revision of arm nerve(s) .................... 11.29 NA NA 6.04 5.96 1.83 090 

64714 .... ............ A ........ Revise low back nerve(s) ................... 10.44 NA NA 4.36 4.28 1.19 090 

64716 .... ............ A ........ Revision of cranial nerve .................... 6.86 NA NA 5.45 5.71 0.63 090 

64718 .... ............ A ........ Revise ulnar nerve at elbow ............... 7.06 NA NA 6.20 6.09 1.05 090 


cprice-sewell on PROD1PC72 with RULES
66482 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

64719 .... ............ A ........ Revise ulnar nerve at wrist ................. 4.89 NA NA 4.14 4.33 0.77 090 

64721 .... ............ A ........ Carpal tunnel surgery ......................... 4.84 4.70 5.03 4.65 5.00 0.73 090 

64722 .... ............ A ........ Relieve pressure on nerve(s) ............. 4.74 NA NA 2.99 3.02 0.48 090 

64726 .... ............ A ........ Release foot/toe nerve ........................ 4.21 NA NA 2.80 2.79 0.54 090 

64727 .... ............ A ........ Internal nerve revision ........................ 3.10 NA NA 1.19 1.34 0.48 ZZZ 

64732 .... ............ A ........ Incision of brow nerve ......................... 4.81 NA NA 3.66 3.58 0.98 090 

64734 .... ............ A ........ Incision of cheek nerve ....................... 5.45 NA NA 4.43 4.24 0.89 090 

64736 .... ............ A ........ Incision of chin nerve .......................... 5.13 NA NA 3.72 3.87 0.52 090 

64738 .... ............ A ........ Incision of jaw nerve ........................... 6.26 NA NA 4.64 4.62 1.08 090 

64740 .... ............ A ........ Incision of tongue nerve ..................... 6.12 NA NA 4.98 5.05 0.69 090 

64742 .... ............ A ........ Incision of facial nerve ........................ 6.75 NA NA 4.28 4.49 0.73 090 

64744 .... ............ A ........ Incise nerve, back of head ................. 5.64 NA NA 4.04 3.90 1.16 090 

64746 .... ............ A ........ Incise diaphragm nerve ...................... 6.46 NA NA 3.86 4.18 0.82 090 

64752 .... ............ A ........ Incision of vagus nerve ....................... 7.59 NA NA 3.79 4.03 0.93 090 

64755 .... ............ A ........ Incision of stomach nerves ................. 14.97 NA NA 5.50 5.56 1.84 090 

64760 .... ............ A ........ Incision of vagus nerve ....................... 7.49 NA NA 3.78 3.61 0.81 090 

64761 .... ............ A ........ Incision of pelvis nerve ....................... 6.94 NA NA 4.32 3.92 0.53 090 

64763 .... ............ A ........ Incise hip/thigh nerve .......................... 7.46 NA NA 3.91 4.55 0.94 090 

64766 .... ............ A ........ Incise hip/thigh nerve .......................... 9.34 NA NA 4.73 4.99 1.06 090 

64771 .... ............ A ........ Sever cranial nerve ............................. 8.02 NA NA 5.63 5.59 1.23 090 

64772 .... ............ A ........ Incision of spinal nerve ....................... 7.74 NA NA 5.12 5.01 1.40 090 

64774 .... ............ A ........ Remove skin nerve lesion .................. 5.70 NA NA 4.03 3.93 0.74 090 

64776 .... ............ A ........ Remove digit nerve lesion .................. 5.52 NA NA 3.72 3.70 0.76 090 

64778 .... ............ A ........ Digit nerve surgery add-on ................. 3.11 NA NA 1.21 1.35 0.46 ZZZ 

64782 .... ............ A ........ Remove limb nerve lesion .................. 6.76 NA NA 4.22 3.99 0.86 090 

64783 .... ............ A ........ Limb nerve surgery add-on ................. 3.71 NA NA 1.36 1.60 0.51 ZZZ 

64784 .... ............ A ........ Remove nerve lesion .......................... 10.49 NA NA 6.40 6.49 1.38 090 

64786 .... ............ A ........ Remove sciatic nerve lesion ............... 16.12 NA NA 8.43 9.13 2.61 090 

64787 .... ............ A ........ Implant nerve end ............................... 4.29 NA NA 1.64 1.88 0.58 ZZZ 

64788 .... ............ A ........ Remove skin nerve lesion .................. 5.14 NA NA 4.05 3.76 0.73 090 

64790 .... ............ A ........ Removal of nerve lesion ..................... 11.97 NA NA 6.97 7.08 2.11 090 

64792 .... ............ A ........ Removal of nerve lesion ..................... 15.71 NA NA 8.29 8.56 2.49 090 

64795 .... ............ A ........ Biopsy of nerve ................................... 3.01 NA NA 1.43 1.49 0.52 000 

64802 .... ............ A ........ Remove sympathetic nerves .............. 10.24 NA NA 3.50 4.31 1.29 090 

64804 .... ............ A ........ Remove sympathetic nerves .............. 15.78 NA NA 5.96 6.56 2.15 090 

64809 .... ............ A ........ Remove sympathetic nerves .............. 14.61 NA NA 7.03 6.39 1.50 090 

64818 .... ............ A ........ Remove sympathetic nerves .............. 11.24 NA NA 4.32 4.80 1.33 090 

64820 .... ............ A ........ Remove sympathetic nerves .............. 10.64 NA NA 6.93 7.02 1.49 090 

64821 .... ............ A ........ Remove sympathetic nerves .............. 9.19 NA NA 6.53 6.93 1.24 090 

64822 .... ............ A ........ Remove sympathetic nerves .............. 9.19 NA NA 6.42 6.82 1.30 090 

64823 .... ............ A ........ Remove sympathetic nerves .............. 10.80 NA NA 6.46 7.29 1.57 090 

64831 .... ............ A ........ Repair of digit nerve ........................... 10.23 NA NA 6.61 6.84 1.41 090 

64832 .... ............ A ........ Repair nerve add-on ........................... 5.65 NA NA 2.31 2.62 0.85 ZZZ 

64834 .... ............ A ........ Repair of hand or foot nerve .............. 10.71 NA NA 6.44 6.76 1.54 090 

64835 .... ............ A ........ Repair of hand or foot nerve .............. 11.60 NA NA 6.90 7.29 1.74 090 

64836 .... ............ A ........ Repair of hand or foot nerve .............. 11.60 NA NA 7.06 7.36 1.68 090 

64837 .... ............ A ........ Repair nerve add-on ........................... 6.25 NA NA 2.57 2.90 0.97 ZZZ 

64840 .... ............ A ........ Repair of leg nerve ............................. 13.87 NA NA 7.51 7.88 1.37 090 

64856 .... ............ A ........ Repair/transpose nerve ....................... 14.94 NA NA 8.47 8.83 2.13 090 

64857 .... ............ A ........ Repair arm/leg nerve .......................... 15.69 NA NA 8.75 9.19 2.22 090 

64858 .... ............ A ........ Repair sciatic nerve ............................ 17.69 NA NA 9.55 10.16 3.34 090 

64859 .... ............ A ........ Nerve surgery ..................................... 4.25 NA NA 1.75 1.97 0.67 ZZZ 

64861 .... ............ A ........ Repair of arm nerves .......................... 20.74 NA NA 10.00 10.88 4.09 090 

64862 .... ............ A ........ Repair of low back nerves .................. 20.94 NA NA 10.12 11.02 4.32 090 

64864 .... ............ A ........ Repair of facial nerve .......................... 13.31 NA NA 7.46 8.11 1.26 090 

64865 .... ............ A ........ Repair of facial nerve .......................... 15.96 NA NA 11.52 12.52 1.50 090 

64866 .... ............ A ........ Fusion of facial/other nerve ................ 16.70 NA NA 11.09 12.13 2.05 090 

64868 .... ............ A ........ Fusion of facial/other nerve ................ 14.80 NA NA 9.78 10.60 1.43 090 

64870 .... ............ A ........ Fusion of facial/other nerve ................ 16.95 NA NA 8.05 8.39 1.30 090 

64872 .... ............ A ........ Subsequent repair of nerve ................ 1.99 NA NA 0.78 0.93 0.29 ZZZ 

64874 .... ............ A ........ Repair & revise nerve add-on ............. 2.98 NA NA 1.26 1.39 0.42 ZZZ 

64876 .... ............ A ........ Repair nerve/shorten bone ................. 3.37 NA NA 1.42 1.58 0.47 ZZZ 

64885 .... ............ A ........ Nerve graft, head or neck ................... 17.50 NA NA 8.94 10.26 1.63 090 

64886 .... ............ A ........ Nerve graft, head or neck ................... 20.72 NA NA 10.36 11.95 2.09 090 

64890 .... ............ A ........ Nerve graft, hand or foot .................... 16.11 NA NA 8.97 9.48 2.30 090 

64891 .... ............ A ........ Nerve graft, hand or foot .................... 17.22 NA NA 9.65 8.61 1.63 090 

64892 .... ............ A ........ Nerve graft, arm or leg ....................... 15.61 NA NA 9.12 8.99 2.48 090 

64893 .... ............ A ........ Nerve graft, arm or leg ....................... 16.74 NA NA 9.62 9.74 2.62 090 

64895 .... ............ A ........ Nerve graft, hand or foot .................... 20.26 NA NA 11.03 10.34 2.58 090 

64896 .... ............ A ........ Nerve graft, hand or foot .................... 21.81 NA NA 11.65 11.31 3.17 090 

64897 .... ............ A ........ Nerve graft, arm or leg ....................... 19.25 NA NA 10.49 10.58 2.55 090 

64898 .... ............ A ........ Nerve graft, arm or leg ....................... 20.82 NA NA 11.45 11.61 2.78 090 


cprice-sewell on PROD1PC72 with RULES
66483 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

64901 .... ............ A ........ Nerve graft add-on .............................. 10.20 NA NA 3.62 4.44 1.37 ZZZ 

64902 .... ............ A ........ Nerve graft add-on .............................. 11.81 NA NA 4.65 5.31 1.55 ZZZ 

64905 .... ............ A ........ Nerve pedicle transfer ......................... 14.98 NA NA 6.99 7.74 2.01 090 

64907 .... ............ A ........ Nerve pedicle transfer ......................... 19.90 NA NA 6.35 9.43 3.17 090 

64910 .... ............ A ........ Nerve repair w/allograft ....................... 11.21 NA NA 4.66 4.66 1.74 090 

64911 .... ............ A ........ Neurorraphy w/vein autograft ............. 14.21 NA NA 5.31 5.31 1.91 090 

64999 .... ............ C ........ Nervous system surgery ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

65091 .... ............ A ........ Revise eye .......................................... 7.13 NA NA 6.72 7.53 0.32 090 

65093 .... ............ A ........ Revise eye with implant ...................... 6.93 NA NA 6.78 7.75 0.34 090 

65101 .... ............ A ........ Removal of eye ................................... 8.10 NA NA 7.95 8.74 0.35 090 

65103 .... ............ A ........ Remove eye/insert implant ................. 8.64 NA NA 8.11 8.92 0.37 090 

65105 .... ............ A ........ Remove eye/attach implant ................ 9.70 NA NA 8.76 9.61 0.42 090 

65110 .... ............ A ........ Removal of eye ................................... 15.42 NA NA 11.41 12.54 0.81 090 

65112 .... ............ A ........ Remove eye/revise socket .................. 18.18 NA NA 13.29 14.71 1.30 090 

65114 .... ............ A ........ Remove eye/revise socket .................. 19.32 NA NA 13.55 14.94 1.02 090 

65125 .... ............ A ........ Revise ocular implant ......................... 3.18 6.70 7.75 3.16 3.38 0.19 090 

65130 .... ............ A ........ Insert ocular implant ........................... 8.22 NA NA 7.67 8.41 0.35 090 

65135 .... ............ A ........ Insert ocular implant ........................... 8.40 NA NA 7.73 8.52 0.36 090 

65140 .... ............ A ........ Attach ocular implant .......................... 9.23 NA NA 8.37 9.12 0.40 090 

65150 .... ............ A ........ Revise ocular implant ......................... 6.32 NA NA 6.29 7.12 0.31 090 

65155 .... ............ A ........ Reinsert ocular implant ....................... 9.87 NA NA 8.76 9.62 0.50 090 

65175 .... ............ A ........ Removal of ocular implant .................. 7.22 NA NA 7.04 7.75 0.31 090 

65205 .... ............ A ........ Remove foreign body from eye .......... 0.71 0.57 0.60 0.32 0.30 0.03 000 

65210 .... ............ A ........ Remove foreign body from eye .......... 0.84 0.71 0.76 0.39 0.38 0.04 000 

65220 .... ............ A ........ Remove foreign body from eye .......... 0.71 0.59 0.62 0.28 0.28 0.05 000 

65222 .... ............ A ........ Remove foreign body from eye .......... 0.93 0.78 0.83 0.41 0.39 0.04 000 

65235 .... ............ A ........ Remove foreign body from eye .......... 8.78 NA NA 6.77 6.76 0.37 090 

65260 .... ............ A ........ Remove foreign body from eye .......... 12.29 NA NA 8.73 9.19 0.57 090 

65265 .... ............ A ........ Remove foreign body from eye .......... 14.06 NA NA 9.58 10.10 0.62 090 

65270 .... ............ A ........ Repair of eye wound ........................... 1.92 3.82 4.52 1.20 1.29 0.09 010 

65272 .... ............ A ........ Repair of eye wound ........................... 4.49 6.29 7.00 3.15 3.22 0.19 090 

65273 .... ............ A ........ Repair of eye wound ........................... 5.03 NA NA 3.36 3.47 0.22 090 

65275 .... ............ A ........ Repair of eye wound ........................... 6.14 6.29 6.30 3.89 3.92 0.26 090 

65280 .... ............ A ........ Repair of eye wound ........................... 8.87 NA NA 5.83 6.03 0.38 090 

65285 .... ............ A ........ Repair of eye wound ........................... 14.43 NA NA 8.38 8.79 0.64 090 

65286 .... ............ A ........ Repair of eye wound ........................... 6.45 8.69 9.91 4.38 4.49 0.27 090 

65290 .... ............ A ........ Repair of eye socket wound ............... 6.35 NA NA 4.43 4.58 0.31 090 

65400 .... ............ A ........ Removal of eye lesion ........................ 7.27 7.43 7.88 5.83 5.98 0.30 090 

65410 .... ............ A ........ Biopsy of cornea ................................. 1.47 1.66 1.89 0.86 0.91 0.07 000 

65420 .... ............ A ........ Removal of eye lesion ........................ 4.24 6.84 7.85 3.95 4.19 0.21 090 

65426 .... ............ A ........ Removal of eye lesion ........................ 5.93 8.08 9.12 4.49 4.70 0.25 090 

65430 .... ............ A ........ Corneal smear .................................... 1.47 1.08 1.18 0.86 0.92 0.07 000 

65435 .... ............ A ........ Curette/treat cornea ............................ 0.92 0.85 0.93 0.64 0.68 0.04 000 

65436 .... ............ A ........ Curette/treat cornea ............................ 4.72 3.75 3.92 3.43 3.55 0.21 090 

65450 .... ............ A ........ Treatment of corneal lesion ................ 3.35 3.67 3.87 3.59 3.76 0.16 090 

65600 .... ............ A ........ Revision of cornea .............................. 4.07 4.42 4.71 3.38 3.36 0.17 090 

65710 .... ............ A ........ Corneal transplant ............................... 14.09 NA NA 10.13 10.66 0.61 090 

65730 .... ............ A ........ Corneal transplant ............................... 15.99 NA NA 10.94 11.48 0.70 090 

65750 .... ............ A ........ Corneal transplant ............................... 16.60 NA NA 10.60 11.28 0.74 090 

65755 .... ............ A ........ Corneal transplant ............................... 16.49 NA NA 10.56 11.22 0.73 090 

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 transplant .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

65770 .... ............ A ........ Revise cornea with implant ................. 19.41 NA NA 11.64 12.42 0.87 090 

65771 .... ............ N ........ Radial keratotomy ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

65772 .... ............ A ........ Correction of astigmatism ................... 4.96 4.84 5.18 3.91 4.02 0.21 090 

65775 .... ............ A ........ Correction of astigmatism ................... 6.73 NA NA 5.29 5.62 0.28 090 

65780 .... ............ A ........ Ocular reconst, transplant ................... 10.43 NA NA 8.91 9.60 0.44 090 

65781 .... ............ A ........ Ocular reconst, transplant ................... 17.84 NA NA 11.56 12.61 0.44 090 

65782 .... ............ A ........ Ocular reconst, transplant ................... 15.16 NA NA 10.17 11.08 0.44 090 

65800 .... ............ A ........ Drainage of eye .................................. 1.91 1.39 1.59 1.02 1.10 0.09 000 

65805 .... ............ A ........ Drainage of eye .................................. 1.91 1.69 1.93 1.02 1.10 0.09 000 

65810 .... ............ A ........ Drainage of eye .................................. 5.67 NA NA 4.66 4.68 0.24 090 

65815 .... ............ A ........ Drainage of eye .................................. 5.85 7.90 8.95 4.57 4.69 0.25 090 

65820 .... ............ A ........ Relieve inner eye pressure ................. 8.72 NA NA 7.49 8.27 0.40 090 

65850 .... ............ A ........ Incision of eye ..................................... 11.24 NA NA 7.31 7.87 0.52 090 

65855 .... ............ A ........ Laser surgery of eye ........................... 3.90 3.48 3.89 2.62 2.86 0.19 010 

65860 .... ............ A ........ Incise inner eye adhesions ................. 3.56 3.25 3.64 2.07 2.29 0.18 090 

65865 .... ............ A ........ Incise inner eye adhesions ................. 5.66 NA NA 4.68 5.15 0.28 090 

65870 .... ............ A ........ Incise inner eye adhesions ................. 7.21 NA NA 5.69 6.05 0.31 090 

65875 .... ............ A ........ Incise inner eye adhesions ................. 7.61 NA NA 6.12 6.45 0.32 090 

65880 .... ............ A ........ Incise inner eye adhesions ................. 8.16 NA NA 6.29 6.66 0.35 090 


cprice-sewell on PROD1PC72 with RULES
66484 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

65900 .... ............ A ........ Remove eye lesion ............................. 12.26 NA NA 8.88 9.56 0.54 090 

65920 .... ............ A ........ Remove implant of eye ....................... 9.74 NA NA 7.45 7.81 0.41 090 

65930 .... ............ A ........ Remove blood clot from eye ............... 8.24 NA NA 5.76 6.30 0.37 090 

66020 .... ............ A ........ Injection treatment of eye ................... 1.61 2.42 2.77 1.27 1.35 0.08 010 

66030 .... ............ A ........ Injection treatment of eye ................... 1.27 2.29 2.63 1.15 1.21 0.06 010 

66130 .... ............ A ........ Remove eye lesion ............................. 7.74 7.50 8.56 4.86 5.23 0.38 090 

66150 .... ............ A ........ Glaucoma surgery ............................... 10.18 NA NA 8.80 9.10 0.46 090 

66155 .... ............ A ........ Glaucoma surgery ............................... 10.17 NA NA 8.80 9.07 0.41 090 

66160 .... ............ A ........ Glaucoma surgery ............................... 12.04 NA NA 9.46 9.82 0.50 090 

66165 .... ............ A ........ Glaucoma surgery ............................... 9.89 NA NA 8.76 9.00 0.40 090 

66170 .... ............ A ........ Glaucoma surgery ............................... 14.57 NA NA 11.52 11.87 0.60 090 

66172 .... ............ A ........ Incision of eye ..................................... 18.26 NA NA 14.61 14.90 0.74 090 

66180 .... ............ A ........ Implant eye shunt ............................... 16.02 NA NA 9.68 10.21 0.71 090 

66185 .... ............ A ........ Revise eye shunt ................................ 9.35 NA NA 7.03 7.20 0.40 090 

66220 .... ............ A ........ Repair eye lesion ................................ 8.98 NA NA 7.16 7.13 0.40 090 

66225 .... ............ A ........ Repair/graft eye lesion ........................ 12.38 NA NA 8.10 8.42 0.55 090 

66250 .... ............ A ........ Follow-up surgery of eye .................... 6.92 9.22 10.45 5.24 5.36 0.30 090 

66500 .... ............ A ........ Incision of iris ...................................... 3.75 NA NA 3.94 4.29 0.18 090 

66505 .... ............ A ........ Incision of iris ...................................... 4.13 NA NA 4.30 4.64 0.20 090 

66600 .... ............ A ........ Remove iris and lesion ....................... 9.89 NA NA 8.24 8.23 0.43 090 

66605 .... ............ A ........ Removal of iris .................................... 13.99 NA NA 9.44 9.73 0.77 090 

66625 .... ............ A ........ Removal of iris .................................... 5.19 NA NA 4.20 4.46 0.26 090 

66630 .... ............ A ........ Removal of iris .................................... 7.10 NA NA 5.33 5.52 0.31 090 

66635 .... ............ A ........ Removal of iris .................................... 7.19 NA NA 5.36 5.55 0.31 090 

66680 .... ............ A ........ Repair iris & ciliary body ..................... 6.24 NA NA 5.05 5.16 0.27 090 

66682 .... ............ A ........ Repair iris & ciliary body ..................... 7.15 NA NA 6.70 6.65 0.31 090 

66700 .... ............ A ........ Destruction, ciliary body ...................... 5.06 4.77 5.01 3.58 3.76 0.24 090 

66710 .... ............ A ........ Ciliary transsleral therapy ................... 5.06 4.59 4.88 3.59 3.72 0.23 090 

66711 .... ............ A ........ Ciliary endoscopic ablation ................. 7.70 NA NA 6.28 6.37 0.30 090 

66720 .... ............ A ........ Destruction, ciliary body ...................... 4.86 5.36 5.58 4.31 4.51 0.26 090 

66740 .... ............ A ........ Destruction, ciliary body ...................... 5.06 4.52 4.80 3.60 3.78 0.23 090 

66761 .... ............ A ........ Revision of iris .................................... 4.87 5.01 5.30 4.18 4.24 0.20 090 

66762 .... ............ A ........ Revision of iris .................................... 5.25 5.09 5.37 4.06 4.17 0.23 090 

66770 .... ............ A ........ Removal of inner eye lesion ............... 5.98 5.52 5.80 4.58 4.69 0.26 090 

66820 .... ............ A ........ Incision, secondary cataract ............... 3.93 NA NA 4.61 5.21 0.19 090 

66821 .... ............ A ........ After cataract laser surgery ................ 3.32 3.82 3.95 3.41 3.51 0.11 090 

66825 .... ............ A ........ Reposition intraocular lens ................. 8.82 NA NA 7.76 8.41 0.40 090 

66830 .... ............ A ........ Removal of lens lesion ....................... 9.27 NA NA 6.36 6.65 0.36 090 

66840 .... ............ A ........ Removal of lens material .................... 8.98 NA NA 6.28 6.57 0.39 090 

66850 .... ............ A ........ Removal of lens material .................... 10.32 NA NA 7.06 7.35 0.45 090 

66852 .... ............ A ........ Removal of lens material .................... 11.18 NA NA 7.38 7.73 0.49 090 

66920 .... ............ A ........ Extraction of lens ................................ 9.93 NA NA 6.63 6.96 0.44 090 

66930 .... ............ A ........ Extraction of lens ................................ 11.38 NA NA 7.44 7.79 0.49 090 

66940 .... ............ A ........ Extraction of lens ................................ 10.14 NA NA 6.99 7.29 0.43 090 

66982 .... ............ A ........ Cataract surgery, complex .................. 14.83 NA NA 8.94 9.40 0.63 090 

66983 .... ............ A ........ Cataract surg w/iol, 1 stage ................ 10.20 NA NA 6.50 6.31 0.14 090 

66984 .... ............ A ........ Cataract surg w/iol, 1 stage ................ 10.36 NA NA 6.44 6.93 0.39 090 

66985 .... ............ A ........ Insert lens prosthesis .......................... 9.73 NA NA 7.12 7.28 0.36 090 

66986 .... ............ A ........ Exchange lens prosthesis ................... 12.26 NA NA 8.04 8.61 0.60 090 

66990 .... ............ A ........ Ophthalmic endoscope add-on ........... 1.51 NA NA 0.54 0.61 0.07 ZZZ 

66999 .... ............ C ........ Eye surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

67005 .... ............ A ........ Partial removal of eye fluid ................. 5.77 NA NA 4.57 4.71 0.28 090 

67010 .... ............ A ........ Partial removal of eye fluid ................. 6.94 NA NA 4.99 5.20 0.34 090 

67015 .... ............ A ........ Release of eye fluid ............................ 7.00 NA NA 5.69 6.07 0.34 090 

67025 .... ............ A ........ Replace eye fluid ................................ 7.91 7.85 8.53 5.91 6.06 0.34 090 

67027 .... ............ A ........ Implant eye drug system .................... 11.43 NA NA 7.36 7.67 0.54 090 

67028 .... ............ A ........ Injection eye drug ............................... 2.52 2.15 2.42 1.24 1.35 0.12 000 

67030 .... ............ A ........ Incise inner eye strands ...................... 5.91 NA NA 5.59 5.72 0.24 090 

67031 .... ............ A ........ Laser surgery, eye strands ................. 4.34 4.09 4.34 3.42 3.53 0.18 090 

67036 .... ............ A ........ Removal of inner eye fluid .................. 13.09 NA NA 8.05 8.58 0.58 090 

67039 .... ............ A ........ Laser treatment of retina .................... 16.39 NA NA 10.68 11.43 0.71 090 

67040 .... ............ A ........ Laser treatment of retina .................... 19.23 NA NA 11.98 12.83 0.85 090 

67041 .... ............ A ........ Vit for macular pucker ......................... 19.00 NA NA 10.36 10.36 0.86 090 

67042 .... ............ A ........ Vit for macular hole ............................. 22.13 NA NA 11.48 11.48 1.00 090 

67043 .... ............ A ........ Vit for membrane dissect .................... 22.94 NA NA 12.34 12.34 1.04 090 

67101 .... ............ A ........ Repair detached retina ....................... 8.60 8.48 8.80 6.16 6.34 0.37 090 

67105 .... ............ A ........ Repair detached retina ....................... 8.35 7.40 7.74 5.78 5.96 0.37 090 

67107 .... ............ A ........ Repair detached retina ....................... 16.35 NA NA 10.33 10.81 0.73 090 

67108 .... ............ A ........ Repair detached retina ....................... 22.49 NA NA 12.92 13.66 1.02 090 

67110 .... ............ A ........ Repair detached retina ....................... 10.02 8.91 9.57 6.95 7.17 0.44 090 

67112 .... ............ A ........ Rerepair detached retina .................... 18.45 NA NA 10.84 11.32 0.83 090 

67113 .... ............ A ........ Repair retinal detach, cplx .................. 22.49 NA NA 12.75 12.75 1.13 090 


cprice-sewell on PROD1PC72 with RULES
66485 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

67115 .... ............ A ........ Release encircling material ................. 5.93 NA NA 4.92 5.00 0.25 090 

67120 .... ............ A ........ Remove eye implant material ............. 6.92 7.34 7.96 5.27 5.40 0.29 090 

67121 .... ............ A ........ Remove eye implant material ............. 12.00 NA NA 7.94 8.23 0.53 090 

67141 .... ............ A ........ Treatment of retina ............................. 6.00 5.40 5.63 4.65 4.75 0.26 090 

67145 .... ............ A ........ Treatment of retina ............................. 6.17 5.33 5.53 4.70 4.81 0.27 090 

67208 .... ............ A ........ Treatment of retinal lesion .................. 7.50 5.64 5.88 5.19 5.35 0.33 090 

67210 .... ............ A ........ Treatment of retinal lesion .................. 9.35 5.91 6.24 5.43 5.65 0.44 090 

67218 .... ............ A ........ Treatment of retinal lesion .................. 20.22 NA NA 10.60 11.37 0.92 090 

67220 .... ............ A ........ Treatment of choroid lesion ................ 14.19 9.20 9.81 8.15 8.58 0.65 090 

67221 .... ............ R ........ Ocular photodynamic ther ................... 3.45 2.91 3.62 1.38 1.59 0.20 000 

67225 .... ............ A ........ Eye photodynamic ther add-on ........... 0.47 0.22 0.24 0.17 0.19 0.02 ZZZ 

67227 .... ............ A ........ Treatment of retinal lesion .................. 7.38 5.99 6.28 5.15 5.34 0.33 090 

67228 .... ............ A ........ Treatment of retinal lesion .................. 13.67 13.58 12.52 10.18 9.36 0.63 090 

67229 .... ............ A ........ Tr retinal les preterm inf ..................... 16.00 NA NA 9.51 9.51 0.71 090 

67250 .... ............ A ........ Reinforce eye wall .............................. 9.46 NA NA 7.66 8.41 0.47 090 

67255 .... ............ A ........ Reinforce/graft eye wall ...................... 9.97 NA NA 8.42 9.15 0.44 090 

67299 .... ............ C ........ Eye surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

67311 .... ............ A ........ Revise eye muscle .............................. 7.59 NA NA 5.49 5.76 0.37 090 

67312 .... ............ A ........ Revise two eye muscles ..................... 9.48 NA NA 6.19 6.47 0.43 090 

67314 .... ............ A ........ Revise eye muscle .............................. 8.59 NA NA 6.15 6.35 0.39 090 

67316 .... ............ A ........ Revise two eye muscles ..................... 10.73 NA NA 6.91 7.20 0.49 090 

67318 .... ............ A ........ Revise eye muscle(s) ......................... 8.92 NA NA 6.50 6.71 0.41 090 

67320 .... ............ A ........ Revise eye muscle(s) add-on ............. 5.40 NA NA 1.92 1.94 0.22 ZZZ 

67331 .... ............ A ........ Eye surgery follow-up add-on ............. 5.13 NA NA 1.81 1.82 0.21 ZZZ 

67332 .... ............ A ........ Rerevise eye muscles add-on ............ 5.56 NA NA 1.97 2.00 0.23 ZZZ 

67334 .... ............ A ........ Revise eye muscle w/suture ............... 5.05 NA NA 1.80 1.80 0.20 ZZZ 

67335 .... ............ A ........ Eye suture during surgery .................. 2.49 NA NA 0.88 1.00 0.13 ZZZ 

67340 .... ............ A ........ Revise eye muscle add-on ................. 6.00 NA NA 2.13 2.17 0.25 ZZZ 

67343 .... ............ A ........ Release eye tissue ............................. 8.29 NA NA 6.06 6.28 0.37 090 

67345 .... ............ A ........ Destroy nerve of eye muscle .............. 2.98 2.17 2.38 1.69 1.85 0.17 010 

67346 .... ............ A ........ Biopsy, eye muscle ............................. 2.87 NA NA 1.62 1.75 0.15 000 

67399 .... ............ C ........ Eye muscle surgery procedure ........... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

67400 .... ............ A ........ Explore/biopsy eye socket .................. 10.97 NA NA 9.41 10.33 0.56 090 

67405 .... ............ A ........ Explore/drain eye socket .................... 9.00 NA NA 8.33 9.05 0.44 090 

67412 .... ............ A ........ Explore/treat eye socket ..................... 10.17 NA NA 8.52 9.72 0.48 090 

67413 .... ............ A ........ Explore/treat eye socket ..................... 10.09 NA NA 8.69 9.73 0.50 090 

67414 .... ............ A ........ Explr/decompress eye socket ............. 17.78 NA NA 11.62 11.83 0.65 090 

67415 .... ............ A ........ Aspiration, orbital contents ................. 1.76 NA NA 0.62 0.69 0.09 000 

67420 .... ............ A ........ Explore/treat eye socket ..................... 21.62 NA NA 14.22 15.80 1.15 090 

67430 .... ............ A ........ Explore/treat eye socket ..................... 14.99 NA NA 11.86 13.37 0.86 090 

67440 .... ............ A ........ Explore/drain eye socket .................... 14.56 NA NA 11.86 13.06 0.70 090 

67445 .... ............ A ........ Explr/decompress eye socket ............. 18.96 NA NA 12.13 13.02 0.90 090 

67450 .... ............ A ........ Explore/biopsy eye socket .................. 15.11 NA NA 12.29 13.48 0.68 090 

67500 .... ............ A ........ Inject/treat eye socket ......................... 1.44 0.57 0.62 0.44 0.37 0.05 000 

67505 .... ............ A ........ Inject/treat eye socket ......................... 1.27 0.65 0.67 0.50 0.41 0.05 000 

67515 .... ............ A ........ Inject/treat eye socket ......................... 1.40 0.77 0.68 0.61 0.49 0.03 000 

67550 .... ............ A ........ Insert eye socket implant .................... 11.52 NA NA 9.81 10.55 0.72 090 

67560 .... ............ A ........ Revise eye socket implant .................. 11.93 NA NA 9.77 10.57 0.60 090 

67570 .... ............ A ........ Decompress optic nerve ..................... 14.21 NA NA 11.00 12.28 0.68 090 

67599 .... ............ C ........ Orbit surgery procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

67700 .... ............ A ........ Drainage of eyelid abscess ................ 1.37 4.30 5.16 1.17 1.22 0.07 010 

67710 .... ............ A ........ Incision of eyelid ................................. 1.04 3.70 4.53 1.07 1.14 0.05 010 

67715 .... ............ A ........ Incision of eyelid fold .......................... 1.24 3.83 4.60 1.15 1.22 0.06 010 

67800 .... ............ A ........ Remove eyelid lesion .......................... 1.39 1.39 1.50 0.90 0.97 0.07 010 

67801 .... ............ A ........ Remove eyelid lesions ........................ 1.89 1.67 1.82 1.07 1.17 0.09 010 

67805 .... ............ A ........ Remove eyelid lesions ........................ 2.24 2.18 2.35 1.40 1.52 0.11 010 

67808 .... ............ A ........ Remove eyelid lesion(s) ..................... 4.47 NA NA 3.60 3.69 0.19 090 

67810 .... ............ A ........ Biopsy of eyelid ................................... 1.48 3.93 3.63 0.68 0.68 0.06 000 

67820 .... ............ A ........ Revise eyelashes ................................ 0.71 0.43 0.52 0.50 0.53 0.04 000 

67825 .... ............ A ........ Revise eyelashes ................................ 1.40 1.40 1.57 1.26 1.33 0.07 010 

67830 .... ............ A ........ Revise eyelashes ................................ 1.72 3.99 4.76 1.32 1.41 0.08 010 

67835 .... ............ A ........ Revise eyelashes ................................ 5.61 NA NA 4.12 4.37 0.28 090 

67840 .... ............ A ........ Remove eyelid lesion .......................... 2.06 3.90 4.69 1.45 1.55 0.10 010 

67850 .... ............ A ........ Treat eyelid lesion ............................... 1.71 3.28 3.33 1.44 1.45 0.07 010 

67875 .... ............ A ........ Closure of eyelid by suture ................. 1.35 2.38 2.84 0.83 0.88 0.07 000 

67880 .... ............ A ........ Revision of eyelid ................................ 4.47 5.43 6.02 3.56 3.68 0.19 090 

67882 .... ............ A ........ Revision of eyelid ................................ 5.87 6.35 6.99 4.45 4.63 0.25 090 

67900 .... ............ A ........ Repair brow defect .............................. 6.69 7.36 8.21 4.60 4.93 0.38 090 

67901 .... ............ A ........ Repair eyelid defect ............................ 7.47 8.98 7.19 5.28 5.34 0.54 090 

67902 .... ............ A ........ Repair eyelid defect ............................ 9.68 NA NA 6.33 5.90 0.60 090 

67903 .... ............ A ........ Repair eyelid defect ............................ 6.42 6.62 8.09 4.33 4.92 0.47 090 

67904 .... ............ A ........ Repair eyelid defect ............................ 7.83 8.16 8.89 5.37 5.30 0.41 090 


cprice-sewell on PROD1PC72 with RULES
66486 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

67906 .... ............ A ........ Repair eyelid defect ............................ 6.84 NA NA 4.46 4.74 0.46 090 

67908 .... ............ A ........ Repair eyelid defect ............................ 5.19 5.55 6.09 4.12 4.73 0.28 090 

67909 .... ............ A ........ Revise eyelid defect ............................ 5.46 6.17 7.10 4.16 4.55 0.31 090 

67911 .... ............ A ........ Revise eyelid defect ............................ 7.38 NA NA 5.04 4.91 0.31 090 

67912 .... ............ A ........ Correction eyelid w/implant ................. 6.23 13.12 16.02 4.73 5.13 0.28 090 

67914 .... ............ A ........ Repair eyelid defect ............................ 3.70 4.74 5.54 2.67 2.86 0.19 090 

67915 .... ............ A ........ Repair eyelid defect ............................ 3.21 4.31 5.15 2.43 2.61 0.16 090 

67916 .... ............ A ........ Repair eyelid defect ............................ 5.37 6.36 7.20 4.14 4.45 0.28 090 

67917 .... ............ A ........ Repair eyelid defect ............................ 6.08 6.72 7.58 4.40 4.73 0.36 090 

67921 .... ............ A ........ Repair eyelid defect ............................ 3.42 4.61 5.40 2.55 2.72 0.17 090 

67922 .... ............ A ........ Repair eyelid defect ............................ 3.09 4.15 5.03 2.33 2.54 0.15 090 

67923 .... ............ A ........ Repair eyelid defect ............................ 5.94 6.43 7.27 4.32 4.64 0.30 090 

67924 .... ............ A ........ Repair eyelid defect ............................ 5.84 6.90 7.91 4.05 4.36 0.30 090 

67930 .... ............ A ........ Repair eyelid wound ........................... 3.62 4.36 5.04 1.78 1.97 0.19 010 

67935 .... ............ A ........ Repair eyelid wound ........................... 6.27 6.76 7.63 3.58 3.99 0.39 090 

67938 .... ............ A ........ Remove eyelid foreign body ............... 1.35 3.83 4.60 1.22 1.24 0.06 010 

67950 .... ............ A ........ Revision of eyelid ................................ 5.88 6.65 7.64 4.37 4.79 0.36 090 

67961 .... ............ A ........ Revision of eyelid ................................ 5.75 6.81 7.74 4.30 4.66 0.33 090 

67966 .... ............ A ........ Revision of eyelid ................................ 8.83 8.04 8.58 5.74 5.65 0.37 090 

67971 .... ............ A ........ Reconstruction of eyelid ..................... 9.87 NA NA 6.17 6.72 0.53 090 

67973 .... ............ A ........ Reconstruction of eyelid ..................... 12.96 NA NA 7.70 8.51 0.75 090 

67974 .... ............ A ........ Reconstruction of eyelid ..................... 12.93 NA NA 7.68 8.45 0.75 090 

67975 .... ............ A ........ Reconstruction of eyelid ..................... 9.21 NA NA 5.94 6.44 0.50 090 

67999 .... ............ C ........ Revision of eyelid ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

68020 .... ............ A ........ Incise/drain eyelid lining ...................... 1.39 1.23 1.32 1.05 1.13 0.06 010 

68040 .... ............ A ........ Treatment of eyelid lesions ................. 0.85 0.60 0.65 0.35 0.39 0.04 000 

68100 .... ............ A ........ Biopsy of eyelid lining ......................... 1.35 2.36 2.80 0.86 0.90 0.07 000 

68110 .... ............ A ........ Remove eyelid lining lesion ................ 1.79 3.07 3.58 1.48 1.56 0.09 010 

68115 .... ............ A ........ Remove eyelid lining lesion ................ 2.38 4.32 5.14 1.69 1.80 0.12 010 

68130 .... ............ A ........ Remove eyelid lining lesion ................ 4.99 6.63 7.67 4.02 4.31 0.24 090 

68135 .... ............ A ........ Remove eyelid lining lesion ................ 1.86 1.58 1.70 1.47 1.56 0.09 010 

68200 .... ............ A ........ Treat eyelid by injection ...................... 0.49 0.45 0.49 0.29 0.31 0.02 000 

68320 .... ............ A ........ Revise/graft eyelid lining ..................... 6.44 9.15 10.21 5.30 5.41 0.27 090 

68325 .... ............ A ........ Revise/graft eyelid lining ..................... 8.43 NA NA 6.09 6.32 0.44 090 

68326 .... ............ A ........ Revise/graft eyelid lining ..................... 8.22 NA NA 5.91 6.16 0.35 090 

68328 .... ............ A ........ Revise/graft eyelid lining ..................... 9.25 NA NA 6.37 6.83 0.54 090 

68330 .... ............ A ........ Revise eyelid lining ............................. 5.63 7.40 8.41 4.44 4.58 0.24 090 

68335 .... ............ A ........ Revise/graft eyelid lining ..................... 8.26 NA NA 5.91 6.14 0.36 090 

68340 .... ............ A ........ Separate eyelid adhesions ................. 4.84 6.87 7.87 3.86 3.98 0.21 090 

68360 .... ............ A ........ Revise eyelid lining ............................. 5.04 6.43 7.23 3.95 4.06 0.22 090 

68362 .... ............ A ........ Revise eyelid lining ............................. 8.41 NA NA 5.97 6.18 0.36 090 

68371 .... ............ A ........ Harvest eye tissue, alograft ................ 4.97 NA NA 4.05 4.39 0.44 010 

68399 .... ............ C ........ Eyelid lining surgery ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

68400 .... ............ A ........ Incise/drain tear gland ........................ 1.71 4.42 5.16 1.21 1.52 0.08 010 

68420 .... ............ A ........ Incise/drain tear sac ............................ 2.32 4.58 5.39 1.41 1.76 0.11 010 

68440 .... ............ A ........ Incise tear duct opening ..................... 0.96 1.25 1.67 1.18 1.22 0.05 010 

68500 .... ............ A ........ Removal of tear gland ........................ 12.49 NA NA 9.51 9.62 0.55 090 

68505 .... ............ A ........ Partial removal, tear gland .................. 12.41 NA NA 8.90 9.77 0.55 090 

68510 .... ............ A ........ Biopsy of tear gland ............................ 4.60 5.21 6.27 2.02 2.06 0.23 000 

68520 .... ............ A ........ Removal of tear sac ............................ 8.58 NA NA 6.49 6.95 0.37 090 

68525 .... ............ A ........ Biopsy of tear sac ............................... 4.42 NA NA 1.56 1.79 0.22 000 

68530 .... ............ A ........ Clearance of tear duct ........................ 3.67 5.59 6.88 2.07 2.36 0.18 010 

68540 .... ............ A ........ Remove tear gland lesion ................... 11.93 NA NA 8.48 8.93 0.52 090 

68550 .... ............ A ........ Remove tear gland lesion ................... 14.86 NA NA 9.66 10.50 0.80 090 

68700 .... ............ A ........ Repair tear ducts ................................ 7.67 NA NA 5.55 5.77 0.32 090 

68705 .... ............ A ........ Revise tear duct opening .................... 2.08 3.03 3.60 1.58 1.69 0.10 010 

68720 .... ............ A ........ Create tear sac drain .......................... 9.78 NA NA 6.87 7.36 0.44 090 

68745 .... ............ A ........ Create tear duct drain ......................... 9.70 NA NA 6.97 7.41 0.52 090 

68750 .... ............ A ........ Create tear duct drain ......................... 9.87 NA NA 7.42 7.84 0.43 090 

68760 .... ............ A ........ Close tear duct opening ...................... 1.75 2.58 3.06 1.45 1.54 0.09 010 

68761 .... ............ A ........ Close tear duct opening ...................... 1.38 1.83 2.05 1.25 1.28 0.06 010 

68770 .... ............ A ........ Close tear system fistula .................... 8.09 NA NA 5.74 4.46 0.35 090 

68801 .... ............ A ........ Dilate tear duct opening ...................... 0.96 1.77 1.86 1.41 1.44 0.05 010 

68810 .... ............ A ........ Probe nasolacrimal duct ..................... 2.63 3.39 3.52 2.68 2.67 0.10 010 

68811 .... ............ A ........ Probe nasolacrimal duct ..................... 2.39 NA NA 2.12 2.27 0.13 010 

68815 .... ............ A ........ Probe nasolacrimal duct ..................... 3.24 6.41 7.32 2.43 2.62 0.17 010 

68816 .... ............ A ........ Probe nl duct w/balloon ...................... 3.00 12.73 12.73 2.51 2.51 0.16 010 

68840 .... ............ A ........ Explore/irrigate tear ducts ................... 1.27 1.51 1.55 1.28 1.20 0.06 010 

68850 .... ............ A ........ Injection for tear sac x-ray .................. 0.80 0.72 0.80 0.60 0.64 0.04 000 

68899 .... ............ C ........ Tear duct system surgery ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

69000 .... ............ A ........ Drain external ear lesion ..................... 1.47 2.88 2.88 1.34 1.35 0.12 010 

69005 .... ............ A ........ Drain external ear lesion ..................... 2.13 2.99 2.96 1.61 1.72 0.17 010 


cprice-sewell on PROD1PC72 with RULES
66487 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

69020 .... ............ A ........ Drain outer ear canal lesion ............... 1.50 4.09 4.04 1.90 1.98 0.12 010 

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 1.85 1.78 0.39 0.39 0.03 000 

69105 .... ............ A ........ Biopsy of external ear canal ............... 0.85 2.64 2.49 0.71 0.74 0.07 000 

69110 .... ............ A ........ Remove external ear, partial .............. 3.47 7.83 7.29 4.44 4.45 0.30 090 

69120 .... ............ A ........ Removal of external ear ..................... 4.08 NA NA 5.36 5.77 0.38 090 

69140 .... ............ A ........ Remove ear canal lesion(s) ................ 8.03 NA NA 13.21 13.24 0.65 090 

69145 .... ............ A ........ Remove ear canal lesion(s) ................ 2.65 7.03 6.40 3.37 3.33 0.21 090 

69150 .... ............ A ........ Extensive ear canal surgery ............... 13.49 NA NA 11.45 12.42 1.22 090 

69155 .... ............ A ........ Extensive ear/neck surgery ................ 23.06 NA NA 16.98 18.25 1.93 090 

69200 .... ............ A ........ Clear outer ear canal .......................... 0.77 2.15 2.27 0.61 0.58 0.06 000 

69205 .... ............ A ........ Clear outer ear canal .......................... 1.20 NA NA 1.24 1.30 0.10 010 

69210 .... ............ A ........ Remove impacted ear wax ................. 0.61 0.58 0.60 0.17 0.20 0.05 000 

69220 .... ............ A ........ Clean out mastoid cavity .................... 0.83 2.56 2.46 0.68 0.70 0.07 000 

69222 .... ............ A ........ Clean out mastoid cavity .................... 1.42 3.97 3.91 1.90 1.98 0.12 010 

69300 .... ............ R ........ Revise external ear ............................. 6.69 10.71 7.46 5.18 4.70 0.72 YYY 

69310 .... ............ A ........ Rebuild outer ear canal ...................... 10.85 NA NA 15.48 15.88 0.85 090 

69320 .... ............ A ........ Rebuild outer ear canal ...................... 17.03 NA NA 20.05 20.94 1.37 090 

69399 .... ............ C ........ Outer ear surgery procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

69400 .... ............ A ........ Inflate middle ear canal ...................... 0.83 2.81 2.49 0.68 0.67 0.07 000 

69401 .... ............ A ........ Inflate middle ear canal ...................... 0.63 1.53 1.38 0.59 0.62 0.05 000 

69405 .... ............ A ........ Catheterize middle ear canal .............. 2.65 3.65 3.58 1.96 2.14 0.21 010 

69420 .... ............ A ........ Incision of eardrum ............................. 1.35 3.32 3.23 1.56 1.57 0.11 010 

69421 .... ............ A ........ Incision of eardrum ............................. 1.75 NA NA 1.85 2.01 0.15 010 

69424 .... ............ A ........ Remove ventilating tube ..................... 0.85 2.34 2.26 0.68 0.68 0.07 000 

69433 .... ............ A ........ Create eardrum opening ..................... 1.54 3.32 3.20 1.59 1.61 0.13 010 

69436 .... ............ A ........ Create eardrum opening ..................... 1.98 NA NA 1.90 2.09 0.19 010 

69440 .... ............ A ........ Exploration of middle ear .................... 7.62 NA NA 9.11 8.94 0.61 090 

69450 .... ............ A ........ Eardrum revision ................................. 5.61 NA NA 7.61 7.32 0.45 090 

69501 .... ............ A ........ Mastoidectomy .................................... 9.12 NA NA 8.65 8.82 0.73 090 

69502 .... ............ A ........ Mastoidectomy .................................... 12.44 NA NA 11.04 11.31 1.00 090 

69505 .... ............ A ........ Remove mastoid structures ................ 13.05 NA NA 16.14 16.66 1.05 090 

69511 .... ............ A ........ Extensive mastoid surgery .................. 13.58 NA NA 16.32 16.89 1.09 090 

69530 .... ............ A ........ Extensive mastoid surgery .................. 20.24 NA NA 19.65 20.63 1.54 090 

69535 .... ............ A ........ Remove part of temporal bone ........... 37.27 NA NA 26.75 29.34 2.93 090 

69540 .... ............ A ........ Remove ear lesion .............................. 1.22 3.90 3.82 1.85 1.91 0.10 010 

69550 .... ............ A ........ Remove ear lesion .............................. 11.04 NA NA 14.27 14.56 0.89 090 

69552 .... ............ A ........ Remove ear lesion .............................. 19.69 NA NA 18.18 19.42 1.59 090 

69554 .... ............ A ........ Remove ear lesion .............................. 35.71 NA NA 23.98 27.15 2.92 090 

69601 .... ............ A ........ Mastoid surgery revision ..................... 13.31 NA NA 11.91 12.29 1.07 090 

69602 .... ............ A ........ Mastoid surgery revision ..................... 13.64 NA NA 12.80 13.01 1.10 090 

69603 .... ............ A ........ Mastoid surgery revision ..................... 14.08 NA NA 16.43 17.39 1.14 090 

69604 .... ............ A ........ Mastoid surgery revision ..................... 14.08 NA NA 12.77 13.23 1.14 090 

69605 .... ............ A ........ Mastoid surgery revision ..................... 18.55 NA NA 19.28 20.11 1.50 090 

69610 .... ............ A ........ Repair of eardrum ............................... 4.44 4.91 5.23 2.58 2.93 0.36 010 

69620 .... ............ A ........ Repair of eardrum ............................... 5.94 10.90 11.01 5.83 6.06 0.48 090 

69631 .... ............ A ........ Repair eardrum structures .................. 9.93 NA NA 11.52 11.36 0.80 090 

69632 .... ............ A ........ Rebuild eardrum structures ................ 12.82 NA NA 13.30 13.38 1.03 090 

69633 .... ............ A ........ Rebuild eardrum structures ................ 12.17 NA NA 13.08 13.06 0.98 090 

69635 .... ............ A ........ Repair eardrum structures .................. 13.39 NA NA 16.28 16.51 1.08 090 

69636 .... ............ A ........ Rebuild eardrum structures ................ 15.29 NA NA 18.19 18.74 1.23 090 

69637 .... ............ A ........ Rebuild eardrum structures ................ 15.18 NA NA 18.10 18.66 1.22 090 

69641 .... ............ A ........ Revise middle ear & mastoid .............. 12.77 NA NA 12.47 12.62 1.03 090 

69642 .... ............ A ........ Revise middle ear & mastoid .............. 16.91 NA NA 15.52 15.90 1.36 090 

69643 .... ............ A ........ Revise middle ear & mastoid .............. 15.45 NA NA 14.15 14.48 1.24 090 

69644 .... ............ A ........ Revise middle ear & mastoid .............. 17.09 NA NA 18.72 19.56 1.37 090 

69645 .... ............ A ........ Revise middle ear & mastoid .............. 16.57 NA NA 18.58 19.30 1.33 090 

69646 .... ............ A ........ Revise middle ear & mastoid .............. 18.23 NA NA 19.10 19.92 1.46 090 

69650 .... ............ A ........ Release middle ear bone .................... 9.71 NA NA 9.53 9.72 0.78 090 

69660 .... ............ A ........ Revise middle ear bone ...................... 11.94 NA NA 10.49 10.83 0.96 090 

69661 .... ............ A ........ Revise middle ear bone ...................... 15.80 NA NA 13.46 14.07 1.27 090 

69662 .... ............ A ........ Revise middle ear bone ...................... 15.49 NA NA 12.50 13.12 1.25 090 

69666 .... ............ A ........ Repair middle ear structures .............. 9.80 NA NA 9.80 9.88 0.79 090 

69667 .... ............ A ........ Repair middle ear structures .............. 9.81 NA NA 9.83 9.90 0.79 090 

69670 .... ............ A ........ Remove mastoid air cells ................... 11.62 NA NA 11.24 11.47 0.93 090 

69676 .... ............ A ........ Remove middle ear nerve .................. 9.58 NA NA 10.60 10.67 0.81 090 

69700 .... ............ A ........ Close mastoid fistula ........................... 8.28 NA NA 8.67 8.96 0.67 090 

69710 .... ............ N ........ Implant/replace hearing aid ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

69711 .... ............ A ........ Remove/repair hearing aid ................. 10.50 NA NA 10.40 10.59 0.83 090 

69714 .... ............ A ........ Implant temple bone w/stimul ............. 14.31 NA NA 11.78 12.22 1.13 090 

69715 .... ............ A ........ Temple bne implnt w/stimulat ............. 18.80 NA NA 13.32 14.17 1.48 090 

69717 .... ............ A ........ Temple bone implant revision ............. 15.29 NA NA 11.95 13.21 0.90 090 


cprice-sewell on PROD1PC72 with RULES
66488 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

69718 .... ............ A ........ Revise temple bone implant ............... 19.05 NA NA 13.40 14.35 3.22 090 

69720 .... ............ A ........ Release facial nerve ........................... 14.57 NA NA 14.01 14.26 1.16 090 

69725 .... ............ A ........ Release facial nerve ........................... 27.44 NA NA 18.01 19.07 2.45 090 

69740 .... ............ A ........ Repair facial nerve .............................. 16.18 NA NA 11.58 12.49 1.27 090 

69745 .... ............ A ........ Repair facial nerve .............................. 16.91 NA NA 9.93 12.44 1.14 090 

69799 .... ............ C ........ Middle ear surgery procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

69801 .... ............ A ........ Incise inner ear ................................... 8.61 NA NA 9.61 9.54 0.69 090 

69802 .... ............ A ........ Incise inner ear ................................... 13.39 NA NA 11.86 12.09 1.06 090 

69805 .... ............ A ........ Explore inner ear ................................ 14.55 NA NA 10.89 11.38 1.12 090 

69806 .... ............ A ........ Explore inner ear ................................ 12.52 NA NA 10.39 10.71 1.00 090 

69820 .... ............ A ........ Establish inner ear window ................. 10.40 NA NA 10.24 10.73 0.90 090 

69840 .... ............ A ........ Revise inner ear window .................... 10.32 NA NA 11.37 12.27 0.79 090 

69905 .... ............ A ........ Remove inner ear ............................... 11.15 NA NA 11.03 11.19 0.90 090 

69910 .... ............ A ........ Remove inner ear & mastoid .............. 13.80 NA NA 10.88 11.39 1.07 090 

69915 .... ............ A ........ Incise inner ear nerve ......................... 22.65 NA NA 14.81 15.63 1.70 090 

69930 .... ............ A ........ Implant cochlear device ...................... 17.60 NA NA 13.10 13.92 1.36 090 

69949 .... ............ C ........ Inner ear surgery procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

69950 .... ............ A ........ Incise inner ear nerve ......................... 27.44 NA NA 16.84 17.86 2.29 090 

69955 .... ............ A ........ Release facial nerve ........................... 29.22 NA NA 19.38 20.37 2.49 090 

69960 .... ............ A ........ Release inner ear canal ...................... 29.22 NA NA 17.90 18.97 2.18 090 

69970 .... ............ A ........ Remove inner ear lesion ..................... 32.21 NA NA 19.51 21.39 2.42 090 

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 NA 1.27 1.53 0.89 ZZZ 

70010 .... ............ A ........ Contrast x-ray of brain ........................ 1.19 2.82 3.76 NA NA 0.27 XXX 

70010 .... TC ...... A ........ Contrast x-ray of brain ........................ 0.00 2.40 3.36 NA NA 0.22 XXX 

70010 .... 26 ....... A ........ Contrast x-ray of brain ........................ 1.19 0.42 0.40 0.42 0.40 0.05 XXX 

70015 .... ............ A ........ Contrast x-ray of brain ........................ 1.19 2.92 2.33 NA NA 0.16 XXX 

70015 .... TC ...... A ........ Contrast x-ray of brain ........................ 0.00 2.49 1.92 NA NA 0.08 XXX 

70015 .... 26 ....... A ........ Contrast x-ray of brain ........................ 1.19 0.43 0.41 0.43 0.41 0.08 XXX 

70030 .... ............ A ........ X-ray eye for foreign body .................. 0.17 0.61 0.54 NA NA 0.03 XXX 

70030 .... TC ...... A ........ X-ray eye for foreign body .................. 0.00 0.55 0.48 NA NA 0.02 XXX 

70030 .... 26 ....... A ........ X-ray eye for foreign body .................. 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

70100 .... ............ A ........ X-ray exam of jaw ............................... 0.18 0.63 0.61 NA NA 0.03 XXX 

70100 .... TC ...... A ........ X-ray exam of jaw ............................... 0.00 0.58 0.55 NA NA 0.02 XXX 

70100 .... 26 ....... A ........ X-ray exam of jaw ............................... 0.18 0.05 0.06 0.05 0.06 0.01 XXX 

70110 .... ............ A ........ X-ray exam of jaw ............................... 0.25 0.81 0.75 NA NA 0.05 XXX 

70110 .... TC ...... A ........ X-ray exam of jaw ............................... 0.00 0.72 0.67 NA NA 0.04 XXX 

70110 .... 26 ....... A ........ X-ray exam of jaw ............................... 0.25 0.09 0.08 0.09 0.08 0.01 XXX 

70120 .... ............ A ........ X-ray exam of mastoids ...................... 0.18 0.69 0.69 NA NA 0.05 XXX 

70120 .... TC ...... A ........ X-ray exam of mastoids ...................... 0.00 0.64 0.63 NA NA 0.04 XXX 

70120 .... 26 ....... A ........ X-ray exam of mastoids ...................... 0.18 0.05 0.06 0.05 0.06 0.01 XXX 

70130 .... ............ A ........ X-ray exam of mastoids ...................... 0.34 1.15 1.02 NA NA 0.07 XXX 

70130 .... TC ...... A ........ X-ray exam of mastoids ...................... 0.00 1.04 0.91 NA NA 0.05 XXX 

70130 .... 26 ....... A ........ X-ray exam of mastoids ...................... 0.34 0.11 0.11 0.11 0.11 0.02 XXX 

70134 .... ............ A ........ X-ray exam of middle ear ................... 0.34 0.92 0.87 NA NA 0.07 XXX 

70134 .... TC ...... A ........ X-ray exam of middle ear ................... 0.00 0.80 0.76 NA NA 0.05 XXX 

70134 .... 26 ....... A ........ X-ray exam of middle ear ................... 0.34 0.12 0.11 0.12 0.11 0.02 XXX 

70140 .... ............ A ........ X-ray exam of facial bones ................. 0.19 0.54 0.62 NA NA 0.05 XXX 

70140 .... TC ...... A ........ X-ray exam of facial bones ................. 0.00 0.49 0.56 NA NA 0.04 XXX 

70140 .... 26 ....... A ........ X-ray exam of facial bones ................. 0.19 0.05 0.06 0.05 0.06 0.01 XXX 

70150 .... ............ A ........ X-ray exam of facial bones ................. 0.26 0.85 0.85 NA NA 0.06 XXX 

70150 .... TC ...... A ........ X-ray exam of facial bones ................. 0.00 0.77 0.77 NA NA 0.05 XXX 

70150 .... 26 ....... A ........ X-ray exam of facial bones ................. 0.26 0.08 0.08 0.08 0.08 0.01 XXX 

70160 .... ............ A ........ X-ray exam of nasal bones ................. 0.17 0.71 0.64 NA NA 0.03 XXX 

70160 .... TC ...... A ........ X-ray exam of nasal bones ................. 0.00 0.65 0.58 NA NA 0.02 XXX 

70160 .... 26 ....... A ........ X-ray exam of nasal bones ................. 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

70170 .... ............ C ........ X-ray exam of tear duct ...................... 0.00 0.00 0.00 NA NA 0.00 XXX 

70170 .... TC ...... C ........ X-ray exam of tear duct ...................... 0.00 0.00 0.00 NA NA 0.00 XXX 

70170 .... 26 ....... A ........ X-ray exam of tear duct ...................... 0.30 0.10 0.10 0.10 0.10 0.01 XXX 

70190 .... ............ A ........ X-ray exam of eye sockets ................. 0.21 0.72 0.70 NA NA 0.05 XXX 

70190 .... TC ...... A ........ X-ray exam of eye sockets ................. 0.00 0.65 0.63 NA NA 0.04 XXX 

70190 .... 26 ....... A ........ X-ray exam of eye sockets ................. 0.21 0.07 0.07 0.07 0.07 0.01 XXX 

70200 .... ............ A ........ X-ray exam of eye sockets ................. 0.28 0.87 0.87 NA NA 0.06 XXX 

70200 .... TC ...... A ........ X-ray exam of eye sockets ................. 0.00 0.78 0.78 NA NA 0.05 XXX 

70200 .... 26 ....... A ........ X-ray exam of eye sockets ................. 0.28 0.09 0.09 0.09 0.09 0.01 XXX 

70210 .... ............ A ........ X-ray exam of sinuses ........................ 0.17 0.58 0.62 NA NA 0.05 XXX 

70210 .... TC ...... A ........ X-ray exam of sinuses ........................ 0.00 0.53 0.57 NA NA 0.04 XXX 

70210 .... 26 ....... A ........ X-ray exam of sinuses ........................ 0.17 0.05 0.05 0.05 0.05 0.01 XXX 

70220 .... ............ A ........ X-ray exam of sinuses ........................ 0.25 0.73 0.80 NA NA 0.06 XXX 

70220 .... TC ...... A ........ X-ray exam of sinuses ........................ 0.00 0.65 0.72 NA NA 0.05 XXX 

70220 .... 26 ....... A ........ X-ray exam of sinuses ........................ 0.25 0.08 0.08 0.08 0.08 0.01 XXX 

70240 .... ............ A ........ X-ray exam, pituitary saddle ............... 0.19 0.61 0.54 NA NA 0.03 XXX 


cprice-sewell on PROD1PC72 with RULES
66489 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

70240 .... TC ...... A ........ X-ray exam, pituitary saddle ............... 0.00 0.55 0.48 NA NA 0.02 XXX 

70240 .... 26 ....... A ........ X-ray exam, pituitary saddle ............... 0.19 0.06 0.06 0.06 0.06 0.01 XXX 

70250 .... ............ A ........ X-ray exam of skull ............................. 0.24 0.70 0.69 NA NA 0.05 XXX 

70250 .... TC ...... A ........ X-ray exam of skull ............................. 0.00 0.63 0.62 NA NA 0.04 XXX 

70250 .... 26 ....... A ........ X-ray exam of skull ............................. 0.24 0.07 0.07 0.07 0.07 0.01 XXX 

70260 .... ............ A ........ X-ray exam of skull ............................. 0.34 0.88 0.94 NA NA 0.08 XXX 

70260 .... TC ...... A ........ X-ray exam of skull ............................. 0.00 0.78 0.83 NA NA 0.06 XXX 

70260 .... 26 ....... A ........ X-ray exam of skull ............................. 0.34 0.10 0.11 0.10 0.11 0.02 XXX 

70300 .... ............ A ........ X-ray exam of teeth ............................ 0.10 0.24 0.27 NA NA 0.03 XXX 

70300 .... TC ...... A ........ X-ray exam of teeth ............................ 0.00 0.21 0.23 NA NA 0.02 XXX 

70300 .... 26 ....... A ........ X-ray exam of teeth ............................ 0.10 0.03 0.04 0.03 0.04 0.01 XXX 

70310 .... ............ A ........ X-ray exam of teeth ............................ 0.16 0.82 0.65 NA NA 0.03 XXX 

70310 .... TC ...... A ........ X-ray exam of teeth ............................ 0.00 0.77 0.59 NA NA 0.02 XXX 

70310 .... 26 ....... A ........ X-ray exam of teeth ............................ 0.16 0.05 0.06 0.05 0.06 0.01 XXX 

70320 .... ............ A ........ Full mouth x-ray of teeth ..................... 0.22 1.06 0.96 NA NA 0.06 XXX 

70320 .... TC ...... A ........ Full mouth x-ray of teeth ..................... 0.00 0.99 0.89 NA NA 0.05 XXX 

70320 .... 26 ....... A ........ Full mouth x-ray of teeth ..................... 0.22 0.07 0.07 0.07 0.07 0.01 XXX 

70328 .... ............ A ........ X-ray exam of jaw joint ....................... 0.18 0.63 0.59 NA NA 0.03 XXX 

70328 .... TC ...... A ........ X-ray exam of jaw joint ....................... 0.00 0.57 0.53 NA NA 0.02 XXX 

70328 .... 26 ....... A ........ X-ray exam of jaw joint ....................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX 

70330 .... ............ A ........ X-ray exam of jaw joints ..................... 0.24 1.01 0.96 NA NA 0.06 XXX 

70330 .... TC ...... A ........ X-ray exam of jaw joints ..................... 0.00 0.93 0.88 NA NA 0.05 XXX 

70330 .... 26 ....... A ........ X-ray exam of jaw joints ..................... 0.24 0.08 0.08 0.08 0.08 0.01 XXX 

70332 .... ............ A ........ X-ray exam of jaw joint ....................... 0.54 1.45 1.88 NA NA 0.14 XXX 

70332 .... TC ...... A ........ X-ray exam of jaw joint ....................... 0.00 1.29 1.70 NA NA 0.12 XXX 

70332 .... 26 ....... A ........ X-ray exam of jaw joint ....................... 0.54 0.16 0.18 0.16 0.18 0.02 XXX 

70336 .... ............ A ........ Magnetic image, jaw joint ................... 1.48 12.15 11.91 NA NA 0.66 XXX 

70336 .... TC ...... A ........ Magnetic image, jaw joint ................... 0.00 11.65 11.42 NA NA 0.59 XXX 

70336 .... 26 ....... A ........ Magnetic image, jaw joint ................... 1.48 0.50 0.49 0.50 0.49 0.07 XXX 

70350 .... ............ A ........ X-ray head for orthodontia .................. 0.17 0.32 0.39 NA NA 0.03 XXX 

70350 .... TC ...... A ........ X-ray head for orthodontia .................. 0.00 0.27 0.33 NA NA 0.02 XXX 

70350 .... 26 ....... A ........ X-ray head for orthodontia .................. 0.17 0.05 0.06 0.05 0.06 0.01 XXX 

70355 .... ............ A ........ Panoramic x-ray of jaws ..................... 0.20 0.30 0.47 NA NA 0.05 XXX 

70355 .... TC ...... A ........ Panoramic x-ray of jaws ..................... 0.00 0.23 0.40 NA NA 0.04 XXX 

70355 .... 26 ....... A ........ Panoramic x-ray of jaws ..................... 0.20 0.07 0.07 0.07 0.07 0.01 XXX 

70360 .... ............ A ........ X-ray exam of neck ............................. 0.17 0.56 0.52 NA NA 0.03 XXX 

70360 .... TC ...... A ........ X-ray exam of neck ............................. 0.00 0.51 0.46 NA NA 0.02 XXX 

70360 .... 26 ....... A ........ X-ray exam of neck ............................. 0.17 0.05 0.06 0.05 0.06 0.01 XXX 

70370 .... ............ A ........ Throat x-ray & fluoroscopy ................. 0.32 1.65 1.53 NA NA 0.08 XXX 

70370 .... TC ...... A ........ Throat x-ray & fluoroscopy ................. 0.00 1.55 1.43 NA NA 0.07 XXX 

70370 .... 26 ....... A ........ Throat x-ray & fluoroscopy ................. 0.32 0.10 0.10 0.10 0.10 0.01 XXX 

70371 .... ............ A ........ Speech evaluation, complex ............... 0.84 1.47 1.93 NA NA 0.16 XXX 

70371 .... TC ...... A ........ Speech evaluation, complex ............... 0.00 1.21 1.66 NA NA 0.12 XXX 

70371 .... 26 ....... A ........ Speech evaluation, complex ............... 0.84 0.26 0.27 0.26 0.27 0.04 XXX 

70373 .... ............ A ........ Contrast x-ray of larynx ...................... 0.44 1.58 1.75 NA NA 0.13 XXX 

70373 .... TC ...... A ........ Contrast x-ray of larynx ...................... 0.00 1.47 1.62 NA NA 0.11 XXX 

70373 .... 26 ....... A ........ Contrast x-ray of larynx ...................... 0.44 0.11 0.13 0.11 0.13 0.02 XXX 

70380 .... ............ A ........ X-ray exam of salivary gland .............. 0.17 0.82 0.78 NA NA 0.05 XXX 

70380 .... TC ...... A ........ X-ray exam of salivary gland .............. 0.00 0.76 0.72 NA NA 0.04 XXX 

70380 .... 26 ....... A ........ X-ray exam of salivary gland .............. 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

70390 .... ............ A ........ X-ray exam of salivary duct ................ 0.38 2.33 2.12 NA NA 0.13 XXX 

70390 .... TC ...... A ........ X-ray exam of salivary duct ................ 0.00 2.20 1.99 NA NA 0.11 XXX 

70390 .... 26 ....... A ........ X-ray exam of salivary duct ................ 0.38 0.13 0.13 0.13 0.13 0.02 XXX 

70450 .... ............ A ........ Ct head/brain w/o dye ......................... 0.85 4.91 4.95 NA NA 0.29 XXX 

70450 .... TC ...... A ........ Ct head/brain w/o dye ......................... 0.00 4.61 4.66 NA NA 0.25 XXX 

70450 .... 26 ....... A ........ Ct head/brain w/o dye ......................... 0.85 0.30 0.29 0.30 0.29 0.04 XXX 

70460 .... ............ A ........ Ct head/brain w/dye ............................ 1.13 6.51 6.27 NA NA 0.35 XXX 

70460 .... TC ...... A ........ Ct head/brain w/dye ............................ 0.00 6.11 5.88 NA NA 0.30 XXX 

70460 .... 26 ....... A ........ Ct head/brain w/dye ............................ 1.13 0.40 0.39 0.40 0.39 0.05 XXX 

70470 .... ............ A ........ Ct head/brain w/o & w/dye ................. 1.27 7.93 7.70 NA NA 0.43 XXX 

70470 .... TC ...... A ........ Ct head/brain w/o & w/dye ................. 0.00 7.48 7.27 NA NA 0.37 XXX 

70470 .... 26 ....... A ........ Ct head/brain w/o & w/dye ................. 1.27 0.45 0.43 0.45 0.43 0.06 XXX 

70480 .... ............ A ........ Ct orbit/ear/fossa w/o dye ................... 1.28 8.48 6.80 NA NA 0.31 XXX 

70480 .... TC ...... A ........ Ct orbit/ear/fossa w/o dye ................... 0.00 8.03 6.37 NA NA 0.25 XXX 

70480 .... 26 ....... A ........ Ct orbit/ear/fossa w/o dye ................... 1.28 0.45 0.43 0.45 0.43 0.06 XXX 

70481 .... ............ A ........ Ct orbit/ear/fossa w/dye ...................... 1.38 9.97 8.04 NA NA 0.36 XXX 

70481 .... TC ...... A ........ Ct orbit/ear/fossa w/dye ...................... 0.00 9.48 7.57 NA NA 0.30 XXX 

70481 .... 26 ....... A ........ Ct orbit/ear/fossa w/dye ...................... 1.38 0.49 0.47 0.49 0.47 0.06 XXX 

70482 .... ............ A ........ Ct orbit/ear/fossa w/o&w/dye .............. 1.45 11.40 9.47 NA NA 0.43 XXX 

70482 .... TC ...... A ........ Ct orbit/ear/fossa w/o&w/dye .............. 0.00 10.89 8.98 NA NA 0.37 XXX 

70482 .... 26 ....... A ........ Ct orbit/ear/fossa w/o&w/dye .............. 1.45 0.51 0.49 0.51 0.49 0.06 XXX 

70486 .... ............ A ........ Ct maxillofacial w/o dye ...................... 1.14 6.78 5.93 NA NA 0.30 XXX 


cprice-sewell on PROD1PC72 with RULES
66490 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

70486 .... TC ...... A ........ Ct maxillofacial w/o dye ...................... 0.00 6.39 5.55 NA NA 0.25 XXX 

70486 .... 26 ....... A ........ Ct maxillofacial w/o dye ...................... 1.14 0.39 0.38 0.39 0.38 0.05 XXX 

70487 .... ............ A ........ Ct maxillofacial w/dye ......................... 1.30 8.34 7.21 NA NA 0.36 XXX 

70487 .... TC ...... A ........ Ct maxillofacial w/dye ......................... 0.00 7.88 6.77 NA NA 0.30 XXX 

70487 .... 26 ....... A ........ Ct maxillofacial w/dye ......................... 1.30 0.46 0.44 0.46 0.44 0.06 XXX 

70488 .... ............ A ........ Ct maxillofacial w/o & w/dye ............... 1.42 10.39 8.96 NA NA 0.43 XXX 

70488 .... TC ...... A ........ Ct maxillofacial w/o & w/dye ............... 0.00 9.90 8.48 NA NA 0.37 XXX 

70488 .... 26 ....... A ........ Ct maxillofacial w/o & w/dye ............... 1.42 0.49 0.48 0.49 0.48 0.06 XXX 

70490 .... ............ A ........ Ct soft tissue neck w/o dye ................ 1.28 6.48 5.81 NA NA 0.31 XXX 

70490 .... TC ...... A ........ Ct soft tissue neck w/o dye ................ 0.00 6.03 5.37 NA NA 0.25 XXX 

70490 .... 26 ....... A ........ Ct soft tissue neck w/o dye ................ 1.28 0.45 0.44 0.45 0.44 0.06 XXX 

70491 .... ............ A ........ Ct soft tissue neck w/dye .................... 1.38 8.03 7.07 NA NA 0.36 XXX 

70491 .... TC ...... A ........ Ct soft tissue neck w/dye .................... 0.00 7.54 6.60 NA NA 0.30 XXX 

70491 .... 26 ....... A ........ Ct soft tissue neck w/dye .................... 1.38 0.49 0.47 0.49 0.47 0.06 XXX 

70492 .... ............ A ........ Ct sft tsue nck w/o & w/dye ................ 1.45 10.03 8.78 NA NA 0.43 XXX 

70492 .... TC ...... A ........ Ct sft tsue nck w/o & w/dye ................ 0.00 9.52 8.29 NA NA 0.37 XXX 

70492 .... 26 ....... A ........ Ct sft tsue nck w/o & w/dye ................ 1.45 0.51 0.49 0.51 0.49 0.06 XXX 

70496 .... ............ A ........ Ct angiography, head ......................... 1.75 17.08 14.12 NA NA 0.66 XXX 

70496 .... TC ...... A ........ Ct angiography, head ......................... 0.00 16.45 13.52 NA NA 0.58 XXX 

70496 .... 26 ....... A ........ Ct angiography, head ......................... 1.75 0.63 0.60 0.63 0.60 0.08 XXX 

70498 .... ............ A ........ Ct angiography, neck .......................... 1.75 17.22 14.19 NA NA 0.66 XXX 

70498 .... TC ...... A ........ Ct angiography, neck .......................... 0.00 16.57 13.58 NA NA 0.58 XXX 

70498 .... 26 ....... A ........ Ct angiography, neck .......................... 1.75 0.65 0.61 0.65 0.61 0.08 XXX 

70540 .... ............ A ........ Mri orbit/face/neck w/o dye ................. 1.35 14.16 12.90 NA NA 0.45 XXX 

70540 .... TC ...... A ........ Mri orbit/face/neck w/o dye ................. 0.00 13.70 12.45 NA NA 0.39 XXX 

70540 .... 26 ....... A ........ Mri orbit/face/neck w/o dye ................. 1.35 0.46 0.45 0.46 0.45 0.06 XXX 

70542 .... ............ A ........ Mri orbit/face/neck w/dye .................... 1.62 15.28 14.61 NA NA 0.54 XXX 

70542 .... TC ...... A ........ Mri orbit/face/neck w/dye .................... 0.00 14.72 14.07 NA NA 0.47 XXX 

70542 .... 26 ....... A ........ Mri orbit/face/neck w/dye .................... 1.62 0.56 0.54 0.56 0.54 0.07 XXX 

70543 .... ............ A ........ Mri orbt/fac/nck w/o & w/dye .............. 2.15 18.75 22.16 NA NA 0.94 XXX 

70543 .... TC ...... A ........ Mri orbt/fac/nck w/o & w/dye .............. 0.00 18.01 21.44 NA NA 0.84 XXX 

70543 .... 26 ....... A ........ Mri orbt/fac/nck w/o & w/dye .............. 2.15 0.74 0.72 0.74 0.72 0.10 XXX 

70544 .... ............ A ........ Mr angiography head w/o dye ............ 1.20 15.84 13.72 NA NA 0.64 XXX 

70544 .... TC ...... A ........ Mr angiography head w/o dye ............ 0.00 15.42 13.31 NA NA 0.59 XXX 

70544 .... 26 ....... A ........ Mr angiography head w/o dye ............ 1.20 0.42 0.41 0.42 0.41 0.05 XXX 

70545 .... ............ A ........ Mr angiography head w/dye ............... 1.20 15.73 13.65 NA NA 0.64 XXX 

70545 .... TC ...... A ........ Mr angiography head w/dye ............... 0.00 15.31 13.25 NA NA 0.59 XXX 

70545 .... 26 ....... A ........ Mr angiography head w/dye ............... 1.20 0.42 0.40 0.42 0.40 0.05 XXX 

70546 .... ............ A ........ Mr angiograph head w/o&w/dye ......... 1.80 24.00 23.50 NA NA 0.67 XXX 

70546 .... TC ...... A ........ Mr angiograph head w/o&w/dye ......... 0.00 23.38 22.89 NA NA 0.59 XXX 

70546 .... 26 ....... A ........ Mr angiograph head w/o&w/dye ......... 1.80 0.62 0.61 0.62 0.61 0.08 XXX 

70547 .... ............ A ........ Mr angiography neck w/o dye ............ 1.20 15.77 13.68 NA NA 0.64 XXX 

70547 .... TC ...... A ........ Mr angiography neck w/o dye ............ 0.00 15.36 13.28 NA NA 0.59 XXX 

70547 .... 26 ....... A ........ Mr angiography neck w/o dye ............ 1.20 0.41 0.40 0.41 0.40 0.05 XXX 

70548 .... ............ A ........ Mr angiography neck w/dye ................ 1.20 16.63 14.11 NA NA 0.64 XXX 

70548 .... TC ...... A ........ Mr angiography neck w/dye ................ 0.00 16.21 13.70 NA NA 0.59 XXX 

70548 .... 26 ....... A ........ Mr angiography neck w/dye ................ 1.20 0.42 0.41 0.42 0.41 0.05 XXX 

70549 .... ............ A ........ Mr angiograph neck w/o&w/dye ......... 1.80 24.02 23.50 NA NA 0.67 XXX 

70549 .... TC ...... A ........ Mr angiograph neck w/o&w/dye ......... 0.00 23.39 22.89 NA NA 0.59 XXX 

70549 .... 26 ....... A ........ Mr angiograph neck w/o&w/dye ......... 1.80 0.63 0.61 0.63 0.61 0.08 XXX 

70551 .... ............ A ........ Mri brain w/o dye ................................ 1.48 14.42 13.05 NA NA 0.66 XXX 

70551 .... TC ...... A ........ Mri brain w/o dye ................................ 0.00 13.91 12.55 NA NA 0.59 XXX 

70551 .... 26 ....... A ........ Mri brain w/o dye ................................ 1.48 0.51 0.50 0.51 0.50 0.07 XXX 

70552 .... ............ A ........ Mri brain w/dye ................................... 1.78 15.58 14.79 NA NA 0.78 XXX 

70552 .... TC ...... A ........ Mri brain w/dye ................................... 0.00 14.96 14.19 NA NA 0.70 XXX 

70552 .... 26 ....... A ........ Mri brain w/dye ................................... 1.78 0.62 0.60 0.62 0.60 0.08 XXX 

70553 .... ............ A ........ Mri brain w/o & w/dye ......................... 2.36 18.06 21.86 NA NA 1.41 XXX 

70553 .... TC ...... A ........ Mri brain w/o & w/dye ......................... 0.00 17.24 21.06 NA NA 1.31 XXX 

70553 .... 26 ....... A ........ Mri brain w/o & w/dye ......................... 2.36 0.82 0.80 0.82 0.80 0.10 XXX 

70554 .... ............ A ........ Fmri brain by tech ............................... 2.11 15.40 15.40 NA NA 0.92 XXX 

70554 .... TC ...... A ........ Fmri brain by tech ............................... 0.00 14.71 14.71 NA NA 0.82 XXX 

70554 .... 26 ....... A ........ Fmri brain by tech ............................... 2.11 0.69 0.69 0.69 0.69 0.10 XXX 

70555 .... ............ C ........ Fmri brain by phys/psych .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

70555 .... TC ...... C ........ Fmri brain by phys/psych .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

70555 .... 26 ....... A ........ Fmri brain by phys/psych .................... 2.54 0.90 0.90 0.90 0.90 0.11 XXX 

70557 .... ............ C ........ Mri brain w/o dye ................................ 0.00 0.00 0.00 NA NA 0.00 XXX 

70557 .... TC ...... C ........ Mri brain w/o dye ................................ 0.00 0.00 0.00 NA NA 0.00 XXX 

70557 .... 26 ....... A ........ Mri brain w/o dye ................................ 2.90 1.03 1.08 1.03 1.08 0.08 XXX 

70558 .... ............ C ........ Mri brain w/dye ................................... 0.00 0.00 0.00 NA NA 0.00 XXX 

70558 .... TC ...... C ........ Mri brain w/dye ................................... 0.00 0.00 0.00 NA NA 0.00 XXX 

70558 .... 26 ....... A ........ Mri brain w/dye ................................... 3.20 1.09 1.16 1.09 1.16 0.10 XXX 

70559 .... ............ C ........ Mri brain w/o & w/dye ......................... 0.00 0.00 0.00 NA NA 0.00 XXX 


cprice-sewell on PROD1PC72 with RULES
66491 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

70559 .... TC ...... C ........ Mri brain w/o & w/dye ......................... 0.00 0.00 0.00 NA NA 0.00 XXX 

70559 .... 26 ....... A ........ Mri brain w/o & w/dye ......................... 3.20 1.14 1.19 1.14 1.19 0.12 XXX 

71010 .... ............ A ........ Chest x-ray .......................................... 0.18 0.43 0.48 NA NA 0.03 XXX 

71010 .... TC ...... A ........ Chest x-ray .......................................... 0.00 0.37 0.42 NA NA 0.02 XXX 

71010 .... 26 ....... A ........ Chest x-ray .......................................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX 

71015 .... ............ A ........ Chest x-ray .......................................... 0.21 0.58 0.58 NA NA 0.03 XXX 

71015 .... TC ...... A ........ Chest x-ray .......................................... 0.00 0.51 0.51 NA NA 0.02 XXX 

71015 .... 26 ....... A ........ Chest x-ray .......................................... 0.21 0.07 0.07 0.07 0.07 0.01 XXX 

71020 .... ............ A ........ Chest x-ray .......................................... 0.22 0.57 0.63 NA NA 0.05 XXX 

71020 .... TC ...... A ........ Chest x-ray .......................................... 0.00 0.50 0.56 NA NA 0.04 XXX 

71020 .... 26 ....... A ........ Chest x-ray .......................................... 0.22 0.07 0.07 0.07 0.07 0.01 XXX 

71021 .... ............ A ........ Chest x-ray .......................................... 0.27 0.71 0.76 NA NA 0.06 XXX 

71021 .... TC ...... A ........ Chest x-ray .......................................... 0.00 0.62 0.67 NA NA 0.05 XXX 

71021 .... 26 ....... A ........ Chest x-ray .......................................... 0.27 0.09 0.09 0.09 0.09 0.01 XXX 

71022 .... ............ A ........ Chest x-ray .......................................... 0.31 0.90 0.86 NA NA 0.06 XXX 

71022 .... TC ...... A ........ Chest x-ray .......................................... 0.00 0.80 0.76 NA NA 0.05 XXX 

71022 .... 26 ....... A ........ Chest x-ray .......................................... 0.31 0.10 0.10 0.10 0.10 0.01 XXX 

71023 .... ............ A ........ Chest x-ray and fluoroscopy ............... 0.38 1.54 1.23 NA NA 0.06 XXX 

71023 .... TC ...... A ........ Chest x-ray and fluoroscopy ............... 0.00 1.40 1.09 NA NA 0.05 XXX 

71023 .... 26 ....... A ........ Chest x-ray and fluoroscopy ............... 0.38 0.14 0.14 0.14 0.14 0.01 XXX 

71030 .... ............ A ........ Chest x-ray .......................................... 0.31 0.92 0.90 NA NA 0.06 XXX 

71030 .... TC ...... A ........ Chest x-ray .......................................... 0.00 0.82 0.80 NA NA 0.05 XXX 

71030 .... 26 ....... A ........ Chest x-ray .......................................... 0.31 0.10 0.10 0.10 0.10 0.01 XXX 

71034 .... ............ A ........ Chest x-ray and fluoroscopy ............... 0.46 2.11 1.85 NA NA 0.10 XXX 

71034 .... TC ...... A ........ Chest x-ray and fluoroscopy ............... 0.00 1.90 1.67 NA NA 0.08 XXX 

71034 .... 26 ....... A ........ Chest x-ray and fluoroscopy ............... 0.46 0.21 0.18 0.21 0.18 0.02 XXX 

71035 .... ............ A ........ Chest x-ray .......................................... 0.18 0.78 0.68 NA NA 0.03 XXX 

71035 .... TC ...... A ........ Chest x-ray .......................................... 0.00 0.72 0.62 NA NA 0.02 XXX 

71035 .... 26 ....... A ........ Chest x-ray .......................................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX 

71040 .... ............ A ........ Contrast x-ray of bronchi .................... 0.58 2.06 1.85 NA NA 0.11 XXX 

71040 .... TC ...... A ........ Contrast x-ray of bronchi .................... 0.00 1.88 1.67 NA NA 0.08 XXX 

71040 .... 26 ....... A ........ Contrast x-ray of bronchi .................... 0.58 0.18 0.18 0.18 0.18 0.03 XXX 

71060 .... ............ A ........ Contrast x-ray of bronchi .................... 0.74 3.11 2.77 NA NA 0.16 XXX 

71060 .... TC ...... A ........ Contrast x-ray of bronchi .................... 0.00 2.85 2.52 NA NA 0.13 XXX 

71060 .... 26 ....... A ........ Contrast x-ray of bronchi .................... 0.74 0.26 0.25 0.26 0.25 0.03 XXX 

71090 .... ............ C ........ X-ray & pacemaker insertion .............. 0.00 0.00 0.00 NA NA 0.00 XXX 

71090 .... TC ...... C ........ X-ray & pacemaker insertion .............. 0.00 0.00 0.00 NA NA 0.00 XXX 

71090 .... 26 ....... A ........ X-ray & pacemaker insertion .............. 0.54 0.28 0.24 0.28 0.24 0.02 XXX 

71100 .... ............ A ........ X-ray exam of ribs .............................. 0.22 0.62 0.63 NA NA 0.05 XXX 

71100 .... TC ...... A ........ X-ray exam of ribs .............................. 0.00 0.55 0.56 NA NA 0.04 XXX 

71100 .... 26 ....... A ........ X-ray exam of ribs .............................. 0.22 0.07 0.07 0.07 0.07 0.01 XXX 

71101 .... ............ A ........ X-ray exam of ribs/chest ..................... 0.27 0.77 0.76 NA NA 0.05 XXX 

71101 .... TC ...... A ........ X-ray exam of ribs/chest ..................... 0.00 0.68 0.67 NA NA 0.04 XXX 

71101 .... 26 ....... A ........ X-ray exam of ribs/chest ..................... 0.27 0.09 0.09 0.09 0.09 0.01 XXX 

71110 .... ............ A ........ X-ray exam of ribs .............................. 0.27 0.77 0.82 NA NA 0.06 XXX 

71110 .... TC ...... A ........ X-ray exam of ribs .............................. 0.00 0.69 0.73 NA NA 0.05 XXX 

71110 .... 26 ....... A ........ X-ray exam of ribs .............................. 0.27 0.08 0.09 0.08 0.09 0.01 XXX 

71111 .... ............ A ........ X-ray exam of ribs/chest ..................... 0.32 1.06 1.02 NA NA 0.07 XXX 

71111 .... TC ...... A ........ X-ray exam of ribs/chest ..................... 0.00 0.96 0.92 NA NA 0.06 XXX 

71111 .... 26 ....... A ........ X-ray exam of ribs/chest ..................... 0.32 0.10 0.10 0.10 0.10 0.01 XXX 

71120 .... ............ A ........ X-ray exam of breastbone .................. 0.20 0.63 0.67 NA NA 0.05 XXX 

71120 .... TC ...... A ........ X-ray exam of breastbone .................. 0.00 0.56 0.60 NA NA 0.04 XXX 

71120 .... 26 ....... A ........ X-ray exam of breastbone .................. 0.20 0.07 0.07 0.07 0.07 0.01 XXX 

71130 .... ............ A ........ X-ray exam of breastbone .................. 0.22 0.76 0.76 NA NA 0.05 XXX 

71130 .... TC ...... A ........ X-ray exam of breastbone .................. 0.00 0.68 0.69 NA NA 0.04 XXX 

71130 .... 26 ....... A ........ X-ray exam of breastbone .................. 0.22 0.08 0.07 0.08 0.07 0.01 XXX 

71250 .... ............ A ........ Ct thorax w/o dye ................................ 1.16 6.45 6.36 NA NA 0.36 XXX 

71250 .... TC ...... A ........ Ct thorax w/o dye ................................ 0.00 6.04 5.97 NA NA 0.31 XXX 

71250 .... 26 ....... A ........ Ct thorax w/o dye ................................ 1.16 0.41 0.39 0.41 0.39 0.05 XXX 

71260 .... ............ A ........ Ct thorax w/dye ................................... 1.24 7.99 7.73 NA NA 0.42 XXX 

71260 .... TC ...... A ........ Ct thorax w/dye ................................... 0.00 7.55 7.31 NA NA 0.37 XXX 

71260 .... 26 ....... A ........ Ct thorax w/dye ................................... 1.24 0.44 0.42 0.44 0.42 0.05 XXX 

71270 .... ............ A ........ Ct thorax w/o & w/dye ........................ 1.38 10.03 9.67 NA NA 0.52 XXX 

71270 .... TC ...... A ........ Ct thorax w/o & w/dye ........................ 0.00 9.55 9.20 NA NA 0.46 XXX 

71270 .... 26 ....... A ........ Ct thorax w/o & w/dye ........................ 1.38 0.48 0.47 0.48 0.47 0.06 XXX 

71275 .... ............ A ........ Ct angiography, chest ......................... 1.92 11.75 12.38 NA NA 0.48 XXX 

71275 .... TC ...... A ........ Ct angiography, chest ......................... 0.00 11.06 11.72 NA NA 0.39 XXX 

71275 .... 26 ....... A ........ Ct angiography, chest ......................... 1.92 0.69 0.66 0.69 0.66 0.09 XXX 

71550 .... ............ A ........ Mri chest w/o dye ................................ 1.46 16.35 14.01 NA NA 0.51 XXX 

71550 .... TC ...... A ........ Mri chest w/o dye ................................ 0.00 15.85 13.52 NA NA 0.45 XXX 

71550 .... 26 ....... A ........ Mri chest w/o dye ................................ 1.46 0.50 0.49 0.50 0.49 0.06 XXX 

71551 .... ............ A ........ Mri chest w/dye ................................... 1.73 17.92 15.96 NA NA 0.60 XXX 


cprice-sewell on PROD1PC72 with RULES
66492 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

71551 .... TC ...... A ........ Mri chest w/dye ................................... 0.00 17.32 15.38 NA NA 0.52 XXX 

71551 .... 26 ....... A ........ Mri chest w/dye ................................... 1.73 0.60 0.58 0.60 0.58 0.08 XXX 

71552 .... ............ A ........ Mri chest w/o & w/dye ........................ 2.26 22.55 24.08 NA NA 0.78 XXX 

71552 .... TC ...... A ........ Mri chest w/o & w/dye ........................ 0.00 21.75 23.31 NA NA 0.68 XXX 

71552 .... 26 ....... A ........ Mri chest w/o & w/dye ........................ 2.26 0.80 0.77 0.80 0.77 0.10 XXX 

71555 .... ............ R ........ Mri angio chest w or w/o dye ............. 1.81 15.30 13.54 NA NA 0.67 XXX 

71555 .... TC ...... R ........ Mri angio chest w or w/o dye ............. 0.00 14.64 12.91 NA NA 0.59 XXX 

71555 .... 26 ....... R ........ Mri angio chest w or w/o dye ............. 1.81 0.66 0.63 0.66 0.63 0.08 XXX 

72010 .... ............ A ........ X-ray exam of spine ............................ 0.45 1.43 1.30 NA NA 0.08 XXX 

72010 .... TC ...... A ........ X-ray exam of spine ............................ 0.00 1.30 1.16 NA NA 0.06 XXX 

72010 .... 26 ....... A ........ X-ray exam of spine ............................ 0.45 0.13 0.14 0.13 0.14 0.02 XXX 

72020 .... ............ A ........ X-ray exam of spine ............................ 0.15 0.47 0.47 NA NA 0.03 XXX 

72020 .... TC ...... A ........ X-ray exam of spine ............................ 0.00 0.42 0.42 NA NA 0.02 XXX 

72020 .... 26 ....... A ........ X-ray exam of spine ............................ 0.15 0.05 0.05 0.05 0.05 0.01 XXX 

72040 .... ............ A ........ X-ray exam of neck spine ................... 0.22 0.76 0.72 NA NA 0.05 XXX 

72040 .... TC ...... A ........ X-ray exam of neck spine ................... 0.00 0.69 0.65 NA NA 0.04 XXX 

72040 .... 26 ....... A ........ X-ray exam of neck spine ................... 0.22 0.07 0.07 0.07 0.07 0.01 XXX 

72050 .... ............ A ........ X-ray exam of neck spine ................... 0.31 1.08 1.03 NA NA 0.07 XXX 

72050 .... TC ...... A ........ X-ray exam of neck spine ................... 0.00 0.97 0.93 NA NA 0.06 XXX 

72050 .... 26 ....... A ........ X-ray exam of neck spine ................... 0.31 0.11 0.10 0.11 0.10 0.01 XXX 

72052 .... ............ A ........ X-ray exam of neck spine ................... 0.36 1.39 1.32 NA NA 0.08 XXX 

72052 .... TC ...... A ........ X-ray exam of neck spine ................... 0.00 1.27 1.20 NA NA 0.06 XXX 

72052 .... 26 ....... A ........ X-ray exam of neck spine ................... 0.36 0.12 0.12 0.12 0.12 0.02 XXX 

72069 .... ............ A ........ X-ray exam of trunk spine .................. 0.22 0.76 0.66 NA NA 0.03 XXX 

72069 .... TC ...... A ........ X-ray exam of trunk spine .................. 0.00 0.68 0.58 NA NA 0.02 XXX 

72069 .... 26 ....... A ........ X-ray exam of trunk spine .................. 0.22 0.08 0.08 0.08 0.08 0.01 XXX 

72070 .... ............ A ........ X-ray exam of thoracic spine .............. 0.22 0.64 0.68 NA NA 0.05 XXX 

72070 .... TC ...... A ........ X-ray exam of thoracic spine .............. 0.00 0.57 0.61 NA NA 0.04 XXX 

72070 .... 26 ....... A ........ X-ray exam of thoracic spine .............. 0.22 0.07 0.07 0.07 0.07 0.01 XXX 

72072 .... ............ A ........ X-ray exam of thoracic spine .............. 0.22 0.77 0.78 NA NA 0.06 XXX 

72072 .... TC ...... A ........ X-ray exam of thoracic spine .............. 0.00 0.70 0.71 NA NA 0.05 XXX 

72072 .... 26 ....... A ........ X-ray exam of thoracic spine .............. 0.22 0.07 0.07 0.07 0.07 0.01 XXX 

72074 .... ............ A ........ X-ray exam of thoracic spine .............. 0.22 0.94 0.96 NA NA 0.07 XXX 

72074 .... TC ...... A ........ X-ray exam of thoracic spine .............. 0.00 0.87 0.89 NA NA 0.06 XXX 

72074 .... 26 ....... A ........ X-ray exam of thoracic spine .............. 0.22 0.07 0.07 0.07 0.07 0.01 XXX 

72080 .... ............ A ........ X-ray exam of trunk spine .................. 0.22 0.70 0.71 NA NA 0.05 XXX 

72080 .... TC ...... A ........ X-ray exam of trunk spine .................. 0.00 0.62 0.64 NA NA 0.04 XXX 

72080 .... 26 ....... A ........ X-ray exam of trunk spine .................. 0.22 0.08 0.07 0.08 0.07 0.01 XXX 

72090 .... ............ A ........ X-ray exam of trunk spine .................. 0.28 1.00 0.88 NA NA 0.05 XXX 

72090 .... TC ...... A ........ X-ray exam of trunk spine .................. 0.00 0.90 0.78 NA NA 0.04 XXX 

72090 .... 26 ....... A ........ X-ray exam of trunk spine .................. 0.28 0.10 0.10 0.10 0.10 0.01 XXX 

72100 .... ............ A ........ X-ray exam of lower spine .................. 0.22 0.81 0.77 NA NA 0.05 XXX 

72100 .... TC ...... A ........ X-ray exam of lower spine .................. 0.00 0.74 0.70 NA NA 0.04 XXX 

72100 .... 26 ....... A ........ X-ray exam of lower spine .................. 0.22 0.07 0.07 0.07 0.07 0.01 XXX 

72110 .... ............ A ........ X-ray exam of lower spine .................. 0.31 1.15 1.07 NA NA 0.07 XXX 

72110 .... TC ...... A ........ X-ray exam of lower spine .................. 0.00 1.04 0.97 NA NA 0.06 XXX 

72110 .... 26 ....... A ........ X-ray exam of lower spine .................. 0.31 0.11 0.10 0.11 0.10 0.01 XXX 

72114 .... ............ A ........ X-ray exam of lower spine .................. 0.36 1.57 1.43 NA NA 0.08 XXX 

72114 .... TC ...... A ........ X-ray exam of lower spine .................. 0.00 1.44 1.31 NA NA 0.06 XXX 

72114 .... 26 ....... A ........ X-ray exam of lower spine .................. 0.36 0.13 0.12 0.13 0.12 0.02 XXX 

72120 .... ............ A ........ X-ray exam of lower spine .................. 0.22 1.08 1.01 NA NA 0.07 XXX 

72120 .... TC ...... A ........ X-ray exam of lower spine .................. 0.00 1.00 0.94 NA NA 0.06 XXX 

72120 .... 26 ....... A ........ X-ray exam of lower spine .................. 0.22 0.08 0.07 0.08 0.07 0.01 XXX 

72125 .... ............ A ........ Ct neck spine w/o dye ........................ 1.16 6.46 6.37 NA NA 0.36 XXX 

72125 .... TC ...... A ........ Ct neck spine w/o dye ........................ 0.00 6.05 5.98 NA NA 0.31 XXX 

72125 .... 26 ....... A ........ Ct neck spine w/o dye ........................ 1.16 0.41 0.39 0.41 0.39 0.05 XXX 

72126 .... ............ A ........ Ct neck spine w/dye ........................... 1.22 7.99 7.72 NA NA 0.42 XXX 

72126 .... TC ...... A ........ Ct neck spine w/dye ........................... 0.00 7.56 7.31 NA NA 0.37 XXX 

72126 .... 26 ....... A ........ Ct neck spine w/dye ........................... 1.22 0.43 0.41 0.43 0.41 0.05 XXX 

72127 .... ............ A ........ Ct neck spine w/o & w/dye ................. 1.27 10.03 9.65 NA NA 0.52 XXX 

72127 .... TC ...... A ........ Ct neck spine w/o & w/dye ................. 0.00 9.59 9.22 NA NA 0.46 XXX 

72127 .... 26 ....... A ........ Ct neck spine w/o & w/dye ................. 1.27 0.44 0.43 0.44 0.43 0.06 XXX 

72128 .... ............ A ........ Ct chest spine w/o dye ....................... 1.16 6.45 6.36 NA NA 0.36 XXX 

72128 .... TC ...... A ........ Ct chest spine w/o dye ....................... 0.00 6.04 5.97 NA NA 0.31 XXX 

72128 .... 26 ....... A ........ Ct chest spine w/o dye ....................... 1.16 0.41 0.39 0.41 0.39 0.05 XXX 

72129 .... ............ A ........ Ct chest spine w/dye .......................... 1.22 7.99 7.72 NA NA 0.42 XXX 

72129 .... TC ...... A ........ Ct chest spine w/dye .......................... 0.00 7.56 7.31 NA NA 0.37 XXX 

72129 .... 26 ....... A ........ Ct chest spine w/dye .......................... 1.22 0.43 0.41 0.43 0.41 0.05 XXX 

72130 .... ............ A ........ Ct chest spine w/o & w/dye ................ 1.27 9.97 9.62 NA NA 0.52 XXX 

72130 .... TC ...... A ........ Ct chest spine w/o & w/dye ................ 0.00 9.53 9.19 NA NA 0.46 XXX 

72130 .... 26 ....... A ........ Ct chest spine w/o & w/dye ................ 1.27 0.44 0.43 0.44 0.43 0.06 XXX 

72131 .... ............ A ........ Ct lumbar spine w/o dye ..................... 1.16 6.42 6.36 NA NA 0.36 XXX 


cprice-sewell on PROD1PC72 with RULES
66493 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

72131 .... TC ...... A ........ Ct lumbar spine w/o dye ..................... 0.00 6.02 5.97 NA NA 0.31 XXX 

72131 .... 26 ....... A ........ Ct lumbar spine w/o dye ..................... 1.16 0.40 0.39 0.40 0.39 0.05 XXX 

72132 .... ............ A ........ Ct lumbar spine w/dye ........................ 1.22 7.97 7.71 NA NA 0.42 XXX 

72132 .... TC ...... A ........ Ct lumbar spine w/dye ........................ 0.00 7.54 7.30 NA NA 0.37 XXX 

72132 .... 26 ....... A ........ Ct lumbar spine w/dye ........................ 1.22 0.43 0.41 0.43 0.41 0.05 XXX 

72133 .... ............ A ........ Ct lumbar spine w/o & w/dye .............. 1.27 10.01 9.64 NA NA 0.52 XXX 

72133 .... TC ...... A ........ Ct lumbar spine w/o & w/dye .............. 0.00 9.57 9.21 NA NA 0.46 XXX 

72133 .... 26 ....... A ........ Ct lumbar spine w/o & w/dye .............. 1.27 0.44 0.43 0.44 0.43 0.06 XXX 

72141 .... ............ A ........ Mri neck spine w/o dye ....................... 1.60 12.45 12.09 NA NA 0.66 XXX 

72141 .... TC ...... A ........ Mri neck spine w/o dye ....................... 0.00 11.90 11.55 NA NA 0.59 XXX 

72141 .... 26 ....... A ........ Mri neck spine w/o dye ....................... 1.60 0.55 0.54 0.55 0.54 0.07 XXX 

72142 .... ............ A ........ Mri neck spine w/dye .......................... 1.92 15.60 14.84 NA NA 0.79 XXX 

72142 .... TC ...... A ........ Mri neck spine w/dye .......................... 0.00 14.94 14.19 NA NA 0.70 XXX 

72142 .... 26 ....... A ........ Mri neck spine w/dye .......................... 1.92 0.66 0.65 0.66 0.65 0.09 XXX 

72146 .... ............ A ........ Mri chest spine w/o dye ...................... 1.60 12.47 12.72 NA NA 0.71 XXX 

72146 .... TC ...... A ........ Mri chest spine w/o dye ...................... 0.00 11.92 12.18 NA NA 0.64 XXX 

72146 .... 26 ....... A ........ Mri chest spine w/o dye ...................... 1.60 0.55 0.54 0.55 0.54 0.07 XXX 

72147 .... ............ A ........ Mri chest spine w/dye ......................... 1.92 13.56 13.81 NA NA 0.79 XXX 

72147 .... TC ...... A ........ Mri chest spine w/dye ......................... 0.00 12.89 13.16 NA NA 0.70 XXX 

72147 .... 26 ....... A ........ Mri chest spine w/dye ......................... 1.92 0.67 0.65 0.67 0.65 0.09 XXX 

72148 .... ............ A ........ Mri lumbar spine w/o dye ................... 1.48 12.41 12.67 NA NA 0.71 XXX 

72148 .... TC ...... A ........ Mri lumbar spine w/o dye ................... 0.00 11.90 12.17 NA NA 0.64 XXX 

72148 .... 26 ....... A ........ Mri lumbar spine w/o dye ................... 1.48 0.51 0.50 0.51 0.50 0.07 XXX 

72149 .... ............ A ........ Mri lumbar spine w/dye ....................... 1.78 15.51 14.77 NA NA 0.78 XXX 

72149 .... TC ...... A ........ Mri lumbar spine w/dye ....................... 0.00 14.89 14.16 NA NA 0.70 XXX 

72149 .... 26 ....... A ........ Mri lumbar spine w/dye ....................... 1.78 0.62 0.61 0.62 0.61 0.08 XXX 

72156 .... ............ A ........ Mri neck spine w/o & w/dye ................ 2.57 17.76 21.74 NA NA 1.42 XXX 

72156 .... TC ...... A ........ Mri neck spine w/o & w/dye ................ 0.00 16.88 20.87 NA NA 1.31 XXX 

72156 .... 26 ....... A ........ Mri neck spine w/o & w/dye ................ 2.57 0.88 0.87 0.88 0.87 0.11 XXX 

72157 .... ............ A ........ Mri chest spine w/o & w/dye ............... 2.57 16.20 20.95 NA NA 1.42 XXX 

72157 .... TC ...... A ........ Mri chest spine w/o & w/dye ............... 0.00 15.30 20.08 NA NA 1.31 XXX 

72157 .... 26 ....... A ........ Mri chest spine w/o & w/dye ............... 2.57 0.90 0.87 0.90 0.87 0.11 XXX 

72158 .... ............ A ........ Mri lumbar spine w/o & w/dye ............ 2.36 17.68 21.66 NA NA 1.41 XXX 

72158 .... TC ...... A ........ Mri lumbar spine w/o & w/dye ............ 0.00 16.86 20.86 NA NA 1.31 XXX 

72158 .... 26 ....... A ........ Mri lumbar spine w/o & w/dye ............ 2.36 0.82 0.80 0.82 0.80 0.10 XXX 

72159 .... ............ N ........ Mr angio spine w/o&w/dye .................. 1.80 14.65 13.78 NA NA 0.74 XXX 

72159 .... TC ...... N ........ Mr angio spine w/o&w/dye .................. 0.00 14.24 13.23 NA NA 0.64 XXX 

72159 .... 26 ....... N ........ Mr angio spine w/o&w/dye .................. 1.80 0.41 0.55 0.41 0.55 0.10 XXX 

72170 .... ............ A ........ X-ray exam of pelvis ........................... 0.17 0.50 0.54 NA NA 0.03 XXX 

72170 .... TC ...... A ........ X-ray exam of pelvis ........................... 0.00 0.44 0.48 NA NA 0.02 XXX 

72170 .... 26 ....... A ........ X-ray exam of pelvis ........................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

72190 .... ............ A ........ X-ray exam of pelvis ........................... 0.21 0.84 0.79 NA NA 0.05 XXX 

72190 .... TC ...... A ........ X-ray exam of pelvis ........................... 0.00 0.77 0.72 NA NA 0.04 XXX 

72190 .... 26 ....... A ........ X-ray exam of pelvis ........................... 0.21 0.07 0.07 0.07 0.07 0.01 XXX 

72191 .... ............ A ........ Ct angiograph pelv w/o&w/dye ........... 1.81 11.32 11.97 NA NA 0.47 XXX 

72191 .... TC ...... A ........ Ct angiograph pelv w/o&w/dye ........... 0.00 10.67 11.35 NA NA 0.39 XXX 

72191 .... 26 ....... A ........ Ct angiograph pelv w/o&w/dye ........... 1.81 0.65 0.62 0.65 0.62 0.08 XXX 

72192 .... ............ A ........ Ct pelvis w/o dye ................................ 1.09 6.03 6.15 NA NA 0.36 XXX 

72192 .... TC ...... A ........ Ct pelvis w/o dye ................................ 0.00 5.64 5.78 NA NA 0.31 XXX 

72192 .... 26 ....... A ........ Ct pelvis w/o dye ................................ 1.09 0.39 0.37 0.39 0.37 0.05 XXX 

72193 .... ............ A ........ Ct pelvis w/dye .................................... 1.16 7.54 7.37 NA NA 0.41 XXX 

72193 .... TC ...... A ........ Ct pelvis w/dye .................................... 0.00 7.13 6.98 NA NA 0.36 XXX 

72193 .... 26 ....... A ........ Ct pelvis w/dye .................................... 1.16 0.41 0.39 0.41 0.39 0.05 XXX 

72194 .... ............ A ........ Ct pelvis w/o & w/dye ......................... 1.22 10.12 9.49 NA NA 0.48 XXX 

72194 .... TC ...... A ........ Ct pelvis w/o & w/dye ......................... 0.00 9.69 9.08 NA NA 0.43 XXX 

72194 .... 26 ....... A ........ Ct pelvis w/o & w/dye ......................... 1.22 0.43 0.41 0.43 0.41 0.05 XXX 

72195 .... ............ A ........ Mri pelvis w/o dye ............................... 1.46 14.43 13.04 NA NA 0.51 XXX 

72195 .... TC ...... A ........ Mri pelvis w/o dye ............................... 0.00 13.92 12.55 NA NA 0.45 XXX 

72195 .... 26 ....... A ........ Mri pelvis w/o dye ............................... 1.46 0.51 0.49 0.51 0.49 0.06 XXX 

72196 .... ............ A ........ Mri pelvis w/dye .................................. 1.73 15.52 14.76 NA NA 0.60 XXX 

72196 .... TC ...... A ........ Mri pelvis w/dye .................................. 0.00 14.91 14.17 NA NA 0.52 XXX 

72196 .... 26 ....... A ........ Mri pelvis w/dye .................................. 1.73 0.61 0.59 0.61 0.59 0.08 XXX 

72197 .... ............ A ........ Mri pelvis w/o & w/dye ........................ 2.26 18.95 22.27 NA NA 1.02 XXX 

72197 .... TC ...... A ........ Mri pelvis w/o & w/dye ........................ 0.00 18.16 21.51 NA NA 0.92 XXX 

72197 .... 26 ....... A ........ Mri pelvis w/o & w/dye ........................ 2.26 0.79 0.76 0.79 0.76 0.10 XXX 

72198 .... ............ A ........ Mr angio pelvis w/o & w/dye ............... 1.80 15.08 13.42 NA NA 0.67 XXX 

72198 .... TC ...... A ........ Mr angio pelvis w/o & w/dye ............... 0.00 14.44 12.81 NA NA 0.59 XXX 

72198 .... 26 ....... A ........ Mr angio pelvis w/o & w/dye ............... 1.80 0.64 0.61 0.64 0.61 0.08 XXX 

72200 .... ............ A ........ X-ray exam sacroiliac joints ................ 0.17 0.59 0.59 NA NA 0.03 XXX 

72200 .... TC ...... A ........ X-ray exam sacroiliac joints ................ 0.00 0.54 0.53 NA NA 0.02 XXX 

72200 .... 26 ....... A ........ X-ray exam sacroiliac joints ................ 0.17 0.05 0.06 0.05 0.06 0.01 XXX 

72202 .... ............ A ........ X-ray exam sacroiliac joints ................ 0.19 0.74 0.71 NA NA 0.05 XXX 


cprice-sewell on PROD1PC72 with RULES
66494 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

72202 .... TC ...... A ........ X-ray exam sacroiliac joints ................ 0.00 0.67 0.65 NA NA 0.04 XXX 

72202 .... 26 ....... A ........ X-ray exam sacroiliac joints ................ 0.19 0.07 0.06 0.07 0.06 0.01 XXX 

72220 .... ............ A ........ X-ray exam of tailbone ........................ 0.17 0.57 0.61 NA NA 0.05 XXX 

72220 .... TC ...... A ........ X-ray exam of tailbone ........................ 0.00 0.52 0.55 NA NA 0.04 XXX 

72220 .... 26 ....... A ........ X-ray exam of tailbone ........................ 0.17 0.05 0.06 0.05 0.06 0.01 XXX 

72240 .... ............ A ........ Contrast x-ray of neck spine ............... 0.91 2.58 3.80 NA NA 0.29 XXX 

72240 .... TC ...... A ........ Contrast x-ray of neck spine ............... 0.00 2.26 3.50 NA NA 0.25 XXX 

72240 .... 26 ....... A ........ Contrast x-ray of neck spine ............... 0.91 0.32 0.30 0.32 0.30 0.04 XXX 

72255 .... ............ A ........ Contrast x-ray, thorax spine ............... 0.91 2.24 3.42 NA NA 0.26 XXX 

72255 .... TC ...... A ........ Contrast x-ray, thorax spine ............... 0.00 1.96 3.14 NA NA 0.22 XXX 

72255 .... 26 ....... A ........ Contrast x-ray, thorax spine ............... 0.91 0.28 0.28 0.28 0.28 0.04 XXX 

72265 .... ............ A ........ Contrast x-ray, lower spine ................. 0.83 2.53 3.43 NA NA 0.26 XXX 

72265 .... TC ...... A ........ Contrast x-ray, lower spine ................. 0.00 2.24 3.16 NA NA 0.22 XXX 

72265 .... 26 ....... A ........ Contrast x-ray, lower spine ................. 0.83 0.29 0.27 0.29 0.27 0.04 XXX 

72270 .... ............ A ........ Contrast x-ray, spine ........................... 1.33 3.99 5.26 NA NA 0.39 XXX 

72270 .... TC ...... A ........ Contrast x-ray, spine ........................... 0.00 3.52 4.81 NA NA 0.33 XXX 

72270 .... 26 ....... A ........ Contrast x-ray, spine ........................... 1.33 0.47 0.45 0.47 0.45 0.06 XXX 

72275 .... ............ A ........ Epidurography ..................................... 0.76 1.73 2.02 NA NA 0.26 XXX 

72275 .... TC ...... A ........ Epidurography ..................................... 0.00 1.53 1.82 NA NA 0.22 XXX 

72275 .... 26 ....... A ........ Epidurography ..................................... 0.76 0.20 0.20 0.20 0.20 0.04 XXX 

72285 .... ............ A ........ X-ray c/t spine disk ............................. 1.16 1.44 5.08 NA NA 0.50 XXX 

72285 .... TC ...... A ........ X-ray c/t spine disk ............................. 0.00 1.14 4.75 NA NA 0.43 XXX 

72285 .... 26 ....... A ........ X-ray c/t spine disk ............................. 1.16 0.30 0.33 0.30 0.33 0.07 XXX 

72291 .... ............ C ........ Perq vertebroplasty, fluor .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

72291 .... TC ...... C ........ Perq vertebroplasty, fluor .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

72291 .... 26 ....... A ........ Perq vertebroplasty, fluor .................... 1.31 0.47 0.47 0.47 0.47 0.10 XXX 

72292 .... ............ C ........ Perq vertebroplasty, ct ........................ 0.00 0.00 0.00 NA NA 0.00 XXX 

72292 .... TC ...... C ........ Perq vertebroplasty, ct ........................ 0.00 0.00 0.00 NA NA 0.00 XXX 

72292 .... 26 ....... A ........ Perq vertebroplasty, ct ........................ 1.38 0.50 0.49 0.50 0.49 0.07 XXX 

72295 .... ............ A ........ X-ray of lower spine disk .................... 0.83 1.45 4.79 NA NA 0.46 XXX 

72295 .... TC ...... A ........ X-ray of lower spine disk .................... 0.00 1.21 4.53 NA NA 0.40 XXX 

72295 .... 26 ....... A ........ X-ray of lower spine disk .................... 0.83 0.24 0.26 0.24 0.26 0.06 XXX 

73000 .... ............ A ........ X-ray exam of collar bone .................. 0.16 0.55 0.56 NA NA 0.03 XXX 

73000 .... TC ...... A ........ X-ray exam of collar bone .................. 0.00 0.50 0.51 NA NA 0.02 XXX 

73000 .... 26 ....... A ........ X-ray exam of collar bone .................. 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

73010 .... ............ A ........ X-ray exam of shoulder blade ............ 0.17 0.58 0.58 NA NA 0.03 XXX 

73010 .... TC ...... A ........ X-ray exam of shoulder blade ............ 0.00 0.52 0.52 NA NA 0.02 XXX 

73010 .... 26 ....... A ........ X-ray exam of shoulder blade ............ 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73020 .... ............ A ........ X-ray exam of shoulder ...................... 0.15 0.44 0.48 NA NA 0.03 XXX 

73020 .... TC ...... A ........ X-ray exam of shoulder ...................... 0.00 0.39 0.43 NA NA 0.02 XXX 

73020 .... 26 ....... A ........ X-ray exam of shoulder ...................... 0.15 0.05 0.05 0.05 0.05 0.01 XXX 

73030 .... ............ A ........ X-ray exam of shoulder ...................... 0.18 0.57 0.60 NA NA 0.05 XXX 

73030 .... TC ...... A ........ X-ray exam of shoulder ...................... 0.00 0.51 0.54 NA NA 0.04 XXX 

73030 .... 26 ....... A ........ X-ray exam of shoulder ...................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX 

73040 .... ............ A ........ Contrast x-ray of shoulder .................. 0.54 2.24 2.26 NA NA 0.14 XXX 

73040 .... TC ...... A ........ Contrast x-ray of shoulder .................. 0.00 2.05 2.08 NA NA 0.12 XXX 

73040 .... 26 ....... A ........ Contrast x-ray of shoulder .................. 0.54 0.19 0.18 0.19 0.18 0.02 XXX 

73050 .... ............ A ........ X-ray exam of shoulders ..................... 0.20 0.74 0.73 NA NA 0.05 XXX 

73050 .... TC ...... A ........ X-ray exam of shoulders ..................... 0.00 0.66 0.66 NA NA 0.04 XXX 

73050 .... 26 ....... A ........ X-ray exam of shoulders ..................... 0.20 0.08 0.07 0.08 0.07 0.01 XXX 

73060 .... ............ A ........ X-ray exam of humerus ...................... 0.17 0.58 0.60 NA NA 0.05 XXX 

73060 .... TC ...... A ........ X-ray exam of humerus ...................... 0.00 0.52 0.54 NA NA 0.04 XXX 

73060 .... 26 ....... A ........ X-ray exam of humerus ...................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73070 .... ............ A ........ X-ray exam of elbow ........................... 0.15 0.55 0.56 NA NA 0.03 XXX 

73070 .... TC ...... A ........ X-ray exam of elbow ........................... 0.00 0.50 0.51 NA NA 0.02 XXX 

73070 .... 26 ....... A ........ X-ray exam of elbow ........................... 0.15 0.05 0.05 0.05 0.05 0.01 XXX 

73080 .... ............ A ........ X-ray exam of elbow ........................... 0.17 0.76 0.69 NA NA 0.05 XXX 

73080 .... TC ...... A ........ X-ray exam of elbow ........................... 0.00 0.70 0.63 NA NA 0.04 XXX 

73080 .... 26 ....... A ........ X-ray exam of elbow ........................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73085 .... ............ A ........ Contrast x-ray of elbow ....................... 0.54 1.83 2.07 NA NA 0.14 XXX 

73085 .... TC ...... A ........ Contrast x-ray of elbow ....................... 0.00 1.65 1.88 NA NA 0.12 XXX 

73085 .... 26 ....... A ........ Contrast x-ray of elbow ....................... 0.54 0.18 0.19 0.18 0.19 0.02 XXX 

73090 .... ............ A ........ X-ray exam of forearm ........................ 0.16 0.55 0.56 NA NA 0.03 XXX 

73090 .... TC ...... A ........ X-ray exam of forearm ........................ 0.00 0.50 0.51 NA NA 0.02 XXX 

73090 .... 26 ....... A ........ X-ray exam of forearm ........................ 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

73092 .... ............ A ........ X-ray exam of arm, infant ................... 0.16 0.58 0.56 NA NA 0.03 XXX 

73092 .... TC ...... A ........ X-ray exam of arm, infant ................... 0.00 0.53 0.51 NA NA 0.02 XXX 

73092 .... 26 ....... A ........ X-ray exam of arm, infant ................... 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

73100 .... ............ A ........ X-ray exam of wrist ............................. 0.16 0.61 0.57 NA NA 0.03 XXX 

73100 .... TC ...... A ........ X-ray exam of wrist ............................. 0.00 0.55 0.52 NA NA 0.02 XXX 

73100 .... 26 ....... A ........ X-ray exam of wrist ............................. 0.16 0.06 0.05 0.06 0.05 0.01 XXX 

73110 .... ............ A ........ X-ray exam of wrist ............................. 0.17 0.78 0.68 NA NA 0.03 XXX 


cprice-sewell on PROD1PC72 with RULES
66495 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

73110 .... TC ...... A ........ X-ray exam of wrist ............................. 0.00 0.72 0.62 NA NA 0.02 XXX 

73110 .... 26 ....... A ........ X-ray exam of wrist ............................. 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73115 .... ............ A ........ Contrast x-ray of wrist ......................... 0.54 2.33 2.04 NA NA 0.12 XXX 

73115 .... TC ...... A ........ Contrast x-ray of wrist ......................... 0.00 2.14 1.86 NA NA 0.10 XXX 

73115 .... 26 ....... A ........ Contrast x-ray of wrist ......................... 0.54 0.19 0.18 0.19 0.18 0.02 XXX 

73120 .... ............ A ........ X-ray exam of hand ............................ 0.16 0.56 0.55 NA NA 0.03 XXX 

73120 .... TC ...... A ........ X-ray exam of hand ............................ 0.00 0.51 0.50 NA NA 0.02 XXX 

73120 .... 26 ....... A ........ X-ray exam of hand ............................ 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

73130 .... ............ A ........ X-ray exam of hand ............................ 0.17 0.66 0.62 NA NA 0.03 XXX 

73130 .... TC ...... A ........ X-ray exam of hand ............................ 0.00 0.60 0.56 NA NA 0.02 XXX 

73130 .... 26 ....... A ........ X-ray exam of hand ............................ 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73140 .... ............ A ........ X-ray exam of finger(s) ....................... 0.13 0.67 0.57 NA NA 0.03 XXX 

73140 .... TC ...... A ........ X-ray exam of finger(s) ....................... 0.00 0.63 0.53 NA NA 0.02 XXX 

73140 .... 26 ....... A ........ X-ray exam of finger(s) ....................... 0.13 0.04 0.04 0.04 0.04 0.01 XXX 

73200 .... ............ A ........ Ct upper extremity w/o dye ................. 1.09 6.39 5.85 NA NA 0.30 XXX 

73200 .... TC ...... A ........ Ct upper extremity w/o dye ................. 0.00 6.01 5.48 NA NA 0.25 XXX 

73200 .... 26 ....... A ........ Ct upper extremity w/o dye ................. 1.09 0.38 0.37 0.38 0.37 0.05 XXX 

73201 .... ............ A ........ Ct upper extremity w/dye .................... 1.16 7.91 7.09 NA NA 0.36 XXX 

73201 .... TC ...... A ........ Ct upper extremity w/dye .................... 0.00 7.50 6.70 NA NA 0.31 XXX 

73201 .... 26 ....... A ........ Ct upper extremity w/dye .................... 1.16 0.41 0.39 0.41 0.39 0.05 XXX 

73202 .... ............ A ........ Ct uppr extremity w/o&w/dye .............. 1.22 10.54 9.18 NA NA 0.44 XXX 

73202 .... TC ...... A ........ Ct uppr extremity w/o&w/dye .............. 0.00 10.12 8.77 NA NA 0.39 XXX 

73202 .... 26 ....... A ........ Ct uppr extremity w/o&w/dye .............. 1.22 0.42 0.41 0.42 0.41 0.05 XXX 

73206 .... ............ A ........ Ct angio upr extrm w/o&w/dye ........... 1.81 10.91 11.23 NA NA 0.47 XXX 

73206 .... TC ...... A ........ Ct angio upr extrm w/o&w/dye ........... 0.00 10.24 10.60 NA NA 0.39 XXX 

73206 .... 26 ....... A ........ Ct angio upr extrm w/o&w/dye ........... 1.81 0.67 0.63 0.67 0.63 0.08 XXX 

73218 .... ............ A ........ Mri upper extremity w/o dye ............... 1.35 14.63 13.13 NA NA 0.45 XXX 

73218 .... TC ...... A ........ Mri upper extremity w/o dye ............... 0.00 14.17 12.68 NA NA 0.39 XXX 

73218 .... 26 ....... A ........ Mri upper extremity w/o dye ............... 1.35 0.46 0.45 0.46 0.45 0.06 XXX 

73219 .... ............ A ........ Mri upper extremity w/dye .................. 1.62 15.39 14.68 NA NA 0.54 XXX 

73219 .... TC ...... A ........ Mri upper extremity w/dye .................. 0.00 14.83 14.13 NA NA 0.47 XXX 

73219 .... 26 ....... A ........ Mri upper extremity w/dye .................. 1.62 0.56 0.55 0.56 0.55 0.07 XXX 

73220 .... ............ A ........ Mri uppr extremity w/o&w/dye ............ 2.15 19.03 22.31 NA NA 0.94 XXX 

73220 .... TC ...... A ........ Mri uppr extremity w/o&w/dye ............ 0.00 18.29 21.58 NA NA 0.84 XXX 

73220 .... 26 ....... A ........ Mri uppr extremity w/o&w/dye ............ 2.15 0.74 0.73 0.74 0.73 0.10 XXX 

73221 .... ............ A ........ Mri joint upr extrem w/o dye ............... 1.35 13.55 12.59 NA NA 0.45 XXX 

73221 .... TC ...... A ........ Mri joint upr extrem w/o dye ............... 0.00 13.08 12.14 NA NA 0.39 XXX 

73221 .... 26 ....... A ........ Mri joint upr extrem w/o dye ............... 1.35 0.47 0.45 0.47 0.45 0.06 XXX 

73222 .... ............ A ........ Mri joint upr extrem w/dye .................. 1.62 14.29 14.12 NA NA 0.54 XXX 

73222 .... TC ...... A ........ Mri joint upr extrem w/dye .................. 0.00 13.73 13.58 NA NA 0.47 XXX 

73222 .... 26 ....... A ........ Mri joint upr extrem w/dye .................. 1.62 0.56 0.54 0.56 0.54 0.07 XXX 

73223 .... ............ A ........ Mri joint upr extr w/o&w/dye ............... 2.15 17.56 21.56 NA NA 0.94 XXX 

73223 .... TC ...... A ........ Mri joint upr extr w/o&w/dye ............... 0.00 16.82 20.84 NA NA 0.84 XXX 

73223 .... 26 ....... A ........ Mri joint upr extr w/o&w/dye ............... 2.15 0.74 0.72 0.74 0.72 0.10 XXX 

73225 .... ............ N ........ Mr angio upr extr w/o&w/dye .............. 1.73 14.64 13.15 NA NA 0.69 XXX 

73225 .... TC ...... N ........ Mr angio upr extr w/o&w/dye .............. 0.00 14.24 12.62 NA NA 0.59 XXX 

73225 .... 26 ....... N ........ Mr angio upr extr w/o&w/dye .............. 1.73 0.40 0.53 0.40 0.53 0.10 XXX 

73500 .... ............ A ........ X-ray exam of hip ............................... 0.17 0.49 0.51 NA NA 0.03 XXX 

73500 .... TC ...... A ........ X-ray exam of hip ............................... 0.00 0.43 0.45 NA NA 0.02 XXX 

73500 .... 26 ....... A ........ X-ray exam of hip ............................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73510 .... ............ A ........ X-ray exam of hip ............................... 0.21 0.77 0.71 NA NA 0.05 XXX 

73510 .... TC ...... A ........ X-ray exam of hip ............................... 0.00 0.70 0.64 NA NA 0.04 XXX 

73510 .... 26 ....... A ........ X-ray exam of hip ............................... 0.21 0.07 0.07 0.07 0.07 0.01 XXX 

73520 .... ............ A ........ X-ray exam of hips .............................. 0.26 0.79 0.77 NA NA 0.05 XXX 

73520 .... TC ...... A ........ X-ray exam of hips .............................. 0.00 0.70 0.68 NA NA 0.04 XXX 

73520 .... 26 ....... A ........ X-ray exam of hips .............................. 0.26 0.09 0.09 0.09 0.09 0.01 XXX 

73525 .... ............ A ........ Contrast x-ray of hip ........................... 0.54 1.82 2.05 NA NA 0.15 XXX 

73525 .... TC ...... A ........ Contrast x-ray of hip ........................... 0.00 1.64 1.87 NA NA 0.12 XXX 

73525 .... 26 ....... A ........ Contrast x-ray of hip ........................... 0.54 0.18 0.18 0.18 0.18 0.03 XXX 

73530 .... ............ C ........ X-ray exam of hip ............................... 0.00 0.00 0.00 NA NA 0.00 XXX 

73530 .... TC ...... C ........ X-ray exam of hip ............................... 0.00 0.00 0.00 NA NA 0.00 XXX 

73530 .... 26 ....... A ........ X-ray exam of hip ............................... 0.29 0.11 0.10 0.11 0.10 0.01 XXX 

73540 .... ............ A ........ X-ray exam of pelvis & hips ................ 0.20 0.81 0.72 NA NA 0.05 XXX 

73540 .... TC ...... A ........ X-ray exam of pelvis & hips ................ 0.00 0.74 0.65 NA NA 0.04 XXX 

73540 .... 26 ....... A ........ X-ray exam of pelvis & hips ................ 0.20 0.07 0.07 0.07 0.07 0.01 XXX 

73542 .... ............ A ........ X-ray exam, sacroiliac joint ................. 0.59 1.12 1.69 NA NA 0.15 XXX 

73542 .... TC ...... A ........ X-ray exam, sacroiliac joint ................. 0.00 0.98 1.54 NA NA 0.12 XXX 

73542 .... 26 ....... A ........ X-ray exam, sacroiliac joint ................. 0.59 0.14 0.15 0.14 0.15 0.03 XXX 

73550 .... ............ A ........ X-ray exam of thigh ............................ 0.17 0.55 0.59 NA NA 0.05 XXX 

73550 .... TC ...... A ........ X-ray exam of thigh ............................ 0.00 0.49 0.53 NA NA 0.04 XXX 

73550 .... 26 ....... A ........ X-ray exam of thigh ............................ 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73560 .... ............ A ........ X-ray exam of knee, 1 or 2 ................. 0.17 0.58 0.58 NA NA 0.03 XXX 


cprice-sewell on PROD1PC72 with RULES
66496 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

73560 .... TC ...... A ........ X-ray exam of knee, 1 or 2 ................. 0.00 0.52 0.52 NA NA 0.02 XXX 

73560 .... 26 ....... A ........ X-ray exam of knee, 1 or 2 ................. 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73562 .... ............ A ........ X-ray exam of knee, 3 ........................ 0.18 0.73 0.68 NA NA 0.05 XXX 

73562 .... TC ...... A ........ X-ray exam of knee, 3 ........................ 0.00 0.66 0.62 NA NA 0.04 XXX 

73562 .... 26 ....... A ........ X-ray exam of knee, 3 ........................ 0.18 0.07 0.06 0.07 0.06 0.01 XXX 

73564 .... ............ A ........ X-ray exam, knee, 4 or more .............. 0.22 0.86 0.77 NA NA 0.05 XXX 

73564 .... TC ...... A ........ X-ray exam, knee, 4 or more .............. 0.00 0.78 0.70 NA NA 0.04 XXX 

73564 .... 26 ....... A ........ X-ray exam, knee, 4 or more .............. 0.22 0.08 0.07 0.08 0.07 0.01 XXX 

73565 .... ............ A ........ X-ray exam of knees ........................... 0.17 0.65 0.60 NA NA 0.03 XXX 

73565 .... TC ...... A ........ X-ray exam of knees ........................... 0.00 0.59 0.54 NA NA 0.02 XXX 

73565 .... 26 ....... A ........ X-ray exam of knees ........................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73580 .... ............ A ........ Contrast x-ray of knee joint ................ 0.54 2.55 2.67 NA NA 0.17 XXX 

73580 .... TC ...... A ........ Contrast x-ray of knee joint ................ 0.00 2.36 2.49 NA NA 0.14 XXX 

73580 .... 26 ....... A ........ Contrast x-ray of knee joint ................ 0.54 0.19 0.18 0.19 0.18 0.03 XXX 

73590 .... ............ A ........ X-ray exam of lower leg ...................... 0.17 0.54 0.56 NA NA 0.03 XXX 

73590 .... TC ...... A ........ X-ray exam of lower leg ...................... 0.00 0.48 0.50 NA NA 0.02 XXX 

73590 .... 26 ....... A ........ X-ray exam of lower leg ...................... 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73592 .... ............ A ........ X-ray exam of leg, infant .................... 0.16 0.58 0.56 NA NA 0.03 XXX 

73592 .... TC ...... A ........ X-ray exam of leg, infant .................... 0.00 0.53 0.51 NA NA 0.02 XXX 

73592 .... 26 ....... A ........ X-ray exam of leg, infant .................... 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

73600 .... ............ A ........ X-ray exam of ankle ............................ 0.16 0.56 0.55 NA NA 0.03 XXX 

73600 .... TC ...... A ........ X-ray exam of ankle ............................ 0.00 0.51 0.50 NA NA 0.02 XXX 

73600 .... 26 ....... A ........ X-ray exam of ankle ............................ 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

73610 .... ............ A ........ X-ray exam of ankle ............................ 0.17 0.68 0.63 NA NA 0.03 XXX 

73610 .... TC ...... A ........ X-ray exam of ankle ............................ 0.00 0.62 0.57 NA NA 0.02 XXX 

73610 .... 26 ....... A ........ X-ray exam of ankle ............................ 0.17 0.06 0.06 0.06 0.06 0.01 XXX 

73615 .... ............ A ........ Contrast x-ray of ankle ....................... 0.54 2.00 2.14 NA NA 0.15 XXX 

73615 .... TC ...... A ........ Contrast x-ray of ankle ....................... 0.00 1.82 1.96 NA NA 0.12 XXX 

73615 .... 26 ....... A ........ Contrast x-ray of ankle ....................... 0.54 0.18 0.18 0.18 0.18 0.03 XXX 

73620 .... ............ A ........ X-ray exam of foot .............................. 0.16 0.52 0.54 NA NA 0.03 XXX 

73620 .... TC ...... A ........ X-ray exam of foot .............................. 0.00 0.48 0.49 NA NA 0.02 XXX 

73620 .... 26 ....... A ........ X-ray exam of foot .............................. 0.16 0.04 0.05 0.04 0.05 0.01 XXX 

73630 .... ............ A ........ X-ray exam of foot .............................. 0.17 0.65 0.62 NA NA 0.03 XXX 

73630 .... TC ...... A ........ X-ray exam of foot .............................. 0.00 0.60 0.56 NA NA 0.02 XXX 

73630 .... 26 ....... A ........ X-ray exam of foot .............................. 0.17 0.05 0.06 0.05 0.06 0.01 XXX 

73650 .... ............ A ........ X-ray exam of heel ............................. 0.16 0.55 0.53 NA NA 0.03 XXX 

73650 .... TC ...... A ........ X-ray exam of heel ............................. 0.00 0.50 0.48 NA NA 0.02 XXX 

73650 .... 26 ....... A ........ X-ray exam of heel ............................. 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

73660 .... ............ A ........ X-ray exam of toe(s) ........................... 0.13 0.64 0.55 NA NA 0.03 XXX 

73660 .... TC ...... A ........ X-ray exam of toe(s) ........................... 0.00 0.60 0.51 NA NA 0.02 XXX 

73660 .... 26 ....... A ........ X-ray exam of toe(s) ........................... 0.13 0.04 0.04 0.04 0.04 0.01 XXX 

73700 .... ............ A ........ Ct lower extremity w/o dye ................. 1.09 6.40 5.86 NA NA 0.30 XXX 

73700 .... TC ...... A ........ Ct lower extremity w/o dye ................. 0.00 6.02 5.49 NA NA 0.25 XXX 

73700 .... 26 ....... A ........ Ct lower extremity w/o dye ................. 1.09 0.38 0.37 0.38 0.37 0.05 XXX 

73701 .... ............ A ........ Ct lower extremity w/dye .................... 1.16 7.97 7.13 NA NA 0.36 XXX 

73701 .... TC ...... A ........ Ct lower extremity w/dye .................... 0.00 7.56 6.73 NA NA 0.31 XXX 

73701 .... 26 ....... A ........ Ct lower extremity w/dye .................... 1.16 0.41 0.40 0.41 0.40 0.05 XXX 

73702 .... ............ A ........ Ct lwr extremity w/o&w/dye ................ 1.22 10.72 9.27 NA NA 0.44 XXX 

73702 .... TC ...... A ........ Ct lwr extremity w/o&w/dye ................ 0.00 10.28 8.85 NA NA 0.39 XXX 

73702 .... 26 ....... A ........ Ct lwr extremity w/o&w/dye ................ 1.22 0.44 0.42 0.44 0.42 0.05 XXX 

73706 .... ............ A ........ Ct angio lwr extr w/o&w/dye ............... 1.90 12.34 11.96 NA NA 0.47 XXX 

73706 .... TC ...... A ........ Ct angio lwr extr w/o&w/dye ............... 0.00 11.62 11.29 NA NA 0.39 XXX 

73706 .... 26 ....... A ........ Ct angio lwr extr w/o&w/dye ............... 1.90 0.72 0.67 0.72 0.67 0.08 XXX 

73718 .... ............ A ........ Mri lower extremity w/o dye ................ 1.35 14.25 12.94 NA NA 0.45 XXX 

73718 .... TC ...... A ........ Mri lower extremity w/o dye ................ 0.00 13.79 12.49 NA NA 0.39 XXX 

73718 .... 26 ....... A ........ Mri lower extremity w/o dye ................ 1.35 0.46 0.45 0.46 0.45 0.06 XXX 

73719 .... ............ A ........ Mri lower extremity w/dye ................... 1.62 15.39 14.68 NA NA 0.54 XXX 

73719 .... TC ...... A ........ Mri lower extremity w/dye ................... 0.00 14.82 14.13 NA NA 0.47 XXX 

73719 .... 26 ....... A ........ Mri lower extremity w/dye ................... 1.62 0.57 0.55 0.57 0.55 0.07 XXX 

73720 .... ............ A ........ Mri lwr extremity w/o&w/dye ............... 2.15 18.98 22.27 NA NA 0.94 XXX 

73720 .... TC ...... A ........ Mri lwr extremity w/o&w/dye ............... 0.00 18.23 21.55 NA NA 0.84 XXX 

73720 .... 26 ....... A ........ Mri lwr extremity w/o&w/dye ............... 2.15 0.75 0.72 0.75 0.72 0.10 XXX 

73721 .... ............ A ........ Mri jnt of lwr extre w/o dye ................. 1.35 13.86 12.74 NA NA 0.45 XXX 

73721 .... TC ...... A ........ Mri jnt of lwr extre w/o dye ................. 0.00 13.39 12.29 NA NA 0.39 XXX 

73721 .... 26 ....... A ........ Mri jnt of lwr extre w/o dye ................. 1.35 0.47 0.45 0.47 0.45 0.06 XXX 

73722 .... ............ A ........ Mri joint of lwr extr w/dye .................... 1.62 14.48 14.22 NA NA 0.54 XXX 

73722 .... TC ...... A ........ Mri joint of lwr extr w/dye .................... 0.00 13.91 13.67 NA NA 0.47 XXX 

73722 .... 26 ....... A ........ Mri joint of lwr extr w/dye .................... 1.62 0.57 0.55 0.57 0.55 0.07 XXX 

73723 .... ............ A ........ Mri joint lwr extr w/o&w/dye ................ 2.15 17.54 21.55 NA NA 0.94 XXX 

73723 .... TC ...... A ........ Mri joint lwr extr w/o&w/dye ................ 0.00 16.80 20.83 NA NA 0.84 XXX 

73723 .... 26 ....... A ........ Mri joint lwr extr w/o&w/dye ................ 2.15 0.74 0.72 0.74 0.72 0.10 XXX 

73725 .... ............ R ........ Mr ang lwr ext w or w/o dye ............... 1.82 15.11 13.45 NA NA 0.67 XXX 


cprice-sewell on PROD1PC72 with RULES
66497 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

73725 .... TC ...... R ........ Mr ang lwr ext w or w/o dye ............... 0.00 14.47 12.83 NA NA 0.59 XXX 

73725 .... 26 ....... R ........ Mr ang lwr ext w or w/o dye ............... 1.82 0.64 0.62 0.64 0.62 0.08 XXX 

74000 .... ............ A ........ X-ray exam of abdomen ..................... 0.18 0.46 0.52 NA NA 0.03 XXX 

74000 .... TC ...... A ........ X-ray exam of abdomen ..................... 0.00 0.40 0.46 NA NA 0.02 XXX 

74000 .... 26 ....... A ........ X-ray exam of abdomen ..................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX 

74010 .... ............ A ........ X-ray exam of abdomen ..................... 0.23 0.79 0.72 NA NA 0.05 XXX 

74010 .... TC ...... A ........ X-ray exam of abdomen ..................... 0.00 0.71 0.64 NA NA 0.04 XXX 

74010 .... 26 ....... A ........ X-ray exam of abdomen ..................... 0.23 0.08 0.08 0.08 0.08 0.01 XXX 

74020 .... ............ A ........ X-ray exam of abdomen ..................... 0.27 0.81 0.76 NA NA 0.05 XXX 

74020 .... TC ...... A ........ X-ray exam of abdomen ..................... 0.00 0.72 0.67 NA NA 0.04 XXX 

74020 .... 26 ....... A ........ X-ray exam of abdomen ..................... 0.27 0.09 0.09 0.09 0.09 0.01 XXX 

74022 .... ............ A ........ X-ray exam series, abdomen .............. 0.32 0.98 0.91 NA NA 0.06 XXX 

74022 .... TC ...... A ........ X-ray exam series, abdomen .............. 0.00 0.87 0.80 NA NA 0.05 XXX 

74022 .... 26 ....... A ........ X-ray exam series, abdomen .............. 0.32 0.11 0.11 0.11 0.11 0.01 XXX 

74150 .... ............ A ........ Ct abdomen w/o dye ........................... 1.19 6.06 6.06 NA NA 0.35 XXX 

74150 .... TC ...... A ........ Ct abdomen w/o dye ........................... 0.00 5.64 5.65 NA NA 0.30 XXX 

74150 .... 26 ....... A ........ Ct abdomen w/o dye ........................... 1.19 0.42 0.41 0.42 0.41 0.05 XXX 

74160 .... ............ A ........ Ct abdomen w/dye .............................. 1.27 8.81 8.03 NA NA 0.42 XXX 

74160 .... TC ...... A ........ Ct abdomen w/dye .............................. 0.00 8.36 7.60 NA NA 0.36 XXX 

74160 .... 26 ....... A ........ Ct abdomen w/dye .............................. 1.27 0.45 0.43 0.45 0.43 0.06 XXX 

74170 .... ............ A ........ Ct abdomen w/o & w/dye ................... 1.40 12.17 10.56 NA NA 0.49 XXX 

74170 .... TC ...... A ........ Ct abdomen w/o & w/dye ................... 0.00 11.68 10.08 NA NA 0.43 XXX 

74170 .... 26 ....... A ........ Ct abdomen w/o & w/dye ................... 1.40 0.49 0.48 0.49 0.48 0.06 XXX 

74175 .... ............ A ........ Ct angio abdom w/o & w/dye ............. 1.90 12.27 12.45 NA NA 0.47 XXX 

74175 .... TC ...... A ........ Ct angio abdom w/o & w/dye ............. 0.00 11.58 11.80 NA NA 0.39 XXX 

74175 .... 26 ....... A ........ Ct angio abdom w/o & w/dye ............. 1.90 0.69 0.65 0.69 0.65 0.08 XXX 

74181 .... ............ A ........ Mri abdomen w/o dye ......................... 1.46 12.44 12.06 NA NA 0.51 XXX 

74181 .... TC ...... A ........ Mri abdomen w/o dye ......................... 0.00 11.93 11.56 NA NA 0.45 XXX 

74181 .... 26 ....... A ........ Mri abdomen w/o dye ......................... 1.46 0.51 0.50 0.51 0.50 0.06 XXX 

74182 .... ............ A ........ Mri abdomen w/dye ............................ 1.73 17.42 15.72 NA NA 0.60 XXX 

74182 .... TC ...... A ........ Mri abdomen w/dye ............................ 0.00 16.82 15.13 NA NA 0.52 XXX 

74182 .... 26 ....... A ........ Mri abdomen w/dye ............................ 1.73 0.60 0.59 0.60 0.59 0.08 XXX 

74183 .... ............ A ........ Mri abdomen w/o & w/dye .................. 2.26 18.98 22.29 NA NA 1.02 XXX 

74183 .... TC ...... A ........ Mri abdomen w/o & w/dye .................. 0.00 18.19 21.53 NA NA 0.92 XXX 

74183 .... 26 ....... A ........ Mri abdomen w/o & w/dye .................. 2.26 0.79 0.76 0.79 0.76 0.10 XXX 

74185 .... ............ R ........ Mri angio, abdom w orw/o dye ........... 1.80 15.07 13.42 NA NA 0.67 XXX 

74185 .... TC ...... R ........ Mri angio, abdom w orw/o dye ........... 0.00 14.43 12.81 NA NA 0.59 XXX 

74185 .... 26 ....... R ........ Mri angio, abdom w orw/o dye ........... 1.80 0.64 0.61 0.64 0.61 0.08 XXX 

74190 .... ............ C ........ X-ray exam of peritoneum .................. 0.00 0.00 0.00 NA NA 0.00 XXX 

74190 .... TC ...... C ........ X-ray exam of peritoneum .................. 0.00 0.00 0.00 NA NA 0.00 XXX 

74190 .... 26 ....... A ........ X-ray exam of peritoneum .................. 0.48 0.17 0.16 0.17 0.16 0.02 XXX 

74210 .... ............ A ........ Contrst x-ray exam of throat ............... 0.36 1.77 1.53 NA NA 0.08 XXX 

74210 .... TC ...... A ........ Contrst x-ray exam of throat ............... 0.00 1.64 1.41 NA NA 0.06 XXX 

74210 .... 26 ....... A ........ Contrst x-ray exam of throat ............... 0.36 0.13 0.12 0.13 0.12 0.02 XXX 

74220 .... ............ A ........ Contrast x-ray, esophagus .................. 0.46 2.01 1.68 NA NA 0.08 XXX 

74220 .... TC ...... A ........ Contrast x-ray, esophagus .................. 0.00 1.85 1.52 NA NA 0.06 XXX 

74220 .... 26 ....... A ........ Contrast x-ray, esophagus .................. 0.46 0.16 0.16 0.16 0.16 0.02 XXX 

74230 .... ............ A ........ Cine/vid x-ray, throat/esoph ................ 0.53 1.95 1.71 NA NA 0.09 XXX 

74230 .... TC ...... A ........ Cine/vid x-ray, throat/esoph ................ 0.00 1.76 1.53 NA NA 0.07 XXX 

74230 .... 26 ....... A ........ Cine/vid x-ray, throat/esoph ................ 0.53 0.19 0.18 0.19 0.18 0.02 XXX 

74235 .... ............ C ........ Remove esophagus obstruction ......... 0.00 0.00 0.00 NA NA 0.00 XXX 

74235 .... TC ...... C ........ Remove esophagus obstruction ......... 0.00 0.00 0.00 NA NA 0.00 XXX 

74235 .... 26 ....... A ........ Remove esophagus obstruction ......... 1.19 0.47 0.43 0.47 0.43 0.05 XXX 

74240 .... ............ A ........ X-ray exam, upper gi tract .................. 0.69 2.30 2.00 NA NA 0.11 XXX 

74240 .... TC ...... A ........ X-ray exam, upper gi tract .................. 0.00 2.06 1.76 NA NA 0.08 XXX 

74240 .... 26 ....... A ........ X-ray exam, upper gi tract .................. 0.69 0.24 0.24 0.24 0.24 0.03 XXX 

74241 .... ............ A ........ X-ray exam, upper gi tract .................. 0.69 2.56 2.13 NA NA 0.11 XXX 

74241 .... TC ...... A ........ X-ray exam, upper gi tract .................. 0.00 2.32 1.90 NA NA 0.08 XXX 

74241 .... 26 ....... A ........ X-ray exam, upper gi tract .................. 0.69 0.24 0.23 0.24 0.23 0.03 XXX 

74245 .... ............ A ........ X-ray exam, upper gi tract .................. 0.91 3.96 3.32 NA NA 0.17 XXX 

74245 .... TC ...... A ........ X-ray exam, upper gi tract .................. 0.00 3.64 3.01 NA NA 0.13 XXX 

74245 .... 26 ....... A ........ X-ray exam, upper gi tract .................. 0.91 0.32 0.31 0.32 0.31 0.04 XXX 

74246 .... ............ A ........ Contrst x-ray uppr gi tract ................... 0.69 2.80 2.33 NA NA 0.13 XXX 

74246 .... TC ...... A ........ Contrst x-ray uppr gi tract ................... 0.00 2.55 2.09 NA NA 0.10 XXX 

74246 .... 26 ....... A ........ Contrst x-ray uppr gi tract ................... 0.69 0.25 0.24 0.25 0.24 0.03 XXX 

74247 .... ............ A ........ Contrst x-ray uppr gi tract ................... 0.69 3.21 2.56 NA NA 0.14 XXX 

74247 .... TC ...... A ........ Contrst x-ray uppr gi tract ................... 0.00 2.97 2.32 NA NA 0.11 XXX 

74247 .... 26 ....... A ........ Contrst x-ray uppr gi tract ................... 0.69 0.24 0.24 0.24 0.24 0.03 XXX 

74249 .... ............ A ........ Contrst x-ray uppr gi tract ................... 0.91 4.35 3.61 NA NA 0.18 XXX 

74249 .... TC ...... A ........ Contrst x-ray uppr gi tract ................... 0.00 4.03 3.30 NA NA 0.14 XXX 

74249 .... 26 ....... A ........ Contrst x-ray uppr gi tract ................... 0.91 0.32 0.31 0.32 0.31 0.04 XXX 

74250 .... ............ A ........ X-ray exam of small bowel ................. 0.47 2.48 1.97 NA NA 0.09 XXX 


cprice-sewell on PROD1PC72 with RULES
66498 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

74250 .... TC ...... A ........ X-ray exam of small bowel ................. 0.00 2.32 1.81 NA NA 0.07 XXX 

74250 .... 26 ....... A ........ X-ray exam of small bowel ................. 0.47 0.16 0.16 0.16 0.16 0.02 XXX 

74251 .... ............ A ........ X-ray exam of small bowel ................. 0.69 10.01 5.77 NA NA 0.10 XXX 

74251 .... TC ...... A ........ X-ray exam of small bowel ................. 0.00 9.76 5.53 NA NA 0.07 XXX 

74251 .... 26 ....... A ........ X-ray exam of small bowel ................. 0.69 0.25 0.24 0.25 0.24 0.03 XXX 

74260 .... ............ A ........ X-ray exam of small bowel ................. 0.50 8.30 4.97 NA NA 0.10 XXX 

74260 .... TC ...... A ........ X-ray exam of small bowel ................. 0.00 8.12 4.80 NA NA 0.08 XXX 

74260 .... 26 ....... A ........ X-ray exam of small bowel ................. 0.50 0.18 0.17 0.18 0.17 0.02 XXX 

74270 .... ............ A ........ Contrast x-ray exam of colon ............. 0.69 3.59 2.76 NA NA 0.14 XXX 

74270 .... TC ...... A ........ Contrast x-ray exam of colon ............. 0.00 3.34 2.52 NA NA 0.11 XXX 

74270 .... 26 ....... A ........ Contrast x-ray exam of colon ............. 0.69 0.25 0.24 0.25 0.24 0.03 XXX 

74280 .... ............ A ........ Contrast x-ray exam of colon ............. 0.99 4.94 3.74 NA NA 0.17 XXX 

74280 .... TC ...... A ........ Contrast x-ray exam of colon ............. 0.00 4.59 3.41 NA NA 0.13 XXX 

74280 .... 26 ....... A ........ Contrast x-ray exam of colon ............. 0.99 0.35 0.33 0.35 0.33 0.04 XXX 

74283 .... ............ A ........ Contrast x-ray exam of colon ............. 2.02 3.49 3.35 NA NA 0.23 XXX 

74283 .... TC ...... A ........ Contrast x-ray exam of colon ............. 0.00 2.80 2.68 NA NA 0.14 XXX 

74283 .... 26 ....... A ........ Contrast x-ray exam of colon ............. 2.02 0.69 0.67 0.69 0.67 0.09 XXX 

74290 .... ............ A ........ Contrast x-ray, gallbladder .................. 0.32 1.58 1.21 NA NA 0.06 XXX 

74290 .... TC ...... A ........ Contrast x-ray, gallbladder .................. 0.00 1.47 1.10 NA NA 0.05 XXX 

74290 .... 26 ....... A ........ Contrast x-ray, gallbladder .................. 0.32 0.11 0.11 0.11 0.11 0.01 XXX 

74291 .... ............ A ........ Contrast x-rays, gallbladder ................ 0.20 1.55 1.02 NA NA 0.03 XXX 

74291 .... TC ...... A ........ Contrast x-rays, gallbladder ................ 0.00 1.48 0.95 NA NA 0.02 XXX 

74291 .... 26 ....... A ........ Contrast x-rays, gallbladder ................ 0.20 0.07 0.07 0.07 0.07 0.01 XXX 

74300 .... ............ C ........ X-ray bile ducts/pancreas ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

74300 .... TC ...... C ........ X-ray bile ducts/pancreas ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

74300 .... 26 ....... A ........ X-ray bile ducts/pancreas ................... 0.36 0.13 0.12 0.13 0.12 0.02 XXX 

74301 .... ............ C ........ X-rays at surgery add-on .................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

74301 .... TC ...... C ........ X-rays at surgery add-on .................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

74301 .... 26 ....... A ........ X-rays at surgery add-on .................... 0.21 0.07 0.07 0.07 0.07 0.01 ZZZ 

74305 .... ............ C ........ X-ray bile ducts/pancreas ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

74305 .... TC ...... C ........ X-ray bile ducts/pancreas ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

74305 .... 26 ....... A ........ X-ray bile ducts/pancreas ................... 0.42 0.15 0.15 0.15 0.15 0.02 XXX 

74320 .... ............ A ........ Contrast x-ray of bile ducts ................. 0.54 2.13 2.73 NA NA 0.19 XXX 

74320 .... TC ...... A ........ Contrast x-ray of bile ducts ................. 0.00 1.93 2.54 NA NA 0.17 XXX 

74320 .... 26 ....... A ........ Contrast x-ray of bile ducts ................. 0.54 0.20 0.19 0.20 0.19 0.02 XXX 

74327 .... ............ A ........ X-ray bile stone removal ..................... 0.70 2.97 2.48 NA NA 0.14 XXX 

74327 .... TC ...... A ........ X-ray bile stone removal ..................... 0.00 2.72 2.24 NA NA 0.11 XXX 

74327 .... 26 ....... A ........ X-ray bile stone removal ..................... 0.70 0.25 0.24 0.25 0.24 0.03 XXX 

74328 .... ............ C ........ X-ray bile duct endoscopy .................. 0.00 0.00 0.00 NA NA 0.00 XXX 

74328 .... TC ...... C ........ X-ray bile duct endoscopy .................. 0.00 0.00 0.00 NA NA 0.00 XXX 

74328 .... 26 ....... A ........ X-ray bile duct endoscopy .................. 0.70 0.26 0.25 0.26 0.25 0.03 XXX 

74329 .... ............ C ........ X-ray for pancreas endoscopy ............ 0.00 0.00 0.00 NA NA 0.00 XXX 

74329 .... TC ...... C ........ X-ray for pancreas endoscopy ............ 0.00 0.00 0.00 NA NA 0.00 XXX 

74329 .... 26 ....... A ........ X-ray for pancreas endoscopy ............ 0.70 0.27 0.25 0.27 0.25 0.03 XXX 

74330 .... ............ C ........ X-ray bile/panc endoscopy ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

74330 .... TC ...... C ........ X-ray bile/panc endoscopy ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

74330 .... 26 ....... A ........ X-ray bile/panc endoscopy ................. 0.90 0.33 0.31 0.33 0.31 0.04 XXX 

74340 .... ............ C ........ X-ray guide for GI tube ....................... 0.00 0.00 0.00 NA NA 0.00 XXX 

74340 .... TC ...... C ........ X-ray guide for GI tube ....................... 0.00 0.00 0.00 NA NA 0.00 XXX 

74340 .... 26 ....... A ........ X-ray guide for GI tube ....................... 0.54 0.19 0.19 0.19 0.19 0.02 XXX 

74355 .... ............ C ........ X-ray guide, intestinal tube ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

74355 .... TC ...... C ........ X-ray guide, intestinal tube ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

74355 .... 26 ....... A ........ X-ray guide, intestinal tube ................. 0.76 0.28 0.26 0.28 0.26 0.03 XXX 

74360 .... ............ C ........ X-ray guide, GI dilation ....................... 0.00 0.00 0.00 NA NA 0.00 XXX 

74360 .... TC ...... C ........ X-ray guide, GI dilation ....................... 0.00 0.00 0.00 NA NA 0.00 XXX 

74360 .... 26 ....... A ........ X-ray guide, GI dilation ....................... 0.54 0.24 0.21 0.24 0.21 0.02 XXX 

74363 .... ............ C ........ X-ray, bile duct dilation ....................... 0.00 0.00 0.00 NA NA 0.00 XXX 

74363 .... TC ...... C ........ X-ray, bile duct dilation ....................... 0.00 0.00 0.00 NA NA 0.00 XXX 

74363 .... 26 ....... A ........ X-ray, bile duct dilation ....................... 0.88 0.32 0.30 0.32 0.30 0.04 XXX 

74400 .... ............ A ........ Contrst x-ray, urinary tract .................. 0.49 2.60 2.22 NA NA 0.13 XXX 

74400 .... TC ...... A ........ Contrst x-ray, urinary tract .................. 0.00 2.43 2.05 NA NA 0.11 XXX 

74400 .... 26 ....... A ........ Contrst x-ray, urinary tract .................. 0.49 0.17 0.17 0.17 0.17 0.02 XXX 

74410 .... ............ A ........ Contrst x-ray, urinary tract .................. 0.49 2.69 2.40 NA NA 0.13 XXX 

74410 .... TC ...... A ........ Contrst x-ray, urinary tract .................. 0.00 2.51 2.23 NA NA 0.11 XXX 

74410 .... 26 ....... A ........ Contrst x-ray, urinary tract .................. 0.49 0.18 0.17 0.18 0.17 0.02 XXX 

74415 .... ............ A ........ Contrst x-ray, urinary tract .................. 0.49 3.27 2.78 NA NA 0.14 XXX 

74415 .... TC ...... A ........ Contrst x-ray, urinary tract .................. 0.00 3.10 2.61 NA NA 0.12 XXX 

74415 .... 26 ....... A ........ Contrst x-ray, urinary tract .................. 0.49 0.17 0.17 0.17 0.17 0.02 XXX 

74420 .... ............ C ........ Contrst x-ray, urinary tract .................. 0.00 0.00 0.00 NA NA 0.00 XXX 

74420 .... TC ...... C ........ Contrst x-ray, urinary tract .................. 0.00 0.00 0.00 NA NA 0.00 XXX 

74420 .... 26 ....... A ........ Contrst x-ray, urinary tract .................. 0.36 0.14 0.13 0.14 0.13 0.02 XXX 

74425 .... ............ C ........ Contrst x-ray, urinary tract .................. 0.00 0.00 0.00 NA NA 0.00 XXX 


cprice-sewell on PROD1PC72 with RULES
66499 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

74425 .... TC ...... C ........ Contrst x-ray, urinary tract .................. 0.00 0.00 0.00 NA NA 0.00 XXX 

74425 .... 26 ....... A ........ Contrst x-ray, urinary tract .................. 0.36 0.13 0.13 0.13 0.13 0.02 XXX 

74430 .... ............ A ........ Contrast x-ray, bladder ....................... 0.32 1.96 1.55 NA NA 0.08 XXX 

74430 .... TC ...... A ........ Contrast x-ray, bladder ....................... 0.00 1.84 1.44 NA NA 0.06 XXX 

74430 .... 26 ....... A ........ Contrast x-ray, bladder ....................... 0.32 0.12 0.11 0.12 0.11 0.02 XXX 

74440 .... ............ A ........ X-ray, male genital tract ...................... 0.38 2.11 1.68 NA NA 0.08 XXX 

74440 .... TC ...... A ........ X-ray, male genital tract ...................... 0.00 1.97 1.55 NA NA 0.06 XXX 

74440 .... 26 ....... A ........ X-ray, male genital tract ...................... 0.38 0.14 0.13 0.14 0.13 0.02 XXX 

74445 .... ............ C ........ X-ray exam of penis ............................ 0.00 0.00 0.00 NA NA 0.00 XXX 

74445 .... TC ...... C ........ X-ray exam of penis ............................ 0.00 0.00 0.00 NA NA 0.00 XXX 

74445 .... 26 ....... A ........ X-ray exam of penis ............................ 1.14 0.45 0.41 0.45 0.41 0.07 XXX 

74450 .... ............ C ........ X-ray, urethra/bladder ......................... 0.00 0.00 0.00 NA NA 0.00 XXX 

74450 .... TC ...... C ........ X-ray, urethra/bladder ......................... 0.00 0.00 0.00 NA NA 0.00 XXX 

74450 .... 26 ....... A ........ X-ray, urethra/bladder ......................... 0.33 0.12 0.12 0.12 0.12 0.02 XXX 

74455 .... ............ A ........ X-ray, urethra/bladder ......................... 0.33 2.18 1.94 NA NA 0.12 XXX 

74455 .... TC ...... A ........ X-ray, urethra/bladder ......................... 0.00 2.06 1.82 NA NA 0.10 XXX 

74455 .... 26 ....... A ........ X-ray, urethra/bladder ......................... 0.33 0.12 0.12 0.12 0.12 0.02 XXX 

74470 .... ............ C ........ X-ray exam of kidney lesion ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

74470 .... TC ...... C ........ X-ray exam of kidney lesion ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

74470 .... 26 ....... A ........ X-ray exam of kidney lesion ............... 0.54 0.17 0.18 0.17 0.18 0.02 XXX 

74475 .... ............ A ........ X-ray control, cath insert ..................... 0.54 2.12 3.18 NA NA 0.24 XXX 

74475 .... TC ...... A ........ X-ray control, cath insert ..................... 0.00 1.92 2.99 NA NA 0.22 XXX 

74475 .... 26 ....... A ........ X-ray control, cath insert ..................... 0.54 0.20 0.19 0.20 0.19 0.02 XXX 

74480 .... ............ A ........ X-ray control, cath insert ..................... 0.54 2.13 3.19 NA NA 0.24 XXX 

74480 .... TC ...... A ........ X-ray control, cath insert ..................... 0.00 1.93 3.00 NA NA 0.22 XXX 

74480 .... 26 ....... A ........ X-ray control, cath insert ..................... 0.54 0.20 0.19 0.20 0.19 0.02 XXX 

74485 .... ............ A ........ X-ray guide, GU dilation ..................... 0.54 2.27 2.80 NA NA 0.20 XXX 

74485 .... TC ...... A ........ X-ray guide, GU dilation ..................... 0.00 2.07 2.61 NA NA 0.17 XXX 

74485 .... 26 ....... A ........ X-ray guide, GU dilation ..................... 0.54 0.20 0.19 0.20 0.19 0.03 XXX 

74710 .... ............ A ........ X-ray measurement of pelvis .............. 0.34 0.64 0.90 NA NA 0.08 XXX 

74710 .... TC ...... A ........ X-ray measurement of pelvis .............. 0.00 0.53 0.79 NA NA 0.06 XXX 

74710 .... 26 ....... A ........ X-ray measurement of pelvis .............. 0.34 0.11 0.11 0.11 0.11 0.02 XXX 

74740 .... ............ A ........ X-ray, female genital tract ................... 0.38 1.76 1.60 NA NA 0.09 XXX 

74740 .... TC ...... A ........ X-ray, female genital tract ................... 0.00 1.63 1.47 NA NA 0.07 XXX 

74740 .... 26 ....... A ........ X-ray, female genital tract ................... 0.38 0.13 0.13 0.13 0.13 0.02 XXX 

74742 .... ............ C ........ X-ray, fallopian tube ............................ 0.00 0.00 0.00 NA NA 0.00 XXX 

74742 .... TC ...... C ........ X-ray, fallopian tube ............................ 0.00 0.00 0.00 NA NA 0.00 XXX 

74742 .... 26 ....... A ........ X-ray, fallopian tube ............................ 0.61 0.19 0.20 0.19 0.20 0.03 XXX 

74775 .... ............ C ........ X-ray exam of perineum ..................... 0.00 0.00 0.00 NA NA 0.00 XXX 

74775 .... TC ...... C ........ X-ray exam of perineum ..................... 0.00 0.00 0.00 NA NA 0.00 XXX 

74775 .... 26 ....... A ........ X-ray exam of perineum ..................... 0.62 0.22 0.21 0.22 0.21 0.03 XXX 

75557 .... ............ A ........ Cardiac mri for morph ......................... 2.35 11.25 11.25 NA NA 0.97 XXX 

75557 .... TC ...... A ........ Cardiac mri for morph ......................... 0.00 10.31 10.31 NA NA 0.87 XXX 

75557 .... 26 ....... A ........ Cardiac mri for morph ......................... 2.35 0.94 0.94 0.94 0.94 0.10 XXX 

75558 .... ............ N ........ Cardiac mri flow/velocity ..................... 2.60 12.38 12.38 NA NA 1.07 XXX 

75558 .... TC ...... N ........ Cardiac mri flow/velocity ..................... 0.00 11.78 11.78 NA NA 0.96 XXX 

75558 .... 26 ....... N ........ Cardiac mri flow/velocity ..................... 2.60 0.60 0.60 0.60 0.60 0.11 XXX 

75559 .... ............ A ........ Cardiac mri w/stress img .................... 2.95 17.24 17.24 NA NA 0.97 XXX 

75559 .... TC ...... A ........ Cardiac mri w/stress img .................... 0.00 15.97 15.97 NA NA 0.87 XXX 

75559 .... 26 ....... A ........ Cardiac mri w/stress img .................... 2.95 1.27 1.27 1.27 1.27 0.10 XXX 

75560 .... ............ N ........ Cardiac mri flow/vel/stress .................. 3.00 16.82 16.82 NA NA 1.00 XXX 

75560 .... TC ...... N ........ Cardiac mri flow/vel/stress .................. 0.00 16.13 16.13 NA NA 0.89 XXX 

75560 .... 26 ....... N ........ Cardiac mri flow/vel/stress .................. 3.00 0.69 0.69 0.69 0.69 0.11 XXX 

75561 .... ............ A ........ Cardiac mri for morph w/dye .............. 2.60 15.95 15.95 NA NA 1.07 XXX 

75561 .... TC ...... A ........ Cardiac mri for morph w/dye .............. 0.00 14.92 14.92 NA NA 0.96 XXX 

75561 .... 26 ....... A ........ Cardiac mri for morph w/dye .............. 2.60 1.03 1.03 1.03 1.03 0.11 XXX 

75562 .... ............ N ........ Card mri flow/vel w/dye ...................... 2.86 16.75 16.75 NA NA 1.03 XXX 

75562 .... TC ...... N ........ Card mri flow/vel w/dye ...................... 0.00 16.09 16.09 NA NA 0.92 XXX 

75562 .... 26 ....... N ........ Card mri flow/vel w/dye ...................... 2.86 0.66 0.66 0.66 0.66 0.11 XXX 

75563 .... ............ A ........ Card mri w/stress img & dye .............. 3.00 20.20 20.20 NA NA 1.08 XXX 

75563 .... TC ...... A ........ Card mri w/stress img & dye .............. 0.00 18.82 18.82 NA NA 0.97 XXX 

75563 .... 26 ....... A ........ Card mri w/stress img & dye .............. 3.00 1.38 1.38 1.38 1.38 0.11 XXX 

75564 .... ............ N ........ Ht mri w/flo/vel/strs & dye ................... 3.35 19.71 19.71 NA NA 1.21 XXX 

75564 .... TC ...... N ........ Ht mri w/flo/vel/strs & dye ................... 0.00 18.94 18.94 NA NA 1.08 XXX 

75564 .... 26 ....... N ........ Ht mri w/flo/vel/strs & dye ................... 3.35 0.77 0.77 0.77 0.77 0.13 XXX 

75600 .... ............ A ........ Contrast x-ray exam of aorta .............. 0.49 6.42 9.61 NA NA 0.67 XXX 

75600 .... TC ...... A ........ Contrast x-ray exam of aorta .............. 0.00 6.18 9.39 NA NA 0.65 XXX 

75600 .... 26 ....... A ........ Contrast x-ray exam of aorta .............. 0.49 0.24 0.22 0.24 0.22 0.02 XXX 

75605 .... ............ A ........ Contrast x-ray exam of aorta .............. 1.14 3.55 8.27 NA NA 0.70 XXX 

75605 .... TC ...... A ........ Contrast x-ray exam of aorta .............. 0.00 3.06 7.83 NA NA 0.65 XXX 

75605 .... 26 ....... A ........ Contrast x-ray exam of aorta .............. 1.14 0.49 0.44 0.49 0.44 0.05 XXX 

75625 .... ............ A ........ Contrast x-ray exam of aorta .............. 1.14 3.35 8.16 NA NA 0.71 XXX 


cprice-sewell on PROD1PC72 with RULES
66500 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

75625 .... TC ...... A ........ Contrast x-ray exam of aorta .............. 0.00 2.93 7.76 NA NA 0.65 XXX 

75625 .... 26 ....... A ........ Contrast x-ray exam of aorta .............. 1.14 0.42 0.40 0.42 0.40 0.06 XXX 

75630 .... ............ A ........ X-ray aorta, leg arteries ...................... 1.79 3.76 8.75 NA NA 0.80 XXX 

75630 .... TC ...... A ........ X-ray aorta, leg arteries ...................... 0.00 3.05 8.09 NA NA 0.69 XXX 

75630 .... 26 ....... A ........ X-ray aorta, leg arteries ...................... 1.79 0.71 0.66 0.71 0.66 0.11 XXX 

75635 .... ............ A ........ Ct angio abdominal arteries ................ 2.40 12.92 14.80 NA NA 0.50 XXX 

75635 .... TC ...... A ........ Ct angio abdominal arteries ................ 0.00 12.00 13.95 NA NA 0.39 XXX 

75635 .... 26 ....... A ........ Ct angio abdominal arteries ................ 2.40 0.92 0.85 0.92 0.85 0.11 XXX 

75650 .... ............ A ........ Artery x-rays, head & neck ................. 1.49 3.52 8.30 NA NA 0.72 XXX 

75650 .... TC ...... A ........ Artery x-rays, head & neck ................. 0.00 2.95 7.77 NA NA 0.65 XXX 

75650 .... 26 ....... A ........ Artery x-rays, head & neck ................. 1.49 0.57 0.53 0.57 0.53 0.07 XXX 

75658 .... ............ A ........ Artery x-rays, arm ............................... 1.31 3.72 8.40 NA NA 0.72 XXX 

75658 .... TC ...... A ........ Artery x-rays, arm ............................... 0.00 3.28 7.94 NA NA 0.65 XXX 

75658 .... 26 ....... A ........ Artery x-rays, arm ............................... 1.31 0.44 0.46 0.44 0.46 0.07 XXX 

75660 .... ............ A ........ Artery x-rays, head & neck ................. 1.31 3.88 8.46 NA NA 0.71 XXX 

75660 .... TC ...... A ........ Artery x-rays, head & neck ................. 0.00 3.39 7.99 NA NA 0.65 XXX 

75660 .... 26 ....... A ........ Artery x-rays, head & neck ................. 1.31 0.49 0.47 0.49 0.47 0.06 XXX 

75662 .... ............ A ........ Artery x-rays, head & neck ................. 1.66 5.01 9.09 NA NA 0.71 XXX 

75662 .... TC ...... A ........ Artery x-rays, head & neck ................. 0.00 4.31 8.45 NA NA 0.65 XXX 

75662 .... 26 ....... A ........ Artery x-rays, head & neck ................. 1.66 0.70 0.64 0.70 0.64 0.06 XXX 

75665 .... ............ A ........ Artery x-rays, head & neck ................. 1.31 4.09 8.57 NA NA 0.74 XXX 

75665 .... TC ...... A ........ Artery x-rays, head & neck ................. 0.00 3.61 8.11 NA NA 0.65 XXX 

75665 .... 26 ....... A ........ Artery x-rays, head & neck ................. 1.31 0.48 0.46 0.48 0.46 0.09 XXX 

75671 .... ............ A ........ Artery x-rays, head & neck ................. 1.66 5.10 9.12 NA NA 0.72 XXX 

75671 .... TC ...... A ........ Artery x-rays, head & neck ................. 0.00 4.46 8.53 NA NA 0.65 XXX 

75671 .... 26 ....... A ........ Artery x-rays, head & neck ................. 1.66 0.64 0.59 0.64 0.59 0.07 XXX 

75676 .... ............ A ........ Artery x-rays, neck .............................. 1.31 3.86 8.45 NA NA 0.72 XXX 

75676 .... TC ...... A ........ Artery x-rays, neck .............................. 0.00 3.38 7.99 NA NA 0.65 XXX 

75676 .... 26 ....... A ........ Artery x-rays, neck .............................. 1.31 0.48 0.46 0.48 0.46 0.07 XXX 

75680 .... ............ A ........ Artery x-rays, neck .............................. 1.66 4.61 8.87 NA NA 0.72 XXX 

75680 .... TC ...... A ........ Artery x-rays, neck .............................. 0.00 3.95 8.27 NA NA 0.65 XXX 

75680 .... 26 ....... A ........ Artery x-rays, neck .............................. 1.66 0.66 0.60 0.66 0.60 0.07 XXX 

75685 .... ............ A ........ Artery x-rays, spine ............................. 1.31 3.88 8.46 NA NA 0.71 XXX 

75685 .... TC ...... A ........ Artery x-rays, spine ............................. 0.00 3.38 7.99 NA NA 0.65 XXX 

75685 .... 26 ....... A ........ Artery x-rays, spine ............................. 1.31 0.50 0.47 0.50 0.47 0.06 XXX 

75705 .... ............ A ........ Artery x-rays, spine ............................. 2.18 4.17 8.74 NA NA 0.78 XXX 

75705 .... TC ...... A ........ Artery x-rays, spine ............................. 0.00 3.37 7.98 NA NA 0.65 XXX 

75705 .... 26 ....... A ........ Artery x-rays, spine ............................. 2.18 0.80 0.76 0.80 0.76 0.13 XXX 

75710 .... ............ A ........ Artery x-rays, arm/leg ......................... 1.14 3.94 8.47 NA NA 0.72 XXX 

75710 .... TC ...... A ........ Artery x-rays, arm/leg ......................... 0.00 3.52 8.06 NA NA 0.65 XXX 

75710 .... 26 ....... A ........ Artery x-rays, arm/leg ......................... 1.14 0.42 0.41 0.42 0.41 0.07 XXX 

75716 .... ............ A ........ Artery x-rays, arms/legs ...................... 1.31 4.92 8.97 NA NA 0.72 XXX 

75716 .... TC ...... A ........ Artery x-rays, arms/legs ...................... 0.00 4.42 8.51 NA NA 0.65 XXX 

75716 .... 26 ....... A ........ Artery x-rays, arms/legs ...................... 1.31 0.50 0.46 0.50 0.46 0.07 XXX 

75722 .... ............ A ........ Artery x-rays, kidney ........................... 1.14 3.84 8.42 NA NA 0.70 XXX 

75722 .... TC ...... A ........ Artery x-rays, kidney ........................... 0.00 3.37 7.98 NA NA 0.65 XXX 

75722 .... 26 ....... A ........ Artery x-rays, kidney ........................... 1.14 0.47 0.44 0.47 0.44 0.05 XXX 

75724 .... ............ A ........ Artery x-rays, kidneys ......................... 1.49 5.12 9.14 NA NA 0.70 XXX 

75724 .... TC ...... A ........ Artery x-rays, kidneys ......................... 0.00 4.38 8.49 NA NA 0.65 XXX 

75724 .... 26 ....... A ........ Artery x-rays, kidneys ......................... 1.49 0.74 0.65 0.74 0.65 0.05 XXX 

75726 .... ............ A ........ Artery x-rays, abdomen ...................... 1.14 3.76 8.36 NA NA 0.70 XXX 

75726 .... TC ...... A ........ Artery x-rays, abdomen ...................... 0.00 3.34 7.97 NA NA 0.65 XXX 

75726 .... 26 ....... A ........ Artery x-rays, abdomen ...................... 1.14 0.42 0.39 0.42 0.39 0.05 XXX 

75731 .... ............ A ........ Artery x-rays, adrenal gland ............... 1.14 4.09 8.54 NA NA 0.71 XXX 

75731 .... TC ...... A ........ Artery x-rays, adrenal gland ............... 0.00 3.59 8.10 NA NA 0.65 XXX 

75731 .... 26 ....... A ........ Artery x-rays, adrenal gland ............... 1.14 0.50 0.44 0.50 0.44 0.06 XXX 

75733 .... ............ A ........ Artery x-rays, adrenals ........................ 1.31 5.45 9.25 NA NA 0.71 XXX 

75733 .... TC ...... A ........ Artery x-rays, adrenals ........................ 0.00 4.80 8.70 NA NA 0.65 XXX 

75733 .... 26 ....... A ........ Artery x-rays, adrenals ........................ 1.31 0.65 0.55 0.65 0.55 0.06 XXX 

75736 .... ............ A ........ Artery x-rays, pelvis ............................ 1.14 3.87 8.42 NA NA 0.71 XXX 

75736 .... TC ...... A ........ Artery x-rays, pelvis ............................ 0.00 3.44 8.02 NA NA 0.65 XXX 

75736 .... 26 ....... A ........ Artery x-rays, pelvis ............................ 1.14 0.43 0.40 0.43 0.40 0.06 XXX 

75741 .... ............ A ........ Artery x-rays, lung ............................... 1.31 3.18 8.10 NA NA 0.71 XXX 

75741 .... TC ...... A ........ Artery x-rays, lung ............................... 0.00 2.69 7.64 NA NA 0.65 XXX 

75741 .... 26 ....... A ........ Artery x-rays, lung ............................... 1.31 0.49 0.46 0.49 0.46 0.06 XXX 

75743 .... ............ A ........ Artery x-rays, lungs ............................. 1.66 3.56 8.35 NA NA 0.72 XXX 

75743 .... TC ...... A ........ Artery x-rays, lungs ............................. 0.00 2.94 7.77 NA NA 0.65 XXX 

75743 .... 26 ....... A ........ Artery x-rays, lungs ............................. 1.66 0.62 0.58 0.62 0.58 0.07 XXX 

75746 .... ............ A ........ Artery x-rays, lung ............................... 1.14 3.52 8.25 NA NA 0.70 XXX 

75746 .... TC ...... A ........ Artery x-rays, lung ............................... 0.00 3.12 7.86 NA NA 0.65 XXX 

75746 .... 26 ....... A ........ Artery x-rays, lung ............................... 1.14 0.40 0.39 0.40 0.39 0.05 XXX 

75756 .... ............ A ........ Artery x-rays, chest ............................. 1.14 4.34 8.69 NA NA 0.69 XXX 


cprice-sewell on PROD1PC72 with RULES
66501 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

75756 .... TC ...... A ........ Artery x-rays, chest ............................. 0.00 3.76 8.18 NA NA 0.65 XXX 

75756 .... 26 ....... A ........ Artery x-rays, chest ............................. 1.14 0.58 0.51 0.58 0.51 0.04 XXX 

75774 .... ............ A ........ Artery x-ray, each vessel .................... 0.36 2.50 7.61 NA NA 0.67 ZZZ 

75774 .... TC ...... A ........ Artery x-ray, each vessel .................... 0.00 2.36 7.48 NA NA 0.65 ZZZ 

75774 .... 26 ....... A ........ Artery x-ray, each vessel .................... 0.36 0.14 0.13 0.14 0.13 0.02 ZZZ 

75790 .... ............ A ........ Visualize A-V shunt ............................. 1.84 3.12 2.53 NA NA 0.17 XXX 

75790 .... TC ...... A ........ Visualize A-V shunt ............................. 0.00 2.52 1.93 NA NA 0.08 XXX 

75790 .... 26 ....... A ........ Visualize A-V shunt ............................. 1.84 0.60 0.60 0.60 0.60 0.09 XXX 

75801 .... ............ C ........ Lymph vessel x-ray, arm/leg ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

75801 .... TC ...... C ........ Lymph vessel x-ray, arm/leg ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

75801 .... 26 ....... A ........ Lymph vessel x-ray, arm/leg ............... 0.81 0.22 0.25 0.22 0.25 0.08 XXX 

75803 .... ............ C ........ Lymph vessel x-ray,arms/legs ............ 0.00 0.00 0.00 NA NA 0.00 XXX 

75803 .... TC ...... C ........ Lymph vessel x-ray,arms/legs ............ 0.00 0.00 0.00 NA NA 0.00 XXX 

75803 .... 26 ....... A ........ Lymph vessel x-ray,arms/legs ............ 1.17 0.40 0.39 0.40 0.39 0.05 XXX 

75805 .... ............ C ........ Lymph vessel x-ray, trunk ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75805 .... TC ...... C ........ Lymph vessel x-ray, trunk ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75805 .... 26 ....... A ........ Lymph vessel x-ray, trunk ................... 0.81 0.27 0.27 0.27 0.27 0.05 XXX 

75807 .... ............ C ........ Lymph vessel x-ray, trunk ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75807 .... TC ...... C ........ Lymph vessel x-ray, trunk ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75807 .... 26 ....... A ........ Lymph vessel x-ray, trunk ................... 1.17 0.39 0.39 0.39 0.39 0.05 XXX 

75809 .... ............ A ........ Nonvascular shunt, x-ray .................... 0.47 2.17 1.54 NA NA 0.07 XXX 

75809 .... TC ...... A ........ Nonvascular shunt, x-ray .................... 0.00 2.01 1.39 NA NA 0.05 XXX 

75809 .... 26 ....... A ........ Nonvascular shunt, x-ray .................... 0.47 0.16 0.15 0.16 0.15 0.02 XXX 

75810 .... ............ C ........ Vein x-ray, spleen/liver ....................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75810 .... TC ...... C ........ Vein x-ray, spleen/liver ....................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75810 .... 26 ....... A ........ Vein x-ray, spleen/liver ....................... 1.14 0.39 0.38 0.39 0.38 0.05 XXX 

75820 .... ............ A ........ Vein x-ray, arm/leg .............................. 0.70 3.01 2.09 NA NA 0.09 XXX 

75820 .... TC ...... A ........ Vein x-ray, arm/leg .............................. 0.00 2.72 1.83 NA NA 0.06 XXX 

75820 .... 26 ....... A ........ Vein x-ray, arm/leg .............................. 0.70 0.29 0.26 0.29 0.26 0.03 XXX 

75822 .... ............ A ........ Vein x-ray, arms/legs .......................... 1.06 3.17 2.50 NA NA 0.13 XXX 

75822 .... TC ...... A ........ Vein x-ray, arms/legs .......................... 0.00 2.80 2.14 NA NA 0.08 XXX 

75822 .... 26 ....... A ........ Vein x-ray, arms/legs .......................... 1.06 0.37 0.36 0.37 0.36 0.05 XXX 

75825 .... ............ A ........ Vein x-ray, trunk .................................. 1.14 2.92 7.95 NA NA 0.72 XXX 

75825 .... TC ...... A ........ Vein x-ray, trunk .................................. 0.00 2.54 7.57 NA NA 0.65 XXX 

75825 .... 26 ....... A ........ Vein x-ray, trunk .................................. 1.14 0.38 0.38 0.38 0.38 0.07 XXX 

75827 .... ............ A ........ Vein x-ray, chest ................................. 1.14 2.95 7.96 NA NA 0.70 XXX 

75827 .... TC ...... A ........ Vein x-ray, chest ................................. 0.00 2.58 7.59 NA NA 0.65 XXX 

75827 .... 26 ....... A ........ Vein x-ray, chest ................................. 1.14 0.37 0.37 0.37 0.37 0.05 XXX 

75831 .... ............ A ........ Vein x-ray, kidney ............................... 1.14 3.05 8.00 NA NA 0.71 XXX 

75831 .... TC ...... A ........ Vein x-ray, kidney ............................... 0.00 2.67 7.63 NA NA 0.65 XXX 

75831 .... 26 ....... A ........ Vein x-ray, kidney ............................... 1.14 0.38 0.37 0.38 0.37 0.06 XXX 

75833 .... ............ A ........ Vein x-ray, kidneys ............................. 1.49 3.67 8.38 NA NA 0.74 XXX 

75833 .... TC ...... A ........ Vein x-ray, kidneys ............................. 0.00 3.17 7.88 NA NA 0.65 XXX 

75833 .... 26 ....... A ........ Vein x-ray, kidneys ............................. 1.49 0.50 0.50 0.50 0.50 0.09 XXX 

75840 .... ............ A ........ Vein x-ray, adrenal gland .................... 1.14 2.96 7.97 NA NA 0.72 XXX 

75840 .... TC ...... A ........ Vein x-ray, adrenal gland .................... 0.00 2.60 7.60 NA NA 0.65 XXX 

75840 .... 26 ....... A ........ Vein x-ray, adrenal gland .................... 1.14 0.36 0.37 0.36 0.37 0.07 XXX 

75842 .... ............ A ........ Vein x-ray, adrenal glands .................. 1.49 3.75 8.41 NA NA 0.72 XXX 

75842 .... TC ...... A ........ Vein x-ray, adrenal glands .................. 0.00 3.20 7.90 NA NA 0.65 XXX 

75842 .... 26 ....... A ........ Vein x-ray, adrenal glands .................. 1.49 0.55 0.51 0.55 0.51 0.07 XXX 

75860 .... ............ A ........ Vein x-ray, neck .................................. 1.14 3.39 8.19 NA NA 0.69 XXX 

75860 .... TC ...... A ........ Vein x-ray, neck .................................. 0.00 2.90 7.75 NA NA 0.65 XXX 

75860 .... 26 ....... A ........ Vein x-ray, neck .................................. 1.14 0.49 0.44 0.49 0.44 0.04 XXX 

75870 .... ............ A ........ Vein x-ray, skull .................................. 1.14 3.29 8.14 NA NA 0.70 XXX 

75870 .... TC ...... A ........ Vein x-ray, skull .................................. 0.00 2.89 7.74 NA NA 0.65 XXX 

75870 .... 26 ....... A ........ Vein x-ray, skull .................................. 1.14 0.40 0.40 0.40 0.40 0.05 XXX 

75872 .... ............ A ........ Vein x-ray, skull .................................. 1.14 4.04 8.51 NA NA 0.79 XXX 

75872 .... TC ...... A ........ Vein x-ray, skull .................................. 0.00 3.60 8.10 NA NA 0.65 XXX 

75872 .... 26 ....... A ........ Vein x-ray, skull .................................. 1.14 0.44 0.41 0.44 0.41 0.14 XXX 

75880 .... ............ A ........ Vein x-ray, eye socket ........................ 0.70 3.21 2.19 NA NA 0.09 XXX 

75880 .... TC ...... A ........ Vein x-ray, eye socket ........................ 0.00 2.94 1.94 NA NA 0.06 XXX 

75880 .... 26 ....... A ........ Vein x-ray, eye socket ........................ 0.70 0.27 0.25 0.27 0.25 0.03 XXX 

75885 .... ............ A ........ Vein x-ray, liver ................................... 1.44 3.18 8.12 NA NA 0.71 XXX 

75885 .... TC ...... A ........ Vein x-ray, liver ................................... 0.00 2.66 7.63 NA NA 0.65 XXX 

75885 .... 26 ....... A ........ Vein x-ray, liver ................................... 1.44 0.52 0.49 0.52 0.49 0.06 XXX 

75887 .... ............ A ........ Vein x-ray, liver ................................... 1.44 3.42 8.24 NA NA 0.71 XXX 

75887 .... TC ...... A ........ Vein x-ray, liver ................................... 0.00 2.85 7.72 NA NA 0.65 XXX 

75887 .... 26 ....... A ........ Vein x-ray, liver ................................... 1.44 0.57 0.52 0.57 0.52 0.06 XXX 

75889 .... ............ A ........ Vein x-ray, liver ................................... 1.14 3.07 8.02 NA NA 0.70 XXX 

75889 .... TC ...... A ........ Vein x-ray, liver ................................... 0.00 2.66 7.63 NA NA 0.65 XXX 

75889 .... 26 ....... A ........ Vein x-ray, liver ................................... 1.14 0.41 0.39 0.41 0.39 0.05 XXX 

75891 .... ............ A ........ Vein x-ray, liver ................................... 1.14 3.06 8.01 NA NA 0.70 XXX 


cprice-sewell on PROD1PC72 with RULES
66502 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

75891 .... TC ...... A ........ Vein x-ray, liver ................................... 0.00 2.65 7.62 NA NA 0.65 XXX 

75891 .... 26 ....... A ........ Vein x-ray, liver ................................... 1.14 0.41 0.39 0.41 0.39 0.05 XXX 

75893 .... ............ A ........ Venous sampling by catheter ............. 0.54 2.86 7.82 NA NA 0.67 XXX 

75893 .... TC ...... A ........ Venous sampling by catheter ............. 0.00 2.66 7.63 NA NA 0.65 XXX 

75893 .... 26 ....... A ........ Venous sampling by catheter ............. 0.54 0.20 0.19 0.20 0.19 0.02 XXX 

75894 .... ............ C ........ X-rays, transcath therapy .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75894 .... TC ...... C ........ X-rays, transcath therapy .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75894 .... 26 ....... A ........ X-rays, transcath therapy .................... 1.31 0.46 0.44 0.46 0.44 0.08 XXX 

75896 .... ............ C ........ X-rays, transcath therapy .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75896 .... TC ...... C ........ X-rays, transcath therapy .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75896 .... 26 ....... A ........ X-rays, transcath therapy .................... 1.31 0.52 0.48 0.52 0.48 0.05 XXX 

75898 .... ............ C ........ Follow-up angiography ........................ 0.00 0.00 0.00 NA NA 0.00 XXX 

75898 .... TC ...... C ........ Follow-up angiography ........................ 0.00 0.00 0.00 NA NA 0.00 XXX 

75898 .... 26 ....... A ........ Follow-up angiography ........................ 1.65 0.63 0.59 0.63 0.59 0.07 XXX 

75900 .... ............ C ........ Intravascular cath exchange ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

75900 .... TC ...... C ........ Intravascular cath exchange ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

75900 .... 26 ....... A ........ Intravascular cath exchange ............... 0.49 0.17 0.16 0.17 0.16 0.03 XXX 

75901 .... ............ A ........ Remove cva device obstruct .............. 0.49 4.15 2.80 NA NA 0.85 XXX 

75901 .... TC ...... A ........ Remove cva device obstruct .............. 0.00 3.98 2.64 NA NA 0.83 XXX 

75901 .... 26 ....... A ........ Remove cva device obstruct .............. 0.49 0.17 0.16 0.17 0.16 0.02 XXX 

75902 .... ............ A ........ Remove cva lumen obstruct ............... 0.39 1.63 1.53 NA NA 0.85 XXX 

75902 .... TC ...... A ........ Remove cva lumen obstruct ............... 0.00 1.50 1.40 NA NA 0.83 XXX 

75902 .... 26 ....... A ........ Remove cva lumen obstruct ............... 0.39 0.13 0.13 0.13 0.13 0.02 XXX 

75940 .... ............ C ........ X-ray placement, vein filter ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

75940 .... TC ...... C ........ X-ray placement, vein filter ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

75940 .... 26 ....... A ........ X-ray placement, vein filter ................. 0.54 0.18 0.18 0.18 0.18 0.04 XXX 

75945 .... ............ C ........ Intravascular us ................................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75945 .... TC ...... C ........ Intravascular us ................................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75945 .... 26 ....... A ........ Intravascular us ................................... 0.40 0.14 0.14 0.14 0.14 0.04 XXX 

75946 .... ............ C ........ Intravascular us add-on ...................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

75946 .... TC ...... C ........ Intravascular us add-on ...................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

75946 .... 26 ....... A ........ Intravascular us add-on ...................... 0.40 0.12 0.13 0.12 0.13 0.05 ZZZ 

75952 .... ............ C ........ Endovasc repair abdom aorta ............ 0.00 0.00 0.00 NA NA 0.00 XXX 

75952 .... TC ...... C ........ Endovasc repair abdom aorta ............ 0.00 0.00 0.00 NA NA 0.00 XXX 

75952 .... 26 ....... A ........ Endovasc repair abdom aorta ............ 4.49 1.30 1.39 1.30 1.39 0.43 XXX 

75953 .... ............ C ........ Abdom aneurysm endovas rpr ........... 0.00 0.00 0.00 NA NA 0.00 XXX 

75953 .... TC ...... C ........ Abdom aneurysm endovas rpr ........... 0.00 0.00 0.00 NA NA 0.00 XXX 

75953 .... 26 ....... A ........ Abdom aneurysm endovas rpr ........... 1.36 0.40 0.42 0.40 0.42 0.13 XXX 

75954 .... ............ C ........ Iliac aneurysm endovas rpr ................ 0.00 0.00 0.00 NA NA 0.00 XXX 

75954 .... TC ...... C ........ Iliac aneurysm endovas rpr ................ 0.00 0.00 0.00 NA NA 0.00 XXX 

75954 .... 26 ....... A ........ Iliac aneurysm endovas rpr ................ 2.25 0.63 0.70 0.63 0.70 0.15 XXX 

75956 .... ............ C ........ Xray, endovasc thor ao repr ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

75956 .... TC ...... C ........ Xray, endovasc thor ao repr ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

75956 .... 26 ....... A ........ Xray, endovasc thor ao repr ............... 7.00 1.88 2.29 1.88 2.29 0.69 XXX 

75957 .... ............ C ........ Xray, endovasc thor ao repr ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

75957 .... TC ...... C ........ Xray, endovasc thor ao repr ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

75957 .... 26 ....... A ........ Xray, endovasc thor ao repr ............... 6.00 1.63 1.97 1.63 1.97 0.59 XXX 

75958 .... ............ C ........ Xray, place prox ext thor ao ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

75958 .... TC ...... C ........ Xray, place prox ext thor ao ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

75958 .... 26 ....... A ........ Xray, place prox ext thor ao ............... 4.00 1.04 1.29 1.04 1.29 0.39 XXX 

75959 .... ............ C ........ Xray, place dist ext thor ao ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

75959 .... TC ...... C ........ Xray, place dist ext thor ao ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

75959 .... 26 ....... A ........ Xray, place dist ext thor ao ................. 3.50 0.92 1.14 0.92 1.14 0.34 XXX 

75960 .... ............ A ........ Transcath iv stent rs&i ........................ 0.82 2.71 8.94 NA NA 0.82 XXX 

75960 .... TC ...... A ........ Transcath iv stent rs&i ........................ 0.00 2.39 8.64 NA NA 0.77 XXX 

75960 .... 26 ....... A ........ Transcath iv stent rs&i ........................ 0.82 0.32 0.30 0.32 0.30 0.05 XXX 

75961 .... ............ A ........ Retrieval, broken catheter ................... 4.24 4.66 8.28 NA NA 0.73 XXX 

75961 .... TC ...... A ........ Retrieval, broken catheter ................... 0.00 3.18 6.84 NA NA 0.55 XXX 

75961 .... 26 ....... A ........ Retrieval, broken catheter ................... 4.24 1.48 1.44 1.48 1.44 0.18 XXX 

75962 .... ............ A ........ Repair arterial blockage ...................... 0.54 3.50 9.71 NA NA 0.86 XXX 

75962 .... TC ...... A ........ Repair arterial blockage ...................... 0.00 3.30 9.52 NA NA 0.83 XXX 

75962 .... 26 ....... A ........ Repair arterial blockage ...................... 0.54 0.20 0.19 0.20 0.19 0.03 XXX 

75964 .... ............ A ........ Repair artery blockage, each .............. 0.36 2.35 5.42 NA NA 0.46 ZZZ 

75964 .... TC ...... A ........ Repair artery blockage, each .............. 0.00 2.22 5.30 NA NA 0.43 ZZZ 

75964 .... 26 ....... A ........ Repair artery blockage, each .............. 0.36 0.13 0.12 0.13 0.12 0.03 ZZZ 

75966 .... ............ A ........ Repair arterial blockage ...................... 1.31 4.16 10.17 NA NA 0.89 XXX 

75966 .... TC ...... A ........ Repair arterial blockage ...................... 0.00 3.59 9.66 NA NA 0.83 XXX 

75966 .... 26 ....... A ........ Repair arterial blockage ...................... 1.31 0.57 0.51 0.57 0.51 0.06 XXX 

75968 .... ............ A ........ Repair artery blockage, each .............. 0.36 2.41 5.46 NA NA 0.45 ZZZ 

75968 .... TC ...... A ........ Repair artery blockage, each .............. 0.00 2.25 5.32 NA NA 0.43 ZZZ 

75968 .... 26 ....... A ........ Repair artery blockage, each .............. 0.36 0.16 0.14 0.16 0.14 0.02 ZZZ 

75970 .... ............ C ........ Vascular biopsy ................................... 0.00 0.00 0.00 NA NA 0.00 XXX 


cprice-sewell on PROD1PC72 with RULES
66503 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

75970 .... TC ...... C ........ Vascular biopsy ................................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75970 .... 26 ....... A ........ Vascular biopsy ................................... 0.83 0.31 0.29 0.31 0.29 0.04 XXX 

75978 .... ............ A ........ Repair venous blockage ..................... 0.54 3.26 9.59 NA NA 0.85 XXX 

75978 .... TC ...... A ........ Repair venous blockage ..................... 0.00 3.08 9.41 NA NA 0.83 XXX 

75978 .... 26 ....... A ........ Repair venous blockage ..................... 0.54 0.18 0.18 0.18 0.18 0.02 XXX 

75980 .... ............ C ........ Contrast xray exam bile duct .............. 0.00 0.00 0.00 NA NA 0.00 XXX 

75980 .... TC ...... C ........ Contrast xray exam bile duct .............. 0.00 0.00 0.00 NA NA 0.00 XXX 

75980 .... 26 ....... A ........ Contrast xray exam bile duct .............. 1.44 0.52 0.49 0.52 0.49 0.06 XXX 

75982 .... ............ C ........ Contrast xray exam bile duct .............. 0.00 0.00 0.00 NA NA 0.00 XXX 

75982 .... TC ...... C ........ Contrast xray exam bile duct .............. 0.00 0.00 0.00 NA NA 0.00 XXX 

75982 .... 26 ....... A ........ Contrast xray exam bile duct .............. 1.44 0.52 0.50 0.52 0.50 0.06 XXX 

75984 .... ............ A ........ Xray control catheter change .............. 0.72 2.31 2.24 NA NA 0.14 XXX 

75984 .... TC ...... A ........ Xray control catheter change .............. 0.00 2.05 2.00 NA NA 0.11 XXX 

75984 .... 26 ....... A ........ Xray control catheter change .............. 0.72 0.26 0.24 0.26 0.24 0.03 XXX 

75989 .... ............ A ........ Abscess drainage under x-ray ............ 1.19 2.24 2.89 NA NA 0.22 XXX 

75989 .... TC ...... A ........ Abscess drainage under x-ray ............ 0.00 1.82 2.48 NA NA 0.17 XXX 

75989 .... 26 ....... A ........ Abscess drainage under x-ray ............ 1.19 0.42 0.41 0.42 0.41 0.05 XXX 

75992 .... ............ C ........ Atherectomy, x-ray exam .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75992 .... TC ...... C ........ Atherectomy, x-ray exam .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75992 .... 26 ....... A ........ Atherectomy, x-ray exam .................... 0.54 0.22 0.21 0.22 0.21 0.03 XXX 

75993 .... ............ C ........ Atherectomy, x-ray exam .................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

75993 .... TC ...... C ........ Atherectomy, x-ray exam .................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

75993 .... 26 ....... A ........ Atherectomy, x-ray exam .................... 0.36 0.14 0.13 0.14 0.13 0.02 ZZZ 

75994 .... ............ C ........ Atherectomy, x-ray exam .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75994 .... TC ...... C ........ Atherectomy, x-ray exam .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75994 .... 26 ....... A ........ Atherectomy, x-ray exam .................... 1.31 0.54 0.50 0.54 0.50 0.07 XXX 

75995 .... ............ C ........ Atherectomy, x-ray exam .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75995 .... TC ...... C ........ Atherectomy, x-ray exam .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

75995 .... 26 ....... A ........ Atherectomy, x-ray exam .................... 1.31 0.48 0.47 0.48 0.47 0.05 XXX 

75996 .... ............ C ........ Atherectomy, x-ray exam .................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

75996 .... TC ...... C ........ Atherectomy, x-ray exam .................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

75996 .... 26 ....... A ........ Atherectomy, x-ray exam .................... 0.36 0.12 0.12 0.12 0.12 0.02 ZZZ 

76000 .... ............ A ........ Fluoroscope examination .................... 0.17 2.77 2.06 NA NA 0.08 XXX 

76000 .... TC ...... A ........ Fluoroscope examination .................... 0.00 2.71 2.01 NA NA 0.07 XXX 

76000 .... 26 ....... A ........ Fluoroscope examination .................... 0.17 0.06 0.05 0.06 0.05 0.01 XXX 

76001 .... ............ C ........ Fluoroscope exam, extensive ............. 0.00 0.00 0.00 NA NA 0.00 XXX 

76001 .... TC ...... C ........ Fluoroscope exam, extensive ............. 0.00 0.00 0.00 NA NA 0.00 XXX 

76001 .... 26 ....... A ........ Fluoroscope exam, extensive ............. 0.67 0.24 0.23 0.24 0.23 0.05 XXX 

76010 .... ............ A ........ X-ray, nose to rectum ......................... 0.18 0.54 0.56 NA NA 0.03 XXX 

76010 .... TC ...... A ........ X-ray, nose to rectum ......................... 0.00 0.48 0.50 NA NA 0.02 XXX 

76010 .... 26 ....... A ........ X-ray, nose to rectum ......................... 0.18 0.06 0.06 0.06 0.06 0.01 XXX 

76080 .... ............ A ........ X-ray exam of fistula ........................... 0.54 1.10 1.16 NA NA 0.08 XXX 

76080 .... TC ...... A ........ X-ray exam of fistula ........................... 0.00 0.90 0.97 NA NA 0.06 XXX 

76080 .... 26 ....... A ........ X-ray exam of fistula ........................... 0.54 0.20 0.19 0.20 0.19 0.02 XXX 

76098 .... ............ A ........ X-ray exam, breast specimen ............. 0.16 0.32 0.39 NA NA 0.03 XXX 

76098 .... TC ...... A ........ X-ray exam, breast specimen ............. 0.00 0.27 0.34 NA NA 0.02 XXX 

76098 .... 26 ....... A ........ X-ray exam, breast specimen ............. 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

76100 .... ............ A ........ X-ray exam of body section ................ 0.58 3.55 2.50 NA NA 0.10 XXX 

76100 .... TC ...... A ........ X-ray exam of body section ................ 0.00 3.35 2.30 NA NA 0.07 XXX 

76100 .... 26 ....... A ........ X-ray exam of body section ................ 0.58 0.20 0.20 0.20 0.20 0.03 XXX 

76101 .... ............ A ........ Complex body section x-ray ............... 0.58 5.45 3.53 NA NA 0.11 XXX 

76101 .... TC ...... A ........ Complex body section x-ray ............... 0.00 5.27 3.34 NA NA 0.08 XXX 

76101 .... 26 ....... A ........ Complex body section x-ray ............... 0.58 0.18 0.19 0.18 0.19 0.03 XXX 

76102 .... ............ A ........ Complex body section x-rays ............. 0.58 7.64 4.78 NA NA 0.14 XXX 

76102 .... TC ...... A ........ Complex body section x-rays ............. 0.00 7.46 4.60 NA NA 0.11 XXX 

76102 .... 26 ....... A ........ Complex body section x-rays ............. 0.58 0.18 0.18 0.18 0.18 0.03 XXX 

76120 .... ............ A ........ Cine/video x-rays ................................ 0.38 1.87 1.52 NA NA 0.08 XXX 

76120 .... TC ...... A ........ Cine/video x-rays ................................ 0.00 1.74 1.39 NA NA 0.06 XXX 

76120 .... 26 ....... A ........ Cine/video x-rays ................................ 0.38 0.13 0.13 0.13 0.13 0.02 XXX 

76125 .... ............ C ........ Cine/video x-rays add-on .................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

76125 .... TC ...... C ........ Cine/video x-rays add-on .................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

76125 .... 26 ....... A ........ Cine/video x-rays add-on .................... 0.27 0.12 0.11 0.12 0.11 0.01 ZZZ 

76140 .... ............ I .......... X-ray consultation ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76150 .... ............ A ........ X-ray exam, dry process ..................... 0.00 0.68 0.55 NA NA 0.02 XXX 

76350 .... ............ C ........ Special x-ray contrast study ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76376 .... ............ A ........ 3d render w/o postprocess ................. 0.20 1.40 2.45 NA NA 0.10 XXX 

76376 .... TC ...... A ........ 3d render w/o postprocess ................. 0.00 1.33 2.38 NA NA 0.08 XXX 

76376 .... 26 ....... A ........ 3d render w/o postprocess ................. 0.20 0.07 0.07 0.07 0.07 0.02 XXX 

76377 .... ............ A ........ 3d rendering w/postprocess ................ 0.79 1.40 2.54 NA NA 0.39 XXX 

76377 .... TC ...... A ........ 3d rendering w/postprocess ................ 0.00 1.12 2.27 NA NA 0.31 XXX 

76377 .... 26 ....... A ........ 3d rendering w/postprocess ................ 0.79 0.28 0.27 0.28 0.27 0.08 XXX 

76380 .... ............ A ........ CAT scan follow-up study ................... 0.98 4.71 4.26 NA NA 0.22 XXX 


cprice-sewell on PROD1PC72 with RULES
66504 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

76380 .... TC ...... A ........ CAT scan follow-up study ................... 0.00 4.37 3.93 NA NA 0.18 XXX 

76380 .... 26 ....... A ........ CAT scan follow-up study ................... 0.98 0.34 0.33 0.34 0.33 0.04 XXX 

76390 .... ............ N ........ Mr spectroscopy .................................. 1.40 9.42 10.44 NA NA 0.66 XXX 

76390 .... TC ...... N ........ Mr spectroscopy .................................. 0.00 9.10 10.05 NA NA 0.59 XXX 

76390 .... 26 ....... N ........ Mr spectroscopy .................................. 1.40 0.32 0.39 0.32 0.39 0.07 XXX 

76496 .... ............ C ........ Fluoroscopic procedure ...................... 0.00 0.00 0.00 NA NA 0.00 XXX 

76496 .... TC ...... C ........ Fluoroscopic procedure ...................... 0.00 0.00 0.00 NA NA 0.00 XXX 

76496 .... 26 ....... C ........ Fluoroscopic procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76497 .... ............ C ........ Ct procedure ....................................... 0.00 0.00 0.00 NA NA 0.00 XXX 

76497 .... TC ...... C ........ Ct procedure ....................................... 0.00 0.00 0.00 NA NA 0.00 XXX 

76497 .... 26 ....... C ........ Ct procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76498 .... ............ C ........ Mri procedure ...................................... 0.00 0.00 0.00 NA NA 0.00 XXX 

76498 .... TC ...... C ........ Mri procedure ...................................... 0.00 0.00 0.00 NA NA 0.00 XXX 

76498 .... 26 ....... C ........ Mri procedure ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76499 .... ............ C ........ Radiographic procedure ...................... 0.00 0.00 0.00 NA NA 0.00 XXX 

76499 .... TC ...... C ........ Radiographic procedure ...................... 0.00 0.00 0.00 NA NA 0.00 XXX 

76499 .... 26 ....... C ........ Radiographic procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76506 .... ............ A ........ Echo exam of head ............................. 0.63 2.76 2.21 NA NA 0.14 XXX 

76506 .... TC ...... A ........ Echo exam of head ............................. 0.00 2.56 1.99 NA NA 0.08 XXX 

76506 .... 26 ....... A ........ Echo exam of head ............................. 0.63 0.20 0.22 0.20 0.22 0.06 XXX 

76510 .... ............ A ........ Ophth us, b & quant a ........................ 1.55 2.25 2.55 NA NA 0.10 XXX 

76510 .... TC ...... A ........ Ophth us, b & quant a ........................ 0.00 1.70 1.94 NA NA 0.07 XXX 

76510 .... 26 ....... A ........ Ophth us, b & quant a ........................ 1.55 0.55 0.61 0.55 0.61 0.03 XXX 

76511 .... ............ A ........ Ophth us, quant a only ....................... 0.94 1.35 1.88 NA NA 0.10 XXX 

76511 .... TC ...... A ........ Ophth us, quant a only ....................... 0.00 1.02 1.52 NA NA 0.07 XXX 

76511 .... 26 ....... A ........ Ophth us, quant a only ....................... 0.94 0.33 0.36 0.33 0.36 0.03 XXX 

76512 .... ............ A ........ Ophth us, b w/non-quant a ................. 0.94 1.16 1.69 NA NA 0.12 XXX 

76512 .... TC ...... A ........ Ophth us, b w/non-quant a ................. 0.00 0.83 1.32 NA NA 0.10 XXX 

76512 .... 26 ....... A ........ Ophth us, b w/non-quant a ................. 0.94 0.33 0.37 0.33 0.37 0.02 XXX 

76513 .... ............ A ........ Echo exam of eye, water bath ............ 0.66 1.52 1.66 NA NA 0.12 XXX 

76513 .... TC ...... A ........ Echo exam of eye, water bath ............ 0.00 1.29 1.40 NA NA 0.10 XXX 

76513 .... 26 ....... A ........ Echo exam of eye, water bath ............ 0.66 0.23 0.26 0.23 0.26 0.02 XXX 

76514 .... ............ A ........ Echo exam of eye, thickness .............. 0.17 0.16 0.15 NA NA 0.02 XXX 

76514 .... TC ...... A ........ Echo exam of eye, thickness .............. 0.00 0.10 0.08 NA NA 0.01 XXX 

76514 .... 26 ....... A ........ Echo exam of eye, thickness .............. 0.17 0.06 0.07 0.06 0.07 0.01 XXX 

76516 .... ............ A ........ Echo exam of eye ............................... 0.54 1.15 1.30 NA NA 0.08 XXX 

76516 .... TC ...... A ........ Echo exam of eye ............................... 0.00 0.97 1.09 NA NA 0.07 XXX 

76516 .... 26 ....... A ........ Echo exam of eye ............................... 0.54 0.18 0.21 0.18 0.21 0.01 XXX 

76519 .... ............ A ........ Echo exam of eye ............................... 0.54 1.28 1.42 NA NA 0.08 XXX 

76519 .... TC ...... A ........ Echo exam of eye ............................... 0.00 1.09 1.20 NA NA 0.07 XXX 

76519 .... 26 ....... A ........ Echo exam of eye ............................... 0.54 0.19 0.22 0.19 0.22 0.01 XXX 

76529 .... ............ A ........ Echo exam of eye ............................... 0.57 1.15 1.26 NA NA 0.10 XXX 

76529 .... TC ...... A ........ Echo exam of eye ............................... 0.00 0.95 1.04 NA NA 0.08 XXX 

76529 .... 26 ....... A ........ Echo exam of eye ............................... 0.57 0.20 0.22 0.20 0.22 0.02 XXX 

76536 .... ............ A ........ Us exam of head and neck ................ 0.56 2.67 2.13 NA NA 0.10 XXX 

76536 .... TC ...... A ........ Us exam of head and neck ................ 0.00 2.49 1.95 NA NA 0.08 XXX 

76536 .... 26 ....... A ........ Us exam of head and neck ................ 0.56 0.18 0.18 0.18 0.18 0.02 XXX 

76604 .... ............ A ........ Us exam, chest ................................... 0.55 1.83 1.66 NA NA 0.09 XXX 

76604 .... TC ...... A ........ Us exam, chest ................................... 0.00 1.64 1.47 NA NA 0.07 XXX 

76604 .... 26 ....... A ........ Us exam, chest ................................... 0.55 0.19 0.19 0.19 0.19 0.02 XXX 

76645 .... ............ A ........ Us exam, breast(s) ............................. 0.54 2.12 1.67 NA NA 0.08 XXX 

76645 .... TC ...... A ........ Us exam, breast(s) ............................. 0.00 1.93 1.49 NA NA 0.06 XXX 

76645 .... 26 ....... A ........ Us exam, breast(s) ............................. 0.54 0.19 0.18 0.19 0.18 0.02 XXX 

76700 .... ............ A ........ Us exam, abdom, complete ................ 0.81 3.02 2.63 NA NA 0.15 XXX 

76700 .... TC ...... A ........ Us exam, abdom, complete ................ 0.00 2.75 2.36 NA NA 0.11 XXX 

76700 .... 26 ....... A ........ Us exam, abdom, complete ................ 0.81 0.27 0.27 0.27 0.27 0.04 XXX 

76705 .... ............ A ........ Echo exam of abdomen ...................... 0.59 2.35 1.98 NA NA 0.11 XXX 

76705 .... TC ...... A ........ Echo exam of abdomen ...................... 0.00 2.14 1.78 NA NA 0.08 XXX 

76705 .... 26 ....... A ........ Echo exam of abdomen ...................... 0.59 0.21 0.20 0.21 0.20 0.03 XXX 

76770 .... ............ A ........ Us exam abdo back wall, comp ......... 0.74 2.93 2.57 NA NA 0.14 XXX 

76770 .... TC ...... A ........ Us exam abdo back wall, comp ......... 0.00 2.67 2.32 NA NA 0.11 XXX 

76770 .... 26 ....... A ........ Us exam abdo back wall, comp ......... 0.74 0.26 0.25 0.26 0.25 0.03 XXX 

76775 .... ............ A ........ Us exam abdo back wall, lim .............. 0.58 2.42 2.01 NA NA 0.11 XXX 

76775 .... TC ...... A ........ Us exam abdo back wall, lim .............. 0.00 2.21 1.81 NA NA 0.08 XXX 

76775 .... 26 ....... A ........ Us exam abdo back wall, lim .............. 0.58 0.21 0.20 0.21 0.20 0.03 XXX 

76776 .... ............ A ........ Us exam k transpl w/doppler .............. 0.76 3.43 2.82 NA NA 0.14 XXX 

76776 .... TC ...... A ........ Us exam k transpl w/doppler .............. 0.00 3.16 2.57 NA NA 0.11 XXX 

76776 .... 26 ....... A ........ Us exam k transpl w/doppler .............. 0.76 0.27 0.25 0.27 0.25 0.03 XXX 

76800 .... ............ A ........ Us exam, spinal canal ........................ 1.13 2.31 2.03 NA NA 0.13 XXX 

76800 .... TC ...... A ........ Us exam, spinal canal ........................ 0.00 2.03 1.72 NA NA 0.08 XXX 

76800 .... 26 ....... A ........ Us exam, spinal canal ........................ 1.13 0.28 0.31 0.28 0.31 0.05 XXX 

76801 .... ............ A ........ Ob us < 14 wks, single fetus .............. 0.99 2.46 2.45 NA NA 0.16 XXX 


cprice-sewell on PROD1PC72 with RULES
66505 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

76801 .... TC ...... A ........ Ob us < 14 wks, single fetus .............. 0.00 2.16 2.13 NA NA 0.12 XXX 

76801 .... 26 ....... A ........ Ob us < 14 wks, single fetus .............. 0.99 0.30 0.32 0.30 0.32 0.04 XXX 

76802 .... ............ A ........ Ob us < 14 wks, add’l fetus ................ 0.83 0.97 1.16 NA NA 0.16 ZZZ 

76802 .... TC ...... A ........ Ob us < 14 wks, add’l fetus ................ 0.00 0.71 0.88 NA NA 0.12 ZZZ 

76802 .... 26 ....... A ........ Ob us < 14 wks, add’l fetus ................ 0.83 0.26 0.28 0.26 0.28 0.04 ZZZ 

76805 .... ............ A ........ Ob us >/= 14 wks, sngl fetus .............. 0.99 3.04 2.74 NA NA 0.16 XXX 

76805 .... TC ...... A ........ Ob us >/= 14 wks, sngl fetus .............. 0.00 2.73 2.42 NA NA 0.12 XXX 

76805 .... 26 ....... A ........ Ob us >/= 14 wks, sngl fetus .............. 0.99 0.31 0.32 0.31 0.32 0.04 XXX 

76810 .... ............ A ........ Ob us >/= 14 wks, addl fetus ............. 0.98 1.65 1.52 NA NA 0.26 ZZZ 

76810 .... TC ...... A ........ Ob us >/= 14 wks, addl fetus ............. 0.00 1.35 1.20 NA NA 0.22 ZZZ 

76810 .... 26 ....... A ........ Ob us >/= 14 wks, addl fetus ............. 0.98 0.30 0.32 0.30 0.32 0.04 ZZZ 

76811 .... ............ A ........ Ob us, detailed, sngl fetus .................. 1.90 3.05 3.64 NA NA 0.52 XXX 

76811 .... TC ...... A ........ Ob us, detailed, sngl fetus .................. 0.00 2.51 3.02 NA NA 0.43 XXX 

76811 .... 26 ....... A ........ Ob us, detailed, sngl fetus .................. 1.90 0.54 0.62 0.54 0.62 0.09 XXX 

76812 .... ............ A ........ Ob us, detailed, addl fetus .................. 1.78 3.98 2.84 NA NA 0.49 ZZZ 

76812 .... TC ...... A ........ Ob us, detailed, addl fetus .................. 0.00 3.48 2.26 NA NA 0.41 ZZZ 

76812 .... 26 ....... A ........ Ob us, detailed, addl fetus .................. 1.78 0.50 0.58 0.50 0.58 0.08 ZZZ 

76813 .... ............ A ........ Ob us nuchal meas, 1 gest ................ 1.18 2.21 2.21 NA NA 0.19 XXX 

76813 .... TC ...... A ........ Ob us nuchal meas, 1 gest ................ 0.00 1.81 1.81 NA NA 0.14 XXX 

76813 .... 26 ....... A ........ Ob us nuchal meas, 1 gest ................ 1.18 0.40 0.40 0.40 0.40 0.05 XXX 

76814 .... ............ A ........ Ob us nuchal meas, add-on ............... 0.99 1.15 1.15 NA NA 0.19 XXX 

76814 .... TC ...... A ........ Ob us nuchal meas, add-on ............... 0.00 0.86 0.86 NA NA 0.14 XXX 

76814 .... 26 ....... A ........ Ob us nuchal meas, add-on ............... 0.99 0.29 0.29 0.29 0.29 0.05 XXX 

76815 .... ............ A ........ Ob us, limited, fetus(s) ........................ 0.65 1.80 1.72 NA NA 0.11 XXX 

76815 .... TC ...... A ........ Ob us, limited, fetus(s) ........................ 0.00 1.60 1.51 NA NA 0.08 XXX 

76815 .... 26 ....... A ........ Ob us, limited, fetus(s) ........................ 0.65 0.20 0.21 0.20 0.21 0.03 XXX 

76816 .... ............ A ........ Ob us, follow-up, per fetus ................. 0.85 2.38 1.90 NA NA 0.10 XXX 

76816 .... TC ...... A ........ Ob us, follow-up, per fetus ................. 0.00 2.13 1.62 NA NA 0.06 XXX 

76816 .... 26 ....... A ........ Ob us, follow-up, per fetus ................. 0.85 0.25 0.28 0.25 0.28 0.04 XXX 

76817 .... ............ A ........ Transvaginal us, obstetric ................... 0.75 2.02 1.89 NA NA 0.09 XXX 

76817 .... TC ...... A ........ Transvaginal us, obstetric ................... 0.00 1.79 1.65 NA NA 0.06 XXX 

76817 .... 26 ....... A ........ Transvaginal us, obstetric ................... 0.75 0.23 0.24 0.23 0.24 0.03 XXX 

76818 .... ............ A ........ Fetal biophys profile w/nst .................. 1.05 2.21 2.11 NA NA 0.15 XXX 

76818 .... TC ...... A ........ Fetal biophys profile w/nst .................. 0.00 1.91 1.76 NA NA 0.10 XXX 

76818 .... 26 ....... A ........ Fetal biophys profile w/nst .................. 1.05 0.30 0.35 0.30 0.35 0.05 XXX 

76819 .... ............ A ........ Fetal biophys profil w/o nst ................. 0.77 1.63 1.75 NA NA 0.13 XXX 

76819 .... TC ...... A ........ Fetal biophys profil w/o nst ................. 0.00 1.40 1.50 NA NA 0.10 XXX 

76819 .... 26 ....... A ........ Fetal biophys profil w/o nst ................. 0.77 0.23 0.25 0.23 0.25 0.03 XXX 

76820 .... ............ A ........ Umbilical artery echo .......................... 0.50 0.56 1.18 NA NA 0.15 XXX 

76820 .... TC ...... A ........ Umbilical artery echo .......................... 0.00 0.42 1.01 NA NA 0.12 XXX 

76820 .... 26 ....... A ........ Umbilical artery echo .......................... 0.50 0.14 0.17 0.14 0.17 0.03 XXX 

76821 .... ............ A ........ Middle cerebral artery echo ................ 0.70 1.86 1.87 NA NA 0.15 XXX 

76821 .... TC ...... A ........ Middle cerebral artery echo ................ 0.00 1.66 1.63 NA NA 0.12 XXX 

76821 .... 26 ....... A ........ Middle cerebral artery echo ................ 0.70 0.20 0.24 0.20 0.24 0.03 XXX 

76825 .... ............ A ........ Echo exam of fetal heart .................... 1.67 4.37 3.47 NA NA 0.18 XXX 

76825 .... TC ...... A ........ Echo exam of fetal heart .................... 0.00 3.87 2.92 NA NA 0.11 XXX 

76825 .... 26 ....... A ........ Echo exam of fetal heart .................... 1.67 0.50 0.55 0.50 0.55 0.07 XXX 

76826 .... ............ A ........ Echo exam of fetal heart .................... 0.83 2.76 1.88 NA NA 0.08 XXX 

76826 .... TC ...... A ........ Echo exam of fetal heart .................... 0.00 2.52 1.61 NA NA 0.05 XXX 

76826 .... 26 ....... A ........ Echo exam of fetal heart .................... 0.83 0.24 0.27 0.24 0.27 0.03 XXX 

76827 .... ............ A ........ Echo exam of fetal heart .................... 0.58 1.07 1.50 NA NA 0.14 XXX 

76827 .... TC ...... A ........ Echo exam of fetal heart .................... 0.00 0.90 1.31 NA NA 0.12 XXX 

76827 .... 26 ....... A ........ Echo exam of fetal heart .................... 0.58 0.17 0.19 0.17 0.19 0.02 XXX 

76828 .... ............ A ........ Echo exam of fetal heart .................... 0.56 0.63 0.98 NA NA 0.11 XXX 

76828 .... TC ...... A ........ Echo exam of fetal heart .................... 0.00 0.48 0.79 NA NA 0.08 XXX 

76828 .... 26 ....... A ........ Echo exam of fetal heart .................... 0.56 0.15 0.19 0.15 0.19 0.03 XXX 

76830 .... ............ A ........ Transvaginal us, non-ob ..................... 0.69 2.76 2.26 NA NA 0.13 XXX 

76830 .... TC ...... A ........ Transvaginal us, non-ob ..................... 0.00 2.54 2.03 NA NA 0.10 XXX 

76830 .... 26 ....... A ........ Transvaginal us, non-ob ..................... 0.69 0.22 0.23 0.22 0.23 0.03 XXX 

76831 .... ............ A ........ Echo exam, uterus .............................. 0.72 2.73 2.25 NA NA 0.13 XXX 

76831 .... TC ...... A ........ Echo exam, uterus .............................. 0.00 2.52 2.02 NA NA 0.10 XXX 

76831 .... 26 ....... A ........ Echo exam, uterus .............................. 0.72 0.21 0.23 0.21 0.23 0.03 XXX 

76856 .... ............ A ........ Us exam, pelvic, complete .................. 0.69 2.79 2.26 NA NA 0.13 XXX 

76856 .... TC ...... A ........ Us exam, pelvic, complete .................. 0.00 2.55 2.03 NA NA 0.10 XXX 

76856 .... 26 ....... A ........ Us exam, pelvic, complete .................. 0.69 0.24 0.23 0.24 0.23 0.03 XXX 

76857 .... ............ A ........ Us exam, pelvic, limited ...................... 0.38 2.48 2.15 NA NA 0.08 XXX 

76857 .... TC ...... A ........ Us exam, pelvic, limited ...................... 0.00 2.34 2.02 NA NA 0.06 XXX 

76857 .... 26 ....... A ........ Us exam, pelvic, limited ...................... 0.38 0.14 0.13 0.14 0.13 0.02 XXX 

76870 .... ............ A ........ Us exam, scrotum ............................... 0.64 2.83 2.28 NA NA 0.13 XXX 

76870 .... TC ...... A ........ Us exam, scrotum ............................... 0.00 2.60 2.06 NA NA 0.10 XXX 

76870 .... 26 ....... A ........ Us exam, scrotum ............................... 0.64 0.23 0.22 0.23 0.22 0.03 XXX 

76872 .... ............ A ........ Us, transrectal ..................................... 0.69 3.40 2.82 NA NA 0.14 XXX 


cprice-sewell on PROD1PC72 with RULES
66506 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

76872 .... TC ...... A ........ Us, transrectal ..................................... 0.00 3.13 2.58 NA NA 0.10 XXX 

76872 .... 26 ....... A ........ Us, transrectal ..................................... 0.69 0.27 0.24 0.27 0.24 0.04 XXX 

76873 .... ............ A ........ Echograp trans r, pros study .............. 1.55 3.40 2.99 NA NA 0.25 XXX 

76873 .... TC ...... A ........ Echograp trans r, pros study .............. 0.00 2.85 2.47 NA NA 0.16 XXX 

76873 .... 26 ....... A ........ Echograp trans r, pros study .............. 1.55 0.55 0.52 0.55 0.52 0.09 XXX 

76880 .... ............ A ........ Us exam, extremity ............................. 0.59 3.18 2.40 NA NA 0.11 XXX 

76880 .... TC ...... A ........ Us exam, extremity ............................. 0.00 3.00 2.21 NA NA 0.08 XXX 

76880 .... 26 ....... A ........ Us exam, extremity ............................. 0.59 0.18 0.19 0.18 0.19 0.03 XXX 

76885 .... ............ A ........ Us exam infant hips, dynamic ............ 0.74 3.26 2.50 NA NA 0.13 XXX 

76885 .... TC ...... A ........ Us exam infant hips, dynamic ............ 0.00 3.01 2.26 NA NA 0.10 XXX 

76885 .... 26 ....... A ........ Us exam infant hips, dynamic ............ 0.74 0.25 0.24 0.25 0.24 0.03 XXX 

76886 .... ............ A ........ Us exam infant hips, static ................. 0.62 2.27 1.94 NA NA 0.11 XXX 

76886 .... TC ...... A ........ Us exam infant hips, static ................. 0.00 2.05 1.73 NA NA 0.08 XXX 

76886 .... 26 ....... A ........ Us exam infant hips, static ................. 0.62 0.22 0.21 0.22 0.21 0.03 XXX 

76930 .... ............ A ........ Echo guide, cardiocentesis ................. 0.67 2.08 1.92 NA NA 0.12 XXX 

76930 .... TC ...... A ........ Echo guide, cardiocentesis ................. 0.00 1.74 1.63 NA NA 0.10 XXX 

76930 .... 26 ....... A ........ Echo guide, cardiocentesis ................. 0.67 0.34 0.29 0.34 0.29 0.02 XXX 

76932 .... ............ C ........ Echo guide for heart biopsy ................ 0.00 0.00 0.00 NA NA 0.00 XXX 

76932 .... TC ...... C ........ Echo guide for heart biopsy ................ 0.00 0.00 0.00 NA NA 0.00 XXX 

76932 .... 26 ....... A ........ Echo guide for heart biopsy ................ 0.67 0.35 0.30 0.35 0.30 0.02 XXX 

76936 .... ............ A ........ Echo guide for artery repair ................ 1.99 6.12 6.54 NA NA 0.47 XXX 

76936 .... TC ...... A ........ Echo guide for artery repair ................ 0.00 5.41 5.85 NA NA 0.34 XXX 

76936 .... 26 ....... A ........ Echo guide for artery repair ................ 1.99 0.71 0.69 0.71 0.69 0.13 XXX 

76937 .... ............ A ........ Us guide, vascular access .................. 0.30 0.62 0.55 NA NA 0.13 ZZZ 

76937 .... TC ...... A ........ Us guide, vascular access .................. 0.00 0.52 0.45 NA NA 0.10 ZZZ 

76937 .... 26 ....... A ........ Us guide, vascular access .................. 0.30 0.10 0.10 0.10 0.10 0.03 ZZZ 

76940 .... ............ C ........ Us guide, tissue ablation .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

76940 .... TC ...... C ........ Us guide, tissue ablation .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

76940 .... 26 ....... A ........ Us guide, tissue ablation .................... 2.00 0.65 0.65 0.65 0.65 0.31 XXX 

76941 .... ............ C ........ Echo guide for transfusion .................. 0.00 0.00 0.00 NA NA 0.00 XXX 

76941 .... TC ...... C ........ Echo guide for transfusion .................. 0.00 0.00 0.00 NA NA 0.00 XXX 

76941 .... 26 ....... A ........ Echo guide for transfusion .................. 1.34 0.38 0.42 0.38 0.42 0.07 XXX 

76942 .... ............ A ........ Echo guide for biopsy ......................... 0.67 4.79 3.91 NA NA 0.13 XXX 

76942 .... TC ...... A ........ Echo guide for biopsy ......................... 0.00 4.55 3.68 NA NA 0.10 XXX 

76942 .... 26 ....... A ........ Echo guide for biopsy ......................... 0.67 0.24 0.23 0.24 0.23 0.03 XXX 

76945 .... ............ C ........ Echo guide, villus sampling ................ 0.00 0.00 0.00 NA NA 0.00 XXX 

76945 .... TC ...... C ........ Echo guide, villus sampling ................ 0.00 0.00 0.00 NA NA 0.00 XXX 

76945 .... 26 ....... A ........ Echo guide, villus sampling ................ 0.67 0.21 0.21 0.21 0.21 0.03 XXX 

76946 .... ............ A ........ Echo guide for amniocentesis ............ 0.38 0.45 1.05 NA NA 0.12 XXX 

76946 .... TC ...... A ........ Echo guide for amniocentesis ............ 0.00 0.34 0.93 NA NA 0.10 XXX 

76946 .... 26 ....... A ........ Echo guide for amniocentesis ............ 0.38 0.11 0.12 0.11 0.12 0.02 XXX 

76948 .... ............ A ........ Echo guide, ova aspiration ................. 0.38 0.45 1.04 NA NA 0.12 XXX 

76948 .... TC ...... A ........ Echo guide, ova aspiration ................. 0.00 0.35 0.93 NA NA 0.10 XXX 

76948 .... 26 ....... A ........ Echo guide, ova aspiration ................. 0.38 0.10 0.11 0.10 0.11 0.02 XXX 

76950 .... ............ A ........ Echo guidance radiotherapy ............... 0.58 1.21 1.35 NA NA 0.10 XXX 

76950 .... TC ...... A ........ Echo guidance radiotherapy ............... 0.00 1.02 1.16 NA NA 0.07 XXX 

76950 .... 26 ....... A ........ Echo guidance radiotherapy ............... 0.58 0.19 0.19 0.19 0.19 0.03 XXX 

76965 .... ............ A ........ Echo guidance radiotherapy ............... 1.34 1.20 3.60 NA NA 0.37 XXX 

76965 .... TC ...... A ........ Echo guidance radiotherapy ............... 0.00 0.70 3.14 NA NA 0.29 XXX 

76965 .... 26 ....... A ........ Echo guidance radiotherapy ............... 1.34 0.50 0.46 0.50 0.46 0.08 XXX 

76970 .... ............ A ........ Ultrasound exam follow-up ................. 0.40 1.98 1.58 NA NA 0.08 XXX 

76970 .... TC ...... A ........ Ultrasound exam follow-up ................. 0.00 1.87 1.46 NA NA 0.06 XXX 

76970 .... 26 ....... A ........ Ultrasound exam follow-up ................. 0.40 0.11 0.12 0.11 0.12 0.02 XXX 

76975 .... ............ C ........ GI endoscopic ultrasound ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

76975 .... TC ...... C ........ GI endoscopic ultrasound ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

76975 .... 26 ....... A ........ GI endoscopic ultrasound ................... 0.81 0.30 0.29 0.30 0.29 0.04 XXX 

76977 .... ............ A ........ Us bone density measure ................... 0.05 0.10 0.48 NA NA 0.06 XXX 

76977 .... TC ...... A ........ Us bone density measure ................... 0.00 0.09 0.46 NA NA 0.05 XXX 

76977 .... 26 ....... A ........ Us bone density measure ................... 0.05 0.01 0.02 0.01 0.02 0.01 XXX 

76998 .... ............ C ........ Us guide, intraop ................................. 0.00 0.00 0.00 NA NA 0.00 XXX 

76998 .... TC ...... C ........ Us guide, intraop ................................. 0.00 0.00 0.00 NA NA 0.00 XXX 

76998 .... 26 ....... A ........ Us guide, intraop ................................. 1.20 0.35 0.37 0.35 0.37 0.13 XXX 

76999 .... ............ C ........ Echo examination procedure .............. 0.00 0.00 0.00 NA NA 0.00 XXX 

76999 .... TC ...... C ........ Echo examination procedure .............. 0.00 0.00 0.00 NA NA 0.00 XXX 

76999 .... 26 ....... C ........ Echo examination procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77001 .... ............ A ........ Fluoroguide for vein device ................ 0.38 2.72 2.08 NA NA 0.11 ZZZ 

77001 .... TC ...... A ........ Fluoroguide for vein device ................ 0.00 2.59 1.95 NA NA 0.10 ZZZ 

77001 .... 26 ....... A ........ Fluoroguide for vein device ................ 0.38 0.13 0.13 0.13 0.13 0.01 ZZZ 

77002 .... ............ A ........ Needle localization by xray ................. 0.54 1.23 1.35 NA NA 0.09 XXX 

77002 .... TC ...... A ........ Needle localization by xray ................. 0.00 1.07 1.19 NA NA 0.07 XXX 

77002 .... 26 ....... A ........ Needle localization by xray ................. 0.54 0.16 0.16 0.16 0.16 0.02 XXX 

77003 .... ............ A ........ Fluoroguide for spine inject ................ 0.60 0.76 1.11 NA NA 0.10 XXX 


cprice-sewell on PROD1PC72 with RULES
66507 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

77003 .... TC ...... A ........ Fluoroguide for spine inject ................ 0.00 0.62 0.96 NA NA 0.07 XXX 

77003 .... 26 ....... A ........ Fluoroguide for spine inject ................ 0.60 0.14 0.15 0.14 0.15 0.03 XXX 

77011 .... ............ A ........ Ct scan for localization ....................... 1.21 20.26 14.45 NA NA 0.47 XXX 

77011 .... TC ...... A ........ Ct scan for localization ....................... 0.00 19.86 14.05 NA NA 0.42 XXX 

77011 .... 26 ....... A ........ Ct scan for localization ....................... 1.21 0.40 0.40 0.40 0.40 0.05 XXX 

77012 .... ............ A ........ Ct scan for needle biopsy ................... 1.16 2.33 5.47 NA NA 0.47 XXX 

77012 .... TC ...... A ........ Ct scan for needle biopsy ................... 0.00 1.92 5.08 NA NA 0.42 XXX 

77012 .... 26 ....... A ........ Ct scan for needle biopsy ................... 1.16 0.41 0.39 0.41 0.39 0.05 XXX 

77013 .... ............ C ........ Ct guide for tissue ablation ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

77013 .... TC ...... C ........ Ct guide for tissue ablation ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

77013 .... 26 ....... A ........ Ct guide for tissue ablation ................. 3.99 1.43 1.36 1.43 1.36 0.18 XXX 

77014 .... ............ A ........ Ct scan for therapy guide ................... 0.85 4.47 3.85 NA NA 0.20 XXX 

77014 .... TC ...... A ........ Ct scan for therapy guide ................... 0.00 4.19 3.57 NA NA 0.16 XXX 

77014 .... 26 ....... A ........ Ct scan for therapy guide ................... 0.85 0.28 0.28 0.28 0.28 0.04 XXX 

77021 .... ............ A ........ Mr guidance for needle place ............. 1.50 9.70 10.70 NA NA 0.64 XXX 

77021 .... TC ...... A ........ Mr guidance for needle place ............. 0.00 9.18 10.19 NA NA 0.55 XXX 

77021 .... 26 ....... A ........ Mr guidance for needle place ............. 1.50 0.52 0.51 0.52 0.51 0.09 XXX 

77022 .... ............ C ........ Mri for tissue ablation ......................... 0.00 0.00 0.00 NA NA 0.00 XXX 

77022 .... TC ...... C ........ Mri for tissue ablation ......................... 0.00 0.00 0.00 NA NA 0.00 XXX 

77022 .... 26 ....... A ........ Mri for tissue ablation ......................... 4.24 1.52 1.45 1.52 1.45 0.24 XXX 

77031 .... ............ A ........ Stereotact guide for brst bx ................ 1.59 1.87 4.77 NA NA 0.46 XXX 

77031 .... TC ...... A ........ Stereotact guide for brst bx ................ 0.00 1.34 4.25 NA NA 0.37 XXX 

77031 .... 26 ....... A ........ Stereotact guide for brst bx ................ 1.59 0.53 0.52 0.53 0.52 0.09 XXX 

77032 .... ............ A ........ Guidance for needle, breast ............... 0.56 0.84 1.16 NA NA 0.09 XXX 

77032 .... TC ...... A ........ Guidance for needle, breast ............... 0.00 0.64 0.97 NA NA 0.07 XXX 

77032 .... 26 ....... A ........ Guidance for needle, breast ............... 0.56 0.20 0.19 0.20 0.19 0.02 XXX 

77051 .... ............ A ........ Computer dx mammogram add-on ..... 0.06 0.20 0.32 NA NA 0.02 ZZZ 

77051 .... TC ...... A ........ Computer dx mammogram add-on ..... 0.00 0.18 0.30 NA NA 0.01 ZZZ 

77051 .... 26 ....... A ........ Computer dx mammogram add-on ..... 0.06 0.02 0.02 0.02 0.02 0.01 ZZZ 

77052 .... ............ A ........ Comp screen mammogram add-on .... 0.06 0.20 0.32 NA NA 0.02 ZZZ 

77052 .... TC ...... A ........ Comp screen mammogram add-on .... 0.00 0.18 0.30 NA NA 0.01 ZZZ 

77052 .... 26 ....... A ........ Comp screen mammogram add-on .... 0.06 0.02 0.02 0.02 0.02 0.01 ZZZ 

77053 .... ............ A ........ X-ray of mammary duct ...................... 0.36 1.24 1.98 NA NA 0.16 XXX 

77053 .... TC ...... A ........ X-ray of mammary duct ...................... 0.00 1.11 1.86 NA NA 0.14 XXX 

77053 .... 26 ....... A ........ X-ray of mammary duct ...................... 0.36 0.13 0.12 0.13 0.12 0.02 XXX 

77054 .... ............ A ........ X-ray of mammary ducts .................... 0.45 1.68 2.74 NA NA 0.21 XXX 

77054 .... TC ...... A ........ X-ray of mammary ducts .................... 0.00 1.52 2.59 NA NA 0.19 XXX 

77054 .... 26 ....... A ........ X-ray of mammary ducts .................... 0.45 0.16 0.15 0.16 0.15 0.02 XXX 

77055 .... ............ A ........ Mammogram, one breast .................... 0.70 1.65 1.46 NA NA 0.09 XXX 

77055 .... TC ...... A ........ Mammogram, one breast .................... 0.00 1.40 1.22 NA NA 0.06 XXX 

77055 .... 26 ....... A ........ Mammogram, one breast .................... 0.70 0.25 0.24 0.25 0.24 0.03 XXX 

77056 .... ............ A ........ Mammogram, both breasts ................. 0.87 2.15 1.86 NA NA 0.11 XXX 

77056 .... TC ...... A ........ Mammogram, both breasts ................. 0.00 1.84 1.57 NA NA 0.07 XXX 

77056 .... 26 ....... A ........ Mammogram, both breasts ................. 0.87 0.31 0.29 0.31 0.29 0.04 XXX 

77057 .... ............ A ........ Mammogram, screening ..................... 0.70 1.44 1.45 NA NA 0.10 XXX 

77057 .... TC ...... A ........ Mammogram, screening ..................... 0.00 1.20 1.21 NA NA 0.07 XXX 

77057 .... 26 ....... A ........ Mammogram, screening ..................... 0.70 0.24 0.24 0.24 0.24 0.03 XXX 

77058 .... ............ A ........ Mri, one breast .................................... 1.63 21.62 19.89 NA NA 0.99 XXX 

77058 .... TC ...... A ........ Mri, one breast .................................... 0.00 21.06 19.34 NA NA 0.92 XXX 

77058 .... 26 ....... A ........ Mri, one breast .................................... 1.63 0.56 0.55 0.56 0.55 0.07 XXX 

77059 .... ............ A ........ Mri, both breasts ................................. 1.63 21.56 22.99 NA NA 1.31 XXX 

77059 .... TC ...... A ........ Mri, both breasts ................................. 0.00 20.99 22.44 NA NA 1.24 XXX 

77059 .... 26 ....... A ........ Mri, both breasts ................................. 1.63 0.57 0.55 0.57 0.55 0.07 XXX 

77071 .... ............ A ........ X-ray stress view ................................ 0.41 0.77 0.47 0.77 0.47 0.06 XXX 

77072 .... ............ A ........ X-rays for bone age ............................ 0.19 0.42 0.42 NA NA 0.03 XXX 

77072 .... TC ...... A ........ X-rays for bone age ............................ 0.00 0.36 0.36 NA NA 0.02 XXX 

77072 .... 26 ....... A ........ X-rays for bone age ............................ 0.19 0.06 0.06 0.06 0.06 0.01 XXX 

77073 .... ............ A ........ X-rays, bone length studies ................ 0.27 0.67 0.77 NA NA 0.06 XXX 

77073 .... TC ...... A ........ X-rays, bone length studies ................ 0.00 0.57 0.67 NA NA 0.05 XXX 

77073 .... 26 ....... A ........ X-rays, bone length studies ................ 0.27 0.10 0.10 0.10 0.10 0.01 XXX 

77074 .... ............ A ........ X-rays, bone survey, limited ............... 0.45 1.44 1.30 NA NA 0.08 XXX 

77074 .... TC ...... A ........ X-rays, bone survey, limited ............... 0.00 1.28 1.14 NA NA 0.06 XXX 

77074 .... 26 ....... A ........ X-rays, bone survey, limited ............... 0.45 0.16 0.16 0.16 0.16 0.02 XXX 

77075 .... ............ A ........ X-rays, bone survey complete ............ 0.54 2.29 1.96 NA NA 0.10 XXX 

77075 .... TC ...... A ........ X-rays, bone survey complete ............ 0.00 2.10 1.77 NA NA 0.08 XXX 

77075 .... 26 ....... A ........ X-rays, bone survey complete ............ 0.54 0.19 0.19 0.19 0.19 0.02 XXX 

77076 .... ............ A ........ X-rays, bone survey, infant ................. 0.70 2.13 1.54 NA NA 0.08 XXX 

77076 .... TC ...... A ........ X-rays, bone survey, infant ................. 0.00 1.90 1.31 NA NA 0.05 XXX 

77076 .... 26 ....... A ........ X-rays, bone survey, infant ................. 0.70 0.23 0.23 0.23 0.23 0.03 XXX 

77077 .... ............ A ........ Joint survey, single view ..................... 0.31 0.66 0.93 NA NA 0.08 XXX 

77077 .... TC ...... A ........ Joint survey, single view ..................... 0.00 0.55 0.83 NA NA 0.06 XXX 

77077 .... 26 ....... A ........ Joint survey, single view ..................... 0.31 0.11 0.10 0.11 0.10 0.02 XXX 


cprice-sewell on PROD1PC72 with RULES
66508 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

77078 .... ............ A ........ Ct bone density, axial ......................... 0.25 4.74 3.88 NA NA 0.17 XXX 

77078 .... TC ...... A ........ Ct bone density, axial ......................... 0.00 4.65 3.80 NA NA 0.16 XXX 

77078 .... 26 ....... A ........ Ct bone density, axial ......................... 0.25 0.09 0.08 0.09 0.08 0.01 XXX 

77079 .... ............ A ........ Ct bone density, peripheral ................. 0.22 0.83 1.92 NA NA 0.06 XXX 

77079 .... TC ...... A ........ Ct bone density, peripheral ................. 0.00 0.75 1.85 NA NA 0.05 XXX 

77079 .... 26 ....... A ........ Ct bone density, peripheral ................. 0.22 0.08 0.07 0.08 0.07 0.01 XXX 

77080 .... ............ A ........ Dxa bone density, axial ...................... 0.20 1.10 2.15 NA NA 0.18 XXX 

77080 .... TC ...... A ........ Dxa bone density, axial ...................... 0.00 1.04 2.07 NA NA 0.17 XXX 

77080 .... 26 ....... A ........ Dxa bone density, axial ...................... 0.20 0.06 0.08 0.06 0.08 0.01 XXX 

77081 .... ............ A ........ Dxa bone density/peripheral ............... 0.22 0.47 0.65 NA NA 0.06 XXX 

77081 .... TC ...... A ........ Dxa bone density/peripheral ............... 0.00 0.41 0.58 NA NA 0.05 XXX 

77081 .... 26 ....... A ........ Dxa bone density/peripheral ............... 0.22 0.06 0.07 0.06 0.07 0.01 XXX 

77082 .... ............ A ........ Dxa bone density, vert fx .................... 0.17 0.53 0.66 NA NA 0.06 XXX 

77082 .... TC ...... A ........ Dxa bone density, vert fx .................... 0.00 0.48 0.61 NA NA 0.05 XXX 

77082 .... 26 ....... A ........ Dxa bone density, vert fx .................... 0.17 0.05 0.05 0.05 0.05 0.01 XXX 

77083 .... ............ A ........ Radiographic absorptiometry .............. 0.20 0.37 0.59 NA NA 0.06 XXX 

77083 .... TC ...... A ........ Radiographic absorptiometry .............. 0.00 0.32 0.53 NA NA 0.05 XXX 

77083 .... 26 ....... A ........ Radiographic absorptiometry .............. 0.20 0.05 0.06 0.05 0.06 0.01 XXX 

77084 .... ............ A ........ Magnetic image, bone marrow ........... 1.60 13.55 12.63 NA NA 0.66 XXX 

77084 .... TC ...... A ........ Magnetic image, bone marrow ........... 0.00 13.03 12.11 NA NA 0.59 XXX 

77084 .... 26 ....... A ........ Magnetic image, bone marrow ........... 1.60 0.52 0.52 0.52 0.52 0.07 XXX 

77261 .... ............ A ........ Radiation therapy planning ................. 1.39 0.48 0.49 0.48 0.49 0.07 XXX 

77262 .... ............ A ........ Radiation therapy planning ................. 2.11 0.69 0.72 0.69 0.72 0.11 XXX 

77263 .... ............ A ........ Radiation therapy planning ................. 3.14 1.03 1.07 1.03 1.07 0.16 XXX 

77280 .... ............ A ........ Set radiation therapy field ................... 0.70 4.43 4.05 NA NA 0.22 XXX 

77280 .... TC ...... A ........ Set radiation therapy field ................... 0.00 4.20 3.83 NA NA 0.18 XXX 

77280 .... 26 ....... A ........ Set radiation therapy field ................... 0.70 0.23 0.22 0.23 0.22 0.04 XXX 

77285 .... ............ A ........ Set radiation therapy field ................... 1.05 8.01 6.96 NA NA 0.35 XXX 

77285 .... TC ...... A ........ Set radiation therapy field ................... 0.00 7.67 6.62 NA NA 0.30 XXX 

77285 .... 26 ....... A ........ Set radiation therapy field ................... 1.05 0.34 0.34 0.34 0.34 0.05 XXX 

77290 .... ............ A ........ Set radiation therapy field ................... 1.56 13.41 10.21 NA NA 0.43 XXX 

77290 .... TC ...... A ........ Set radiation therapy field ................... 0.00 12.90 9.71 NA NA 0.35 XXX 

77290 .... 26 ....... A ........ Set radiation therapy field ................... 1.56 0.51 0.50 0.51 0.50 0.08 XXX 

77295 .... ............ A ........ Set radiation therapy field ................... 4.56 7.45 18.41 NA NA 1.71 XXX 

77295 .... TC ...... A ........ Set radiation therapy field ................... 0.00 5.95 16.93 NA NA 1.48 XXX 

77295 .... 26 ....... A ........ Set radiation therapy field ................... 4.56 1.50 1.48 1.50 1.48 0.23 XXX 

77299 .... ............ C ........ Radiation therapy planning ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

77299 .... TC ...... C ........ Radiation therapy planning ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

77299 .... 26 ....... C ........ Radiation therapy planning ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77300 .... ............ A ........ Radiation therapy dose plan ............... 0.62 1.18 1.36 NA NA 0.10 XXX 

77300 .... TC ...... A ........ Radiation therapy dose plan ............... 0.00 0.98 1.16 NA NA 0.07 XXX 

77300 .... 26 ....... A ........ Radiation therapy dose plan ............... 0.62 0.20 0.20 0.20 0.20 0.03 XXX 

77301 .... ............ A ........ Radiotherapy dose plan, imrt .............. 7.99 57.41 43.94 NA NA 1.88 XXX 

77301 .... TC ...... A ........ Radiotherapy dose plan, imrt .............. 0.00 54.79 41.35 NA NA 1.48 XXX 

77301 .... 26 ....... A ........ Radiotherapy dose plan, imrt .............. 7.99 2.62 2.59 2.62 2.59 0.40 XXX 

77305 .... ............ A ........ Teletx isodose plan simple ................. 0.70 0.90 1.50 NA NA 0.15 XXX 

77305 .... TC ...... A ........ Teletx isodose plan simple ................. 0.00 0.67 1.27 NA NA 0.11 XXX 

77305 .... 26 ....... A ........ Teletx isodose plan simple ................. 0.70 0.23 0.23 0.23 0.23 0.04 XXX 

77310 .... ............ A ........ Teletx isodose plan intermed .............. 1.05 1.24 1.96 NA NA 0.18 XXX 

77310 .... TC ...... A ........ Teletx isodose plan intermed .............. 0.00 0.90 1.62 NA NA 0.13 XXX 

77310 .... 26 ....... A ........ Teletx isodose plan intermed .............. 1.05 0.34 0.34 0.34 0.34 0.05 XXX 

77315 .... ............ A ........ Teletx isodose plan complex .............. 1.56 2.08 2.62 NA NA 0.22 XXX 

77315 .... TC ...... A ........ Teletx isodose plan complex .............. 0.00 1.57 2.12 NA NA 0.14 XXX 

77315 .... 26 ....... A ........ Teletx isodose plan complex .............. 1.56 0.51 0.50 0.51 0.50 0.08 XXX 

77321 .... ............ A ........ Special teletx port plan ....................... 0.95 1.51 2.93 NA NA 0.26 XXX 

77321 .... TC ...... A ........ Special teletx port plan ....................... 0.00 1.20 2.62 NA NA 0.21 XXX 

77321 .... 26 ....... A ........ Special teletx port plan ....................... 0.95 0.31 0.31 0.31 0.31 0.05 XXX 

77326 .... ............ A ........ Brachytx isodose calc simp ................ 0.93 2.98 2.82 NA NA 0.18 XXX 

77326 .... TC ...... A ........ Brachytx isodose calc simp ................ 0.00 2.68 2.52 NA NA 0.13 XXX 

77326 .... 26 ....... A ........ Brachytx isodose calc simp ................ 0.93 0.30 0.30 0.30 0.30 0.05 XXX 

77327 .... ............ A ........ Brachytx isodose calc interm .............. 1.39 4.09 4.00 NA NA 0.25 XXX 

77327 .... TC ...... A ........ Brachytx isodose calc interm .............. 0.00 3.64 3.55 NA NA 0.18 XXX 

77327 .... 26 ....... A ........ Brachytx isodose calc interm .............. 1.39 0.45 0.45 0.45 0.45 0.07 XXX 

77328 .... ............ A ........ Brachytx isodose plan compl .............. 2.09 5.25 5.44 NA NA 0.36 XXX 

77328 .... TC ...... A ........ Brachytx isodose plan compl .............. 0.00 4.56 4.76 NA NA 0.25 XXX 

77328 .... 26 ....... A ........ Brachytx isodose plan compl .............. 2.09 0.69 0.68 0.69 0.68 0.11 XXX 

77331 .... ............ A ........ Special radiation dosimetry ................. 0.87 0.81 0.79 NA NA 0.06 XXX 

77331 .... TC ...... A ........ Special radiation dosimetry ................. 0.00 0.52 0.51 NA NA 0.02 XXX 

77331 .... 26 ....... A ........ Special radiation dosimetry ................. 0.87 0.29 0.28 0.29 0.28 0.04 XXX 

77332 .... ............ A ........ Radiation treatment aid(s) .................. 0.54 1.55 1.52 NA NA 0.10 XXX 

77332 .... TC ...... A ........ Radiation treatment aid(s) .................. 0.00 1.37 1.35 NA NA 0.07 XXX 

77332 .... 26 ....... A ........ Radiation treatment aid(s) .................. 0.54 0.18 0.17 0.18 0.17 0.03 XXX 


cprice-sewell on PROD1PC72 with RULES
66509 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

77333 .... ............ A ........ Radiation treatment aid(s) .................. 0.84 0.52 1.34 NA NA 0.15 XXX 

77333 .... TC ...... A ........ Radiation treatment aid(s) .................. 0.00 0.24 1.07 NA NA 0.11 XXX 

77333 .... 26 ....... A ........ Radiation treatment aid(s) .................. 0.84 0.28 0.27 0.28 0.27 0.04 XXX 

77334 .... ............ A ........ Radiation treatment aid(s) .................. 1.24 2.71 3.18 NA NA 0.23 XXX 

77334 .... TC ...... A ........ Radiation treatment aid(s) .................. 0.00 2.31 2.78 NA NA 0.17 XXX 

77334 .... 26 ....... A ........ Radiation treatment aid(s) .................. 1.24 0.40 0.40 0.40 0.40 0.06 XXX 

77336 .... ............ A ........ Radiation physics consult ................... 0.00 1.14 2.06 NA NA 0.16 XXX 

77370 .... ............ A ........ Radiation physics consult ................... 0.00 3.04 3.27 NA NA 0.18 XXX 

77371 .... ............ A ........ Srs, multisource .................................. 0.00 30.07 30.07 NA NA 0.13 XXX 

77372 .... ............ A ........ Srs, linear based ................................. 0.00 22.80 22.80 NA NA 0.13 XXX 

77373 .... ............ A ........ Sbrt delivery ........................................ 0.00 42.62 42.62 NA NA 0.13 XXX 

77399 .... ............ C ........ External radiation dosimetry ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

77399 .... TC ...... C ........ External radiation dosimetry ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

77399 .... 26 ....... C ........ External radiation dosimetry ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77401 .... ............ A ........ Radiation treatment delivery ............... 0.00 0.47 1.12 NA NA 0.11 XXX 

77402 .... ............ A ........ Radiation treatment delivery ............... 0.00 4.34 3.06 NA NA 0.11 XXX 

77403 .... ............ A ........ Radiation treatment delivery ............... 0.00 3.75 2.76 NA NA 0.11 XXX 

77404 .... ............ A ........ Radiation treatment delivery ............... 0.00 4.20 2.99 NA NA 0.11 XXX 

77406 .... ............ A ........ Radiation treatment delivery ............... 0.00 4.23 3.00 NA NA 0.11 XXX 

77407 .... ............ A ........ Radiation treatment delivery ............... 0.00 5.78 3.93 NA NA 0.12 XXX 

77408 .... ............ A ........ Radiation treatment delivery ............... 0.00 5.19 3.64 NA NA 0.12 XXX 

77409 .... ............ A ........ Radiation treatment delivery ............... 0.00 5.76 3.93 NA NA 0.12 XXX 

77411 .... ............ A ........ Radiation treatment delivery ............... 0.00 5.73 3.91 NA NA 0.12 XXX 

77412 .... ............ A ........ Radiation treatment delivery ............... 0.00 6.78 4.56 NA NA 0.13 XXX 

77413 .... ............ A ........ Radiation treatment delivery ............... 0.00 6.85 4.59 NA NA 0.13 XXX 

77414 .... ............ A ........ Radiation treatment delivery ............... 0.00 7.71 5.02 NA NA 0.13 XXX 

77416 .... ............ A ........ Radiation treatment delivery ............... 0.00 7.72 5.02 NA NA 0.13 XXX 

77417 .... ............ A ........ Radiology port film(s) .......................... 0.00 0.36 0.48 NA NA 0.04 XXX 

77418 .... ............ A ........ Radiation tx delivery, imrt ................... 0.00 13.15 15.58 NA NA 0.13 XXX 

77421 .... ............ A ........ Stereoscopic x-ray guidance .............. 0.39 2.38 2.93 NA NA 0.12 XXX 

77421 .... TC ...... A ........ Stereoscopic x-ray guidance .............. 0.00 2.25 2.80 NA NA 0.10 XXX 

77421 .... 26 ....... A ........ Stereoscopic x-ray guidance .............. 0.39 0.13 0.13 0.13 0.13 0.02 XXX 

77422 .... ............ A ........ Neutron beam tx, simple ..................... 0.00 5.35 3.53 NA NA 0.13 XXX 

77423 .... ............ A ........ Neutron beam tx, complex .................. 0.00 7.46 4.86 NA NA 0.13 XXX 

77427 .... ............ A ........ Radiation tx management, x5 ............. 3.70 1.39 1.22 1.39 1.22 0.17 XXX 

77431 .... ............ A ........ Radiation therapy management .......... 1.81 0.77 0.73 0.77 0.73 0.09 XXX 

77432 .... ............ A ........ Stereotactic radiation trmt ................... 7.92 2.59 2.75 2.59 2.75 0.41 XXX 

77435 .... ............ A ........ Sbrt management ............................... 13.00 4.75 4.75 NA NA 0.67 XXX 

77470 .... ............ A ........ Special radiation treatment ................. 2.09 1.92 6.87 NA NA 0.70 XXX 

77470 .... TC ...... A ........ Special radiation treatment ................. 0.00 1.24 6.19 NA NA 0.59 XXX 

77470 .... 26 ....... A ........ Special radiation treatment ................. 2.09 0.68 0.68 0.68 0.68 0.11 XXX 

77499 .... ............ C ........ Radiation therapy management .......... 0.00 0.00 0.00 NA NA 0.00 XXX 

77499 .... TC ...... C ........ Radiation therapy management .......... 0.00 0.00 0.00 NA NA 0.00 XXX 

77499 .... 26 ....... C ........ Radiation therapy management .......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77520 .... ............ C ........ Proton trmt, simple w/o comp ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77522 .... ............ C ........ Proton trmt, simple w/comp ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77523 .... ............ C ........ Proton trmt, intermediate .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77525 .... ............ C ........ Proton treatment, complex .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77600 .... ............ R ........ Hyperthermia treatment ...................... 1.56 10.23 6.89 NA NA 0.24 XXX 

77600 .... TC ...... R ........ Hyperthermia treatment ...................... 0.00 9.73 6.39 NA NA 0.16 XXX 

77600 .... 26 ....... R ........ Hyperthermia treatment ...................... 1.56 0.50 0.50 0.50 0.50 0.08 XXX 

77605 .... ............ R ........ Hyperthermia treatment ...................... 2.09 18.46 11.58 NA NA 0.38 XXX 

77605 .... TC ...... R ........ Hyperthermia treatment ...................... 0.00 17.91 10.98 NA NA 0.22 XXX 

77605 .... 26 ....... R ........ Hyperthermia treatment ...................... 2.09 0.55 0.60 0.55 0.60 0.16 XXX 

77610 .... ............ R ........ Hyperthermia treatment ...................... 1.56 17.92 10.74 NA NA 0.24 XXX 

77610 .... TC ...... R ........ Hyperthermia treatment ...................... 0.00 17.56 10.31 NA NA 0.16 XXX 

77610 .... 26 ....... R ........ Hyperthermia treatment ...................... 1.56 0.36 0.43 0.36 0.43 0.08 XXX 

77615 .... ............ R ........ Hyperthermia treatment ...................... 2.09 25.90 15.31 NA NA 0.33 XXX 

77615 .... TC ...... R ........ Hyperthermia treatment ...................... 0.00 25.26 14.66 NA NA 0.22 XXX 

77615 .... 26 ....... R ........ Hyperthermia treatment ...................... 2.09 0.64 0.65 0.64 0.65 0.11 XXX 

77620 .... ............ R ........ Hyperthermia treatment ...................... 1.56 10.49 7.03 NA NA 0.36 XXX 

77620 .... TC ...... R ........ Hyperthermia treatment ...................... 0.00 10.09 6.57 NA NA 0.16 XXX 

77620 .... 26 ....... R ........ Hyperthermia treatment ...................... 1.56 0.40 0.46 0.40 0.46 0.20 XXX 

77750 .... ............ A ........ Infuse radioactive materials ................ 4.94 4.55 3.73 NA NA 0.32 090 

77750 .... TC ...... A ........ Infuse radioactive materials ................ 0.00 2.93 2.13 NA NA 0.07 090 

77750 .... 26 ....... A ........ Infuse radioactive materials ................ 4.94 1.62 1.60 1.62 1.60 0.25 090 

77761 .... ............ A ........ Apply intrcav radiat simple .................. 3.82 6.34 4.96 NA NA 0.33 090 

77761 .... TC ...... A ........ Apply intrcav radiat simple .................. 0.00 5.10 3.80 NA NA 0.14 090 

77761 .... 26 ....... A ........ Apply intrcav radiat simple .................. 3.82 1.24 1.16 1.24 1.16 0.19 090 

77762 .... ............ A ........ Apply intrcav radiat interm .................. 5.73 7.62 6.53 NA NA 0.48 090 

77762 .... TC ...... A ........ Apply intrcav radiat interm .................. 0.00 5.75 4.68 NA NA 0.19 090 

77762 .... 26 ....... A ........ Apply intrcav radiat interm .................. 5.73 1.87 1.85 1.87 1.85 0.29 090 


cprice-sewell on PROD1PC72 with RULES
66510 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

77763 .... ............ A ........ Apply intrcav radiat compl .................. 8.60 10.33 8.78 NA NA 0.66 090 

77763 .... TC ...... A ........ Apply intrcav radiat compl .................. 0.00 7.52 6.00 NA NA 0.23 090 

77763 .... 26 ....... A ........ Apply intrcav radiat compl .................. 8.60 2.81 2.78 2.81 2.78 0.43 090 

77776 .... ............ A ........ Apply interstit radiat simpl ................... 4.67 7.46 5.29 NA NA 0.57 090 

77776 .... TC ...... A ........ Apply interstit radiat simpl ................... 0.00 5.79 3.98 NA NA 0.13 090 

77776 .... 26 ....... A ........ Apply interstit radiat simpl ................... 4.67 1.67 1.31 1.67 1.31 0.44 090 

77777 .... ............ A ........ Apply interstit radiat inter .................... 7.49 7.92 7.26 NA NA 0.61 090 

77777 .... TC ...... A ........ Apply interstit radiat inter .................... 0.00 5.47 4.85 NA NA 0.22 090 

77777 .... 26 ....... A ........ Apply interstit radiat inter .................... 7.49 2.45 2.41 2.45 2.41 0.39 090 

77778 .... ............ A ........ Apply interstit radiat compl ................. 11.23 11.31 10.00 NA NA 0.84 090 

77778 .... TC ...... A ........ Apply interstit radiat compl ................. 0.00 7.62 6.37 NA NA 0.27 090 

77778 .... 26 ....... A ........ Apply interstit radiat compl ................. 11.23 3.69 3.63 3.69 3.63 0.57 090 

77781 .... ............ A ........ High intensity brachytherapy .............. 1.21 4.41 12.61 NA NA 1.14 XXX 

77781 .... TC ...... A ........ High intensity brachytherapy .............. 0.00 4.01 12.15 NA NA 1.06 XXX 

77781 .... 26 ....... A ........ High intensity brachytherapy .............. 1.21 0.40 0.46 0.40 0.46 0.08 XXX 

77782 .... ............ A ........ High intensity brachytherapy .............. 2.04 12.41 16.74 NA NA 1.19 XXX 

77782 .... TC ...... A ........ High intensity brachytherapy .............. 0.00 11.74 16.01 NA NA 1.06 XXX 

77782 .... 26 ....... A ........ High intensity brachytherapy .............. 2.04 0.67 0.73 0.67 0.73 0.13 XXX 

77783 .... ............ A ........ High intensity brachytherapy .............. 3.27 24.19 22.83 NA NA 1.25 XXX 

77783 .... TC ...... A ........ High intensity brachytherapy .............. 0.00 23.12 21.70 NA NA 1.06 XXX 

77783 .... 26 ....... A ........ High intensity brachytherapy .............. 3.27 1.07 1.13 1.07 1.13 0.19 XXX 

77784 .... ............ A ........ High intensity brachytherapy .............. 5.15 45.65 33.87 NA NA 1.35 XXX 

77784 .... TC ...... A ........ High intensity brachytherapy .............. 0.00 43.97 32.13 NA NA 1.06 XXX 

77784 .... 26 ....... A ........ High intensity brachytherapy .............. 5.15 1.68 1.74 1.68 1.74 0.29 XXX 

77789 .... ............ A ........ Apply surface radiation ....................... 1.14 2.02 1.42 NA NA 0.08 000 

77789 .... TC ...... A ........ Apply surface radiation ....................... 0.00 1.64 1.04 NA NA 0.02 000 

77789 .... 26 ....... A ........ Apply surface radiation ....................... 1.14 0.38 0.38 0.38 0.38 0.06 000 

77790 .... ............ A ........ Radiation handling .............................. 1.05 1.46 1.15 NA NA 0.07 XXX 

77790 .... TC ...... A ........ Radiation handling .............................. 0.00 1.12 0.81 NA NA 0.02 XXX 

77790 .... 26 ....... A ........ Radiation handling .............................. 1.05 0.34 0.34 0.34 0.34 0.05 XXX 

77799 .... ............ C ........ Radium/radioisotope therapy .............. 0.00 0.00 0.00 NA NA 0.00 XXX 

77799 .... TC ...... C ........ Radium/radioisotope therapy .............. 0.00 0.00 0.00 NA NA 0.00 XXX 

77799 .... 26 ....... C ........ Radium/radioisotope therapy .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78000 .... ............ A ........ Thyroid, single uptake ......................... 0.19 1.85 1.44 NA NA 0.07 XXX 

78000 .... TC ...... A ........ Thyroid, single uptake ......................... 0.00 1.79 1.38 NA NA 0.06 XXX 

78000 .... 26 ....... A ........ Thyroid, single uptake ......................... 0.19 0.06 0.06 0.06 0.06 0.01 XXX 

78001 .... ............ A ........ Thyroid, multiple uptakes .................... 0.26 2.30 1.85 NA NA 0.08 XXX 

78001 .... TC ...... A ........ Thyroid, multiple uptakes .................... 0.00 2.21 1.76 NA NA 0.07 XXX 

78001 .... 26 ....... A ........ Thyroid, multiple uptakes .................... 0.26 0.09 0.09 0.09 0.09 0.01 XXX 

78003 .... ............ A ........ Thyroid suppress/stimul ...................... 0.33 1.94 1.50 NA NA 0.07 XXX 

78003 .... TC ...... A ........ Thyroid suppress/stimul ...................... 0.00 1.82 1.39 NA NA 0.06 XXX 

78003 .... 26 ....... A ........ Thyroid suppress/stimul ...................... 0.33 0.12 0.11 0.12 0.11 0.01 XXX 

78006 .... ............ A ........ Thyroid imaging with uptake ............... 0.49 6.22 4.38 NA NA 0.15 XXX 

78006 .... TC ...... A ........ Thyroid imaging with uptake ............... 0.00 6.05 4.22 NA NA 0.13 XXX 

78006 .... 26 ....... A ........ Thyroid imaging with uptake ............... 0.49 0.17 0.16 0.17 0.16 0.02 XXX 

78007 .... ............ A ........ Thyroid image, mult uptakes .............. 0.50 3.05 2.90 NA NA 0.16 XXX 

78007 .... TC ...... A ........ Thyroid image, mult uptakes .............. 0.00 2.88 2.73 NA NA 0.14 XXX 

78007 .... 26 ....... A ........ Thyroid image, mult uptakes .............. 0.50 0.17 0.17 0.17 0.17 0.02 XXX 

78010 .... ............ A ........ Thyroid imaging .................................. 0.39 4.18 3.07 NA NA 0.13 XXX 

78010 .... TC ...... A ........ Thyroid imaging .................................. 0.00 4.05 2.94 NA NA 0.11 XXX 

78010 .... 26 ....... A ........ Thyroid imaging .................................. 0.39 0.13 0.13 0.13 0.13 0.02 XXX 

78011 .... ............ A ........ Thyroid imaging with flow ................... 0.45 4.54 3.55 NA NA 0.15 XXX 

78011 .... TC ...... A ........ Thyroid imaging with flow ................... 0.00 4.38 3.40 NA NA 0.13 XXX 

78011 .... 26 ....... A ........ Thyroid imaging with flow ................... 0.45 0.16 0.15 0.16 0.15 0.02 XXX 

78015 .... ............ A ........ Thyroid met imaging ........................... 0.67 5.34 4.07 NA NA 0.17 XXX 

78015 .... TC ...... A ........ Thyroid met imaging ........................... 0.00 5.12 3.84 NA NA 0.14 XXX 

78015 .... 26 ....... A ........ Thyroid met imaging ........................... 0.67 0.22 0.23 0.22 0.23 0.03 XXX 

78016 .... ............ A ........ Thyroid met imaging/studies ............... 0.82 8.52 6.14 NA NA 0.21 XXX 

78016 .... TC ...... A ........ Thyroid met imaging/studies ............... 0.00 8.25 5.86 NA NA 0.18 XXX 

78016 .... 26 ....... A ........ Thyroid met imaging/studies ............... 0.82 0.27 0.28 0.27 0.28 0.03 XXX 

78018 .... ............ A ........ Thyroid met imaging, body ................. 0.86 7.93 6.82 NA NA 0.33 XXX 

78018 .... TC ...... A ........ Thyroid met imaging, body ................. 0.00 7.63 6.52 NA NA 0.29 XXX 

78018 .... 26 ....... A ........ Thyroid met imaging, body ................. 0.86 0.30 0.30 0.30 0.30 0.04 XXX 

78020 .... ............ A ........ Thyroid met uptake ............................. 0.60 1.80 1.66 NA NA 0.16 ZZZ 

78020 .... TC ...... A ........ Thyroid met uptake ............................. 0.00 1.60 1.45 NA NA 0.14 ZZZ 

78020 .... 26 ....... A ........ Thyroid met uptake ............................. 0.60 0.20 0.21 0.20 0.21 0.02 ZZZ 

78070 .... ............ A ........ Parathyroid nuclear imaging ............... 0.82 3.48 4.01 NA NA 0.15 XXX 

78070 .... TC ...... A ........ Parathyroid nuclear imaging ............... 0.00 3.20 3.73 NA NA 0.11 XXX 

78070 .... 26 ....... A ........ Parathyroid nuclear imaging ............... 0.82 0.28 0.28 0.28 0.28 0.04 XXX 

78075 .... ............ A ........ Adrenal nuclear imaging ..................... 0.74 11.61 8.64 NA NA 0.32 XXX 

78075 .... TC ...... A ........ Adrenal nuclear imaging ..................... 0.00 11.36 8.39 NA NA 0.29 XXX 

78075 .... 26 ....... A ........ Adrenal nuclear imaging ..................... 0.74 0.25 0.25 0.25 0.25 0.03 XXX 


cprice-sewell on PROD1PC72 with RULES
66511 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

78099 .... ............ C ........ Endocrine nuclear procedure .............. 0.00 0.00 0.00 NA NA 0.00 XXX 

78099 .... TC ...... C ........ Endocrine nuclear procedure .............. 0.00 0.00 0.00 NA NA 0.00 XXX 

78099 .... 26 ....... C ........ Endocrine nuclear procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78102 .... ............ A ........ Bone marrow imaging, ltd ................... 0.55 4.18 3.20 NA NA 0.14 XXX 

78102 .... TC ...... A ........ Bone marrow imaging, ltd ................... 0.00 3.99 3.01 NA NA 0.12 XXX 

78102 .... 26 ....... A ........ Bone marrow imaging, ltd ................... 0.55 0.19 0.19 0.19 0.19 0.02 XXX 

78103 .... ............ A ........ Bone marrow imaging, mult ................ 0.75 5.43 4.43 NA NA 0.20 XXX 

78103 .... TC ...... A ........ Bone marrow imaging, mult ................ 0.00 5.17 4.17 NA NA 0.17 XXX 

78103 .... 26 ....... A ........ Bone marrow imaging, mult ................ 0.75 0.26 0.26 0.26 0.26 0.03 XXX 

78104 .... ............ A ........ Bone marrow imaging, body ............... 0.80 6.23 5.28 NA NA 0.25 XXX 

78104 .... TC ...... A ........ Bone marrow imaging, body ............... 0.00 5.94 5.00 NA NA 0.22 XXX 

78104 .... 26 ....... A ........ Bone marrow imaging, body ............... 0.80 0.29 0.28 0.29 0.28 0.03 XXX 

78110 .... ............ A ........ Plasma volume, single ........................ 0.19 2.13 1.57 NA NA 0.07 XXX 

78110 .... TC ...... A ........ Plasma volume, single ........................ 0.00 2.06 1.50 NA NA 0.06 XXX 

78110 .... 26 ....... A ........ Plasma volume, single ........................ 0.19 0.07 0.07 0.07 0.07 0.01 XXX 

78111 .... ............ A ........ Plasma volume, multiple ..................... 0.22 2.14 2.40 NA NA 0.15 XXX 

78111 .... TC ...... A ........ Plasma volume, multiple ..................... 0.00 2.07 2.32 NA NA 0.14 XXX 

78111 .... 26 ....... A ........ Plasma volume, multiple ..................... 0.22 0.07 0.08 0.07 0.08 0.01 XXX 

78120 .... ............ A ........ Red cell mass, single .......................... 0.23 2.10 1.96 NA NA 0.12 XXX 

78120 .... TC ...... A ........ Red cell mass, single .......................... 0.00 2.02 1.88 NA NA 0.11 XXX 

78120 .... 26 ....... A ........ Red cell mass, single .......................... 0.23 0.08 0.08 0.08 0.08 0.01 XXX 

78121 .... ............ A ........ Red cell mass, multiple ....................... 0.32 2.20 2.61 NA NA 0.15 XXX 

78121 .... TC ...... A ........ Red cell mass, multiple ....................... 0.00 2.10 2.50 NA NA 0.14 XXX 

78121 .... 26 ....... A ........ Red cell mass, multiple ....................... 0.32 0.10 0.11 0.10 0.11 0.01 XXX 

78122 .... ............ A ........ Blood volume ...................................... 0.45 2.25 3.51 NA NA 0.26 XXX 

78122 .... TC ...... A ........ Blood volume ...................................... 0.00 2.10 3.35 NA NA 0.24 XXX 

78122 .... 26 ....... A ........ Blood volume ...................................... 0.45 0.15 0.16 0.15 0.16 0.02 XXX 

78130 .... ............ A ........ Red cell survival study ........................ 0.61 3.50 3.28 NA NA 0.17 XXX 

78130 .... TC ...... A ........ Red cell survival study ........................ 0.00 3.29 3.07 NA NA 0.14 XXX 

78130 .... 26 ....... A ........ Red cell survival study ........................ 0.61 0.21 0.21 0.21 0.21 0.03 XXX 

78135 .... ............ A ........ Red cell survival kinetics .................... 0.64 8.67 6.88 NA NA 0.28 XXX 

78135 .... TC ...... A ........ Red cell survival kinetics .................... 0.00 8.45 6.66 NA NA 0.25 XXX 

78135 .... 26 ....... A ........ Red cell survival kinetics .................... 0.64 0.22 0.22 0.22 0.22 0.03 XXX 

78140 .... ............ A ........ Red cell sequestration ........................ 0.61 2.94 3.53 NA NA 0.24 XXX 

78140 .... TC ...... A ........ Red cell sequestration ........................ 0.00 2.72 3.32 NA NA 0.21 XXX 

78140 .... 26 ....... A ........ Red cell sequestration ........................ 0.61 0.22 0.21 0.22 0.21 0.03 XXX 

78185 .... ............ A ........ Spleen imaging ................................... 0.40 5.19 3.85 NA NA 0.15 XXX 

78185 .... TC ...... A ........ Spleen imaging ................................... 0.00 5.05 3.71 NA NA 0.13 XXX 

78185 .... 26 ....... A ........ Spleen imaging ................................... 0.40 0.14 0.14 0.14 0.14 0.02 XXX 

78190 .... ............ A ........ Platelet survival, kinetics ..................... 1.09 8.37 7.24 NA NA 0.38 XXX 

78190 .... TC ...... A ........ Platelet survival, kinetics ..................... 0.00 8.12 6.92 NA NA 0.30 XXX 

78190 .... 26 ....... A ........ Platelet survival, kinetics ..................... 1.09 0.25 0.32 0.25 0.32 0.08 XXX 

78191 .... ............ A ........ Platelet survival ................................... 0.61 3.51 5.53 NA NA 0.40 XXX 

78191 .... TC ...... A ........ Platelet survival ................................... 0.00 3.30 5.32 NA NA 0.37 XXX 

78191 .... 26 ....... A ........ Platelet survival ................................... 0.61 0.21 0.21 0.21 0.21 0.03 XXX 

78195 .... ............ A ........ Lymph system imaging ....................... 1.20 8.68 6.58 NA NA 0.28 XXX 

78195 .... TC ...... A ........ Lymph system imaging ....................... 0.00 8.27 6.17 NA NA 0.22 XXX 

78195 .... 26 ....... A ........ Lymph system imaging ....................... 1.20 0.41 0.41 0.41 0.41 0.06 XXX 

78199 .... ............ C ........ Blood/lymph nuclear exam ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

78199 .... TC ...... C ........ Blood/lymph nuclear exam ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

78199 .... 26 ....... C ........ Blood/lymph nuclear exam ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78201 .... ............ A ........ Liver imaging ....................................... 0.44 4.59 3.55 NA NA 0.15 XXX 

78201 .... TC ...... A ........ Liver imaging ....................................... 0.00 4.46 3.41 NA NA 0.13 XXX 

78201 .... 26 ....... A ........ Liver imaging ....................................... 0.44 0.13 0.14 0.13 0.14 0.02 XXX 

78202 .... ............ A ........ Liver imaging with flow ....................... 0.51 5.34 4.20 NA NA 0.16 XXX 

78202 .... TC ...... A ........ Liver imaging with flow ....................... 0.00 5.17 4.03 NA NA 0.14 XXX 

78202 .... 26 ....... A ........ Liver imaging with flow ....................... 0.51 0.17 0.17 0.17 0.17 0.02 XXX 

78205 .... ............ A ........ Liver imaging (3D) .............................. 0.71 5.27 5.70 NA NA 0.34 XXX 

78205 .... TC ...... A ........ Liver imaging (3D) .............................. 0.00 5.02 5.46 NA NA 0.31 XXX 

78205 .... 26 ....... A ........ Liver imaging (3D) .............................. 0.71 0.25 0.24 0.25 0.24 0.03 XXX 

78206 .... ............ A ........ Liver image (3d) with flow ................... 0.96 8.60 7.41 NA NA 0.15 XXX 

78206 .... TC ...... A ........ Liver image (3d) with flow ................... 0.00 8.26 7.08 NA NA 0.11 XXX 

78206 .... 26 ....... A ........ Liver image (3d) with flow ................... 0.96 0.34 0.33 0.34 0.33 0.04 XXX 

78215 .... ............ A ........ Liver and spleen imaging .................... 0.49 4.82 3.96 NA NA 0.16 XXX 

78215 .... TC ...... A ........ Liver and spleen imaging .................... 0.00 4.65 3.79 NA NA 0.14 XXX 

78215 .... 26 ....... A ........ Liver and spleen imaging .................... 0.49 0.17 0.17 0.17 0.17 0.02 XXX 

78216 .... ............ A ........ Liver & spleen image/flow ................... 0.57 2.84 3.26 NA NA 0.20 XXX 

78216 .... TC ...... A ........ Liver & spleen image/flow ................... 0.00 2.65 3.07 NA NA 0.18 XXX 

78216 .... 26 ....... A ........ Liver & spleen image/flow ................... 0.57 0.19 0.19 0.19 0.19 0.02 XXX 

78220 .... ............ A ........ Liver function study ............................. 0.49 3.08 3.47 NA NA 0.21 XXX 

78220 .... TC ...... A ........ Liver function study ............................. 0.00 2.91 3.31 NA NA 0.19 XXX 

78220 .... 26 ....... A ........ Liver function study ............................. 0.49 0.17 0.16 0.17 0.16 0.02 XXX 


cprice-sewell on PROD1PC72 with RULES
66512 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

78223 .... ............ A ........ Hepatobiliary imaging ......................... 0.84 8.50 6.22 NA NA 0.23 XXX 

78223 .... TC ...... A ........ Hepatobiliary imaging ......................... 0.00 8.21 5.93 NA NA 0.19 XXX 

78223 .... 26 ....... A ........ Hepatobiliary imaging ......................... 0.84 0.29 0.29 0.29 0.29 0.04 XXX 

78230 .... ............ A ........ Salivary gland imaging ........................ 0.45 4.17 3.25 NA NA 0.15 XXX 

78230 .... TC ...... A ........ Salivary gland imaging ........................ 0.00 4.01 3.10 NA NA 0.13 XXX 

78230 .... 26 ....... A ........ Salivary gland imaging ........................ 0.45 0.16 0.15 0.16 0.15 0.02 XXX 

78231 .... ............ A ........ Serial salivary imaging ........................ 0.52 2.80 3.07 NA NA 0.19 XXX 

78231 .... TC ...... A ........ Serial salivary imaging ........................ 0.00 2.63 2.90 NA NA 0.17 XXX 

78231 .... 26 ....... A ........ Serial salivary imaging ........................ 0.52 0.17 0.17 0.17 0.17 0.02 XXX 

78232 .... ............ A ........ Salivary gland function exam .............. 0.47 2.77 3.24 NA NA 0.20 XXX 

78232 .... TC ...... A ........ Salivary gland function exam .............. 0.00 2.62 3.08 NA NA 0.18 XXX 

78232 .... 26 ....... A ........ Salivary gland function exam .............. 0.47 0.15 0.16 0.15 0.16 0.02 XXX 

78258 .... ............ A ........ Esophageal motility study ................... 0.74 5.52 4.32 NA NA 0.17 XXX 

78258 .... TC ...... A ........ Esophageal motility study ................... 0.00 5.25 4.06 NA NA 0.14 XXX 

78258 .... 26 ....... A ........ Esophageal motility study ................... 0.74 0.27 0.26 0.27 0.26 0.03 XXX 

78261 .... ............ A ........ Gastric mucosa imaging ..................... 0.69 6.00 5.17 NA NA 0.25 XXX 

78261 .... TC ...... A ........ Gastric mucosa imaging ..................... 0.00 5.76 4.93 NA NA 0.22 XXX 

78261 .... 26 ....... A ........ Gastric mucosa imaging ..................... 0.69 0.24 0.24 0.24 0.24 0.03 XXX 

78262 .... ............ A ........ Gastroesophageal reflux exam ........... 0.68 5.95 5.21 NA NA 0.25 XXX 

78262 .... TC ...... A ........ Gastroesophageal reflux exam ........... 0.00 5.73 4.99 NA NA 0.22 XXX 

78262 .... 26 ....... A ........ Gastroesophageal reflux exam ........... 0.68 0.22 0.22 0.22 0.22 0.03 XXX 

78264 .... ............ A ........ Gastric emptying study ....................... 0.78 7.16 5.78 NA NA 0.25 XXX 

78264 .... TC ...... A ........ Gastric emptying study ....................... 0.00 6.89 5.51 NA NA 0.22 XXX 

78264 .... 26 ....... A ........ Gastric emptying study ....................... 0.78 0.27 0.27 0.27 0.27 0.03 XXX 

78267 .... ............ X ........ Breath tst attain/anal c-14 ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78268 .... ............ X ........ Breath test analysis, c-14 ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78270 .... ............ A ........ Vit B-12 absorption exam ................... 0.20 1.95 1.78 NA NA 0.11 XXX 

78270 .... TC ...... A ........ Vit B-12 absorption exam ................... 0.00 1.88 1.71 NA NA 0.10 XXX 

78270 .... 26 ....... A ........ Vit B-12 absorption exam ................... 0.20 0.07 0.07 0.07 0.07 0.01 XXX 

78271 .... ............ A ........ Vit b-12 absrp exam, int fac ............... 0.20 1.88 1.79 NA NA 0.11 XXX 

78271 .... TC ...... A ........ Vit b-12 absrp exam, int fac ............... 0.00 1.83 1.73 NA NA 0.10 XXX 

78271 .... 26 ....... A ........ Vit b-12 absrp exam, int fac ............... 0.20 0.05 0.06 0.05 0.06 0.01 XXX 

78272 .... ............ A ........ Vit B-12 absorp, combined ................. 0.27 2.06 2.23 NA NA 0.14 XXX 

78272 .... TC ...... A ........ Vit B-12 absorp, combined ................. 0.00 1.99 2.15 NA NA 0.13 XXX 

78272 .... 26 ....... A ........ Vit B-12 absorp, combined ................. 0.27 0.07 0.08 0.07 0.08 0.01 XXX 

78278 .... ............ A ........ Acute GI blood loss imaging ............... 0.99 8.60 6.90 NA NA 0.29 XXX 

78278 .... TC ...... A ........ Acute GI blood loss imaging ............... 0.00 8.25 6.56 NA NA 0.25 XXX 

78278 .... 26 ....... A ........ Acute GI blood loss imaging ............... 0.99 0.35 0.34 0.35 0.34 0.04 XXX 

78282 .... ............ C ........ GI protein loss exam ........................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78282 .... TC ...... C ........ GI protein loss exam ........................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78282 .... 26 ....... A ........ GI protein loss exam ........................... 0.38 0.13 0.13 0.13 0.13 0.02 XXX 

78290 .... ............ A ........ Meckel’s divert exam .......................... 0.68 8.51 5.89 NA NA 0.19 XXX 

78290 .... TC ...... A ........ Meckel’s divert exam .......................... 0.00 8.27 5.66 NA NA 0.16 XXX 

78290 .... 26 ....... A ........ Meckel’s divert exam .......................... 0.68 0.24 0.23 0.24 0.23 0.03 XXX 

78291 .... ............ A ........ Leveen/shunt patency exam ............... 0.88 6.14 4.75 NA NA 0.20 XXX 

78291 .... TC ...... A ........ Leveen/shunt patency exam ............... 0.00 5.84 4.45 NA NA 0.16 XXX 

78291 .... 26 ....... A ........ Leveen/shunt patency exam ............... 0.88 0.30 0.30 0.30 0.30 0.04 XXX 

78299 .... ............ C ........ GI nuclear procedure .......................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78299 .... TC ...... C ........ GI nuclear procedure .......................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78299 .... 26 ....... C ........ GI nuclear procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78300 .... ............ A ........ Bone imaging, limited area ................. 0.62 4.23 3.46 NA NA 0.17 XXX 

78300 .... TC ...... A ........ Bone imaging, limited area ................. 0.00 4.01 3.25 NA NA 0.14 XXX 

78300 .... 26 ....... A ........ Bone imaging, limited area ................. 0.62 0.22 0.21 0.22 0.21 0.03 XXX 

78305 .... ............ A ........ Bone imaging, multiple areas ............. 0.83 5.47 4.70 NA NA 0.23 XXX 

78305 .... TC ...... A ........ Bone imaging, multiple areas ............. 0.00 5.19 4.42 NA NA 0.19 XXX 

78305 .... 26 ....... A ........ Bone imaging, multiple areas ............. 0.83 0.28 0.28 0.28 0.28 0.04 XXX 

78306 .... ............ A ........ Bone imaging, whole body ................. 0.86 6.06 5.31 NA NA 0.26 XXX 

78306 .... TC ...... A ........ Bone imaging, whole body ................. 0.00 5.76 5.01 NA NA 0.22 XXX 

78306 .... 26 ....... A ........ Bone imaging, whole body ................. 0.86 0.30 0.30 0.30 0.30 0.04 XXX 

78315 .... ............ A ........ Bone imaging, 3 phase ....................... 1.02 8.59 6.85 NA NA 0.29 XXX 

78315 .... TC ...... A ........ Bone imaging, 3 phase ....................... 0.00 8.23 6.50 NA NA 0.25 XXX 

78315 .... 26 ....... A ........ Bone imaging, 3 phase ....................... 1.02 0.36 0.35 0.36 0.35 0.04 XXX 

78320 .... ............ A ........ Bone imaging (3D) .............................. 1.04 5.35 5.81 NA NA 0.35 XXX 

78320 .... TC ...... A ........ Bone imaging (3D) .............................. 0.00 4.99 5.45 NA NA 0.31 XXX 

78320 .... 26 ....... A ........ Bone imaging (3D) .............................. 1.04 0.36 0.36 0.36 0.36 0.04 XXX 

78350 .... ............ N ........ Bone mineral, single photon ............... 0.22 0.51 0.67 NA NA 0.06 XXX 

78350 .... TC ...... N ........ Bone mineral, single photon ............... 0.00 0.46 0.61 NA NA 0.05 XXX 

78350 .... 26 ....... N ........ Bone mineral, single photon ............... 0.22 0.05 0.06 0.05 0.06 0.01 XXX 

78351 .... ............ N ........ Bone mineral, dual photon .................. 0.30 NA NA 0.07 0.09 0.01 XXX 

78399 .... ............ C ........ Musculoskeletal nuclear exam ............ 0.00 0.00 0.00 NA NA 0.00 XXX 

78399 .... TC ...... C ........ Musculoskeletal nuclear exam ............ 0.00 0.00 0.00 NA NA 0.00 XXX 

78399 .... 26 ....... C ........ Musculoskeletal nuclear exam ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 


cprice-sewell on PROD1PC72 with RULES
66513 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

78414 .... ............ C ........ Non-imaging heart function ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

78414 .... TC ...... C ........ Non-imaging heart function ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

78414 .... 26 ....... A ........ Non-imaging heart function ................. 0.45 0.17 0.17 0.17 0.17 0.02 XXX 

78428 .... ............ A ........ Cardiac shunt imaging ........................ 0.78 5.26 3.90 NA NA 0.16 XXX 

78428 .... TC ...... A ........ Cardiac shunt imaging ........................ 0.00 4.90 3.58 NA NA 0.13 XXX 

78428 .... 26 ....... A ........ Cardiac shunt imaging ........................ 0.78 0.36 0.32 0.36 0.32 0.03 XXX 

78445 .... ............ A ........ Vascular flow imaging ......................... 0.49 4.48 3.26 NA NA 0.13 XXX 

78445 .... TC ...... A ........ Vascular flow imaging ......................... 0.00 4.31 3.09 NA NA 0.11 XXX 

78445 .... 26 ....... A ........ Vascular flow imaging ......................... 0.49 0.17 0.17 0.17 0.17 0.02 XXX 

78456 .... ............ A ........ Acute venous thrombus image ........... 1.00 8.80 6.56 NA NA 0.33 XXX 

78456 .... TC ...... A ........ Acute venous thrombus image ........... 0.00 8.43 6.20 NA NA 0.29 XXX 

78456 .... 26 ....... A ........ Acute venous thrombus image ........... 1.00 0.37 0.36 0.37 0.36 0.04 XXX 

78457 .... ............ A ........ Venous thrombosis imaging ............... 0.77 4.65 3.78 NA NA 0.17 XXX 

78457 .... TC ...... A ........ Venous thrombosis imaging ............... 0.00 4.41 3.53 NA NA 0.14 XXX 

78457 .... 26 ....... A ........ Venous thrombosis imaging ............... 0.77 0.24 0.25 0.24 0.25 0.03 XXX 

78458 .... ............ A ........ Ven thrombosis images, bilat ............. 0.90 4.51 4.43 NA NA 0.25 XXX 

78458 .... TC ...... A ........ Ven thrombosis images, bilat ............. 0.00 4.22 4.12 NA NA 0.21 XXX 

78458 .... 26 ....... A ........ Ven thrombosis images, bilat ............. 0.90 0.29 0.31 0.29 0.31 0.04 XXX 

78459 .... ............ C ........ Heart muscle imaging (PET) .............. 0.00 0.00 0.00 NA NA 0.00 XXX 

78459 .... TC ...... C ........ Heart muscle imaging (PET) .............. 0.00 0.00 0.00 NA NA 0.00 XXX 

78459 .... 26 ....... A ........ Heart muscle imaging (PET) .............. 1.50 0.60 0.59 0.60 0.59 0.05 XXX 

78460 .... ............ A ........ Heart muscle blood, single ................. 0.86 4.66 3.65 NA NA 0.17 XXX 

78460 .... TC ...... A ........ Heart muscle blood, single ................. 0.00 4.34 3.35 NA NA 0.13 XXX 

78460 .... 26 ....... A ........ Heart muscle blood, single ................. 0.86 0.32 0.30 0.32 0.30 0.04 XXX 

78461 .... ............ A ........ Heart muscle blood, multiple .............. 1.23 4.07 4.60 NA NA 0.30 XXX 

78461 .... TC ...... A ........ Heart muscle blood, multiple .............. 0.00 3.61 4.16 NA NA 0.25 XXX 

78461 .... 26 ....... A ........ Heart muscle blood, multiple .............. 1.23 0.46 0.44 0.46 0.44 0.05 XXX 

78464 .... ............ A ........ Heart image (3d), single ..................... 1.09 5.86 6.65 NA NA 0.41 XXX 

78464 .... TC ...... A ........ Heart image (3d), single ..................... 0.00 5.36 6.21 NA NA 0.37 XXX 

78464 .... 26 ....... A ........ Heart image (3d), single ..................... 1.09 0.50 0.44 0.50 0.44 0.04 XXX 

78465 .... ............ A ........ Heart image (3d), multiple .................. 1.46 11.44 11.87 NA NA 0.67 XXX 

78465 .... TC ...... A ........ Heart image (3d), multiple .................. 0.00 10.73 11.26 NA NA 0.62 XXX 

78465 .... 26 ....... A ........ Heart image (3d), multiple .................. 1.46 0.71 0.61 0.71 0.61 0.05 XXX 

78466 .... ............ A ........ Heart infarct image ............................. 0.69 4.57 3.71 NA NA 0.17 XXX 

78466 .... TC ...... A ........ Heart infarct image ............................. 0.00 4.28 3.45 NA NA 0.14 XXX 

78466 .... 26 ....... A ........ Heart infarct image ............................. 0.69 0.29 0.26 0.29 0.26 0.03 XXX 

78468 .... ............ A ........ Heart infarct image (ef) ....................... 0.80 5.86 4.89 NA NA 0.22 XXX 

78468 .... TC ...... A ........ Heart infarct image (ef) ....................... 0.00 5.47 4.56 NA NA 0.19 XXX 

78468 .... 26 ....... A ........ Heart infarct image (ef) ....................... 0.80 0.39 0.33 0.39 0.33 0.03 XXX 

78469 .... ............ A ........ Heart infarct image (3D) ..................... 0.92 6.28 5.90 NA NA 0.31 XXX 

78469 .... TC ...... A ........ Heart infarct image (3D) ..................... 0.00 5.84 5.53 NA NA 0.28 XXX 

78469 .... 26 ....... A ........ Heart infarct image (3D) ..................... 0.92 0.44 0.37 0.44 0.37 0.03 XXX 

78472 .... ............ A ........ Gated heart, planar, single ................. 0.98 6.03 5.93 NA NA 0.34 XXX 

78472 .... TC ...... A ........ Gated heart, planar, single ................. 0.00 5.62 5.56 NA NA 0.30 XXX 

78472 .... 26 ....... A ........ Gated heart, planar, single ................. 0.98 0.41 0.37 0.41 0.37 0.04 XXX 

78473 .... ............ A ........ Gated heart, multiple .......................... 1.47 7.76 8.25 NA NA 0.48 XXX 

78473 .... TC ...... A ........ Gated heart, multiple .......................... 0.00 7.12 7.68 NA NA 0.42 XXX 

78473 .... 26 ....... A ........ Gated heart, multiple .......................... 1.47 0.64 0.57 0.64 0.57 0.06 XXX 

78478 .... ............ A ........ Heart wall motion add-on .................... 0.50 0.80 1.30 NA NA 0.12 XXX 

78478 .... TC ...... A ........ Heart wall motion add-on .................... 0.00 0.56 1.06 NA NA 0.10 XXX 

78478 .... 26 ....... A ........ Heart wall motion add-on .................... 0.50 0.24 0.24 0.24 0.24 0.02 XXX 

78480 .... ............ A ........ Heart function add-on ......................... 0.30 0.70 1.24 NA NA 0.12 XXX 

78480 .... TC ...... A ........ Heart function add-on ......................... 0.00 0.56 1.06 NA NA 0.10 XXX 

78480 .... 26 ....... A ........ Heart function add-on ......................... 0.30 0.14 0.18 0.14 0.18 0.02 XXX 

78481 .... ............ A ........ Heart first pass, single ........................ 0.98 5.07 5.33 NA NA 0.31 XXX 

78481 .... TC ...... A ........ Heart first pass, single ........................ 0.00 4.58 4.90 NA NA 0.28 XXX 

78481 .... 26 ....... A ........ Heart first pass, single ........................ 0.98 0.49 0.43 0.49 0.43 0.03 XXX 

78483 .... ............ A ........ Heart first pass, multiple ..................... 1.47 6.87 7.63 NA NA 0.46 XXX 

78483 .... TC ...... A ........ Heart first pass, multiple ..................... 0.00 6.09 6.97 NA NA 0.41 XXX 

78483 .... 26 ....... A ........ Heart first pass, multiple ..................... 1.47 0.78 0.66 0.78 0.66 0.05 XXX 

78491 .... ............ C ........ Heart image (pet), single .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78491 .... TC ...... C ........ Heart image (pet), single .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78491 .... 26 ....... A ........ Heart image (pet), single .................... 1.50 0.63 0.61 0.63 0.61 0.06 XXX 

78492 .... ............ C ........ Heart image (pet), multiple ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

78492 .... TC ...... C ........ Heart image (pet), multiple ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

78492 .... 26 ....... A ........ Heart image (pet), multiple ................. 1.87 0.91 0.82 0.91 0.82 0.07 XXX 

78494 .... ............ A ........ Heart image, spect .............................. 1.19 6.22 6.85 NA NA 0.35 XXX 

78494 .... TC ...... A ........ Heart image, spect .............................. 0.00 5.68 6.37 NA NA 0.30 XXX 

78494 .... 26 ....... A ........ Heart image, spect .............................. 1.19 0.54 0.48 0.54 0.48 0.05 XXX 

78496 .... ............ A ........ Heart first pass add-on ....................... 0.50 0.88 4.06 NA NA 0.32 ZZZ 

78496 .... TC ...... A ........ Heart first pass add-on ....................... 0.00 0.65 3.86 NA NA 0.30 ZZZ 

78496 .... 26 ....... A ........ Heart first pass add-on ....................... 0.50 0.23 0.20 0.23 0.20 0.02 ZZZ 


cprice-sewell on PROD1PC72 with RULES
66514 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

78499 .... ............ C ........ Cardiovascular nuclear exam ............. 0.00 0.00 0.00 NA NA 0.00 XXX 

78499 .... TC ...... C ........ Cardiovascular nuclear exam ............. 0.00 0.00 0.00 NA NA 0.00 XXX 

78499 .... 26 ....... C ........ Cardiovascular nuclear exam ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78580 .... ............ A ........ Lung perfusion imaging ...................... 0.74 5.13 4.41 NA NA 0.21 XXX 

78580 .... TC ...... A ........ Lung perfusion imaging ...................... 0.00 4.87 4.15 NA NA 0.18 XXX 

78580 .... 26 ....... A ........ Lung perfusion imaging ...................... 0.74 0.26 0.26 0.26 0.26 0.03 XXX 

78584 .... ............ A ........ Lung V/Q image single breath ............ 0.99 3.02 3.27 NA NA 0.21 XXX 

78584 .... TC ...... A ........ Lung V/Q image single breath ............ 0.00 2.67 2.93 NA NA 0.17 XXX 

78584 .... 26 ....... A ........ Lung V/Q image single breath ............ 0.99 0.35 0.34 0.35 0.34 0.04 XXX 

78585 .... ............ A ........ Lung V/Q imaging ............................... 1.09 8.62 7.31 NA NA 0.35 XXX 

78585 .... TC ...... A ........ Lung V/Q imaging ............................... 0.00 8.24 6.94 NA NA 0.30 XXX 

78585 .... 26 ....... A ........ Lung V/Q imaging ............................... 1.09 0.38 0.37 0.38 0.37 0.05 XXX 

78586 .... ............ A ........ Aerosol lung image, single ................. 0.40 4.17 3.44 NA NA 0.16 XXX 

78586 .... TC ...... A ........ Aerosol lung image, single ................. 0.00 4.03 3.31 NA NA 0.14 XXX 

78586 .... 26 ....... A ........ Aerosol lung image, single ................. 0.40 0.14 0.13 0.14 0.13 0.02 XXX 

78587 .... ............ A ........ Aerosol lung image, multiple .............. 0.49 5.43 4.20 NA NA 0.16 XXX 

78587 .... TC ...... A ........ Aerosol lung image, multiple .............. 0.00 5.26 4.03 NA NA 0.14 XXX 

78587 .... 26 ....... A ........ Aerosol lung image, multiple .............. 0.49 0.17 0.17 0.17 0.17 0.02 XXX 

78588 .... ............ A ........ Perfusion lung image .......................... 1.09 8.65 6.11 NA NA 0.23 XXX 

78588 .... TC ...... A ........ Perfusion lung image .......................... 0.00 8.27 5.74 NA NA 0.18 XXX 

78588 .... 26 ....... A ........ Perfusion lung image .......................... 1.09 0.38 0.37 0.38 0.37 0.05 XXX 

78591 .... ............ A ........ Vent image, 1 breath, 1 proj ............... 0.40 4.17 3.57 NA NA 0.16 XXX 

78591 .... TC ...... A ........ Vent image, 1 breath, 1 proj ............... 0.00 4.03 3.44 NA NA 0.14 XXX 

78591 .... 26 ....... A ........ Vent image, 1 breath, 1 proj ............... 0.40 0.14 0.13 0.14 0.13 0.02 XXX 

78593 .... ............ A ........ Vent image, 1 proj, gas ...................... 0.49 4.82 4.21 NA NA 0.20 XXX 

78593 .... TC ...... A ........ Vent image, 1 proj, gas ...................... 0.00 4.65 4.05 NA NA 0.18 XXX 

78593 .... 26 ....... A ........ Vent image, 1 proj, gas ...................... 0.49 0.17 0.16 0.17 0.16 0.02 XXX 

78594 .... ............ A ........ Vent image, mult proj, gas .................. 0.53 5.29 5.22 NA NA 0.27 XXX 

78594 .... TC ...... A ........ Vent image, mult proj, gas .................. 0.00 5.11 5.04 NA NA 0.25 XXX 

78594 .... 26 ....... A ........ Vent image, mult proj, gas .................. 0.53 0.18 0.18 0.18 0.18 0.02 XXX 

78596 .... ............ A ........ Lung differential function ..................... 1.27 8.67 8.08 NA NA 0.42 XXX 

78596 .... TC ...... A ........ Lung differential function ..................... 0.00 8.28 7.67 NA NA 0.37 XXX 

78596 .... 26 ....... A ........ Lung differential function ..................... 1.27 0.39 0.41 0.39 0.41 0.05 XXX 

78599 .... ............ C ........ Respiratory nuclear exam ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78599 .... TC ...... C ........ Respiratory nuclear exam ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78599 .... 26 ....... C ........ Respiratory nuclear exam ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78600 .... ............ A ........ Brain image < 4 views ........................ 0.44 4.39 3.71 NA NA 0.16 XXX 

78600 .... TC ...... A ........ Brain image < 4 views ........................ 0.00 4.24 3.56 NA NA 0.14 XXX 

78600 .... 26 ....... A ........ Brain image < 4 views ........................ 0.44 0.15 0.15 0.15 0.15 0.02 XXX 

78601 .... ............ A ........ Brain image w/flow < 4 views ............. 0.51 5.38 4.47 NA NA 0.20 XXX 

78601 .... TC ...... A ........ Brain image w/flow < 4 views ............. 0.00 5.20 4.30 NA NA 0.18 XXX 

78601 .... 26 ....... A ........ Brain image w/flow < 4 views ............. 0.51 0.18 0.17 0.18 0.17 0.02 XXX 

78605 .... ............ A ........ Brain image 4+ views ......................... 0.53 4.84 4.22 NA NA 0.20 XXX 

78605 .... TC ...... A ........ Brain image 4+ views ......................... 0.00 4.65 4.03 NA NA 0.18 XXX 

78605 .... 26 ....... A ........ Brain image 4+ views ......................... 0.53 0.19 0.19 0.19 0.19 0.02 XXX 

78606 .... ............ A ........ Brain image w/flow 4 + views ............. 0.64 8.53 6.30 NA NA 0.24 XXX 

78606 .... TC ...... A ........ Brain image w/flow 4 + views ............. 0.00 8.31 6.09 NA NA 0.21 XXX 

78606 .... 26 ....... A ........ Brain image w/flow 4 + views ............. 0.64 0.22 0.21 0.22 0.21 0.03 XXX 

78607 .... ............ A ........ Brain imaging (3D) .............................. 1.23 8.63 7.80 NA NA 0.40 XXX 

78607 .... TC ...... A ........ Brain imaging (3D) .............................. 0.00 8.22 7.38 NA NA 0.35 XXX 

78607 .... 26 ....... A ........ Brain imaging (3D) .............................. 1.23 0.41 0.42 0.41 0.42 0.05 XXX 

78608 .... ............ C ........ Brain imaging (PET) ........................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78608 .... TC ...... C ........ Brain imaging (PET) ........................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78608 .... 26 ....... A ........ Brain imaging (PET) ........................... 1.50 0.49 0.50 0.49 0.50 0.06 XXX 

78609 .... ............ N ........ Brain imaging (PET) ........................... 1.50 0.00 0.49 NA NA 0.06 XXX 

78609 .... TC ...... N ........ Brain imaging (PET) ........................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78609 .... 26 ....... N ........ Brain imaging (PET) ........................... 1.50 0.00 0.49 0.00 0.49 0.06 XXX 

78610 .... ............ A ........ Brain flow imaging only ....................... 0.30 4.45 4.23 NA NA 0.11 XXX 

78610 .... TC ...... A ........ Brain flow imaging only ....................... 0.00 4.35 4.10 NA NA 0.10 XXX 

78610 .... 26 ....... A ........ Brain flow imaging only ....................... 0.30 0.10 0.13 0.10 0.13 0.01 XXX 

78630 .... ............ A ........ Cerebrospinal fluid scan ..................... 0.68 8.65 6.95 NA NA 0.30 XXX 

78630 .... TC ...... A ........ Cerebrospinal fluid scan ..................... 0.00 8.41 6.72 NA NA 0.27 XXX 

78630 .... 26 ....... A ........ Cerebrospinal fluid scan ..................... 0.68 0.24 0.23 0.24 0.23 0.03 XXX 

78635 .... ............ A ........ CSF ventriculography ......................... 0.61 8.79 5.78 NA NA 0.16 XXX 

78635 .... TC ...... A ........ CSF ventriculography ......................... 0.00 8.58 5.56 NA NA 0.14 XXX 

78635 .... 26 ....... A ........ CSF ventriculography ......................... 0.61 0.21 0.22 0.21 0.22 0.02 XXX 

78645 .... ............ A ........ CSF shunt evaluation ......................... 0.57 8.48 6.04 NA NA 0.20 XXX 

78645 .... TC ...... A ........ CSF shunt evaluation ......................... 0.00 8.28 5.85 NA NA 0.18 XXX 

78645 .... 26 ....... A ........ CSF shunt evaluation ......................... 0.57 0.20 0.19 0.20 0.19 0.02 XXX 

78647 .... ............ A ........ Cerebrospinal fluid scan ..................... 0.90 8.52 7.37 NA NA 0.35 XXX 

78647 .... TC ...... A ........ Cerebrospinal fluid scan ..................... 0.00 8.23 7.07 NA NA 0.31 XXX 

78647 .... 26 ....... A ........ Cerebrospinal fluid scan ..................... 0.90 0.29 0.30 0.29 0.30 0.04 XXX 


cprice-sewell on PROD1PC72 with RULES
66515 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

78650 .... ............ A ........ CSF leakage imaging ......................... 0.61 8.56 6.70 NA NA 0.27 XXX 

78650 .... TC ...... A ........ CSF leakage imaging ......................... 0.00 8.35 6.49 NA NA 0.24 XXX 

78650 .... 26 ....... A ........ CSF leakage imaging ......................... 0.61 0.21 0.21 0.21 0.21 0.03 XXX 

78660 .... ............ A ........ Nuclear exam of tear flow ................... 0.53 4.26 3.28 NA NA 0.14 XXX 

78660 .... TC ...... A ........ Nuclear exam of tear flow ................... 0.00 4.07 3.10 NA NA 0.12 XXX 

78660 .... 26 ....... A ........ Nuclear exam of tear flow ................... 0.53 0.19 0.18 0.19 0.18 0.02 XXX 

78699 .... ............ C ........ Nervous system nuclear exam ........... 0.00 0.00 0.00 NA NA 0.00 XXX 

78699 .... TC ...... C ........ Nervous system nuclear exam ........... 0.00 0.00 0.00 NA NA 0.00 XXX 

78699 .... 26 ....... C ........ Nervous system nuclear exam ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78700 .... ............ A ........ Kidney imaging, morphol .................... 0.45 4.38 3.80 NA NA 0.18 XXX 

78700 .... TC ...... A ........ Kidney imaging, morphol .................... 0.00 4.22 3.64 NA NA 0.16 XXX 

78700 .... 26 ....... A ........ Kidney imaging, morphol .................... 0.45 0.16 0.16 0.16 0.16 0.02 XXX 

78701 .... ............ A ........ Kidney imaging with flow .................... 0.49 5.38 4.55 NA NA 0.20 XXX 

78701 .... TC ...... A ........ Kidney imaging with flow .................... 0.00 5.21 4.38 NA NA 0.18 XXX 

78701 .... 26 ....... A ........ Kidney imaging with flow .................... 0.49 0.17 0.17 0.17 0.17 0.02 XXX 

78707 .... ............ A ........ K flow/funct image w/o drug ............... 0.96 5.49 5.14 NA NA 0.27 XXX 

78707 .... TC ...... A ........ K flow/funct image w/o drug ............... 0.00 5.15 4.81 NA NA 0.23 XXX 

78707 .... 26 ....... A ........ K flow/funct image w/o drug ............... 0.96 0.34 0.33 0.34 0.33 0.04 XXX 

78708 .... ............ A ........ K flow/funct image w/drug .................. 1.21 3.48 4.18 NA NA 0.28 XXX 

78708 .... TC ...... A ........ K flow/funct image w/drug .................. 0.00 3.05 3.76 NA NA 0.23 XXX 

78708 .... 26 ....... A ........ K flow/funct image w/drug .................. 1.21 0.43 0.42 0.43 0.42 0.05 XXX 

78709 .... ............ A ........ K flow/funct image, multiple ................ 1.41 8.88 6.91 NA NA 0.29 XXX 

78709 .... TC ...... A ........ K flow/funct image, multiple ................ 0.00 8.39 6.43 NA NA 0.23 XXX 

78709 .... 26 ....... A ........ K flow/funct image, multiple ................ 1.41 0.49 0.48 0.49 0.48 0.06 XXX 

78710 .... ............ A ........ Kidney imaging (3D) ........................... 0.66 5.28 5.70 NA NA 0.34 XXX 

78710 .... TC ...... A ........ Kidney imaging (3D) ........................... 0.00 5.06 5.48 NA NA 0.31 XXX 

78710 .... 26 ....... A ........ Kidney imaging (3D) ........................... 0.66 0.22 0.22 0.22 0.22 0.03 XXX 

78725 .... ............ A ........ Kidney function study .......................... 0.38 2.35 2.14 NA NA 0.13 XXX 

78725 .... TC ...... A ........ Kidney function study .......................... 0.00 2.23 2.01 NA NA 0.11 XXX 

78725 .... 26 ....... A ........ Kidney function study .......................... 0.38 0.12 0.13 0.12 0.13 0.02 XXX 

78730 .... ............ A ........ Urinary bladder retention .................... 0.15 1.98 1.78 NA NA 0.10 ZZZ 

78730 .... TC ...... A ........ Urinary bladder retention .................... 0.00 1.92 1.69 NA NA 0.08 ZZZ 

78730 .... 26 ....... A ........ Urinary bladder retention .................... 0.15 0.06 0.09 0.06 0.09 0.02 ZZZ 

78740 .... ............ A ........ Ureteral reflux study ............................ 0.57 5.65 3.98 NA NA 0.15 XXX 

78740 .... TC ...... A ........ Ureteral reflux study ............................ 0.00 5.46 3.79 NA NA 0.12 XXX 

78740 .... 26 ....... A ........ Ureteral reflux study ............................ 0.57 0.19 0.19 0.19 0.19 0.03 XXX 

78761 .... ............ A ........ Testicular imaging w/flow .................... 0.71 5.05 4.24 NA NA 0.20 XXX 

78761 .... TC ...... A ........ Testicular imaging w/flow .................... 0.00 4.80 4.00 NA NA 0.17 XXX 

78761 .... 26 ....... A ........ Testicular imaging w/flow .................... 0.71 0.25 0.24 0.25 0.24 0.03 XXX 

78799 .... ............ C ........ Genitourinary nuclear exam ................ 0.00 0.00 0.00 NA NA 0.00 XXX 

78799 .... TC ...... C ........ Genitourinary nuclear exam ................ 0.00 0.00 0.00 NA NA 0.00 XXX 

78799 .... 26 ....... C ........ Genitourinary nuclear exam ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78800 .... ............ A ........ Tumor imaging, limited area ............... 0.66 4.33 3.98 NA NA 0.22 XXX 

78800 .... TC ...... A ........ Tumor imaging, limited area ............... 0.00 4.12 3.76 NA NA 0.18 XXX 

78800 .... 26 ....... A ........ Tumor imaging, limited area ............... 0.66 0.21 0.22 0.21 0.22 0.04 XXX 

78801 .... ............ A ........ Tumor imaging, mult areas ................. 0.79 6.04 5.27 NA NA 0.27 XXX 

78801 .... TC ...... A ........ Tumor imaging, mult areas ................. 0.00 5.78 5.00 NA NA 0.22 XXX 

78801 .... 26 ....... A ........ Tumor imaging, mult areas ................. 0.79 0.26 0.27 0.26 0.27 0.05 XXX 

78802 .... ............ A ........ Tumor imaging, whole body ............... 0.86 8.14 6.98 NA NA 0.34 XXX 

78802 .... TC ...... A ........ Tumor imaging, whole body ............... 0.00 7.84 6.69 NA NA 0.30 XXX 

78802 .... 26 ....... A ........ Tumor imaging, whole body ............... 0.86 0.30 0.29 0.30 0.29 0.04 XXX 

78803 .... ............ A ........ Tumor imaging (3D) ............................ 1.09 8.53 7.74 NA NA 0.40 XXX 

78803 .... TC ...... A ........ Tumor imaging (3D) ............................ 0.00 8.16 7.36 NA NA 0.35 XXX 

78803 .... 26 ....... A ........ Tumor imaging (3D) ............................ 1.09 0.37 0.38 0.37 0.38 0.05 XXX 

78804 .... ............ A ........ Tumor imaging, whole body ............... 1.07 14.83 13.13 NA NA 0.34 XXX 

78804 .... TC ...... A ........ Tumor imaging, whole body ............... 0.00 14.46 12.76 NA NA 0.30 XXX 

78804 .... 26 ....... A ........ Tumor imaging, whole body ............... 1.07 0.37 0.37 0.37 0.37 0.04 XXX 

78805 .... ............ A ........ Abscess imaging, ltd area .................. 0.73 4.22 3.94 NA NA 0.21 XXX 

78805 .... TC ...... A ........ Abscess imaging, ltd area .................. 0.00 3.97 3.69 NA NA 0.18 XXX 

78805 .... 26 ....... A ........ Abscess imaging, ltd area .................. 0.73 0.25 0.25 0.25 0.25 0.03 XXX 

78806 .... ............ A ........ Abscess imaging, whole body ............ 0.86 8.35 7.53 NA NA 0.39 XXX 

78806 .... TC ...... A ........ Abscess imaging, whole body ............ 0.00 8.05 7.24 NA NA 0.35 XXX 

78806 .... 26 ....... A ........ Abscess imaging, whole body ............ 0.86 0.30 0.29 0.30 0.29 0.04 XXX 

78807 .... ............ A ........ Nuclear localization/abscess ............... 1.09 8.51 7.73 NA NA 0.39 XXX 

78807 .... TC ...... A ........ Nuclear localization/abscess ............... 0.00 8.14 7.35 NA NA 0.35 XXX 

78807 .... 26 ....... A ........ Nuclear localization/abscess ............... 1.09 0.37 0.38 0.37 0.38 0.04 XXX 

78811 .... ............ C ........ Pet image, ltd area ............................. 0.00 0.00 0.00 NA NA 0.00 XXX 

78811 .... TC ...... C ........ Pet image, ltd area ............................. 0.00 0.00 0.00 NA NA 0.00 XXX 

78811 .... 26 ....... A ........ Pet image, ltd area ............................. 1.54 0.54 0.53 0.54 0.53 0.11 XXX 

78812 .... ............ C ........ Pet image, skull-thigh ......................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78812 .... TC ...... C ........ Pet image, skull-thigh ......................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78812 .... 26 ....... A ........ Pet image, skull-thigh ......................... 1.93 0.67 0.66 0.67 0.66 0.11 XXX 


cprice-sewell on PROD1PC72 with RULES
66516 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

78813 .... ............ C ........ Pet image, full body ............................ 0.00 0.00 0.00 NA NA 0.00 XXX 

78813 .... TC ...... C ........ Pet image, full body ............................ 0.00 0.00 0.00 NA NA 0.00 XXX 

78813 .... 26 ....... A ........ Pet image, full body ............................ 2.00 0.68 0.68 0.68 0.68 0.11 XXX 

78814 .... ............ C ........ Pet image w/ct, lmtd ........................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78814 .... TC ...... C ........ Pet image w/ct, lmtd ........................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78814 .... 26 ....... A ........ Pet image w/ct, lmtd ........................... 2.20 0.74 0.75 0.74 0.75 0.11 XXX 

78815 .... ............ C ........ Pet image w/ct, skull-thigh .................. 0.00 0.00 0.00 NA NA 0.00 XXX 

78815 .... TC ...... C ........ Pet image w/ct, skull-thigh .................. 0.00 0.00 0.00 NA NA 0.00 XXX 

78815 .... 26 ....... A ........ Pet image w/ct, skull-thigh .................. 2.44 0.84 0.84 0.84 0.84 0.11 XXX 

78816 .... ............ C ........ Pet image w/ct, full body .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78816 .... TC ...... C ........ Pet image w/ct, full body .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78816 .... 26 ....... A ........ Pet image w/ct, full body .................... 2.50 0.85 0.85 0.85 0.85 0.11 XXX 

78890 .... ............ B ........ Nuclear medicine data proc ................ 0.05 0.39 0.86 NA NA 0.07 XXX 

78890 .... TC ...... B ........ Nuclear medicine data proc ................ 0.00 0.38 0.84 NA NA 0.06 XXX 

78890 .... 26 ....... B ........ Nuclear medicine data proc ................ 0.05 0.01 0.02 0.01 0.02 0.01 XXX 

78891 .... ............ B ........ Nuclear med data proc ....................... 0.10 0.88 1.77 NA NA 0.14 XXX 

78891 .... TC ...... B ........ Nuclear med data proc ....................... 0.00 0.86 1.74 NA NA 0.13 XXX 

78891 .... 26 ....... B ........ Nuclear med data proc ....................... 0.10 0.02 0.03 0.02 0.03 0.01 XXX 

78999 .... ............ C ........ Nuclear diagnostic exam .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78999 .... TC ...... C ........ Nuclear diagnostic exam .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

78999 .... 26 ....... C ........ Nuclear diagnostic exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79005 .... ............ A ........ Nuclear rx, oral admin ........................ 1.80 1.85 2.53 NA NA 0.22 XXX 

79005 .... TC ...... A ........ Nuclear rx, oral admin ........................ 0.00 1.27 1.94 NA NA 0.14 XXX 

79005 .... 26 ....... A ........ Nuclear rx, oral admin ........................ 1.80 0.58 0.59 0.58 0.59 0.08 XXX 

79101 .... ............ A ........ Nuclear rx, iv admin ............................ 1.96 2.17 2.72 NA NA 0.22 XXX 

79101 .... TC ...... A ........ Nuclear rx, iv admin ............................ 0.00 1.43 2.02 NA NA 0.14 XXX 

79101 .... 26 ....... A ........ Nuclear rx, iv admin ............................ 1.96 0.74 0.70 0.74 0.70 0.08 XXX 

79200 .... ............ A ........ Nuclear rx, intracav admin .................. 1.99 2.22 2.77 NA NA 0.23 XXX 

79200 .... TC ...... A ........ Nuclear rx, intracav admin .................. 0.00 1.57 2.10 NA NA 0.14 XXX 

79200 .... 26 ....... A ........ Nuclear rx, intracav admin .................. 1.99 0.65 0.67 0.65 0.67 0.09 XXX 

79300 .... ............ C ........ Nuclr rx, interstit colloid ...................... 0.00 0.00 0.00 NA NA 0.00 XXX 

79300 .... TC ...... C ........ Nuclr rx, interstit colloid ...................... 0.00 0.00 0.00 NA NA 0.00 XXX 

79300 .... 26 ....... A ........ Nuclr rx, interstit colloid ...................... 1.60 0.54 0.55 0.54 0.55 0.13 XXX 

79403 .... ............ A ........ Hematopoietic nuclear tx .................... 2.25 2.92 4.04 NA NA 0.24 XXX 

79403 .... TC ...... A ........ Hematopoietic nuclear tx .................... 0.00 2.17 3.22 NA NA 0.14 XXX 

79403 .... 26 ....... A ........ Hematopoietic nuclear tx .................... 2.25 0.75 0.82 0.75 0.82 0.10 XXX 

79440 .... ............ A ........ Nuclear rx, intra-articular .................... 1.99 1.84 2.59 NA NA 0.22 XXX 

79440 .... TC ...... A ........ Nuclear rx, intra-articular .................... 0.00 1.16 1.89 NA NA 0.14 XXX 

79440 .... 26 ....... A ........ Nuclear rx, intra-articular .................... 1.99 0.68 0.70 0.68 0.70 0.08 XXX 

79445 .... ............ C ........ Nuclear rx, intra-arterial ...................... 0.00 0.00 0.00 NA NA 0.00 XXX 

79445 .... TC ...... C ........ Nuclear rx, intra-arterial ...................... 0.00 0.00 0.00 NA NA 0.00 XXX 

79445 .... 26 ....... A ........ Nuclear rx, intra-arterial ...................... 2.40 0.85 0.83 0.85 0.83 0.12 XXX 

79999 .... ............ C ........ Nuclear medicine therapy ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

79999 .... TC ...... C ........ Nuclear medicine therapy ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

79999 .... 26 ....... C ........ Nuclear medicine therapy ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

80500 .... ............ A ........ Lab pathology consultation ................. 0.37 0.20 0.20 0.11 0.14 0.01 XXX 

80502 .... ............ A ........ Lab pathology consultation ................. 1.33 0.31 0.43 0.25 0.40 0.04 XXX 

83020 .... 26 ....... A ........ Hemoglobin electrophoresis ............... 0.37 0.12 0.13 0.12 0.13 0.01 XXX 

83912 .... 26 ....... A ........ Genetic examination ........................... 0.37 0.11 0.12 0.11 0.12 0.01 XXX 

84165 .... 26 ....... A ........ Protein e-phoresis, serum ................... 0.37 0.12 0.13 0.12 0.13 0.01 XXX 

84166 .... 26 ....... A ........ Protein e-phoresis/urine/csf ................ 0.37 0.12 0.13 0.12 0.13 0.01 XXX 

84181 .... 26 ....... A ........ Western blot test ................................. 0.37 0.12 0.13 0.12 0.13 0.01 XXX 

84182 .... 26 ....... A ........ Protein, western blot test .................... 0.37 0.12 0.14 0.12 0.14 0.02 XXX 

85060 .... ............ A ........ Blood smear interpretation .................. 0.45 0.14 0.16 0.14 0.16 0.02 XXX 

85097 .... ............ A ........ Bone marrow interpretation ................ 0.94 1.25 1.58 0.27 0.34 0.04 XXX 

85390 .... 26 ....... A ........ Fibrinolysins screen ............................ 0.37 0.13 0.13 0.13 0.13 0.01 XXX 

85396 .... ............ A ........ Clotting assay, whole blood ................ 0.37 NA NA 0.10 0.13 0.04 XXX 

85576 .... 26 ....... A ........ Blood platelet aggregation .................. 0.37 0.12 0.14 0.12 0.14 0.01 XXX 

86077 .... ............ A ........ Physician blood bank service ............. 0.94 0.38 0.39 0.30 0.34 0.03 XXX 

86078 .... ............ A ........ Physician blood bank service ............. 0.94 0.38 0.42 0.30 0.35 0.03 XXX 

86079 .... ............ A ........ Physician blood bank service ............. 0.94 0.39 0.42 0.30 0.36 0.03 XXX 

86255 .... 26 ....... A ........ Fluorescent antibody, screen .............. 0.37 0.12 0.13 0.12 0.13 0.01 XXX 

86256 .... 26 ....... A ........ Fluorescent antibody, titer .................. 0.37 0.12 0.13 0.12 0.13 0.01 XXX 

86320 .... 26 ....... A ........ Serum immunoelectrophoresis ........... 0.37 0.12 0.14 0.12 0.14 0.01 XXX 

86325 .... 26 ....... A ........ Other immunoelectrophoresis ............. 0.37 0.12 0.13 0.12 0.13 0.01 XXX 

86327 .... 26 ....... A ........ Immunoelectrophoresis assay ............ 0.42 0.12 0.15 0.12 0.15 0.02 XXX 

86334 .... 26 ....... A ........ Immunofix e-phoresis, serum ............. 0.37 0.12 0.13 0.12 0.13 0.01 XXX 

86335 .... 26 ....... A ........ Immunfix e-phorsis/urine/csf ............... 0.37 0.12 0.13 0.12 0.13 0.01 XXX 

86485 .... ............ C ........ Skin test, candida ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

86486 .... ............ A ........ Skin test, nos antigen ......................... 0.00 0.13 0.13 NA NA 0.02 XXX 

86490 .... ............ A ........ Coccidioidomycosis skin test .............. 0.00 0.13 0.21 NA NA 0.02 XXX 

86510 .... ............ A ........ Histoplasmosis skin test ..................... 0.00 0.13 0.22 NA NA 0.02 XXX 


cprice-sewell on PROD1PC72 with RULES
66517 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

86580 .... ............ A ........ TB intradermal test ............................. 0.00 0.16 0.20 NA NA 0.02 XXX 

87164 .... 26 ....... A ........ Dark field examination ........................ 0.37 0.12 0.12 0.12 0.12 0.01 XXX 

87207 .... 26 ....... A ........ Smear, special stain ........................... 0.37 0.12 0.14 0.12 0.14 0.01 XXX 

88104 .... ............ A ........ Cytopath fl nongyn, smears ................ 0.56 1.19 1.02 NA NA 0.04 XXX 

88104 .... TC ...... A ........ Cytopath fl nongyn, smears ................ 0.00 1.03 0.82 NA NA 0.02 XXX 

88104 .... 26 ....... A ........ Cytopath fl nongyn, smears ................ 0.56 0.16 0.20 0.16 0.20 0.02 XXX 

88106 .... ............ A ........ Cytopath fl nongyn, filter ..................... 0.56 1.52 1.44 NA NA 0.04 XXX 

88106 .... TC ...... A ........ Cytopath fl nongyn, filter ..................... 0.00 1.37 1.24 NA NA 0.02 XXX 

88106 .... 26 ....... A ........ Cytopath fl nongyn, filter ..................... 0.56 0.15 0.20 0.15 0.20 0.02 XXX 

88107 .... ............ A ........ Cytopath fl nongyn, sm/fltr .................. 0.76 2.00 1.77 NA NA 0.05 XXX 

88107 .... TC ...... A ........ Cytopath fl nongyn, sm/fltr .................. 0.00 1.77 1.49 NA NA 0.02 XXX 

88107 .... 26 ....... A ........ Cytopath fl nongyn, sm/fltr .................. 0.76 0.23 0.28 0.23 0.28 0.03 XXX 

88108 .... ............ A ........ Cytopath, concentrate tech ................. 0.56 1.47 1.34 NA NA 0.04 XXX 

88108 .... TC ...... A ........ Cytopath, concentrate tech ................. 0.00 1.32 1.14 NA NA 0.02 XXX 

88108 .... 26 ....... A ........ Cytopath, concentrate tech ................. 0.56 0.15 0.20 0.15 0.20 0.02 XXX 

88112 .... ............ A ........ Cytopath, cell enhance tech ............... 1.18 1.47 1.72 NA NA 0.04 XXX 

88112 .... TC ...... A ........ Cytopath, cell enhance tech ............... 0.00 1.18 1.32 NA NA 0.02 XXX 

88112 .... 26 ....... A ........ Cytopath, cell enhance tech ............... 1.18 0.29 0.40 0.29 0.40 0.02 XXX 

88125 .... ............ A ........ Forensic cytopathology ....................... 0.26 0.21 0.24 NA NA 0.02 XXX 

88125 .... TC ...... A ........ Forensic cytopathology ....................... 0.00 0.16 0.16 NA NA 0.01 XXX 

88125 .... 26 ....... A ........ Forensic cytopathology ....................... 0.26 0.05 0.08 0.05 0.08 0.01 XXX 

88141 .... ............ A ........ Cytopath, c/v, interpret ........................ 0.42 0.38 0.26 0.38 0.26 0.02 XXX 

88160 .... ............ A ........ Cytopath smear, other source ............ 0.50 0.91 0.87 NA NA 0.04 XXX 

88160 .... TC ...... A ........ Cytopath smear, other source ............ 0.00 0.78 0.70 NA NA 0.02 XXX 

88160 .... 26 ....... A ........ Cytopath smear, other source ............ 0.50 0.13 0.17 0.13 0.17 0.02 XXX 

88161 .... ............ A ........ Cytopath smear, other source ............ 0.50 1.06 1.00 NA NA 0.04 XXX 

88161 .... TC ...... A ........ Cytopath smear, other source ............ 0.00 0.92 0.82 NA NA 0.02 XXX 

88161 .... 26 ....... A ........ Cytopath smear, other source ............ 0.50 0.14 0.18 0.14 0.18 0.02 XXX 

88162 .... ............ A ........ Cytopath smear, other source ............ 0.76 1.58 1.30 NA NA 0.05 XXX 

88162 .... TC ...... A ........ Cytopath smear, other source ............ 0.00 1.35 1.02 NA NA 0.02 XXX 

88162 .... 26 ....... A ........ Cytopath smear, other source ............ 0.76 0.23 0.28 0.23 0.28 0.03 XXX 

88172 .... ............ A ........ Cytopathology eval of fna ................... 0.60 0.81 0.77 NA NA 0.04 XXX 

88172 .... TC ...... A ........ Cytopathology eval of fna ................... 0.00 0.64 0.55 NA NA 0.02 XXX 

88172 .... 26 ....... A ........ Cytopathology eval of fna ................... 0.60 0.17 0.22 0.17 0.22 0.02 XXX 

88173 .... ............ A ........ Cytopath eval, fna, report ................... 1.39 2.20 2.16 NA NA 0.07 XXX 

88173 .... TC ...... A ........ Cytopath eval, fna, report ................... 0.00 1.82 1.68 NA NA 0.02 XXX 

88173 .... 26 ....... A ........ Cytopath eval, fna, report ................... 1.39 0.38 0.48 0.38 0.48 0.05 XXX 

88182 .... ............ A ........ Cell marker study ................................ 0.77 2.02 1.99 NA NA 0.07 XXX 

88182 .... TC ...... A ........ Cell marker study ................................ 0.00 1.88 1.76 NA NA 0.04 XXX 

88182 .... 26 ....... A ........ Cell marker study ................................ 0.77 0.14 0.23 0.14 0.23 0.03 XXX 

88184 .... ............ A ........ Flowcytometry/ tc, 1 marker ............... 0.00 2.46 1.89 NA NA 0.02 XXX 

88185 .... ............ A ........ Flowcytometry/tc, add-on .................... 0.00 1.50 1.07 NA NA 0.02 ZZZ 

88187 .... ............ A ........ Flowcytometry/read, 2–8 ..................... 1.36 0.39 0.42 0.39 0.42 0.01 XXX 

88188 .... ............ A ........ Flowcytometry/read, 9–15 ................... 1.69 0.44 0.50 0.44 0.50 0.01 XXX 

88189 .... ............ A ........ Flowcytometry/read, 16 & > ................ 2.23 0.47 0.61 0.47 0.61 0.01 XXX 

88199 .... ............ C ........ Cytopathology procedure .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

88199 .... TC ...... C ........ Cytopathology procedure .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

88199 .... 26 ....... C ........ Cytopathology procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88291 .... ............ A ........ Cyto/molecular report .......................... 0.52 0.27 0.22 0.27 0.22 0.02 XXX 

88299 .... ............ C ........ Cytogenetic study ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88300 .... ............ A ........ Surgical path, gross ............................ 0.08 0.56 0.51 NA NA 0.02 XXX 

88300 .... TC ...... A ........ Surgical path, gross ............................ 0.00 0.54 0.48 NA NA 0.01 XXX 

88300 .... 26 ....... A ........ Surgical path, gross ............................ 0.08 0.02 0.03 0.02 0.03 0.01 XXX 

88302 .... ............ A ........ Tissue exam by pathologist ................ 0.13 1.29 1.16 NA NA 0.03 XXX 

88302 .... TC ...... A ........ Tissue exam by pathologist ................ 0.00 1.25 1.11 NA NA 0.02 XXX 

88302 .... 26 ....... A ........ Tissue exam by pathologist ................ 0.13 0.04 0.05 0.04 0.05 0.01 XXX 

88304 .... ............ A ........ Tissue exam by pathologist ................ 0.22 1.47 1.39 NA NA 0.03 XXX 

88304 .... TC ...... A ........ Tissue exam by pathologist ................ 0.00 1.41 1.32 NA NA 0.02 XXX 

88304 .... 26 ....... A ........ Tissue exam by pathologist ................ 0.22 0.06 0.07 0.06 0.07 0.01 XXX 

88305 .... ............ A ........ Tissue exam by pathologist ................ 0.75 2.04 1.97 NA NA 0.07 XXX 

88305 .... TC ...... A ........ Tissue exam by pathologist ................ 0.00 1.84 1.71 NA NA 0.04 XXX 

88305 .... 26 ....... A ........ Tissue exam by pathologist ................ 0.75 0.20 0.26 0.20 0.26 0.03 XXX 

88307 .... ............ A ........ Tissue exam by pathologist ................ 1.59 4.41 3.78 NA NA 0.12 XXX 

88307 .... TC ...... A ........ Tissue exam by pathologist ................ 0.00 3.94 3.20 NA NA 0.06 XXX 

88307 .... 26 ....... A ........ Tissue exam by pathologist ................ 1.59 0.47 0.58 0.47 0.58 0.06 XXX 

88309 .... ............ A ........ Tissue exam by pathologist ................ 2.80 6.16 5.28 NA NA 0.14 XXX 

88309 .... TC ...... A ........ Tissue exam by pathologist ................ 0.00 5.34 4.38 NA NA 0.06 XXX 

88309 .... 26 ....... A ........ Tissue exam by pathologist ................ 2.80 0.82 0.90 0.82 0.90 0.08 XXX 

88311 .... ............ A ........ Decalcify tissue ................................... 0.24 0.24 0.23 NA NA 0.02 XXX 

88311 .... TC ...... A ........ Decalcify tissue ................................... 0.00 0.17 0.15 NA NA 0.01 XXX 

88311 .... 26 ....... A ........ Decalcify tissue ................................... 0.24 0.07 0.08 0.07 0.08 0.01 XXX 

88312 .... ............ A ........ Special stains ...................................... 0.54 2.29 1.90 NA NA 0.03 XXX 


cprice-sewell on PROD1PC72 with RULES
66518 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

88312 .... TC ...... A ........ Special stains ...................................... 0.00 2.15 1.72 NA NA 0.01 XXX 

88312 .... 26 ....... A ........ Special stains ...................................... 0.54 0.14 0.18 0.14 0.18 0.02 XXX 

88313 .... ............ A ........ Special stains ...................................... 0.24 1.94 1.59 NA NA 0.02 XXX 

88313 .... TC ...... A ........ Special stains ...................................... 0.00 1.88 1.51 NA NA 0.01 XXX 

88313 .... 26 ....... A ........ Special stains ...................................... 0.24 0.06 0.08 0.06 0.08 0.01 XXX 

88314 .... ............ A ........ Histochemical stain ............................. 0.45 1.96 2.00 NA NA 0.04 XXX 

88314 .... TC ...... A ........ Histochemical stain ............................. 0.00 1.82 1.84 NA NA 0.02 XXX 

88314 .... 26 ....... A ........ Histochemical stain ............................. 0.45 0.14 0.16 0.14 0.16 0.02 XXX 

88318 .... ............ A ........ Chemical histochemistry ..................... 0.42 2.94 2.29 NA NA 0.03 XXX 

88318 .... TC ...... A ........ Chemical histochemistry ..................... 0.00 2.82 2.14 NA NA 0.01 XXX 

88318 .... 26 ....... A ........ Chemical histochemistry ..................... 0.42 0.12 0.15 0.12 0.15 0.02 XXX 

88319 .... ............ A ........ Enzyme histochemistry ....................... 0.53 3.22 3.32 NA NA 0.04 XXX 

88319 .... TC ...... A ........ Enzyme histochemistry ....................... 0.00 3.07 3.13 NA NA 0.02 XXX 

88319 .... 26 ....... A ........ Enzyme histochemistry ....................... 0.53 0.15 0.19 0.15 0.19 0.02 XXX 

88321 .... ............ A ........ Microslide consultation ........................ 1.63 0.71 0.75 0.46 0.51 0.05 XXX 

88323 .... ............ A ........ Microslide consultation ........................ 1.83 2.21 1.99 NA NA 0.07 XXX 

88323 .... TC ...... A ........ Microslide consultation ........................ 0.00 1.75 1.48 NA NA 0.02 XXX 

88323 .... 26 ....... A ........ Microslide consultation ........................ 1.83 0.46 0.51 0.46 0.51 0.05 XXX 

88325 .... ............ A ........ Comprehensive review of data ........... 2.50 2.40 2.66 0.69 0.82 0.07 XXX 

88329 .... ............ A ........ Path consult introp .............................. 0.67 0.66 0.66 0.20 0.24 0.02 XXX 

88331 .... ............ A ........ Path consult intraop, 1 bloc ................ 1.19 1.21 1.15 NA NA 0.08 XXX 

88331 .... TC ...... A ........ Path consult intraop, 1 bloc ................ 0.00 0.84 0.71 NA NA 0.04 XXX 

88331 .... 26 ....... A ........ Path consult intraop, 1 bloc ................ 1.19 0.37 0.44 0.37 0.44 0.04 XXX 

88332 .... ............ A ........ Path consult intraop, add’l .................. 0.59 0.48 0.46 NA NA 0.04 XXX 

88332 .... TC ...... A ........ Path consult intraop, add’l .................. 0.00 0.30 0.25 NA NA 0.02 XXX 

88332 .... 26 ....... A ........ Path consult intraop, add’l .................. 0.59 0.18 0.21 0.18 0.21 0.02 XXX 

88333 .... ............ A ........ Intraop cyto path consult, 1 ................ 1.20 1.32 1.20 NA NA 0.08 XXX 

88333 .... TC ...... A ........ Intraop cyto path consult, 1 ................ 0.00 0.95 0.75 NA NA 0.04 XXX 

88333 .... 26 ....... A ........ Intraop cyto path consult, 1 ................ 1.20 0.37 0.45 0.37 0.45 0.04 XXX 

88334 .... ............ A ........ Intraop cyto path consult, 2 ................ 0.73 0.78 0.69 NA NA 0.04 XXX 

88334 .... TC ...... A ........ Intraop cyto path consult, 2 ................ 0.00 0.56 0.45 NA NA 0.02 XXX 

88334 .... 26 ....... A ........ Intraop cyto path consult, 2 ................ 0.73 0.22 0.24 0.22 0.24 0.02 XXX 

88342 .... ............ A ........ Immunohistochemistry ........................ 0.85 1.99 1.72 NA NA 0.05 XXX 

88342 .... TC ...... A ........ Immunohistochemistry ........................ 0.00 1.77 1.43 NA NA 0.02 XXX 

88342 .... 26 ....... A ........ Immunohistochemistry ........................ 0.85 0.22 0.29 0.22 0.29 0.03 XXX 

88346 .... ............ A ........ Immunofluorescent study .................... 0.86 1.91 1.73 NA NA 0.05 XXX 

88346 .... TC ...... A ........ Immunofluorescent study .................... 0.00 1.68 1.44 NA NA 0.02 XXX 

88346 .... 26 ....... A ........ Immunofluorescent study .................... 0.86 0.23 0.29 0.23 0.29 0.03 XXX 

88347 .... ............ A ........ Immunofluorescent study .................... 0.86 1.31 1.29 NA NA 0.05 XXX 

88347 .... TC ...... A ........ Immunofluorescent study .................... 0.00 1.13 1.02 NA NA 0.02 XXX 

88347 .... 26 ....... A ........ Immunofluorescent study .................... 0.86 0.18 0.27 0.18 0.27 0.03 XXX 

88348 .... ............ A ........ Electron microscopy ............................ 1.51 18.24 13.79 NA NA 0.13 XXX 

88348 .... TC ...... A ........ Electron microscopy ............................ 0.00 17.82 13.26 NA NA 0.07 XXX 

88348 .... 26 ....... A ........ Electron microscopy ............................ 1.51 0.42 0.53 0.42 0.53 0.06 XXX 

88349 .... ............ A ........ Scanning electron microscopy ............ 0.76 9.39 6.47 NA NA 0.09 XXX 

88349 .... TC ...... A ........ Scanning electron microscopy ............ 0.00 9.16 6.19 NA NA 0.06 XXX 

88349 .... 26 ....... A ........ Scanning electron microscopy ............ 0.76 0.23 0.28 0.23 0.28 0.03 XXX 

88355 .... ............ A ........ Analysis, skeletal muscle .................... 1.85 3.22 5.99 NA NA 0.13 XXX 

88355 .... TC ...... A ........ Analysis, skeletal muscle .................... 0.00 2.85 5.41 NA NA 0.06 XXX 

88355 .... 26 ....... A ........ Analysis, skeletal muscle .................... 1.85 0.37 0.58 0.37 0.58 0.07 XXX 

88356 .... ............ A ........ Analysis, nerve .................................... 3.02 5.35 4.77 NA NA 0.19 XXX 

88356 .... TC ...... A ........ Analysis, nerve .................................... 0.00 4.77 3.85 NA NA 0.07 XXX 

88356 .... 26 ....... A ........ Analysis, nerve .................................... 3.02 0.58 0.92 0.58 0.92 0.12 XXX 

88358 .... ............ A ........ Analysis, tumor ................................... 0.95 1.10 0.97 NA NA 0.17 XXX 

88358 .... TC ...... A ........ Analysis, tumor ................................... 0.00 0.94 0.69 NA NA 0.07 XXX 

88358 .... 26 ....... A ........ Analysis, tumor ................................... 0.95 0.16 0.28 0.16 0.28 0.10 XXX 

88360 .... ............ A ........ Tumor immunohistochem/manual ....... 1.10 2.22 1.97 NA NA 0.08 XXX 

88360 .... TC ...... A ........ Tumor immunohistochem/manual ....... 0.00 1.95 1.60 NA NA 0.02 XXX 

88360 .... 26 ....... A ........ Tumor immunohistochem/manual ....... 1.10 0.27 0.37 0.27 0.37 0.06 XXX 

88361 .... ............ A ........ Tumor immunohistochem/comput ....... 1.18 2.79 2.91 NA NA 0.17 XXX 

88361 .... TC ...... A ........ Tumor immunohistochem/comput ....... 0.00 2.52 2.53 NA NA 0.07 XXX 

88361 .... 26 ....... A ........ Tumor immunohistochem/comput ....... 1.18 0.27 0.38 0.27 0.38 0.10 XXX 

88362 .... ............ A ........ Nerve teasing preparations ................. 2.17 4.99 4.84 NA NA 0.15 XXX 

88362 .... TC ...... A ........ Nerve teasing preparations ................. 0.00 4.42 4.09 NA NA 0.06 XXX 

88362 .... 26 ....... A ........ Nerve teasing preparations ................. 2.17 0.57 0.75 0.57 0.75 0.09 XXX 

88365 .... ............ A ........ Insitu hybridization (fish) ..................... 1.20 3.34 2.73 NA NA 0.05 XXX 

88365 .... TC ...... A ........ Insitu hybridization (fish) ..................... 0.00 3.04 2.33 NA NA 0.02 XXX 

88365 .... 26 ....... A ........ Insitu hybridization (fish) ..................... 1.20 0.30 0.40 0.30 0.40 0.03 XXX 

88367 .... ............ A ........ Insitu hybridization, auto ..................... 1.30 5.15 4.59 NA NA 0.12 XXX 

88367 .... TC ...... A ........ Insitu hybridization, auto ..................... 0.00 4.93 4.21 NA NA 0.06 XXX 

88367 .... 26 ....... A ........ Insitu hybridization, auto ..................... 1.30 0.22 0.38 0.22 0.38 0.06 XXX 

88368 .... ............ A ........ Insitu hybridization, manual ................ 1.40 4.97 3.69 NA NA 0.12 XXX 


cprice-sewell on PROD1PC72 with RULES
66519 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

88368 .... TC ...... A ........ Insitu hybridization, manual ................ 0.00 4.72 3.26 NA NA 0.06 XXX 

88368 .... 26 ....... A ........ Insitu hybridization, manual ................ 1.40 0.25 0.43 0.25 0.43 0.06 XXX 

88371 .... 26 ....... A ........ Protein, western blot tissue ................ 0.37 0.10 0.12 0.10 0.12 0.01 XXX 

88372 .... 26 ....... A ........ Protein analysis w/probe ..................... 0.37 0.12 0.14 0.12 0.14 0.01 XXX 

88380 .... ............ A ........ Microdissection, laser ......................... 1.56 2.65 2.65 NA NA 0.14 XXX 

88380 .... TC ...... A ........ Microdissection, laser ......................... 0.00 2.22 2.22 NA NA 0.07 XXX 

88380 .... 26 ....... A ........ Microdissection, laser ......................... 1.56 0.43 0.43 0.43 0.43 0.07 XXX 

88381 .... ............ A ........ Microdissection, manual ..................... 1.18 4.47 4.47 NA NA 0.08 XXX 

88381 .... TC ...... A ........ Microdissection, manual ..................... 0.00 4.15 4.15 NA NA 0.02 XXX 

88381 .... 26 ....... A ........ Microdissection, manual ..................... 1.18 0.32 0.32 0.32 0.32 0.06 XXX 

88384 .... ............ C ........ Eval molecular probes, 11–50 ............ 0.00 0.00 0.00 NA NA 0.00 XXX 

88384 .... TC ...... C ........ Eval molecular probes, 11–50 ............ 0.00 0.00 0.00 NA NA 0.00 XXX 

88384 .... 26 ....... C ........ Eval molecular probes, 11–50 ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88385 .... ............ A ........ Eval molecul probes, 51–250 ............. 1.50 15.53 11.31 NA NA 0.12 XXX 

88385 .... TC ...... A ........ Eval molecul probes, 51–250 ............. 0.00 15.26 10.85 NA NA 0.06 XXX 

88385 .... 26 ....... A ........ Eval molecul probes, 51–250 ............. 1.50 0.27 0.46 0.27 0.46 0.06 XXX 

88386 .... ............ A ........ Eval molecul probes, 251–500 ........... 1.88 15.44 11.24 NA NA 0.16 XXX 

88386 .... TC ...... A ........ Eval molecul probes, 251–500 ........... 0.00 15.10 10.66 NA NA 0.08 XXX 

88386 .... 26 ....... A ........ Eval molecul probes, 251–500 ........... 1.88 0.34 0.58 0.34 0.58 0.08 XXX 

88399 .... ............ C ........ Surgical pathology procedure ............. 0.00 0.00 0.00 NA NA 0.00 XXX 

88399 .... TC ...... C ........ Surgical pathology procedure ............. 0.00 0.00 0.00 NA NA 0.00 XXX 

88399 .... 26 ....... C ........ Surgical pathology procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

89049 .... ............ A ........ Chct for mal hyperthermia .................. 1.40 3.56 3.55 0.19 0.23 0.06 XXX 

89060 .... 26 ....... A ........ Exam,synovial fluid crystals ................ 0.37 0.12 0.14 0.12 0.14 0.01 XXX 

89100 .... ............ A ........ Sample intestinal contents .................. 0.60 7.89 4.86 0.54 0.37 0.03 XXX 

89105 .... ............ A ........ Sample intestinal contents .................. 0.50 7.84 5.03 0.46 0.31 0.02 XXX 

89130 .... ............ A ........ Sample stomach contents .................. 0.45 6.54 4.14 0.38 0.25 0.02 XXX 

89132 .... ............ A ........ Sample stomach contents .................. 0.19 8.38 4.96 0.39 0.22 0.01 XXX 

89135 .... ............ A ........ Sample stomach contents .................. 0.79 8.82 5.36 0.67 0.46 0.04 XXX 

89136 .... ............ A ........ Sample stomach contents .................. 0.21 5.94 3.84 0.26 0.18 0.01 XXX 

89140 .... ............ A ........ Sample stomach contents .................. 0.94 6.22 4.15 0.43 0.35 0.04 XXX 

89141 .... ............ A ........ Sample stomach contents .................. 0.85 6.36 4.57 0.49 0.41 0.03 XXX 

89220 .... ............ A ........ Sputum specimen collection ............... 0.00 0.37 0.40 NA NA 0.02 XXX 

89230 .... ............ A ........ Collect sweat for test .......................... 0.00 0.07 0.09 NA NA 0.02 XXX 

89240 .... ............ C ........ Pathology lab procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

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 

90284 .... ............ X ........ Human ig, sc ....................................... 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 treated ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

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, im ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90399 .... ............ I .......... Immune globulin .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90465 .... ............ A ........ Immune admin 1 inj, < 8 yrs ............... 0.17 0.44 0.38 NA NA 0.01 XXX 

90466 .... ............ A ........ Immune admin addl inj, < 8 y ............. 0.15 0.12 0.12 0.04 0.08 0.01 ZZZ 

90467 .... ............ R ........ Immune admin o or n, < 8 yrs ............ 0.17 0.17 0.17 0.07 0.08 0.01 XXX 

90468 .... ............ R ........ Immune admin o/n, addl < 8 y ............ 0.15 0.11 0.11 0.04 0.05 0.01 ZZZ 

90471 .... ............ A ........ Immunization admin ............................ 0.17 0.44 0.38 NA NA 0.01 XXX 

90472 .... ............ A ........ Immunization admin, each add ........... 0.15 0.12 0.13 0.04 0.08 0.01 ZZZ 

90473 .... ............ R ........ Immune admin oral/nasal ................... 0.17 0.17 0.18 0.04 0.06 0.01 XXX 

90474 .... ............ R ........ Immune admin oral/nasal addl ........... 0.15 0.08 0.09 0.04 0.05 0.01 ZZZ 

90476 .... ............ E ........ Adenovirus vaccine, type 4 ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90477 .... ............ E ........ Adenovirus vaccine, type 7 ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90581 .... ............ E ........ Anthrax vaccine, sc ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90585 .... ............ E ........ Bcg vaccine, percut ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90586 .... ............ E ........ Bcg vaccine, intravesical .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90632 .... ............ E ........ Hep a vaccine, adult im ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90633 .... ............ E ........ Hep a vacc, ped/adol, 2 dose ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90634 .... ............ E ........ Hep a vacc, ped/adol, 3 dose ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90636 .... ............ E ........ Hep a/hep b vacc, adult im ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90645 .... ............ E ........ Hib vaccine, hboc, im ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 


cprice-sewell on PROD1PC72 with RULES
66520 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

90646 .... ............ E ........ Hib vaccine, prp-d, im ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90647 .... ............ E ........ Hib vaccine, prp-omp, im .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90648 .... ............ E ........ Hib vaccine, prp-t, im .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90649 .... ............ E ........ H papilloma vacc 3 dose im ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90655 .... ............ X ........ Flu vaccine no preserv 6–35m ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90656 .... ............ X ........ Flu vaccine no preserv 3 & > ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90657 .... ............ X ........ Flu vaccine, 3 yrs, im .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90658 .... ............ X ........ Flu vaccine, 3 yrs & >, im ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90660 .... ............ X ........ Flu vaccine, nasal ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90661 .... ............ X ........ Flu vacc cell cult prsv free .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90662 .... ............ X ........ Flu vacc prsv free inc antig ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90663 .... ............ X ........ Flu vacc pandemic .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90665 .... ............ E ........ Lyme disease vaccine, im .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90669 .... ............ X ........ Pneumococcal vacc, ped <5 ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90675 .... ............ E ........ Rabies vaccine, im .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90676 .... ............ E ........ Rabies vaccine, id ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90680 .... ............ E ........ Rotovirus vacc 3 dose, oral ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90690 .... ............ E ........ Typhoid vaccine, oral .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90691 .... ............ E ........ Typhoid vaccine, im ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90692 .... ............ E ........ Typhoid vaccine, h-p, sc/id ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90693 .... ............ E ........ Typhoid vaccine, akd, sc .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90698 .... ............ E ........ Dtap-hib-ip vaccine, im ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90700 .... ............ E ........ Dtap vaccine, < 7 yrs, im .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90701 .... ............ E ........ Dtp vaccine, im ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90702 .... ............ E ........ Dt vaccine < 7, im ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90703 .... ............ E ........ Tetanus vaccine, im ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90704 .... ............ E ........ Mumps vaccine, sc ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90705 .... ............ E ........ Measles vaccine, sc ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90706 .... ............ E ........ Rubella vaccine, sc ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90707 .... ............ E ........ Mmr vaccine, sc .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90708 .... ............ E ........ Measles-rubella vaccine, sc ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90710 .... ............ E ........ Mmrv vaccine, sc ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90712 .... ............ E ........ Oral poliovirus vaccine ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90713 .... ............ E ........ Poliovirus, ipv, sc/im ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90714 .... ............ E ........ Td vaccine no prsrv >/= 7 im .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90715 .... ............ E ........ Tdap vaccine >7 im ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90716 .... ............ E ........ Chicken pox vaccine, sc ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90717 .... ............ E ........ Yellow fever vaccine, sc ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

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 vaccine, im ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90725 .... ............ E ........ Cholera vaccine, injectable ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

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, sc ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90734 .... ............ E ........ Meningococcal vaccine, im ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90735 .... ............ E ........ Encephalitis vaccine, sc ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

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 dose im ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90743 .... ............ X ........ Hep b vacc, adol, 2 dose, im .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90744 .... ............ X ........ Hepb vacc ped/adol 3 dose im ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90746 .... ............ X ........ Hep b vaccine, adult, im ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90747 .... ............ X ........ Hepb vacc, ill pat 4 dose im ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

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, init ..................... 0.17 1.32 1.37 NA NA 0.07 XXX 

90761 .... ............ A ........ Hydrate iv infusion, add-on ................. 0.09 0.32 0.36 NA NA 0.04 ZZZ 

90765 .... ............ A ........ Ther/proph/diag iv inf, init ................... 0.21 1.62 1.69 NA NA 0.07 XXX 

90766 .... ............ A ........ Ther/proph/dg iv inf, add-on ............... 0.18 0.37 0.42 NA NA 0.04 ZZZ 

90767 .... ............ A ........ Tx/proph/dg addl seq iv inf ................. 0.19 0.69 0.79 NA NA 0.04 ZZZ 

90768 .... ............ A ........ Ther/diag concurrent inf ...................... 0.17 0.33 0.39 NA NA 0.04 ZZZ 

90769 .... ............ A ........ Sc ther infusion, up to 1 hr ................. 0.21 3.92 3.92 NA NA 0.06 XXX 

90770 .... ............ A ........ Sc ther infusion, addl hr ...................... 0.18 0.22 0.22 NA NA 0.04 ZZZ 

90771 .... ............ A ........ Sc ther infusion, reset pump ............... 0.00 1.86 1.86 NA NA 0.01 ZZZ 

90772 .... ............ A ........ Ther/proph/diag inj, sc/im ................... 0.17 0.44 0.38 NA NA 0.01 XXX 

90773 .... ............ A ........ Ther/proph/diag inj, ia ......................... 0.17 0.30 0.31 NA NA 0.02 XXX 

90774 .... ............ A ........ Ther/proph/diag inj, iv push ................ 0.18 1.33 1.31 NA NA 0.04 XXX 

90775 .... ............ A ........ Tx/pro/dx inj new drug addon ............. 0.10 0.51 0.54 NA NA 0.04 ZZZ 

90776 .... ............ X ........ Tx/pro/dx inj same drug adon ............. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

90779 .... ............ C ........ Ther/prop/diag inj/inf proc ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 


cprice-sewell on PROD1PC72 with RULES
66521 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

90801 .... ............ A ........ Psy dx interview .................................. 2.80 1.49 1.33 0.60 0.76 0.06 XXX 

90802 .... ............ A ........ Intac psy dx interview ......................... 3.01 1.54 1.37 0.68 0.83 0.07 XXX 

90804 .... ............ A ........ Psytx, office, 20–30 min ..................... 1.21 0.56 0.52 0.21 0.30 0.03 XXX 

90805 .... ............ A ........ Psytx, off, 20–30 min w/e&m .............. 1.37 0.60 0.55 0.24 0.33 0.03 XXX 

90806 .... ............ A ........ Psytx, off, 45–50 min .......................... 1.86 0.53 0.61 0.33 0.46 0.04 XXX 

90807 .... ............ A ........ Psytx, off, 45–50 min w/e&m .............. 2.02 0.70 0.70 0.35 0.49 0.05 XXX 

90808 .... ............ A ........ Psytx, office, 75–80 min ..................... 2.79 0.69 0.86 0.49 0.69 0.06 XXX 

90809 .... ............ A ........ Psytx, off, 75–80, w/e&m .................... 2.95 0.86 0.93 0.52 0.72 0.07 XXX 

90810 .... ............ A ........ Intac psytx, off, 20–30 min ................. 1.32 0.54 0.52 0.23 0.33 0.04 XXX 

90811 .... ............ A ........ Intac psytx, 20–30, w/e&m ................. 1.48 0.72 0.64 0.26 0.36 0.04 XXX 

90812 .... ............ A ........ Intac psytx, off, 45–50 min ................. 1.97 0.65 0.72 0.34 0.49 0.04 XXX 

90813 .... ............ A ........ Intac psytx, 45–50 min w/e&m ........... 2.13 0.83 0.80 0.37 0.52 0.05 XXX 

90814 .... ............ A ........ Intac psytx, off, 75–80 min ................. 2.90 0.81 0.95 0.53 0.75 0.06 XXX 

90815 .... ............ A ........ Intac psytx, 75–80 w/e&m .................. 3.06 0.99 1.02 0.53 0.74 0.07 XXX 

90816 .... ............ A ........ Psytx, hosp, 20–30 min ...................... 1.25 NA NA 0.32 0.39 0.03 XXX 

90817 .... ............ A ........ Psytx, hosp, 20–30 min w/e&m .......... 1.41 NA NA 0.35 0.40 0.03 XXX 

90818 .... ............ A ........ Psytx, hosp, 45–50 min ...................... 1.89 NA NA 0.44 0.56 0.04 XXX 

90819 .... ............ A ........ Psytx, hosp, 45–50 min w/e&m .......... 2.05 NA NA 0.46 0.55 0.05 XXX 

90821 .... ............ A ........ Psytx, hosp, 75–80 min ...................... 2.83 NA NA 0.60 0.80 0.06 XXX 

90822 .... ............ A ........ Psytx, hosp, 75–80 min w/e&m .......... 2.99 NA NA 0.62 0.79 0.08 XXX 

90823 .... ............ A ........ Intac psytx, hosp, 20–30 min .............. 1.36 NA NA 0.35 0.41 0.03 XXX 

90824 .... ............ A ........ Intac psytx, hsp 20–30 w/e&m ........... 1.52 NA NA 0.37 0.43 0.04 XXX 

90826 .... ............ A ........ Intac psytx, hosp, 45–50 min .............. 2.01 NA NA 0.46 0.59 0.05 XXX 

90827 .... ............ A ........ Intac psytx, hsp 45–50 w/e&m ........... 2.16 NA NA 0.48 0.58 0.05 XXX 

90828 .... ............ A ........ Intac psytx, hosp, 75–80 min .............. 2.94 NA NA 0.62 0.84 0.06 XXX 

90829 .... ............ A ........ Intac psytx, hsp 75–80 w/e&m ........... 3.10 NA NA 0.64 0.81 0.07 XXX 

90845 .... ............ A ........ Psychoanalysis ................................... 1.79 0.39 0.48 0.32 0.43 0.04 XXX 

90846 .... ............ R ........ Family psytx w/o patient ..................... 1.83 0.51 0.58 0.42 0.54 0.04 XXX 

90847 .... ............ R ........ Family psytx w/patient ........................ 2.21 0.74 0.78 0.49 0.63 0.05 XXX 

90849 .... ............ R ........ Multiple family group psytx ................. 0.59 0.33 0.30 0.21 0.22 0.02 XXX 

90853 .... ............ A ........ Group psychotherapy .......................... 0.59 0.26 0.26 0.20 0.21 0.01 XXX 

90857 .... ............ A ........ Intac group psytx ................................ 0.63 0.38 0.33 0.21 0.23 0.01 XXX 

90862 .... ............ A ........ Medication management ..................... 0.95 0.62 0.51 0.27 0.29 0.02 XXX 

90865 .... ............ A ........ Narcosynthesis .................................... 2.84 1.16 1.26 0.63 0.77 0.12 XXX 

90870 .... ............ A ........ Electroconvulsive therapy ................... 1.88 1.92 1.93 0.38 0.48 0.04 000 

90875 .... ............ N ........ Psychophysiological therapy ............... 1.20 0.53 0.71 0.28 0.37 0.04 XXX 

90876 .... ............ N ........ Psychophysiological therapy ............... 1.90 0.67 0.91 0.44 0.58 0.05 XXX 

90880 .... ............ A ........ Hypnotherapy ...................................... 2.19 0.57 0.81 0.39 0.54 0.05 XXX 

90882 .... ............ N ........ Environmental manipulation ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90885 .... ............ B ........ Psy evaluation of records ................... 0.97 0.22 0.30 0.22 0.30 0.02 XXX 

90887 .... ............ B ........ Consultation with family ...................... 1.48 0.61 0.71 0.34 0.45 0.04 XXX 

90889 .... ............ B ........ Preparation of report ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90899 .... ............ C ........ Psychiatric service/therapy ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90901 .... ............ A ........ Biofeedback train, any meth ............... 0.41 0.46 0.56 0.10 0.12 0.02 000 

90911 .... ............ A ........ Biofeedback peri/uro/rectal ................. 0.89 1.37 1.46 0.30 0.30 0.06 000 

90918 .... ............ I .......... ESRD related services, month ........... 11.16 4.70 5.40 3.74 4.92 0.36 XXX 

90919 .... ............ I .......... ESRD related services, month ........... 8.53 3.03 3.51 2.55 3.27 0.29 XXX 

90920 .... ............ I .......... ESRD related services, month ........... 7.26 2.73 3.24 2.26 3.01 0.23 XXX 

90921 .... ............ I .......... ESRD related services, month ........... 4.46 1.71 2.07 1.61 2.03 0.14 XXX 

90922 .... ............ I .......... ESRD related services, day ................ 0.37 0.16 0.18 0.13 0.17 0.01 XXX 

90923 .... ............ I .......... Esrd related services, day .................. 0.28 0.10 0.11 0.08 0.11 0.01 XXX 

90924 .... ............ I .......... Esrd related services, day .................. 0.24 0.09 0.10 0.07 0.10 0.01 XXX 

90925 .... ............ I .......... Esrd related services, day .................. 0.15 0.05 0.07 0.05 0.07 0.01 XXX 

90935 .... ............ A ........ Hemodialysis, one evaluation ............. 1.22 NA NA 0.53 0.60 0.04 000 

90937 .... ............ A ........ Hemodialysis, repeated eval ............... 2.11 NA NA 0.77 0.87 0.07 000 

90940 .... ............ X ........ Hemodialysis access study ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90945 .... ............ A ........ Dialysis, one evaluation ...................... 1.28 NA NA 0.55 0.62 0.04 000 

90947 .... ............ A ........ Dialysis, repeated eval ........................ 2.16 NA NA 0.79 0.89 0.07 000 

90989 .... ............ X ........ Dialysis training, complete .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90993 .... ............ X ........ Dialysis training, incompl .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90997 .... ............ A ........ Hemoperfusion .................................... 1.84 NA NA 0.50 0.58 0.06 000 

90999 .... ............ C ........ Dialysis procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91000 .... ............ A ........ Esophageal intubation ........................ 0.73 2.13 1.23 NA NA 0.04 000 

91000 .... TC ...... A ........ Esophageal intubation ........................ 0.00 1.91 0.99 NA NA 0.01 000 

91000 .... 26 ....... A ........ Esophageal intubation ........................ 0.73 0.22 0.24 0.22 0.24 0.03 000 

91010 .... ............ A ........ Esophagus motility study .................... 1.25 3.67 4.03 NA NA 0.12 000 

91010 .... TC ...... A ........ Esophagus motility study .................... 0.00 3.12 3.54 NA NA 0.06 000 

91010 .... 26 ....... A ........ Esophagus motility study .................... 1.25 0.55 0.49 0.55 0.49 0.06 000 

91011 .... ............ A ........ Esophagus motility study .................... 1.50 5.37 5.29 NA NA 0.13 000 

91011 .... TC ...... A ........ Esophagus motility study .................... 0.00 4.65 4.67 NA NA 0.06 000 

91011 .... 26 ....... A ........ Esophagus motility study .................... 1.50 0.72 0.62 0.72 0.62 0.07 000 

91012 .... ............ A ........ Esophagus motility study .................... 1.46 5.44 5.60 NA NA 0.13 000 


cprice-sewell on PROD1PC72 with RULES
66522 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

91012 .... TC ...... A ........ Esophagus motility study .................... 0.00 4.76 5.00 NA NA 0.07 000 

91012 .... 26 ....... A ........ Esophagus motility study .................... 1.46 0.68 0.60 0.68 0.60 0.06 000 

91020 .... ............ A ........ Gastric motility studies ........................ 1.44 4.81 4.66 NA NA 0.13 000 

91020 .... TC ...... A ........ Gastric motility studies ........................ 0.00 4.20 4.11 NA NA 0.06 000 

91020 .... 26 ....... A ........ Gastric motility studies ........................ 1.44 0.61 0.55 0.61 0.55 0.07 000 

91022 .... ............ A ........ Duodenal motility study ....................... 1.44 3.13 3.76 NA NA 0.13 000 

91022 .... TC ...... A ........ Duodenal motility study ....................... 0.00 2.51 3.20 NA NA 0.06 000 

91022 .... 26 ....... A ........ Duodenal motility study ....................... 1.44 0.62 0.56 0.62 0.56 0.07 000 

91030 .... ............ A ........ Acid perfusion of esophagus .............. 0.91 2.90 2.66 NA NA 0.06 000 

91030 .... TC ...... A ........ Acid perfusion of esophagus .............. 0.00 2.48 2.29 NA NA 0.02 000 

91030 .... 26 ....... A ........ Acid perfusion of esophagus .............. 0.91 0.42 0.37 0.42 0.37 0.04 000 

91034 .... ............ A ........ Gastroesophageal reflux test .............. 0.97 4.15 4.69 NA NA 0.12 000 

91034 .... TC ...... A ........ Gastroesophageal reflux test .............. 0.00 3.73 4.31 NA NA 0.06 000 

91034 .... 26 ....... A ........ Gastroesophageal reflux test .............. 0.97 0.42 0.38 0.42 0.38 0.06 000 

91035 .... ............ A ........ G-esoph reflx tst w/electrod ................ 1.59 11.37 11.08 NA NA 0.12 000 

91035 .... TC ...... A ........ G-esoph reflx tst w/electrod ................ 0.00 10.67 10.45 NA NA 0.06 000 

91035 .... 26 ....... A ........ G-esoph reflx tst w/electrod ................ 1.59 0.70 0.63 0.70 0.63 0.06 000 

91037 .... ............ A ........ Esoph imped function test .................. 0.97 3.47 3.20 NA NA 0.12 000 

91037 .... TC ...... A ........ Esoph imped function test .................. 0.00 3.03 2.81 NA NA 0.06 000 

91037 .... 26 ....... A ........ Esoph imped function test .................. 0.97 0.44 0.39 0.44 0.39 0.06 000 

91038 .... ............ A ........ Esoph imped funct test > 1h ............... 1.10 2.80 2.52 NA NA 0.12 000 

91038 .... TC ...... A ........ Esoph imped funct test > 1h ............... 0.00 2.30 2.07 NA NA 0.06 000 

91038 .... 26 ....... A ........ Esoph imped funct test > 1h ............... 1.10 0.50 0.45 0.50 0.45 0.06 000 

91040 .... ............ A ........ Esoph balloon distension tst ............... 0.97 7.72 9.42 NA NA 0.12 000 

91040 .... TC ...... A ........ Esoph balloon distension tst ............... 0.00 7.44 9.11 NA NA 0.06 000 

91040 .... 26 ....... A ........ Esoph balloon distension tst ............... 0.97 0.28 0.31 0.28 0.31 0.06 000 

91052 .... ............ A ........ Gastric analysis test ............................ 0.79 2.92 2.68 NA NA 0.05 000 

91052 .... TC ...... A ........ Gastric analysis test ............................ 0.00 2.55 2.36 NA NA 0.02 000 

91052 .... 26 ....... A ........ Gastric analysis test ............................ 0.79 0.37 0.32 0.37 0.32 0.03 000 

91055 .... ............ A ........ Gastric intubation for smear ............... 0.94 2.57 2.76 NA NA 0.07 000 

91055 .... TC ...... A ........ Gastric intubation for smear ............... 0.00 2.28 2.48 NA NA 0.02 000 

91055 .... 26 ....... A ........ Gastric intubation for smear ............... 0.94 0.29 0.28 0.29 0.28 0.05 000 

91065 .... ............ A ........ Breath hydrogen test .......................... 0.20 1.33 1.40 NA NA 0.03 000 

91065 .... TC ...... A ........ Breath hydrogen test .......................... 0.00 1.27 1.33 NA NA 0.02 000 

91065 .... 26 ....... A ........ Breath hydrogen test .......................... 0.20 0.06 0.07 0.06 0.07 0.01 000 

91100 .... ............ A ........ Pass intestine bleeding tube ............... 1.08 2.14 2.46 0.32 0.30 0.07 000 

91105 .... ............ A ........ Gastric intubation treatment ................ 0.37 1.67 1.89 0.07 0.08 0.03 000 

91110 .... ............ A ........ Gi tract capsule endoscopy ................ 3.64 20.63 21.40 NA NA 0.16 XXX 

91110 .... TC ...... A ........ Gi tract capsule endoscopy ................ 0.00 18.97 19.93 NA NA 0.07 XXX 

91110 .... 26 ....... A ........ Gi tract capsule endoscopy ................ 3.64 1.66 1.47 1.66 1.47 0.09 XXX 

91111 .... ............ A ........ Esophageal capsule endoscopy ......... 1.00 18.82 18.82 NA NA 0.05 XXX 

91111 .... TC ...... A ........ Esophageal capsule endoscopy ......... 0.00 18.37 18.37 NA NA 0.02 XXX 

91111 .... 26 ....... A ........ Esophageal capsule endoscopy ......... 1.00 0.45 0.45 0.45 0.45 0.03 XXX 

91120 .... ............ A ........ Rectal sensation test .......................... 0.97 8.88 9.92 NA NA 0.11 XXX 

91120 .... TC ...... A ........ Rectal sensation test .......................... 0.00 8.61 9.62 NA NA 0.04 XXX 

91120 .... 26 ....... A ........ Rectal sensation test .......................... 0.97 0.27 0.30 0.27 0.30 0.07 XXX 

91122 .... ............ A ........ Anal pressure record .......................... 1.77 4.30 4.70 NA NA 0.21 000 

91122 .... TC ...... A ........ Anal pressure record .......................... 0.00 3.68 4.09 NA NA 0.08 000 

91122 .... 26 ....... A ........ Anal pressure record .......................... 1.77 0.62 0.61 0.62 0.61 0.13 000 

91123 .... ............ B ........ Irrigate fecal impaction ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91132 .... ............ C ........ Electrogastrography ............................ 0.00 0.00 0.00 NA NA 0.00 XXX 

91132 .... TC ...... C ........ Electrogastrography ............................ 0.00 0.00 0.00 NA NA 0.00 XXX 

91132 .... 26 ....... A ........ Electrogastrography ............................ 0.52 0.25 0.22 0.25 0.22 0.02 XXX 

91133 .... ............ C ........ Electrogastrography w/test ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

91133 .... TC ...... C ........ Electrogastrography w/test ................. 0.00 0.00 0.00 NA NA 0.00 XXX 

91133 .... 26 ....... A ........ Electrogastrography w/test ................. 0.66 0.32 0.28 0.32 0.28 0.03 XXX 

91299 .... ............ C ........ Gastroenterology procedure ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

91299 .... TC ...... C ........ Gastroenterology procedure ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

91299 .... 26 ....... C ........ Gastroenterology procedure ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92002 .... ............ A ........ Eye exam, new patient ....................... 0.88 0.93 0.95 0.25 0.30 0.02 XXX 

92004 .... ............ A ........ Eye exam, new patient ....................... 1.82 1.57 1.63 0.55 0.62 0.04 XXX 

92012 .... ............ A ........ Eye exam established pat .................. 0.92 0.99 1.01 0.31 0.30 0.02 XXX 

92014 .... ............ A ........ Eye exam & treatment ........................ 1.42 1.37 1.39 0.46 0.46 0.03 XXX 

92015 .... ............ N ........ Refraction ............................................ 0.38 0.10 0.79 0.09 0.12 0.01 XXX 

92018 .... ............ A ........ New eye exam & treatment ................ 2.50 NA NA 0.86 0.96 0.07 XXX 

92019 .... ............ A ........ Eye exam & treatment ........................ 1.31 NA NA 0.35 0.46 0.03 XXX 

92020 .... ............ A ........ Special eye evaluation ........................ 0.37 0.25 0.29 0.13 0.14 0.01 XXX 

92025 .... ............ A ........ Corneal topography ............................ 0.35 0.49 0.49 NA NA 0.02 XXX 

92025 .... TC ...... A ........ Corneal topography ............................ 0.00 0.37 0.37 NA NA 0.01 XXX 

92025 .... 26 ....... A ........ Corneal topography ............................ 0.35 0.12 0.12 0.12 0.12 0.01 XXX 

92060 .... ............ A ........ Special eye evaluation ........................ 0.69 0.76 0.75 NA NA 0.03 XXX 

92060 .... TC ...... A ........ Special eye evaluation ........................ 0.00 0.54 0.49 NA NA 0.01 XXX 


cprice-sewell on PROD1PC72 with RULES
66523 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

92060 .... 26 ....... A ........ Special eye evaluation ........................ 0.69 0.22 0.26 0.22 0.26 0.02 XXX 

92065 .... ............ A ........ Orthoptic/pleoptic training ................... 0.37 0.86 0.69 NA NA 0.02 XXX 

92065 .... TC ...... A ........ Orthoptic/pleoptic training ................... 0.00 0.77 0.57 NA NA 0.01 XXX 

92065 .... 26 ....... A ........ Orthoptic/pleoptic training ................... 0.37 0.09 0.12 0.09 0.12 0.01 XXX 

92070 .... ............ A ........ Fitting of contact lens .......................... 0.70 0.90 0.98 0.22 0.27 0.02 XXX 

92081 .... ............ A ........ Visual field examination(s) .................. 0.36 0.95 0.94 NA NA 0.02 XXX 

92081 .... TC ...... A ........ Visual field examination(s) .................. 0.00 0.84 0.81 NA NA 0.01 XXX 

92081 .... 26 ....... A ........ Visual field examination(s) .................. 0.36 0.11 0.13 0.11 0.13 0.01 XXX 

92082 .... ............ A ........ Visual field examination(s) .................. 0.44 1.32 1.27 NA NA 0.02 XXX 

92082 .... TC ...... A ........ Visual field examination(s) .................. 0.00 1.18 1.11 NA NA 0.01 XXX 

92082 .... 26 ....... A ........ Visual field examination(s) .................. 0.44 0.14 0.16 0.14 0.16 0.01 XXX 

92083 .... ............ A ........ Visual field examination(s) .................. 0.50 1.51 1.47 NA NA 0.02 XXX 

92083 .... TC ...... A ........ Visual field examination(s) .................. 0.00 1.35 1.28 NA NA 0.01 XXX 

92083 .... 26 ....... A ........ Visual field examination(s) .................. 0.50 0.16 0.19 0.16 0.19 0.01 XXX 

92100 .... ............ A ........ Serial tonometry exam(s) .................... 0.92 1.24 1.29 0.27 0.32 0.02 XXX 

92120 .... ............ A ........ Tonography & eye evaluation ............. 0.81 0.97 1.02 0.25 0.28 0.02 XXX 

92130 .... ............ A ........ Water provocation tonography ............ 0.81 1.18 1.23 0.27 0.32 0.02 XXX 

92135 .... ............ A ........ Ophth dx imaging post seg ................. 0.35 0.79 0.78 NA NA 0.02 XXX 

92135 .... TC ...... A ........ Ophth dx imaging post seg ................. 0.00 0.67 0.65 NA NA 0.01 XXX 

92135 .... 26 ....... A ........ Ophth dx imaging post seg ................. 0.35 0.12 0.13 0.12 0.13 0.01 XXX 

92136 .... ............ A ........ Ophthalmic biometry ........................... 0.54 1.42 1.54 NA NA 0.08 XXX 

92136 .... TC ...... A ........ Ophthalmic biometry ........................... 0.00 1.23 1.32 NA NA 0.07 XXX 

92136 .... 26 ....... A ........ Ophthalmic biometry ........................... 0.54 0.19 0.22 0.19 0.22 0.01 XXX 

92140 .... ............ A ........ Glaucoma provocative tests ............... 0.50 0.89 0.94 0.14 0.18 0.01 XXX 

92225 .... ............ A ........ Special eye exam, initial ..................... 0.38 0.24 0.23 0.12 0.14 0.01 XXX 

92226 .... ............ A ........ Special eye exam, subsequent ........... 0.33 0.23 0.22 0.11 0.13 0.01 XXX 

92230 .... ............ A ........ Eye exam with photos ........................ 0.60 0.68 1.10 0.19 0.19 0.02 XXX 

92235 .... ............ A ........ Eye exam with photos ........................ 0.81 2.26 2.44 NA NA 0.08 XXX 

92235 .... TC ...... A ........ Eye exam with photos ........................ 0.00 1.97 2.11 NA NA 0.06 XXX 

92235 .... 26 ....... A ........ Eye exam with photos ........................ 0.81 0.29 0.33 0.29 0.33 0.02 XXX 

92240 .... ............ A ........ Icg angiography .................................. 1.10 4.38 5.23 NA NA 0.09 XXX 

92240 .... TC ...... A ........ Icg angiography .................................. 0.00 3.99 4.79 NA NA 0.06 XXX 

92240 .... 26 ....... A ........ Icg angiography .................................. 1.10 0.39 0.44 0.39 0.44 0.03 XXX 

92250 .... ............ A ........ Eye exam with photos ........................ 0.44 1.30 1.41 NA NA 0.02 XXX 

92250 .... TC ...... A ........ Eye exam with photos ........................ 0.00 1.16 1.25 NA NA 0.01 XXX 

92250 .... 26 ....... A ........ Eye exam with photos ........................ 0.44 0.14 0.16 0.14 0.16 0.01 XXX 

92260 .... ............ A ........ Ophthalmoscopy/dynamometry .......... 0.20 0.23 0.24 0.07 0.08 0.01 XXX 

92265 .... ............ A ........ Eye muscle evaluation ........................ 0.81 1.00 1.24 NA NA 0.06 XXX 

92265 .... TC ...... A ........ Eye muscle evaluation ........................ 0.00 0.76 0.98 NA NA 0.02 XXX 

92265 .... 26 ....... A ........ Eye muscle evaluation ........................ 0.81 0.24 0.26 0.24 0.26 0.04 XXX 

92270 .... ............ A ........ Electro-oculography ............................ 0.81 1.32 1.42 NA NA 0.05 XXX 

92270 .... TC ...... A ........ Electro-oculography ............................ 0.00 1.09 1.14 NA NA 0.02 XXX 

92270 .... 26 ....... A ........ Electro-oculography ............................ 0.81 0.23 0.28 0.23 0.28 0.03 XXX 

92275 .... ............ A ........ Electroretinography ............................. 1.01 2.42 2.18 NA NA 0.05 XXX 

92275 .... TC ...... A ........ Electroretinography ............................. 0.00 2.07 1.79 NA NA 0.02 XXX 

92275 .... 26 ....... A ........ Electroretinography ............................. 1.01 0.35 0.39 0.35 0.39 0.03 XXX 

92283 .... ............ A ........ Color vision examination ..................... 0.17 0.99 0.91 NA NA 0.02 XXX 

92283 .... TC ...... A ........ Color vision examination ..................... 0.00 0.94 0.85 NA NA 0.01 XXX 

92283 .... 26 ....... A ........ Color vision examination ..................... 0.17 0.05 0.06 0.05 0.06 0.01 XXX 

92284 .... ............ A ........ Dark adaptation eye exam .................. 0.24 1.13 1.50 NA NA 0.02 XXX 

92284 .... TC ...... A ........ Dark adaptation eye exam .................. 0.00 1.06 1.43 NA NA 0.01 XXX 

92284 .... 26 ....... A ........ Dark adaptation eye exam .................. 0.24 0.07 0.07 0.07 0.07 0.01 XXX 

92285 .... ............ A ........ Eye photography ................................. 0.20 0.80 0.89 NA NA 0.02 XXX 

92285 .... TC ...... A ........ Eye photography ................................. 0.00 0.73 0.81 NA NA 0.01 XXX 

92285 .... 26 ....... A ........ Eye photography ................................. 0.20 0.07 0.08 0.07 0.08 0.01 XXX 

92286 .... ............ A ........ Internal eye photography .................... 0.66 2.08 2.56 NA NA 0.04 XXX 

92286 .... TC ...... A ........ Internal eye photography .................... 0.00 1.86 2.31 NA NA 0.02 XXX 

92286 .... 26 ....... A ........ Internal eye photography .................... 0.66 0.22 0.25 0.22 0.25 0.02 XXX 

92287 .... ............ A ........ Internal eye photography .................... 0.81 1.90 2.14 0.27 0.29 0.02 XXX 

92310 .... ............ N ........ Contact lens fitting .............................. 1.17 1.06 1.09 0.27 0.36 0.04 XXX 

92311 .... ............ A ........ Contact lens fitting .............................. 1.08 1.27 1.18 0.30 0.33 0.03 XXX 

92312 .... ............ A ........ Contact lens fitting .............................. 1.26 1.45 1.26 0.33 0.41 0.03 XXX 

92313 .... ............ A ........ Contact lens fitting .............................. 0.92 1.42 1.24 0.31 0.30 0.02 XXX 

92314 .... ............ N ........ Prescription of contact lens ................ 0.69 1.14 1.04 0.16 0.21 0.01 XXX 

92315 .... ............ A ........ Prescription of contact lens ................ 0.45 1.31 1.08 0.13 0.14 0.01 XXX 

92316 .... ............ A ........ Prescription of contact lens ................ 0.68 1.63 1.27 0.22 0.26 0.02 XXX 

92317 .... ............ A ........ Prescription of contact lens ................ 0.45 1.31 1.12 0.11 0.13 0.01 XXX 

92325 .... ............ A ........ Modification of contact lens ................ 0.00 0.83 0.62 NA NA 0.01 XXX 

92326 .... ............ A ........ Replacement of contact lens .............. 0.00 0.73 1.18 NA NA 0.06 XXX 

92340 .... ............ N ........ Fitting of spectacles ............................ 0.37 0.44 0.57 0.09 0.11 0.01 XXX 

92341 .... ............ N ........ Fitting of spectacles ............................ 0.47 0.46 0.60 0.11 0.14 0.01 XXX 

92342 .... ............ N ........ Fitting of spectacles ............................ 0.53 0.48 0.62 0.12 0.17 0.01 XXX 


cprice-sewell on PROD1PC72 with RULES
66524 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

92352 .... ............ B ........ Special spectacles fitting .................... 0.37 0.56 0.62 0.09 0.11 0.01 XXX 

92353 .... ............ B ........ Special spectacles fitting .................... 0.50 0.59 0.66 0.11 0.15 0.02 XXX 

92354 .... ............ B ........ Special spectacles fitting .................... 0.00 0.28 4.57 NA NA 0.10 XXX 

92355 .... ............ B ........ Special spectacles fitting .................... 0.00 0.44 2.38 NA NA 0.01 XXX 

92358 .... ............ B ........ Eye prosthesis service ........................ 0.00 0.24 0.60 NA NA 0.05 XXX 

92370 .... ............ N ........ Repair & adjust spectacles ................. 0.32 0.39 0.47 0.07 0.10 0.02 XXX 

92371 .... ............ B ........ Repair & adjust spectacles ................. 0.00 0.24 0.43 NA NA 0.02 XXX 

92499 .... ............ C ........ Eye service or procedure .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

92499 .... TC ...... C ........ Eye service or procedure .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

92499 .... 26 ....... C ........ Eye service or procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92502 .... ............ A ........ Ear and throat examination ................ 1.51 NA NA 0.90 1.00 0.05 000 

92504 .... ............ A ........ Ear microscopy examination ............... 0.18 0.60 0.55 0.06 0.07 0.01 XXX 

92506 .... ............ A ........ Speech/hearing evaluation ................. 0.86 3.49 3.04 0.28 0.34 0.03 XXX 

92507 .... ............ A ........ Speech/hearing therapy ...................... 0.52 1.23 1.17 0.16 0.19 0.02 XXX 

92508 .... ............ A ........ Speech/hearing therapy ...................... 0.26 0.55 0.53 0.09 0.11 0.01 XXX 

92511 .... ............ A ........ Nasopharyngoscopy ........................... 0.84 3.12 3.21 0.67 0.72 0.03 000 

92512 .... ............ A ........ Nasal function studies ......................... 0.55 1.00 1.07 0.17 0.18 0.02 XXX 

92516 .... ............ A ........ Facial nerve function test .................... 0.43 1.23 1.21 0.14 0.18 0.01 XXX 

92520 .... ............ A ........ Laryngeal function studies .................. 0.75 0.93 0.72 0.24 0.31 0.03 XXX 

92526 .... ............ A ........ Oral function therapy .......................... 0.55 1.70 1.67 0.16 0.18 0.02 XXX 

92531 .... ............ B ........ Spontaneous nystagmus study ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92532 .... ............ B ........ Positional nystagmus test ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92533 .... ............ B ........ Caloric vestibular test ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92534 .... ............ B ........ Optokinetic nystagmus test ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92541 .... ............ A ........ Spontaneous nystagmus test ............. 0.40 1.14 1.09 NA NA 0.04 XXX 

92541 .... TC ...... A ........ Spontaneous nystagmus test ............. 0.00 1.03 0.94 NA NA 0.02 XXX 

92541 .... 26 ....... A ........ Spontaneous nystagmus test ............. 0.40 0.11 0.15 0.11 0.15 0.02 XXX 

92542 .... ............ A ........ Positional nystagmus test ................... 0.33 1.29 1.22 NA NA 0.03 XXX 

92542 .... TC ...... A ........ Positional nystagmus test ................... 0.00 1.20 1.09 NA NA 0.02 XXX 

92542 .... 26 ....... A ........ Positional nystagmus test ................... 0.33 0.09 0.13 0.09 0.13 0.01 XXX 

92543 .... ............ A ........ Caloric vestibular test ......................... 0.10 0.65 0.61 NA NA 0.02 XXX 

92543 .... TC ...... A ........ Caloric vestibular test ......................... 0.00 0.62 0.57 NA NA 0.01 XXX 

92543 .... 26 ....... A ........ Caloric vestibular test ......................... 0.10 0.03 0.04 0.03 0.04 0.01 XXX 

92544 .... ............ A ........ Optokinetic nystagmus test ................. 0.26 1.03 0.97 NA NA 0.03 XXX 

92544 .... TC ...... A ........ Optokinetic nystagmus test ................. 0.00 0.96 0.87 NA NA 0.02 XXX 

92544 .... 26 ....... A ........ Optokinetic nystagmus test ................. 0.26 0.07 0.10 0.07 0.10 0.01 XXX 

92545 .... ............ A ........ Oscillating tracking test ....................... 0.23 1.00 0.90 NA NA 0.03 XXX 

92545 .... TC ...... A ........ Oscillating tracking test ....................... 0.00 0.94 0.81 NA NA 0.02 XXX 

92545 .... 26 ....... A ........ Oscillating tracking test ....................... 0.23 0.06 0.09 0.06 0.09 0.01 XXX 

92546 .... ............ A ........ Sinusoidal rotational test ..................... 0.29 1.81 1.89 NA NA 0.03 XXX 

92546 .... TC ...... A ........ Sinusoidal rotational test ..................... 0.00 1.73 1.79 NA NA 0.02 XXX 

92546 .... 26 ....... A ........ Sinusoidal rotational test ..................... 0.29 0.08 0.10 0.08 0.10 0.01 XXX 

92547 .... ............ A ........ Supplemental electrical test ................ 0.00 0.11 0.09 0.11 0.09 0.06 ZZZ 

92548 .... ............ A ........ Posturography ..................................... 0.50 1.70 1.98 NA NA 0.15 XXX 

92548 .... TC ...... A ........ Posturography ..................................... 0.00 1.56 1.78 NA NA 0.13 XXX 

92548 .... 26 ....... A ........ Posturography ..................................... 0.50 0.14 0.20 0.14 0.20 0.02 XXX 

92551 .... ............ N ........ Pure tone hearing test, air .................. 0.00 0.25 0.25 NA NA 0.01 XXX 

92552 .... ............ A ........ Pure tone audiometry, air ................... 0.00 0.61 0.52 NA NA 0.04 XXX 

92553 .... ............ A ........ Audiometry, air & bone ....................... 0.00 0.77 0.71 NA NA 0.06 XXX 

92555 .... ............ A ........ Speech threshold audiometry ............. 0.00 0.41 0.40 NA NA 0.04 XXX 

92556 .... ............ A ........ Speech audiometry, complete ............ 0.00 0.51 0.54 NA NA 0.06 XXX 

92557 .... ............ A ........ Comprehensive hearing test ............... 0.60 0.29 0.74 0.20 0.69 0.12 XXX 

92559 .... ............ N ........ Group audiometric testing ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92560 .... ............ N ........ Bekesy audiometry, screen ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92561 .... ............ A ........ Bekesy audiometry, diagnosis ............ 0.00 0.70 0.71 NA NA 0.06 XXX 

92562 .... ............ A ........ Loudness balance test ........................ 0.00 0.62 0.51 NA NA 0.04 XXX 

92563 .... ............ A ........ Tone decay hearing test ..................... 0.00 0.55 0.46 NA NA 0.04 XXX 

92564 .... ............ A ........ Sisi hearing test .................................. 0.00 0.48 0.47 NA NA 0.05 XXX 

92565 .... ............ A ........ Stenger test, pure tone ....................... 0.00 0.25 0.33 NA NA 0.04 XXX 

92567 .... ............ A ........ Tympanometry .................................... 0.20 0.13 0.33 0.07 0.29 0.06 XXX 

92568 .... ............ A ........ Acoustic refl threshold tst ................... 0.29 0.10 0.24 0.09 0.24 0.04 XXX 

92569 .... ............ A ........ Acoustic reflex decay test ................... 0.20 0.07 0.24 0.07 0.24 0.04 XXX 

92571 .... ............ A ........ Filtered speech hearing test ............... 0.00 0.44 0.41 NA NA 0.04 XXX 

92572 .... ............ A ........ Staggered spondaic word test ............ 0.00 0.59 0.34 NA NA 0.01 XXX 

92575 .... ............ A ........ Sensorineural acuity test .................... 0.00 1.15 0.72 NA NA 0.02 XXX 

92576 .... ............ A ........ Synthetic sentence test ....................... 0.00 0.58 0.51 NA NA 0.05 XXX 

92577 .... ............ A ........ Stenger test, speech ........................... 0.00 0.26 0.49 NA NA 0.07 XXX 

92579 .... ............ A ........ Visual audiometry (vra) ....................... 0.70 0.35 0.54 0.23 0.48 0.06 XXX 

92582 .... ............ A ........ Conditioning play audiometry ............. 0.00 1.17 0.95 NA NA 0.06 XXX 

92583 .... ............ A ........ Select picture audiometry ................... 0.00 0.73 0.81 NA NA 0.08 XXX 

92584 .... ............ A ........ Electrocochleography .......................... 0.00 1.36 1.91 NA NA 0.21 XXX 

92585 .... ............ A ........ Auditor evoke potent, compre ............. 0.50 2.10 2.08 NA NA 0.17 XXX 


cprice-sewell on PROD1PC72 with RULES
66525 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

92585 .... TC ...... A ........ Auditor evoke potent, compre ............. 0.00 1.95 1.90 NA NA 0.14 XXX 

92585 .... 26 ....... A ........ Auditor evoke potent, compre ............. 0.50 0.15 0.18 0.15 0.18 0.03 XXX 

92586 .... ............ A ........ Auditor evoke potent, limit .................. 0.00 1.41 1.63 NA NA 0.14 XXX 

92587 .... ............ A ........ Evoked auditory test ........................... 0.13 0.65 1.01 NA NA 0.12 XXX 

92587 .... TC ...... A ........ Evoked auditory test ........................... 0.00 0.61 0.96 NA NA 0.11 XXX 

92587 .... 26 ....... A ........ Evoked auditory test ........................... 0.13 0.04 0.05 0.04 0.05 0.01 XXX 

92588 .... ............ A ........ Evoked auditory test ........................... 0.36 1.11 1.37 NA NA 0.14 XXX 

92588 .... TC ...... A ........ Evoked auditory test ........................... 0.00 1.00 1.23 NA NA 0.13 XXX 

92588 .... 26 ....... A ........ Evoked auditory test ........................... 0.36 0.11 0.14 0.11 0.14 0.01 XXX 

92590 .... ............ N ........ Hearing aid exam, one ear ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92591 .... ............ N ........ Hearing aid exam, both ears .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92592 .... ............ N ........ Hearing aid check, one ear ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92593 .... ............ N ........ Hearing aid check, both ears .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92594 .... ............ N ........ Electro hearng aid test, one ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92595 .... ............ N ........ Electro hearng aid tst, both ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92596 .... ............ A ........ Ear protector evaluation ...................... 0.00 1.02 0.80 NA NA 0.06 XXX 

92597 .... ............ A ........ Oral speech device eval ..................... 0.86 1.99 1.84 0.28 0.37 0.03 XXX 

92601 .... ............ A ........ Cochlear implt f/up exam < 7 ............. 2.30 1.08 2.29 0.64 2.07 0.07 XXX 

92602 .... ............ A ........ Reprogram cochlear implt < 7 ............ 1.30 0.84 1.61 0.40 1.39 0.07 XXX 

92603 .... ............ A ........ Cochlear implt f/up exam 7 > ............. 2.25 1.19 1.66 0.73 1.44 0.07 XXX 

92604 .... ............ A ........ Reprogram cochlear implt 7 > ............ 1.25 0.78 1.06 0.41 0.88 0.07 XXX 

92605 .... ............ B ........ Eval for nonspeech device rx ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92606 .... ............ B ........ Non-speech device service ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92607 .... ............ A ........ Ex for speech device rx, 1hr ............... 0.00 4.63 3.85 NA NA 0.05 XXX 

92608 .... ............ A ........ Ex for speech device rx addl .............. 0.00 0.88 0.72 NA NA 0.05 XXX 

92609 .... ............ A ........ Use of speech device service ............. 0.00 2.45 2.02 NA NA 0.04 XXX 

92610 .... ............ A ........ Evaluate swallowing function .............. 0.00 1.70 2.56 NA NA 0.08 XXX 

92611 .... ............ A ........ Motion fluoroscopy/swallow ................ 0.00 1.95 2.69 NA NA 0.08 XXX 

92612 .... ............ A ........ Endoscopy swallow tst (fees) ............. 1.27 2.97 2.85 0.42 0.54 0.04 XXX 

92613 .... ............ A ........ Endoscopy swallow tst (fees) ............. 0.71 0.24 0.32 0.23 0.31 0.05 XXX 

92614 .... ............ A ........ Laryngoscopic sensory test ................ 1.27 2.42 2.46 0.42 0.54 0.04 XXX 

92615 .... ............ A ........ Eval laryngoscopy sense tst ............... 0.63 0.21 0.28 0.20 0.28 0.05 XXX 

92616 .... ............ A ........ Fees w/laryngeal sense test ............... 1.88 3.16 3.27 0.60 0.80 0.06 XXX 

92617 .... ............ A ........ Interprt fees/laryngeal test .................. 0.79 0.26 0.35 0.26 0.35 0.05 XXX 

92620 .... ............ A ........ Auditory function, 60 min .................... 0.00 1.93 1.53 NA NA 0.06 XXX 

92621 .... ............ A ........ Auditory function, + 15 min ................. 0.00 0.44 0.34 NA NA 0.06 ZZZ 

92625 .... ............ A ........ Tinnitus assessment ........................... 0.00 1.94 1.53 1.94 1.53 0.06 XXX 

92626 .... ............ A ........ Eval aud rehab status ......................... 0.00 2.00 2.10 NA NA 0.06 XXX 

92627 .... ............ A ........ Eval aud status rehab add-on ............ 0.00 0.46 0.50 0.46 0.50 0.02 ZZZ 

92630 .... ............ I .......... Aud rehab pre-ling hear loss .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92633 .... ............ I .......... Aud rehab postling hear loss .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92640 .... ............ A ........ Aud brainstem implt programg ........... 0.00 1.34 1.34 1.34 1.34 0.01 XXX 

92700 .... ............ C ........ Ent procedure/service ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92950 .... ............ A ........ Heart/lung resuscitation cpr ................ 3.79 3.24 3.72 0.77 0.87 0.28 000 

92953 .... ............ A ........ Temporary external pacing ................. 0.23 NA NA 0.07 0.07 0.02 000 

92960 .... ............ A ........ Cardioversion electric, ext .................. 2.25 4.37 5.34 1.45 1.31 0.07 000 

92961 .... ............ A ........ Cardioversion, electric, int .................. 4.59 NA NA 2.43 2.26 0.29 000 

92970 .... ............ A ........ Cardioassist, internal .......................... 3.51 NA NA 1.46 1.26 0.16 000 

92971 .... ............ A ........ Cardioassist, external ......................... 1.77 NA NA 1.09 0.97 0.06 000 

92973 .... ............ A ........ Percut coronary thrombectomy ........... 3.28 NA NA 1.76 1.52 0.23 ZZZ 

92974 .... ............ A ........ Cath place, cardio brachytx ................ 3.00 NA NA 1.62 1.40 0.21 ZZZ 

92975 .... ............ A ........ Dissolve clot, heart vessel .................. 7.24 NA NA 3.83 3.32 0.50 000 

92977 .... ............ A ........ Dissolve clot, heart vessel .................. 0.00 1.73 4.88 NA NA 0.46 XXX 

92978 .... ............ C ........ Intravasc us, heart add-on .................. 0.00 0.00 0.00 NA NA 0.00 ZZZ 

92978 .... TC ...... C ........ Intravasc us, heart add-on .................. 0.00 0.00 0.00 NA NA 0.00 ZZZ 

92978 .... 26 ....... A ........ Intravasc us, heart add-on .................. 1.80 0.96 0.83 0.96 0.83 0.06 ZZZ 

92979 .... ............ C ........ Intravasc us, heart add-on .................. 0.00 0.00 0.00 NA NA 0.00 ZZZ 

92979 .... TC ...... C ........ Intravasc us, heart add-on .................. 0.00 0.00 0.00 NA NA 0.00 ZZZ 

92979 .... 26 ....... A ........ Intravasc us, heart add-on .................. 1.44 0.77 0.67 0.77 0.67 0.06 ZZZ 

92980 .... ............ A ........ Insert intracoronary stent .................... 14.82 NA NA 8.12 7.08 1.03 000 

92981 .... ............ A ........ Insert intracoronary stent .................... 4.16 NA NA 2.22 1.92 0.29 ZZZ 

92982 .... ............ A ........ Coronary artery dilation ...................... 10.96 NA NA 6.05 5.29 0.76 000 

92984 .... ............ A ........ Coronary artery dilation ...................... 2.97 NA NA 1.58 1.37 0.21 ZZZ 

92986 .... ............ A ........ Revision of aortic valve ....................... 22.70 NA NA 15.32 13.57 1.51 090 

92987 .... ............ A ........ Revision of mitral valve ....................... 23.48 NA NA 15.94 14.07 1.59 090 

92990 .... ............ A ........ Revision of pulmonary valve ............... 18.12 NA NA 11.33 10.56 1.20 090 

92992 .... ............ C ........ Revision of heart chamber .................. 0.00 0.00 0.00 0.00 0.00 0.00 090 

92993 .... ............ C ........ Revision of heart chamber .................. 0.00 0.00 0.00 0.00 0.00 0.00 090 

92995 .... ............ A ........ Coronary atherectomy ........................ 12.07 NA NA 6.64 5.80 0.84 000 

92996 .... ............ A ........ Coronary atherectomy add-on ............ 3.26 NA NA 1.76 1.51 0.10 ZZZ 

92997 .... ............ A ........ Pul art balloon repr, percut ................. 11.98 NA NA 5.61 5.21 0.40 000 

92998 .... ............ A ........ Pul art balloon repr, percut ................. 5.99 NA NA 3.00 2.60 0.28 ZZZ 


cprice-sewell on PROD1PC72 with RULES
66526 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

93000 .... ............ A ........ Electrocardiogram, complete .............. 0.17 0.35 0.42 NA NA 0.03 XXX 

93005 .... ............ A ........ Electrocardiogram, tracing .................. 0.00 0.28 0.36 NA NA 0.02 XXX 

93010 .... ............ A ........ Electrocardiogram report .................... 0.17 0.07 0.06 0.07 0.06 0.01 XXX 

93012 .... ............ A ........ Transmission of ecg ............................ 0.00 4.16 5.09 NA NA 0.18 XXX 

93014 .... ............ A ........ Report on transmitted ecg .................. 0.52 0.22 0.21 0.22 0.21 0.02 XXX 

93015 .... ............ A ........ Cardiovascular stress test .................. 0.75 1.90 1.93 NA NA 0.14 XXX 

93016 .... ............ A ........ Cardiovascular stress test .................. 0.45 0.22 0.20 0.22 0.20 0.02 XXX 

93017 .... ............ A ........ Cardiovascular stress test .................. 0.00 1.53 1.60 NA NA 0.11 XXX 

93018 .... ............ A ........ Cardiovascular stress test .................. 0.30 0.15 0.13 0.15 0.13 0.01 XXX 

93024 .... ............ A ........ Cardiac drug stress test ...................... 1.17 2.40 1.98 NA NA 0.12 XXX 

93024 .... TC ...... A ........ Cardiac drug stress test ...................... 0.00 1.82 1.47 NA NA 0.08 XXX 

93024 .... 26 ....... A ........ Cardiac drug stress test ...................... 1.17 0.58 0.51 0.58 0.51 0.04 XXX 

93025 .... ............ A ........ Microvolt t-wave assess ...................... 0.75 3.93 5.76 NA NA 0.14 XXX 

93025 .... TC ...... A ........ Microvolt t-wave assess ...................... 0.00 3.55 5.42 NA NA 0.11 XXX 

93025 .... 26 ....... A ........ Microvolt t-wave assess ...................... 0.75 0.38 0.34 0.38 0.34 0.03 XXX 

93040 .... ............ A ........ Rhythm ECG with report ..................... 0.16 0.19 0.20 NA NA 0.02 XXX 

93041 .... ............ A ........ Rhythm ECG, tracing .......................... 0.00 0.14 0.15 NA NA 0.01 XXX 

93042 .... ............ A ........ Rhythm ECG, report ........................... 0.16 0.05 0.05 0.05 0.05 0.01 XXX 

93224 .... ............ A ........ ECG monitor/report, 24 hrs ................ 0.52 2.31 2.96 NA NA 0.24 XXX 

93225 .... ............ A ........ ECG monitor/record, 24 hrs ................ 0.00 0.85 1.04 NA NA 0.08 XXX 

93226 .... ............ A ........ ECG monitor/report, 24 hrs ................ 0.00 1.19 1.69 NA NA 0.14 XXX 

93227 .... ............ A ........ ECG monitor/review, 24 hrs ............... 0.52 0.27 0.23 0.27 0.23 0.02 XXX 

93230 .... ............ A ........ ECG monitor/report, 24 hrs ................ 0.52 2.30 3.09 NA NA 0.26 XXX 

93231 .... ............ A ........ Ecg monitor/record, 24 hrs ................. 0.00 0.72 1.12 NA NA 0.11 XXX 

93232 .... ............ A ........ ECG monitor/report, 24 hrs ................ 0.00 1.35 1.76 NA NA 0.13 XXX 

93233 .... ............ A ........ ECG monitor/review, 24 hrs ............... 0.52 0.23 0.21 0.23 0.21 0.02 XXX 

93235 .... ............ C ........ ECG monitor/report, 24 hrs ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93236 .... ............ C ........ ECG monitor/report, 24 hrs ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93237 .... ............ A ........ ECG monitor/review, 24 hrs ............... 0.45 0.22 0.19 0.22 0.19 0.02 XXX 

93268 .... ............ A ........ ECG record/review .............................. 0.52 5.78 6.60 NA NA 0.28 XXX 

93270 .... ............ A ........ ECG recording .................................... 0.00 0.29 0.76 NA NA 0.08 XXX 

93271 .... ............ A ........ Ecg/monitoring and analysis ............... 0.00 5.27 5.64 NA NA 0.18 XXX 

93272 .... ............ A ........ Ecg/review, interpret only ................... 0.52 0.22 0.20 0.22 0.20 0.02 XXX 

93278 .... ............ A ........ ECG/signal-averaged .......................... 0.25 0.62 0.93 NA NA 0.12 XXX 

93278 .... TC ...... A ........ ECG/signal-averaged .......................... 0.00 0.52 0.83 NA NA 0.11 XXX 

93278 .... 26 ....... A ........ ECG/signal-averaged .......................... 0.25 0.10 0.10 0.10 0.10 0.01 XXX 

93303 .... ............ A ........ Echo transthoracic .............................. 1.30 4.49 4.41 NA NA 0.27 XXX 

93303 .... TC ...... A ........ Echo transthoracic .............................. 0.00 3.96 3.91 NA NA 0.23 XXX 

93303 .... 26 ....... A ........ Echo transthoracic .............................. 1.30 0.53 0.50 0.53 0.50 0.04 XXX 

93304 .... ............ A ........ Echo transthoracic .............................. 0.75 3.10 2.66 NA NA 0.15 XXX 

93304 .... TC ...... A ........ Echo transthoracic .............................. 0.00 2.80 2.37 NA NA 0.13 XXX 

93304 .... 26 ....... A ........ Echo transthoracic .............................. 0.75 0.30 0.29 0.30 0.29 0.02 XXX 

93307 .... ............ A ........ Echo exam of heart ............................ 0.92 3.73 3.97 NA NA 0.26 XXX 

93307 .... TC ...... A ........ Echo exam of heart ............................ 0.00 3.28 3.57 NA NA 0.23 XXX 

93307 .... 26 ....... A ........ Echo exam of heart ............................ 0.92 0.45 0.40 0.45 0.40 0.03 XXX 

93308 .... ............ A ........ Echo exam of heart ............................ 0.53 2.62 2.38 NA NA 0.15 XXX 

93308 .... TC ...... A ........ Echo exam of heart ............................ 0.00 2.35 2.15 NA NA 0.13 XXX 

93308 .... 26 ....... A ........ Echo exam of heart ............................ 0.53 0.27 0.23 0.27 0.23 0.02 XXX 

93312 .... ............ A ........ Echo transesophageal ........................ 2.20 7.39 5.98 NA NA 0.37 XXX 

93312 .... TC ...... A ........ Echo transesophageal ........................ 0.00 6.42 5.10 NA NA 0.29 XXX 

93312 .... 26 ....... A ........ Echo transesophageal ........................ 2.20 0.97 0.88 0.97 0.88 0.08 XXX 

93313 .... ............ A ........ Echo transesophageal ........................ 0.95 NA NA 0.12 0.17 0.06 XXX 

93314 .... ............ A ........ Echo transesophageal ........................ 1.25 7.21 5.73 NA NA 0.33 XXX 

93314 .... TC ...... A ........ Echo transesophageal ........................ 0.00 6.65 5.22 NA NA 0.29 XXX 

93314 .... 26 ....... A ........ Echo transesophageal ........................ 1.25 0.56 0.51 0.56 0.51 0.04 XXX 

93315 .... ............ C ........ Echo transesophageal ........................ 0.00 0.00 0.00 NA NA 0.00 XXX 

93315 .... TC ...... C ........ Echo transesophageal ........................ 0.00 0.00 0.00 NA NA 0.00 XXX 

93315 .... 26 ....... A ........ Echo transesophageal ........................ 2.78 1.30 1.16 1.30 1.16 0.09 XXX 

93316 .... ............ A ........ Echo transesophageal ........................ 0.95 NA NA 0.26 0.25 0.05 XXX 

93317 .... ............ C ........ Echo transesophageal ........................ 0.00 0.00 0.00 NA NA 0.00 XXX 

93317 .... TC ...... C ........ Echo transesophageal ........................ 0.00 0.00 0.00 NA NA 0.00 XXX 

93317 .... 26 ....... A ........ Echo transesophageal ........................ 1.83 0.55 0.61 0.55 0.61 0.08 XXX 

93318 .... ............ C ........ Echo transesophageal intraop ............ 0.00 0.00 0.00 NA NA 0.00 XXX 

93318 .... TC ...... C ........ Echo transesophageal intraop ............ 0.00 0.00 0.00 NA NA 0.00 XXX 

93318 .... 26 ....... A ........ Echo transesophageal intraop ............ 2.20 0.85 0.67 0.85 0.67 0.14 XXX 

93320 .... ............ A ........ Doppler echo exam, heart .................. 0.38 1.67 1.77 NA NA 0.13 ZZZ 

93320 .... TC ...... A ........ Doppler echo exam, heart .................. 0.00 1.49 1.60 NA NA 0.12 ZZZ 

93320 .... 26 ....... A ........ Doppler echo exam, heart .................. 0.38 0.18 0.17 0.18 0.17 0.01 ZZZ 

93321 .... ............ A ........ Doppler echo exam, heart .................. 0.15 0.61 0.89 NA NA 0.09 ZZZ 

93321 .... TC ...... A ........ Doppler echo exam, heart .................. 0.00 0.54 0.82 NA NA 0.08 ZZZ 

93321 .... 26 ....... A ........ Doppler echo exam, heart .................. 0.15 0.07 0.07 0.07 0.07 0.01 ZZZ 

93325 .... ............ A ........ Doppler color flow add-on ................... 0.07 0.66 1.80 NA NA 0.22 ZZZ 


cprice-sewell on PROD1PC72 with RULES
66527 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

93325 .... TC ...... A ........ Doppler color flow add-on ................... 0.00 0.63 1.77 NA NA 0.21 ZZZ 

93325 .... 26 ....... A ........ Doppler color flow add-on ................... 0.07 0.03 0.03 0.03 0.03 0.01 ZZZ 

93350 .... ............ A ........ Echo transthoracic .............................. 1.48 5.09 3.71 NA NA 0.18 XXX 

93350 .... TC ...... A ........ Echo transthoracic .............................. 0.00 4.33 3.05 NA NA 0.13 XXX 

93350 .... 26 ....... A ........ Echo transthoracic .............................. 1.48 0.76 0.66 0.76 0.66 0.05 XXX 

93501 .... ............ A ........ Right heart catheterization .................. 3.02 18.69 18.37 NA NA 1.27 000 

93501 .... TC ...... A ........ Right heart catheterization .................. 0.00 17.12 17.01 NA NA 1.06 000 

93501 .... 26 ....... A ........ Right heart catheterization .................. 3.02 1.57 1.36 1.57 1.36 0.21 000 

93503 .... ............ C ........ Insert/place heart catheter .................. 0.00 NA NA NA NA 0.00 000 

93505 .... ............ A ........ Biopsy of heart lining .......................... 4.37 20.90 12.28 NA NA 0.46 000 

93505 .... TC ...... A ........ Biopsy of heart lining .......................... 0.00 18.62 10.30 NA NA 0.16 000 

93505 .... 26 ....... A ........ Biopsy of heart lining .......................... 4.37 2.28 1.98 2.28 1.98 0.30 000 

93508 .... ............ A ........ Cath placement, angiography ............. 4.09 28.82 21.75 NA NA 0.93 000 

93508 .... TC ...... A ........ Cath placement, angiography ............. 0.00 26.65 19.62 NA NA 0.65 000 

93508 .... 26 ....... A ........ Cath placement, angiography ............. 4.09 2.17 2.13 2.17 2.13 0.28 000 

93510 .... ............ A ........ Left heart catheterization .................... 4.32 28.12 33.61 NA NA 2.61 000 

93510 .... TC ...... A ........ Left heart catheterization .................... 0.00 25.84 31.39 NA NA 2.31 000 

93510 .... 26 ....... A ........ Left heart catheterization .................... 4.32 2.28 2.22 2.28 2.22 0.30 000 

93511 .... ............ C ........ Left heart catheterization .................... 0.00 NA NA NA NA 0.00 000 

93511 .... TC ...... C ........ Left heart catheterization .................... 0.00 NA NA NA NA 0.00 000 

93511 .... 26 ....... A ........ Left heart catheterization .................... 5.02 2.65 2.54 2.65 2.54 0.35 000 

93514 .... ............ C ........ Left heart catheterization .................... 0.00 NA NA NA NA 0.00 000 

93514 .... TC ...... C ........ Left heart catheterization .................... 0.00 NA NA NA NA 0.00 000 

93514 .... 26 ....... A ........ Left heart catheterization .................... 7.04 2.95 3.03 2.95 3.03 0.49 000 

93524 .... ............ C ........ Left heart catheterization .................... 0.00 NA NA NA NA 0.00 000 

93524 .... TC ...... C ........ Left heart catheterization .................... 0.00 NA NA NA NA 0.00 000 

93524 .... 26 ....... A ........ Left heart catheterization .................... 6.94 3.77 3.47 3.77 3.47 0.48 000 

93526 .... ............ A ........ Rt & Lt heart catheters ....................... 5.98 35.09 42.99 NA NA 3.46 000 

93526 .... TC ...... A ........ Rt & Lt heart catheters ....................... 0.00 31.93 40.00 NA NA 3.04 000 

93526 .... 26 ....... A ........ Rt & Lt heart catheters ....................... 5.98 3.16 2.99 3.16 2.99 0.42 000 

93527 .... ............ C ........ Rt & Lt heart catheters ....................... 0.00 NA NA NA NA 0.00 000 

93527 .... TC ...... C ........ Rt & Lt heart catheters ....................... 0.00 NA NA NA NA 0.00 000 

93527 .... 26 ....... A ........ Rt & Lt heart catheters ....................... 7.27 3.85 3.58 3.85 3.58 0.51 000 

93528 .... ............ C ........ Rt & Lt heart catheters ....................... 0.00 NA NA NA NA 0.00 000 

93528 .... TC ...... C ........ Rt & Lt heart catheters ....................... 0.00 NA NA NA NA 0.00 000 

93528 .... 26 ....... A ........ Rt & Lt heart catheters ....................... 8.99 4.43 4.23 4.43 4.23 0.62 000 

93529 .... ............ C ........ Rt, lt heart catheterization ................... 0.00 NA NA NA NA 0.00 000 

93529 .... TC ...... C ........ Rt, lt heart catheterization ................... 0.00 NA NA NA NA 0.00 000 

93529 .... 26 ....... A ........ Rt, lt heart catheterization ................... 4.79 2.58 2.43 2.58 2.43 0.33 000 

93530 .... ............ C ........ Rt heart cath, congenital ..................... 0.00 NA NA NA NA 0.00 000 

93530 .... TC ...... C ........ Rt heart cath, congenital ..................... 0.00 NA NA NA NA 0.00 000 

93530 .... 26 ....... A ........ Rt heart cath, congenital ..................... 4.22 1.84 1.89 1.84 1.89 0.29 000 

93531 .... ............ C ........ R & l heart cath, congenital ................ 0.00 NA NA NA NA 0.00 000 

93531 .... TC ...... C ........ R & l heart cath, congenital ................ 0.00 NA NA NA NA 0.00 000 

93531 .... 26 ....... A ........ R & l heart cath, congenital ................ 8.34 3.57 3.57 3.57 3.57 0.58 000 

93532 .... ............ C ........ R & l heart cath, congenital ................ 0.00 NA NA NA NA 0.00 000 

93532 .... TC ...... C ........ R & l heart cath, congenital ................ 0.00 NA NA NA NA 0.00 000 

93532 .... 26 ....... A ........ R & l heart cath, congenital ................ 9.99 3.65 3.95 3.65 3.95 0.69 000 

93533 .... ............ C ........ R & l heart cath, congenital ................ 0.00 NA NA NA NA 0.00 000 

93533 .... TC ...... C ........ R & l heart cath, congenital ................ 0.00 NA NA NA NA 0.00 000 

93533 .... 26 ....... A ........ R & l heart cath, congenital ................ 6.69 3.15 2.97 3.15 2.97 0.47 000 

93539 .... ............ A ........ Injection, cardiac cath ......................... 0.40 2.46 11.72 0.21 0.19 0.01 000 

93540 .... ............ A ........ Injection, cardiac cath ......................... 0.43 8.61 15.53 0.23 0.20 0.01 000 

93541 .... ............ A ........ Injection for lung angiogram ............... 0.29 0.15 7.60 0.15 0.13 0.01 000 

93542 .... ............ A ........ Injection for heart x-rays ..................... 0.29 5.18 10.07 0.15 0.13 0.01 000 

93543 .... ............ A ........ Injection for heart x-rays ..................... 0.29 2.62 8.86 0.16 0.13 0.01 000 

93544 .... ............ A ........ Injection for aortography ..................... 0.25 1.84 7.41 0.13 0.12 0.01 000 

93545 .... ............ A ........ Inject for coronary x-rays .................... 0.40 5.86 13.42 0.21 0.19 0.01 000 

93555 .... ............ A ........ Imaging, cardiac cath .......................... 0.81 0.59 3.59 NA NA 0.37 XXX 

93555 .... TC ...... A ........ Imaging, cardiac cath .......................... 0.00 0.17 3.22 NA NA 0.34 XXX 

93555 .... 26 ....... A ........ Imaging, cardiac cath .......................... 0.81 0.42 0.37 0.42 0.37 0.03 XXX 

93556 .... ............ A ........ Imaging, cardiac cath .......................... 0.83 0.88 5.54 NA NA 0.54 XXX 

93556 .... TC ...... A ........ Imaging, cardiac cath .......................... 0.00 0.44 5.16 NA NA 0.51 XXX 

93556 .... 26 ....... A ........ Imaging, cardiac cath .......................... 0.83 0.44 0.38 0.44 0.38 0.03 XXX 

93561 .... ............ C ........ Cardiac output measurement ............. 0.00 NA NA NA NA 0.00 000 

93561 .... TC ...... C ........ Cardiac output measurement ............. 0.00 NA NA NA NA 0.00 000 

93561 .... 26 ....... A ........ Cardiac output measurement ............. 0.50 0.14 0.15 0.14 0.15 0.02 000 

93562 .... ............ C ........ Cardiac output measurement ............. 0.00 NA NA NA NA 0.00 000 

93562 .... TC ...... C ........ Cardiac output measurement ............. 0.00 NA NA NA NA 0.00 000 

93562 .... 26 ....... A ........ Cardiac output measurement ............. 0.16 0.03 0.04 0.03 0.04 0.01 000 

93571 .... ............ C ........ Heart flow reserve measure ............... 0.00 NA NA NA NA 0.00 ZZZ 

93571 .... TC ...... C ........ Heart flow reserve measure ............... 0.00 NA NA NA NA 0.00 ZZZ 


cprice-sewell on PROD1PC72 with RULES
66528 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

93571 .... 26 ....... A ........ Heart flow reserve measure ............... 1.80 0.95 0.82 0.95 0.82 0.06 ZZZ 

93572 .... ............ C ........ Heart flow reserve measure ............... 0.00 NA NA NA NA 0.00 ZZZ 

93572 .... TC ...... C ........ Heart flow reserve measure ............... 0.00 NA NA NA NA 0.00 ZZZ 

93572 .... 26 ....... A ........ Heart flow reserve measure ............... 1.44 0.74 0.62 0.74 0.62 0.04 ZZZ 

93580 .... ............ A ........ Transcath closure of asd .................... 17.97 NA NA 9.40 8.39 1.25 000 

93581 .... ............ A ........ Transcath closure of vsd .................... 24.39 NA NA 11.55 10.47 1.72 000 

93600 .... ............ C ........ Bundle of His recording ...................... 0.00 0.00 0.00 NA NA 0.00 000 

93600 .... TC ...... C ........ Bundle of His recording ...................... 0.00 0.00 0.00 NA NA 0.00 000 

93600 .... 26 ....... A ........ Bundle of His recording ...................... 2.12 1.09 0.96 1.09 0.96 0.16 000 

93602 .... ............ C ........ Intra-atrial recording ............................ 0.00 0.00 0.00 NA NA 0.00 000 

93602 .... TC ...... C ........ Intra-atrial recording ............................ 0.00 0.00 0.00 NA NA 0.00 000 

93602 .... 26 ....... A ........ Intra-atrial recording ............................ 2.12 1.04 0.93 1.04 0.93 0.17 000 

93603 .... ............ C ........ Right ventricular recording .................. 0.00 0.00 0.00 NA NA 0.00 000 

93603 .... TC ...... C ........ Right ventricular recording .................. 0.00 0.00 0.00 NA NA 0.00 000 

93603 .... 26 ....... A ........ Right ventricular recording .................. 2.12 1.04 0.92 1.04 0.92 0.18 000 

93609 .... ............ C ........ Map tachycardia, add-on .................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

93609 .... TC ...... C ........ Map tachycardia, add-on .................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

93609 .... 26 ....... A ........ Map tachycardia, add-on .................... 4.99 2.61 2.28 2.61 2.28 0.35 ZZZ 

93610 .... ............ C ........ Intra-atrial pacing ................................ 0.00 0.00 0.00 NA NA 0.00 000 

93610 .... TC ...... C ........ Intra-atrial pacing ................................ 0.00 0.00 0.00 NA NA 0.00 000 

93610 .... 26 ....... A ........ Intra-atrial pacing ................................ 3.02 1.47 1.31 1.47 1.31 0.24 000 

93612 .... ............ C ........ Intraventricular pacing ......................... 0.00 0.00 0.00 NA NA 0.00 000 

93612 .... TC ...... C ........ Intraventricular pacing ......................... 0.00 0.00 0.00 NA NA 0.00 000 

93612 .... 26 ....... A ........ Intraventricular pacing ......................... 3.02 1.42 1.29 1.42 1.29 0.25 000 

93613 .... ............ A ........ Electrophys map 3d, add-on ............... 6.99 NA NA 3.69 3.22 0.49 ZZZ 

93615 .... ............ C ........ Esophageal recording ......................... 0.00 0.00 0.00 NA NA 0.00 000 

93615 .... TC ...... C ........ Esophageal recording ......................... 0.00 0.00 0.00 NA NA 0.00 000 

93615 .... 26 ....... A ........ Esophageal recording ......................... 0.99 0.54 0.40 0.54 0.40 0.03 000 

93616 .... ............ C ........ Esophageal recording ......................... 0.00 0.00 0.00 NA NA 0.00 000 

93616 .... TC ...... C ........ Esophageal recording ......................... 0.00 0.00 0.00 NA NA 0.00 000 

93616 .... 26 ....... A ........ Esophageal recording ......................... 1.49 0.26 0.35 0.26 0.35 0.09 000 

93618 .... ............ C ........ Heart rhythm pacing ........................... 0.00 0.00 0.00 NA NA 0.00 000 

93618 .... TC ...... C ........ Heart rhythm pacing ........................... 0.00 0.00 0.00 NA NA 0.00 000 

93618 .... 26 ....... A ........ Heart rhythm pacing ........................... 4.25 2.28 1.97 2.28 1.97 0.30 000 

93619 .... ............ C ........ Electrophysiology evaluation .............. 0.00 0.00 0.00 NA NA 0.00 000 

93619 .... TC ...... C ........ Electrophysiology evaluation .............. 0.00 0.00 0.00 NA NA 0.00 000 

93619 .... 26 ....... A ........ Electrophysiology evaluation .............. 7.31 3.87 3.52 3.87 3.52 0.51 000 

93620 .... ............ C ........ Electrophysiology evaluation .............. 0.00 0.00 0.00 NA NA 0.00 000 

93620 .... TC ...... C ........ Electrophysiology evaluation .............. 0.00 0.00 0.00 NA NA 0.00 000 

93620 .... 26 ....... A ........ Electrophysiology evaluation .............. 11.57 6.08 5.46 6.08 5.46 0.80 000 

93621 .... ............ C ........ Electrophysiology evaluation .............. 0.00 0.00 0.00 NA NA 0.00 ZZZ 

93621 .... TC ...... C ........ Electrophysiology evaluation .............. 0.00 0.00 0.00 NA NA 0.00 ZZZ 

93621 .... 26 ....... A ........ Electrophysiology evaluation .............. 2.10 1.10 0.96 1.10 0.96 0.15 ZZZ 

93622 .... ............ C ........ Electrophysiology evaluation .............. 0.00 0.00 0.00 NA NA 0.00 ZZZ 

93622 .... TC ...... C ........ Electrophysiology evaluation .............. 0.00 0.00 0.00 NA NA 0.00 ZZZ 

93622 .... 26 ....... A ........ Electrophysiology evaluation .............. 3.10 1.56 1.39 1.56 1.39 0.22 ZZZ 

93623 .... ............ C ........ Stimulation, pacing heart .................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

93623 .... TC ...... C ........ Stimulation, pacing heart .................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

93623 .... 26 ....... A ........ Stimulation, pacing heart .................... 2.85 1.49 1.30 1.49 1.30 0.20 ZZZ 

93624 .... ............ C ........ Electrophysiologic study ..................... 0.00 0.00 0.00 NA NA 0.00 000 

93624 .... TC ...... C ........ Electrophysiologic study ..................... 0.00 0.00 0.00 NA NA 0.00 000 

93624 .... 26 ....... A ........ Electrophysiologic study ..................... 4.80 2.60 2.39 2.60 2.39 0.33 000 

93631 .... ............ C ........ Heart pacing, mapping ........................ 0.00 0.00 0.00 NA NA 0.00 000 

93631 .... TC ...... C ........ Heart pacing, mapping ........................ 0.00 0.00 0.00 NA NA 0.00 000 

93631 .... 26 ....... A ........ Heart pacing, mapping ........................ 7.59 2.75 2.76 2.75 2.76 0.97 000 

93640 .... ............ C ........ Evaluation heart device ...................... 0.00 0.00 0.00 NA NA 0.00 000 

93640 .... TC ...... C ........ Evaluation heart device ...................... 0.00 0.00 0.00 NA NA 0.00 000 

93640 .... 26 ....... A ........ Evaluation heart device ...................... 3.51 1.81 1.58 1.81 1.58 0.24 000 

93641 .... ............ C ........ Electrophysiology evaluation .............. 0.00 0.00 0.00 NA NA 0.00 000 

93641 .... TC ...... C ........ Electrophysiology evaluation .............. 0.00 0.00 0.00 NA NA 0.00 000 

93641 .... 26 ....... A ........ Electrophysiology evaluation .............. 5.92 3.10 2.71 3.10 2.71 0.41 000 

93642 .... ............ C ........ Electrophysiology evaluation .............. 0.00 0.00 0.00 NA NA 0.00 000 

93642 .... TC ...... A ........ Electrophysiology evaluation .............. 0.00 4.76 5.97 NA NA 0.42 000 

93642 .... 26 ....... A ........ Electrophysiology evaluation .............. 4.88 2.60 2.40 2.60 2.40 0.15 000 

93650 .... ............ A ........ Ablate heart dysrhythm focus ............. 10.49 NA NA 5.80 5.11 0.73 000 

93651 .... ............ A ........ Ablate heart dysrhythm focus ............. 16.23 NA NA 8.52 7.42 1.13 000 

93652 .... ............ A ........ Ablate heart dysrhythm focus ............. 17.65 NA NA 9.34 8.11 1.23 000 

93660 .... ............ A ........ Tilt table evaluation ............................. 1.89 3.01 2.71 NA NA 0.08 000 

93660 .... TC ...... A ........ Tilt table evaluation ............................. 0.00 2.04 1.86 NA NA 0.02 000 

93660 .... 26 ....... A ........ Tilt table evaluation ............................. 1.89 0.97 0.85 0.97 0.85 0.06 000 

93662 .... ............ C ........ Intracardiac ecg (ice) .......................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

93662 .... TC ...... C ........ Intracardiac ecg (ice) .......................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 


cprice-sewell on PROD1PC72 with RULES
66529 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

93662 .... 26 ....... A ........ Intracardiac ecg (ice) .......................... 2.80 1.47 1.29 1.47 1.29 0.09 ZZZ 

93668 .... ............ N ........ Peripheral vascular rehab ................... 0.00 0.41 0.41 NA NA 0.01 XXX 

93701 .... ............ A ........ Bioimpedance, thoracic ....................... 0.17 0.70 0.84 NA NA 0.02 XXX 

93701 .... TC ...... A ........ Bioimpedance, thoracic ....................... 0.00 0.64 0.77 NA NA 0.01 XXX 

93701 .... 26 ....... A ........ Bioimpedance, thoracic ....................... 0.17 0.06 0.07 0.06 0.07 0.01 XXX 

93720 .... ............ A ........ Total body plethysmography ............... 0.17 1.17 0.97 NA NA 0.07 XXX 

93721 .... ............ A ........ Plethysmography tracing .................... 0.00 1.13 0.92 NA NA 0.06 XXX 

93722 .... ............ A ........ Plethysmography report ...................... 0.17 0.04 0.05 0.04 0.05 0.01 XXX 

93724 .... ............ A ........ Analyze pacemaker system ................ 4.88 3.22 4.55 NA NA 0.39 000 

93724 .... TC ...... A ........ Analyze pacemaker system ................ 0.00 0.87 2.42 NA NA 0.24 000 

93724 .... 26 ....... A ........ Analyze pacemaker system ................ 4.88 2.35 2.13 2.35 2.13 0.15 000 

93727 .... ............ A ........ Analyze ilr system ............................... 0.52 0.63 0.42 0.63 0.42 0.02 XXX 

93731 .... ............ A ........ Analyze pacemaker system ................ 0.45 0.79 0.72 NA NA 0.05 XXX 

93731 .... TC ...... A ........ Analyze pacemaker system ................ 0.00 0.55 0.52 NA NA 0.04 XXX 

93731 .... 26 ....... A ........ Analyze pacemaker system ................ 0.45 0.24 0.20 0.24 0.20 0.01 XXX 

93732 .... ............ A ........ Analyze pacemaker system ................ 0.92 1.15 1.00 NA NA 0.07 XXX 

93732 .... TC ...... A ........ Analyze pacemaker system ................ 0.00 0.67 0.59 NA NA 0.04 XXX 

93732 .... 26 ....... A ........ Analyze pacemaker system ................ 0.92 0.48 0.41 0.48 0.41 0.03 XXX 

93733 .... ............ A ........ Telephone analy, pacemaker ............. 0.17 0.93 0.86 NA NA 0.07 XXX 

93733 .... TC ...... A ........ Telephone analy, pacemaker ............. 0.00 0.85 0.79 NA NA 0.06 XXX 

93733 .... 26 ....... A ........ Telephone analy, pacemaker ............. 0.17 0.08 0.07 0.08 0.07 0.01 XXX 

93734 .... ............ A ........ Analyze pacemaker system ................ 0.38 0.69 0.59 NA NA 0.03 XXX 

93734 .... TC ...... A ........ Analyze pacemaker system ................ 0.00 0.50 0.42 NA NA 0.02 XXX 

93734 .... 26 ....... A ........ Analyze pacemaker system ................ 0.38 0.19 0.17 0.19 0.17 0.01 XXX 

93735 .... ............ A ........ Analyze pacemaker system ................ 0.74 0.96 0.84 NA NA 0.06 XXX 

93735 .... TC ...... A ........ Analyze pacemaker system ................ 0.00 0.57 0.51 NA NA 0.04 XXX 

93735 .... 26 ....... A ........ Analyze pacemaker system ................ 0.74 0.39 0.33 0.39 0.33 0.02 XXX 

93736 .... ............ A ........ Telephonic analy, pacemaker ............. 0.15 0.91 0.79 NA NA 0.07 XXX 

93736 .... TC ...... A ........ Telephonic analy, pacemaker ............. 0.00 0.84 0.73 NA NA 0.06 XXX 

93736 .... 26 ....... A ........ Telephonic analy, pacemaker ............. 0.15 0.07 0.06 0.07 0.06 0.01 XXX 

93740 .... ............ B ........ Temperature gradient studies ............. 0.16 0.04 0.11 NA NA 0.02 XXX 

93740 .... TC ...... B ........ Temperature gradient studies ............. 0.00 0.00 0.07 NA NA 0.01 XXX 

93740 .... 26 ....... B ........ Temperature gradient studies ............. 0.16 0.04 0.04 0.04 0.04 0.01 XXX 

93741 .... ............ A ........ Analyze ht pace device sngl ............... 0.80 1.01 0.99 NA NA 0.07 XXX 

93741 .... TC ...... A ........ Analyze ht pace device sngl ............... 0.00 0.59 0.63 NA NA 0.04 XXX 

93741 .... 26 ....... A ........ Analyze ht pace device sngl ............... 0.80 0.42 0.36 0.42 0.36 0.03 XXX 

93742 .... ............ A ........ Analyze ht pace device sngl ............... 0.91 1.15 1.09 NA NA 0.07 XXX 

93742 .... TC ...... A ........ Analyze ht pace device sngl ............... 0.00 0.67 0.67 NA NA 0.04 XXX 

93742 .... 26 ....... A ........ Analyze ht pace device sngl ............... 0.91 0.48 0.42 0.48 0.42 0.03 XXX 

93743 .... ............ A ........ Analyze ht pace device dual ............... 1.03 1.19 1.16 NA NA 0.07 XXX 

93743 .... TC ...... A ........ Analyze ht pace device dual ............... 0.00 0.64 0.69 NA NA 0.04 XXX 

93743 .... 26 ....... A ........ Analyze ht pace device dual ............... 1.03 0.55 0.47 0.55 0.47 0.03 XXX 

93744 .... ............ A ........ Analyze ht pace device dual ............... 1.18 1.35 1.23 NA NA 0.08 XXX 

93744 .... TC ...... A ........ Analyze ht pace device dual ............... 0.00 0.72 0.69 NA NA 0.04 XXX 

93744 .... 26 ....... A ........ Analyze ht pace device dual ............... 1.18 0.63 0.54 0.63 0.54 0.04 XXX 

93745 .... ............ C ........ Set-up cardiovert-defibrill .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

93745 .... TC ...... C ........ Set-up cardiovert-defibrill .................... 0.00 0.00 0.00 NA NA 0.00 XXX 

93745 .... 26 ....... C ........ Set-up cardiovert-defibrill .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

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 .... ............ B ........ Measure venous pressure .................. 0.16 0.04 0.05 NA NA 0.02 XXX 

93770 .... TC ...... B ........ Measure venous pressure .................. 0.00 0.00 0.01 NA NA 0.01 XXX 

93770 .... 26 ....... B ........ Measure venous pressure .................. 0.16 0.04 0.04 0.04 0.04 0.01 XXX 

93784 .... ............ A ........ Ambulatory BP monitoring .................. 0.38 1.39 1.47 NA NA 0.03 XXX 

93786 .... ............ A ........ Ambulatory BP recording .................... 0.00 0.81 0.86 NA NA 0.01 XXX 

93788 .... ............ A ........ Ambulatory BP analysis ...................... 0.00 0.45 0.48 NA NA 0.01 XXX 

93790 .... ............ A ........ Review/report BP recording ................ 0.38 0.13 0.13 0.13 0.13 0.01 XXX 

93797 .... ............ A ........ Cardiac rehab ..................................... 0.18 0.32 0.31 0.09 0.08 0.01 000 

93798 .... ............ A ........ Cardiac rehab/monitor ........................ 0.28 0.44 0.45 0.13 0.12 0.01 000 

93799 .... ............ C ........ Cardiovascular procedure ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

93799 .... TC ...... C ........ Cardiovascular procedure ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

93799 .... 26 ....... C ........ Cardiovascular procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93875 .... ............ A ........ Extracranial study ............................... 0.22 2.54 2.43 NA NA 0.12 XXX 

93875 .... TC ...... A ........ Extracranial study ............................... 0.00 2.47 2.36 NA NA 0.11 XXX 

93875 .... 26 ....... A ........ Extracranial study ............................... 0.22 0.07 0.07 0.07 0.07 0.01 XXX 

93880 .... ............ A ........ Extracranial study ............................... 0.60 6.15 5.85 NA NA 0.39 XXX 

93880 .... TC ...... A ........ Extracranial study ............................... 0.00 5.94 5.65 NA NA 0.35 XXX 

93880 .... 26 ....... A ........ Extracranial study ............................... 0.60 0.21 0.20 0.21 0.20 0.04 XXX 

93882 .... ............ A ........ Extracranial study ............................... 0.40 4.11 3.81 NA NA 0.26 XXX 

93882 .... TC ...... A ........ Extracranial study ............................... 0.00 4.00 3.68 NA NA 0.22 XXX 

93882 .... 26 ....... A ........ Extracranial study ............................... 0.40 0.11 0.13 0.11 0.13 0.04 XXX 

93886 .... ............ A ........ Intracranial study ................................. 0.94 7.02 6.87 NA NA 0.45 XXX 


cprice-sewell on PROD1PC72 with RULES
66530 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

93886 .... TC ...... A ........ Intracranial study ................................. 0.00 6.74 6.55 NA NA 0.39 XXX 

93886 .... 26 ....... A ........ Intracranial study ................................. 0.94 0.28 0.32 0.28 0.32 0.06 XXX 

93888 .... ............ A ........ Intracranial study ................................. 0.62 4.91 4.57 NA NA 0.32 XXX 

93888 .... TC ...... A ........ Intracranial study ................................. 0.00 4.71 4.36 NA NA 0.27 XXX 

93888 .... 26 ....... A ........ Intracranial study ................................. 0.62 0.20 0.21 0.20 0.21 0.05 XXX 

93890 .... ............ A ........ Tcd, vasoreactivity study .................... 1.00 6.44 5.67 NA NA 0.45 XXX 

93890 .... TC ...... A ........ Tcd, vasoreactivity study .................... 0.00 6.13 5.31 NA NA 0.39 XXX 

93890 .... 26 ....... A ........ Tcd, vasoreactivity study .................... 1.00 0.31 0.36 0.31 0.36 0.06 XXX 

93892 .... ............ A ........ Tcd, emboli detect w/o inj ................... 1.15 6.84 6.00 NA NA 0.45 XXX 

93892 .... TC ...... A ........ Tcd, emboli detect w/o inj ................... 0.00 6.52 5.61 NA NA 0.39 XXX 

93892 .... 26 ....... A ........ Tcd, emboli detect w/o inj ................... 1.15 0.32 0.39 0.32 0.39 0.06 XXX 

93893 .... ............ A ........ Tcd, emboli detect w/inj ...................... 1.15 6.99 6.00 NA NA 0.45 XXX 

93893 .... TC ...... A ........ Tcd, emboli detect w/inj ...................... 0.00 6.66 5.61 NA NA 0.39 XXX 

93893 .... 26 ....... A ........ Tcd, emboli detect w/inj ...................... 1.15 0.33 0.39 0.33 0.39 0.06 XXX 

93922 .... ............ A ........ Extremity study ................................... 0.25 3.10 2.89 NA NA 0.15 XXX 

93922 .... TC ...... A ........ Extremity study ................................... 0.00 3.02 2.81 NA NA 0.13 XXX 

93922 .... 26 ....... A ........ Extremity study ................................... 0.25 0.08 0.08 0.08 0.08 0.02 XXX 

93923 .... ............ A ........ Extremity study ................................... 0.45 4.68 4.35 NA NA 0.26 XXX 

93923 .... TC ...... A ........ Extremity study ................................... 0.00 4.54 4.21 NA NA 0.22 XXX 

93923 .... 26 ....... A ........ Extremity study ................................... 0.45 0.14 0.14 0.14 0.14 0.04 XXX 

93924 .... ............ A ........ Extremity study ................................... 0.50 5.93 5.36 NA NA 0.30 XXX 

93924 .... TC ...... A ........ Extremity study ................................... 0.00 5.76 5.19 NA NA 0.25 XXX 

93924 .... 26 ....... A ........ Extremity study ................................... 0.50 0.17 0.17 0.17 0.17 0.05 XXX 

93925 .... ............ A ........ Lower extremity study ......................... 0.58 8.01 7.39 NA NA 0.39 XXX 

93925 .... TC ...... A ........ Lower extremity study ......................... 0.00 7.82 7.20 NA NA 0.35 XXX 

93925 .... 26 ....... A ........ Lower extremity study ......................... 0.58 0.19 0.19 0.19 0.19 0.04 XXX 

93926 .... ............ A ........ Lower extremity study ......................... 0.39 5.14 4.59 NA NA 0.27 XXX 

93926 .... TC ...... A ........ Lower extremity study ......................... 0.00 5.03 4.47 NA NA 0.23 XXX 

93926 .... 26 ....... A ........ Lower extremity study ......................... 0.39 0.11 0.12 0.11 0.12 0.04 XXX 

93930 .... ............ A ........ Upper extremity study ......................... 0.46 6.24 5.79 NA NA 0.41 XXX 

93930 .... TC ...... A ........ Upper extremity study ......................... 0.00 6.09 5.64 NA NA 0.37 XXX 

93930 .... 26 ....... A ........ Upper extremity study ......................... 0.46 0.15 0.15 0.15 0.15 0.04 XXX 

93931 .... ............ A ........ Upper extremity study ......................... 0.31 4.18 3.83 NA NA 0.27 XXX 

93931 .... TC ...... A ........ Upper extremity study ......................... 0.00 4.08 3.73 NA NA 0.24 XXX 

93931 .... 26 ....... A ........ Upper extremity study ......................... 0.31 0.10 0.10 0.10 0.10 0.03 XXX 

93965 .... ............ A ........ Extremity study ................................... 0.35 3.00 2.89 NA NA 0.14 XXX 

93965 .... TC ...... A ........ Extremity study ................................... 0.00 2.89 2.78 NA NA 0.12 XXX 

93965 .... 26 ....... A ........ Extremity study ................................... 0.35 0.11 0.11 0.11 0.11 0.02 XXX 

93970 .... ............ A ........ Extremity study ................................... 0.68 6.20 5.72 NA NA 0.46 XXX 

93970 .... TC ...... A ........ Extremity study ................................... 0.00 5.99 5.50 NA NA 0.40 XXX 

93970 .... 26 ....... A ........ Extremity study ................................... 0.68 0.21 0.22 0.21 0.22 0.06 XXX 

93971 .... ............ A ........ Extremity study ................................... 0.45 4.07 3.83 NA NA 0.30 XXX 

93971 .... TC ...... A ........ Extremity study ................................... 0.00 3.92 3.68 NA NA 0.27 XXX 

93971 .... 26 ....... A ........ Extremity study ................................... 0.45 0.15 0.15 0.15 0.15 0.03 XXX 

93975 .... ............ A ........ Vascular study .................................... 1.80 8.45 8.03 NA NA 0.56 XXX 

93975 .... TC ...... A ........ Vascular study .................................... 0.00 7.82 7.42 NA NA 0.43 XXX 

93975 .... 26 ....... A ........ Vascular study .................................... 1.80 0.63 0.61 0.63 0.61 0.13 XXX 

93976 .... ............ A ........ Vascular study .................................... 1.21 4.57 4.45 NA NA 0.35 XXX 

93976 .... TC ...... A ........ Vascular study .................................... 0.00 4.15 4.04 NA NA 0.30 XXX 

93976 .... 26 ....... A ........ Vascular study .................................... 1.21 0.42 0.41 0.42 0.41 0.05 XXX 

93978 .... ............ A ........ Vascular study .................................... 0.65 6.02 5.27 NA NA 0.43 XXX 

93978 .... TC ...... A ........ Vascular study .................................... 0.00 5.81 5.05 NA NA 0.37 XXX 

93978 .... 26 ....... A ........ Vascular study .................................... 0.65 0.21 0.22 0.21 0.22 0.06 XXX 

93979 .... ............ A ........ Vascular study .................................... 0.44 4.16 3.69 NA NA 0.27 XXX 

93979 .... TC ...... A ........ Vascular study .................................... 0.00 4.02 3.54 NA NA 0.24 XXX 

93979 .... 26 ....... A ........ Vascular study .................................... 0.44 0.14 0.15 0.14 0.15 0.03 XXX 

93980 .... ............ A ........ Penile vascular study .......................... 1.25 3.48 3.16 NA NA 0.42 XXX 

93980 .... TC ...... A ........ Penile vascular study .......................... 0.00 3.02 2.73 NA NA 0.34 XXX 

93980 .... 26 ....... A ........ Penile vascular study .......................... 1.25 0.46 0.43 0.46 0.43 0.08 XXX 

93981 .... ............ A ........ Penile vascular study .......................... 0.44 2.84 2.85 NA NA 0.33 XXX 

93981 .... TC ...... A ........ Penile vascular study .......................... 0.00 2.68 2.70 NA NA 0.31 XXX 

93981 .... 26 ....... A ........ Penile vascular study .......................... 0.44 0.16 0.15 0.16 0.15 0.02 XXX 

93982 .... ............ R ........ Aneurysm pressure sens study .......... 0.30 0.80 0.80 NA NA 0.01 XXX 

93990 .... ............ A ........ Doppler flow testing ............................ 0.25 5.21 4.61 NA NA 0.26 XXX 

93990 .... TC ...... A ........ Doppler flow testing ............................ 0.00 5.15 4.53 NA NA 0.23 XXX 

93990 .... 26 ....... A ........ Doppler flow testing ............................ 0.25 0.06 0.08 0.06 0.08 0.03 XXX 

94002 .... ............ A ........ Vent mgmt inpat, init day .................... 1.99 NA NA 0.35 0.34 0.09 XXX 

94003 .... ............ A ........ Vent mgmt inpat, subq day ................. 1.37 NA NA 0.32 0.32 0.06 XXX 

94004 .... ............ A ........ Vent mgmt nf per day ......................... 1.00 NA NA 0.23 0.23 0.04 XXX 

94005 .... ............ B ........ Home vent mgmt supervision ............. 1.50 0.70 0.70 NA NA 0.06 XXX 

94010 .... ............ A ........ Breathing capacity test ....................... 0.17 0.74 0.71 NA NA 0.03 XXX 

94010 .... TC ...... A ........ Breathing capacity test ....................... 0.00 0.70 0.66 NA NA 0.02 XXX 


cprice-sewell on PROD1PC72 with RULES
66531 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

94010 .... 26 ....... A ........ Breathing capacity test ....................... 0.17 0.04 0.05 0.04 0.05 0.01 XXX 

94014 .... ............ A ........ Patient recorded spirometry ................ 0.52 0.81 0.78 NA NA 0.03 XXX 

94015 .... ............ A ........ Patient recorded spirometry ................ 0.00 0.67 0.63 NA NA 0.01 XXX 

94016 .... ............ A ........ Review patient spirometry .................. 0.52 0.14 0.15 0.14 0.15 0.02 XXX 

94060 .... ............ A ........ Evaluation of wheezing ....................... 0.31 1.32 1.19 NA NA 0.07 XXX 

94060 .... TC ...... A ........ Evaluation of wheezing ....................... 0.00 1.24 1.11 NA NA 0.06 XXX 

94060 .... 26 ....... A ........ Evaluation of wheezing ....................... 0.31 0.08 0.08 0.08 0.08 0.01 XXX 

94070 .... ............ A ........ Evaluation of wheezing ....................... 0.60 1.00 0.90 NA NA 0.13 XXX 

94070 .... TC ...... A ........ Evaluation of wheezing ....................... 0.00 0.85 0.74 NA NA 0.10 XXX 

94070 .... 26 ....... A ........ Evaluation of wheezing ....................... 0.60 0.15 0.16 0.15 0.16 0.03 XXX 

94150 .... ............ B ........ Vital capacity test ................................ 0.07 0.48 0.47 NA NA 0.02 XXX 

94150 .... TC ...... B ........ Vital capacity test ................................ 0.00 0.46 0.45 NA NA 0.01 XXX 

94150 .... 26 ....... B ........ Vital capacity test ................................ 0.07 0.02 0.02 0.02 0.02 0.01 XXX 

94200 .... ............ A ........ Lung function test (MBC/MVV) ........... 0.11 0.50 0.47 NA NA 0.03 XXX 

94200 .... TC ...... A ........ Lung function test (MBC/MVV) ........... 0.00 0.47 0.44 NA NA 0.02 XXX 

94200 .... 26 ....... A ........ Lung function test (MBC/MVV) ........... 0.11 0.03 0.03 0.03 0.03 0.01 XXX 

94240 .... ............ A ........ Residual lung capacity ........................ 0.26 0.81 0.74 NA NA 0.06 XXX 

94240 .... TC ...... A ........ Residual lung capacity ........................ 0.00 0.75 0.67 NA NA 0.05 XXX 

94240 .... 26 ....... A ........ Residual lung capacity ........................ 0.26 0.06 0.07 0.06 0.07 0.01 XXX 

94250 .... ............ A ........ Expired gas collection ......................... 0.11 0.51 0.58 NA NA 0.02 XXX 

94250 .... TC ...... A ........ Expired gas collection ......................... 0.00 0.48 0.55 NA NA 0.01 XXX 

94250 .... 26 ....... A ........ Expired gas collection ......................... 0.11 0.03 0.03 0.03 0.03 0.01 XXX 

94260 .... ............ A ........ Thoracic gas volume ........................... 0.13 0.75 0.66 NA NA 0.05 XXX 

94260 .... TC ...... A ........ Thoracic gas volume ........................... 0.00 0.72 0.63 NA NA 0.04 XXX 

94260 .... 26 ....... A ........ Thoracic gas volume ........................... 0.13 0.03 0.03 0.03 0.03 0.01 XXX 

94350 .... ............ A ........ Lung nitrogen washout curve ............. 0.26 0.61 0.69 NA NA 0.05 XXX 

94350 .... TC ...... A ........ Lung nitrogen washout curve ............. 0.00 0.55 0.62 NA NA 0.04 XXX 

94350 .... 26 ....... A ........ Lung nitrogen washout curve ............. 0.26 0.06 0.07 0.06 0.07 0.01 XXX 

94360 .... ............ A ........ Measure airflow resistance ................. 0.26 0.95 0.82 NA NA 0.07 XXX 

94360 .... TC ...... A ........ Measure airflow resistance ................. 0.00 0.89 0.75 NA NA 0.06 XXX 

94360 .... 26 ....... A ........ Measure airflow resistance ................. 0.26 0.06 0.07 0.06 0.07 0.01 XXX 

94370 .... ............ A ........ Breath airway closing volume ............. 0.26 0.60 0.66 NA NA 0.03 XXX 

94370 .... TC ...... A ........ Breath airway closing volume ............. 0.00 0.53 0.59 NA NA 0.02 XXX 

94370 .... 26 ....... A ........ Breath airway closing volume ............. 0.26 0.07 0.07 0.07 0.07 0.01 XXX 

94375 .... ............ A ........ Respiratory flow volume loop ............. 0.31 0.73 0.66 NA NA 0.03 XXX 

94375 .... TC ...... A ........ Respiratory flow volume loop ............. 0.00 0.65 0.58 NA NA 0.02 XXX 

94375 .... 26 ....... A ........ Respiratory flow volume loop ............. 0.31 0.08 0.08 0.08 0.08 0.01 XXX 

94400 .... ............ A ........ CO2 breathing response curve ........... 0.40 1.03 0.93 NA NA 0.09 XXX 

94400 .... TC ...... A ........ CO2 breathing response curve ........... 0.00 0.93 0.82 NA NA 0.06 XXX 

94400 .... 26 ....... A ........ CO2 breathing response curve ........... 0.40 0.10 0.11 0.10 0.11 0.03 XXX 

94450 .... ............ A ........ Hypoxia response curve ..................... 0.40 1.01 0.92 NA NA 0.04 XXX 

94450 .... TC ...... A ........ Hypoxia response curve ..................... 0.00 0.92 0.82 NA NA 0.02 XXX 

94450 .... 26 ....... A ........ Hypoxia response curve ..................... 0.40 0.09 0.10 0.09 0.10 0.02 XXX 

94452 .... ............ A ........ Hast w/report ....................................... 0.31 1.27 1.14 NA NA 0.04 XXX 

94452 .... TC ...... A ........ Hast w/report ....................................... 0.00 1.20 1.06 NA NA 0.02 XXX 

94452 .... 26 ....... A ........ Hast w/report ....................................... 0.31 0.07 0.08 0.07 0.08 0.02 XXX 

94453 .... ............ A ........ Hast w/oxygen titrate .......................... 0.40 1.69 1.60 NA NA 0.04 XXX 

94453 .... TC ...... A ........ Hast w/oxygen titrate .......................... 0.00 1.59 1.49 NA NA 0.02 XXX 

94453 .... 26 ....... A ........ Hast w/oxygen titrate .......................... 0.40 0.10 0.11 0.10 0.11 0.02 XXX 

94610 .... ............ A ........ Surfactant admin thru tube ................. 1.16 0.34 0.34 0.34 0.34 0.26 XXX 

94620 .... ............ A ........ Pulmonary stress test/simple .............. 0.64 0.79 1.64 NA NA 0.13 XXX 

94620 .... TC ...... A ........ Pulmonary stress test/simple .............. 0.00 0.63 1.46 NA NA 0.10 XXX 

94620 .... 26 ....... A ........ Pulmonary stress test/simple .............. 0.64 0.16 0.18 0.16 0.18 0.03 XXX 

94621 .... ............ A ........ Pulm stress test/complex .................... 1.42 3.18 2.69 NA NA 0.16 XXX 

94621 .... TC ...... A ........ Pulm stress test/complex .................... 0.00 2.73 2.25 NA NA 0.10 XXX 

94621 .... 26 ....... A ........ Pulm stress test/complex .................... 1.42 0.45 0.44 0.45 0.44 0.06 XXX 

94640 .... ............ A ........ Airway inhalation treatment ................ 0.00 0.38 0.34 NA NA 0.02 XXX 

94642 .... ............ C ........ Aerosol inhalation treatment ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94644 .... ............ A ........ Cbt, 1st hour ....................................... 0.00 0.96 0.96 NA NA 0.02 XXX 

94645 .... ............ A ........ Cbt, each addl hour ............................ 0.00 0.35 0.35 NA NA 0.02 XXX 

94660 .... ............ A ........ Pos airway pressure, CPAP ............... 0.76 0.81 0.73 0.19 0.21 0.04 XXX 

94662 .... ............ A ........ Neg press ventilation, cnp .................. 0.76 NA NA 0.20 0.21 0.03 XXX 

94664 .... ............ A ........ Evaluate pt use of inhaler ................... 0.00 0.40 0.35 NA NA 0.04 XXX 

94667 .... ............ A ........ Chest wall manipulation ...................... 0.00 0.53 0.53 NA NA 0.05 XXX 

94668 .... ............ A ........ Chest wall manipulation ...................... 0.00 0.50 0.48 NA NA 0.02 XXX 

94680 .... ............ A ........ Exhaled air analysis, o2 ...................... 0.26 1.06 1.46 NA NA 0.07 XXX 

94680 .... TC ...... A ........ Exhaled air analysis, o2 ...................... 0.00 1.00 1.39 NA NA 0.06 XXX 

94680 .... 26 ....... A ........ Exhaled air analysis, o2 ...................... 0.26 0.06 0.07 0.06 0.07 0.01 XXX 

94681 .... ............ A ........ Exhaled air analysis, o2/co2 ............... 0.20 1.07 1.79 NA NA 0.13 XXX 

94681 .... TC ...... A ........ Exhaled air analysis, o2/co2 ............... 0.00 1.02 1.74 NA NA 0.12 XXX 

94681 .... 26 ....... A ........ Exhaled air analysis, o2/co2 ............... 0.20 0.05 0.05 0.05 0.05 0.01 XXX 

94690 .... ............ A ........ Exhaled air analysis ............................ 0.07 1.04 1.52 NA NA 0.05 XXX 


cprice-sewell on PROD1PC72 with RULES
66532 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

94690 .... TC ...... A ........ Exhaled air analysis ............................ 0.00 1.02 1.50 NA NA 0.04 XXX 

94690 .... 26 ....... A ........ Exhaled air analysis ............................ 0.07 0.02 0.02 0.02 0.02 0.01 XXX 

94720 .... ............ A ........ Monoxide diffusing capacity ................ 0.26 1.15 1.08 NA NA 0.07 XXX 

94720 .... TC ...... A ........ Monoxide diffusing capacity ................ 0.00 1.09 1.01 NA NA 0.06 XXX 

94720 .... 26 ....... A ........ Monoxide diffusing capacity ................ 0.26 0.06 0.07 0.06 0.07 0.01 XXX 

94725 .... ............ A ........ Membrane diffusion capacity .............. 0.26 0.98 1.94 NA NA 0.13 XXX 

94725 .... TC ...... A ........ Membrane diffusion capacity .............. 0.00 0.91 1.87 NA NA 0.12 XXX 

94725 .... 26 ....... A ........ Membrane diffusion capacity .............. 0.26 0.07 0.07 0.07 0.07 0.01 XXX 

94750 .... ............ A ........ Pulmonary compliance study .............. 0.23 1.77 1.55 NA NA 0.05 XXX 

94750 .... TC ...... A ........ Pulmonary compliance study .............. 0.00 1.71 1.49 NA NA 0.04 XXX 

94750 .... 26 ....... A ........ Pulmonary compliance study .............. 0.23 0.06 0.06 0.06 0.06 0.01 XXX 

94760 .... ............ T ......... Measure blood oxygen level ............... 0.00 0.06 0.05 NA NA 0.02 XXX 

94761 .... ............ T ......... Measure blood oxygen level ............... 0.00 0.11 0.09 NA NA 0.06 XXX 

94762 .... ............ A ........ Measure blood oxygen level ............... 0.00 0.84 0.66 NA NA 0.10 XXX 

94770 .... ............ A ........ Exhaled carbon dioxide test ............... 0.15 0.81 0.78 NA NA 0.08 XXX 

94770 .... TC ...... A ........ Exhaled carbon dioxide test ............... 0.00 0.77 0.74 NA NA 0.07 XXX 

94770 .... 26 ....... A ........ Exhaled carbon dioxide test ............... 0.15 0.04 0.04 0.04 0.04 0.01 XXX 

94772 .... ............ C ........ Breath recording, infant ...................... 0.00 0.00 0.00 NA NA 0.00 XXX 

94772 .... TC ...... C ........ Breath recording, infant ...................... 0.00 0.00 0.00 NA NA 0.00 XXX 

94772 .... 26 ....... C ........ Breath recording, infant ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94774 .... ............ C ........ Ped home apnea rec, compl .............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

94775 .... ............ C ........ Ped home apnea rec, hk-up ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

94776 .... ............ C ........ Ped home apnea rec, downld ............. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

94777 .... ............ C ........ Ped home apnea rec, report ............... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

94799 .... ............ C ........ Pulmonary service/procedure ............. 0.00 0.00 0.00 NA NA 0.00 XXX 

94799 .... TC ...... C ........ Pulmonary service/procedure ............. 0.00 0.00 0.00 NA NA 0.00 XXX 

94799 .... 26 ....... C ........ Pulmonary service/procedure ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95004 .... ............ A ........ Percut allergy skin tests ...................... 0.01 0.15 0.13 NA NA 0.01 XXX 

95010 .... ............ A ........ Percut allergy titrate test ..................... 0.15 0.31 0.31 NA NA 0.01 XXX 

95012 .... ............ A ........ Exhaled nitric oxide meas ................... 0.00 0.49 0.49 NA NA 0.01 XXX 

95015 .... ............ A ........ Id allergy titrate-drug/bug .................... 0.15 0.21 0.18 NA NA 0.01 XXX 

95024 .... ............ A ........ Id allergy test, drug/bug ...................... 0.01 0.17 0.16 NA NA 0.01 XXX 

95027 .... ............ A ........ Id allergy titrate-airborne ..................... 0.01 0.10 0.12 NA NA 0.01 XXX 

95028 .... ............ A ........ Id allergy test-delayed type ................. 0.00 0.31 0.27 NA NA 0.01 XXX 

95044 .... ............ A ........ Allergy patch tests .............................. 0.00 0.15 0.18 NA NA 0.01 XXX 

95052 .... ............ A ........ Photo patch test .................................. 0.00 0.16 0.20 NA NA 0.01 XXX 

95056 .... ............ A ........ Photosensitivity tests .......................... 0.00 1.25 0.71 NA NA 0.01 XXX 

95060 .... ............ A ........ Eye allergy tests ................................. 0.00 0.73 0.54 0.73 0.54 0.02 XXX 

95065 .... ............ A ........ Nose allergy test ................................. 0.00 0.70 0.45 0.70 0.45 0.01 XXX 

95070 .... ............ A ........ Bronchial allergy tests ......................... 0.00 0.81 1.55 NA NA 0.02 XXX 

95071 .... ............ A ........ Bronchial allergy tests ......................... 0.00 0.98 1.95 NA NA 0.02 XXX 

95075 .... ............ A ........ Ingestion challenge test ...................... 0.95 0.68 0.75 0.26 0.32 0.03 XXX 

95115 .... ............ A ........ Immunotherapy, one injection ............. 0.00 0.23 0.31 NA NA 0.02 XXX 

95117 .... ............ A ........ Immunotherapy injections ................... 0.00 0.28 0.39 NA NA 0.02 XXX 

95120 .... ............ I .......... Immunotherapy, one injection ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95125 .... ............ I .......... Immunotherapy, many antigens ......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95130 .... ............ I .......... Immunotherapy, insect venom ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95131 .... ............ I .......... Immunotherapy, insect venoms .......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95132 .... ............ I .......... Immunotherapy, insect venoms .......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95133 .... ............ I .......... Immunotherapy, insect venoms .......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95134 .... ............ I .......... Immunotherapy, insect venoms .......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95144 .... ............ A ........ Antigen therapy services .................... 0.06 0.27 0.23 0.02 0.02 0.01 XXX 

95145 .... ............ A ........ Antigen therapy services .................... 0.06 0.36 0.34 0.02 0.02 0.01 XXX 

95146 .... ............ A ........ Antigen therapy services .................... 0.06 0.68 0.56 0.02 0.02 0.01 XXX 

95147 .... ............ A ........ Antigen therapy services .................... 0.06 0.66 0.54 0.02 0.02 0.01 XXX 

95148 .... ............ A ........ Antigen therapy services .................... 0.06 0.98 0.78 0.02 0.02 0.01 XXX 

95149 .... ............ A ........ Antigen therapy services .................... 0.06 1.30 1.05 0.02 0.02 0.01 XXX 

95165 .... ............ A ........ Antigen therapy services .................... 0.06 0.26 0.23 0.02 0.02 0.01 XXX 

95170 .... ............ A ........ Antigen therapy services .................... 0.06 0.20 0.17 0.02 0.02 0.01 XXX 

95180 .... ............ A ........ Rapid desensitization .......................... 2.01 1.66 1.85 0.77 0.85 0.04 XXX 

95199 .... ............ C ........ Allergy immunology services .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95250 .... ............ A ........ Glucose monitoring, cont .................... 0.00 3.49 3.80 NA NA 0.01 XXX 

95251 .... ............ A ........ Gluc monitor, cont, phys i&r ............... 0.85 0.26 0.22 0.26 0.22 0.02 XXX 

95805 .... ............ A ........ Multiple sleep latency test .................. 1.88 7.01 12.13 NA NA 0.43 XXX 

95805 .... TC ...... A ........ Multiple sleep latency test .................. 0.00 6.50 11.55 NA NA 0.34 XXX 

95805 .... 26 ....... A ........ Multiple sleep latency test .................. 1.88 0.51 0.58 0.51 0.58 0.09 XXX 

95806 .... ............ A ........ Sleep study, unattended ..................... 1.66 3.92 3.62 NA NA 0.39 XXX 

95806 .... TC ...... A ........ Sleep study, unattended ..................... 0.00 3.45 3.12 NA NA 0.31 XXX 

95806 .... 26 ....... A ........ Sleep study, unattended ..................... 1.66 0.47 0.50 0.47 0.50 0.08 XXX 

95807 .... ............ A ........ Sleep study, attended ......................... 1.66 12.29 12.07 NA NA 0.50 XXX 

95807 .... TC ...... A ........ Sleep study, attended ......................... 0.00 11.88 11.60 NA NA 0.42 XXX 

95807 .... 26 ....... A ........ Sleep study, attended ......................... 1.66 0.41 0.47 0.41 0.47 0.08 XXX 


cprice-sewell on PROD1PC72 with RULES
66533 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

95808 .... ............ A ........ Polysomnography, 1–3 ....................... 2.65 15.74 14.46 NA NA 0.55 XXX 

95808 .... TC ...... A ........ Polysomnography, 1–3 ....................... 0.00 15.04 13.65 NA NA 0.42 XXX 

95808 .... 26 ....... A ........ Polysomnography, 1–3 ....................... 2.65 0.70 0.81 0.70 0.81 0.13 XXX 

95810 .... ............ A ........ Polysomnography, 4 or more ............. 3.52 17.68 17.58 NA NA 0.59 XXX 

95810 .... TC ...... A ........ Polysomnography, 4 or more ............. 0.00 16.78 16.54 NA NA 0.42 XXX 

95810 .... 26 ....... A ........ Polysomnography, 4 or more ............. 3.52 0.90 1.04 0.90 1.04 0.17 XXX 

95811 .... ............ A ........ Polysomnography w/cpap ................... 3.79 19.68 19.42 NA NA 0.61 XXX 

95811 .... TC ...... A ........ Polysomnography w/cpap ................... 0.00 18.72 18.31 NA NA 0.43 XXX 

95811 .... 26 ....... A ........ Polysomnography w/cpap ................... 3.79 0.96 1.11 0.96 1.11 0.18 XXX 

95812 .... ............ A ........ Eeg, 41–60 minutes ............................ 1.08 5.89 4.96 NA NA 0.17 XXX 

95812 .... TC ...... A ........ Eeg, 41–60 minutes ............................ 0.00 5.59 4.58 NA NA 0.11 XXX 

95812 .... 26 ....... A ........ Eeg, 41–60 minutes ............................ 1.08 0.30 0.38 0.30 0.38 0.06 XXX 

95813 .... ............ A ........ Eeg, over 1 hour ................................. 1.73 6.51 5.76 NA NA 0.20 XXX 

95813 .... TC ...... A ........ Eeg, over 1 hour ................................. 0.00 6.03 5.17 NA NA 0.11 XXX 

95813 .... 26 ....... A ........ Eeg, over 1 hour ................................. 1.73 0.48 0.59 0.48 0.59 0.09 XXX 

95816 .... ............ A ........ Eeg, awake and drowsy ..................... 1.08 5.27 4.49 NA NA 0.16 XXX 

95816 .... TC ...... A ........ Eeg, awake and drowsy ..................... 0.00 4.97 4.11 NA NA 0.10 XXX 

95816 .... 26 ....... A ........ Eeg, awake and drowsy ..................... 1.08 0.30 0.38 0.30 0.38 0.06 XXX 

95819 .... ............ A ........ Eeg, awake and asleep ...................... 1.08 6.13 4.55 NA NA 0.16 XXX 

95819 .... TC ...... A ........ Eeg, awake and asleep ...................... 0.00 5.83 4.17 NA NA 0.10 XXX 

95819 .... 26 ....... A ........ Eeg, awake and asleep ...................... 1.08 0.30 0.38 0.30 0.38 0.06 XXX 

95822 .... ............ A ........ Eeg, coma or sleep only ..................... 1.08 5.51 5.05 NA NA 0.19 XXX 

95822 .... TC ...... A ........ Eeg, coma or sleep only ..................... 0.00 5.21 4.67 NA NA 0.13 XXX 

95822 .... 26 ....... A ........ Eeg, coma or sleep only ..................... 1.08 0.30 0.38 0.30 0.38 0.06 XXX 

95824 .... ............ C ........ Eeg, cerebral death only ..................... 0.00 0.00 0.00 NA NA 0.00 XXX 

95824 .... TC ...... C ........ Eeg, cerebral death only ..................... 0.00 0.00 0.00 NA NA 0.00 XXX 

95824 .... 26 ....... A ........ Eeg, cerebral death only ..................... 0.74 0.21 0.26 0.21 0.26 0.04 XXX 

95827 .... ............ A ........ Eeg, all night recording ....................... 1.08 11.52 7.11 NA NA 0.19 XXX 

95827 .... TC ...... A ........ Eeg, all night recording ....................... 0.00 11.22 6.76 NA NA 0.14 XXX 

95827 .... 26 ....... A ........ Eeg, all night recording ....................... 1.08 0.30 0.35 0.30 0.35 0.05 XXX 

95829 .... ............ A ........ Surgery electrocorticogram ................. 6.20 24.75 27.87 NA NA 0.50 XXX 

95829 .... TC ...... A ........ Surgery electrocorticogram ................. 0.00 22.99 25.83 NA NA 0.02 XXX 

95829 .... 26 ....... A ........ Surgery electrocorticogram ................. 6.20 1.76 2.04 1.76 2.04 0.48 XXX 

95830 .... ............ A ........ Insert electrodes for EEG ................... 1.70 2.96 3.13 0.41 0.57 0.11 XXX 

95831 .... ............ A ........ Limb muscle testing, manual .............. 0.28 0.40 0.43 0.09 0.11 0.01 XXX 

95832 .... ............ A ........ Hand muscle testing, manual ............. 0.29 0.37 0.35 0.10 0.11 0.02 XXX 

95833 .... ............ A ........ Body muscle testing, manual .............. 0.47 0.49 0.54 0.14 0.18 0.02 XXX 

95834 .... ............ A ........ Body muscle testing, manual .............. 0.60 0.54 0.58 0.17 0.23 0.03 XXX 

95851 .... ............ A ........ Range of motion measurements ........ 0.16 0.26 0.31 0.04 0.06 0.01 XXX 

95852 .... ............ A ........ Range of motion measurements ........ 0.11 0.24 0.25 0.04 0.04 0.01 XXX 

95857 .... ............ A ........ Tensilon test ........................................ 0.53 0.58 0.59 0.16 0.19 0.02 XXX 

95860 .... ............ A ........ Muscle test, one limb .......................... 0.96 1.16 1.29 NA NA 0.07 XXX 

95860 .... TC ...... A ........ Muscle test, one limb .......................... 0.00 0.84 0.92 NA NA 0.02 XXX 

95860 .... 26 ....... A ........ Muscle test, one limb .......................... 0.96 0.32 0.37 0.32 0.37 0.05 XXX 

95861 .... ............ A ........ Muscle test, 2 limbs ............................ 1.54 1.66 1.53 NA NA 0.13 XXX 

95861 .... TC ...... A ........ Muscle test, 2 limbs ............................ 0.00 1.15 0.94 NA NA 0.06 XXX 

95861 .... 26 ....... A ........ Muscle test, 2 limbs ............................ 1.54 0.51 0.59 0.51 0.59 0.07 XXX 

95863 .... ............ A ........ Muscle test, 3 limbs ............................ 1.87 1.92 1.82 NA NA 0.15 XXX 

95863 .... TC ...... A ........ Muscle test, 3 limbs ............................ 0.00 1.35 1.14 NA NA 0.06 XXX 

95863 .... 26 ....... A ........ Muscle test, 3 limbs ............................ 1.87 0.57 0.68 0.57 0.68 0.09 XXX 

95864 .... ............ A ........ Muscle test, 4 limbs ............................ 1.99 2.14 2.40 NA NA 0.21 XXX 

95864 .... TC ...... A ........ Muscle test, 4 limbs ............................ 0.00 1.53 1.66 NA NA 0.12 XXX 

95864 .... 26 ....... A ........ Muscle test, 4 limbs ............................ 1.99 0.61 0.74 0.61 0.74 0.09 XXX 

95865 .... ............ A ........ Muscle test, larynx .............................. 1.57 1.39 1.42 NA NA 0.11 XXX 

95865 .... TC ...... A ........ Muscle test, larynx .............................. 0.00 0.90 0.79 NA NA 0.03 XXX 

95865 .... 26 ....... A ........ Muscle test, larynx .............................. 1.57 0.49 0.63 0.49 0.63 0.08 XXX 

95866 .... ............ A ........ Muscle test, hemidiaphragm ............... 1.25 1.32 1.03 NA NA 0.10 XXX 

95866 .... TC ...... A ........ Muscle test, hemidiaphragm ............... 0.00 0.93 0.56 NA NA 0.03 XXX 

95866 .... 26 ....... A ........ Muscle test, hemidiaphragm ............... 1.25 0.39 0.47 0.39 0.47 0.07 XXX 

95867 .... ............ A ........ Muscle test cran nerv unilat ................ 0.79 1.15 1.03 NA NA 0.07 XXX 

95867 .... TC ...... A ........ Muscle test cran nerv unilat ................ 0.00 0.91 0.74 NA NA 0.04 XXX 

95867 .... 26 ....... A ........ Muscle test cran nerv unilat ................ 0.79 0.24 0.29 0.24 0.29 0.03 XXX 

95868 .... ............ A ........ Muscle test cran nerve bilat ................ 1.18 1.47 1.34 NA NA 0.10 XXX 

95868 .... TC ...... A ........ Muscle test cran nerve bilat ................ 0.00 1.11 0.90 NA NA 0.05 XXX 

95868 .... 26 ....... A ........ Muscle test cran nerve bilat ................ 1.18 0.36 0.44 0.36 0.44 0.05 XXX 

95869 .... ............ A ........ Muscle test, thor paraspinal ................ 0.37 1.03 0.70 NA NA 0.04 XXX 

95869 .... TC ...... A ........ Muscle test, thor paraspinal ................ 0.00 0.91 0.56 NA NA 0.02 XXX 

95869 .... 26 ....... A ........ Muscle test, thor paraspinal ................ 0.37 0.12 0.14 0.12 0.14 0.02 XXX 

95870 .... ............ A ........ Muscle test, nonparaspinal ................. 0.37 0.99 0.68 NA NA 0.04 XXX 

95870 .... TC ...... A ........ Muscle test, nonparaspinal ................. 0.00 0.87 0.54 NA NA 0.02 XXX 

95870 .... 26 ....... A ........ Muscle test, nonparaspinal ................. 0.37 0.12 0.14 0.12 0.14 0.02 XXX 

95872 .... ............ A ........ Muscle test, one fiber ......................... 2.88 1.63 1.43 NA NA 0.13 XXX 


cprice-sewell on PROD1PC72 with RULES
66534 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

95872 .... TC ...... A ........ Muscle test, one fiber ......................... 0.00 0.76 0.68 NA NA 0.05 XXX 

95872 .... 26 ....... A ........ Muscle test, one fiber ......................... 2.88 0.87 0.75 0.87 0.75 0.08 XXX 

95873 .... ............ A ........ Guide nerv destr, elec stim ................. 0.37 1.02 0.69 NA NA 0.04 ZZZ 

95873 .... TC ...... A ........ Guide nerv destr, elec stim ................. 0.00 0.88 0.54 NA NA 0.02 ZZZ 

95873 .... 26 ....... A ........ Guide nerv destr, elec stim ................. 0.37 0.14 0.15 0.14 0.15 0.02 ZZZ 

95874 .... ............ A ........ Guide nerv destr, needle emg ............ 0.37 0.95 0.67 NA NA 0.04 ZZZ 

95874 .... TC ...... A ........ Guide nerv destr, needle emg ............ 0.00 0.83 0.52 NA NA 0.02 ZZZ 

95874 .... 26 ....... A ........ Guide nerv destr, needle emg ............ 0.37 0.12 0.15 0.12 0.15 0.02 ZZZ 

95875 .... ............ A ........ Limb exercise test ............................... 1.10 1.46 1.46 NA NA 0.11 XXX 

95875 .... TC ...... A ........ Limb exercise test ............................... 0.00 1.08 1.03 NA NA 0.06 XXX 

95875 .... 26 ....... A ........ Limb exercise test ............................... 1.10 0.38 0.43 0.38 0.43 0.05 XXX 

95900 .... ............ A ........ Motor nerve conduction test ............... 0.42 0.92 1.09 NA NA 0.04 XXX 

95900 .... TC ...... A ........ Motor nerve conduction test ............... 0.00 0.78 0.93 NA NA 0.02 XXX 

95900 .... 26 ....... A ........ Motor nerve conduction test ............... 0.42 0.14 0.16 0.14 0.16 0.02 XXX 

95903 .... ............ A ........ Motor nerve conduction test ............... 0.60 0.99 1.09 NA NA 0.05 XXX 

95903 .... TC ...... A ........ Motor nerve conduction test ............... 0.00 0.82 0.88 NA NA 0.02 XXX 

95903 .... 26 ....... A ........ Motor nerve conduction test ............... 0.60 0.17 0.21 0.17 0.21 0.03 XXX 

95904 .... ............ A ........ Sense nerve conduction test .............. 0.34 0.84 0.97 NA NA 0.04 XXX 

95904 .... TC ...... A ........ Sense nerve conduction test .............. 0.00 0.74 0.84 NA NA 0.02 XXX 

95904 .... 26 ....... A ........ Sense nerve conduction test .............. 0.34 0.10 0.13 0.10 0.13 0.02 XXX 

95920 .... ............ A ........ Intraop nerve test add-on ................... 2.11 1.72 1.97 NA NA 0.23 ZZZ 

95920 .... TC ...... A ........ Intraop nerve test add-on ................... 0.00 1.10 1.20 NA NA 0.07 ZZZ 

95920 .... 26 ....... A ........ Intraop nerve test add-on ................... 2.11 0.62 0.77 0.62 0.77 0.16 ZZZ 

95921 .... ............ A ........ Autonomic nerv function test .............. 0.90 1.16 0.93 NA NA 0.06 XXX 

95921 .... TC ...... A ........ Autonomic nerv function test .............. 0.00 0.91 0.64 NA NA 0.02 XXX 

95921 .... 26 ....... A ........ Autonomic nerv function test .............. 0.90 0.25 0.29 0.25 0.29 0.04 XXX 

95922 .... ............ A ........ Autonomic nerv function test .............. 0.96 1.61 1.19 NA NA 0.07 XXX 

95922 .... TC ...... A ........ Autonomic nerv function test .............. 0.00 1.35 0.86 NA NA 0.02 XXX 

95922 .... 26 ....... A ........ Autonomic nerv function test .............. 0.96 0.26 0.33 0.26 0.33 0.05 XXX 

95923 .... ............ A ........ Autonomic nerv function test .............. 0.90 2.33 2.14 NA NA 0.07 XXX 

95923 .... TC ...... A ........ Autonomic nerv function test .............. 0.00 2.08 1.82 NA NA 0.02 XXX 

95923 .... 26 ....... A ........ Autonomic nerv function test .............. 0.90 0.25 0.32 0.25 0.32 0.05 XXX 

95925 .... ............ A ........ Somatosensory testing ....................... 0.54 3.07 2.10 NA NA 0.10 XXX 

95925 .... TC ...... A ........ Somatosensory testing ....................... 0.00 2.92 1.91 NA NA 0.06 XXX 

95925 .... 26 ....... A ........ Somatosensory testing ....................... 0.54 0.15 0.19 0.15 0.19 0.04 XXX 

95926 .... ............ A ........ Somatosensory testing ....................... 0.54 3.00 2.07 NA NA 0.09 XXX 

95926 .... TC ...... A ........ Somatosensory testing ....................... 0.00 2.85 1.88 NA NA 0.06 XXX 

95926 .... 26 ....... A ........ Somatosensory testing ....................... 0.54 0.15 0.19 0.15 0.19 0.03 XXX 

95927 .... ............ A ........ Somatosensory testing ....................... 0.54 3.12 2.14 NA NA 0.10 XXX 

95927 .... TC ...... A ........ Somatosensory testing ....................... 0.00 2.96 1.93 NA NA 0.06 XXX 

95927 .... 26 ....... A ........ Somatosensory testing ....................... 0.54 0.16 0.21 0.16 0.21 0.04 XXX 

95928 .... ............ A ........ C motor evoked, uppr limbs ............... 1.50 3.94 3.47 NA NA 0.09 XXX 

95928 .... TC ...... A ........ C motor evoked, uppr limbs ............... 0.00 3.50 2.93 NA NA 0.03 XXX 

95928 .... 26 ....... A ........ C motor evoked, uppr limbs ............... 1.50 0.44 0.54 0.44 0.54 0.06 XXX 

95929 .... ............ A ........ C motor evoked, lwr limbs .................. 1.50 4.25 3.74 NA NA 0.09 XXX 

95929 .... TC ...... A ........ C motor evoked, lwr limbs .................. 0.00 3.81 3.19 NA NA 0.03 XXX 

95929 .... 26 ....... A ........ C motor evoked, lwr limbs .................. 1.50 0.44 0.55 0.44 0.55 0.06 XXX 

95930 .... ............ A ........ Visual evoked potential test ................ 0.35 2.63 2.44 NA NA 0.03 XXX 

95930 .... TC ...... A ........ Visual evoked potential test ................ 0.00 2.53 2.31 NA NA 0.01 XXX 

95930 .... 26 ....... A ........ Visual evoked potential test ................ 0.35 0.10 0.13 0.10 0.13 0.02 XXX 

95933 .... ............ A ........ Blink reflex test ................................... 0.59 1.11 1.07 NA NA 0.10 XXX 

95933 .... TC ...... A ........ Blink reflex test ................................... 0.00 0.94 0.86 NA NA 0.06 XXX 

95933 .... 26 ....... A ........ Blink reflex test ................................... 0.59 0.17 0.21 0.17 0.21 0.04 XXX 

95934 .... ............ A ........ H-reflex test ......................................... 0.51 0.85 0.64 NA NA 0.04 XXX 

95934 .... TC ...... A ........ H-reflex test ......................................... 0.00 0.70 0.45 NA NA 0.02 XXX 

95934 .... 26 ....... A ........ H-reflex test ......................................... 0.51 0.15 0.19 0.15 0.19 0.02 XXX 

95936 .... ............ A ........ H-reflex test ......................................... 0.55 0.59 0.52 NA NA 0.05 XXX 

95936 .... TC ...... A ........ H-reflex test ......................................... 0.00 0.43 0.32 NA NA 0.02 XXX 

95936 .... 26 ....... A ........ H-reflex test ......................................... 0.55 0.16 0.20 0.16 0.20 0.03 XXX 

95937 .... ............ A ........ Neuromuscular junction test ............... 0.65 0.92 0.76 NA NA 0.10 XXX 

95937 .... TC ...... A ........ Neuromuscular junction test ............... 0.00 0.72 0.53 NA NA 0.02 XXX 

95937 .... 26 ....... A ........ Neuromuscular junction test ............... 0.65 0.20 0.23 0.20 0.23 0.08 XXX 

95950 .... ............ A ........ Ambulatory eeg monitoring ................. 1.51 4.92 4.42 NA NA 0.51 XXX 

95950 .... TC ...... A ........ Ambulatory eeg monitoring ................. 0.00 4.50 3.89 NA NA 0.43 XXX 

95950 .... 26 ....... A ........ Ambulatory eeg monitoring ................. 1.51 0.42 0.53 0.42 0.53 0.08 XXX 

95951 .... ............ C ........ EEG monitoring/videorecord ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

95951 .... TC ...... C ........ EEG monitoring/videorecord ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

95951 .... 26 ....... A ........ EEG monitoring/videorecord ............... 5.99 1.68 2.12 1.68 2.12 0.32 XXX 

95953 .... ............ A ........ EEG monitoring/computer ................... 3.30 7.21 7.42 NA NA 0.60 XXX 

95953 .... TC ...... A ........ EEG monitoring/computer ................... 0.00 6.29 6.31 NA NA 0.43 XXX 

95953 .... 26 ....... A ........ EEG monitoring/computer ................... 3.30 0.92 1.11 0.92 1.11 0.17 XXX 

95954 .... ............ A ........ EEG monitoring/giving drugs .............. 2.45 4.37 4.30 NA NA 0.19 XXX 


cprice-sewell on PROD1PC72 with RULES
66535 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

95954 .... TC ...... A ........ EEG monitoring/giving drugs .............. 0.00 3.95 3.57 NA NA 0.06 XXX 

95954 .... 26 ....... A ........ EEG monitoring/giving drugs .............. 2.45 0.42 0.73 0.42 0.73 0.13 XXX 

95955 .... ............ A ........ EEG during surgery ............................ 1.01 2.75 2.54 NA NA 0.22 XXX 

95955 .... TC ...... A ........ EEG during surgery ............................ 0.00 2.47 2.22 NA NA 0.17 XXX 

95955 .... 26 ....... A ........ EEG during surgery ............................ 1.01 0.28 0.32 0.28 0.32 0.05 XXX 

95956 .... ............ A ........ Eeg monitoring, cable/radio ................ 3.08 16.28 15.84 NA NA 0.59 XXX 

95956 .... TC ...... A ........ Eeg monitoring, cable/radio ................ 0.00 15.42 14.76 NA NA 0.43 XXX 

95956 .... 26 ....... A ........ Eeg monitoring, cable/radio ................ 3.08 0.86 1.08 0.86 1.08 0.16 XXX 

95957 .... ............ A ........ EEG digital analysis ............................ 1.98 5.84 4.19 NA NA 0.23 XXX 

95957 .... TC ...... A ........ EEG digital analysis ............................ 0.00 5.29 3.49 NA NA 0.12 XXX 

95957 .... 26 ....... A ........ EEG digital analysis ............................ 1.98 0.55 0.70 0.55 0.70 0.11 XXX 

95958 .... ............ A ........ EEG monitoring/function test .............. 4.24 6.70 5.09 NA NA 0.34 XXX 

95958 .... TC ...... A ........ EEG monitoring/function test .............. 0.00 5.47 3.60 NA NA 0.13 XXX 

95958 .... 26 ....... A ........ EEG monitoring/function test .............. 4.24 1.23 1.49 1.23 1.49 0.21 XXX 

95961 .... ............ A ........ Electrode stimulation, brain ................ 2.97 3.05 2.83 NA NA 0.55 XXX 

95961 .... TC ...... A ........ Electrode stimulation, brain ................ 0.00 2.18 1.74 NA NA 0.07 XXX 

95961 .... 26 ....... A ........ Electrode stimulation, brain ................ 2.97 0.87 1.09 0.87 1.09 0.48 XXX 

95962 .... ............ A ........ Electrode stim, brain add-on ............... 3.21 2.21 2.45 NA NA 0.39 ZZZ 

95962 .... TC ...... A ........ Electrode stim, brain add-on ............... 0.00 1.30 1.30 NA NA 0.07 ZZZ 

95962 .... 26 ....... A ........ Electrode stim, brain add-on ............... 3.21 0.91 1.15 0.91 1.15 0.32 ZZZ 

95965 .... ............ C ........ Meg, spontaneous .............................. 0.00 0.00 0.00 NA NA 0.00 XXX 

95965 .... TC ...... C ........ Meg, spontaneous .............................. 0.00 0.00 0.00 NA NA 0.00 XXX 

95965 .... 26 ....... A ........ Meg, spontaneous .............................. 7.99 2.39 2.90 2.39 2.90 0.46 XXX 

95966 .... ............ C ........ Meg, evoked, single ............................ 0.00 0.00 0.00 NA NA 0.00 XXX 

95966 .... TC ...... C ........ Meg, evoked, single ............................ 0.00 0.00 0.00 NA NA 0.00 XXX 

95966 .... 26 ....... A ........ Meg, evoked, single ............................ 3.99 1.19 1.45 1.19 1.45 0.19 XXX 

95967 .... ............ C ........ Meg, evoked, each add’l ..................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

95967 .... TC ...... C ........ Meg, evoked, each add’l ..................... 0.00 0.00 0.00 NA NA 0.00 ZZZ 

95967 .... 26 ....... A ........ Meg, evoked, each add’l ..................... 3.49 1.01 1.09 1.01 1.09 0.16 ZZZ 

95970 .... ............ A ........ Analyze neurostim, no prog ................ 0.45 0.90 0.87 0.13 0.13 0.03 XXX 

95971 .... ............ A ........ Analyze neurostim, simple .................. 0.78 0.58 0.63 0.18 0.20 0.07 XXX 

95972 .... ............ A ........ Analyze neurostim, complex ............... 1.50 1.14 1.18 0.44 0.46 0.14 XXX 

95973 .... ............ A ........ Analyze neurostim, complex ............... 0.92 0.49 0.55 0.21 0.28 0.07 ZZZ 

95974 .... ............ A ........ Cranial neurostim, complex ................ 3.00 1.44 1.57 0.78 1.04 0.16 XXX 

95975 .... ............ A ........ Cranial neurostim, complex ................ 1.70 0.73 0.81 0.47 0.60 0.12 ZZZ 

95978 .... ............ A ........ Analyze neurostim brain/1h ................ 3.50 1.85 1.89 1.02 1.16 0.18 XXX 

95979 .... ............ A ........ Analyz neurostim brain addon ............ 1.64 0.72 0.79 0.46 0.57 0.08 ZZZ 

95980 .... ............ A ........ Io anal gast n-stim init ........................ 0.80 NA NA 0.25 0.25 0.07 XXX 

95981 .... ............ A ........ Io anal gast n-stim subsq ................... 0.30 0.44 0.44 0.12 0.12 0.02 XXX 

95982 .... ............ A ........ Io ga n-stim subsq w/reprog ............... 0.65 0.47 0.47 0.18 0.18 0.05 XXX 

95990 .... ............ A ........ Spin/brain pump refil & main .............. 0.00 1.62 1.56 NA NA 0.06 XXX 

95991 .... ............ A ........ Spin/brain pump refil & main .............. 0.77 1.61 1.55 0.17 0.17 0.06 XXX 

95999 .... ............ C ........ Neurological procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

96000 .... ............ A ........ Motion analysis, video/3d ................... 1.80 NA NA 0.44 0.48 0.11 XXX 

96001 .... ............ A ........ Motion test w/ft press meas ................ 2.15 NA NA 0.56 0.61 0.10 XXX 

96002 .... ............ A ........ Dynamic surface emg ......................... 0.41 NA NA 0.10 0.13 0.02 XXX 

96003 .... ............ A ........ Dynamic fine wire emg ....................... 0.37 NA NA 0.09 0.10 0.02 XXX 

96004 .... ............ A ........ Phys review of motion tests ................ 2.14 0.65 0.79 0.65 0.79 0.11 XXX 

96020 .... ............ C ........ Functional brain mapping ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

96020 .... TC ...... C ........ Functional brain mapping ................... 0.00 0.00 0.00 NA NA 0.00 XXX 

96020 .... 26 ....... A ........ Functional brain mapping ................... 3.43 1.07 1.07 1.07 1.07 0.17 XXX 

96040 .... ............ B ........ Genetic counseling, 30 min ................ 0.00 0.98 0.98 NA NA 0.01 XXX 

96101 .... ............ A ........ Psycho testing by psych/phys ............ 1.86 0.35 0.50 0.33 0.48 0.05 XXX 

96102 .... ............ A ........ Psycho testing by technician .............. 0.50 1.10 0.88 0.09 0.13 0.01 XXX 

96103 .... ............ A ........ Psycho testing admin by comp ........... 0.51 0.92 0.56 0.10 0.14 0.02 XXX 

96105 .... ............ A ........ Assessment of aphasia ....................... 0.00 1.66 1.71 NA NA 0.18 XXX 

96110 .... ............ A ........ Developmental test, lim ...................... 0.00 0.19 0.18 NA NA 0.18 XXX 

96111 .... ............ A ........ Developmental test, extend ................ 2.60 0.69 0.87 0.58 0.81 0.18 XXX 

96116 .... ............ A ........ Neurobehavioral status exam ............. 1.86 0.52 0.68 0.40 0.52 0.18 XXX 

96118 .... ............ A ........ Neuropsych tst by psych/phys ............ 1.86 0.84 1.11 0.33 0.48 0.18 XXX 

96119 .... ............ A ........ Neuropsych testing by tec .................. 0.55 1.53 1.27 0.10 0.14 0.18 XXX 

96120 .... ............ A ........ Neuropsych tst admin w/comp ........... 0.51 1.69 1.21 0.10 0.13 0.02 XXX 

96125 .... ............ A ........ Cognitive test by hc pro ...................... 1.70 0.76 0.76 0.37 0.37 0.16 XXX 

96150 .... ............ A ........ Assess hlth/behave, init ...................... 0.50 0.10 0.14 0.09 0.13 0.01 XXX 

96151 .... ............ A ........ Assess hlth/behave, subseq ............... 0.48 0.10 0.14 0.09 0.13 0.01 XXX 

96152 .... ............ A ........ Intervene hlth/behave, indiv ................ 0.46 0.09 0.13 0.08 0.12 0.01 XXX 

96153 .... ............ A ........ Intervene hlth/behave, group .............. 0.10 0.02 0.03 0.02 0.02 0.01 XXX 

96154 .... ............ A ........ Interv hlth/behav, fam w/pt ................. 0.45 0.09 0.13 0.08 0.12 0.01 XXX 

96155 .... ............ N ........ Interv hlth/behav fam no pt ................. 0.44 0.10 0.14 0.10 0.14 0.02 XXX 

96401 .... ............ A ........ Chemo, anti-neopl, sq/im .................... 0.21 1.86 1.51 NA NA 0.01 XXX 

96402 .... ............ A ........ Chemo hormon antineopl sq/im .......... 0.19 0.77 0.89 NA NA 0.01 XXX 

96405 .... ............ A ........ Chemo intralesional, up to 7 ............... 0.52 3.69 3.06 0.24 0.24 0.03 000 


cprice-sewell on PROD1PC72 with RULES
66536 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

96406 .... ............ A ........ Chemo intralesional over 7 ................. 0.80 3.61 3.31 0.32 0.31 0.03 000 

96409 .... ............ A ........ Chemo, iv push, sngl drug .................. 0.24 2.79 2.86 NA NA 0.06 XXX 

96411 .... ............ A ........ Chemo, iv push, addl drug ................. 0.20 1.50 1.55 NA NA 0.06 ZZZ 

96413 .... ............ A ........ Chemo, iv infusion, 1 hr ...................... 0.28 3.63 3.91 NA NA 0.08 XXX 

96415 .... ............ A ........ Chemo, iv infusion, addl hr ................. 0.19 0.66 0.71 NA NA 0.07 ZZZ 

96416 .... ............ A ........ Chemo prolong infuse w/pump ........... 0.21 4.08 4.34 NA NA 0.08 XXX 

96417 .... ............ A ........ Chemo iv infus each addl seq ............ 0.21 1.73 1.83 NA NA 0.07 ZZZ 

96420 .... ............ A ........ Chemo, ia, push tecnique ................... 0.17 2.78 2.72 NA NA 0.08 XXX 

96422 .... ............ A ........ Chemo ia infusion up to 1 hr .............. 0.17 4.49 4.66 NA NA 0.08 XXX 

96423 .... ............ A ........ Chemo ia infuse each addl hr ............ 0.17 1.99 1.94 NA NA 0.02 ZZZ 

96425 .... ............ A ........ Chemotherapy,infusion method .......... 0.17 4.67 4.57 NA NA 0.08 XXX 

96440 .... ............ A ........ Chemotherapy, intracavitary ............... 2.37 5.55 6.84 0.98 1.10 0.17 000 

96445 .... ............ A ........ Chemotherapy, intracavitary ............... 2.20 5.41 6.72 0.96 1.07 0.14 000 

96450 .... ............ A ........ Chemotherapy, into CNS .................... 1.53 4.99 5.97 0.83 1.06 0.09 000 

96521 .... ............ A ........ Refill/maint, portable pump ................. 0.21 3.15 3.45 NA NA 0.06 XXX 

96522 .... ............ A ........ Refill/maint pump/resvr syst ................ 0.21 2.78 2.71 NA NA 0.06 XXX 

96523 .... ............ T ......... Irrig drug delivery device .................... 0.04 0.64 0.66 NA NA 0.01 XXX 

96542 .... ............ A ........ Chemotherapy injection ...................... 0.75 3.55 3.90 0.32 0.49 0.07 XXX 

96549 .... ............ C ........ Chemotherapy, unspecified ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

96567 .... ............ A ........ Photodynamic tx, skin ......................... 0.00 3.74 2.84 NA NA 0.04 XXX 

96570 .... ............ A ........ Photodynamic tx, 30 min .................... 1.10 0.40 0.38 0.40 0.38 0.11 ZZZ 

96571 .... ............ A ........ Photodynamic tx, addl 15 min ............ 0.55 0.19 0.19 0.19 0.19 0.03 ZZZ 

96900 .... ............ A ........ Ultraviolet light therapy ....................... 0.00 0.57 0.50 NA NA 0.02 XXX 

96902 .... ............ B ........ Trichogram .......................................... 0.41 0.11 0.15 0.09 0.13 0.01 XXX 

96904 .... ............ R ........ Whole body photography .................... 0.00 1.90 1.90 NA NA 0.01 XXX 

96910 .... ............ A ........ Photochemotherapy with UV-B ........... 0.00 2.01 1.50 NA NA 0.04 XXX 

96912 .... ............ A ........ Photochemotherapy with UV-A ........... 0.00 2.58 1.92 NA NA 0.05 XXX 

96913 .... ............ A ........ Photochemotherapy, UV-A or B ......... 0.00 3.47 2.57 NA NA 0.10 XXX 

96920 .... ............ A ........ Laser tx, skin < 250 sq cm ................. 1.15 3.58 3.05 0.56 0.56 0.02 000 

96921 .... ............ A ........ Laser tx, skin 250–500 sq cm ............ 1.17 3.32 2.96 0.51 0.54 0.03 000 

96922 .... ............ A ........ Laser tx, skin > 500 sq cm ................. 2.10 4.63 4.06 1.04 0.83 0.04 000 

96999 .... ............ C ........ Dermatological procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97001 .... ............ A ........ Pt evaluation ....................................... 1.20 0.65 0.70 NA NA 0.05 XXX 

97002 .... ............ A ........ Pt re-evaluation ................................... 0.60 0.41 0.42 NA NA 0.02 XXX 

97003 .... ............ A ........ Ot evaluation ....................................... 1.20 0.76 0.82 NA NA 0.06 XXX 

97004 .... ............ A ........ Ot re-evaluation .................................. 0.60 0.54 0.60 NA NA 0.02 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 therapy ................... 0.06 0.07 0.06 NA NA 0.01 XXX 

97012 .... ............ A ........ Mechanical traction therapy ................ 0.25 0.14 0.13 NA NA 0.01 XXX 

97014 .... ............ I .......... Electric stimulation therapy ................. 0.18 0.18 0.18 NA NA 0.01 XXX 

97016 .... ............ A ........ Vasopneumatic device therapy ........... 0.18 0.24 0.21 NA NA 0.01 XXX 

97018 .... ............ A ........ Paraffin bath therapy .......................... 0.06 0.17 0.13 NA NA 0.01 XXX 

97022 .... ............ A ........ Whirlpool therapy ................................ 0.17 0.33 0.27 NA NA 0.01 XXX 

97024 .... ............ A ........ Diathermy eg, microwave ................... 0.06 0.08 0.07 NA NA 0.01 XXX 

97026 .... ............ A ........ Infrared therapy ................................... 0.06 0.07 0.06 NA NA 0.01 XXX 

97028 .... ............ A ........ Ultraviolet therapy ............................... 0.08 0.08 0.08 NA NA 0.01 XXX 

97032 .... ............ A ........ Electrical stimulation ........................... 0.25 0.20 0.18 NA NA 0.01 XXX 

97033 .... ............ A ........ Electric current therapy ....................... 0.26 0.44 0.36 NA NA 0.01 XXX 

97034 .... ............ A ........ Contrast bath therapy ......................... 0.21 0.20 0.17 NA NA 0.01 XXX 

97035 .... ............ A ........ Ultrasound therapy .............................. 0.21 0.10 0.10 NA NA 0.01 XXX 

97036 .... ............ A ........ Hydrotherapy ....................................... 0.28 0.44 0.38 NA NA 0.01 XXX 

97039 .... ............ C ........ Physical therapy treatment ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97110 .... ............ A ........ Therapeutic exercises ......................... 0.45 0.32 0.29 NA NA 0.02 XXX 

97112 .... ............ A ........ Neuromuscular reeducation ................ 0.45 0.34 0.33 NA NA 0.01 XXX 

97113 .... ............ A ........ Aquatic therapy/exercises ................... 0.44 0.53 0.46 NA NA 0.01 XXX 

97116 .... ............ A ........ Gait training therapy ........................... 0.40 0.27 0.26 NA NA 0.01 XXX 

97124 .... ............ A ........ Massage therapy ................................ 0.35 0.27 0.25 NA NA 0.01 XXX 

97139 .... ............ C ........ Physical medicine procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97140 .... ............ A ........ Manual therapy ................................... 0.43 0.29 0.27 NA NA 0.01 XXX 

97150 .... ............ A ........ Group therapeutic procedures ............ 0.27 0.22 0.20 NA NA 0.01 XXX 

97530 .... ............ A ........ Therapeutic activities .......................... 0.44 0.38 0.35 NA NA 0.01 XXX 

97532 .... ............ A ........ Cognitive skills development .............. 0.44 0.22 0.21 NA NA 0.01 XXX 

97533 .... ............ A ........ Sensory integration ............................. 0.44 0.27 0.25 NA NA 0.01 XXX 

97535 .... ............ A ........ Self care mngment training ................. 0.45 0.37 0.35 NA NA 0.01 XXX 

97537 .... ............ A ........ Community/work reintegration ............ 0.45 0.28 0.27 NA NA 0.01 XXX 

97542 .... ............ A ........ Wheelchair mngment training ............. 0.45 0.29 0.28 NA NA 0.01 XXX 

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 cm or < ............ 0.58 1.09 0.88 0.12 0.39 0.05 XXX 

97598 .... ............ A ........ Active wound care > 20 cm ................ 0.80 1.27 1.03 0.17 0.48 0.05 XXX 

97602 .... ............ B ........ Wound(s) care non-selective .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 


cprice-sewell on PROD1PC72 with RULES
66537 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

97605 .... ............ A ........ Neg press wound tx, < 50 cm ............ 0.55 0.40 0.37 0.11 0.17 0.02 XXX 

97606 .... ............ A ........ Neg press wound tx, > 50 cm ............ 0.60 0.41 0.38 0.13 0.18 0.03 XXX 

97750 .... ............ A ........ Physical performance test .................. 0.45 0.33 0.32 NA NA 0.02 XXX 

97755 .... ............ A ........ Assistive technology assess ............... 0.62 0.27 0.28 NA NA 0.02 XXX 

97760 .... ............ A ........ Orthotic mgmt and training ................. 0.45 0.42 0.38 NA NA 0.03 XXX 

97761 .... ............ A ........ Prosthetic training ............................... 0.45 0.33 0.30 NA NA 0.02 XXX 

97762 .... ............ A ........ C/o for orthotic/prosth use .................. 0.25 0.73 0.57 NA NA 0.02 XXX 

97799 .... ............ C ........ Physical medicine procedure .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97802 .... ............ A ........ Medical nutrition, indiv, in ................... 0.45 0.14 0.30 0.11 0.29 0.01 XXX 

97803 .... ............ A ........ Med nutrition, indiv, subseq ................ 0.37 0.12 0.29 0.09 0.28 0.01 XXX 

97804 .... ............ A ........ Medical nutrition, group ...................... 0.25 0.08 0.13 0.07 0.12 0.01 XXX 

97810 .... ............ N ........ Acupunct w/o stimul 15 min ................ 0.60 0.26 0.32 0.14 0.18 0.03 XXX 

97811 .... ............ N ........ Acupunct w/o stimul addl 15m ............ 0.50 0.15 0.20 0.11 0.15 0.03 ZZZ 

97813 .... ............ N ........ Acupunct w/stimul 15 min ................... 0.65 0.27 0.33 0.15 0.20 0.03 XXX 

97814 .... ............ N ........ Acupunct w/stimul addl 15m ............... 0.55 0.19 0.24 0.13 0.17 0.03 ZZZ 

98925 .... ............ A ........ Osteopathic manipulation ................... 0.45 0.29 0.30 0.12 0.13 0.02 000 

98926 .... ............ A ........ Osteopathic manipulation ................... 0.65 0.37 0.39 0.17 0.21 0.03 000 

98927 .... ............ A ........ Osteopathic manipulation ................... 0.87 0.45 0.47 0.22 0.26 0.03 000 

98928 .... ............ A ........ Osteopathic manipulation ................... 1.03 0.51 0.55 0.26 0.30 0.04 000 

98929 .... ............ A ........ Osteopathic manipulation ................... 1.19 0.57 0.62 0.30 0.33 0.05 000 

98940 .... ............ A ........ Chiropractic manipulation ................... 0.45 0.21 0.22 0.12 0.12 0.01 000 

98941 .... ............ A ........ Chiropractic manipulation ................... 0.65 0.27 0.29 0.17 0.17 0.01 000 

98942 .... ............ A ........ Chiropractic manipulation ................... 0.87 0.33 0.35 0.24 0.23 0.02 000 

98943 .... ............ N ........ Chiropractic manipulation ................... 0.40 0.17 0.21 0.09 0.13 0.01 XXX 

98960 .... ............ B ........ Self-mgmt educ & train, 1 pt ............... 0.00 0.58 0.58 NA NA 0.01 XXX 

98961 .... ............ B ........ Self-mgmt educ/train, 2–4 pt .............. 0.00 0.28 0.28 NA NA 0.01 XXX 

98962 .... ............ B ........ Self-mgmt educ/train, 5–8 pt .............. 0.00 0.20 0.20 NA NA 0.01 XXX 

98966 .... ............ N ........ Hc pro phone call 5–10 min ............... 0.25 0.09 0.09 0.06 0.06 0.01 XXX 

98967 .... ............ N ........ Hc pro phone call 11–20 min ............. 0.50 0.14 0.14 0.11 0.11 0.02 XXX 

98968 .... ............ N ........ Hc pro phone call 21–30 min ............. 0.75 0.20 0.20 0.17 0.17 0.03 XXX 

98969 .... ............ N ........ Online service by hc pro ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

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 service ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99027 .... ............ N ........ Out-of-hosp on call service ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99050 .... ............ B ........ Medical services after hrs ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99051 .... ............ B ........ Med serv, eve/wkend/holiday ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99053 .... ............ B ........ Med serv 10pm-8am, 24 hr fac .......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99056 .... ............ B ........ Med service out of office .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99058 .... ............ B ........ Office emergency care ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99060 .... ............ B ........ Out of office emerg med serv ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99070 .... ............ B ........ Special supplies .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99071 .... ............ B ........ Patient education materials ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

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 forms ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99082 .... ............ C ........ Unusual physician travel ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99090 .... ............ B ........ Computer data analysis ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99091 .... ............ B ........ Collect/review data from pt ................. 1.10 0.25 0.25 NA NA 0.04 XXX 

99100 .... ............ B ........ Special anesthesia service ................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99116 .... ............ B ........ Anesthesia with hypothermia .............. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99135 .... ............ B ........ Special anesthesia procedure ............ 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99140 .... ............ B ........ Emergency anesthesia ....................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99143 .... ............ C ........ Mod cs by same phys, < 5 yrs ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99144 .... ............ C ........ Mod cs by same phys, 5 yrs + ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99145 .... ............ C ........ Mod cs by same phys add-on ............ 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99148 .... ............ C ........ Mod cs diff phys < 5 yrs ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99149 .... ............ C ........ Mod cs diff phys 5 yrs + ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99150 .... ............ C ........ Mod cs diff phys add-on ..................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99170 .... ............ A ........ Anogenital exam, child ........................ 1.75 1.83 1.80 0.61 0.58 0.08 000 

99172 .... ............ N ........ Ocular function screen ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99173 .... ............ N ........ Visual acuity screen ............................ 0.00 0.06 0.06 NA NA 0.01 XXX 

99174 .... ............ N ........ Ocular photoscreening ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99175 .... ............ A ........ Induction of vomiting ........................... 0.00 0.36 0.87 NA NA 0.10 XXX 

99183 .... ............ A ........ Hyperbaric oxygen therapy ................. 2.34 2.60 2.92 0.57 0.65 0.16 XXX 

99185 .... ............ A ........ Regional hypothermia ......................... 0.00 1.67 1.15 NA NA 0.04 XXX 

99186 .... ............ A ........ Total body hypothermia ...................... 0.00 1.63 1.70 NA NA 0.45 XXX 

99190 .... ............ X ........ Special pump services ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99191 .... ............ X ........ Special pump services ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99192 .... ............ X ........ Special pump services ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 


cprice-sewell on PROD1PC72 with RULES
66538 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

99195 .... ............ A ........ Phlebotomy ......................................... 0.00 2.56 1.50 NA NA 0.02 XXX 

99199 .... ............ C ........ Special service/proc/report ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99201 .... ............ A ........ Office/outpatient visit, new .................. 0.45 0.55 0.52 0.16 0.15 0.03 XXX 

99202 .... ............ A ........ Office/outpatient visit, new .................. 0.88 0.84 0.81 0.29 0.30 0.05 XXX 

99203 .... ............ A ........ Office/outpatient visit, new .................. 1.34 1.11 1.12 0.43 0.45 0.09 XXX 

99204 .... ............ A ........ Office/outpatient visit, new .................. 2.30 1.49 1.49 0.71 0.71 0.12 XXX 

99205 .... ............ A ........ Office/outpatient visit, new .................. 3.00 1.78 1.78 0.91 0.93 0.15 XXX 

99211 .... ............ A ........ Office/outpatient visit, est .................... 0.17 0.32 0.36 0.06 0.06 0.01 XXX 

99212 .... ............ A ........ Office/outpatient visit, est .................... 0.45 0.55 0.55 0.15 0.15 0.03 XXX 

99213 .... ............ A ........ Office/outpatient visit, est .................... 0.92 0.76 0.72 0.28 0.26 0.03 XXX 

99214 .... ............ A ........ Office/outpatient visit, est .................... 1.42 1.10 1.06 0.44 0.42 0.05 XXX 

99215 .... ............ A ........ Office/outpatient visit, est .................... 2.00 1.38 1.35 0.61 0.63 0.08 XXX 

99217 .... ............ A ........ Observation care discharge ................ 1.28 NA NA 0.50 0.51 0.06 XXX 

99218 .... ............ A ........ Observation care ................................. 1.28 NA NA 0.38 0.41 0.06 XXX 

99219 .... ............ A ........ Observation care ................................. 2.14 NA NA 0.59 0.65 0.10 XXX 

99220 .... ............ A ........ Observation care ................................. 2.99 NA NA 0.84 0.93 0.14 XXX 

99221 .... ............ A ........ Initial hospital care .............................. 1.88 NA NA 0.54 0.50 0.07 XXX 

99222 .... ............ A ........ Initial hospital care .............................. 2.56 NA NA 0.71 0.72 0.10 XXX 

99223 .... ............ A ........ Initial hospital care .............................. 3.78 NA NA 1.07 1.05 0.13 XXX 

99231 .... ............ A ........ Subsequent hospital care ................... 0.76 NA NA 0.24 0.23 0.03 XXX 

99232 .... ............ A ........ Subsequent hospital care ................... 1.39 NA NA 0.42 0.40 0.04 XXX 

99233 .... ............ A ........ Subsequent hospital care ................... 2.00 NA NA 0.59 0.56 0.06 XXX 

99234 .... ............ A ........ Observ/hosp same date ...................... 2.56 NA NA 0.78 0.83 0.13 XXX 

99235 .... ............ A ........ Observ/hosp same date ...................... 3.41 NA NA 0.98 1.06 0.16 XXX 

99236 .... ............ A ........ Observ/hosp same date ...................... 4.26 NA NA 1.21 1.32 0.19 XXX 

99238 .... ............ A ........ Hospital discharge day ....................... 1.28 NA NA 0.49 0.52 0.05 XXX 

99239 .... ............ A ........ Hospital discharge day ....................... 1.90 NA NA 0.67 0.70 0.07 XXX 

99241 .... ............ A ........ Office consultation .............................. 0.64 0.66 0.65 0.22 0.22 0.05 XXX 

99242 .... ............ A ........ Office consultation .............................. 1.34 1.08 1.06 0.48 0.47 0.10 XXX 

99243 .... ............ A ........ Office consultation .............................. 1.88 1.45 1.42 0.67 0.65 0.13 XXX 

99244 .... ............ A ........ Office consultation .............................. 3.02 1.93 1.88 1.08 1.00 0.16 XXX 

99245 .... ............ A ........ Office consultation .............................. 3.77 2.26 2.27 1.31 1.27 0.21 XXX 

99251 .... ............ A ........ Inpatient consultation .......................... 1.00 NA NA 0.31 0.27 0.05 XXX 

99252 .... ............ A ........ Inpatient consultation .......................... 1.50 NA NA 0.49 0.49 0.09 XXX 

99253 .... ............ A ........ Inpatient consultation .......................... 2.27 NA NA 0.80 0.74 0.11 XXX 

99254 .... ............ A ........ Inpatient consultation .......................... 3.29 NA NA 1.18 1.08 0.13 XXX 

99255 .... ............ A ........ Inpatient consultation .......................... 4.00 NA NA 1.38 1.36 0.18 XXX 

99281 .... ............ A ........ Emergency dept visit .......................... 0.45 NA NA 0.09 0.09 0.02 XXX 

99282 .... ............ A ........ Emergency dept visit .......................... 0.88 NA NA 0.17 0.15 0.04 XXX 

99283 .... ............ A ........ Emergency dept visit .......................... 1.34 NA NA 0.25 0.28 0.09 XXX 

99284 .... ............ A ........ Emergency dept visit .......................... 2.56 NA NA 0.46 0.47 0.14 XXX 

99285 .... ............ A ........ Emergency dept visit .......................... 3.80 NA NA 0.67 0.69 0.23 XXX 

99288 .... ............ B ........ Direct advanced life support ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99289 .... ............ A ........ Ped crit care transport ........................ 4.79 NA NA 1.08 1.26 0.24 XXX 

99290 .... ............ A ........ Ped crit care transport addl ................ 2.40 NA NA 0.89 0.85 0.12 ZZZ 

99291 .... ............ A ........ Critical care, first hour ......................... 4.50 2.26 2.41 1.10 1.19 0.21 XXX 

99292 .... ............ A ........ Critical care, add’l 30 min ................... 2.25 0.80 0.85 0.56 0.60 0.11 ZZZ 

99293 .... ............ A ........ Ped critical care, initial ........................ 15.98 NA NA 3.78 4.26 1.12 XXX 

99294 .... ............ A ........ Ped critical care, subseq .................... 7.99 NA NA 1.65 2.03 0.45 XXX 

99295 .... ............ A ........ Neonate crit care, initial ...................... 18.46 NA NA 4.56 4.97 1.16 XXX 

99296 .... ............ A ........ Neonate critical care subseq .............. 7.99 NA NA 2.06 2.30 0.32 XXX 

99298 .... ............ A ........ Ic for lbw infant < 1500 gm ................. 2.75 NA NA 0.68 0.80 0.17 XXX 

99299 .... ............ A ........ Ic, lbw infant 1500–2500 gm .............. 2.50 NA NA 0.58 0.72 0.16 XXX 

99300 .... ............ A ........ Ic, infant pbw 2501–5000 gm ............. 2.40 NA NA 0.71 0.77 0.15 XXX 

99304 .... ............ A ........ Nursing facility care, init ...................... 1.61 0.57 0.53 0.57 0.53 0.05 XXX 

99305 .... ............ A ........ Nursing facility care, init ...................... 2.30 0.74 0.68 0.74 0.68 0.07 XXX 

99306 .... ............ A ........ Nursing facility care, init ...................... 3.00 0.90 0.83 0.90 0.83 0.09 XXX 

99307 .... ............ A ........ Nursing fac care, subseq .................... 0.76 0.31 0.29 0.31 0.29 0.03 XXX 

99308 .... ............ A ........ Nursing fac care, subseq .................... 1.16 0.47 0.46 0.47 0.46 0.04 XXX 

99309 .... ............ A ........ Nursing fac care, subseq .................... 1.55 0.61 0.61 0.61 0.61 0.06 XXX 

99310 .... ............ A ........ Nursing fac care, subseq .................... 2.35 0.87 0.82 0.87 0.82 0.08 XXX 

99315 .... ............ A ........ Nursing fac discharge day .................. 1.13 0.41 0.43 0.41 0.43 0.05 XXX 

99316 .... ............ A ........ Nursing fac discharge day .................. 1.50 0.50 0.55 0.50 0.55 0.06 XXX 

99318 .... ............ A ........ Annual nursing fac assessmnt ............ 1.71 0.56 0.53 0.56 0.53 0.05 XXX 

99324 .... ............ A ........ Domicil/r-home visit new pat ............... 1.01 0.43 0.46 NA NA 0.05 XXX 

99325 .... ............ A ........ Domicil/r-home visit new pat ............... 1.52 0.55 0.62 NA NA 0.07 XXX 

99326 .... ............ A ........ Domicil/r-home visit new pat ............... 2.63 0.82 0.87 NA NA 0.10 XXX 

99327 .... ............ A ........ Domicil/r-home visit new pat ............... 3.46 1.02 1.09 NA NA 0.13 XXX 

99328 .... ............ A ........ Domicil/r-home visit new pat ............... 4.09 1.16 1.29 NA NA 0.16 XXX 

99334 .... ............ A ........ Domicil/r-home visit est pat ................ 1.07 0.43 0.41 NA NA 0.04 XXX 

99335 .... ............ A ........ Domicil/r-home visit est pat ................ 1.72 0.59 0.58 NA NA 0.06 XXX 

99336 .... ............ A ........ Domicil/r-home visit est pat ................ 2.46 0.77 0.79 NA NA 0.09 XXX 


cprice-sewell on PROD1PC72 with RULES
66539 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

99337 .... ............ A ........ Domicil/r-home visit est pat ................ 3.58 1.03 1.09 NA NA 0.13 XXX 

99339 .... ............ B ........ Domicil/r-home care supervis ............. 1.25 0.58 0.58 NA NA 0.06 XXX 

99340 .... ............ B ........ Domicil/r-home care supervis ............. 1.80 0.77 0.77 NA NA 0.07 XXX 

99341 .... ............ A ........ Home visit, new patient ...................... 1.01 0.43 0.45 NA NA 0.05 XXX 

99342 .... ............ A ........ Home visit, new patient ...................... 1.52 0.56 0.62 NA NA 0.07 XXX 

99343 .... ............ A ........ Home visit, new patient ...................... 2.53 0.82 0.88 NA NA 0.10 XXX 

99344 .... ............ A ........ Home visit, new patient ...................... 3.38 1.00 1.09 NA NA 0.13 XXX 

99345 .... ............ A ........ Home visit, new patient ...................... 4.09 1.15 1.29 NA NA 0.16 XXX 

99347 .... ............ A ........ Home visit, est patient ........................ 1.00 0.42 0.41 NA NA 0.04 XXX 

99348 .... ............ A ........ Home visit, est patient ........................ 1.56 0.56 0.57 NA NA 0.06 XXX 

99349 .... ............ A ........ Home visit, est patient ........................ 2.33 0.73 0.78 NA NA 0.09 XXX 

99350 .... ............ A ........ Home visit, est patient ........................ 3.28 0.96 1.07 NA NA 0.13 XXX 

99354 .... ............ A ........ Prolonged service, office .................... 1.77 0.65 0.71 0.50 0.58 0.08 ZZZ 

99355 .... ............ A ........ Prolonged service, office .................... 1.77 0.62 0.68 0.47 0.54 0.07 ZZZ 

99356 .... ............ A ........ Prolonged service, inpatient ............... 1.71 NA NA 0.50 0.56 0.07 ZZZ 

99357 .... ............ A ........ Prolonged service, inpatient ............... 1.71 NA NA 0.50 0.56 0.08 ZZZ 

99358 .... ............ B ........ Prolonged serv, w/o contact ............... 2.10 0.51 0.51 0.51 0.51 0.09 ZZZ 

99359 .... ............ B ........ Prolonged serv, w/o contact ............... 1.00 0.26 0.26 0.26 0.26 0.04 ZZZ 

99360 .... ............ X ........ Physician standby services ................. 1.20 0.28 0.28 0.28 0.28 0.05 XXX 

99363 .... ............ B ........ Anticoag mgmt, init ............................. 1.65 1.30 1.30 0.38 0.38 0.07 XXX 

99364 .... ............ B ........ Anticoag mgmt, subseq ...................... 0.63 0.38 0.38 0.14 0.14 0.04 XXX 

99366 .... ............ B ........ Team conf w/pat by hc pro ................. 0.82 0.20 0.20 0.19 0.19 0.06 XXX 

99367 .... ............ B ........ Team conf w/o pat by phys ................ 1.10 0.25 0.25 0.25 0.25 0.05 XXX 

99368 .... ............ B ........ Team conf w/o pat by hc pro .............. 0.72 0.16 0.16 0.16 0.16 0.03 XXX 

99374 .... ............ B ........ Home health care supervision ............ 1.10 0.55 0.62 0.25 0.34 0.05 XXX 

99375 .... ............ I .......... Home health care supervision ............ 1.73 0.75 1.15 0.40 0.97 0.07 XXX 

99377 .... ............ B ........ Hospice care supervision .................... 1.10 0.55 0.62 0.25 0.34 0.05 XXX 

99378 .... ............ I .......... Hospice care supervision .................... 1.73 0.75 1.35 0.40 1.17 0.07 XXX 

99379 .... ............ B ........ Nursing fac care supervision .............. 1.10 0.55 0.62 0.25 0.34 0.04 XXX 

99380 .... ............ B ........ Nursing fac care supervision .............. 1.73 0.75 0.87 0.40 0.53 0.06 XXX 

99381 .... ............ N ........ Init pm e/m, new pat, inf ..................... 1.19 1.00 1.25 0.27 0.36 0.05 XXX 

99382 .... ............ N ........ Init pm e/m, new pat 1–4 yrs .............. 1.36 1.04 1.29 0.31 0.42 0.05 XXX 

99383 .... ............ N ........ Prev visit, new, age 5–11 ................... 1.36 1.03 1.25 0.31 0.42 0.05 XXX 

99384 .... ............ N ........ Prev visit, new, age 12–17 ................. 1.53 1.07 1.31 0.35 0.47 0.06 XXX 

99385 .... ............ N ........ Prev visit, new, age 18–39 ................. 1.53 1.07 1.31 0.35 0.47 0.06 XXX 

99386 .... ............ N ........ Prev visit, new, age 40–64 ................. 1.88 1.15 1.45 0.43 0.58 0.07 XXX 

99387 .... ............ N ........ Init pm e/m, new pat 65+ yrs .............. 2.06 1.28 1.58 0.47 0.63 0.07 XXX 

99391 .... ............ N ........ Per pm reeval, est pat, inf .................. 1.02 0.86 0.94 0.23 0.31 0.04 XXX 

99392 .... ............ N ........ Prev visit, est, age 1–4 ....................... 1.19 0.90 0.99 0.27 0.36 0.05 XXX 

99393 .... ............ N ........ Prev visit, est, age 5–11 ..................... 1.19 0.89 0.98 0.27 0.36 0.05 XXX 

99394 .... ............ N ........ Prev visit, est, age 12–17 ................... 1.36 0.93 1.03 0.31 0.42 0.05 XXX 

99395 .... ............ N ........ Prev visit, est, age 18–39 ................... 1.36 0.94 1.05 0.31 0.42 0.05 XXX 

99396 .... ............ N ........ Prev visit, est, age 40–64 ................... 1.53 0.98 1.11 0.35 0.47 0.06 XXX 

99397 .... ............ N ........ Per pm reeval est pat 65+ yr .............. 1.71 1.12 1.24 0.39 0.53 0.06 XXX 

99401 .... ............ N ........ Preventive counseling, indiv ............... 0.48 0.36 0.49 0.11 0.15 0.01 XXX 

99402 .... ............ N ........ Preventive counseling, indiv ............... 0.98 0.48 0.67 0.22 0.30 0.02 XXX 

99403 .... ............ N ........ Preventive counseling, indiv ............... 1.46 0.59 0.84 0.34 0.45 0.04 XXX 

99404 .... ............ N ........ Preventive counseling, indiv ............... 1.95 0.70 1.01 0.45 0.60 0.05 XXX 

99406 .... ............ A ........ Behav chng smoking 3–10 min .......... 0.24 0.11 0.10 0.07 0.08 0.01 XXX 

99407 .... ............ A ........ Behav chng smoking < 10 min ........... 0.50 0.18 0.18 0.13 0.15 0.01 XXX 

99408 .... ............ N ........ Audit/dast, 15–30 min ......................... 0.65 0.19 0.19 0.15 0.15 0.01 XXX 

99409 .... ............ N ........ Audit/dast, over 30 min ....................... 1.30 0.34 0.34 0.30 0.30 0.03 XXX 

99411 .... ............ N ........ Preventive counseling, group ............. 0.15 0.22 0.20 0.03 0.05 0.01 XXX 

99412 .... ............ N ........ Preventive counseling, group ............. 0.25 0.24 0.25 0.06 0.08 0.01 XXX 

99420 .... ............ N ........ Health risk assessment test ................ 0.00 0.22 0.22 NA NA 0.01 XXX 

99429 .... ............ N ........ Unlisted preventive service ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99431 .... ............ A ........ Initial care, normal newborn ............... 1.17 NA NA 0.27 0.32 0.05 XXX 

99432 .... ............ A ........ Newborn care, not in hosp ................. 1.26 1.01 0.97 0.29 0.34 0.07 XXX 

99433 .... ............ A ........ Normal newborn care/hospital ............ 0.62 NA NA 0.17 0.19 0.02 XXX 

99435 .... ............ A ........ Newborn discharge day hosp ............. 1.50 NA NA 0.50 0.54 0.06 XXX 

99436 .... ............ A ........ Attendance, birth ................................. 1.50 NA NA 0.33 0.40 0.06 XXX 

99440 .... ............ A ........ Newborn resuscitation ........................ 2.93 NA NA 0.67 0.80 0.12 XXX 

99441 .... ............ N ........ Phone e/m by phys 5–10 min ............. 0.25 0.09 0.09 0.06 0.06 0.02 XXX 

99442 .... ............ N ........ Phone e/m by phys 11–20 min ........... 0.50 0.14 0.14 0.11 0.11 0.02 XXX 

99443 .... ............ N ........ Phone e/m by phys 21–30 min ........... 0.75 0.20 0.20 0.17 0.17 0.03 XXX 

99444 .... ............ N ........ Online e/m by phys ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99450 .... ............ N ........ Basic life disability exam ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99455 .... ............ R ........ Work related disability exam ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99456 .... ............ R ........ Disability examination ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99477 .... ............ A ........ Init day hosp neonate care ................. 7.00 1.98 1.98 1.98 1.98 0.32 XXX 

99499 .... ............ C ........ Unlisted e&m service .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99500 .... ............ I .......... Home visit, prenatal ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 


cprice-sewell on PROD1PC72 with RULES
66540 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

99501 .... ............ I .......... Home visit, postnatal .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99502 .... ............ I .......... Home visit, nb care ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99503 .... ............ I .......... Home visit, resp therapy ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99504 .... ............ I .......... Home visit mech ventilator ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99505 .... ............ I .......... Home visit, stoma care ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99506 .... ............ I .......... Home visit, im injection ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99507 .... ............ I .......... Home visit, cath maintain ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99509 .... ............ I .......... Home visit day life activity .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99510 .... ............ I .......... Home visit, sing/m/fam couns ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99511 .... ............ I .......... Home visit, fecal/enema mgmt ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99512 .... ............ I .......... Home visit for hemodialysis ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99600 .... ............ I .......... Home visit nos .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99601 .... ............ I .......... Home infusion/visit, 2 hrs ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99602 .... ............ I .......... Home infusion, each addtl hr .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99605 .... ............ X ........ Mtms by pharm, np, 15 min ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99606 .... ............ X ........ Mtms by pharm, est, 15 min ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99607 .... ............ X ........ Mtms by pharm, addl 15 min .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

A4890 .... ............ R ........ Repair/maint cont hemo equip ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0008 ... ............ X ........ Admin influenza virus vac ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0009 ... ............ X ........ Admin pneumococcal vaccine ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0010 ... ............ X ........ Admin hepatitis b vaccine ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0027 ... ............ X ........ Semen analysis ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0101 ... ............ A ........ CA screen;pelvic/breast exam ............ 0.45 0.48 0.50 NA NA 0.02 XXX 

G0102 ... ............ A ........ Prostate ca screening; dre .................. 0.17 0.32 0.36 0.06 0.06 0.01 XXX 

G0103 ... ............ X ........ PSA screening .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0104 ... ............ A ........ CA screen;flexi sigmoidscope ............. 0.96 2.52 2.40 0.62 0.56 0.08 000 

G0105 ... ............ A ........ Colorectal scrn; hi risk ind .................. 3.69 6.38 6.26 1.82 1.64 0.30 000 

G0105 ... 53 ....... A ........ Colorectal scrn; hi risk ind .................. 0.96 2.52 2.40 0.62 0.56 0.08 000 

G0106 ... ............ A ........ Colon CA screen;barium enema ........ 0.99 4.94 3.74 NA NA 0.17 XXX 

G0106 ... TC ...... A ........ Colon CA screen;barium enema ........ 0.00 4.59 3.41 NA NA 0.13 XXX 

G0106 ... 26 ....... A ........ Colon CA screen;barium enema ........ 0.99 0.35 0.33 0.35 0.33 0.04 XXX 

G0108 ... ............ A ........ Diab manage trn per indiv .................. 0.00 0.59 0.71 NA NA 0.01 XXX 

G0109 ... ............ A ........ Diab manage trn ind/group ................. 0.00 0.31 0.40 NA NA 0.01 XXX 

G0117 ... ............ T ......... Glaucoma scrn hgh risk direc ............. 0.45 0.76 0.74 NA NA 0.01 XXX 

G0118 ... ............ T ......... Glaucoma scrn hgh risk direc ............. 0.17 0.71 0.62 NA NA 0.01 XXX 

G0120 ... ............ A ........ Colon ca scrn; barium enema ............ 0.99 4.94 3.74 NA NA 0.17 XXX 

G0120 ... TC ...... A ........ Colon ca scrn; barium enema ............ 0.00 4.59 3.41 NA NA 0.13 XXX 

G0120 ... 26 ....... A ........ Colon ca scrn; barium enema ............ 0.99 0.35 0.33 0.35 0.33 0.04 XXX 

G0121 ... ............ A ........ Colon ca scrn not hi rsk ind ................ 3.69 6.38 6.26 1.82 1.64 0.30 000 

G0121 ... 53 ....... A ........ Colon ca scrn not hi rsk ind ................ 0.96 2.52 2.40 0.62 0.56 0.08 000 

G0122 ... ............ N ........ Colon ca scrn; barium enema ............ 0.99 5.64 4.10 NA NA 0.18 XXX 

G0122 ... TC ...... N ........ Colon ca scrn; barium enema ............ 0.00 5.41 3.80 NA NA 0.13 XXX 

G0122 ... 26 ....... N ........ Colon ca scrn; barium enema ............ 0.99 0.23 0.30 0.23 0.30 0.05 XXX 

G0123 ... ............ X ........ Screen cerv/vag thin layer .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0124 ... ............ A ........ Screen c/v thin layer by MD ............... 0.42 0.38 0.26 0.38 0.26 0.02 XXX 

G0127 ... ............ R ........ Trim nail(s) .......................................... 0.17 0.38 0.32 0.04 0.06 0.01 000 

G0128 ... ............ R ........ CORF skilled nursing service ............. 0.08 0.02 0.02 0.02 0.02 0.01 XXX 

G0130 ... ............ A ........ Single energy x-ray study ................... 0.22 0.55 0.71 NA NA 0.06 XXX 

G0130 ... TC ...... A ........ Single energy x-ray study ................... 0.00 0.49 0.64 NA NA 0.05 XXX 

G0130 ... 26 ....... A ........ Single energy x-ray study ................... 0.22 0.06 0.07 0.06 0.07 0.01 XXX 

G0141 ... ............ A ........ Scr c/v cyto,autosys and md .............. 0.42 0.38 0.26 0.38 0.26 0.02 XXX 

G0143 ... ............ X ........ Scr c/v cyto,thinlayer,rescr .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0144 ... ............ X ........ Scr c/v cyto,thinlayer,rescr .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0145 ... ............ X ........ Scr c/v cyto,thinlayer,rescr .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0147 ... ............ X ........ Scr c/v cyto, automated sys ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0148 ... ............ X ........ Scr c/v cyto, autosys, rescr ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0166 ... ............ A ........ Extrnl counterpulse, per tx .................. 0.07 4.50 4.03 NA NA 0.01 XXX 

G0168 ... ............ A ........ Wound closure by adhesive ............... 0.45 1.58 1.76 0.21 0.21 0.03 000 

G0173 ... ............ X ........ Linear acc stereo radsur com ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0175 ... ............ X ........ OPPS Service,sched team conf ......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0176 ... ............ X ........ OPPS/PHP;activity therapy ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0177 ... ............ X ........ OPPS/PHP; train & educ serv ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0179 ... ............ A ........ MD recertification HHA PT ................. 0.45 0.48 0.75 NA NA 0.02 XXX 

G0180 ... ............ A ........ MD certification HHA patient .............. 0.67 0.56 0.91 NA NA 0.03 XXX 

G0181 ... ............ A ........ Home health care supervision ............ 1.73 0.80 1.14 NA NA 0.07 XXX 

G0182 ... ............ A ........ Hospice care supervision .................... 1.73 0.82 1.24 NA NA 0.07 XXX 

G0186 ... ............ C ........ Dstry eye lesn,fdr vssl tech ................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

G0202 ... ............ A ........ Screeningmammographydigital ........... 0.70 2.80 2.78 NA NA 0.10 XXX 

G0202 ... TC ...... A ........ Screeningmammographydigital ........... 0.00 2.56 2.55 NA NA 0.07 XXX 

G0202 ... 26 ....... A ........ Screeningmammographydigital ........... 0.70 0.24 0.23 0.24 0.23 0.03 XXX 

G0204 ... ............ A ........ Diagnosticmammographydigital .......... 0.87 3.40 3.09 NA NA 0.11 XXX 

G0204 ... TC ...... A ........ Diagnosticmammographydigital .......... 0.00 3.10 2.80 NA NA 0.07 XXX 


cprice-sewell on PROD1PC72 with RULES
66541 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

G0204 ... 26 ....... A ........ Diagnosticmammographydigital .......... 0.87 0.30 0.29 0.30 0.29 0.04 XXX 

G0206 ... ............ A ........ Diagnosticmammographydigital .......... 0.70 2.66 2.45 NA NA 0.09 XXX 

G0206 ... TC ...... A ........ Diagnosticmammographydigital .......... 0.00 2.42 2.22 NA NA 0.06 XXX 

G0206 ... 26 ....... A ........ Diagnosticmammographydigital .......... 0.70 0.24 0.23 0.24 0.23 0.03 XXX 

G0219 ... ............ N ........ PET img wholbod melano nonco ........ 0.00 0.00 0.00 NA NA 0.00 XXX 

G0219 ... TC ...... N ........ PET img wholbod melano nonco ........ 0.00 0.00 0.00 NA NA 0.00 XXX 

G0219 ... 26 ....... N ........ PET img wholbod melano nonco ........ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0235 ... ............ N ........ PET not otherwise specified ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

G0235 ... TC ...... N ........ PET not otherwise specified ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

G0235 ... 26 ....... N ........ PET not otherwise specified ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0237 ... ............ A ........ Therapeutic procd strg endur ............. 0.00 0.21 0.34 NA NA 0.02 XXX 

G0238 ... ............ A ........ Oth resp proc, indiv ............................ 0.00 0.23 0.36 NA NA 0.02 XXX 

G0239 ... ............ A ........ Oth resp proc, group ........................... 0.00 0.31 0.32 NA NA 0.02 XXX 

G0245 ... ............ R ........ Initial foot exam pt lops ....................... 0.88 0.84 0.81 0.29 0.30 0.04 XXX 

G0246 ... ............ R ........ Followup eval of foot pt lop ................ 0.45 0.55 0.55 0.15 0.15 0.02 XXX 

G0247 ... ............ R ........ Routine footcare pt w lops .................. 0.50 0.68 0.60 0.16 0.18 0.02 ZZZ 

G0248 ... ............ R ........ Demonstrate use home inr mon ......... 0.00 3.40 5.00 NA NA 0.01 XXX 

G0249 ... ............ R ........ Provide test material,equipm .............. 0.00 3.40 3.68 NA NA 0.01 XXX 

G0250 ... ............ R ........ MD review interpret of test ................. 0.18 0.08 0.07 NA NA 0.01 XXX 

G0251 ... ............ E ........ Linear acc based stero radio .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0252 ... ............ N ........ PET imaging initial dx ......................... 0.00 0.00 0.00 NA NA 0.00 XXX 

G0252 ... TC ...... N ........ PET imaging initial dx ......................... 0.00 0.00 0.00 NA NA 0.00 XXX 

G0252 ... 26 ....... N ........ PET imaging initial dx ......................... 1.50 0.00 0.60 0.00 0.60 0.04 XXX 

G0255 ... ............ N ........ Current percep threshold tst ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

G0255 ... TC ...... N ........ Current percep threshold tst ............... 0.00 0.00 0.00 NA NA 0.00 XXX 

G0255 ... 26 ....... N ........ Current percep threshold tst ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0257 ... ............ E ........ Unsched dialysis ESRD pt hos ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0259 ... ............ E ........ Inject for sacroiliac joint ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0260 ... ............ E ........ Inj for sacroiliac jt anesth .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0268 ... ............ A ........ Removal of impacted wax md ............ 0.61 0.66 0.65 0.20 0.22 0.02 000 

G0269 ... ............ B ........ Occlusive device in vein art ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0270 ... ............ A ........ MNT subs tx for change dx ................ 0.37 0.12 0.29 0.09 0.28 0.01 XXX 

G0271 ... ............ A ........ Group MNT 2 or more 30 mins .......... 0.25 0.08 0.13 0.07 0.12 0.01 XXX 

G0275 ... ............ A ........ Renal angio, cardiac cath ................... 0.25 NA NA 0.13 0.12 0.01 ZZZ 

G0278 ... ............ A ........ Iliac art angio,cardiac cath .................. 0.25 NA NA 0.13 0.12 0.01 ZZZ 

G0281 ... ............ A ........ Elec stim unattend for press ............... 0.18 0.14 0.12 NA NA 0.01 XXX 

G0282 ... ............ N ........ Elect stim wound care not pd ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0283 ... ............ A ........ Elec stim other than wound ................ 0.18 0.14 0.12 NA NA 0.01 XXX 

G0288 ... ............ A ........ Recon, CTA for surg plan ................... 0.00 1.03 5.82 NA NA 0.18 XXX 

G0289 ... ............ A ........ Arthro, loose body + chondro ............. 1.48 NA NA 0.58 0.69 0.26 ZZZ 

G0290 ... ............ E ........ Drug-eluting stents, single .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0291 ... ............ E ........ Drug-eluting stents,each add .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0293 ... ............ E ........ Non-cov surg proc,clin trial ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0294 ... ............ E ........ Non-cov proc, clinical trial ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0295 ... ............ N ........ Electromagnetic therapy onc .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0297 ... ............ X ........ Insert single chamber/cd ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0300 ... ............ X ........ Insert reposit lead dual+gen ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0302 ... ............ X ........ Pre-op service LVRS complete .......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0303 ... ............ X ........ Pre-op service LVRS 10–15dos ......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0304 ... ............ X ........ Pre-op service LVRS 1–9 dos ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0305 ... ............ X ........ Post op service LVRS min 6 .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0306 ... ............ X ........ CBC/diffwbc w/o platelet ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0307 ... ............ X ........ CBC without platelet ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0308 ... ............ A ........ ESRD related svc 4+mo < 2yrs .......... 12.74 5.57 7.05 5.57 7.05 0.42 XXX 

G0309 ... ............ A ........ ESRD related svc 2–3mo <2yrs ......... 10.61 4.16 5.63 4.16 5.63 0.36 XXX 

G0310 ... ............ A ........ ESRD related svc 1 vst <2yrs ............ 8.49 2.78 4.23 2.78 4.23 0.28 XXX 

G0311 ... ............ A ........ ESRD related svs 4+mo 2–11yr ......... 9.73 3.54 4.13 3.54 4.13 0.34 XXX 

G0312 ... ............ A ........ ESRD relate svs 2–3 mo 2–11y ......... 8.11 2.70 3.31 2.70 3.31 0.29 XXX 

G0313 ... ............ A ........ ESRD related svs 1 mon 2–11y ......... 6.49 1.83 2.49 1.83 2.49 0.22 XXX 

G0314 ... ............ A ........ ESRD related svs 4+ mo 12–19 ......... 8.28 3.39 3.90 3.39 3.90 0.27 XXX 

G0315 ... ............ A ........ ESRD related svs 2–3mo/12–19 ........ 6.90 2.56 3.11 2.56 3.11 0.23 XXX 

G0316 ... ............ A ........ ESRD related svs 1vis/12–19y ........... 5.52 1.66 2.30 1.66 2.30 0.17 XXX 

G0317 ... ............ A ........ ESRD related svs 4+mo 20+yrs ......... 5.09 2.25 2.55 2.25 2.55 0.17 XXX 

G0318 ... ............ A ........ ESRD related svs 2–3 mo 20+y ......... 4.24 1.69 2.04 1.69 2.04 0.14 XXX 

G0319 ... ............ A ........ ESRD related svs 1visit 20+y ............. 3.39 1.13 1.52 1.13 1.52 0.11 XXX 

G0320 ... ............ A ........ ESD related svs home undr 2 ............ 10.61 2.68 4.89 2.68 4.89 0.36 XXX 

G0321 ... ............ A ........ ESRDrelatedsvs home mo 2–11y ...... 8.11 1.99 2.95 1.99 2.95 0.29 XXX 

G0322 ... ............ A ........ ESRD related svs hom mo12–19 ....... 6.90 1.71 2.69 1.71 2.69 0.23 XXX 

G0323 ... ............ A ........ ESRD related svs home mo 20+ ........ 4.24 1.14 1.76 1.14 1.76 0.14 XXX 

G0324 ... ............ A ........ ESRD relate svs home/dy <2yr .......... 0.35 0.16 0.20 0.16 0.20 0.01 XXX 

G0325 ... ............ A ........ ESRD relate home/day/ 2–11yr .......... 0.23 0.09 0.10 0.09 0.10 0.01 XXX 

G0326 ... ............ A ........ ESRD relate home/dy 12–19yr ........... 0.27 0.10 0.11 0.10 0.11 0.01 XXX 


cprice-sewell on PROD1PC72 with RULES
66542 

——————————

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not used for Medicare 

payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

G0327 ... ............ A ........ ESRD relate home/dy 20+yrs ............. 0.14 0.06 0.07 0.06 0.07 0.01 XXX 

G0328 ... ............ X ........ Fecal blood scrn immunoassay .......... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0329 ... ............ A ........ Electromagntic tx for ulcers ................ 0.06 0.15 0.14 NA NA 0.01 XXX 

G0332 ... ............ A ........ Preadmin IV immunoglobulin .............. 0.00 0.00 1.97 NA NA 0.00 XXX 

G0333 ... ............ X ........ Dispense fee initial 30 day ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0337 ... ............ X ........ Hospice evaluation preelecti ............... 1.34 0.31 0.41 0.31 0.41 0.09 XXX 

G0339 ... ............ C ........ Robot lin-radsurg com, first ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0340 ... ............ C ........ Robt lin-radsurg fractx 2–5 ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0341 ... ............ A ........ Percutaneous islet celltrans ................ 6.98 NA NA 2.35 2.47 0.48 000 

G0342 ... ............ A ........ Laparoscopy islet cell trans ................ 11.92 NA NA 5.06 5.18 1.46 090 

G0343 ... ............ A ........ Laparotomy islet cell transp ................ 19.85 NA NA 8.54 8.65 2.07 090 

G0344 ... ............ A ........ Initial preventive exam ........................ 1.34 1.11 1.12 0.43 0.45 0.10 XXX 

G0364 ... ............ A ........ Bone marrow aspirate &biopsy ........... 0.16 0.16 0.15 0.07 0.06 0.04 ZZZ 

G0365 ... ............ A ........ Vessel mapping hemo access ............ 0.25 5.21 4.61 NA NA 0.25 XXX 

G0365 ... TC ...... A ........ Vessel mapping hemo access ............ 0.00 5.15 4.53 NA NA 0.23 XXX 

G0365 ... 26 ....... A ........ Vessel mapping hemo access ............ 0.25 0.06 0.08 0.06 0.08 0.02 XXX 

G0366 ... ............ A ........ EKG for initial prevent exam ............... 0.17 0.35 0.42 NA NA 0.03 XXX 

G0367 ... ............ A ........ EKG tracing for initial prev .................. 0.00 0.28 0.36 NA NA 0.02 XXX 

G0368 ... ............ A ........ EKG interpret & report preve .............. 0.17 0.07 0.06 0.07 0.06 0.01 XXX 

G0372 ... ............ A ........ MD service required for PMD ............. 0.17 0.04 0.22 0.04 0.05 0.01 XXX 

G0377 ... ............ X ........ Administra Part D vaccine .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0378 ... ............ X ........ Hospital observation per hr ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0379 ... ............ X ........ Direct admit hospital observ ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0389 ... ............ A ........ Ultrasound exam AAA screen ............ 0.58 2.41 2.41 NA NA 0.11 XXX 

G0389 ... TC ...... A ........ Ultrasound exam AAA screen ............ 0.00 2.21 2.21 NA NA 0.08 XXX 

G0389 ... 26 ....... A ........ Ultrasound exam AAA screen ............ 0.58 0.20 0.20 0.20 0.20 0.03 XXX 

G0392 ... ............ A ........ AV fistula or graft arterial .................... 9.48 48.63 48.63 NA NA 0.62 000 

G0393 ... ............ A ........ AV fistula or graft venous ................... 6.03 37.11 37.11 NA NA 0.34 000 

G0394 ... ............ X ........ Blood occult test,colorectal ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0396 ... ............ A ........ Alcohol/subs interv 15–30mn .............. 0.65 0.19 0.19 0.15 0.15 0.01 XXX 

G0397 ... ............ A ........ Alcohol/subs interv >30 min ................ 1.30 0.34 0.34 0.29 0.29 0.03 XXX 

G3001 ... ............ X ........ Admin + supply, tositumomab ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

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, initial ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9004 ... ............ X ........ MCCD, risk adj lo, initial ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9005 ... ............ X ........ MCCD, risk adj, maintenance ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

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 ovrsght .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9009 ... ............ X ........ MCCD, risk adj, level 3 ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9010 ... ............ X ........ MCCD, risk adj, level 4 ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9011 ... ............ X ........ MCCD, risk adj, level 5 ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9012 ... ............ X ........ Other Specified Case Mgmt ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9013 ... ............ N ........ ESRD demo bundle level I ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9014 ... ............ N ........ ESRD demo bundle-level II ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9016 ... ............ N ........ Demo-smoking cessation coun ........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9017 ... ............ X ........ Amantadine HCL 100mg oral ............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9018 ... ............ X ........ Zanamivir,inhalation pwd 10m ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9019 ... ............ X ........ Oseltamivir phosphate 75mg .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9020 ... ............ X ........ Rimantadine HCL 100mg oral ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9033 ... ............ X ........ Amantadine HCL oral brand ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9034 ... ............ X ........ Zanamivir, inh pwdr, brand ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9035 ... ............ X ........ Oseltamivir phosp, brand .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9036 ... ............ X ........ Rimantadine HCL, brand .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9041 ... ............ A ........ Low vision rehab occupationa ............ 0.44 0.10 0.20 0.10 0.20 0.01 XXX 

G9042 ... ............ A ........ Low vision rehab orient/mobi .............. 0.10 0.02 0.16 0.02 0.16 0.01 XXX 

G9043 ... ............ A ........ Low vision lowvision therapi ............... 0.10 0.02 0.16 0.02 0.16 0.01 XXX 

G9044 ... ............ A ........ Low vision rehabilate teache .............. 0.10 0.02 0.13 0.02 0.13 0.01 XXX 

G9140 ... ............ X ........ Frontier extended stay demo .............. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

M0064 ... ............ A ........ Visit for drug monitoring ...................... 0.37 0.91 0.62 0.07 0.09 0.01 XXX 

P3001 .... ............ A ........ Screening pap smear by phys ............ 0.42 0.38 0.26 0.38 0.26 0.02 XXX 

Q0035 ... ............ A ........ Cardiokymography .............................. 0.17 0.30 0.37 NA NA 0.03 XXX 

Q0035 ... TC ...... A ........ Cardiokymography .............................. 0.00 0.25 0.32 NA NA 0.02 XXX 

Q0035 ... 26 ....... A ........ Cardiokymography .............................. 0.17 0.05 0.05 0.05 0.05 0.01 XXX 

Q0091 ... ............ A ........ Obtaining screen pap smear .............. 0.37 0.75 0.71 0.10 0.12 0.02 XXX 

Q0092 ... ............ A ........ Set up port xray equipment ................ 0.00 0.47 0.40 0.47 0.40 0.01 XXX 

Q3001 ... ............ C ........ Brachytherapy Radioelements ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

Q3014 ... ............ X ........ Telehealth facility fee .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

R0070 ... ............ C ........ Transport portable x-ray ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

R0075 ... ............ C ........ Transport port x-ray multipl ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

R0076 ... ............ B ........ Transport portable EKG ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 


cprice-sewell on PROD1PC72 with RULES
66543 

ADDENDUM B.—RELATIVE VALUE UNITS AND RELATED INFORMATION USED IN DETERMINING MEDICARE PAYMENTS FOR

2008—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented facility PE 

RVUs 2

Year 2008 

transitional facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

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 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courteesy to the general public and are not 

used for Medicare payment. 

Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM C.—CODES WITH INTERIM RVUS

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented 

facility PE 

RVUs 2

Year 2008 

transitional 

facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

20555 .... ............ A ........ Place ndl musc/tis for rt ...................... 6.00 NA NA 2.18 2.18 0.43 000 

20660 .... ............ A ........ Apply, rem fixation device .................. 4.00 2.27 2.27 1.55 1.55 0.59 000 

20690 .... ............ A ........ Apply bone fixation device ................. 8.65 NA NA 3.71 3.71 0.59 090 

20692 .... ............ A ........ Apply bone fixation device ................. 16.00 NA NA 6.78 6.78 1.05 090 

20985 .... ............ A ........ Cptr-asst dir ms px ............................. 2.50 0.99 0.99 0.99 0.99 0.48 ZZZ 

20986 .... ............ C ........ Cptr-asst dir ms px io img .................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

20987 .... ............ C ........ Cptr-asst dir ms px pre img ................ 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

21073 .... ............ A ........ Mnpj of tmj w/anesth .......................... 3.33 5.50 5.50 2.31 2.31 0.43 090 

22206 .... ............ A ........ Cut spine 3 col, thor ........................... 37.00 NA NA 17.71 17.71 6.23 090 

22207 .... ............ A ........ Cut spine 3 col, lumb ......................... 36.50 NA NA 17.59 17.59 6.07 090 

22208 .... ............ A ........ Cut spine 3 col, addl seg ................... 9.66 3.72 3.72 3.72 3.72 2.07 ZZZ 

23515 .... ............ A ........ Treat clavicle fracture ......................... 9.53 NA NA 6.77 6.77 1.28 090 

23585 .... ............ A ........ Treat scapula fracture ........................ 14.07 NA NA 8.07 8.07 1.54 090 

23615 .... ............ A ........ Treat humerus fracture ....................... 12.12 NA NA 8.44 8.44 1.62 090 

23616 .... ............ A ........ Treat humerus fracture ....................... 18.19 NA NA 12.29 12.29 3.70 090 

23630 .... ............ A ........ Treat humerus fracture ....................... 10.39 NA NA 7.00 7.00 1.27 090 

23670 .... ............ A ........ Treat dislocation/fracture .................... 12.12 NA NA 7.37 7.37 1.36 090 

23680 .... ............ A ........ Treat dislocation/fracture .................... 12.99 NA NA 8.16 8.16 1.76 090 

24357 .... ............ A ........ Repair elbow, perc ............................. 5.32 NA NA 5.15 5.15 0.87 090 

24358 .... ............ A ........ Repair elbow w/deb, open .................. 6.54 NA NA 5.73 5.73 1.07 090 

24359 .... ............ A ........ Repair elbow deb/attch open ............. 8.86 NA NA 6.19 6.19 1.41 090 

24545 .... ............ A ........ Treat humerus fracture ....................... 12.99 NA NA 8.36 8.36 1.83 090 

24546 .... ............ A ........ Treat humerus fracture ....................... 14.73 NA NA 10.20 10.20 2.74 090 

24575 .... ............ A ........ Treat humerus fracture ....................... 9.53 NA NA 7.68 7.68 1.87 090 

24579 .... ............ A ........ Treat humerus fracture ....................... 11.26 NA NA 8.28 8.28 2.03 090 

24635 .... ............ A ........ Treat elbow fracture ........................... 8.64 NA NA 10.29 10.29 2.29 090 

24685 .... ............ A ........ Treat ulnar fracture ............................. 8.21 NA NA 7.01 7.01 1.52 090 

25515 .... ............ A ........ Treat fracture of radius ....................... 8.64 NA NA 6.96 6.96 1.59 090 

25525 .... ............ A ........ Treat fracture of radius ....................... 10.37 NA NA 8.70 8.70 2.13 090 

25526 .... ............ A ........ Treat fracture of radius ....................... 12.96 NA NA 11.09 11.09 2.20 090 

25545 .... ............ A ........ Treat fracture of ulna .......................... 7.78 NA NA 6.94 6.94 1.53 090 

25574 .... ............ A ........ Treat fracture radius & ulna ............... 8.64 NA NA 6.87 6.87 1.21 090 

25575 .... ............ A ........ Treat fracture radius/ulna ................... 12.10 NA NA 8.93 8.93 1.82 090 

25628 .... ............ A ........ Treat wrist bone fracture .................... 9.51 NA NA 7.33 7.33 1.37 090 

26615 .... ............ A ........ Treat metacarpal fracture ................... 6.91 NA NA 5.66 5.66 0.86 090 

26650 .... ............ A ........ Treat thumb fracture ........................... 5.19 NA NA 5.78 5.78 0.94 090 

26665 .... ............ A ........ Treat thumb fracture ........................... 7.78 NA NA 6.46 6.46 0.90 090 

26685 .... ............ A ........ Treat hand dislocation ........................ 6.91 NA NA 6.05 6.05 1.09 090 

26715 .... ............ A ........ Treat knuckle dislocation .................... 6.87 NA NA 5.75 5.75 0.91 090 

26735 .... ............ A ........ Treat finger fracture, each .................. 7.26 NA NA 5.84 5.84 0.95 090 

26746 .... ............ A ........ Treat finger fracture, each .................. 9.59 NA NA 6.38 6.38 0.91 090 

26765 .... ............ A ........ Treat finger fracture, each .................. 5.70 NA NA 4.93 4.93 0.66 090 

26785 .... ............ A ........ Treat finger dislocation ....................... 6.44 NA NA 5.15 5.15 0.68 090 

27248 .... ............ A ........ Treat thigh fracture ............................. 10.64 NA NA 7.29 7.29 1.82 090 

27267 .... ............ A ........ Cltx thigh fx ......................................... 5.38 NA NA 4.39 4.39 0.89 090 

27268 .... ............ A ........ Cltx thigh fx w/mnpj ............................ 7.00 NA NA 5.02 5.02 1.16 090 

27269 .... ............ A ........ Optx thigh fx ....................................... 18.75 NA NA 9.88 9.88 2.93 090 

27416 .... ............ A ........ Osteochondral knee autograft ............ 14.00 NA NA 8.38 8.38 2.32 090 

27511 .... ............ A ........ Treatment of thigh fracture ................. 14.97 NA NA 9.65 9.65 2.38 090 

27513 .... ............ A ........ Treatment of thigh fracture ................. 19.11 NA NA 11.81 11.81 3.13 090 

27514 .... ............ A ........ Treatment of thigh fracture ................. 14.46 NA NA 10.61 10.61 3.01 090 

27519 .... ............ A ........ Treat thigh fx growth plate ................. 13.11 NA NA 9.48 9.48 2.56 090 

27535 .... ............ A ........ Treat knee fracture ............................. 13.27 NA NA 8.77 8.77 2.01 090 

27540 .... ............ A ........ Treat knee fracture ............................. 11.16 NA NA 8.44 8.44 2.28 090 

27556 .... ............ A ........ Treat knee dislocation ........................ 12.86 NA NA 9.45 9.45 2.51 090 

27557 .... ............ A ........ Treat knee dislocation ........................ 15.76 NA NA 10.78 10.78 2.98 090 

27558 .... ............ A ........ Treat knee dislocation ........................ 18.25 NA NA 11.16 11.16 3.09 090 

27726 .... ............ A ........ Repair fibula nonunion ....................... 14.20 NA NA 7.67 7.67 1.43 090 

27766 .... ............ A ........ Optx medial ankle fx ........................... 7.73 NA NA 6.67 6.67 1.44 090 

27767 .... ............ A ........ Cltx post ankle fx ................................ 2.50 3.62 3.62 3.65 3.65 0.30 090 


cprice-sewell on PROD1PC72 with RULES
66544 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM C.—CODES WITH INTERIM RVUS—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented 

facility PE 

RVUs 2

Year 2008 

transitional 

facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

27768 .... ............ A ........ Cltx post ankle fx w/mnpj ................... 5.00 NA NA 4.29 4.29 0.79 090 

27769 .... ............ A ........ Optx post ankle fx .............................. 10.00 NA NA 6.07 6.07 1.45 090 

27784 .... ............ A ........ Treatment of fibula fracture ................ 9.51 NA NA 6.65 6.65 1.23 090 

27792 .... ............ A ........ Treatment of ankle fracture ................ 9.55 NA NA 6.88 6.88 1.32 090 

27814 .... ............ A ........ Treatment of ankle fracture ................ 10.46 NA NA 7.89 7.89 1.86 090 

27822 .... ............ A ........ Treatment of ankle fracture ................ 11.03 NA NA 9.42 9.42 1.92 090 

27823 .... ............ A ........ Treatment of ankle fracture ................ 12.98 NA NA 10.19 10.19 2.26 090 

27826 .... ............ A ........ Treat lower leg fracture ...................... 10.92 NA NA 8.51 8.51 1.47 090 

27827 .... ............ A ........ Treat lower leg fracture ...................... 14.56 NA NA 11.47 11.47 2.44 090 

27828 .... ............ A ........ Treat lower leg fracture ...................... 18.20 NA NA 12.74 12.74 2.82 090 

27829 .... ............ A ........ Treat lower leg joint ............................ 8.64 NA NA 6.87 6.87 0.95 090 

27832 .... ............ A ........ Treat lower leg dislocation ................. 10.01 NA NA 6.50 6.50 1.03 090 

28415 .... ............ A ........ Treat heel fracture .............................. 15.96 NA NA 11.75 11.75 2.67 090 

28420 .... ............ A ........ Treat/graft heel fracture ...................... 17.29 NA NA 11.59 11.59 2.81 090 

28445 .... ............ A ........ Treat ankle fracture ............................ 15.53 NA NA 10.25 10.25 2.59 090 

28446 .... ............ A ........ Osteochondral talus autogrft .............. 17.50 NA NA 10.34 10.34 2.45 090 

28465 .... ............ A ........ Treat midfoot fracture, each ............... 8.64 NA NA 6.18 6.18 1.10 090 

28485 .... ............ A ........ Treat metatarsal fracture .................... 7.28 NA NA 5.50 5.50 0.83 090 

28505 .... ............ A ........ Treat big toe fracture .......................... 7.28 8.27 8.27 4.36 4.36 0.56 090 

28525 .... ............ A ........ Treat toe fracture ................................ 5.46 7.81 7.81 3.87 3.87 0.49 090 

28555 .... ............ A ........ Repair foot dislocation ........................ 9.49 10.35 10.35 5.98 5.98 1.04 090 

28585 .... ............ A ........ Repair foot dislocation ........................ 10.92 9.44 9.44 6.40 6.40 1.25 090 

28615 .... ............ A ........ Repair foot dislocation ........................ 10.46 NA NA 8.08 8.08 1.30 090 

28645 .... ............ A ........ Repair toe dislocation ......................... 7.28 6.64 6.64 3.94 3.94 0.57 090 

28675 .... ............ A ........ Repair of toe dislocation ..................... 5.46 7.68 7.68 3.90 3.90 0.45 090 

29828 .... ............ A ........ Arthroscopy biceps tenodesis ............ 13.00 NA NA 8.17 8.17 2.17 090 

29904 .... ............ A ........ Subtalar arthro w/fb rmvl .................... 8.50 NA NA 5.89 5.89 1.25 090 

29905 .... ............ A ........ Subtalar arthro w/exc ......................... 9.00 NA NA 6.51 6.51 1.32 090 

29906 .... ............ A ........ Subtalar arthro w/deb ......................... 9.47 NA NA 6.87 6.87 1.39 090 

29907 .... ............ A ........ Subtalar arthro w/fusion ..................... 12.00 NA NA 7.86 7.86 1.90 090 

31500 .... ............ A ........ Insert emergency airway .................... 2.33 NA NA 0.48 0.48 0.17 000 

33257 .... ............ A ........ Ablate atria, lmtd, add-on ................... 9.63 NA NA 5.46 5.46 0.89 ZZZ 

33258 .... ............ A ........ Ablate atria, x10sv, add-on ................ 11.00 NA NA 5.98 5.98 1.09 ZZZ 

33259 .... ............ A ........ Ablate atria w/bypass add-on ............. 14.14 NA NA 7.79 7.79 1.78 ZZZ 

33864 .... ............ A ........ Ascending aortic graft ......................... 60.00 NA NA 20.09 20.09 6.73 090 

34806 .... ............ A ........ Aneurysm press sensor add-on ......... 2.06 0.51 0.51 0.51 0.51 0.30 ZZZ 

35523 .... ............ A ........ Artery bypass graft ............................. 24.00 NA NA 9.20 9.20 2.14 090 

36591 .... ............ T ......... Draw blood off venous device ............ 0.00 0.54 0.54 NA NA 0.01 XXX 

36592 .... ............ T ......... Collect blood from picc ....................... 0.00 0.67 0.67 NA NA 0.01 XXX 

36593 .... ............ A ........ Declot vascular device ....................... 0.00 0.60 0.60 NA NA 0.37 XXX 

36620 .... ............ A ........ Insertion catheter, artery .................... 1.15 NA NA 0.19 0.19 0.07 000 

41019 .... ............ A ........ Place needles h&n for rt ..................... 8.84 NA NA 3.28 3.28 0.59 000 

43760 .... ............ A ........ Change gastrostomy tube .................. 0.90 4.03 4.03 0.39 0.39 0.09 000 

49203 .... ............ A ........ Exc abd tum 5 cm or less .................. 20.00 NA NA 7.65 7.65 2.27 090 

49204 .... ............ A ........ Exc abd tum over 5 cm ...................... 26.00 NA NA 9.26 9.26 2.94 090 

49205 .... ............ A ........ Exc abd tum over 10 cm .................... 30.00 NA NA 10.34 10.34 3.40 090 

49440 .... ............ A ........ Place gastrostomy tube perc .............. 4.18 25.03 25.03 1.81 1.81 0.49 010 

49441 .... ............ A ........ Place duod/jej tube perc ..................... 4.77 30.10 30.10 2.00 2.00 0.29 010 

49442 .... ............ A ........ Place cecostomy tube perc ................ 4.00 24.43 24.43 1.63 1.63 0.24 010 

49446 .... ............ A ........ Change g-tube to g-j perc .................. 3.31 25.74 25.74 1.15 1.15 0.18 000 

49450 .... ............ A ........ Replace g/c tube perc ........................ 1.36 18.94 18.94 0.44 0.44 0.08 000 

49451 .... ............ A ........ Replace duod/jej tube perc ................ 1.84 19.69 19.69 0.64 0.64 0.11 000 

49452 .... ............ A ........ Replace g-j tube perc ......................... 2.86 23.48 23.48 1.00 1.00 0.18 000 

49460 .... ............ A ........ Fix g/colon tube w/device ................... 0.96 20.56 20.56 0.31 0.31 0.05 000 

49465 .... ............ A ........ Fluoro exam of g/colon tube .............. 0.62 3.88 3.88 0.22 0.22 0.03 000 

50385 .... ............ A ........ Change stent via transureth ............... 4.44 30.61 30.61 2.05 2.05 0.27 000 

50386 .... ............ A ........ Remove stent via transureth .............. 3.30 19.36 19.36 1.60 1.60 0.20 000 

50593 .... ............ A ........ Perc cryo ablate renal tum ................. 9.08 114.48 114.48 3.44 3.44 0.58 010 

51797 .... 26 A ........ Intraabdominal pressure test .............. 0.80 0.41 0.41 0.41 0.41 0.12 ZZZ 

52649 .... ............ A ........ 2Prostate laser enucleation ................ 17.16 NA NA 9.31 9.31 1.11 090 

55920 .... ............ A ........ Place needles pelvic for rt .................. 8.31 NA NA 3.13 3.13 0.58 000 

57284 .... ............ A ........ Repair paravag defect, open .............. 14.25 NA NA 6.56 6.56 1.41 090 

57285 .... ............ A ........ Repair paravag defect, vag ................ 11.52 NA NA 5.16 5.16 0.63 090 

57423 .... ............ A ........ Repair paravag defect, lap ................. 16.00 NA NA 6.51 6.51 1.65 090 

58570 .... ............ A ........ Tlh, uterus 250 g or less .................... 15.75 NA NA 6.45 6.45 1.82 090 

58571 .... ............ A ........ Tlh w/t/o 250 g or less ........................ 17.56 NA NA 6.94 6.94 1.81 090 

58572 .... ............ A ........ Tlh, uterus over 250 g ........................ 19.96 NA NA 7.59 7.59 2.31 090 

58573 .... ............ A ........ Tlh w/t/o uterus over 250 g ................ 22.98 NA NA 8.41 8.41 2.28 090 

67041 .... ............ A ........ Vit for macular pucker ........................ 19.00 NA NA 10.36 10.36 0.86 090 

67042 .... ............ A ........ Vit for macular hole ............................ 22.13 NA NA 11.48 11.48 1.00 090 

67043 .... ............ A ........ Vit for membrane dissect ................... 22.94 NA NA 12.34 12.34 1.04 090 

67113 .... ............ A ........ Repair retinal detach, cplx .................. 22.49 NA NA 12.75 12.75 1.13 090 

67229 .... ............ A ........ Tr retinal les preterm inf ..................... 16.00 NA NA 9.51 9.51 0.71 090 

68816 .... ............ A ........ Probe nl duct w/balloon ...................... 3.00 12.73 12.73 2.51 2.51 0.16 010 

75557 .... 26 A ........ Cardiac mri for morph ........................ 2.35 0.94 0.94 0.94 0.94 0.10 XXX 

75558 .... 26 N ........ Cardiac mri flow/velocity ..................... 2.60 0.60 0.60 0.60 0.60 0.11 XXX 

75559 .... 26 A ........ Cardiac mri w/stress img .................... 2.95 1.27 1.27 1.27 1.27 0.10 XXX 

75560 .... 26 N ........ Cardiac mri flow/vel/stress ................. 3.00 0.69 0.69 0.69 0.69 0.11 XXX 


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66545 

ADDENDUM C.—CODES WITH INTERIM RVUS—Continued 

CPT 1/ 

HCPCS Mod Status Description 

Physician 

work 

RVUs 2

Fully 

implemented 

non-facility 

PE RVUs 2

Year 2008 

transitional nonfacility PE 

RVUs 2

Fully 

implemented 

facility PE 

RVUs 2

Year 2008 

transitional 

facility PE 

RVUs 2

Malpractice 

RVUs 2

Global 

75561 .... 26 A ........ Cardiac mri for morph w/dye .............. 2.60 1.03 1.03 1.03 1.03 0.11 XXX 

75562 .... 26 N ........ Card mri flow/vel w/dye ...................... 2.86 0.66 0.66 0.66 0.66 0.11 XXX 

75563 .... 26 A ........ Card mri w/stress img & dye .............. 3.00 1.38 1.38 1.38 1.38 0.11 XXX 

75564 .... 26 N ........ Ht mri w/flo/vel/strs & dye .................. 3.35 0.77 0.77 0.77 0.77 0.13 XXX 

78811 .... 26 A ........ Pet image, ltd area ............................. 1.54 0.53 0.53 0.53 0.53 0.11 XXX 

78812 .... 26 A ........ Pet image, skull-thigh ......................... 1.93 0.66 0.66 0.66 0.66 0.11 XXX 

78813 .... 26 A ........ Pet image, full body ............................ 2.00 0.68 0.68 0.68 0.68 0.11 XXX 

78814 .... 26 A ........ Pet image w/ct, lmtd ........................... 2.20 0.75 0.75 0.75 0.75 0.11 XXX 

78815 .... 26 A ........ Pet image w/ct, skull-thigh ................. 2.44 0.84 0.84 0.84 0.84 0.11 XXX 

78816 .... 26 A ........ Pet image w/ct, full body .................... 2.50 0.85 0.85 0.85 0.85 0.11 XXX 

86486 .... ............ A ........ Skin test, nos antigen ......................... 0.00 0.13 0.13 NA NA 0.02 XXX 

88380 .... 26 A ........ Microdissection, laser ......................... 1.56 0.43 0.43 0.43 0.43 0.07 XXX 

88381 .... 26 A ........ Microdissection, manual ..................... 1.18 0.32 0.32 0.32 0.32 0.06 XXX 

90769 .... ............ A ........ Sc ther infusion, up to 1 hr ................. 0.21 3.92 3.92 NA NA 0.06 XXX 

90770 .... ............ A ........ Sc ther infusion, addl hr ..................... 0.18 0.22 0.22 NA NA 0.04 ZZZ 

90771 .... ............ A ........ Sc ther infusion, reset pump .............. 0.00 1.86 1.86 NA NA 0.01 ZZZ 

93503 .... ............ C ........ Insert/place heart catheter .................. 0.00 NA NA NA NA 0.00 000 

93982 .... ............ R ........ Aneurysm pressure sens study .......... 0.30 0.80 0.80 NA NA 0.01 XXX 

95004 .... ............ A ........ Percut allergy skin tests ..................... 0.01 0.13 0.13 NA NA 0.01 XXX 

95024 .... ............ A ........ Id allergy test, drug/bug ...................... 0.01 0.16 0.16 NA NA 0.01 XXX 

95027 .... ............ A ........ Id allergy titrate-airborne .................... 0.01 0.12 0.12 NA NA 0.01 XXX 

95980 .... ............ A ........ Io anal gast n-stim init ........................ 0.80 NA NA 0.25 0.25 0.07 XXX 

95981 .... ............ A ........ Io anal gast n-stim subsq ................... 0.30 0.44 0.44 0.12 0.12 0.02 XXX 

95982 .... ............ A ........ Io ga n-stim subsq w/reprog ............... 0.65 0.47 0.47 0.18 0.18 0.05 XXX 

96125 .... ............ A ........ Cognitive test by hc pro ..................... 1.70 0.76 0.76 0.37 0.37 0.16 XXX 

98966 .... ............ N ........ Hc pro phone call 5–10 min ............... 0.25 0.09 0.09 0.06 0.06 0.01 XXX 

98967 .... ............ N ........ Hc pro phone call 11–20 min ............. 0.50 0.14 0.14 0.11 0.11 0.02 XXX 

98968 .... ............ N ........ Hc pro phone call 21–30 min ............. 0.75 0.20 0.20 0.17 0.17 0.03 XXX 

98969 .... ............ N ........ Online service by hc pro .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99174 .... ............ N ........ Ocular photoscreening ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99366 .... ............ B ........ Team conf w/pat by hc pro ................ 0.82 0.20 0.20 0.19 0.19 0.06 XXX 

99367 .... ............ B ........ Team conf w/o pat by phys ................ 1.10 0.25 0.25 0.25 0.25 0.05 XXX 

99368 .... ............ B ........ Team conf w/o pat by hc pro ............. 0.72 0.16 0.16 0.16 0.16 0.03 XXX 

99406 .... ............ A ........ Behav chng smoking 3–10 min .......... 0.24 0.10 0.10 0.08 0.08 0.01 XXX 

99407 .... ............ A ........ Behav chng smoking < 10 min .......... 0.50 0.18 0.18 0.15 0.15 0.01 XXX 

99408 .... ............ N ........ Audit/dast, 15–30 min ......................... 0.65 0.19 0.19 0.15 0.15 0.01 XXX 

99409 .... ............ N ........ Audit/dast, over 30 min ...................... 1.30 0.34 0.34 0.30 0.30 0.03 XXX 

99441 .... ............ N ........ Phone e/m by phys 5–10 min ............ 0.25 0.09 0.09 0.06 0.06 0.02 XXX 

99442 .... ............ N ........ Phone e/m by phys 11–20 min .......... 0.50 0.14 0.14 0.11 0.11 0.02 XXX 

99443 .... ............ N ........ Phone e/m by phys 21–30 min .......... 0.75 0.20 0.20 0.17 0.17 0.03 XXX 

99444 .... ............ N ........ Online e/m by phys ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99477 .... ............ A ........ Init day hosp neonate care ................. 7.00 1.98 1.98 1.98 1.98 0.32 XXX 

G0396 .... ............ A ........ Alcohol/subs interv 15–30 min ........... 0.65 0.19 0.19 0.15 0.15 0.01 XXX 

G0397 .... ............ A ........ Alcohol/subs interv >30 min ............... 1.30 0.34 0.34 0.29 0.29 0.03 XXX 

1 CPT codes and descriptions only are copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 2 If values are reflected for codes not payable by Medicare, please note that these values have been established as a courtesy to the general public and are not 

used for Medicare payment. 

ADDENDUM D.—2008 GEOGRAPHIC ADJUSTMENT FACTORS (GAFS) 

Carrier Locality Locality name GAF 

31140 ....... 06 ......... San Mateo, CA ........................................................................................................................................................ 1.232 

31140 ....... 05 ......... San Francisco, CA .................................................................................................................................................. 1.229 

31140 ....... 09 ......... Santa Clara, CA ...................................................................................................................................................... 1.207 

00803 ....... 01 ......... Manhattan, NY ........................................................................................................................................................ 1.174 

00803 ....... 02 ......... NYC Suburbs/Long I., NY ....................................................................................................................................... 1.171 

31140 ....... 07 ......... Oakland/Berkley, CA ............................................................................................................................................... 1.154 

31143 ....... 01 ......... Metropolitan Boston ................................................................................................................................................ 1.143 

14330 ....... 04 ......... Queens, NY ............................................................................................................................................................. 1.137 

31140 ....... 03 ......... Marin/Napa/Solano, CA ........................................................................................................................................... 1.133 

00805 ....... 01 ......... Northern NJ ............................................................................................................................................................. 1.130 

00903 ....... 01 ......... DC + MD/VA Suburbs ............................................................................................................................................. 1.127 

31146 ....... 26 ......... Anaheim/Santa Ana, CA ......................................................................................................................................... 1.124 

31146 ....... 17 ......... Ventura, CA ............................................................................................................................................................. 1.102 

31146 ....... 18 ......... Los Angeles, CA ..................................................................................................................................................... 1.100 

00591 ....... 00 ......... Connecticut .............................................................................................................................................................. 1.096 

00952 ....... 16 ......... Chicago, IL .............................................................................................................................................................. 1.093 

00590 ....... 04 ......... Miami, FL ................................................................................................................................................................. 1.092 

00953 ....... 01 ......... Detroit, MI ................................................................................................................................................................ 1.091 

00805 ....... 99 ......... Rest of New Jersey ................................................................................................................................................. 1.078 

00952 ....... 15 ......... Suburban Chicago, IL ............................................................................................................................................. 1.074 

00865 ....... 01 ......... Metropolitan Philadelphia, PA ................................................................................................................................. 1.072 

00836 ....... 02 ......... Seattle (King Cnty), WA .......................................................................................................................................... 1.046 


cprice-sewell on PROD1PC72 with RULES
66546 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM D.—2008 GEOGRAPHIC ADJUSTMENT FACTORS (GAFS)—Continued 

Carrier Locality Locality name GAF 

00831 ....... 01 ......... Alaska ...................................................................................................................................................................... 1.045 

00833 ....... 01 ......... Hawaii/Guam ........................................................................................................................................................... 1.044 

31143 ....... 99 ......... Rest of Massachusetts ............................................................................................................................................ 1.042 

00803 ....... 03 ......... Poughkpsie/N NYC Suburbs, NY ............................................................................................................................ 1.040 

00901 ....... 01 ......... Baltimore/Surr. Cntys, MD ...................................................................................................................................... 1.037 

00590 ....... 03 ......... Fort Lauderdale, FL ................................................................................................................................................. 1.033 

00524 ....... 01 ......... Rhode Island ........................................................................................................................................................... 1.030 

00511 ....... 01 ......... Atlanta, GA .............................................................................................................................................................. 1.024 

00900 ....... 11 ......... Dallas, TX ................................................................................................................................................................ 1.022 

00900 ....... 18 ......... Houston, TX ............................................................................................................................................................ 1.021 

00834 ....... 00 ......... Nevada .................................................................................................................................................................... 1.019 

31140 ....... 99 ......... Rest of California * ................................................................................................................................................... 1.015 

31146 ....... 99 ......... Rest of California * ................................................................................................................................................... 1.015 

00902 ....... 01 ......... Delaware ................................................................................................................................................................. 1.012 

00900 ....... 31 ......... Austin, TX ................................................................................................................................................................ 1.001 

00835 ....... 01 ......... Portland, OR ............................................................................................................................................................ 0.997 

00900 ....... 09 ......... Brazoria, TX ............................................................................................................................................................ 0.995 

00528 ....... 01 ......... New Orleans, LA ..................................................................................................................................................... 0.993 

31144 ....... 40 ......... New Hampshire ....................................................................................................................................................... 0.993 

00952 ....... 15 ......... East St. Louis, IL ..................................................................................................................................................... 0.992 

00900 ....... 28 ......... Fort Worth, TX ......................................................................................................................................................... 0.990 

00973 ....... 50 ......... Virgin Islands ........................................................................................................................................................... 0.989 

00900 ....... 15 ......... Galveston, TX .......................................................................................................................................................... 0.985 

00824 ....... 01 ......... Colorado .................................................................................................................................................................. 0.983 

00901 ....... 99 ......... Rest of Maryland ..................................................................................................................................................... 0.981 

31142 ....... 03 ......... Southern Maine ....................................................................................................................................................... 0.981 

03102 ....... 00 ......... Arizona .................................................................................................................................................................... 0.980 

00523 ....... 01 ......... Metropolitan Kansas City, MO ................................................................................................................................ 0.980 

00590 ....... 99 ......... Rest of Florida ......................................................................................................................................................... 0.977 

00953 ....... 99 ......... Rest of Michigan ..................................................................................................................................................... 0.976 

00836 ....... 99 ......... Rest of Washington ................................................................................................................................................. 0.973 

00740 ....... 02 ......... Metropolitan St. Louis, MO ..................................................................................................................................... 0.971 

00883 ....... 00 ......... Ohio ......................................................................................................................................................................... 0.969 

00954 ....... 00 ......... Minnesota ................................................................................................................................................................ 0.967 

00865 ....... 99 ......... Rest of Pennsylvania .............................................................................................................................................. 0.956 

31145 ....... 50 ......... Vermont ................................................................................................................................................................... 0.953 

00904 ....... 00 ......... Virginia ..................................................................................................................................................................... 0.950 

03502 ....... 09 ......... Utah ......................................................................................................................................................................... 0.948 

00900 ....... 20 ......... Beaumont, TX ......................................................................................................................................................... 0.946 

00801 ....... 99 ......... Rest of New York .................................................................................................................................................... 0.946 

00951 ....... 00 ......... Wisconsin ................................................................................................................................................................ 0.942 

00952 ....... 99 ......... Rest of Illinois .......................................................................................................................................................... 0.940 

05535 ....... 00 ......... North Carolina ......................................................................................................................................................... 0.937 

00521 ....... 05 ......... New Mexico ............................................................................................................................................................. 0.936 

00630 ....... 00 ......... Indiana ..................................................................................................................................................................... 0.935 

00511 ....... 99 ......... Rest of Georgia ....................................................................................................................................................... 0.932 

00900 ....... 99 ......... Rest of Texas .......................................................................................................................................................... 0.931 

00835 ....... 99 ......... Rest of Oregon ........................................................................................................................................................ 0.930 

00884 ....... 16 ......... West Virginia ........................................................................................................................................................... 0.926 

00528 ....... 99 ......... Rest of Louisiana .................................................................................................................................................... 0.923 

05440 ....... 35 ......... Tennessee ............................................................................................................................................................... 0.923 

00880 ....... 01 ......... South Carolina ......................................................................................................................................................... 0.921 

00650 ....... 00 ......... Kansas * ................................................................................................................................................................... 0.917 

00740 ....... 04 ......... Kansas * ................................................................................................................................................................... 0.917 

31142 ....... 99 ......... Rest of Maine .......................................................................................................................................................... 0.915 

00660 ....... 00 ......... Kentucky .................................................................................................................................................................. 0.912 

00510 ....... 00 ......... Alabama .................................................................................................................................................................. 0.910 

05130 ....... 00 ......... Idaho ........................................................................................................................................................................ 0.909 

03602 ....... 21 ......... Wyoming .................................................................................................................................................................. 0.907 

00826 ....... 00 ......... Iowa ......................................................................................................................................................................... 0.906 

00512 ....... 00 ......... Mississippi ............................................................................................................................................................... 0.903 

00655 ....... 00 ......... Nebraska ................................................................................................................................................................. 0.902 

03202 ....... 01 ......... Montana ................................................................................................................................................................... 0.898 

00522 ....... 00 ......... Oklahoma ................................................................................................................................................................ 0.898 

00740 ....... 99 ......... Rest of Missouri * .................................................................................................................................................... 0.890 

03402 ....... 02 ......... South Dakota ........................................................................................................................................................... 0.890 

00523 ....... 99 ......... Rest of Missouri * .................................................................................................................................................... 0.889 

03302 ....... 01 ......... North Dakota ........................................................................................................................................................... 0.888 

00520 ....... 13 ......... Arkansas .................................................................................................................................................................. 0.888 

00973 ....... 20 ......... Puerto Rico .............................................................................................................................................................. 0.789 


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66547 

ADDENDUM E.—2008 *** GEOGRAPHIC PRACTICE COST INDICES BY STATE AND MEDICARE LOCALITY

Carrier Locality Locality name 

2008 budget neutral 

GPCIs 

Work PE MP 

00510 ....... 00 ......... Alabama .................................................................................................................................. 0.982 0.850 0.617 

00831 ....... 01 ......... Alaska ..................................................................................................................................... 1.018 1.097 0.828 

03102 ....... 00 ......... Arizona .................................................................................................................................... 0.987 0.975 0.936 

00520 ....... 13 ......... Arkansas ................................................................................................................................. 0.961 0.839 0.439 

31146 ....... 26 ......... Anaheim/Santa Ana, CA ......................................................................................................... 1.034 1.254 0.875 

31146 ....... 18 ......... Los Angeles, CA ..................................................................................................................... 1.041 1.192 0.871 

31140 ....... 03 ......... Marin/Napa/Solano, CA .......................................................................................................... 1.035 1.304 0.535 

31140 ....... 07 ......... Oakland/Berkley, CA ............................................................................................................... 1.054 1.330 0.532 

31140 ....... 05 ......... San Francisco, CA .................................................................................................................. 1.060 1.494 0.526 

31140 ....... 06 ......... San Mateo, CA ....................................................................................................................... 1.073 1.486 0.511 

31140 ....... 09 ......... Santa Clara, CA ...................................................................................................................... 1.083 1.419 0.485 

31146 ....... 17 ......... Ventura, CA ............................................................................................................................ 1.028 1.223 0.749 

31140 ....... 99 ......... Rest of California * .................................................................................................................. 1.008 1.056 0.634 

31146 ....... 99 ......... Rest of California * .................................................................................................................. .008 1.056 0.634 

00824 ....... 01 ......... Colorado .................................................................................................................................. 0.986 1.003 0.715 

00591 ....... 00 ......... Connecticut ............................................................................................................................. 1.038 1.179 0.934 

00903 ....... 01 ......... DC + MD/VA Suburbs ............................................................................................................. 1.048 1.235 0.972 

00902 ....... 01 ......... Delaware ................................................................................................................................. 1.012 1.033 0.777 

00590 ....... 03 ......... Fort Lauderdale, FL ................................................................................................................ 0.988 1.004 1.965 

00590 ....... 04 ......... Miami, FL ................................................................................................................................ 1.001 1.058 2.705 

00590 ....... 99 ......... Rest of Florida ........................................................................................................................ 0.973 0.937 1.490 

00511 ....... 01 ......... Atlanta, GA .............................................................................................................................. 1.010 1.052 0.893 

00511 ....... 99 ......... Rest of Georgia ....................................................................................................................... 0.979 0.879 0.889 

00833 ....... 01 ......... Hawaii/Guam ........................................................................................................................... 0.990 1.137 0.726 

05130 ....... 00 ......... Idaho ....................................................................................................................................... 0.967 0.876 0.499 

00952 ....... 16 ......... Chicago, IL .............................................................................................................................. 1.025 1.104 1.889 

00952 ....... 12 ......... East St. Louis, IL .................................................................................................................... 0.988 0.929 1.758 

00952 ....... 15 ......... Suburban Chicago, IL ............................................................................................................. 1.018 1.092 1.628 

00952 ....... 99 ......... Rest of Illinois ......................................................................................................................... 0.974 0.877 1.197 

00630 ....... 00 ......... Indiana .................................................................................................................................... 0.985 0.913 0.515 

00826 ....... 00 ......... Iowa ......................................................................................................................................... 0.966 0.870 0.506 

00650 ....... 00 ......... Kansas * .................................................................................................................................. 0.968 0.881 0.633 

00740 ....... 04 ......... Kansas * .................................................................................................................................. 0.968 0.881 0.633 

00660 ....... 00 ......... Kentucky ................................................................................................................................. 0.969 0.858 0.755 

00528 ....... 01 ......... New Orleans, LA ..................................................................................................................... 0.986 0.995 1.066 

00528 ....... 99 ......... Rest of Louisiana .................................................................................................................... 0.970 0.863 0.966 

31142 ....... 03 ......... Southern Maine ....................................................................................................................... 0.980 1.019 0.558 

31142 ....... 99 ......... Rest of Maine .......................................................................................................................... 0.962 0.890 0.558 

00901 ....... 01 ......... Baltimore/Surr. Cntys, MD ...................................................................................................... 1.013 1.068 1.010 

00901 ....... 99 ......... Rest of Maryland ..................................................................................................................... 0.993 0.981 0.812 

31143 ....... 01 ......... Metropolitan Boston ................................................................................................................ 1.030 1.311 0.787 

31143 ....... 99 ......... Rest of Massachusetts ........................................................................................................... 1.008 1.105 0.787 

00953 ....... 01 ......... Detroit, MI ............................................................................................................................... 1.037 1.048 2.300 

00953 ....... 99 ......... Rest of Michigan ..................................................................................................................... 0.998 0.922 1.287 

00954 ....... 00 ......... Minnesota ................................................................................................................................ 0.991 0.994 0.324 

00512 ....... 00 ......... Mississippi ............................................................................................................................... 0.959 0.848 0.760 

00523 ....... 01 ......... Metropolitan Kansas City, MO ................................................................................................ 0.989 0.961 1.061 

00740 ....... 02 ......... Metropolitan St. Louis, MO ..................................................................................................... 0.992 0.943 1.001 

00523 ....... 99 ......... Rest of Missouri * .................................................................................................................... 0.950 0.812 0.938 

00740 ....... 99 ......... Rest of Missouri * .................................................................................................................... 0.951 0.812 0.938 

03202 ....... 01 ......... Montana .................................................................................................................................. 0.950 0.846 0.781 

00655 ....... 00 ......... Nebraska ................................................................................................................................. 0.959 0.883 0.345 

00834 ....... 00 ......... Nevada .................................................................................................................................... 1.003 1.035 1.067 

31144 ....... 40 ......... New Hampshire ...................................................................................................................... 0.981 1.034 0.693 

00805 ....... 01 ......... Northern NJ ............................................................................................................................. 1.058 1.225 1.038 

00805 ....... 99 ......... Rest of New Jersey ................................................................................................................ 1.043 1.124 1.038 

00521 ....... 05 ......... New Mexico ............................................................................................................................ 0.972 0.889 0.989 

00803 ....... 01 ......... Manhattan, NY ........................................................................................................................ 1.065 1.299 1.243 

00803 ....... 02 ......... NYC Suburbs/Long I., NY ....................................................................................................... 1.052 1.286 1.494 

00803 ....... 03 ......... Poughkpsie/N NYC Suburbs, NY ........................................................................................... 1.015 1.076 0.984 

14330 ....... 04 ......... Queens, NY ............................................................................................................................ 1.032 1.235 1.450 

00801 ....... 99 ......... Rest of New York .................................................................................................................... 0.997 0.920 0.544 

05535 ....... 00 ......... North Carolina ......................................................................................................................... 0.971 0.923 0.632 

03302 ....... 01 ......... North Dakota ........................................................................................................................... 0.946 0.853 0.489 

00883 ....... 00 ......... Ohio ......................................................................................................................................... 0.992 0.930 1.097 

00522 ....... 00 ......... Oklahoma ................................................................................................................................ 0.964 0.853 0.503 

00835 ....... 01 ......... Portland, OR ........................................................................................................................... 1.003 1.037 0.453 

00835 ....... 99 ......... Rest of Oregon ....................................................................................................................... 0.968 0.927 0.453 

00865 ....... 01 ......... Metropolitan Philadelphia, PA ................................................................................................. 1.017 1.101 1.492 


cprice-sewell on PROD1PC72 with RULES
66548 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM E.—2008 *** GEOGRAPHIC PRACTICE COST INDICES BY STATE AND MEDICARE LOCALITY—Continued 

Carrier Locality Locality name 

2008 budget neutral 

GPCIs 

Work PE MP 

00865 ....... 99 ......... Rest of Pennsylvania .............................................................................................................. 0.992 0.914 0.938 

00973 ....... 20 ......... Puerto Rico ............................................................................................................................. 0.905 0.697 0.253 

00524 ....... 01 ......... Rhode Island ........................................................................................................................... 1.029 1.039 0.946 

00880 ....... 01 ......... South Carolina ........................................................................................................................ 0.975 0.900 0.418 

03402 ....... 02 ......... South Dakota .......................................................................................................................... 0.942 0.871 0.390 

05440 ....... 35 ......... Tennessee .............................................................................................................................. 0.977 0.885 0.614 

00900 ....... 31 ......... Austin, TX ............................................................................................................................... 0.991 1.015 0.970 

00900 ....... 20 ......... Beaumont, TX ......................................................................................................................... 0.983 0.869 1.312 

00900 ....... 09 ......... Brazoria, TX ............................................................................................................................ 1.020 0.942 1.250 

00900 ....... 11 ......... Dallas, TX ............................................................................................................................... 1.010 1.032 1.078 

00900 ....... 28 ......... Fort Worth, TX ........................................................................................................................ 0.998 0.972 1.078 

00900 ....... 15 ......... Galveston, TX ......................................................................................................................... 0.990 0.956 1.250 

00900 ....... 18 ......... Houston, TX ............................................................................................................................ 1,017 1.000 1.311 

00900 ....... 99 ......... Rest of Texas .......................................................................................................................... 0.968 0.873 1.092 

03502 ....... 09 ......... Utah ......................................................................................................................................... 0.977 0.922 0.841 

31145 ....... 50 ......... Vermont ................................................................................................................................... 0.968 0.976 0.497 

00904 ....... 00 ......... Virginia .................................................................................................................................... 0.981 0.942 0.613 

00973 ....... 50 ......... Virgin Islands .......................................................................................................................... 0.982 0.996 0.998 

00836 ....... 02 ......... Seattle (King Cnty), WA .......................................................................................................... 1.015 1.109 0.755 

00836 ....... 99 ......... Rest of Washington ................................................................................................................ 0.987 0.977 0.749 

00884 ....... 16 ......... West Virginia ........................................................................................................................... 0.973 0.824 1.437 

00951 ....... 00 ......... Wisconsin ................................................................................................................................ 0.987 0.920 0.592 

03602 ....... 21 ......... Wyoming ................................................................................................................................. 0.956 0.849 0.905 

* Indicates multiple carriers. 

** Transition value for work GPCI does not reflect the 2007 1.000 floor. 

*** 2008 GPCIs are the first year of the update transition. 

ADDENDUM F.—CPT/HCPCS IMAGING

CODES DEFINED BY DRA 5102(B) 

HCPCS/ 

CPT * Short descriptor 

31620 ........ Endobronchial us add-on. 

37250 ........ Iv us first vessel add-on. 

37251 ........ Iv us each add vessel add-on. 

51798 ........ Us urine capacity measure. 

70010 ........ Contrast x-ray of brain. 

70015 ........ Contrast x-ray of brain. 

70030 ........ X-ray eye for foreign body. 

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. 

70170 ........ X-ray exam of tear duct. 

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. 

70332 ........ X-ray exam of jaw joint. 

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. 

70373 ........ Contrast x-ray of larynx. 

ADDENDUM F.—CPT/HCPCS IMAGING

CODES DEFINED BY DRA 5102(B)—

Continued 

HCPCS/ 

CPT * Short descriptor 

70380 ........ X-ray exam of salivary gland. 

70390 ........ X-ray exam of salivary duct. 

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. 

70557 ........ Mri brain w/o dye. 

70558 ........ Mri brain w/dye. 

70559 ........ Mri brain w/o & w/dye. 

71010 ........ Chest x-ray. 

ADDENDUM F.—CPT/HCPCS IMAGING

CODES DEFINED BY DRA 5102(B)—

Continued 

HCPCS/ 

CPT * Short descriptor 

71015 ........ Chest x-ray. 

71020 ........ Chest x-ray. 

71021 ........ Chest x-ray. 

71022 ........ Chest x-ray. 

71023 ........ Chest x-ray and fluoroscopy. 

71030 ........ Chest x-ray. 

71034 ........ Chest x-ray and fluoroscopy. 

71035 ........ Chest x-ray. 

71040 ........ Contrast x-ray of bronchi. 

71060 ........ Contrast x-ray of bronchi. 

71090 ........ X-ray & pacemaker insertion. 

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. 


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66549 

ADDENDUM F.—CPT/HCPCS IMAGING

CODES DEFINED BY DRA 5102(B)—

Continued 

HCPCS/ 

CPT * Short descriptor 

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. 

72159 ........ Mr angio 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. 

72240 ........ Contrast x-ray of neck spine. 

72255 ........ Contrast x-ray, thorax spine. 

72265 ........ Contrast x-ray, lower spine. 

72270 ........ Contrast x-ray, spine. 

72275 ........ Epidurography. 

72285 ........ X-ray c/t spine disk. 

72291 ........ Percut vertebroplasty fluor. 

72293 ........ Percut vertebroplasty, ct. 

72295 ........ X-ray of lower spine disk. 

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. 

73040 ........ Contrast x-ray 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. 

73085 ........ Contrast x-ray 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. 

73115 ........ Contrast x-ray 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. 

ADDENDUM F.—CPT/HCPCS IMAGING

CODES DEFINED BY DRA 5102(B)—

Continued 

HCPCS/ 

CPT * Short descriptor 

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. 

73225 ........ Mr angio upr extr w/o & w/dye. 

73500 ........ X-ray exam of hip. 

73510 ........ X-ray exam of hip. 

73520 ........ X-ray exam of hips. 

73525 ........ Contrast x-ray of hip. 

73530 ........ X-ray exam of hip. 

73540 ........ X-ray exam of pelvis & hips. 

73542 ........ X-ray exam, sacroiliac joint. 

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. 

73580 ........ Contrast x-ray of knee joint. 

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. 

73615 ........ Contrast x-ray 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/ or w/o 

dye. 

74190 ........ X-ray exam of peritoneum. 

74210 ........ Contrast x-ray exam of throat. 

74220 ........ Contrast x-ray, esophagus. 

74230 ........ Cine/vid x-ray, throat/esoph. 

74235 ........ Remove esophagus obstruction. 

74240 ........ X-ray exam, upper gi tract. 

74241 ........ X-ray exam, upper gi tract. 

74245 ........ X-ray exam, upper gi tract. 

74246 ........ Contrast x-ray uppr gi tract. 

74247 ........ Contrast x-ray uppr gi tract. 

74249 ........ Contrast x-ray uppr gi tract. 

74250 ........ X-ray exam of small bowel. 

74251 ........ X-ray exam of small bowel. 

ADDENDUM F.—CPT/HCPCS IMAGING

CODES DEFINED BY DRA 5102(B)—

Continued 

HCPCS/ 

CPT * Short descriptor 

74260 ........ X-ray exam of small bowel. 

74270 ........ Contrast x-ray exam of colon. 

74280 ........ Contrast x-ray exam of colon. 

74283 ........ Contrast x-ray exam of colon. 

74290 ........ Contrast x-ray, gallbladder. 

74291 ........ Contrast x-rays, gallbladder. 

74300 ........ X-ray bile ducts/pancreas. 

74301 ........ X-rays at surgery add-on. 

74305 ........ X-ray bile ducts/pancreas. 

74320 ........ Contrast x-ray of bile ducts. 

74327 ........ X-ray bile stone removal. 

74328 ........ X-ray bile duct endoscopy. 

74329 ........ X-ray for pancreas endoscopy. 

74330 ........ X-ray bile/panc endoscopy. 

74340 ........ X-ray guide for GI tube. 

74355 ........ X-ray guide, intestinal tube. 

74360 ........ X-ray guide, GI dilation. 

74363 ........ X-ray, bile duct dilation. 

74400 ........ Contrast x-ray, urinary tract. 

74410 ........ Contrast x-ray, urinary tract. 

74415 ........ Contrast x-ray, urinary tract. 

74420 ........ Contrast x-ray, urinary tract. 

74425 ........ Contrast x-ray, urinary tract. 

74430 ........ Contrast x-ray, bladder. 

74440 ........ X-ray, male genital tract. 

74445 ........ X-ray exam of penis. 

74450 ........ X-ray, urethra/bladder. 

74455 ........ X-ray, urethra/bladder. 

74470 ........ X-ray exam of kidney lesion. 

74475 ........ X-ray control, cath insert. 

74480 ........ X-ray control, cath insert. 

74485 ........ X-ray guide, GU dilation. 

74710 ........ X-ray measurement of pelvis. 

74740 ........ X-ray, female genital tract. 

74742 ........ X-ray, fallopian tube. 

74775 ........ X-ray exam of perineum. 

75557 ........ Cardiac MRI w/o contrast. 

75558 ........ Cardiac MRI w/flow/velocity. 

75559 ........ Cardiac MRI w/stress imaging. 

75560 ........ Cardiac MRI w/flow/velocity/ 

stress. 

75561 ........ Cardiac MRI w/ & w/o contrast. 

75562 ........ Cardiac MRI w/flow velocity. 

75563 ........ Cardiac MRI w/stress imaging. 

75564 ........ Cardiac MRI w/flow/velocity/ 

stress. 

75600 ........ Contrast x-ray exam of aorta. 

75605 ........ Contrast x-ray exam of aorta. 

75625 ........ Contrast x-ray exam of aorta. 

75630 ........ X-ray aorta, leg arteries. 

75635 ........ Ct angio abdominal arteries. 

75650 ........ Artery x-rays, head & neck. 

75658 ........ Artery x-rays, arm. 

75660 ........ Artery x-rays, head & neck. 

75662 ........ Artery x-rays, head & neck. 

75665 ........ Artery x-rays, head & neck. 

75671 ........ Artery x-rays, head & neck. 

75676 ........ Artery x-rays, neck. 

75680 ........ Artery x-rays, neck. 

75685 ........ Artery x-rays, spine. 

75705 ........ Artery x-rays, spine. 

75710 ........ Artery x-rays, arm/leg. 

75716 ........ Artery x-rays, arms/legs. 

75722 ........ Artery x-rays, kidney. 

75724 ........ Artery x-rays, kidneys. 

75726 ........ Artery x-rays, abdomen. 

75731 ........ Artery x-rays, adrenal gland. 

75733 ........ Artery x-rays, adrenals. 

75736 ........ Artery x-rays, pelvis. 


cprice-sewell on PROD1PC72 with RULES
66550 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM F.—CPT/HCPCS IMAGING

CODES DEFINED BY DRA 5102(B)—

Continued 

HCPCS/ 

CPT * Short descriptor 

75741 ........ Artery x-rays, lung. 

75743 ........ Artery x-rays, lungs. 

75746 ........ Artery x-rays, lung. 

75756 ........ Artery x-rays, chest. 

75774 ........ Artery x-ray, each vessel. 

75790 ........ Visualize A–V shunt. 

75801 ........ Lymph vessel x-ray, arm/leg. 

75803 ........ Lymph vessel x-ray, arms/legs. 

75805 ........ Lymph vessel x-ray, trunk. 

75807 ........ Lymph vessel x-ray, trunk. 

75809 ........ Nonvascular shunt, x-ray. 

75810 ........ Vein x-ray, spleen/liver. 

75820 ........ Vein x-ray, arm/leg. 

75822 ........ Vein x-ray, arms/legs. 

75825 ........ Vein x-ray, trunk. 

75827 ........ Vein x-ray, chest. 

75831 ........ Vein x-ray, kidney. 

75833 ........ Vein x-ray, kidneys. 

75840 ........ Vein x-ray, adrenal gland. 

75842 ........ Vein x-ray, adrenal glands. 

75860 ........ Vein x-ray, neck. 

75870 ........ Vein x-ray, skull. 

75872 ........ Vein x-ray, skull. 

75880 ........ Vein x-ray, eye socket. 

75885 ........ Vein x-ray, liver. 

75887 ........ Vein x-ray, liver. 

75889 ........ Vein x-ray, liver. 

75891 ........ Vein x-ray, liver. 

75893 ........ Venous sampling by catheter. 

75894 ........ X-rays, transcath therapy. 

75896 ........ X-rays, transcath therapy. 

75898 ........ Follow-up angiography. 

75900 ........ Intravascular cath exchange. 

75901 ........ Remove cva device obstruct. 

75902 ........ Remove cva lumen obstruct. 

75940 ........ X-ray placement, vein filter. 

75945 ........ Intravascular us. 

75946 ........ Intravascular us add-on. 

75953 ........ Abdom aneurysm endovas rpr. 

75956 ........ X-ray, endovasc thor ao repr. 

75957 ........ X-ray, endovasc thor ao repr. 

75958 ........ X-ray, place prox ext thor ao. 

75959 ........ X-ray, place dist ext thor ao. 

75960 ........ Transcath iv stent rs&i. 

75961 ........ Retrieval, broken catheter. 

75962 ........ Repair arterial blockage. 

75964 ........ Repair artery blockage, each. 

75966 ........ Repair arterial blockage. 

75968 ........ Repair artery blockage, each. 

75970 ........ Vascular biopsy. 

75978 ........ Repair venous blockage. 

75980 ........ Contrast x-ray exam bile duct. 

75982 ........ Contrast x-ray exam bile duct. 

75984 ........ X-ray control catheter change. 

75989 ........ Abscess drainage under x-ray. 

75992 ........ Atherectomy, x-ray exam. 

76000 ........ Fluoroscope examination. 

76001 ........ Fluoroscope exam, extensive. 

76010 ........ X-ray, nose to rectum. 

76080 ........ X-ray exam of fistula. 

76098 ........ X-ray exam, breast specimen. 

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. 

76140 ........ X-ray consultation. 

76150 ........ X-ray exam, dry process. 

76350 ........ Special x-ray contrast study. 

ADDENDUM F.—CPT/HCPCS IMAGING

CODES DEFINED BY DRA 5102(B)—

Continued 

HCPCS/ 

CPT * Short descriptor 

76376 ........ 3d render w/o postprocess. 

76377 ........ 3d rendering w/postprocess. 

76380 ........ CAT scan follow-up study. 

76390 ........ Mr spectroscopy. 

76496 ........ Fluoroscopic procedure. 

76497 ........ Ct procedure. 

76498 ........ Mri 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. 

76529 ........ 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, single fetus. 

76802 ........ Ob us < 14 wks, addl fetus. 

76805 ........ 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. 

76817 ........ Transvaginal us, obstetric. 

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. 

76830 ........ Transvaginal us, non-ob. 

76831 ........ Echo exam, uterus. 

76856 ........ Us exam, pelvic, complete. 

76857 ........ Us exam, pelvic, limited. 

76870 ........ Us exam, scrotum. 

76872 ........ Us, transrectal. 

76873 ........ Echograp trans r, pros study. 

76880 ........ Us exam, extremity. 

76885 ........ Us exam infant hips, dynamic. 

76886 ........ Us exam infant hips, static. 

76930 ........ Echo guide, cardiocentesis. 

76932 ........ Echo guide for heart biopsy. 

76936 ........ Echo guide for artery repair. 

76937 ........ Us guide, vascular access. 

76940 ........ Us guide, tissue ablation. 

76941 ........ Echo guide for transfusion. 

76942 ........ Echo guide for biopsy. 

76945 ........ Echo guide, villus sampling. 

76946 ........ Echo guide for amniocentesis. 

76948 ........ Echo guide, ova aspiration. 

76950 ........ Echo guidance radiotherapy. 

76965 ........ Echo guidance radiotherapy. 

76970 ........ Ultrasound exam follow-up. 

76975 ........ GI endoscopic ultrasound. 

76977 ........ Us bone density measure. 

76998 ........ Ultrasound guide intraoper. 

ADDENDUM F.—CPT/HCPCS IMAGING

CODES DEFINED BY DRA 5102(B)—

Continued 

HCPCS/ 

CPT * Short descriptor 

77001 ........ Fluoroguide for vein device. 

77002 ........ Needle localization by x-ray. 

77003 ........ Fluoroguide for spine inject. 

77011 ........ Ct scan for localization. 

77012 ........ Ct scan for needle biopsy. 

77013 ........ Ct guide for tissue ablation. 

77014 ........ Ct scan for therapy guide. 

77021 ........ Mr guidance for needle place. 

77022 ........ Mri for tissue ablation. 

77031 ........ Stereotactic breast biopsy. 

77032 ........ X-ray of needle wire, breast. 

77053 ........ X-ray of mammary duct. 

77054 ........ X-ray of mammary ducts. 

77058 ........ Magnetic image, breast. 

77059 ........ Magnetic image, both breasts. 

77071 ........ X-ray stress view. 

77072 ........ X-rays for bone age. 

77073 ........ X-rays, bone evaluation. 

77074 ........ X-rays, bone survey. 

77075 ........ X-rays, bone survey. 

77076 ........ X-rays, bone evaluation. 

77077 ........ Joint survey, single view. 

77078 ........ Ct bone density, axial. 

77079 ........ Ct bone density, peripheral. 

77080 ........ Dxa bone density, axial. 

77081 ........ Dxa bone density/peripheral. 

77082 ........ Dxa bone density/v-fracture. 

77083 ........ Radiographic absorptiometry. 

77084 ........ Magnetic image, bone marrow. 

77417 ........ Radiology port film(s). 

77421 ........ Stereoscopic x-ray guidance. 

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. 

78102 ........ Bone marrow imaging, ltd. 

78103 ........ Bone marrow imaging, mult. 

78104 ........ Bone marrow imaging, body. 

78135 ........ Red cell survival kinetics. 

78140 ........ Red cell sequestration. 

78185 ........ Spleen imaging. 

78190 ........ Platelet survival, kinetics. 

78195 ........ Lymph system imaging. 

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. 

78278 ........ Acute GI blood loss imaging. 

78282 ........ GI protein loss exam. 

78290 ........ Meckels divert exam. 

78291 ........ Leveen/shunt patency exam. 

78300 ........ Bone imaging, limited area. 


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66551 

ADDENDUM F.—CPT/HCPCS IMAGING

CODES DEFINED BY DRA 5102(B)—

Continued 

HCPCS/ 

CPT * Short descriptor 

78305 ........ Bone imaging, multiple areas. 

78306 ........ Bone imaging, whole body. 

78315 ........ Bone imaging, 3 phase. 

78320 ........ Bone imaging (3D). 

78350 ........ Bone mineral, single photon. 

78351 ........ Bone mineral, dual photon. 

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. 

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. 

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. 

78630 ........ Cerebrospinal fluid scan. 

78635 ........ CSF ventriculography. 

78645 ........ CSF shunt evaluation. 

78647 ........ Cerebrospinal fluid scan. 

78650 ........ CSF leakage imaging. 

ADDENDUM F.—CPT/HCPCS IMAGING

CODES DEFINED BY DRA 5102(B)—

Continued 

HCPCS/ 

CPT * Short descriptor 

78660 ........ Nuclear exam of tear flow. 

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. 

78730 ........ Urinary bladder retention. 

78740 ........ Ureteral reflux study. 

78760 ........ Testicular imaging. 

78761 ........ Testicular imaging/flow. 

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 ........ Tumorimage pet/ct skul-thigh. 

78816 ........ Tumor image pet/ct full body. 

78890 ........ Nuclear medicine data proc. 

78891 ........ Nuclear med data proc. 

92135 ........ Scanning computer ophthalmic. 

92235 ........ Fluorscein angioscopy. 

92240 ........ IDC green angiography. 

92250 ........ Fundus photography. 

92285 ........ External ocular photography. 

92286 ........ Anterior segment photography. 

93303 ........ Echo transthoracic. 

93304 ........ Echo transthoracic. 

93307 ........ Echo exam of heart. 

93308 ........ Echo exam of heart. 

93312 ........ Echo transesophageal. 

93313 ........ Echo transesophageal. 

93314 ........ Echo transesophageal. 

93315 ........ Echo transesophageal. 

93316 ........ Echo transesophageal. 

93317 ........ Echo transesophageal. 

93318 ........ Echo transesophageal intraop. 

93320 ........ Doppler echo exam, heart. 

93321 ........ Doppler echo exam, heart. 

93325 ........ Doppler color flow add-on. 

93350 ........ Echo transthoracic. 

93555 ........ Imaging, cardiac cath. 

93556 ........ Imaging, cardiac cath. 

ADDENDUM F.—CPT/HCPCS IMAGING

CODES DEFINED BY DRA 5102(B)—

Continued 

HCPCS/ 

CPT * Short descriptor 

93571 ........ Heart flow reserve measure. 

93572 ........ Heart flow reserve measure. 

93880 ........ Extracranial study. 

93882 ........ Extracranial study. 

93886 ........ Intracranial study. 

93888 ........ Intracranial study. 

93890 ........ Tcd, vasoreactivity study. 

93892 ........ Tcd, emboli detect w/o inj. 

93893 ........ Tcd, emboli detect w/inj. 

93925 ........ Lower extremity study. 

93926 ........ Lower extremity study. 

93930 ........ Upper extremity study. 

93931 ........ Upper 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. 

0028T ........ Dexa body composition study. 

0042T ........ Ct perfusion w/contrast, cbf. 

0066T ........ Ct colonography; screen. 

0067T ........ Ct colonography; dx. 

0080T ........ Endovasc aort repr rad s&i. 

0081T ........ Endovasc visc extnsn s&i. 

0144T ........ CT heart wo dye; qual calc. 

0145T ........ CT heart w/wo dye funct. 

0146T ........ CCTA w/wo dye. 

0147T ........ CCTA w/wo, quan calcium. 

0148T ........ CCTA w/wo, strxr. 

0149T ........ CCTA w/wo, strxr quan calc. 

0150T ........ CCTA w/wo, disease strxr. 

0151T ........ CT heart funct add-on. 

0152T ........ Computer chest add-on. 

G0120 ........ Colon ca scrn; barium enema. 

G0122 ........ Colon ca scrn; barium enema. 

G0130 ........ Single energy x-ray study. 

G0219 ........ PET img wholbod melano 

nonco. 

G0235 ........ PET not otherwise specified. 

G0275 ........ Renal angio, cardiac cath. 

G0278 ........ Iliac art angio, cardiac cath. 

G0288 ........ Recon, CTA for surg plan. 

G0365 ........ Vessel mapping hemo access. 

* CPT codes are descriptors only are copyright 2007 American Medical Association. 

All rights reserved. 

Applicable FARS/DFARS apply. 


cprice-sewell on PROD1PC72 with RULES
66552 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

10180 ....... Abilene, TX ................................................................................................................................................................................ 0.8398 

Callahan County, TX.

Jones County, TX.

Taylor County, TX.

10380 ....... Aguadilla-Isabela-San Sebastia ́n, PR ....................................................................................................................................... 0.7916 

Aguada Municipio, PR.

Aguadilla Municipio, PR.

An ̃asco Municipio, PR.

Isabela Municipio, PR.

Lares Municipio, PR.

Moca Municipio, PR.

Rinco ́n Municipio, PR.

San Sebastia ́n Municipio, PR.

10420 ....... Akron, OH .................................................................................................................................................................................. 0.9282 

Portage County, OH.

Summit County, OH.

10500 ....... Albany, GA ................................................................................................................................................................................ 0.8986 

Baker County, GA.

Dougherty County, GA.

Lee County, GA.

Terrell County, GA.

Worth County, GA.

10580 ....... Albany-Schenectady-Troy, NY .................................................................................................................................................. 0.9064 

Albany County, NY.

Rensselaer County, NY.

Saratoga County, NY.

Schenectady County, NY.

Schoharie County, NY.

10740 ....... Albuquerque, NM ...................................................................................................................................................................... 1.0084 

Bernalillo County, NM.

Sandoval County, NM.

Torrance County, NM.

Valencia County, NM.

10780 ....... Alexandria, LA ........................................................................................................................................................................... 0.8422 

Grant Parish, LA.

Rapides Parish, LA.

10900 ....... Allentown-Bethlehem-Easton, PA–NJ ....................................................................................................................................... 1.0412 

Warren County, NJ.

Carbon County, PA.

Lehigh County, PA.

Northampton County, PA.

11020 ....... Altoona, PA ............................................................................................................................................................................... 0.9096 

Blair County, PA.

11100 ....... Amarillo, TX ............................................................................................................................................................................... 0.9622 

Armstrong County, TX.

Carson County, TX.

Potter County, TX.

Randall County, TX.

11180 ....... Ames, IA .................................................................................................................................................................................... 1.0603 

Story County, IA.

11260 ....... Anchorage, AK .......................................................................................................................................................................... 1.2574 

Anchorage Municipality, AK.

Matanuska-Susitna Borough, AK.

11300 ....... Anderson, IN ............................................................................................................................................................................. 0.9317 

Madison County, IN.

11340 ....... Anderson, SC ............................................................................................................................................................................ 0.9590 

Anderson County, SC.

11460 ....... Ann Arbor, MI ............................................................................................................................................................................ 1.1124 

Washtenaw County, MI.

11500 ....... Anniston-Oxford, AL .................................................................................................................................................................. 0.8366 

Calhoun County, AL.

11540 ....... Appleton, WI .............................................................................................................................................................................. 1.0130 

Calumet County, WI.

Outagamie County, WI.

11700 ....... Asheville, NC ............................................................................................................................................................................. 0.9695 

Buncombe County, NC.

Haywood County, NC.

Henderson County, NC.

Madison County, NC.

12020 ....... Athens-Clarke County, GA ........................................................................................................................................................ 1.1100 

Clarke County, GA.


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66553 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

Madison County, GA.

Oconee County, GA.

Oglethorpe County, GA.

12060 ....... Atlanta-Sandy Springs-Marietta, GA ......................................................................................................................................... 1.0373 

Barrow County, GA.

Bartow County, GA.

Butts County, GA.

Carroll County, GA.

Cherokee County, GA.

Clayton County, GA.

Cobb County, GA.

Coweta County, GA.

Dawson County, GA.

DeKalb County, GA.

Douglas County, GA.

Fayette County, GA.

Forsyth County, GA.

Fulton County, GA.

Gwinnett County, GA.

Haralson County, GA.

Heard County, GA.

Henry County, GA.

Jasper County, GA.

Lamar County, GA.

Meriwether County, GA.

Newton County, GA.

Paulding County, GA.

Pickens County, GA.

Pike County, GA.

Rockdale County, GA.

Spalding County, GA.

Walton County, GA.

12100 ....... Atlantic City, NJ ......................................................................................................................................................................... 1.2875 

Atlantic County, NJ.

12220 ....... Auburn-Opelika, AL ................................................................................................................................................................... 0.8539 

Lee County, AL.

12260 ....... Augusta-Richmond County, GA–SC ......................................................................................................................................... 1.0180 

Burke County, GA.

Columbia County, GA.

McDuffie County, GA.

Richmond County, GA.

Aiken County, SC.

Edgefield County, SC.

12420 ....... Austin-Round Rock, TX ............................................................................................................................................................. 1.0073 

Bastrop County, TX.

Caldwell County, TX.

Hays County, TX.

Travis County, TX.

Williamson County, TX.

12540 ....... Bakersfield, CA .......................................................................................................................................................................... 1.1664 

Kern County, CA.

12580 ....... Baltimore-Towson, MD .............................................................................................................................................................. 1.0696 

Anne Arundel County, MD.

Baltimore County, MD.

Carroll County, MD.

Harford County, MD.

Howard County, MD.

Queen Anne’s County, MD.

Baltimore City, MD.

12620 ....... Bangor, ME ............................................................................................................................................................................... 1.0532 

Penobscot County, ME.

12700 ....... Barnstable Town, MA ................................................................................................................................................................ 1.3302 

Barnstable County, MA.

12940 ....... Baton Rouge, LA ....................................................................................................................................................................... 0.8480 

Ascension Parish, LA.

East Baton Rouge Parish, LA.

East Feliciana Parish, LA.

Iberville Parish, LA.

Livingston Parish, LA.

Pointe Coupee Parish, LA.

St. Helena Parish, LA.


cprice-sewell on PROD1PC72 with RULES
66554 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

West Baton Rouge Parish, LA.

West Feliciana Parish, LA.

12980 ....... Battle Creek, MI ........................................................................................................................................................................ 1.0744 

Calhoun County, MI.

13020 ....... Bay City, MI ............................................................................................................................................................................... 0.9391 

Bay County, MI.

13140 ....... Beaumont-Port Arthur, TX ......................................................................................................................................................... 0.9004 

Hardin County, TX.

Jefferson County, TX.

Orange County, TX.

13380 ....... Bellingham, WA ......................................................................................................................................................................... 1.2110 

Whatcom County, WA.

13460 ....... Bend, OR ................................................................................................................................................................................... 1.1549 

Deschutes County, OR.

13644 ....... Bethesda-Frederick-Gaithersburg, MD ..................................................................................................................................... 1.1094 

Frederick County, MD.

Montgomery County, MD.

13740 ....... Billings, MT ................................................................................................................................................................................ 0.9147 

Carbon County, MT.

Yellowstone County, MT.

13780 ....... Binghamton, NY ........................................................................................................................................................................ 0.9445 

Broome County, NY.

Tioga County, NY.

13820 ....... Birmingham-Hoover, AL ............................................................................................................................................................ 0.9392 

Bibb County, AL.

Blount County, AL.

Chilton County, AL.

Jefferson County, AL.

St. Clair County, AL.

Shelby County, AL.

Walker County, AL.

13900 ....... Bismarck, ND ............................................................................................................................................................................ 0.7916 

Burleigh County, ND.

Morton County, ND.

13980 ....... Blacksburg-Christiansburg-Radford, VA ................................................................................................................................... 0.8646 

Giles County, VA.

Montgomery County, VA.

Pulaski County, VA.

Radford City, VA.

14020 ....... Bloomington, IN ......................................................................................................................................................................... 0.9410 

Greene County, IN.

Monroe County, IN.

Owen County, IN.

14060 ....... Bloomington-Normal, IL ............................................................................................................................................................. 0.9842 

McLean County, IL.

14260 ....... Boise City-Nampa, ID ................................................................................................................................................................ 0.9990 

Ada County, ID.

Boise County, ID.

Canyon County, ID.

Gem County, ID.

Owyhee County, ID.

14484 ....... Boston-Quincy, MA ................................................................................................................................................................... 1.2285 

Norfolk County, MA.

Plymouth County, MA.

Suffolk County, MA.

14500 ....... Boulder, CO ............................................................................................................................................................................... 1.1004 

Boulder County, CO.

14540 ....... Bowling Green, KY .................................................................................................................................................................... 0.8612 

Edmonson County, KY.

Warren County, KY.

14740 ....... Bremerton-Silverdale, WA ......................................................................................................................................................... 1.1509 

Kitsap County, WA.

14860 ....... Bridgeport-Stamford-Norwalk, CT ............................................................................................................................................. 1.3441 

Fairfield County, CT.

15180 ....... Brownsville-Harlingen, TX ......................................................................................................................................................... 0.9408 

Cameron County, TX.

15260 ....... Brunswick, GA ........................................................................................................................................................................... 1.0001 

Brantley County, GA.

Glynn County, GA.

McIntosh County, GA.

15380 ....... Buffalo-Niagara Falls, NY .......................................................................................................................................................... 1.0099 


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66555 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

Erie County, NY.

Niagara County, NY.

15500 ....... Burlington, NC ........................................................................................................................................................................... 0.9232 

Alamance County, NC.

15540 ....... Burlington-South Burlington, VT ................................................................................................................................................ 1.0196 

Chittenden County, VT.

Franklin County, VT.

Grand Isle County, VT.

15764 ....... Cambridge-Newton-Framingham, MA ....................................................................................................................................... 1.1837 

Middlesex County, MA.

15804 ....... Camden, NJ .............................................................................................................................................................................. 1.0989 

Burlington County, NJ.

Camden County, NJ.

Gloucester County, NJ.

15940 ....... Canton-Massillon, OH ............................................................................................................................................................... 0.9431 

Carroll County, OH.

Stark County, OH.

15980 ....... Cape Coral-Fort Myers, FL ....................................................................................................................................................... 0.9917 

Lee County, FL.

16180 ....... Carson City, NV ........................................................................................................................................................................ 1.0558 

Carson City, NV.

16220 ....... Casper, WY ............................................................................................................................................................................... 0.9906 

Natrona County, WY.

16300 ....... Cedar Rapids, IA ....................................................................................................................................................................... 0.9343 

Benton County, IA.

Jones County, IA.

Linn County, IA.

16580 ....... Champaign-Urbana, IL .............................................................................................................................................................. 0.9913 

Champaign County, IL.

Ford County, IL.

Piatt County, IL.

16620 ....... Charleston, WV ......................................................................................................................................................................... 0.8749 

Boone County, WV.

Clay County, WV.

Kanawha County, WV.

Lincoln County, WV.

Putnam County, WV.

16700 ....... Charleston-North Charleston, SC ............................................................................................................................................. 0.9630 

Berkeley County, SC.

Charleston County, SC.

Dorchester County, SC.

16740 ....... Charlotte-Gastonia-Concord, NC SC ........................................................................................................................................ 1.0048 

Anson County, NC.

Cabarrus County, NC.

Gaston County, NC.

Mecklenburg County, NC.

Union County, NC.

York County, SC.

16820 ....... Charlottesville, VA ..................................................................................................................................................................... 0.9792 

Albemarle County, VA.

Fluvanna County, VA.

Greene County, VA.

Nelson County, VA.

Charlottesville City, VA.

16860 ....... Chattanooga, TN–GA ................................................................................................................................................................ 0.9493 

Catoosa County, GA.

Dade County, GA.

Walker County, GA.

Hamilton County, TN.

Marion County, TN.

Sequatchie County, TN.

16940 ....... Cheyenne, WY .......................................................................................................................................................................... 0.9824 

Laramie County, WY.

16974 ....... Chicago-Naperville-Joliet, IL ..................................................................................................................................................... 1.1331 

Cook County, IL.

DeKalb County, IL.

DuPage County, IL.

Grundy County, IL.

Kane County, IL.

Kendall County, IL.

McHenry County, IL.


cprice-sewell on PROD1PC72 with RULES
66556 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

Will County, IL.

17020 ....... Chico, CA .................................................................................................................................................................................. 1.1916 

Butte County, CA.

17140 ....... Cincinnati-Middletown, OH–KY–IN ........................................................................................................................................... 1.0327 

Dearborn County, IN.

Franklin County, IN.

Ohio County, IN.

Boone County, KY.

Bracken County, KY.

Campbell County, KY.

Gallatin County, KY.

Grant County, KY.

Kenton County, KY.

Pendleton County, KY.

Brown County, OH.

Butler County, OH.

Clermont County, OH.

Hamilton County, OH.

Warren County, OH.

17300 ....... Clarksville, TN–KY .................................................................................................................................................................... 0.8709 

Christian County, KY.

Trigg County, KY.

Montgomery County, TN.

Stewart County, TN.

17420 ....... Cleveland, TN ............................................................................................................................................................................ 0.8499 

Bradley County, TN.

Polk County, TN.

17460 ....... Cleveland-Elyria-Mentor, OH .................................................................................................................................................... 0.9857 

Cuyahoga County, OH.

Geauga County, OH.

Lake County, OH.

Lorain County, OH.

Medina County, OH.

17660 ....... Coeur d’Alene, ID ...................................................................................................................................................................... 1.0061 

Kootenai County, ID.

17780 ....... College Station-Bryan, TX ......................................................................................................................................................... 0.9877 

Brazos County, TX.

Burleson County, TX.

Robertson County, TX.

17820 ....... Colorado Springs, CO ............................................................................................................................................................... 1.0258 

El Paso County, CO.

Teller County, CO.

17860 ....... Columbia, MO ........................................................................................................................................................................... 0.9138 

Boone County, MO.

Howard County, MO.

17900 ....... Columbia, SC ............................................................................................................................................................................ 0.9288 

Calhoun County, SC.

Fairfield County, SC.

Kershaw County, SC.

Lexington County, SC.

Richland County, SC.

Saluda County, SC.

17980 ....... Columbus, GA–AL ..................................................................................................................................................................... 0.9213 

Russell County, AL.

Chattahoochee County, GA.

Harris County, GA.

Marion County, GA.

Muscogee County, GA.

18020 ....... Columbus, IN ............................................................................................................................................................................. 1.0066 

Bartholomew County, IN.

18140 ....... Columbus, OH ........................................................................................................................................................................... 1.0644 

Delaware County, OH.

Fairfield County, OH.

Franklin County, OH.

Licking County, OH.

Madison County, OH.

Morrow County, OH.

Pickaway County, OH.

Union County, OH.

18580 ....... Corpus Christi, TX ..................................................................................................................................................................... 0.9064 

Aransas County, TX.


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66557 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

Nueces County, TX.

San Patricio County, TX.

18700 ....... Corvallis, OR ............................................................................................................................................................................. 1.1567 

Benton County, OR.

19060 ....... Cumberland, MD–WV ............................................................................................................................................................... 0.8754 

Allegany County, MD.

Mineral County, WV.

19124 ....... Dallas-Plano-Irving, TX ............................................................................................................................................................. 1.0465 

Collin County, TX.

Dallas County, TX.

Delta County, TX.

Denton County, TX.

Ellis County, TX.

Hunt County, TX.

Kaufman County, TX.

Rockwall County, TX.

19140 ....... Dalton, GA ................................................................................................................................................................................. 0.9246 

Murray County, GA.

Whitfield County, GA.

19180 ....... Danville, IL ................................................................................................................................................................................. 0.9454 

Vermilion County, IL.

19260 ....... Danville, VA ............................................................................................................................................................................... 0.8697 

Pittsylvania County, VA.

Danville City, VA.

19340 ....... Davenport-Moline-Rock Island, IA–IL ....................................................................................................................................... 0.9320 

Henry County, IL.

Mercer County, IL.

Rock Island County, IL.

Scott County, IA.

19380 ....... Dayton, OH ................................................................................................................................................................................ 0.9700 

Greene County, OH.

Miami County, OH.

Montgomery County, OH.

Preble County, OH.

19460 ....... Decatur, AL ............................................................................................................................................................................... 0.8322 

Lawrence County, AL.

Morgan County, AL.

19500 ....... Decatur, IL ................................................................................................................................................................................. 0.8522 

Macon County, IL.

19660 ....... Deltona-Daytona Beach-Ormond Beach, FL ............................................................................................................................ 0.9532 

Volusia County, FL.

19740 ....... Denver-Aurora, CO ................................................................................................................................................................... 1.1313 

Adams County, CO.

Arapahoe County, CO.

Broomfield County, CO.

Clear Creek County, CO.

Denver County, CO.

Douglas County, CO.

Elbert County, CO.

Gilpin County, CO.

Jefferson County, CO.

Park County, CO.

19780 ....... Des Moines-West Des Moines, IA ............................................................................................................................................ 0.9738 

Dallas County, IA.

Guthrie County, IA.

Madison County, IA.

Polk County, IA.

Warren County, IA.

19804 ....... Detroit-Livonia-Dearborn, MI ..................................................................................................................................................... 1.0554 

Wayne County, MI.

20020 ....... Dothan, AL ................................................................................................................................................................................ 0.7916 

Geneva County, AL.

Henry County, AL.

Houston County, AL.

20100 ....... Dover, DE .................................................................................................................................................................................. 1.0659 

Kent County, DE.

20220 ....... Dubuque, IA .............................................................................................................................................................................. 0.9560 

Dubuque County, IA.

20260 ....... Duluth, MN–WI .......................................................................................................................................................................... 1.0528 

Carlton County, MN.

St. Louis County, MN.


cprice-sewell on PROD1PC72 with RULES
66558 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

Douglas County, WI.

20500 ....... Durham, NC .............................................................................................................................................................................. 1.0361 

Chatham County, NC.

Durham County, NC.

Orange County, NC.

Person County, NC.

20740 ....... Eau Claire, WI ........................................................................................................................................................................... 1.0001 

Chippewa County, WI.

Eau Claire County, WI.

20764 ....... Edison, NJ ................................................................................................................................................................................. 1.1801 

Middlesex County, NJ.

Monmouth County, NJ.

Ocean County, NJ.

Somerset County, NJ.

20940 ....... El Centro, CA ............................................................................................................................................................................ 0.9408 

Imperial County, CA.

21060 ....... Elizabethtown, KY ..................................................................................................................................................................... 0.9194 

Hardin County, KY.

Larue County, KY.

21140 ....... Elkhart-Goshen, IN .................................................................................................................................................................... 1.0144 

Elkhart County, IN.

21300 ....... Elmira, NY ................................................................................................................................................................................. 0.8722 

Chemung County, NY.

21340 ....... El Paso, TX ............................................................................................................................................................................... 0.9488 

El Paso County, TX.

21500 ....... Erie, PA ..................................................................................................................................................................................... 0.8966 

Erie County, PA.

21660 ....... Eugene-Springfield, OR ............................................................................................................................................................ 1.1538 

Lane County, OR.

21780 ....... Evansville, IN–KY ...................................................................................................................................................................... 0.9143 

Gibson County, IN.

Posey County, IN.

Vanderburgh County, IN.

Warrick County, IN.

Henderson County, KY.

Webster County, KY.

21820 ....... Fairbanks, AK ............................................................................................................................................................................ 1.1663 

Fairbanks North Star Borough, AK.

21940 ....... Fajardo, PR ............................................................................................................................................................................... 0.7916 

Ceiba Municipio, PR.

Fajardo Municipio, PR.

Luquillo Municipio, PR.

22020 ....... Fargo, ND–MN .......................................................................................................................................................................... 0.8488 

Cass County, ND.

Clay County, MN.

22140 ....... Farmington, NM ......................................................................................................................................................................... 1.0119 

San Juan County, NM.

22180 ....... Fayetteville, NC ......................................................................................................................................................................... 0.9888 

Cumberland County, NC.

Hoke County, NC.

22220 ....... Fayetteville-Springdale-Rogers, AR–MO .................................................................................................................................. 0.9227 

Benton County, AR.

Madison County, AR.

Washington County, AR.

McDonald County, MO.

22380 ....... Flagstaff, AZ .............................................................................................................................................................................. 1.2335 

Coconino County, AZ.

22420 ....... Flint, MI ...................................................................................................................................................................................... 1.1842 

Genesee County, MI.

22500 ....... Florence, SC ............................................................................................................................................................................. 0.8707 

Darlington County, SC.

Florence County, SC.

22520 ....... Florence-Muscle Shoals, AL ..................................................................................................................................................... 0.8106 

Colbert County, AL.

Lauderdale County, AL.

22540 ....... Fond du Lac, WI ........................................................................................................................................................................ 1.0203 

Fond du Lac County, WI.

22660 ....... Fort Collins-Loveland, CO ......................................................................................................................................................... 1.0446 

Larimer County, CO.

22744 ....... Fort Lauderdale-Pompano Beach-Deerfield Beach, FL ............................................................................................................ 1.0796 

Broward County, FL.


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66559 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

22900 ....... Fort Smith, AR–OK ................................................................................................................................................................... 0.8373 

Crawford County, AR.

Franklin County, AR.

Sebastian County, AR.

Le Flore County, OK.

Sequoyah County, OK.

23020 ....... Fort Walton Beach-Crestview-Destin, FL .................................................................................................................................. 0.9228 

Okaloosa County, FL.

23060 ....... Fort Wayne, IN .......................................................................................................................................................................... 0.9799 

Allen County, IN.

Wells County, IN.

Whitley County, IN.

23104 ....... Fort Worth-Arlington, TX ........................................................................................................................................................... 1.0231 

Johnson County, TX.

Parker County, TX.

Tarrant County, TX.

Wise County, TX.

23420 ....... Fresno, CA ................................................................................................................................................................................ 1.1603 

Fresno County, CA.

23460 ....... Gadsden, AL ............................................................................................................................................................................. 0.8612 

Etowah County, AL.

23540 ....... Gainesville, FL ........................................................................................................................................................................... 0.9706 

Alachua County, FL.

Gilchrist County, FL.

23580 ....... Gainesville, GA .......................................................................................................................................................................... 0.9727 

Hall County, GA.

23844 ....... Gary, IN ..................................................................................................................................................................................... 0.9736 

Jasper County, IN.

Lake County, IN.

Newton County, IN.

Porter County, IN.

24020 ....... Glens Falls, NY ......................................................................................................................................................................... 0.8714 

Warren County, NY.

Washington County, NY.

24140 ....... Goldsboro, NC ........................................................................................................................................................................... 0.9803 

Wayne County, NC.

24220 ....... Grand Forks, ND–MN ............................................................................................................................................................... 0.8318 

Polk County, MN.

Grand Forks County, ND.

24300 ....... Grand Junction, CO .................................................................................................................................................................. 1.0411 

Mesa County, CO.

24340 ....... Grand Rapids-Wyoming, MI ...................................................................................................................................................... 0.9832 

Barry County, MI.

Ionia County, MI.

Kent County, MI.

Newaygo County, MI.

24500 ....... Great Falls, MT ......................................................................................................................................................................... 0.9156 

Cascade County, MT.

24540 ....... Greeley, CO .............................................................................................................................................................................. 1.0194 

Weld County, CO.

24580 ....... Green Bay, WI ........................................................................................................................................................................... 1.0267 

Brown County, WI.

Kewaunee County, WI.

Oconto County, WI.

24660 ....... Greensboro-High Point, NC ...................................................................................................................................................... 0.9510 

Guilford County, NC.

Randolph County, NC.

Rockingham County, NC.

24780 ....... Greenville, NC ........................................................................................................................................................................... 0.9924 

Greene County, NC.

Pitt County, NC.

24860 ....... Greenville-Maudlin-Easley, SC ................................................................................................................................................. 1.0407 

Greenville County, SC.

Laurens County, SC.

Pickens County, SC.

25020 ....... Guayama, PR ............................................................................................................................................................................ 0.7916 

Arroyo Municipio, PR.

Guayama Municipio, PR.

Patillas Municipio, PR.

25060 ....... Gulfport-Biloxi, MS .................................................................................................................................................................... 0.9260 

Hancock County, MS.


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66560 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

Harrison County, MS.

Stone County, MS.

25180 ....... Hagerstown-Martinsburg, MD–WV ............................................................................................................................................ 0.9513 

Washington County, MD.

Berkeley County, WV.

Morgan County, WV.

25260 ....... Hanford-Corcoran, CA ............................................................................................................................................................... 1.1081 

Kings County, CA.

25420 ....... Harrisburg-Carlisle, PA .............................................................................................................................................................. 0.9795 

Cumberland County, PA.

Dauphin County, PA.

Perry County, PA.

25500 ....... Harrisonburg, VA ....................................................................................................................................................................... 0.9359 

Rockingham County, VA.

Harrisonburg City, VA.

25540 ....... Hartford-West Hartford-East Hartford, CT ................................................................................................................................ 1.1536 

Hartford County, CT.

Litchfield County, CT.

Middlesex County, CT.

Tolland County, CT.

25620 ....... Hattiesburg, MS ......................................................................................................................................................................... 0.7916 

Forrest County, MS.

Lamar County, MS.

Perry County, MS.

25860 ....... Hickory-Lenoir-Morganton, NC .................................................................................................................................................. 0.9529 

Alexander County, NC.

Burke County, NC.

Caldwell County, NC.

Catawba County, NC.

25980 ....... Hinesville-Fort Stewart, GA3 ..................................................................................................................................................... 0.9697 

Liberty County, GA.

Long County, GA.

26100 ....... Holland-Grand Haven, MI ......................................................................................................................................................... 0.9506 

Ottawa County, MI.

26180 ....... Honolulu, HI ............................................................................................................................................................................... 1.2197 

Honolulu County, HI.

26300 ....... Hot Springs, AR ........................................................................................................................................................................ 0.9614 

Garland County, AR.

26380 ....... Houma-Bayou Cane-Thibodaux, LA ......................................................................................................................................... 0.8330 

Lafourche Parish, LA.

Terrebonne Parish, LA.

26420 ....... Houston-Sugar Land-Baytown, TX ........................................................................................................................................... 1.0490 

Austin County, TX.

Brazoria County, TX.

Chambers County, TX.

Fort Bend County, TX.

Galveston County, TX.

Harris County, TX.

Liberty County, TX.

Montgomery County, TX.

San Jacinto County, TX.

Waller County, TX.

26580 ....... Huntington-Ashland, WV–KY–OH ............................................................................................................................................. 0.9543 

Boyd County, KY.

Greenup County, KY.

Lawrence County, OH.

Cabell County, WV.

Wayne County, WV.

26620 ....... Huntsville, AL ............................................................................................................................................................................ 0.9653 

Limestone County, AL.

Madison County, AL.

26820 ....... Idaho Falls, ID ........................................................................................................................................................................... 0.9778 

Bonneville County, ID.

Jefferson County, ID.

26900 ....... Indianapolis-Carmel, IN ............................................................................................................................................................. 1.0390 

Boone County, IN.

Brown County, IN.

Hamilton County, IN.

Hancock County, IN.

Hendricks County, IN.

Johnson County, IN.


cprice-sewell on PROD1PC72 with RULES
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ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

Marion County, IN.

Morgan County, IN.

Putnam County, IN.

Shelby County, IN.

26980 ....... Iowa City, IA .............................................................................................................................................................................. 1.0099 

Johnson County, IA.

Washington County, IA.

27060 ....... Ithaca, NY .................................................................................................................................................................................. 1.0164 

Tompkins County, NY.

27100 ....... Jackson, MI ............................................................................................................................................................................... 0.9847 

Jackson County, MI.

27140 ....... Jackson, MS .............................................................................................................................................................................. 0.8455 

Copiah County, MS.

Hinds County, MS.

Madison County, MS.

Rankin County, MS.

Simpson County, MS.

27180 ....... Jackson, TN .............................................................................................................................................................................. 0.9157 

Chester County, TN.

Madison County, TN.

27260 ....... Jacksonville, FL ......................................................................................................................................................................... 0.9521 

Baker County, FL.

Clay County, FL.

Duval County, FL.

Nassau County, FL.

St. Johns County, FL.

27340 ....... Jacksonville, NC ........................................................................................................................................................................ 0.8527 

Onslow County, NC.

27500 ....... Janesville, WI ............................................................................................................................................................................ 1.0240 

Rock County, WI.

27620 ....... Jefferson City, MO .................................................................................................................................................................... 0.8948 

Callaway County, MO.

Cole County, MO.

Moniteau County, MO.

Osage County, MO.

27740 ....... Johnson City, TN ....................................................................................................................................................................... 0.8103 

Carter County, TN.

Unicoi County, TN.

Washington County, TN.

27780 ....... Johnstown, PA .......................................................................................................................................................................... 0.7961 

Cambria County, PA.

27860 ....... Jonesboro, AR ........................................................................................................................................................................... 0.8222 

Craighead County, AR.

Poinsett County, AR.

27900 ....... Joplin, MO ................................................................................................................................................................................. 0.9448 

Jasper County, MO.

Newton County, MO.

28020 ....... Kalamazoo-Portage, MI ............................................................................................................................................................. 1.1012 

Kalamazoo County, MI.

Van Buren County, MI.

28100 ....... Kankakee-Bradley, IL ................................................................................................................................................................ 1.0806 

Kankakee County, IL.

28140 ....... Kansas City, MO–KS ................................................................................................................................................................ 1.0031 

Franklin County, KS.

Johnson County, KS.

Leavenworth County, KS.

Linn County, KS.

Miami County, KS.

Wyandotte County, KS.

Bates County, MO.

Caldwell County, MO.

Cass County, MO.

Clay County, MO.

Clinton County, MO.

Jackson County, MO.

Lafayette County, MO.

Platte County, MO.

Ray County, MO.

28420 ....... Kennewick-Richland-Pasco, WA ............................................................................................................................................... 1.0634 

Benton County, WA.

Franklin County, WA.


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66562 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

28660 ....... Killeen-Temple-Fort Hood, TX .................................................................................................................................................. 0.8707 

Bell County, TX.

Coryell County, TX.

Lampasas County, TX.

28700 ....... Kingsport-Bristol-Bristol, TN–VA ............................................................................................................................................... 0.8083 

Hawkins County, TN.

Sullivan County, TN.

Bristol City, VA.

Scott County, VA.

Washington County, VA.

28740 ....... Kingston, NY ............................................................................................................................................................................. 1.0086 

Ulster County, NY.

28940 ....... Knoxville, TN ............................................................................................................................................................................. 0.8482 

Anderson County, TN.

Blount County, TN.

Knox County, TN.

Loudon County, TN.

Union County, TN.

29020 ....... Kokomo, IN ................................................................................................................................................................................ 1.0123 

Howard County, IN.

Tipton County, IN.

29100 ....... La Crosse, WI–MN .................................................................................................................................................................... 1.0222 

Houston County, MN.

La Crosse County, WI.

29140 ....... Lafayette, IN .............................................................................................................................................................................. 0.9361 

Benton County, IN.

Carroll County, IN.

Tippecanoe County, IN.

29180 ....... Lafayette, LA ............................................................................................................................................................................. 0.8704 

Lafayette Parish, LA.

St. Martin Parish, LA.

29340 ....... Lake Charles, LA ....................................................................................................................................................................... 0.8208 

Calcasieu Parish, LA.

Cameron Parish, LA.

29404 ....... Lake County-Kenosha County, IL–WI ....................................................................................................................................... 1.0887 

Lake County, IL.

Kenosha County, WI.

29420 ....... Lake Havasu City—Kingman, AZ ............................................................................................................................................. 0.9851 

Mohave, County, AZ.

29460 ....... Lakeland, FL .............................................................................................................................................................................. 0.9141 

Polk County, FL.

29540 ....... Lancaster, PA ............................................................................................................................................................................ 0.9765 

Lancaster County, PA.

29620 ....... Lansing-East Lansing, MI .......................................................................................................................................................... 1.0680 

Clinton County, MI.

Eaton County, MI.

Ingham County, MI.

29700 ....... Laredo, TX ................................................................................................................................................................................. 0.8542 

Webb County, TX.

29740 ....... Las Cruces, NM ........................................................................................................................................................................ 0.9157 

Dona Ana County, NM.

29820 ....... Las Vegas-Paradise, NV ........................................................................................................................................................... 1.2454 

Clark County, NV.

29940 ....... Lawrence, KS ............................................................................................................................................................................ 0.8683 

Douglas County, KS.

30020 ....... Lawton, OK ................................................................................................................................................................................ 0.8470 

Comanche County, OK.

30140 ....... Lebanon, PA .............................................................................................................................................................................. 0.8646 

Lebanon County, PA.

30300 ....... Lewiston, ID–WA ....................................................................................................................................................................... 0.9978 

Nez Perce County, ID.

Asotin County, WA.

30340 ....... Lewiston-Auburn, ME ................................................................................................................................................................ 0.9703 

Androscoggin County, ME.

30460 ....... Lexington-Fayette, KY ............................................................................................................................................................... 0.9701 

Bourbon County, KY.

Clark County, KY.

Fayette County, KY.

Jessamine County, KY.

Scott County, KY.

Woodford County, KY.


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66563 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

30620 ....... Lima, OH ................................................................................................................................................................................... 0.9947 

Allen County, OH.

30700 ....... Lincoln, NE ................................................................................................................................................................................ 1.0609 

Lancaster County, NE.

Seward County, NE.

30780 ....... Little Rock-North Little Rock-Conway, AR ................................................................................................................................ 0.9355 

Faulkner County, AR.

Grant County, AR.

Lonoke County, AR.

Perry County, AR.

Pulaski County, AR.

Saline County, AR.

30860 ....... Logan, UT–ID ............................................................................................................................................................................ 0.9692 

Franklin County, ID.

Cache County, UT.

30980 ....... Longview, TX ............................................................................................................................................................................. 0.9201 

Gregg County, TX.

Rusk County, TX.

Upshur County, TX.

31020 ....... Longview, WA ........................................................................................................................................................................... 1.1428 

Cowlitz County, WA.

31084 ....... Los Angeles-Long Beach-Glendale, CA ................................................................................................................................... 1.2424 

Los Angeles County, CA.

31140 ....... Louisville-Jefferson County, KY–IN ........................................................................................................................................... 0.9568 

Clark County, IN.

Floyd County, IN.

Harrison County, IN.

Washington County, IN.

Bullitt County, KY.

Henry County, KY.

Jefferson County, KY.

Meade County, KY.

Nelson County, KY.

Oldham County, KY.

Shelby County, KY.

Spencer County, KY.

Trimble County, KY.

31180 ....... Lubbock, TX .............................................................................................................................................................................. 0.9162 

Crosby County, TX.

Lubbock County, TX.

31340 ....... Lynchburg, VA ........................................................................................................................................................................... 0.9216 

Amherst County, VA.

Appomattox County, VA.

Bedford County, VA.

Campbell County, VA.

Bedford City, VA.

Lynchburg City, VA.

31420 ....... Macon, GA ................................................................................................................................................................................ 1.0070 

Bibb County, GA.

Crawford County, GA.

Jones County, GA.

Monroe County, GA.

Twiggs County, GA.

31460 ....... Madera, CA ............................................................................................................................................................................... 0.8517 

Madera County, CA.

31540 ....... Madison, WI .............................................................................................................................................................................. 1.1542 

Columbia County, WI.

Dane County, WI.

Iowa County, WI.

31700 ....... Manchester-Nashua, NH ........................................................................................................................................................... 1.0621 

Hillsborough County, NH.

Merrimack County, NH.

31900 ....... Mansfield, OH 1 ......................................................................................................................................................................... 0.9785 

Richland County, OH.

32420 ....... Mayagu ̈ez, PR ........................................................................................................................................................................... 0.7916 

Hormigueros Municipio, PR.

Mayagu ̈ez Municipio, PR.

32580 ....... McAllen-Edinburg-Mission, TX .................................................................................................................................................. 0.9629 

Hidalgo County, TX.

32780 ....... Medford, OR .............................................................................................................................................................................. 1.0890 

Jackson County, OR.


cprice-sewell on PROD1PC72 with RULES
66564 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

32820 ....... Memphis, TN–MS–AR ............................................................................................................................................................... 0.9763 

Crittenden County, AR.

DeSoto County, MS.

Marshall County, MS.

Tate County, MS.

Tunica County, MS.

Fayette County, TN.

Shelby County, TN.

Tipton County, TN.

32900 ....... Merced, CA ............................................................................................................................................................................... 1.2792 

Merced County, CA.

33124 ....... Miami-Miami Beach-Kendall, FL ............................................................................................................................................... 1.0557 

Miami-Dade County, FL.

33140 ....... Michigan City-La Porte, IN ........................................................................................................................................................ 0.9408 

LaPorte County, IN.

33260 ....... Midland, TX ............................................................................................................................................................................... 1.0573 

Midland County, TX.

33340 ....... Milwaukee-Waukesha-West Allis, WI ........................................................................................................................................ 1.0781 

Milwaukee County, WI.

Ozaukee County, WI.

Washington County, WI.

Waukesha County, WI.

33460 ....... Minneapolis-St. Paul-Bloomington, MN–WI .............................................................................................................................. 1.1708 

Anoka County, MN.

Carver County, MN.

Chisago County, MN.

Dakota County, MN.

Hennepin County, MN.

Isanti County, MN.

Ramsey County, MN.

Scott County, MN.

Sherburne County, MN.

Washington County, MN.

Wright County, MN.

Pierce County, WI.

St. Croix County, WI.

33540 ....... Missoula, MT ............................................................................................................................................................................. 0.9450 

Missoula County, MT.

33660 ....... Mobile, AL ................................................................................................................................................................................. 0.8479 

Mobile County, AL.

33700 ....... Modesto, CA .............................................................................................................................................................................. 1.2626 

Stanislaus County, CA.

33740 ....... Monroe, LA ................................................................................................................................................................................ 0.8266 

Ouachita Parish, LA.

Union Parish, LA.

33780 ....... Monroe, MI ................................................................................................................................................................................ 0.9936 

Monroe County, MI.

33860 ....... Montgomery, AL ........................................................................................................................................................................ 0.8537 

Autauga County, AL.

Elmore County, AL.

Lowndes County, AL.

Montgomery County, AL.

34060 ....... Morgantown, WV ....................................................................................................................................................................... 0.8783 

Monongalia County, WV.

Preston County, WV.

34100 ....... Morristown, TN .......................................................................................................................................................................... 0.7916 

Grainger County, TN.

Hamblen County, TN.

Jefferson County, TN.

34580 ....... Mount Vernon-Anacortes, WA .................................................................................................................................................. 1.1113 

Skagit County, WA.

34620 ....... Muncie, IN ................................................................................................................................................................................. 0.8670 

Delaware County, IN.

34740 ....... Muskegon-Norton Shores, MI ................................................................................................................................................... 1.0382 

Muskegon County, MI.

34820 ....... Myrtle Beach-Conway-North Myrtle Beach, SC ........................................................................................................................ 0.9113 

Horry County, SC.

34900 ....... Napa, CA ................................................................................................................................................................................... 1.5279 

Napa County, CA.

34940 ....... Naples-Marco Island, FL ........................................................................................................................................................... 1.0013 

Collier County, FL.


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66565 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

34980 ....... Nashville-Davidson-Murfreesboro, TN ...................................................................................................................................... 1.0226 

Cannon County, TN.

Cheatham County, TN.

Davidson County, TN.

Dickson County, TN.

Hickman County, TN.

Macon County, TN.

Robertson County, TN.

Rutherford County, TN.

Smith County, TN.

Sumner County, TN.

Trousdale County, TN.

Williamson County, TN.

Wilson County, TN.

35004 ....... Nassau-Suffolk, NY ................................................................................................................................................................... 1.3341 

Nassau County, NY.

Suffolk County, NY.

35084 ....... Newark-Union, NJ–PA .............................................................................................................................................................. 1.2520 

Essex County, NJ.

Hunterdon County, NJ.

Morris County, NJ.

Sussex County, NJ.

Union County, NJ.

Pike County, PA.

35300 ....... New Haven-Milford, CT ............................................................................................................................................................. 1.2530 

New Haven County, CT.

35380 ....... New Orleans-Metairie-Kenner, LA ............................................................................................................................................ 0.9391 

Jefferson Parish, LA.

Orleans Parish, LA.

Plaquemines Parish, LA.

St. Bernard Parish, LA.

St. Charles Parish, LA.

St. John the Baptist Parish, LA.

St. Tammany Parish, LA.

35644 ....... New York-Wayne-White Plains, NY–NJ ................................................................................................................................... 1.3843 

Bergen County, NJ.

Hudson County, NJ.

Passaic County, NJ.

Bronx County, NY.

Kings County, NY.

New York County, NY.

Putnam County, NY.

Queens County, NY.

Richmond County, NY.

Rockland County, NY.

Westchester County, NY.

35660 ....... Niles-Benton Harbor, MI ............................................................................................................................................................ 0.9648 

Berrien County, MI.

35980 ....... Norwich-New London, CT ......................................................................................................................................................... 1.2066 

New London County, CT.

36084 ....... Oakland-Fremont-Hayward, CA ................................................................................................................................................ 1.6555 

Alameda County, CA.

Contra Costa County, CA.

36100 ....... Ocala, FL ................................................................................................................................................................................... 0.9106 

Marion County, FL.

36140 ....... Ocean City, NJ .......................................................................................................................................................................... 1.1598 

Cape May County, NJ.

36220 ....... Odessa, TX ............................................................................................................................................................................... 1.0599 

Ector County, TX.

36260 ....... Ogden-Clearfield, UT ................................................................................................................................................................ 0.9499 

Davis County, UT.

Morgan County, UT.

Weber County, UT.

36420 ....... Oklahoma City, OK ................................................................................................................................................................... 0.9304 

Canadian County, OK.

Cleveland County, OK.

Grady County, OK.

Lincoln County, OK.

Logan County, OK.

McClain County, OK.

Oklahoma County, OK.


cprice-sewell on PROD1PC72 with RULES
66566 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

36500 ....... Olympia, WA ............................................................................................................................................................................. 1.2151 

Thurston County, WA.

36540 ....... Omaha-Council Bluffs, NE–IA ................................................................................................................................................... 1.0091 

Harrison County, IA.

Mills County, IA.

Pottawattamie County, IA.

Cass County, NE.

Douglas County, NE.

Sarpy County, NE.

Saunders County, NE.

Washington County, NE.

36740 ....... Orlando-Kissimmee, FL ............................................................................................................................................................. 0.9738 

Lake County, FL.

Orange County, FL.

Osceola County, FL.

Seminole County, FL.

36780 ....... Oshkosh-Neenah, WI ................................................................................................................................................................ 1.0081 

Winnebago County, WI.

36980 ....... Owensboro, KY ......................................................................................................................................................................... 0.9132 

Daviess County, KY.

Hancock County, KY.

McLean County, KY.

37100 ....... Oxnard-Thousand Oaks-Ventura, CA ....................................................................................................................................... 1.2509 

Ventura County, CA.

37340 ....... Palm Bay-Melbourne-Titusville, FL ........................................................................................................................................... 0.9842 

Brevard County, FL.

37380 ....... Palm Coast, FL ......................................................................................................................................................................... 0.9441 

Flagler County, FL.

37460 ....... Panama City-Lynn Haven, FL ................................................................................................................................................... 0.8774 

Bay County, FL.

37620 ....... Parkersburg-Marietta-Vienna, WV–OH ..................................................................................................................................... 0.8555 

Washington County, OH.

Pleasants County, WV.

Wirt County, WV.

Wood County, WV.

37700 ....... Pascagoula, MS ........................................................................................................................................................................ 0.9127 

George County, MS.

Jackson County, MS.

37764 ....... Peabody, MA ............................................................................................................................................................................. 1.1241 

Essex County, MA.

37860 ....... Pensacola-Ferry Pass-Brent, FL ............................................................................................................................................... 0.8740 

Escambia County, FL.

Santa Rosa County, FL.

37900 ....... Peoria, IL ................................................................................................................................................................................... 0.9815 

Marshall County, IL.

Peoria County, IL.

Stark County, IL.

Tazewell County, IL.

Woodford County, IL.

37964 ....... Philadelphia, PA ........................................................................................................................................................................ 1.1531 

Bucks County, PA.

Chester County, PA.

Delaware County, PA.

Montgomery County, PA.

Philadelphia County, PA.

38060 ....... Phoenix-Mesa-Scottsdale, AZ ................................................................................................................................................... 1.0833 

Maricopa County, AZ.

Pinal County, AZ.

38220 ....... Pine Bluff, AR ............................................................................................................................................................................ 0.8274 

Cleveland County, AR.

Jefferson County, AR.

Lincoln County, AR.

38300 ....... Pittsburgh, PA ........................................................................................................................................................................... 0.8998 

Allegheny County, PA.

Armstrong County, PA.

Beaver County, PA.

Butler County, PA.

Fayette County, PA.

Washington County, PA.

Westmoreland County, PA.

38340 ....... Pittsfield, MA ............................................................................................................................................................................. 1.0651 


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66567 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

Berkshire County, MA.

38540 ....... Pocatello, ID .............................................................................................................................................................................. 0.9990 

Bannock County, ID.

Power County, ID.

38660 ....... Ponce, PR ................................................................................................................................................................................. 0.7916 

Juana Dı ́az Municipio, PR.

Ponce Municipio, PR.

Villalba Municipio, PR.

38860 ....... Portland-South Portland-Biddeford, ME .................................................................................................................................... 1.0599 

Cumberland County, ME.

Sagadahoc County, ME.

York County, ME.

38900 ....... Portland-Vancouver-Beaverton, OR–WA .................................................................................................................................. 1.2136 

Clackamas County, OR.

Columbia County, OR.

Multnomah County, OR.

Washington County, OR.

Yamhill County, OR.

Clark County, WA.

Skamania County, WA.

38940 ....... Port St. Lucie, FL ...................................................................................................................................................................... 1.0572 

Martin County, FL.

St. Lucie County, FL.

39100 ....... Poughkeepsie-Newburgh-Middletown, NY ................................................................................................................................ 1.1591 

Dutchess County, NY.

Orange County, NY.

39140 ....... Prescott, AZ ............................................................................................................................................................................... 1.0576 

Yavapai County, AZ.

39300 ....... Providence-New Bedford-Fall River, RI–MA ............................................................................................................................. 1.1278 

Bristol County, MA.

Bristol County, RI.

Kent County, RI.

Newport County, RI.

Providence County, RI.

Washington County, RI.

39340 ....... Provo-Orem, UT ........................................................................................................................................................................ 1.0087 

Juab County, UT.

Utah County, UT.

39380 ....... Pueblo, CO ................................................................................................................................................................................ 0.9342 

Pueblo County, CO.

39460 ....... Punta Gorda, FL ........................................................................................................................................................................ 0.9767 

Charlotte County, FL.

39540 ....... Racine, WI ................................................................................................................................................................................. 1.0025 

Racine County, WI.

39580 ....... Raleigh-Cary, NC ...................................................................................................................................................................... 1.0385 

Franklin County, NC.

Johnston County, NC.

Wake County, NC.

39660 ....... Rapid City, SD ........................................................................................................................................................................... 0.9300 

Meade County, SD.

Pennington County, SD.

39740 ....... Reading, PA .............................................................................................................................................................................. 0.9875 

Berks County, PA.

39820 ....... Redding, CA .............................................................................................................................................................................. 1.4292 

Shasta County, CA.

39900 ....... Reno-Sparks, NV ...................................................................................................................................................................... 1.1309 

Storey County, NV.

Washoe County, NV.

40060 ....... Richmond, VA ........................................................................................................................................................................... 0.9948 

Amelia County, VA.

Caroline County, VA.

Charles City County, VA.

Chesterfield County, VA.

Cumberland County, VA.

Dinwiddie County, VA.

Goochland County, VA.

Hanover County, VA.

Henrico County, VA.

King and Queen County, VA.

King William County, VA.

Louisa County, VA.


cprice-sewell on PROD1PC72 with RULES
66568 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

New Kent County, VA.

Powhatan County, VA.

Prince George County, VA.

Sussex County, VA.

Colonial Heights City, VA.

Hopewell City, VA.

Petersburg City, VA.

Richmond City, VA.

40140 ....... Riverside-San Bernardino-Ontario, CA ..................................................................................................................................... 1.1716 

Riverside County, CA.

San Bernardino County, CA.

40220 ....... Roanoke, VA ............................................................................................................................................................................. 0.9173 

Botetourt County, VA.

Craig County, VA.

Franklin County, VA.

Roanoke County, VA.

Roanoke City, VA.

Salem City, VA.

40340 ....... Rochester, MN .......................................................................................................................................................................... 1.1352 

Dodge County, MN.

Olmsted County, MN.

Wabasha County, MN.

40380 ....... Rochester, NY ........................................................................................................................................................................... 0.9349 

Livingston County, NY.

Monroe County, NY.

Ontario County, NY.

Orleans County, NY.

Wayne County, NY.

40420 ....... Rockford, IL ............................................................................................................................................................................... 1.0358 

Boone County, IL.

Winnebago County, IL.

40484 ....... Rockingham County-Strafford County, NH ............................................................................................................................... 1.0672 

Rockingham County, NH.

Strafford County, NH.

40580 ....... Rocky Mount, NC ...................................................................................................................................................................... 0.9500 

Edgecombe County, NC.

Nash County, NC.

40660 ....... Rome, GA .................................................................................................................................................................................. 0.9544 

Floyd County, GA.

40900 ....... Sacramento-Arden-Arcade-Roseville, CA ................................................................................................................................. 1.4254 

El Dorado County, CA.

Placer County, CA.

Sacramento County, CA.

Yolo County, CA.

40980 ....... Saginaw-Saginaw Township North, MI ..................................................................................................................................... 0.9301 

Saginaw County, MI.

41060 ....... St. Cloud, MN ............................................................................................................................................................................ 1.1134 

Benton County, MN.

Stearns County, MN.

41100 ....... St. George, UT .......................................................................................................................................................................... 0.9877 

Washington County, UT.

41140 ....... St. Joseph, MO–KS ................................................................................................................................................................... 0.9248 

Doniphan County, KS.

Andrew County, MO.

Buchanan County, MO.

DeKalb County, MO.

41180 ....... St. Louis, MO–IL ....................................................................................................................................................................... 0.9525 

Bond County, IL.

Calhoun County, IL.

Clinton County, IL.

Jersey County, IL.

Macoupin County, IL.

Madison County, IL.

Monroe County, IL.

St. Clair County, IL.

Crawford County, MO.

Franklin County, MO.

Jefferson County, MO.

Lincoln County, MO.

St. Charles County, MO.

St. Louis County, MO.


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66569 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

Warren County, MO.

Washington County, MO.

St. Louis City, MO.

41420 ....... Salem, OR ................................................................................................................................................................................. 1.1158 

Marion County, OR.

Polk County, OR.

41500 ....... Salinas, CA ................................................................................................................................................................................ 1.5595 

Monterey County, CA.

41540 ....... Salisbury, MD ............................................................................................................................................................................ 0.9493 

Somerset County, MD.

Wicomico County, MD.

41620 ....... Salt Lake City, UT ..................................................................................................................................................................... 0.9920 

Salt Lake County, UT.

Summit County, UT.

Tooele County, UT.

41660 ....... San Angelo, TX ......................................................................................................................................................................... 0.9055 

Irion County, TX.

Tom Green County, TX.

41700 ....... San Antonio, TX ........................................................................................................................................................................ 0.9324 

Atascosa County, TX.

Bandera County, TX.

Bexar County, TX.

Comal County, TX.

Guadalupe County, TX.

Kendall County, TX.

Medina County, TX.

Wilson County, TX.

41740 ....... San Diego-Carlsbad-San Marcos, CA ...................................................................................................................................... 1.2129 

San Diego County, CA.

41780 ....... Sandusky, OH ........................................................................................................................................................................... 0.9311 

Erie County, OH.

41884 ....... San Francisco-San Mateo-Redwood City, CA .......................................................................................................................... 1.6038 

Marin County, CA.

San Francisco County, CA.

San Mateo County, CA.

41900 ....... San Germa ́n-Cabo Rojo, PR .................................................................................................................................................... 0.7916 

Cabo Rojo Municipio, PR.

Lajas Municipio, PR.

Sabana Grande Municipio, PR.

San Germa ́n Municipio, PR.

41940 ....... San Jose-Sunnyvale-Santa Clara, CA ...................................................................................................................................... 1.6608 

San Benito County, CA.

Santa Clara County, CA.

41980 ....... San Juan-Caguas-Guaynabo, PR ............................................................................................................................................. 0.7916 

Aguas Buenas Municipio, PR.

Aibonito Municipio, PR.

Arecibo Municipio, PR.

Barceloneta Municipio, PR.

Barranquitas Municipio, PR.

Bayamo ́n Municipio, PR.

Caguas Municipio, PR.

Camuy Municipio, PR.

Cano ́vanas Municipio, PR.

Carolina Municipio, PR.

Catan ̃o Municipio, PR.

Cayey Municipio, PR.

Ciales Municipio, PR.

Cidra Municipio, PR.

Comer ́ıo Municipio, PR.

Corozal Municipio, PR.

Dorado Municipio, PR.

Florida Municipio, PR.

Guaynabo Municipio, PR.

Gurabo Municipio, PR.

Hatillo Municipio, PR.

Humacao Municipio, PR.

Juncos Municipio, PR.

Las Piedras Municipio, PR.

Lo ́ıza Municipio, PR.

Manat ́ı Municipio, PR.

Maunabo Municipio, PR.


cprice-sewell on PROD1PC72 with RULES
66570 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

Morovis Municipio, PR.

Naguabo Municipio, PR.

Naranjito Municipio, PR.

Orocovis Municipio, PR.

Quebradillas Municipio, PR.

R ́ıo Grande Municipio, PR.

San Juan Municipio, PR.

San Lorenzo Municipio, PR.

Toa Alta Municipio, PR.

Toa Baja Municipio, PR.

Trujillo Alto Municipio, PR.

Vega Alta Municipio, PR.

Vega Baja Municipio, PR.

Yabucoa Municipio, PR.

42020 ....... San Luis Obispo-Paso Robles, CA ........................................................................................................................................... 1.3181 

San Luis Obispo County, CA.

42044 ....... Santa Ana-Anaheim-Irvine, CA ................................................................................................................................................. 1.2419 

Orange County, CA.

42060 ....... Santa Barbara-Santa Maria-Goleta, CA ................................................................................................................................... 1.2364 

Santa Barbara County, CA.

42100 ....... Santa Cruz-Watsonville, CA ...................................................................................................................................................... 1.7016 

Santa Cruz County, CA.

42140 ....... Santa Fe, NM ............................................................................................................................................................................ 1.1329 

Santa Fe County, NM.

42220 ....... Santa Rosa-Petaluma, CA ........................................................................................................................................................ 1.5511 

Sonoma County, CA.

42260 ....... Sarasota-Bradenton-Venice, FL ................................................................................................................................................ 1.0484 

Manatee County, FL.

Sarasota County, FL.

42340 ....... Savannah, GA ........................................................................................................................................................................... 0.9638 

Bryan County, GA.

Chatham County, GA.

Effingham County, GA.

42540 ....... Scranton-Wilkes-Barre, PA ....................................................................................................................................................... 0.8926 

Lackawanna County, PA.

Luzerne County, PA.

Wyoming County, PA.

42644 ....... Seattle-Bellevue-Everett, WA .................................................................................................................................................... 1.2214 

King County, WA.

Snohomish County, WA.

42680 ....... Sebastian-Vero Beach, FL ........................................................................................................................................................ 0.9934 

Indian River County, FL.

43100 ....... Sheboygan, WI .......................................................................................................................................................................... 0.9473 

Sheboygan County, WI.

43300 ....... Sherman-Denison, TX ............................................................................................................................................................... 0.8782 

Grayson County, TX.

43340 ....... Shreveport-Bossier City, LA ...................................................................................................................................................... 0.8946 

Bossier Parish, LA.

Caddo Parish, LA.

De Soto Parish, LA.

43580 ....... Sioux City, IA–NE–SD ............................................................................................................................................................... 0.9764 

Woodbury County, IA.

Dakota County, NE.

Dixon County, NE.

Union County, SD.

43620 ....... Sioux Falls, SD .......................................................................................................................................................................... 1.0093 

Lincoln County, SD.

McCook County, SD.

Minnehaha County, SD.

Turner County, SD.

43780 ....... South Bend-Mishawaka, IN–MI ................................................................................................................................................. 1.0150 

St. Joseph County, IN.

Cass County, MI.

43900 ....... Spartanburg, SC ........................................................................................................................................................................ 0.9945 

Spartanburg County, SC.

44060 ....... Spokane, WA ............................................................................................................................................................................ 1.1035 

Spokane County, WA.

44100 ....... Springfield, IL ............................................................................................................................................................................ 0.9440 

Menard County, IL.

Sangamon County, IL.

44140 ....... Springfield, MA .......................................................................................................................................................................... 1.0941 


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66571 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

Franklin County, MA.

Hampden County, MA.

Hampshire County, MA.

44180 ....... Springfield, MO .......................................................................................................................................................................... 0.9177 

Christian County, MO.

Dallas County, MO.

Greene County, MO.

Polk County, MO.

Webster County, MO.

44220 ....... Springfield, OH .......................................................................................................................................................................... 0.9176 

Clark County, OH.

44300 ....... State College, PA ...................................................................................................................................................................... 0.9254 

Centre County, PA.

44700 ....... Stockton, CA ............................................................................................................................................................................. 1.2513 

San Joaquin County, CA.

44940 ....... Sumter, SC ................................................................................................................................................................................ 0.9076 

Sumter County, SC.

45060 ....... Syracuse, NY ............................................................................................................................................................................ 1.0460 

Madison County, NY.

Onondaga County, NY.

Oswego County, NY.

45104 ....... Tacoma, WA .............................................................................................................................................................................. 1.1668 

Pierce County, WA.

45220 ....... Tallahassee, FL ......................................................................................................................................................................... 0.9526 

Gadsden County, FL.

Jefferson County, FL.

Leon County, FL.

Wakulla County, FL.

45300 ....... Tampa-St. Petersburg-Clearwater, FL ...................................................................................................................................... 0.9520 

Hernando County, FL.

Hillsborough County, FL.

Pasco County, FL.

Pinellas County, FL.

45460 ....... Terre Haute, IN ......................................................................................................................................................................... 0.9293 

Clay County, IN.

Sullivan County, IN.

Vermillion County, IN.

Vigo County, IN.

45500 ....... Texarkana, TX-Texarkana, AR ................................................................................................................................................. 0.8201 

Miller County, AR.

Bowie County, TX.

45780 ....... Toledo, OH ................................................................................................................................................................................ 0.9954 

Fulton County, OH.

Lucas County, OH.

Ottawa County, OH.

Wood County, OH.

45820 ....... Topeka, KS ................................................................................................................................................................................ 0.9012 

Jackson County, KS.

Jefferson County, KS.

Osage County, KS.

Shawnee County, KS.

Wabaunsee County, KS.

45940 ....... Trenton-Ewing, NJ ..................................................................................................................................................................... 1.1293 

Mercer County, NJ.

46060 ....... Tucson, AZ ................................................................................................................................................................................ 0.9758 

Pima County, AZ.

46140 ....... Tulsa, OK .................................................................................................................................................................................. 0.8803 

Creek County, OK.

Okmulgee County, OK.

Osage County, OK.

Pawnee County, OK.

Rogers County, OK.

Tulsa County, OK.

Wagoner County, OK.

46220 ....... Tuscaloosa, AL .......................................................................................................................................................................... 0.8764 

Greene County, AL.

Hale County, AL.

Tuscaloosa County, AL.

46340 ....... Tyler, TX .................................................................................................................................................................................... 0.9620 

Smith County, TX.

46540 ....... Utica-Rome, NY ........................................................................................................................................................................ 0.8957 


cprice-sewell on PROD1PC72 with RULES
66572 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

Herkimer County, NY.

Oneida County, NY.

46660 ....... Valdosta, GA ............................................................................................................................................................................. 0.8547 

Brooks County, GA.

Echols County, GA.

Lanier County, GA.

Lowndes County, GA.

46700 ....... Vallejo-Fairfield, CA ................................................................................................................................................................... 1.5480 

Solano County, CA.

47020 ....... Victoria, TX ................................................................................................................................................................................ 0.8763 

Calhoun County, TX.

Goliad County, TX.

Victoria County, TX.

47220 ....... Vineland-Millville-Bridgeton, NJ ................................................................................................................................................. 1.0695 

Cumberland County, NJ.

47260 ....... Virginia Beach-Norfolk-Newport News, VA–NC ........................................................................................................................ 0.9307 

Currituck County, NC.

Gloucester County, VA.

Isle of Wight County, VA.

James City County, VA.

Mathews County, VA.

Surry County, VA.

York County, VA.

Chesapeake City, VA.

Hampton City, VA.

Newport News City, VA.

Norfolk City, VA.

Poquoson City, VA.

Portsmouth City, VA.

Suffolk City, VA.

Virginia Beach City, VA.

Williamsburg City, VA.

47300 ....... Visalia-Porterville, CA ................................................................................................................................................................ 1.0651 

Tulare County, CA.

47380 ....... Waco, TX ................................................................................................................................................................................... 0.8991 

McLennan County, TX.

47580 ....... Warner Robins, GA ................................................................................................................................................................... 0.9634 

Houston County, GA.

47644 ....... Warren-Troy-Farmington Hills, MI ............................................................................................................................................. 1.0556 

Lapeer County, MI.

Livingston County, MI.

Macomb County, MI.

Oakland County, MI.

St. Clair County, MI.

47894 ....... Washington-Arlington-Alexandria, DC–VA–MD–WV ................................................................................................................ 1.1457 

District of Columbia, DC.

Calvert County, MD.

Charles County, MD.

Prince George’s County, MD.

Arlington County, VA.

Clarke County, VA.

Fairfax County, VA.

Fauquier County, VA.

Loudoun County, VA.

Prince William County, VA.

Spotsylvania County, VA.

Stafford County, VA.

Warren County, VA.

Alexandria City, VA.

Fairfax City, VA.

Falls Church City, VA.

Fredericksburg City, VA.

Manassas City, VA.

Manassas Park City, VA.

Jefferson County, WV.

47940 ....... Waterloo-Cedar Falls, IA ........................................................................................................................................................... 0.8992 

Black Hawk County, IA.

Bremer County, IA.

Grundy County, IA.

48140 ....... Wausau, WI ............................................................................................................................................................................... 1.0216 

Marathon County, WI.


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66573 

ADDENDUM G.—CY 2008 ESRD WAGE INDEX FOR URBAN AREAS BASED ON CBSA LABOR MARKET AREAS—Continued 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

48260 ....... Weirton-Steubenville, WV–OH .................................................................................................................................................. 0.8364 

Jefferson County, OH.

Brooke County, WV.

Hancock County, WV.

48300 ....... Wenatchee, WA ........................................................................................................................................................................ 1.2105 

Chelan County, WA.

Douglas County, WA.

48424 ....... West Palm Beach-Boca Raton-Boynton Beach, FL ................................................................................................................. 1.0268 

Palm Beach County, FL.

48540 ....... Wheeling, WV–OH .................................................................................................................................................................... 0.7916 

Belmont County, OH.

Marshall County, WV.

Ohio County, WV.

48620 ....... Wichita, KS ................................................................................................................................................................................ 0.9565 

Butler County, KS.

Harvey County, KS.

Sedgwick County, KS.

Sumner County, KS.

48660 ....... Wichita Falls, TX ....................................................................................................................................................................... 0.8359 

Archer County, TX.

Clay County, TX.

Wichita County, TX.

48700 ....... Williamsport, PA ........................................................................................................................................................................ 0.8489 

Lycoming County, PA.

48864 ....... Wilmington, DE–MD–NJ ............................................................................................................................................................ 1.1424 

New Castle County, DE.

Cecil County, MD.

Salem County, NJ.

48900 ....... Wilmington, NC ......................................................................................................................................................................... 0.9932 

Brunswick County, NC.

New Hanover County, NC.

Pender County, NC.

49020 ....... Winchester, VA–WV .................................................................................................................................................................. 1.0463 

Frederick County, VA.

Winchester City, VA.

Hampshire County, WV.

49180 ....... Winston-Salem, NC ................................................................................................................................................................... 0.9624 

Davie County, NC.

Forsyth County, NC.

Stokes County, NC.

Yadkin County, NC.

49340 ....... Worcester, MA ........................................................................................................................................................................... 1.1913 

Worcester County, MA.

49420 ....... Yakima, WA ............................................................................................................................................................................... 1.0837 

Yakima County, WA.

49500 ....... Yauco, PR ................................................................................................................................................................................. 0.7916 

Gua ́nica Municipio, PR.

Guayanilla Municipio, PR.

Pen ̃uelas Municipio, PR.

Yauco Municipio, PR.

49620 ....... York-Hanover, PA ..................................................................................................................................................................... 0.9878 

York County, PA.

49660 ....... Youngstown-Warren-Boardman, OH–PA .................................................................................................................................. 0.9501 

Mahoning County, OH.

Trumbull County, OH.

Mercer County, PA.

49700 ....... Yuba City, CA ............................................................................................................................................................................ 1.1353 

Sutter County, CA.

Yuba County, CA.

49740 ....... Yuma, AZ .................................................................................................................................................................................. 1.0014 

Yuma County, AZ.

1At this time, there are no hospitals located in this urban area on which to base a wage index. 


cprice-sewell on PROD1PC72 with RULES
66574 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM H.—CY 2008 ESRD 

WAGE INDEX BASED ON CBSA 

LABOR MARKET AREAS FOR RURAL

AREAS

CBSA 

code Nonurban area Wage index 

1 ......... Alabama ....................... 0.7951 

2 ......... Alaska .......................... 1.2781 

3 ......... Arizona ......................... 0.8949 

4 ......... Arkansas ...................... 0.7916 

5 ......... California ...................... 1.2690 

6 ......... Colorado ...................... 1.0242 

7 ......... Connecticut .................. 1.2361 

8 ......... Delaware ...................... 1.0267 

10 ....... Florida .......................... 0.8935 

11 ....... Georgia ........................ 0.8084 

12 ....... Hawaii .......................... 1.1201 

13 ....... Idaho ............................ 0.8359 

14 ....... Illinois ........................... 0.8797 

15 ....... Indiana ......................... 0.9052 

16 ....... Iowa ............................. 0.9041 

17 ....... Kansas ......................... 0.8424 

18 ....... Kentucky ...................... 0.8225 

19 ....... Louisiana ...................... 0.7916 

20 ....... Maine ........................... 0.8946 

21 ....... Maryland ...................... 0.9535 

22 ....... Massachusetts 1 ........... 1.2290 

23 ....... Michigan ....................... 0.9450 

24 ....... Minnesota .................... 0.9583 

25 ....... Mississippi .................... 0.8127 

26 ....... Missouri ........................ 0.8370 

27 ....... Montana ....................... 0.8844 

28 ....... Nebraska ...................... 0.9340 

29 ....... Nevada ......................... 0.9786 

30 ....... New Hampshire ........... 1.1466 

31 ....... New Jersey 1 ................ ................

32 ....... New Mexico ................. 0.9436 

33 ....... New York ..................... 0.8727 

34 ....... North Carolina .............. 0.9080 

35 ....... North Dakota ................ 0.7916 

36 ....... Ohio ............................. 0.9197 

37 ....... Oklahoma ..................... 0.7916 

38 ....... Oregon ......................... 1.0456 

39 ....... Pennsylvania ................ 0.8850 

40 ....... Puerto Rico 1 ................ 0.7916 

41 ....... Rhode Island 1 ............. ................

42 ....... South Carolina ............. 0.9136 

43 ....... South Dakota ............... 0.9023 

44 ....... Tennessee ................... 0.8151 

45 ....... Texas ........................... 0.8410 

46 ....... Utah ............................. 0.8566 

47 ....... Vermont ....................... 1.0469 

48 ....... Virgin Islands ............... 0.7916 

49 ....... Virginia ......................... 0.8334 

50 ....... Washington .................. 1.0828 

51 ....... West Virginia ................ 0.7916 

52 ....... Wisconsin ..................... 1.0203 

53 ....... Wyoming ...................... 0.9802 

1All counties within the State are classified 

as urban, with the exception of Massachusetts 

and Puerto Rico. Massachusetts and Puerto 

Rico have areas designated as rural; however, 

no short-term, acute care hospitals are located 

in the area(s) for FY 2008. 

ADDENDUM I.—LIST OF CPT 1/HCPCS 

CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE

CATEGORIES 2 UNDER SECTION

1877 OF THE SOCIAL SECURITY ACT

[Effective Date: January 1, 2008] 

CLINICAL LABORATORY SERVICES 

INCLUDE CPT codes for all clinical laboratory services in the 80000 series, except EXCLUDE CPT 

codes for the following blood component collection services: 

86890 ................... Autologous blood process. 

86891 ................... Autologous blood, op salvage. 

86927 ................... Plasma, fresh frozen. 

86930 ................... Frozen blood prep. 

86931 ................... Frozen blood thaw. 

86932 ................... Frozen blood freeze/thaw. 

86945 ................... Blood product/irradiation. 

86950 ................... Leukacyte transfusion. 

86960 ................... Vol reduction of blood/prod. 

86965 ................... Pooling blood platelets. 

86985 ................... Split blood or products. 

INCLUDE the following CPT and HCPCS level 2 

codes for other clinical laboratory services: 

0026T ................... Measure remnant lipoproteins. 

0030T ................... Antiprothrombin antibody. 

0041T ................... Detect ur infect agnt w/cpas. 

0043T ................... Co expired gas analysis. 

0058T ................... Cryopreservation, ovary tiss. 

0059T ................... Cryopreservation, oocyte. 

0064T ................... Spectroscop eval expired gas. 

0085T ................... Breath test heart reject. 

0087T ................... Sperm eval hyaluronan. 

0103T ................... Holotranscobalamin. 

0104T ................... At rest cardio gas rebreathe. 

0111T ................... RBC membranes fatty acids. 

0140T ................... Exhaled breath condensate ph. 

36415 ................... Routine venipuncture. 

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. 

78191 ................... Platelet survival. 

78267 ................... Breath tst attain/anal c–14. 

78268 ................... Breath test analysis c–14. 

78270 ................... Vit B–12 absorption exam. 

78271 ................... Vit B–12 absrp exam, int fac. 

78272 ................... Vit B–12 absorp, combined. 

78725 ................... Kidney function study. 

G0027 .................. Semen analysis. 

G0103 .................. Psa, total screening. 

G0123 .................. Screen cerv/vag thin layer. 

G0124 .................. Screen c/v thin layer by MD. 

G0141 .................. Scr c/v cyto,autosys and md. 

G0143 .................. Scr c/v cyto,thinlayer,rescr. 

G0144 .................. Scr c/v cyto,thinlayer,rescr. 

G0145 .................. Scr c/v cyto,thinlayer,rescr. 

G0147 .................. Scr c/v cyto, automated sys. 

G0148 .................. Scr c/v cyto, autosys, rescr. 

G0306 .................. CBC/diffwbc w/o platelet. 

G0307 .................. CBC without platelet. 

G0328 .................. Fecal blood scrn immunoassay. 

G0394 .................. Blood occult test colorectal. 

P2028 ................... Cephalin floculation test. 

P2029 ................... Congo red blood test. 

P2033 ................... Blood thymol turbidity. 

P2038 ................... Blood mucoprotein. 

P3000 ................... Screen pap by tech w md supv. 

P3001 ................... Screening pap smear by phys. 

P9612 ................... Catheterize for urine spec. 

P9615 ................... Urine specimen collect mult. 

Q0111 .................. Wet mounts/w preparations. 

Q0112 .................. Potassium hydroxide preps. 

Q0113 .................. Pinworm examinations. 

Q0114 .................. Fern test. 

Q0115 .................. Post-coital mucous exam. 

ADDENDUM I.—LIST OF CPT 1/HCPCS 

CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE

CATEGORIES 2 UNDER SECTION

1877 OF THE SOCIAL SECURITY

ACT—Continued 

[Effective Date: January 1, 2008] 

PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH-LANGUAGE PATHOLOGY 

SERVICES 

INCLUDE the following CPT and HCPCS codes for 

physical therapy/occupational therapy/speech-language pathology services: 

0019T ................... Extracorp shock wv tx, ms nos. 

0029T ................... Magnetic tx for incontinence. 

64550 ................... Apply neurostimulator. 

90901 ................... Biofeedback train, any meth. 

90911 ................... Biofeedback peri/uro/rectal. 

92506 ................... Speech/hearing evaluation. 

92507 ................... Speech/hearing therapy. 

92508 ................... Speech/hearing therapy. 

92526 ................... Oral function therapy. 

92597 ................... Oral speech device eval. 

92607 ................... Ex for speech device rx, 1hr. 

92608 ................... Ex for speech device rx addl. 

92609 ................... Use of speech device service. 

92610 ................... Evaluate swallowing function. 

92611 ................... Motion fluoroscopy/swallow. 

92612 ................... Endoscopy swallow tst (fees). 

92614 ................... Laryngoscopic sensory test. 

92616 ................... Fees w/laryngeal sense test. 

93797 ................... Cardiac rehab. 

93798 ................... Cardiac rehab/monitor. 

94667 ................... Chest wall manipulation. 

94668 ................... Chest wall manipulation. 

95831 ................... Limb muscle testing, manual. 

95832 ................... Hand muscle testing, manual. 

95833 ................... Body muscle testing, manual. 

95834 ................... Body muscle testing, manual. 

95851 ................... Range of motion measurements. 

95852 ................... Range of motion measurements. 

96000 ................... Motion analysis, video/3d. 

96001 ................... Motion test w/ft press meas. 

96002 ................... Dynamic surface emg. 

96003 ................... Dynamic fine wire emg. 

96105 ................... Assessment of aphasia. 

96110 ................... Developmental test, lim. 

96111 ................... Developmental test, extend. 

96125 ................... Cognitive test by HC pro. 

97001 ................... Pt evaluation. 

97002 ................... Pt re-evaluation. 

97003 ................... Ot evaluation. 

97004 ................... Ot re-evaluation. 

97010 ................... Hot or cold packs therapy. 

97012 ................... Mechanical traction therapy. 

97016 ................... Vasopneumatic device therapy. 

97018 ................... Paraffin bath therapy. 

97022 ................... Whirlpool therapy. 

97024 ................... Diathermy eg, microwave. 

97026 ................... Infrared therapy. 

97028 ................... Ultraviolet therapy. 

97032 ................... Electrical stimulation. 

97033 ................... Electric current therapy. 

97034 ................... Contrast bath therapy. 

97035 ................... Ultrasound therapy. 

97036 ................... Hydrotherapy. 

97039 ................... Physical therapy treatment. 

97110 ................... Therapeutic exercises. 

97112 ................... Neuromuscular reeducation. 

97113 ................... Aquatic therapy/exercises. 

97116 ................... Gait training therapy. 

97124 ................... Massage therapy. 

97139 ................... Physical medicine procedure. 

97140 ................... Manual therapy. 

97150 ................... Group therapeutic procedures. 

97530 ................... Therapeutic activities. 

97532 ................... Cognitive skills development. 

97533 ................... Sensory integration. 

97535 ................... Self care mngment training. 

97537 ................... Community/work reintegration. 


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66575 

ADDENDUM I.—LIST OF CPT 1/HCPCS 

CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE

CATEGORIES 2 UNDER SECTION

1877 OF THE SOCIAL SECURITY

ACT—Continued 

[Effective Date: January 1, 2008] 

97542 ................... Wheelchair mngment training. 

97545 ................... Work hardening. 

97546 ................... Work hardening add-on. 

97597 ................... Active wound care/20cm or <. 

97598 ................... Active wound care > 20cm. 

97602 ................... Wound(s) care nonselective. 

97605 ................... Neg press wound tx, < 50 cm. 

97606 ................... 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. 

0144T ................... Ct heart wo dye; qual calc. 

0145T ................... Ct heart w/wo dye funct. 

0146T ................... Ccta w/wo dye 0147T Ccta w/ 

wo, quan calcium. 

0148T ................... Ccta w/wo, strxr. 

0149T ................... Ccta w/wo, strxr quan calc. 

0150T ................... Ccta w/wo, disease strxr. 

0151T ................... Ct heart funct add-on. 

0159T ................... Cad breast mri. 

0174T ................... Cad cxr with interp. 

0175T ................... Cad cxr remote. 

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. 

ADDENDUM I.—LIST OF CPT 1/HCPCS 

CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE

CATEGORIES 2 UNDER SECTION

1877 OF THE SOCIAL SECURITY

ACT—Continued 

[Effective Date: January 1, 2008] 

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. 

70554 ................... Fmri brain by tech. 

70555 ................... Fmri brain by phys/psych. 

71010 ................... Chest x-ray 71015 Chest x-ray. 

71020 ................... Chest x-ray. 

71021 ................... Chest x-ray. 

71022 ................... Chest x-ray. 

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. 

ADDENDUM I.—LIST OF CPT 1/HCPCS 

CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE

CATEGORIES 2 UNDER SECTION

1877 OF THE SOCIAL SECURITY

ACT—Continued 

[Effective Date: January 1, 2008] 

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. 


cprice-sewell on PROD1PC72 with RULES
66576 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM I.—LIST OF CPT 1/HCPCS 

CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE

CATEGORIES 2 UNDER SECTION

1877 OF THE SOCIAL SECURITY

ACT—Continued 

[Effective Date: January 1, 2008] 

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. 

75557 ................... Cardiac MRI for morph. 

75558 ................... Cardiac MRI flow/velocity. 

75559 ................... Cardiac MRI w/stress img. 

75560 ................... Cardiac MRI flo/vel/stress. 

75561 ................... Cardiac MRI for morph w/dye. 

75562 ................... Card MRI flow/vel w/dye. 

75563 ................... Card MRI w/stress img & dye. 

75564 ................... Ht MRI w/flo/vel/strs & dye. 

75635 ................... Ct angio abdominal arteries. 

76000 ................... Fluoroscope examination. 

76010 ................... X-ray, nose to rectum. 

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. 

76376 ................... 3d render w/o postprocess. 

76377 ................... 3d rendering w/postprocess. 

76380 ................... CAT scan follow-up study. 

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. 

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. 

76776 ................... Us exam k transpl w/Doppler. 

76800 ................... Us exam, spinal canal. 

76802 ................... Ob us < 14 wks, add’l fetus. 

76805 ................... 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. 

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. 

ADDENDUM I.—LIST OF CPT 1/HCPCS 

CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE

CATEGORIES 2 UNDER SECTION

1877 OF THE SOCIAL SECURITY

ACT—Continued 

[Effective Date: January 1, 2008] 

76977 ................... Us bone density measure. 

76999 ................... Echo examination procedure. 

77014 ................... Ct scan for therapy guide. 

77051 ................... Computer dx mammogram 

add-on. 

77052 ................... Comp screen mammogram 

add-on. 

77055 ................... Mammogram, one breast. 

77056 ................... Mammogram, both breasts. 

77057 ................... Mammogram, screening. 

77058 ................... Mri, one breast. 

77059 ................... Mri, both breasts. 

77071 ................... X-ray stress view. 

77072 ................... X-rays for bone age. 

77073 ................... X-rays, bone length studies. 

77074 ................... X-rays, bone survey, limited. 

77075 ................... X-rays, bone survey complete. 

77076 ................... X-rays, bone survey, infant. 

77077 ................... Joint survey, single view. 

77078 ................... Ct bone density, axial. 

77079 ................... Ct bone density, peripheral. 

77080 ................... Dxa bone density, axial. 

77081 ................... Dxa bone density/peripheral. 

77082 ................... Dxa bone density, vert fx. 

77083 ................... Radiographic absorptiometry. 

77084 ................... Magnetic image, bone marrow. 

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. 

78135 ................... Red cell survival kinetics. 

78140 ................... Red cell sequestration. 

78185 ................... Spleen imaging. 

78190 ................... Platelet survival, kinetics. 

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. 

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). 

78399 ................... Musculoskeletal nuclear exam. 

ADDENDUM I.—LIST OF CPT 1/HCPCS 

CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE

CATEGORIES 2 UNDER SECTION

1877 OF THE SOCIAL SECURITY

ACT—Continued 

[Effective Date: January 1, 2008] 

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 image < 4 views. 

78601 ................... Brain image w/flow < 4 views. 

78605 ................... Brain image 4+ views. 

78606 ................... Brain image w/flow 4 + views. 

78607 ................... Brain imaging (3D). 

78608 ................... Brain imaging (PET). 

78610 ................... Brain flow imaging only. 

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, morphol. 

78701 ................... Kidney imaging with flow. 

78707 ................... K flow/funct image w/o drug. 

78708 ................... K flow/funct image w/drug. 

78709 ................... K flow/funct image, multiple. 

78710 ................... Kidney imaging (3D). 

78730 ................... Urinary bladder retention. 

78740 ................... Ureteral reflux study. 

78761 ................... Testicular imaging w/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 ................... PET image, ltd area. 

78812 ................... PET image, skull-thigh. 

78813 ................... PET image, full body. 

78814 ................... PET image w/ct, lmtd. 

78815 ................... PET image w/ct, skull-thigh. 

78816 ................... PET image w/ct, full body. 

78890 ................... Nuclear medicine data proc. 


cprice-sewell on PROD1PC72 with RULES
Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 66577 

ADDENDUM I.—LIST OF CPT 1/HCPCS 

CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE

CATEGORIES 2 UNDER SECTION

1877 OF THE SOCIAL SECURITY

ACT—Continued 

[Effective Date: January 1, 2008] 

78891 ................... Nuclear med data proc. 

78999 ................... Nuclear diagnostic exam. 

91110 ................... Gi tract capsule endoscopy. 

91111 ................... Esophageal 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 ................... Radiopharm dx agent noc. 

A4642 ................... In111 satumomab. 

A9500 ................... Tc99m sestamibi. 

A9501 ................... Technitium TC–99m 

teboroxime. 

A9502 ................... Tc99m tetrofosmin. 

A9503 ................... Tc99m medronate. 

A9504 ................... Tc99m apcitide. 

A9505 ................... TL201 thallium. 

A9507 ................... In111 capromab. 

A9508 ................... I131 iodobenguate, dx. 

A9509 ................... Iodine I–123 sod iodide mil. 

A9510 ................... Tc99m disofenin. 

A9512 ................... Tc99m pertechnetate. 

A9516 ................... Iodine I–123 sod iodide mic. 

A9521 ................... Tc99m exametazime. 

A9524 ................... I131 serum albumin, dx. 

A9526 ................... Nitrogen N–13 ammonia. 

A9528 ................... Iodine I–131 iodide cap, dx. 

A9529 ................... I131 iodide sol, dx. 

A9531 ................... I131 max 100uCi. 

A9532 ................... I125 serum albumin, dx. 

A9536 ................... TC99m depreotide. 

A9537 ................... Tc99m mebrofenin. 

A9538 ................... Tc99m pyrophosphate. 

A9539 ................... Tc99m pentetate. 

A9540 ................... Tc99m MAA. 

A9541 ................... Tc99m sulfur colloid. 

A9542 ................... In111 ibritumomab, dx. 

A9544 ................... I131 tositumomab, dx. 

A9546 ................... CO57/58. 

A9547 ................... In111 oxyquinoline. 

A9548 ................... In111 pentetate. 

ADDENDUM I.—LIST OF CPT 1/HCPCS 

CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE

CATEGORIES 2 UNDER SECTION

1877 OF THE SOCIAL SECURITY

ACT—Continued 

[Effective Date: January 1, 2008] 

A9550 ................... Tc99m gluceptate. 

A9551 ................... Tc99m succimer. 

A9552 ................... F18 fdg. 

A9553 ................... Cr51 chromate. 

A9554 ................... I125 iothalamate, dx. 

A9555 ................... Rb82 rubidium. 

A9556 ................... Ga67 gallium. 

A9557 ................... Tc99m bicisate. 

A9558 ................... Xe133 xenon 10mci. 

A9559 ................... Co57 cyano. 

A9560 ................... Tc99m labeled rbc. 

A9561 ................... Tc99m oxidronate. 

A9562 ................... Tc99m mertiatide. 

A9566 ................... Tc99m fanolesomab. 

A9567 ................... Technetium TC–99m aerosol. 

A9568 ................... Technetium tc99m 

arcitumomab. 

A9569 ................... Technetium TC–99m auto 

WBC. 

A9570 ................... Indium In-111 auto WBC. 

A9571 ................... Indium In-111 auto platelet. 

A9572 ................... Indium In-111 pentetreotide. 

A9576 ................... Inj prohance multipack. 

A9577 ................... Inj multihance. 

A9578 ................... Inj multihance multipack. 

A9579 ................... Gad-base MR contrast 

NOS,1ml. 

A9700 ................... Echocardiography contrast. 

G0130 .................. Single energy x-ray study. 

G0202 .................. Screeningmammographydigital. 

G0204 .................. Diagnosticmammographydigital. 

G0206 .................. Diagnosticmammographydigital. 

G0288 .................. Recon, CTA for surg plan. 

G0389 .................. Ultrasound exam AAA screen. 

Q0092 .................. Set up port xray equipment. 

Q9951 .................. LOCM>=400 mg/ml iodine,1ml. 

Q9953 .................. Inj Fe-base MR contrast,1ml. 

Q9954 .................. Oral MR contrast, 100ml. 

Q9955 .................. Inj perflexane lip micros,ml. 

Q9956 .................. Inj octafluoropropane mic,ml. 

Q9957 .................. Inj perflutren lip micros,ml. 

Q9958 .................. HOCM <=149 mg/ml iodine, 

1ml. 

Q9959 .................. HOCM 150–199mg/ml iodine,1ml. 

Q9960 .................. HOCM 200–249mg/ml iodine,1ml. 

Q9961 .................. HOCM 250–299mg/ml iodine,1ml. 

Q9962 .................. HOCM 300–349mg/ml iodine,1ml. 

Q9963 .................. HOCM 350–399mg/ml iodine,1ml. 

Q9964 .................. HOCM>= 400mg/ml iodine, 

1ml. 

Q9965 .................. LOCM 100–199mg/ml iodine,1ml. 

Q9966 .................. LOCM 200–299mg/ml iodine,1ml. 

Q9967 .................. LOCM 300–399mg/ml iodine,1ml. 

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. 

0182T ................... HDR elect brachytherapy. 

19296 ................... Place po breast cath for rad. 

19297 ................... Place breast cath for rad. 

19298 ................... Place breast rad tube/caths. 

20555 ................... Place ndl musc/tis for rt. 

31643 ................... Diag bronchoscope/catheter. 

41019 ................... Place needles h&n for rt. 

55875 ................... Transperi needle place, pros. 

ADDENDUM I.—LIST OF CPT 1/HCPCS 

CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE

CATEGORIES 2 UNDER SECTION

1877 OF THE SOCIAL SECURITY

ACT—Continued 

[Effective Date: January 1, 2008] 

55876 ................... Place rt device/marker, pros. 

55920 ................... Place needles pelvic for rt. 

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. 

77371 ................... Srs, multisource. 

77372 ................... Srs, linear based. 

77373 ................... Sbrt delivery. 

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, simple. 

77423 ................... Neutron beam tx, complex. 

77427 ................... Radiation tx management, x5. 

77431 ................... Radiation therapy management. 

77432 ................... Stereotactic radiation trmt. 

77435 ................... Sbrt management. 

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. 


cprice-sewell on PROD1PC72 with RULES
66578 Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / Rules and Regulations 

ADDENDUM I.—LIST OF CPT 1/HCPCS 

CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE

CATEGORIES 2 UNDER SECTION

1877 OF THE SOCIAL SECURITY

ACT—Continued 

[Effective Date: January 1, 2008] 

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 ................... I131 iodide cap, rx. 

A9527 ................... Iodine I–125 sodium iodide. 

A9530 ................... I131 iodide sol, rx. 

A9543 ................... Y90 ibritumomab, rx. 

A9545 ................... I131 tositumomab, rx. 

A9563 ................... P32 Na phosphate. 

A9564 ................... P32 chromic phosphate. 

A9600 ................... Sr89 strontium. 

A9605 ................... Sm 153 lexidronm. 

A9699 ................... Radiopharm rx agent noc. 

C1716 ................... Brachytx source, Gold 198. 

C1717 ................... Brachytx source, HDR Ir-192. 

C1719 ................... Brachytx sour, Non-HDR Ir192. 

C2616 ................... Brachytx source, Yttrium-9. 

C2634 ................... Brachytx source, HA, I–125. 

C2635 ................... Brachytx source, HA, P–13. 

C2636 ................... Brachytx linear source, P–13. 

C2637 ................... Brachytx, Ytterbium-169. 

C2638 ................... Brachytx, stranded, I–125. 

C2639 ................... Brachytx,non-stranded, I–125. 

C2640 ................... Brachytx, stranded, P–13. 

C2641 ................... Brachytx, non-stranded, P–13. 

C2642 ................... Brachytx, stranded, C–131. 

C2643 ................... Brachytx, non-stranded, C–131. 

C2698 ................... Brachytx, stranded, NOS. 

C2699 ................... Brachytx, non-stranded, NOS. 

G0173 .................. Linear acc stereo radsur com. 

G0251 .................. Linear acc based stero radio. 

G0339 .................. Robot lin-radsurg com, first. 

G0340 .................. Robt lin-radsurg fractx 2–5. 

Q3001 .................. Brachytherapy Radioelements. 

EPO AND OTHER DIALYSIS-RELATED DRUGS 

The physician self-referral prohibition does not 

apply to the following codes for EPO and other 

dialysis-related drugs furnished in or by an ESRD 

facility if the conditions in § 411.355(g) are satisfied: 

ADDENDUM I.—LIST OF CPT 1/HCPCS 

CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE

CATEGORIES 2 UNDER SECTION

1877 OF THE SOCIAL SECURITY

ACT—Continued 

[Effective Date: January 1, 2008] 

J0630 ................... Calcitonin salmon injection. 

J0636 ................... Inj calcitriol per 0.1 mcg. 

J0882 ................... Darbepoetin alfa, esrd use. 

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. 

Q4081 .................. Epoetin alfa, 100 units ESRD. 

PREVENTIVE SCREENING TESTS, 

IMMUNIZATIONS AND VACCINES 

The physician self-referral prohibition does not 

apply to the following tests if they are performed 

for screening purposes and satisfy the conditions 

in § 411.355(h): 

77052 ................... Comp screen mammogram 

add-on. 

77057 ................... 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]. 

82270 ................... Occult blood, feces. 

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]. 

ADDENDUM I.—LIST OF CPT 1/HCPCS 

CODES USED TO DESCRIBE CERTAIN DESIGNATED HEALTH SERVICE

CATEGORIES 2 UNDER SECTION

1877 OF THE SOCIAL SECURITY

ACT—Continued 

[Effective Date: January 1, 2008] 

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. 

G0123 .................. Screen cerv/vag thin layer. 

G0124 .................. Screen c/v thin layer by MD. 

G0141 .................. Scr c/v cyto,autosys and md. 

G0143 .................. Scr c/v cyto,thinlayer,rescr. 

G0144 .................. Scr c/v cyto,thinlayer,rescr. 

G0145 .................. Scr c/v cyto,thinlayer,rescr. 

G0147 .................. Scr c/v cyto, automated sys. 

G0148 .................. Scr c/v cyto, autosys, rescr. 

G0202 .................. Screeningmammographydigital. 

G0328 .................. Fecal blood scrn immunoassay. 

G0389 .................. Ultrasound exam AAA screen. 

P3000 ................... Screen pap by tech w md supv. 

P3001 ................... Screening pap smear by phys. 

The physician self-referral prohibition does not 

apply to the following immunization and vaccine 

codes if they satisfy the conditions in 

§ 411.355(h): 

90655 ................... Flu vaccine no preserv 6–35m. 

90656 ................... Flu vaccine no preserv 3 & >. 

90657 ................... Flu vaccine, 3 yrs, im. 

90658 ................... Flu vaccine 3 yrs & >, im. 

90660 ................... Flu vaccine, nasal. 

90669 ................... Pneumococcal vacc, ped <5. 

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 2007 American Medical Association. All 

rights are reserved and applicable FARS/ 

DFARS clauses apply. 2This 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 § 411.351. For more information, refer to the 

CMS Web site at http://www.cms.hhs.gov/ 

PhysicianSelfReferral/. 

[FR Doc. 07–5506 Filed 11–1–07; 4:00 pm] 

BILLING CODE 4120–01–P 


cprice-sewell on PROD1PC72 with RULES